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Obstetric Complications (obstetric + complications)
Selected AbstractsObstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health SystemHEALTH SERVICES RESEARCH, Issue 1 2010Dorothy Thornton Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Data Source. Linked California hospital discharge (2000,2001), birth, fetal death, and county mental health system (CMHS) records. Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors. Results. Compared with deliveries in the general non,mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis). Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention. [source] Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza StripPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008Henry D. Kalter Summary Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15,49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings. [source] Are rural adolescents necessarily at risk of poorer obstetric and birth outcomes?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2005Mavis Gaff-Smith Abstract Objective:,The purpose of the present study were to describe the sociodemographic and clinical characteristics of adolescent women giving birth at Wagga Wagga Base Hospital, and compare these with those with all adolescents in New South Wales. Design:,An investigative approach. Main outcome measures:,Obstetric complications, delivery intervention and adverse infant outcomes. Setting:,Wagga Wagga Base Hospital. Participants:,One hundred and sixteen adolescents aged 15,19 years. Results:,In relation to obstetric complications and infants with complications, the study sample was found to be representative of New South Wales adolescents. However, for type of delivery there was a higher rate of forceps delivery (12.3% (15) vs 4.7% (415) P = 0.0001), forceps rotation (4.1% (5) vs 0.9% (80) P = 0.004) and fewer normal vaginal deliveries (67.2% (82) vs 80.8% (7108) P = 0.006) at Wagga Wagga Base Hospital. Conclusion:,These findings suggest that rural adolescents are at risk of delivery complications and are less likely to have a normal vaginal delivery. More research is required into obstetric and birth outcomes for the rural adolescent population. [source] Reduced risk of cancer in schizophrenia: a role for obstetric complications?ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2008Antonio Preti No abstract is available for this article. [source] Physical illness and schizophrenia: a review of the literatureACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2007S. Leucht Objective:, The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method:, We searched MEDLINE (1966 , May 2006) combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results:, A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion:, The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. [source] Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetesDIABETIC MEDICINE, Issue 2 2004A. Ben-Haroush Abstract Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost-effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high-risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high-risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors. Diabet. Med. 20, ***,*** (2003) [source] Sex differences in schizophrenia, a review of the literatureACTA PSYCHIATRICA SCANDINAVICA, Issue 401 2000Dr. Alice Leung M.D. Objective: To comprehensively and critically review the literature on gender differences in schizophrenia. Method: An initial search of MEDLINE abstracts (1966,1999) was conducted using the terms sex or gender and schizophrenia, followed by systematic search of all relevant articles. Results: Males have consistently an earlier onset, poorer premorbid functioning and different premorbid behavioral predictors. Males show more negative symptoms and cognitive deficits, with greater structural brain and neurophysiological abnormalities. Females display more affective symptoms, auditory hallucinations and persecutory delusions with more rapid and greater responsivity to antipsychotics in the pre-menopausal period but increased side effects. Course of illness is more favorable in females in the short- and middle-term, with less smoking and substance abuse. Families of males are more critical, and expressed emotion has a greater negative impact on males. There are no clear sex differences in family history, obstetric complications, minor physical anomalies and neurological soft signs. Conclusion: This review supports the presence of significant differences between schizophrenic males and females arising from the interplay of sex hormones, neurodevelopmental and psychosocial sex differences. [source] Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health SystemHEALTH SERVICES RESEARCH, Issue 1 2010Dorothy Thornton Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Data Source. Linked California hospital discharge (2000,2001), birth, fetal death, and county mental health system (CMHS) records. Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors. Results. Compared with deliveries in the general non,mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis). Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention. [source] Correlations between clinical and historical variables, and cerebral structural variables in people with mild intellectual disability and schizophreniaJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2001T. L. Sanderson Abstract The increased prevalence of schizophrenia in the population with mildly intellectual disability (ID) remains unexplained. The present study explores several possibilities by examining historical/clinical findings in relation to structural neuroimaging findings in three groups: (1) comorbid mild ID and schizophrenia; (2) schizophrenia alone; and (3) mild ID alone. Information about clinical and historical variables was obtained from 101 subjects (39 with comorbidity, 34 with schizophrenia and 28 with mild ID), out of whom 68 (23, 25 and 20, respectively) had had a cerebral magnetic resonance imaging (MRI) scan. Although a number of significant correlations exist between clinical variables and structural MRI abnormalities in all three groups, no clearly predictive inter- or between-group differences emerged. More striking was the finding that showed small amygdalo-hippocampal size to be associated with a history of central nervous system injury, especially meningitis. These findings provide support for the view that cognitive impairment and comorbid psychosis can result from a common cause, such as meningitis or obstetric complications, possibly interacting with other factors, such as family history. [source] Double inherited thrombophilias and adverse pregnancy outcomes: Fashion or science?JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010Giovanni Larciprete Abstract Aim:, To determine to what extent double inherited thrombophilias are associated with adverse obstetric complications correlated with fetoplacental insufficiency, such as preeclampsia, hemolytic anemia elevated liver enzymes and low platelet count (HELLP) syndrome, gestational hypertension, fetal growth restriction (FGR), intrauterine death (ID), abruptio placentae and disseminated intravascular coagulopathy. Methods:, Pregnant women coming to delivery were retrospectively divided into two groups: group A (controls) and group B (cases). Patients belonging to group B had one of the following: severe preeclampsia, HELLP syndrome, gestational hypertension, FGR, intrauterine death, abruptio placentae of disseminated intravascular coagulopathy. We detected methylenetetrahydrofolate reductase (MTHFR) A1298C, MTHFR C677T, factor V Leiden, PAI-1, mutant prothrombin G20210A, plasma homocysteine, antithrombin III, protein S and activated protein C resistance. Normal pregnant women or pregnant women with double defects were enrolled in this study. Results:, The combination of MTHFR C677T mutation with PAI-1 (5G/5G) mutation was significantly linked with the occurrence of ID. HELLP syndrome was significantly related to the simultaneous presence of factor VIII and X mutations. The combination of MTHFR C677T with factor VIII mutation and the combination of factor II and V mutations were significantly related to the occurrence of abruptio placentae. We found an association between double isoforms MTHFR mutation and FGR. Conclusion:, It seems that some thrombophilias and a combination of thrombophilic factors carry a greater risk than others for a given adverse outcome. Further studies are needed to check the link between thrombophilic gene mutations and adverse pregnancy outcomes, such as recurrent miscarriages and deep venous thrombosis. [source] Spontaneous uterine rupture during a second trimester pregnancy with a history of laparoscopic myomectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2009Gokhan Goynumer Abstract Uterine rupture is one of the most feared obstetric complications, carrying an increased risk of maternal and perinatal morbidity and mortality. Here, we present a case of spontaneous uterine rupture during the first half of pregnancy. The patient did not report any recent trauma, however she had a history of laparoscopic myomectomy conducted three years earlier. The uterine rupture was 6,7 cm in length, located at the fundal level and was thought to originate from the previous myomectomy scar. In this report, we discuss the importance of choosing the right surgical technique and suturing method in patients undergoing myomectomy who desire to conceive in the future, and how obscure the findings of uterine rupture during pregnancy can be. [source] New frontiers of assisted reproductive technology (Chien Tien Hsu Memorial