[Early and late primiparity; observations on 2764 primiparous births].
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Differences in fertility and suckling patterns between primiparous and multiparous rhesus mothers (Macaca mulatta).
Primiparous females gave birth around the same time as multiparous nonlactating females, and earlier than did multiparous lactating females. No differences in birth sex ratio were found between primiparous and multiparous females. During the breeding season following birth, primiparous mothers returned to oestrus later than did multiparous mothers, and while few primiparous mothers conceived successfully during that season, most multiparous mothers did. Primiparous females suckled their infants more frequently than did multiparous females at all ages; infants of primiparous females also made more nipple contacts per bout, and had shorter sucking bouts. When mothers came into oestrus, suckling frequency drastically increased for primiparous females, but not for multiparous females, magnifying the differences between the two groups. After the first oestrus, suckling frequency declined for all mothers, but multiparous mothers had consistently lower suckling frequencies than did primiparous mothers. The high suckling frequency, and numerous nipple contacts per bout, found among primiparous mothers are likely to be related to the low reproductive chances that these females faced during the breeding season. Multiparous mothers seemed to compensate for their low suckling frequency by lengthening the suckling bouts, and this suckling pattern did not hinder their reproduction. It is argued that primiparous mothers might have to suckle their infants more frequently because they can only produce milk at slow rates, being in this way forced into a reproductively inhibiting suckling pattern. However, the delay in subsequent reproduction could be ultimately advantageous for primiparous mothers if it enhanced infant survival, and allowed the mothers to regain physical condition before reproducing again.
Animals↗
Postpartum ovarian follicular dynamics in primiparous and pluriparous Mediterranean Italian buffaloes (Bubalus bubalis).
The objective of this study was to monitor ovarian function in postpartum primiparous and pluriparous Mediterranean Italian buffaloes (Bubalus bubalis) during months of increasing daylength. Ovarian ultrasound monitoring was carried out for a total of 60 days from calving in 10 primiparous and 10 pluriparous buffaloes. Progesterone was determined from calving until a week after first postpartum ovulation. The study was undertaken during months of increasing day length. Time required for complete postpartum uterine involution was 31 +/- 1.0 and 33 +/- 1.3 days in primiparous and pluriparous buffaloes respectively (P = 0.1). The first postpartum ovulation was recorded on 4 primiparous and 8 pluriparous buffaloes (P = 0.16). Time for first postpartum ovulation to occur was 25.5 +/- 6.9 and 15.5 +/- 1.3 days in primiparous and pluriparous buffaloes, respectively (P = 0.07). Overall, 8 of the 12 first postpartum ovulations (66.6%) occurred in the ovary contra-lateral to the one bearing the gravidic CL, one out of 4 in primiparous and 3 out of 8 in pluriparous buffaloes (P = 1.0). Following a first postpartum ovulation, 3 primiparous and 4 pluriparous buffaloes displayed a complete wave of follicular development leading to a new ovulation. Ovulation following parturition was not recorded in 6 primiparous and two pluriparous buffaloes for the 60 days of ultrasound monitoring. Growth rate (mm/d) and largest size (mm) of first postpartum ovulating follicle was 0.95 +/- 0.18 and 1.07 +/- 0.07 (P = 0.4), and 13.5 +/- 0.8 and 14.1 +/- 0.4 (P = 0.4) in primiparous and pluriparous buffaloes, respectively. Following calving, the total number of available antral follicles (> or =2 mm) declined gradually towards the end of the study period. Follicles greater or equal to 3 mm in diameter on the contrary showed a prominent increase in the first 2 weeks from calving. The number of follicles greater or equal to 3 mm in diameter was significantly higher in the ovary contra-lateral to the one bearing the gravidic CL. A balance in the number of such follicles was reached toward the end of the first month. In conclusion, although some follicular activity was recorded in the ovaries of all buffaloes, true postpartum resumption of cyclicity in the months of increasing daylight hours was delayed in the majority of animals.
