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Obstetric History (obstetric + history)
Kinds of Obstetric History Selected AbstractsAntinuclear Autoantibodies, Complement Level, Hypergammaglobulinemia and Spontaneous Intrauterine Hematoma in Pregnant WomenAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 1 2003Jaume Alijotas Problem: To examine the associative relationship among autoantibodies, C4 levels and intrauterine hematomas (IUH) in more detail than in the studies published earlier. Method Of Study: We performed a retrospective study of 54 women with poor obstetric outcomes. Sera were screened for antinuclear antibodies (ANA), anti-DNA antibodies, antiphospholipid antibodies (aPL), and antithyroid antibodies. C4-complement and gammaglobulin levels were also monitored. We compared the main variables in IUH complicated pregnancy group with the risk pregnancy group without IUH. We also compared these variables in the IUH cases before and during IUH. Results: Eight IUH were detected. The average number of spontaneous losses for these eight women was 3.3 ± 2.1 (range: 1,8). aPL was present in 100% of cases. ANAs and hypergammaglobulinemia were present in 50% of cases and low C4 in 87.5% of cases. After comparing these variables apart from C4 before and during IUH, we found no statistical differences. However, C4 was low in four patients before IUH and in seven patients during IUH (OR: 7.0; 95% CI: 0.57,86.33). When we compared autoantibodies apart from lupus anticoagulant (LAC) between the two groups, no differences were observed. However, seven of the eight (87.5%) patients with IUH were LAC positive whereas only 24 of the 46 patients (52.1%) were positive in the non-IUH group (OR: 6.42; 95% CI: 0.73,56.41). Rapid plasma reagin was present in 8/46 in the non-IUH group (16.7%) and 5/8 in the IUH group (62.5%) P < 0.015). Conclusions: In women with poor obstetric histories, autoantibodies, especially antiphospholid antibodies, may play a role in the IUH development especially if low C4 and/or hypergammaglobulinemia are present. [source] A review of termination of pregnancy: prevalent health care professional attitudes and ways of influencing themJOURNAL OF CLINICAL NURSING, Issue 13 2008Allyson Lipp MA, Dip N Aim., To review the literature on attitudes of health care professionals to termination of pregnancy and draw out underlying themes. Background., The controversy surrounding therapeutic abortion is unremitting with public opinion often polemic and unyielding. Nurses and midwives are at the centre of this turmoil, and as more termination of pregnancies are being performed using pharmacological agents, they are becoming ever more involved in direct care and treatment. Attitudes towards termination of pregnancy have been found to vary depending on the nationality of those asked, the professionals involved, experience in abortion care, as well as personal attributes of those asked such as their obstetric history and religious beliefs. The reasons for women undergoing abortion were also found to influence attitudes to a greater or lesser extent. Conclusion., This paper explores research studies undertaken into attitudes of health care professionals towards termination of pregnancy, to appreciate the complexity of the debate. It is possible that the increased involvement of nurses in termination of pregnancy, that current methods demand, may lead to change in attitudes. Consideration is given to a number of remedies to create an optimum environment for women undergoing termination of pregnancy. Relevance to clinical practice., This paper establishes via a literature review that attitudes in those working in this area of care depend upon a variety of influences. Suggestions are made for measures to be put into place to foster appropriate attitudes in those working in termination of pregnancy services. [source] Urinary Incontinence in Pregnancy and the PuerperiumJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2001Charlotte E. Spellacy MS Objective: To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors. Design: A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics. Setting: A secluded area of a university teaching hospital prenatal clinic. Participants: A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States. Results: First Interview (N= 50). More than half (62%; n= 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n= 2). Among the participants who experienced UI (n= 31), 76% (n= 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n= 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n= 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n= 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n= 4). Among the participants reporting episiotomy (n= 4), 3 (75%) reported having UI 4 to 6 weeks postpartum. Conclusions: Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors. [source] The relationship between periodontal disease and preterm low birthweight: clinical and microbiological resultsJOURNAL OF PERIODONTAL RESEARCH, Issue 6 2008M. V. Vettore Background and Objective:, Findings on the effect of periodontal disease on preterm low birthweight are inconclusive. The objective of this study was to compare periodontal clinical measures and the levels and proportions of 39 bacterial species