Lecture 2007)JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2009P. C. Ho Abstract Many significant advances have been made in assisted reproductive technology since the birth of the first baby conceived with in vitro fertilization and embryo transfer. The development of recombinant gonadotropins and gonadotropin releasing hormone antagonists helps to simplify the ovarian stimulation. Excessive ovarian stimulation should be avoided because of the risks of ovarian hyperstimulation syndrome and reduction in endometrial receptivity. Maturation of oocytes in vitro has been developed in some centers. It is still uncertain whether techniques such as assisted hatching, blastocyst transfer and pre-implantation aneuploidy screening can improve the live birth rates in assisted reproduction. The introduction of pre-implantation genetic diagnosis for selection of human lymphocyte antigens (HLA) compatible embryos for treatment of siblings has raised ethical concerns. There is a higher risk of obstetric complications and congenital abnormalities even in singleton pregnancies achieved with assisted reproduction. Because of the risks of multiple pregnancies, elective single embryo transfer is increasingly used in good-prognosis patients. With a good freezing program, the cumulative pregnancy rate (including the pregnancies from subsequent replacement of frozen-thawed embryos) is not adversely affected. Improvement in cryopreservation techniques has made it possible to cryopreserve slices of ovarian tissue or oocytes, thus helping women who have to receive sterilizing forms of anti-cancer treatment to preserve their fertility. It is important that the development of the new techniques should be based on good scientific evidence. Ethical, legal and social implications should also be considered before the introduction of new techniques. [source] Adolescent primiparas: Changes in obstetrical risk between 1983,1987 and 1999,2005JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2008Willibald Zeck Abstract Aims:, Teenage pregnancies have always been considered at increased risk for obstetric complications. Deliveries in adolescent primiparas in the 5-year time periods 1983,1987 and 1999,2005 were compared against each other, the general population and against primiparas aged 20,29 years in order to reveal trends and differences in obstetric outcome. Methods:, A total of 186 primiparas delivering at an age of 17 or less between October 1999 and October 2005 were compared with 353 adolescent primiparas delivered between 1983 and 1987. Type of delivery and complications such as low birthweight, pre-eclampsia, breech presentation and third stage complications were studied. Results:, The percentage of adolescents in the overall obstetric population decreased. The cesarean section rate remained the same in the adolescents while increasing in the general population. Rates of low birthweight and operative vaginal delivery increased in the adolescent group and overall. Third stage complications (abnormally adherent or incomplete placentas) decreased in both groups. There were no intrauterine fetal deaths in adolescent pregnancies in either time period. Other obstetric variables were unchanged in the adolescent as well as in the general population between 1999 and 2005. When comparing the adolescents' outcome with the outcome of the 20,29-year-old primiparas between 1999 and 2005, it was noted that the rates of abstracted obstetric variables were higher in the population of the 20,29-year-olds. Conclusions:, The obstetric outcome of adolescent pregnancies has remained favorable over the last 18 years. We do not consider adolescence as an obstetrical risk. We suggest that adolescent pregnancy is more a public health issue than a clinical problem. [source] Clinical significance of polymicrobial bacteremia in newbornsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2005Piyush Gupta Objective: To identify whether polymicrobial bacteremia in newborns is associated with any predisposing factors, distinguishing clinical features, or higher mortality. Methods: Results of blood cultures obtained over a period of 1 year from neonates admitted to the paediatric ward and Neonatal Intensive Care Unit of a tertiary care hospital were retrospectively analysed. The study group included all cases with polymicrobial bacteremia (isolation of two or more organisms). Controls (double the number of study cases) were randomly selected from the monomicrobial group. Case records of included cases were retrieved and scrutinized. Results: Of 770 positive cultures during the study period, 52 (6.8%) cultures were positive for more than one organism. Complete case records were retrieved for 40 polymicrobial and 78 monomicrobial cases. The two groups were comparable for maternal and neonatal parameters including: maternal and obstetric complications; period