Animals↗
Use of Ovsynch in dairy herds--differences between primiparous and multiparous cows.
Ovsynch protocols are used to increase service rate and decrease days open and cullings for infertility. Recent reports have indicated better results after Ovsynch in primiparous than in older cows. However, this was not observed in all investigations on the subject. The objective of the study was to evaluate differences between primiparous and multiparous cows after synchronization of ovulation with an Ovsynch protocol in six trials. A total of 1584 cows (583 primiparous and 1001 multiparous cows, respectively) on three dairy farms were synchronized with an Ovsynch protocol consisting of a GnRH-analogue at Days 0 and 9, and a prostaglandin F(2alpha) analogue on Day 7. AI was carried out in all cows 16-20 h after the last treatment. Cows were categorized into primiparous and multiparous cows for analysis. Conception rate (CR) to timed AI, to further AI, overall conception rate and proportion of cows pregnant by 200 days in milk were compared between the age groups. Finally, two logistic regression models were calculated with conception to first service and conception by 200 DIM as the outcome variables. Independent variables were trial (categorical) and age group (primiparous versus multiparous). Conception rates to TAI were higher in primiparous than in older cows (37.9% versus 31.6%, P=0.015). Likewise pregnancy rates by 200 DIM were higher in primiparous cows (81.8% versus 75.4%, P=0.003). However, the extent of the difference varied between trials. Results indicate that Ovsynch protocols are more effective in primiparous than in older cows.
Aging↗
Coagulase-positive Staphylococcus intramammary infections in primiparous dairy cows.
Objectives were to determine the prevalence of coagulase-positive staphylococcal IMI in primiparous cows at first parturition, to contrast the differences in coagulase-positive staphylococcal IMI in primiparous cows at parturition in herds with high and low prevalences of coagulase-positive staphylococcal IMI in the lactating herd, and to determine the percentage of primiparous cows having persistent coagulase-positive staphylococcal IMI. Milk samples were collected aseptically from cows at the start and end of the study, at dry-off, and at parturition. Herds (n = 18) were split evenly into two categories: high (> 10%) or low (< 5%) prevalence of coagulase-positive staphylococcal IMI. At the start, the mean prevalence of coagulase-positive staphylococcal IMI in high prevalence herds was 30%, ranging from 13 to 65%, and in low prevalence herds was 2%, ranging from 0 to 5%. Overall the prevalence of coagulase-positive staphylococcal IMI in primiparous cows at parturition was 8.1% (67 of 828), ranging from 0 to 27%. Although primiparous cows from high prevalence herds had a higher prevalence of coagulase-positive staphylococcal IMI (9.2%; 40 of 436) at parturition than did primiparous cows from low herds (6.9%; 27 of 392), the difference was not significant. Of primiparous cows with coagulase-positive staphylococcal IMI at parturition, 43% had coagulase-positive staphylococcal IMI at least 2 mo after parturition. Primiparous cows with coagulase-positive staphylococcal IMI at parturition may represent significant reservoirs of infection to uninfected herdmates.
Animals↗
Remote prognosis of primiparous women with preeclampsia.
OBJECTIVE: To describe the maternal characteristics of pregnancy and perinatal outcome of primiparous women with preeclampsia, to determine the recurrence rate and to define the maternal risk factors for preeclampsia in subsequent pregnancies. METHODS: A retrospective cohort study. Two groups of patients were defined: the study group consisted of 380 primiparous women with preeclampsia, and in a control group of 385 primiparous women without preeclampsia. The patients were followed during their consecutive deliveries. Multiple logistic regression analysis was used to determine the independent risk factors for the recurrence of preeclampsia in the second pregnancy. RESULTS: In the study and the control group there were a total of 1207 and 1293 deliveries, respectively. Of the 380 primiparous women in study group, 305 (80%) were identified as suffering from mild preeclampsia, 64 (17%) from severe preeclampsia, 10 (2.6%) from super imposed preeclampsia and only one (0.3%) had eclampsia. Primiparous with severe preeclampsia had a significantly higher rate of preterm delivery then those with mild preeclampsia (34 versus 11% respectively, P<0.0001). In addition, the study group had significantly higher rate of perinatal mortality (3.4 versus 0.3%, P=0.013) and perinatal complications. The recurrence rate of preeclampsia was significantly higher in the study group (25% versus 1.9%, P<0.0001). When adjusted for confounding variables, gestational diabetes was strongly associated with the recurrence of preeclampsia in the second pregnancy (OR 3.72 95% CI 1.45-9.53). CONCLUSION: Primiparous women with preeclampsia are at an increased risk for recurrence in subsequent pregnancies. Gestational diabetes in primiparous women with preeclampsia is an independent risk factor for developing preeclampsia in the second pregnancy.
