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Singleton Deliveries (singleton + delivery)
Selected AbstractsThe reproductive health of daughters of pregestational diabetic women: Medical Birth Registry of NorwayPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2002Grace M. Egeland Summary Maternal diabetes may have an impact upon a daughter's reproductive health through genetic influences, an altered fetal metabolic environment or both. We examined the reproductive health of daughters of diabetic women using linked generation data from the Medical Birth Registry of Norway. Among all female births between 1967 and 1982 (n = 459 182), 739 had a mother with registered pregestational diabetes, a rate of 1.6 per 1000 deliveries. A total of 142 904 daughters delivered at least one child by 1998. After taking into account differences in survival, we observed no differences in the percentage of childbearing and in the average number of children born by 1998 between daughters with and without a diabetic mother in age-stratified analyses. In analyses limited to singleton deliveries and stratified by mothers' and daughters' diabetic status, we found a threefold excess stillbirth delivery rate among women who had either a mother with pregestational diabetes (2.6%) or pregestational diabetes themselves (2.6%) compared with the stillbirth delivery rate observed in non-diabetic women with no maternal history of diabetes (0.8%). These findings were unaltered in multivariable analyses adjusting for daughters' maternal age and registered obstetric risk factors. Our results indicate that pregestational diabetes remains a health care challenge in Norway and that further evaluation of the reproductive health of daughters of diabetic pregnancies is warranted. [source] Clinical, sonographic, and epidemiologic features of second- and early third-trimester spontaneous antepartum uterine rupture: a cohort studyPRENATAL DIAGNOSIS, Issue 6 2008Zvi Vaknin Abstract Objective To present prenatal findings and maternal and neonatal outcomes following second- and early third-trimester spontaneous antepartum uterine rupture events in our institute. Method Charts of patients with full-thickness second- or early third-trimester symptomatic uterine ruptures locally treated between 1984 and 2007 were evaluated. Results There were seven events involving six women, all requiring emergency laparotomy, and cesarean section (CS). During the study period in our institute, there were 120 636 singleton deliveries (,22 weeks' gestation), including 5 of our cases, while in 2 cases, the rupture occurred earlier (<22 weeks' gestation). The rupture occurred after , 1 previous CSs in five cases. Six events were associated with abnormal placentation: placenta previa (n = 3), placenta percreta (n = 1), or both (n = 2). Other associated events included short, interpregnancy (IP) interval (n = 3) and past uterine rupture (n = 2). Pregnant women at gestational age , 22 weeks, who had the combination of placenta previa, and previous CS (n = 3), had a higher chance for spontaneous symptomatic antepartum uterine rupture when compared to women with placenta previa without a previous CS (OR 29.3, 95% CI 1.5,569.3, p = 0.007). There were no maternal deaths. Three of the five viable neonates survived. Conclusions Spontaneous symptomatic second- or early third-trimester uterine rupture in nonlaboring women is a very rare, obstetric emergency, which is hard to diagnose. Maternal and neonatal outcomes can be optimized by awareness of risk factors, recognition of clinical signs and symptoms, and availability of ultrasound to assist in establishing diagnosis, and enabling prompt surgical intervention. Copyright © 2008 John Wiley & Sons, Ltd. [source] Birth outcomes for teenage women in New South Wales, 1998,2003AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2006Stephen ROBSON Abstract Background:, Pregnancy and childbirth in teenage women are associated with obstetric and social risks, and there is evidence that the birth rate among teenagers in rural and remote areas of Australia is not in decline. The combination of non-urban residence and young age at delivery might define a subgroup of women at special risk of adverse birth outcomes. Aims:, To compare birth outcomes of New South Wales (NSW) teenagers residing in rural and remote areas with those living in larger centres with greater access to services. Methods:, Outcomes for all singleton deliveries to teenage women living in NSW during the period 1998,2003 were reviewed. The women's place of residence was assigned an ARIA (Accessibility/Remoteness Index of Australia) classification according to remoteness and access to services. Analysis included obstetric factors (such as parity), and smoking status. Logistic regression analysis was undertaken to examine the impact of maternal factors on obstetric outcomes. Results:, During the study period, 21 880 teenage women had singleton deliveries. Babies of teenage mothers in very remote areas had higher rates of preterm birth, small-for-gestational age and stillbirth. Rates of smoking were higher in more remote areas, and smoking correlated with preterm birth and stillbirth. Conclusions:, Teenagers living in remote areas of NSW face a higher risk of adverse pregnancy outcomes than their urban cousins. [source] The recurrence risk of severe de novo pre-eclampsia in singleton pregnancies: a population-based cohortBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2009SD McDonald Objective, Previous studies have found recurrence risks of severe pre-eclampsia as high as 40%. Our objective was to determine both the recurrence risk of severe de novo pre-eclampsia and risk factors associated with it in a contemporaneous population. Study design, Population-based retrospective cohort study. Population, Women who had two or more singleton liveborn or stillborn hospital deliveries in Ontario, Canada between April 1994 and March 2002 and without a history of chronic hypertension Methods, International Classification of Disease codes were used to identify patients in the Canadian Institute for Health Information Discharge Abstract Database. Main outcome measures, The absolute and adjusted risks of recurrent severe de novo pre-eclampsia were determined. Results, Between 1 April 1994 and 30 March 2002, there were 185 098 women with two or more singleton deliveries >20 weeks in the province of Ontario, Canada. There were 1954 women who had severe de novo pre-eclampsia in the index pregnancy, 133 of whom had recurrent severe pre-eclampsia, for a risk of recurrent severe pre-eclampsia of 6.8% (95% CI 5.7,7.9%). The risk of recurrent severe de novo pre-eclampsia was increased in women with pre-existing renal disease (adjusted OR 17.98, 95% CI 3.50,92.52) and those >35 years of age (adjusted OR 3.79, 95% CI 2.04,7.04, reference 20,25 years). Conclusions, The recurrence risk of severe de novo pre-eclampsia in our population-based cohort study (6.8%) is lower than previously published reports in selected populations. [source] Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2003W.C. Leung Objective The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia. Design A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12-month period (13 March 2000 to 12 March 2001). Setting A local teaching hospital. Sample Six hundred and seventy deliveries. Methods A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery. Main outcome measures Birth trauma and birth asphyxia. Results There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period (1998 and 1999) (RR 0.27, 95% CI 0.11,0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88,1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82,0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period. Conclusions Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period. [source] High incidence of obstetric interventions after successful external cephalic versionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002Louis Yik-Si Chan Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [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] Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the motherBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2010JA Lykke Please cite this paper as: Lykke J, Paidas M, Damm P, Triche E, Kuczynski E, Langhoff-Roos J. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG 2010;117:274,281. Objective, Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated. Design, National registry-based retrospective cohort study. Setting, Women delivering in Denmark from 1978 to 2007. Population, Women with a first singleton delivery (n = 782 287), and with a first and second singleton delivery (n = 536 419). Methods, Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth. Main outcome measures, Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes. Results, After a first delivery at 32,36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69,2.10) and the risk of thromboembolism increased 1.42-fold (1.24,1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34,1.86) increased risk of type-II diabetes and a 1.18-fold (0.96,1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71,3.10) increased risk of type-II diabetes and a 1.80-fold (1.29,2.50) increased risk of thromboembolism. Conclusions, Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks. [source] | ||||||||||