of gestation; mode of delivery; birthweight and perinatal asphyxia; clinical symptomatology; invasive therapeutic interventions; and mortality. Conclusions: Isolation of more than one organism from the blood culture of a suspected septic newborn is not rare. It does not always represent a true invasion by multiple organisms. Polymicrobial isolation per se should not be the criterion for hastily changing the therapeutic decisions. [source] Study of subjectivity in the perception of cesarean birthNURSING & HEALTH SCIENCES, Issue 1 2005Chai Soon Park rn Abstract This study defined the structural patterns of subjectivity in the perception of cesarean birth. Q methodology was used on 71 statements collected through interviews with seven persons and a literature review followed. Twenty-nine Q samples were selected and administered to 22 persons, and four types of subjectivity were revealed by the QUANL PC Program. Type 1, or the ,naturalist', is characterized by a passive tendency and dislikes artificial methods, feeling that they are performed for hospital income and the trend for social preference. Type 2, ,logical thinker', thinks that cesarean birth should be selected if there are obstetric complications and severe anxiety about labor, even though it results in low intimacy with the baby. Type 3, ,maternal instinctivism', values the maternal-baby relationship and the sense of accomplishment from childbirth. Type 4, ,egocentric', thinks that cesarean section should be chosen when the woman has severe anxiety about labor or when the obstetric condition becomes dangerous. Before commencement of the patient's labor pains, the nurses and medical personnel who are participating in the delivery should assess the structural pattern on parturient woman's subjectivity in the perception of cesarean section. As a further step, they should encourage the woman and her family to participate in the decision-making process for considering the type of delivery the mother wants. [source] Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural GhanaPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2008Karen M. Edmond Summary This study evaluated the diagnostic accuracy of a verbal autopsy (VA) tool in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana and was nested within a community-based maternal vitamin A supplementation trial (ObaapaVitA trial). All stillbirths and neonatal deaths between 1 January 2003 and 30 June 2004 were prospectively included. Community VAs were carried out within 6 months of death and were classified with a primary cause of death by three experienced paediatricans. The reference standard diagnosis was obtained by the study paediatrician in 4 district hospitals in the study area. There were 20 317 deliveries, 661 stillbirths and 590 neonatal deaths with a VA diagnosis in the study population. A total of 311 stillbirths and 191 neonatal deaths had both a VA and a hospital reference standard diagnosis. The VA performed poorly for stillbirth diagnoses such as congenital abnormalities and maternal haemorrhage. Accuracy was higher for intrapartum obstetric complications and antepartum maternal disease. For neonatal deaths, sensitivity was >60% for all major causes; specificity was 76% for birth asphyxia but >85% for prematurity and infection. Overall, VA diagnostic accuracy was higher than expected in this rural African setting. Our classification system was based on the expected public health importance of the individual causes of death, differing implications for intervention and the ability to distinguish between the individual causes in low-resource settings. We believe this system was easier to use than traditional approaches and resulted in high precision and accuracy. However, further simplifications are needed to allow use of the World Health Organisation VA in routine child health programmes. The diagnostic accuracy of the VA tool should also be assessed in other regions and in multicentre studies. [source] Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza StripPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008Henry D. Kalter Summary Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15,49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings. [source] Are psychotropics drugs used in pregnancy?,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2007Carlos De las Cuevas Abstract Purpose To assess the prevalence and characteristics of psychiatric drug use in pregnancy. Methods A prospective observational study was performed on a total of 1332 consecutive women admitted for delivery, during a 3 months period, in the public obstetric services of Tenerife Island (covering a population of 1,000,000 inhabitants). Results Less than 4% (3.6%) of the women recognised having a psychiatric disorder, and only 2.5% were receiving psychiatric drug treatment at the moment