Adult↗
Obstetric anal sphincter rupture in older primiparous women: a case-control study.
OBJECTIVE: To determine if maternal age (35 years of age or older) in primiparous women is a risk factor for the development of obstetric anal sphincter rupture (OASR) and to identify obstetric factors associated with it. MATERIAL AND METHODS: This is a retrospective case-control study. The study population was made up of the 5,345 primiparous women aged 24-45 years who delivered vaginally with singleton live-born neonates during 1990-99 at the Department of Obstetrics and Gynecology, Linköping University Hospital, Sweden. As cases the 327 primiparous women aged 35-45 years at delivery were selected. For each case two primiparous controls ten years younger were selected, matched for gestational age and year of delivery, in all 654 controls. Maternal, obstetrical, and neonatal data were obtained from the delivery records. Obstetric factors for the development of OASR were assessed with multivariate logistic regression analysis. RESULTS: No significant association was found between the primiparous age category and OASR. Vacuum extraction, forceps delivery, and the head circumference of the neonate were found to be independent risk factors for OASR, while the use of mediolateral episiotomy or epidural analgesia were independent protective factors for developing OASR. CONCLUSIONS: Primiparous women, 35 years of age or older, do not seem to have a greater risk of OASR than younger primiparous women. Risk factors for OASR are instrumental vaginal delivery and the size of the neonate. Mediolateral episiotomy and epidural analgesia seem to reduce the risk for OASR.
Adult↗
Inefficiency of lactation in primiparous rats: the costs of first reproduction.
To investigate the energetic costs of lactation in a female mammal in relation to previous reproductive history, we compared the performance of adult female Long-Evans rats that had previously bred (multiparous) with young females that had not previously given birth (primiparous). All litters were standardized to 10 +/- 1 young. We compared maternal production (growth of pups), body mass, and energy intake (food consumption) of mothers, as well as their energy expenditure (resting oxygen consumption). The mass of litters at birth and the growth of pups during lactation did not differ according to reproductive history of the mothers. The body mass of primiparous mothers was less than that of multiparous mothers, and primiparous mothers showed an increase in mass during early lactation. To accomplish the essentially identical production of offspring under these circumstances, the primiparous mothers consumed and expended more energy than the multiparous mothers. This remarkable performance of first-time mothers results in an overall efficiency of energy allocation to reproduction amounting to only 25%, compared with 38% in multiparous mothers. The energetic inefficiency of primiparous female lactation results largely from the excessive expenditures associated with physiological and behavioral performances of first-time reproduction, together with a small component of additional expenditure due to further growth by the primiparous mothers. We suggest that this inefficiency probably contributes to the observed low reproductive success of novice breeders; furthermore, active restraint of fecundity may be an evolutionary response to the constraints of the energetic inefficiency of primiparous breeding by female mammals.
Analysis of Variance↗
Influence of milk production potential on forage dry matter intake by multiparous and primiparous Brangus females.
