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Next Pregnancy (next + pregnancy)
Selected AbstractsTranslocation of a cerclage band into the endocervical canal after preconception transabdominal cervico-isthmic cerclageJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2010Moon-Il Park Abstract A 34-year-old woman, who had a history of five spontaneous losses and failures of two McDonald purse-string cerclages, underwent a transabdominal cervico-isthmic cerclage (TCC). She became pregnant 17 months after TCC. At 35 weeks of gestation, she was admitted to our hospital due to preterm labor and delivered a healthy female baby (2270 g) by cesarean section. After delivery of the newborn infant, we found a migration of about one third of the cerclage band into the endocervical canal. Two years later, she had one further pregnancy, reached 33 weeks of gestation, and delivered a 1450 g male baby by cesarean section due to a preterm labor without any signs of infection. Although it could have been a case of pure coincidence, we take a chance to speculate that the migration of the cerclage band into the endocervical canal might have been the reason for the preterm labor, and it must have been removed at her first cesarean section and replaced by a new cerclage band for her next pregnancy. [source] Women's expectations of management in their next pregnancy after an unexplained stillbirth: An Internet-based empirical studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Stephen J. ROBSON Background:, Unexplained stillbirth is the largest contributor to perinatal death, accounting for one-third of stillbirths. There appears to be no increase in perinatal death rates in the pregnancies that follow an unexplained stillbirth. However, these pregnancies have increased rates of induced labour and elective caesarean section, as well as preterm birth, low birthweight, instrumental delivery, ,fetal distress' and postpartum haemorrhage. Aim:, To study the wishes for future pregnancy management in women who have suffered an unexplained stillbirth. Methods: An Internet-based survey of women after an unexplained stillbirth, seeking demographic information and reproductive history, details of management of the index stillbirth and information about their wishes for subsequent pregnancy management (antenatal surveillance, early delivery and caesarean delivery). Results:, Of the total respondents included in the study, 93% wanted ,testing' over and above normal pregnancy care in their next pregnancy. Of the respondents, 81% wanted early delivery and 26% wanted a Caesarean delivery, irrespective of obstetric indications. These wishes were not influenced by socio-demographic factors, management of the index stillbirth (with the exception of having had a Caesarean delivery) or advice received on management of the next pregnancy (with the exception of being advised to have an early or Caesarean delivery). Conclusions:, The women surveyed wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. [source] Influence of previous pregnancy outcomes and continued smoking on subsequent pregnancy outcomes: an exploratory study in AustraliaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2008M Mohsin Objective, To examine the influence of continued smoking and previous pregnancy outcomes on subsequent pregnancy outcomes. Design, Retrospective descriptive epidemiological study. Setting, New South Wales, Australia, 1994,2004. Population, Mothers who delivered two consecutive singleton births. Methods, Bivariate and multiple logistic regression analyses were used to explore the influence of continued smoking on subsequent pregnancy outcomes. Main outcome measures, Subsequent preterm birth (PTB), low birthweight (LBW) and perinatal deaths. Results, The findings showed that in addition to maternal and neonatal characteristics, birth outcomes in subsequent pregnancies were affected by poor birth outcomes in previous pregnancy. Previous PTB, short birth interval, antenatal care, gestational diabetes and smoking habits in two successive pregnancies had relatively strong association with a subsequent PTB and LBW. Mothers who continued to smoke in subsequent pregnancies were more likely to have adverse pregnancy outcomes compared with others. A change from smoking in first pregnancy to not smoking in next pregnancy had reduced the chance of a subsequent PTB and LBW. The risk of a subsequent preterm and LBW delivery increased with the amount of smoking during the second pregnancy. For mothers who remain as moderate smokers in subsequent pregnancies, the odds ratios for a PTB and LBW delivery were significantly lower than those who remain as heavy smokers. Conclusions, Effective interventions to help women to stop smoking during pregnancy could reduce the risk of adverse obstetric and pregnancy outcomes. Strategies to reduce the prevalence of smoking during pregnancy may include intense intervention for women who have had smoking-related adverse outcomes in a previous pregnancy. [source] Can we predict recurrence of pre-eclampsia or gestational hypertension?