they knew they were pregnant; of those, 68.7% introduced substantial modifications in their treatment at that moment, 47.9% did not report any change with respect to the period before pregnancy and 35.4% recognised that their mood was worse than previously. Although patients affected by a psychiatric disorder registered a higher rate of abdominal delivery, no differences in delivery or obstetric complications were found between women with and without psychiatric illness or in relation to psychiatric drug treatment. Conclusions Compared to the literature, the studied population shows a lower rate of psychiatric problems and pharmacological treatment. This might reflect underrecognition or undertreatment. Copyright © 2007 John Wiley & Sons, Ltd. [source] Reproductive ageing in women,THE JOURNAL OF PATHOLOGY, Issue 2 2007O Djahanbakhch Abstract The traditional view in respect to female reproduction is that the number of oocytes at birth is fixed and continuously declines towards the point when no more oocytes are available after menopause. In this review we briefly discuss the embryonic development of female germ cells and ovarian follicles. The ontogeny of the hypothalamic-pituitary-gonadal axis is then discussed, with a focus on pubertal transition and normal ovulatory menstrual cycles during female adult life. Biochemical markers of menopausal transition are briefly examined. We also examine the effects of age on female fertility, the contribution of chromosomal abnormalities of the oocyte to the observed decline in female fertility with age and the possible biological basis for the occurrence of such abnormalities. Finally, we consider the effects of maternal age on obstetric complications and perinatal outcome. New data that have the potential to revolutionize our understanding of mammalian oogenesis and follicular formation, and of the female reproductive ageing process, are also briefly considered. Copyright © 2007 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] ORIGINAL ARTICLE: Thrombin Activatable Fibrinolysis Inhibitor and Clot Lysis Time in Pregnant Patients with Antiphospholipid Syndrome: Relationship with Pregnancy Outcome and ThrombosisAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 6 2009Maria Angeles Martinez-Zamora Problem, Antiphospholipid syndrome (APS) pregnancies are associated with thrombotic obstetric complications, despite treatment. This study evaluated Thrombin Activatable Fibrinolysis Inhibitor (TAFI) levels, TAFI gene polymorphisms and Clot Lysis Time (CLT) in pregnant patients with APS in relation to pregnancy outcome and thrombosis. Method of study, Group 1 consisted of 67 pregnant patients with APS. Group 2 included 66 pregnant patients with uneventful term pregnancies and delivery. Patients were sampled during each trimester and at baseline. TAFI antigen and CLT and two polymorphisms of the TAFI gene, Ala147Thr and +1542C/G, were determined. Results, Significantly prolonged CLT was found at baseline in Group 1. Allele distribution of the TAFI gene polymorphisms was similar in both groups. Basal TAFI and CLT in patients with APS having an adverse or a good obstetrical outcome were similar. Comparison of TAFI and CLT baseline levels in patients with APS with or without previous thrombosis showed no statistical differences. Conclusion, Patients with APS have impairment in fibrinolysis evidenced by prolonged CLT at baseline. TAFI and CLT do not seem to be useful as markers of obstetric outcome or risk of thrombosis in patients with APS. [source] Screening of antenatal depression in Pakistan: risk factors and effects on obstetric and neonatal outcomesASIA-PACIFIC PSYCHIATRY, Issue 1 2010Nazish Imran MBBS MRCPsych Abstract Introduction: To determine the frequency of probable antenatal depression (AD) in pregnant women in third trimester, assess the risk factors and its impact on obstetric and neonatal outcomes in a developing country. Methods: A prospective study conducted in a tertiary care hospital in Lahore from March 2007 to July 2007. Two hundred and thirteen pregnant women in the third trimester, attending the Gynecology Outpatient Clinic were recruited. They were assessed by a semistructured questionnaire to gather demographic details and various risk factors for AD. AD was assessed by Edinburgh Postnatal Depression Scale. All women were followed until delivery to determine their obstetric and neonatal outcomes. Results: Out of 213 women, 91 (42.7%) scored above the cut-off for AD. More women with depression reported problems in their marriage, problems with parents/in laws, history of domestic violence, past history of psychiatric problems and history of postnatal depression. In the obstetric risk factors history of previous miscarriages, stillbirths, and complications in previous pregnancy reached statistical significance. Thirty-seven (17.3%) women were lost