Brangus cows (n = 29) were used in three experiments to evaluate the effects of parity (multiparous vs. primiparous) and potential genetic merit for milk production (high vs. low) on forage intake during late gestation, early lactation, and late lactation. Cows were selected for milk production based on their sire's EPD for milk production (MEPD). Cows had ad libitum access to (130% of previous 2-d average intake) low-quality hay (5.3% CP and 76% NDF), and cottonseed meal was supplemented to ensure adequate degradable intake protein. All females were adapted to diets for at least 7 d, and individual intake data were collected for 9 d. During the lactation trials, actual milk production was determined using a portable milking machine following a 12-h separation from calves. During late gestation, multiparous cows consumed 24% more (P = 0.01) forage DM (kg/d) than primiparous cows; however, parity class did not influence forage intake when intake was expressed relative to BW. Furthermore, MEPD did not influence forage intake during late gestation. During early lactation, multiparous cows produced 66% more (P < 0.001) milk than primiparous cows, and high MEPD tended (P = 0.10) to produce more milk than low MEPD. Multiparous cows consumed 19% more (P < 0.0001) forage DM than did primiparous cows when expressed on an absolute basis, but not when expressed on a BW basis. High-MEPD cows consumed 8% more (P < 0.05) forage DM than did low-MEPD cows. During late lactation, multiparous cows produced 84% more milk than primiparous cows, although MEPD did not influence (P = 0.40) milk yield. In addition, multiparous cows consumed 17% more (P < 0.01) forage DM per day than primiparous cows, but when intake was expressed relative to BW, neither parity nor MEPD influenced forage DMI during late lactation. Milk yield and BW explained significant proportions of the variation in forage DMI during early and late lactation. Each kilogram increase in milk yield was associated with a 0.33- and 0.37-kg increase in forage DMI for early and late lactation, respectively. Results suggest that multiand primiparous cows consume similar amounts of low-quality forage DM, expressed per unit of BW, during late gestation and lactation. Selecting beef cows for increased genetic merit for milk production increases forage DMI during early lactation.
Animal Feed↗
Blood and milk neutrophil chemiluminescence and viability in primiparous and pluriparous dairy cows during late pregnancy, around parturition and early lactation.
Extensive studies have shown the polymorphonuclear leukocytes (PMN) dysfunction inextricably links to parturition. To investigate the effect of parity on PMN function, phorbol 12-myristate 13-acetate (PMA) stimulated luminol-amplified chemiluminescence (CL) and viability of blood and milk PMN were investigated in primiparous and pluriparous dairy cows during periparturient period. The CL kinetics of blood and milk PMN and hematological profiles were also assessed. Milk PMN CL was always lower than blood PMN CL. Blood and milk PMN CL and milk PMN viability were significantly higher in primiparous cows throughout the study. Blood PMN CL in pluriparous cows showed a sharper decrease. Both in pluriparous and in primiparous cows, minimal blood PMN CL appeared at periparturient day (PPD) 2. After PPD 7, blood PMN CL recovery rate was faster in primiparous cows. Milk PMN CL was minimal at PPD 2 in both groups. Whereas no changes were observed in blood PMN viability, the viability of milk PMN in primiparous cows was substantially higher than in pluriparous cows. The number of circulating eosinophils and immature neutrophils was substantially higher in primiparous cows throughout the study. The CL kinetics of blood PMN at PPD -2 and 2 and of milk PMN at PPD 2 exhibited different responses to PMA, with higher intensity and durability, peaking and subsiding more slowly in primiparous dairy cows. The pronounced reduction in PMN CL and viability in milk PMN of pluriparous cows may be involved in the underlying mechanisms that make these animals more susceptible to periparturient infectious diseases.
Animals↗
Pregnancy increases plasma leptin in nulliparous but not primiparous goats while lactation depresses it.