in subgingival biofilm samples in puerperal women with preterm low birthweight and nonpreterm low birthweight. Material and Methods:, A case-control study with 116 postpartum women over 30 years of age was conducted. Four case groups of subjects with preterm and/or low birthweight [preterm (n = 40), low birthweight (n = 35), preterm and/or low birthweight (n = 50) and preterm and low birthweight (n = 25)] were compared with normal nonpreterm low-birthweight controls (n = 66). Periodontal clinical parameters of dental plaque, calculus, bleeding on probing, periodontal pocket depth and clinical attachment level were recorded. Covariates included socio-demographic and anthropometric characteristics, smoking, alcohol consumption, obstetric history, prenatal care and diseases during pregnancy. Two subgingival biofilm samples per women were analyzed for 39 bacterial species using a checkerboard DNA,DNA hybridization technique. Results:, The mean periodontal pocket depth was significantly higher in nonpreterm low-birthweight controls than in subjects in the preterm low birthweight, preterm and/or low birthweight, and preterm and low-birthweight groups. Clinical attachment level measures were not different between all pairs of cases and control groups. Groups did not differ with respect to the mean proportions of different microbial complexes. The mean counts of Treponema socranskii were lower in all case groups compared with the control group. Conclusion:, Maternal periodontal microbiota and clinical characteristics of periodontal disease were not associated with having preterm low-birthweight babies. [source] Impact of a diabetes midwifery educator on the diabetes in pregnancy service at Middlemore HospitalPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2001D. Simmons Professor of Rural Health Abstract We have assessed the effectiveness of a diabetes midwifery educator within a diabetes-in-pregnancy service serving a predominantly Polynesian population. A retrospective audit was undertaken of the charts of all women seen by the diabetes-in-pregnancy service at Middlemore Hospital, South Auckland for 8 months prior to introduction (n=76) and the same 8 months the following year (n=93). The women were well matched for age, ethnicity and past obstetric history. Previously known diabetes was present in 10%. After introduction of the role, insulin therapy (65% versus 50%. p<0.05), and maternal mean laboratory 2 hour post prandial glucose concentration (6.3±1.3 versus 5.7±1.0,mmol/l, p<0.01) were reduced and the proportion starting insulin as outpatients was increased (14% versus 89%, p<0.001). Birthweight and proportion receiving Caesarean delivery were non-significantly lower. Total antenatal length of stay (7.5±6.6 vs 3.0±3.3 per patient, p<0.001) was reduced. The proportion receiving a post natal oral glucose tolerance test remained low but increased after the introduction of the follow up role (10% versus 29%, p<0.01). The introduction of the diabetes midwifery educator was associated with substantial reductions in resource utilisation with an improvement in glycaemic control and postnatal follow up. Copyright © 2001 John Wiley & Sons, Ltd. [source] The presence of trophoblastic cells in intrauterine lavage samples: lack of correlation with maternal and obstetric characteristicsPRENATAL DIAGNOSIS, Issue 11 2008Riccardo Cioni Abstract Objectives To investigate the correlation between maternal, obstetric and sample characteristics and the quality (i.e. yield of trophoblastic cells) of intrauterine lavage (IUL) samples. Methods We collected 202 IUL samples from women scheduled for first trimester termination of pregnancy (TOP). Trophoblastic cells were isolated from IUL samples and used for DNA analysis by a multiplex quantitative fluorescent polymerase chain reaction (QF-PCR) assay. A multivariate logistic regression analysis was performed, and a p < 0.05 was considered statistically significant. Results The presence of trophoblastic cells in IUL samples was documented in 151/202 cases (74.7%). Blood contamination of IULs was the only characteristic to positively correlate with the presence of trophoblasts (p = 0.039; OR: 1.99; 95% CI: 1.03,3.82). Conclusions The correlation between the presence of contaminating blood and trophoblastic cells would indirectly confirm the hypothesis that IUL might act as a mini-CVS. The high yield rate of trophoblasts irrespective of maternal characteristics and past obstetric history would support the clinical use of this sampling technique, provided that its safety is clearly defined. Copyright © 2008 John Wiley & Sons, Ltd. [source] The impact of first-trimester screening on AMA patients' uptake of invasive testingPRENATAL DIAGNOSIS, Issue 5 2005Andrea M. Wray Abstract Objective Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002. Methods We compared AMA patients presenting for prenatal care who underwent early genetic counseling (<13 weeks' gestation) from 2001 to those from 2003. Charts were reviewed for maternal age, gestational age, past obstetric history, prior CVS or amniocentesis, abnormal ultrasound findings and decision to proceed with invasive testing. The two groups were compared using Student t -test and chi-square tests. Results In 2001, 552 AMA women enrolled in prenatal