to follow up. Women with AD had more obstetric complications during delivery. Babies of mothers with AD had significantly low birth weight, as well as low mean APGAR scores at 1 and 5 minutes following birth. Discussion: AD is a common problem in Pakistani Society. In view of the risk factors and adverse outcomes associated with depression during pregnancy, there is need for close liaison between Gynaecologists and Psychiatrists in managing these patients. [source] Multiple obstetric complications of factor V Leiden mutationAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2000Jeremy Tuohy No abstract is available for this article. [source] Are rural adolescents necessarily at risk of poorer obstetric and birth outcomes?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2005Mavis Gaff-Smith Abstract Objective:,The purpose of the present study were to describe the sociodemographic and clinical characteristics of adolescent women giving birth at Wagga Wagga Base Hospital, and compare these with those with all adolescents in New South Wales. Design:,An investigative approach. Main outcome measures:,Obstetric complications, delivery intervention and adverse infant outcomes. Setting:,Wagga Wagga Base Hospital. Participants:,One hundred and sixteen adolescents aged 15,19 years. Results:,In relation to obstetric complications and infants with complications, the study sample was found to be representative of New South Wales adolescents. However, for type of delivery there was a higher rate of forceps delivery (12.3% (15) vs 4.7% (415) P = 0.0001), forceps rotation (4.1% (5) vs 0.9% (80) P = 0.004) and fewer normal vaginal deliveries (67.2% (82) vs 80.8% (7108) P = 0.006) at Wagga Wagga Base Hospital. Conclusion:,These findings suggest that rural adolescents are at risk of delivery complications and are less likely to have a normal vaginal delivery. More research is required into obstetric and birth outcomes for the rural adolescent population. [source] Immersion in Water in the First Stage of Labor: A Randomized Controlled TrialBIRTH, Issue 2 2001Kerena Eckert RN Background:Current forms of analgesia often have significant side effects for women in labor. Bathing in warm water during labor has been reported to increase a woman's comfort level and cause a reduction in painful contractions. The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes.Methods:A prospective randomized controlled trial of 274 pregnant women, who were free from medical and obstetric complications and expecting a singleton pregnancy at term, was conducted at the Women's and Children's Hospital, a maternity tertiary referral center in Adelaide, South Australia. Women in labor were randomized to an experimental group who received immersion in a bath or to a nonbath group who received routine care. Pharmacological pain relief was the primary outcome that was measured, and secondary outcomes included maternal and neonatal clinical outcomes, factors relating to maternal and neonatal infectious morbidity, psychological outcomes, and satisfaction with care.Results:The use of pharmacological analgesia was similar for both the experimental and control groups; 85 and 77 percent, respectively, used major analgesia. No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma, length of labor, mode of delivery, or frequency of cardiotocographic trace abnormalities. Neonatal outcomes (birthweight, Apgar score, nursery care, meconium-stained liquor, cord pH estimations) revealed no statistically significant differences. Infants of bath group women required significantly more resuscitation than routine group women. Routine group women rated their overall experience of childbirth more positively than bath group women. Psychological outcomes, such as satisfaction with care or postnatal distress, were the same for both groups.Conclusion:Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate. [source] Trends in mode of delivery during 1984,2003: can they be explained by pregnancy and delivery complications?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2007CM O'Leary Objectives, To describe trends in mode of delivery, to identify significant factors which affected mode of delivery, and to describe how these factors and their impact have changed over time. Design, Total population birth cohort. Setting, Western Australia 1984,2003. Participants, The analysis was restricted to all singleton infants delivered at 37,42 weeks of gestation with a cephalic presentation (n= 432 327). Methods, Logistic regression analyses were undertaken to estimate significant independent risk factors separately for elective and emergency caesarean sections compared with vaginal delivery (spontaneous and instrumental), adjusting for potential confounding variables. Main outcome measures, Trends in mode of delivery, demographic factors, and pregnancy and delivery