Most dairy ruminants are still lactating during early pregnancy, which could induce hormonal adaptations different from those observed during pregnancy alone. The incidence of concomitant lactation and pregnancy on plasma leptin has not been studied, and physiological factors involved in its regulation have not been addressed in goats. We assayed leptinemia throughout the pregnancy-lactation cycle in nulliparous and primiparous goats, starting 165 days prior to parturition and finishing 59 days after. During the first half of pregnancy, primiparous goats were lactating. Lactating non-pregnant primiparous goats were studied in parallel. Plasma leptin increased (+49%) up to mid-pregnancy in nulliparous, but not in primiparous goats. Furthermore, leptinemia was similar between pregnant and non-pregnant lactating primiparous goats, suggesting a strong leptinemia down-regulation by late lactation. Plasma leptin decreased from mid-pregnancy to parturition, more markedly in nulliparous goats, and remained depressed during early lactation at a similar level in both female types. It was lower, at 130 days of pregnancy, in goats carrying two fetuses. The leptinemia down-regulation by late pregnancy was highlighted by the lack of plasma leptin increase after drying-off late-pregnant primiparous goats, while it strongly increased in non-pregnant goats. The observation of leptinemia increase only in nulliparous goats suggests that it is not an essential endocrine adaptation during early pregnancy. By contrast, in both female types, the low leptinemia during transition from late pregnancy to lactation, and during late lactation, may be important for the adaptations that occur during lactation such as the partitioning of energy and nutrients towards essential functions and/or hyperphagia.
Animals↗
Primiparous rhesus monkey mothers are more sensitive to the nursing-induced inhibition of LH and ovarian steroid secretion.
The duration of lactational infertility is prolonged significantly in adolescent, primiparous rhesus monkey (Macaca mulatta) mothers compared with adult, multiparous mothers. The present study examined the hypothesis that this parity/age difference in lactational infertility is due to a difference in the physiological responsiveness to nursing behaviour between adolescent and fully adult mothers and is not a consequence of differences in nursing behaviour, per se. At 22 weeks postpartum, mother-infant pairs were randomly assigned to one of four conditions: primiparous, nursing restricted (PR; n = 9); primiparous, nursing unrestricted (PU; n = 11); multiparous, nursing restricted (MR; n = 12); and multiparous, nursing unrestricted (MU; n = 8). Nursing was restricted for a 2-week period by mothers wearing a primate vest which prevented suckling behaviour but allowed infants to interact with their mothers. Nursing restriction resulted in a significant increase in serum oestradiol concentrations in both PR and MR mothers. Although nursing bout frequencies and durations were similar between PU and MU mothers, serum oestradiol also rose in MU mothers but remained suppressed in PU mothers. Once the nursing manipulation period ended and all mothers were allowed to nurse ad libitum, serum oestradiol concentrations continued to rise in all but the PU mothers. This brief interruption of nursing at 22 weeks postpartum advanced the subsequent timing of the first postpartum ovulation in MR and PR mothers relative to that of PU mothers. Again, despite similarities in nursing behaviour, the occurrence of first ovulation was also advanced in MU mothers compared with PU mothers. Just prior to the first postpartum ovulation, females were randomly assigned to one of four treatment groups to determine the effects of nursing behaviour on the hormonal parameters of the luteal phase: primiparous, nursing restricted (PRL; n = 9); primiparous, nursing unrestricted (PUL; n = 11); multiparous, nursing restricted (MRL; n = 10); and multiparous, nursing unrestricted (MUL; n = 10). Nursing restriction significantly elevated serum progesterone concentrations in PRL females compared with other mothers. Serum concentrations of oestradiol were higher in PRL, MRL and MUL mothers relative to PUL females. Again, this difference in oestradiol between PUL and MUL mothers occurred despite similarities in nursing behaviour. These data suggest that parity/age differences in the period of lactational infertility are not due to differences in nursing behaviour but rather to an increased sensitivity to the inhibitory aspects of the suckling stimulus in adolescent primiparous mothers.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Increase of Escherichia coli inoculum doses induces faster innate immune response in primiparous cows.