care; 68 presented for early genetic counseling. In 2003, 728 AMA women enrolled in prenatal care; 172 presented for early genetic counseling. More counseled women chose genetic testing in 2003 than in 2001 (95% vs 79%, p < 0.01). More patients elected an invasive procedure in 2001 compared to 2003 (71% vs 26%, p < 0.01). Conclusion Availability of FTS results in more AMA women having early prenatal genetic counseling and choosing some form of genetic testing. Such women are less likely to choose invasive tests than those without access to FTS. Copyright © 2005 John Wiley & Sons, Ltd. [source] A new way of looking at Caesarean section birthsAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2007Fergus P. McCARTHY Abstract Aims:, To implement the Robson Ten Group Classification System (TGCS) at the Royal Women's Hospital (RWH), Melbourne, in order to determine the main contributors to the rising Caesarean section (CS) rate. Methods:, The TGCS divides women into ten groups according to parity, past obstetric history, singleton or multiple pregnancy, fetal presentation, gestational age and mode of onset of labour/delivery. The TGCS was applied retrospectively to the population of women who had a registered birth at the RWH between January 2005 and 31 December 2005. Results:, A total of 5833 women gave birth to 6011 babies during the study period. A total of 1651 women (28.3%) had a CS birth. The total CS rates ranged from 3.7% (group 3) to 100% (group 9). Women in groups 1 and 2 were the greatest contributors to the emergency CS rate, 4.2% and 4.9%, respectively. Women in group 5 were the single greatest contributor to both the elective CS rate and the total CS rate. Conclusions:, The TGCS was successfully implemented at the RWH in 2005. The TGCS is ongoing, enabling monitoring of CS rates. The Robson TGCS demonstrates the need to focus on the care of women in groups 1, 2 and 5 in particular, if CS rates are to be reduced. [source] Who remains undelivered more than seven days after a single course of prenatal corticosteroids and gives birth at less than 34 weeks?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2002KJ McLaughlin ABSTRACT Minimal information exists as to how women who give birth more than seven days after initial corticosteroid treatment, who may benefit from repeat prenatal corticosteroids, differ from women who give birth within seven days, at < 34 weeks gestation. OBJECTIVES To examine the differences, if any, between women who received a single course of prenatal corticosteroids and remained undelivered more than seven days later and women who gave birth within seven days of treatment, at < 34 weeks gestation. DESIGN Retrospective cohort. Setting Women's and Children's Hospital, Adelaide. Population Women who gave birth at < 34 weeks gestation from 1 January 1994 to 31 December 1996. Methods Data were extracted from medical records and retrieved from the hospital's database. Main potential predictors collected Prenatal corticosteroid exposure, reason for risk of preterm birth, maternal demographics and previous and current obstetric history. Results Of the 506 women, 122 (24%) remained undelivered more than seven days following prenatal corticosteroid therapy. Initial corticosteroid treatment was given on average 1.6 weeks earlier to women who remained undelivered more than seven days after treatment. Women who were given prenatal corticosteroids for placenta praevia (RR 6.03, 95% CI 2.67-13.61, p < 0.01) or cervical incompetence (RR 3.40, 95% CI 1.06-10.95, p = 0.04) were more likely to give birth more than seven days after corticosteroid treatment. Conclusions Women who give birth very preterm, who remain undelivered more than seven days after prenatal corticosteroids, differ in the reasons for and timing of their first course from women who give birth within seven days. [source] Fear of childbirth according to parity, gestational age, and obstetric historyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2009H Rouhe Objective, To examine fear of childbirth according to parity, gestational age, and obstetric history. Design, A questionnaire study. Population and setting, 1400 unselected pregnant women in outpatient maternity clinics of a university central hospital. Methods, Visual analogue scale (VAS) and Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and preferred mode of delivery. Main outcome measures, W-DEQ and VAS scores according to parity, gestational age, obstetric history, and preferred mode of delivery. Results, The W-DEQ and VAS scores were higher in nulliparous (W-DEQ 72.0 ± 20.0 [mean ± SD] and VAS 4.7 [median]) than parous women (65.4 ± 21.9; 3.2, P < 0.001 for both W-DEQ and VAS). Higher W-DEQ and VAS scores were found for those beyond 21 weeks of gestation compared with those before (W-DEQ 71.6 ± 23.0 versus 66.6 ± 20.0, P < 0.001; VAS 4.7 versus 3.2, P < 0.001). Caesarean section was preferred mode of delivery for 8.1% and these women scored higher on fear (W-DEQ 87.6 ± 26.5, VAS median 7.0) than those who preferred vaginal delivery (W-DEQ 61.8 ± 18.7, VAS 2.7, P < 0.001, respectively). Those with a previous caesarean scored higher on fear (W-DEQ 73.2 ± 23.5, VAS 5.1) than parous women without previous caesarean (W-DEQ 63.3 ± 20.8, VAS 2.9, P < 0.001, respectively). Those