complications. Estimated likelihood of elective caesarean section compared with vaginal delivery and emergency caesarean section compared with vaginal delivery. Results, Between 1984,88 and 1999,2003, the likelihood of women having an elective caesarean section increased by a factor of 2.35 times (95% CI 2.28,2.42) and the likelihood of an emergency caesarean section increased 1.89 times (95% CI 1.83,1.96). These caesarean section rate increases remained even after adjustment for their strong associations with many sociodemographic factors, obstetric risk factors, and obstetric complications. Rates of caesarean section were higher in older mothers, especially those older than 40 years of age (elective caesarean section, OR 5.42 [95% CI 4.88,6.01]; emergency caesarean section, OR 2.67 [95% CI 2.39,2.97]), and in nulliparous women (elective caesarean section, OR 1.54 [95% CI 1.47,1.61]; emergency caesarean section, OR 3.61 [95% CI 3.47,3.76]). Conclusions, Our data show significant changes in mode of delivery in Western Australia from 1984,2003, with an increasing trend in both elective and emergency caesarean section rates that do not appear to be explained by increased risk or indication. [source] Schizophrenia: genetics, prevention and rehabilitationACTA NEUROPSYCHIATRICA, Issue 3 2009Paolo Olgiati Objective:, Genetic factors are largely implicated in predisposing to schizophrenia. Environmental factors contribute to the onset of the disorder in individuals at increased genetic risk. Cognitive deficits have emerged as endophenotypes and potential therapeutic targets for schizophrenia because of their association with functional outcome. The aims of this review were to analyse the joint effect of genetic and environmental (G×E) factors on liability to schizophrenia and to investigate relationships between genes and cognitive endophenotypes focusing on practical applications for prevention and rehabilitation. Methods:, Medline search of relevant studies published between 1990 and 2008. Results:, In schizophrenia, examples of G×E interaction include the catechol- O -methyl transferase (COMT) (Val158Met) polymorphism, which was found to moderate the onset of psychotic manifestations in response to stress and to increase the risk for psychosis related to cannabis use, and neurodevelopmental genes such as AKT1 (serine-threonine kinase), brain-derived neurotrophic factor (BDNF), DTNBP1 (dysbindin) and GRM3 (metabotropic glutamate receptor 3), which were associated with development of schizophrenia in adulthood after exposure to perinatal obstetric complications. Neurocognitive deficits are recognised as core features of schizophrenia that facilitate the onset of the disorder and have a great impact on functional outcome. Neurocognitive deficits are also endophenotypes that have been linked to a variety of genes [COMT, neuregulin (NRG1), BDNF, Disrupted-In-Schizophrenia 1 (DISC1) and dysbindin] conferring susceptibility to schizophrenia. Recently, it has emerged that cognitive improvement during rehabilitation therapy was under control of COMT (Val158Met) polymorphism. Conclusion:, This review could indicate a pivotal role of psychiatric genetics in prevention and rehabilitation of schizophrenic psychoses. [source] Birth weight charts for gestational age in 63 620 healthy infants born in Peruvian public hospitals at low and at high altitudeACTA PAEDIATRICA, Issue 3 2009Gustavo F Gonzales Abstract Aim: To construct distribution curves for birth weight, length and head circumference using a large sample of infants born at low (150 m) and high (3000,4400 m) altitude. Methods: Cross-sectional analysis of a perinatal database. All live singleton deliveries from public hospitals during 2001,2006 (gestational age from 26 to 42 weeks) with no history of perinatal deaths or smoking and no current obstetric complications (n = 63 620) were included. Fractional polynomial regression models were used to smooth curves for each gestational age. Results: Mean and median birth weight differences between those born at low and high altitudes reached statistical significance after 35 and 33 weeks, respectively. Values of the 10th percentile were higher at low altitude from 36 weeks, whereas values at the 90th percentile were different from 34 weeks. In the Peruvian growth curves, birth weight was greater at each gestational age than in the curves derived by Lubchenco. Conclusion: Altitude affects growth patterns; these growth standards will provide useful references for the care of the newborn in highland populations. In addition, the data have implications for the antepartum management of pregnant patients undergoing sonographic evaluation of fetal weight in whom new definitions of what represents small or large for gestational age in utero can result in differences in time or mode of delivery. [source] | ||||||||||||||||||||||||||||