The objective of the current study was to evaluate the dynamics of infection and the immunological response to varying numbers of Escherichia coli injected into the mammary glands of primiparous cows during the periparturient period. Primiparous cows have been shown to be more resistant to intramammary E. coli challenge, and an increase of the inoculum dose by 2 log10 units induced a more rapid clinical response and clearance of the organisms. Recognition of lipopolysaccharide (LPS) is a key event in the innate immunity response to gram-negative infection and is mediated by the accessory molecules CD14 and LPS-binding protein (LBP). Primiparous cows were inoculated with 1 x 10(4) (Group A; n=8) or 1 x 10(6) (Group B; n=8) cfu E. coli P4:O32 in their 2 left quarters during the periparturient period. Clinical examination and analysis of blood and milk parameters, including IL-8, complement fragment 5a (C5a), LBP, and soluble CD14 (sCD14), were performed from d -4 to d +3 relative to infection. Primiparous cows in Group B initiated a more rapid clinical response following intramammary infection (IMI), resulting in typical clinical signs and changes in blood and milk parameters approximately 3 h earlier compared with primiparous cows in Group A. Based on average milk production in the noninfected quarters on d +2 postinoculation, all heifers reacted as moderate responders. Distinct differences in the kinetic patterns of rectal temperature, somatic cell count (SCC), IL-8, C5a, LBP, and sCD14 were observed between both groups during the early phase of inflammation. Both C5a and IL-8 increased before cellular influx into the infected glands, followed by increases in sCD14 and LBP. In conclusion, primiparous cows are able to clear an intramammary E. coli infection efficiently. Moreover, increasing the inoculum dose induces a more rapid inflammatory reaction, mainly because of early activation of the innate host immune response.
Animals↗
Performance and feeding behavior of primiparous cows loose housed alone or together with multiparous cows.
Lactating Holstein cows (52 multiparous and 90 primiparous) were monitored over a period of 10 mo to observe effects of grouping primiparous cows (PPC) separately from multiparous cows (MPC) on performance, feeding behavior, feed intake, feed efficiency, and milk production of PPC. Cows were kept in 2 symmetrical pens each equipped with a robotic milking unit, 2 waterers, and 28 feeding spaces. Typically, 100 lactating cows were present at a time, thereby ensuring 1.78 cows per feeding place in each pen. One pen (PP) was composed exclusively of PPC whereas the other pen (PM) included 30% PPC and 70% MPC. Primiparous cows were evenly distributed to each pen by days in milk and daily milk production. As they calved, additional primiparous cows were assigned sequentially to each of the 2 treatment groups; multiparous cows calving during the study were allocated to the PM group. Both PP and PM groups were managed equally and were fed the same basal ration twice daily plus 3 kg/d of concentrate during milking. Individual eating behavior and feed consumption at each visit were monitored electronically. Milk production was recorded daily, and milk composition monthly. Observed arithmetic means and standard errors are presented but application to other management situations is limited because animals within pen were not independent. Total dry matter intake (18.7 vs. 18.1 +/- 0.9 kg/d) and milk production (25.9 vs. 25.6 +/- 0.8 kg/d) of PPC were similar in both the PM and PP groups, respectively. Primiparous cows in the PP group had numerically more visits to the robotic milking unit (3.26 vs. 2.68 +/- 0.15) and to the feed troughs (4.91 vs. 4.02 +/- 0.43), but apparently spent less time eating (2.72 vs. 3.22 +/- 0.1 h/d) than did PPC in the PM group. Differences in feed efficiency were low but PPC in the PP group had numerically higher feed efficiency at times through 200 d in milk. Alternative grouping strategies illustrate potentially important differential responses among primiparous cows that warrant further study.
Animal Nutritional Physiological Phenomena↗
Differential analgesic effect of tenoxicam on post-cesarean uterine cramping pain between primiparous and multiparous women.