with a history of a vacuum extraction (VE) (W-DEQ 70.6 ± 19.7, VAS 5.0) had higher fear scores than those without (W-DEQ 64.8 ± 22.0, P < 0.05 and VAS 3.0, P < 0.001). Conclusion, Severe fear of childbirth was more common in nulliparous women, in later pregnancy, and in women with previous caesarean section or VE. Caesarean section as a preferred mode of childbirth was strongly associated with high score in both W-DEQ and VAS. [source] Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005Caroline Moreau Objectives To evaluate the risk of very preterm birth (22,32 weeks of gestation) associated with previous induced abortion according to the complications leading to very preterm delivery in singletons. Design Multicentre, case-control study (the French EPIPAGE study). Setting Regionally defined population of births in France. Sample The sample consisted of 1943 very preterm live-born singletons (<33 weeks of gestation), 276 moderate preterm live-born singletons (33,34 weeks) and 618 unmatched full-term controls (39,40 weeks). Methods Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, premature rupture of membranes, idiopathic preterm labor and other causes. Main outcome measures Odds ratios for very preterm birth by gestational age and by pregnancy complications leading to preterm delivery associated with a history of induced abortion. Results Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1,2.0); the risk was even higher for extremely preterm deliveries (<28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (<28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension. Conclusion Previous induced abortion was associated with an increased risk of very preterm delivery. The strength of the association increased with decreasing gestational age. [source] Pregnancy outcome in women with heart disease undergoing induction of labourBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2004Galia Oron Objective To examine the safety and outcome of induction of labour in women with heart disease. Design Prospective single-centre comparative study. Setting Major university-based medical centre. Population/Sample One hundred and twenty-one pregnant women with heart disease. Methods The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. Main outcome measures Pregnancy outcome. Results Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. Conclusion Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour. [source] The complex relationship between smoking in pregnancy and very preterm deliveryBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2004Results of the Epipage study Objective To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth. Design Case,control study (the French Epipage study). Setting Regionally defined population of births in France. Population Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls. Methods Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms. Main outcome measures Odds ratios for very preterm birth for low to moderate (1,9 cigarettes/day) and heavy (,10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth. Results Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3,2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3,1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8). Conclusion These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women. [source] The risk of preterm delivery in women from different ethnic groupsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2002Paul Aveyard Objective To examine whether routinely measured variables explained the increased risk of preterm delivery in some UK ethnic groups. Design Cross sectional study of deliveries recorded in the Child Health Record System. Setting North Birmingham, UK. Population All North Birmingham women delivering singletons, 1994,1997 inclusive. Method Logistic regression. Main outcome measures Odds ratio (OR) and 95% confidence interval (CI) for preterm delivery, defined as less than 37 weeks, less than 34 weeks and less than 28 weeks, unadjusted and adjusted for maternal age, an area-based socio-economic status measure, and marital status, year of birth, fetal sex and past obstetric history. Results For Afro-Caribbean women, the ORs (95% CIs) were: for delivery less than 37 weeks, 1.44 (1.26,1.64) unadjusted and 1.22 (1.07,1.41) adjusted; for delivery less than 34 weeks, 1.55 (1.25,1.92) unadjusted and 1.29 (1.02,1.61) adjusted; for delivery less than 28 weeks, 1.66 (1.08,2.55) unadjusted and 1.32 (0.84,2.06) adjusted. For African women, the risk of delivery less than 37 weeks was not significantly raised; for delivery less than 34 weeks, the OR (95% CI) was 1.88 (0.99,3.58) unadjusted and 1.78 (0.93,3.40) adjusted; for delivery less than 28 weeks, the OR (95% CI) was 4.02 (1.60,10.12) unadjusted and 4.10 (1.66,10.16) adjusted. In Afro-Caribbeans, deprivation and marital status explained the differences between the unadjusted and adjusted ORs. There was a linear relation between deprivation and preterm delivery for all ethnic groups, except for Asians. Conclusions Factors associated with deprivation and marital status explain about half of the excess of preterm births in Afro-Caribbeans, but not Africans. The risk of preterm delivery might not be related to deprivation in Asians. [source] | ||||||||||