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2007MA Brown Objective, To estimate the rates of recurrence of pre-eclampsia or gestational hypertension in a subsequent pregnancy and to determine factors predictive of recurrence. Design, Retrospective cohort study. Setting, St George Public and Private Hospitals, teaching hospitals without neonatal intensive care units. Participants, A total of 1515 women with a diagnosis of pre-eclampsia or gestational hypertension between 1988 and 1998 were identified from the St George Hypertension in Pregnancy database, a system designed initially for ensuring quality outcomes of hypertensive pregnancies. Of these, 1354 women were followed up, and a further 333 records from women coded as having a normal pregnancy during that period were selected randomly as controls. Main outcome measures, Likelihood of recurrent pre-eclampsia or gestational hypertension and clinical and routine laboratory factors in the index pregnancy predictive of recurrence of pre-eclampsia or gestational hypertension. Methods, The index cases from our unit's database were linked to the matched pregnancy on the State Department of Health database, allowing us to determine whether further pregnancies had occurred at any hospital in the State. The outcome of these pregnancies was determined by review of medical records, using strict criteria for diagnosis of pre-eclampsia or gestational hypertension. Results, Almost all women with a normal index pregnancy had a further normotensive pregnancy. One in 50 women hypertensive in their index pregnancy had developed essential hypertension by the time of their next pregnancy. Women with pre-eclampsia in their index pregnancy were equally likely to develop either pre-eclampsia or gestational hypertension (approximately 14% each), while women with gestational hypertension were more likely to develop gestational hypertension (26%) rather than pre-eclampsia (6%) in their next pregnancy. Multiparous women with gestational hypertension were more likely than primiparous women to develop pre-eclampsia (11 versus 4%) or gestational hypertension (45 versus 22%) in their next pregnancy. Early gestation at diagnosis in the index pregnancy, multiparity, uric acid levels in the index pregnancy and booking blood pressure parameters in the next pregnancy significantly influenced the likelihood of recurrence, predominantly for gestational hypertension and less so for pre-eclampsia. No value for these parameters was significant enough to be clinically useful as a discriminate value predictive of recurrent pre-eclampsia or gestational hypertension. Conclusions, Approximately 70% of women with pre-eclampsia or gestational hypertension will have a normotensive next pregnancy. The highest risk group for recurrent hypertension in pregnancy in this study was multiparous women with gestational hypertension. No readily available clinical or laboratory factor in the index pregnancy reliably predicts recurrence of pre-eclampsia. [source] Low plasma volume following pregnancy complicated by pre-eclampsia predisposes for hypertensive disease in a next pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2003Robert Aardenburg Objective A large number of women with a history of pre-eclampsia/HELLP have a low plasma volume at least six months postpartum. The objective of this study was to determine whether a low plasma volume in formerly pre-eclamptic women and HELLP patients is associated with an increased risk for recurrent hypertensive complications in a next pregnancy. Design Prospective observational study. Setting Tertiary obstetric centre. Sample Formerly pre-eclamptic women and controls. Methods In 316 women with a history of pre-eclampsia and/or HELLP, we measured, plasma volume along with haemodynamic, metabolic and haemostatic variables at least six months postpartum. A group of 22 healthy parous controls was used as a reference. After standardising plasma volume for body mass index, women were subdivided into normotensive and normal plasma volume (n = 199), normotensive and low plasma volume (n = 76) and hypertensive (n = 41) subgroups, which were compared for demography, clinical parameters and course of a next pregnancy. Main outcome measures Recurrent hypertensive disease of pregnancy. Results Relative to the normal plasma volume subgroup, normotensive women in the low plasma volume subgroup have a higher body mass index, a lower total vascular compliance and a shorter estimated systemic circulation time. They have a higher HOMA index and higher fasting triglyceride levels. In normotensive and hypertensive former patients alike, low plasma volume is associated with a higher recurrence of hypertensive complications in a next pregnancy compared with normotensive women with normal plasma volume. Conclusion Low plasma volume in normotensive women with a history of pre-eclampsia and/or HELLP is associated with overweight, reduced vascular compliance and insulin resistance and a predisposition for recurrent pre-eclampsia and HELLP syndrome in a next pregnancy. [source] | ||||||||||