BACKGROUND AND PURPOSE: Uterine cramping pain is related to prostaglandins, which are mediated by cyclooxygenase. However, it is unknown whether the analgesic effects of the non-selective cyclooxygenase inhibitor tenoxicam are different between primiparous and multiparous women. This placebo-controlled, double-blind study compared the analgesic effect of tenoxicam on post-cesarean uterine cramping pain in primiparous and multiparous women. METHODS: Forty primiparous women and 40 multiparous women who were scheduled for elective cesarean delivery were allocated into the following 4 groups: saline-primipara (SP) group, tenoxicam-primipara (TP) group, saline-multipara (SM) group, and tenoxicam-multipara (TM) group. Saline or 20 mg tenoxicam was intravenously injected immediately after clamping of the umbilical cord. All patients received patient-controlled analgesia for postoperative pain control. Resting wound pain, uterine cramping pain, morphine consumption, and morphine-related side effects were evaluated at 4 and 24 hours after surgery. RESULTS: At 24 hours after surgery, tenoxicam-related relief of uterine cramping pain was 2.1 in primiparous women (visual analog scale: SP 5.6 (4.4-6.8) minus TP 3.5 (2.2-4.9); p < 0.01). The tenoxicam-related morphine-sparing effect was 14 mg (45%) in primiparous women (SP 31.4 mg (23.9-38.8) minus TP 17.4 mg (11.6-23.2); p < 0.01). The tenoxicam-related relief of uterine cramping pain and tenoxicam-related morphine-sparing effect were not significant in multiparous women. CONCLUSIONS: This study revealed that the analgesic effect of tenoxicam on post-cesarean uterine cramping pain is greater in primiparous women than in multiparous women. Further studies are required to determine whether a higher dosage of tenoxicam is beneficial to reduce uterine cramping pain in multiparous women.
Adult↗
Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique.
OBJECTIVE: Intrapartum damage to the anal sphincter is an important factor in fecal incontinence. Recognized lacerations occur in 0.36-8.4% of vaginal deliveries, and occult sphincter damage in up to 35% of primiparous women. We examined the role of three-dimensional transperineal ultrasound (3DTUS) in the evaluation of the anal sphincter in primiparous women after vaginal delivery and after surgical repair of third-degree intrapartum tears by the overlapping technique. METHODS: During 2004-2005 139 primiparous women without clinically recognized third- to fourth-degree anal sphincter tears were prospectively studied 24-72 h postpartum (Group 1) and 13 primiparous women were examined 48 h to 4 months following surgical repair of third-degree tears with the overlapping technique (Group 2). A 3D 5-9-MHz transvaginal probe was placed in the area of the fourchette and perineal body in transverse and sagittal planes and 2-4 volumes were stored. The parameters studied were: examination duration; continuity of the internal and external sphincters; occult sphincter damage; internal sphincter and external sphincter width-measured 1.5 cm from the distal margin of the anus-at the '12, 3, 6 and 9 o'clock positions'; length of the posterior internal sphincter. RESULTS: Scanning was possible in all women and the stored volumes were adequate in 127/139 (91.4%) cases. Mean examination time was 3.5 min. In Group 1, occult sphincter defect was suspected in 10/127 women (7.9%). These patients were excluded from measurement calculations, leaving 117 cases for analysis. The internal sphincter was consistently visualized in all the remaining patients (n = 117), while the external sphincter was fully visualized in 99/117 women (84.6%), and partially visualized in the remainder. Mean internal sphincter thickness was 2.60, 2.55, 2.60 and 2.72 mm at the 12, 3, 6 and 9 o'clock positions, respectively, and mean internal sphincter length was 3.34 cm. Mean external sphincter thickness was 4.15, 4.20, 4.21 and 4.20 mm at the 12, 3, 6 and 9 o'clock measurement points. In Group 2, 3DTUS confirmed anatomic abnormalities in all the women in the area surrounding the 12 o'clock position. Evaluation of sphincter tears and their position and length was possible using the longitudinal view. Thinning of the internal sphincter in the area of damage and thickening on the opposite side, the 'half moon sign', sphincter discontinuity, thickening of the external sphincter in the area of repair and abnormality of mucous folds, seemed to be common signs of third-degree intrapartum sphincter tears, even after repair. CONCLUSIONS: 3DTUS is an accessible and promising method for postpartum sphincter evaluation, that is apparently well tolerated by patients. Reference data for sphincter anatomy representative of findings at transperineal ultrasound in primiparous women in the postpartum period have been established.
Anal Canal↗
Prevalence of Staphylococcus species during the periparturient period in primiparous and multiparous cows.
During a 14-mo period, 77 multiparous and 36 primiparous cows were sampled to determine the prevalence of staphylococci during the periparturient period. Distal streak canal swabs were taken at 14 d prepartum, and foremilk was sampled the first 5 consecutive wk of lactation. Staphylococcus aureus was isolated from 7.6% of quarters of primiparous cows but from only .6% of quarters of multiparous cows at parturition. Prevalence in primiparous cows declined to 3.5% by the wk-1 sampling. Quarter prevalence of coagulase-negative Staphylococcus species prepartum, at parturition, and wk 1 to 5 in primiparous cows was 38.9, 27.8, 15.3, 14.6, 13.2, 15.3, and 14.6%, respectively. In multiparous cows, prevalence at these times was 50.3, 12.3, 6.2, 8.1, 10.7, 7.1, and 8.1%. Staphylococcus chromogenes was the predominant species isolated, accounting for over 50% of the staphylococci isolated at each sampling time. Results suggest that high prevalence of staphylococci isolated prepartum is a reflection of natural skin flora and that a higher postpartum prevalence of these organisms was observed in primiparous cows than in multiparous cows. These data suggest also that the peripartum heifer could be a source of Staphylococcus aureus in the lactating herd.
Animals↗
Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore.
INTRODUCTION: To study the use, safety and effectiveness of a novel antenatal vaginal birth training device (EPI-NO) in primiparous women. METHODS: Antenatal use of the EPI-NO vaginal birth trainer was prospectively studied in 31 primiparous booked patients who were delivered by obstetricians from July to December 2002 at the KK Women's and Children's Hospital. This was studied in relation to episiotomy rate, perineal trauma and analgesic requirements during the postpartum period. A patient questionnaire form was used to assess their perception of pain and how well they coped with its use. For comparison, perineal trauma was also studied retrospectively in 60 consecutive obstetrician-booked primiparous term patients who had normal vaginal delivery (NVD) and who did not use EPI-NO during the same study period. RESULTS: The mean length of usage was for 2.1 weeks (standard deviation [sd] 1.2 weeks). The mean frequency of use was 5.3 episodes per week (sd 2.1, range 1 to 7). There was no laceration and vaginal infection arising from its usage. There was a case of minimal bleeding post-usage. There were 20 (64.5 percent) NVDs, four (12.9 percent) forceps deliveries, five vacuum deliveries (16.1 percent) and two (6.5 percent) Caesarean sections. Of the 29 vaginal delivery cases, 19 (65.5 percent) had episiotomy, eight (27.6 percent) had lacerations, and two (6.9 percent) did not sustain laceration. The reasons for episiotomy in the 19 cases were nine cases of pending tearing of vagina/perineum, nine cases of instrumental vaginal deliveries, and one to shorten second stage. There was no third degree tear. 21 (67.7 percent) out of 30 required a painkiller. The majority of patients (17; 54.8 percent) appeared to be comfortable with the use of EPI-NO. All coped well with vaginal examination after using EPI-NO perineal training. Comparing among term primiparous NVD cases with (n value equals 20) and without (n value equals 60) EPI-NO, the perineal trauma rate (90.0 percent vs 96.6 percent, p value equals 0.24) was slightly but not significantly lower in the EPI-NO group. The episiotomy rate was significantly lower (50.0 percent vs 93.3 percent, p value is less than 0.0001) and the extent of perineal trauma in the patient appeared to be less severe in cases using EPI-NO. CONCLUSION: EPI-NO appeared to be safe and acceptable to the majority of users. Although birth training with EPI-NO significantly decreases the rate of episiotomies in term primiparous patients, and the degree of perineal tissue injury appeared to be less in the EPI-NO group especially among those with lacerations, the overall perineal trauma rate was slightly but not significantly lower, in view of the higher spontaneous laceration rate in the EPI-NO group.
Analgesics↗