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Uncomplicated Pregnancies (uncomplicated + pregnancy)
Selected AbstractsORIGINAL ARTICLE: Maternal Blood Serum and Plasma Human Tumor-Associated Antigen RCAS1 During the Course of Uncomplicated Pregnancies: A Prospective StudyAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2010Ekaterine Tskitishvili Citation Tskitishvili E, Sharentuya N, Tsubouchi H, Kinugasa-Taniguchi Y, Kanagawa T, Shimoya K, Tomimatsu T, Kimura T. Maternal blood serum and plasma human tumor-associated antigen RCAS1 during the course of uncomplicated pregnancies: a prospective study. Am J Reprod Immunol 2010; 64: 218,224 Problem, We aimed to investigate the expression of the tumor-associated RCAS1 protein in maternal blood of uncomplicated pregnancies. Method of study, Maternal blood was obtained from women with uncomplicated pregnancies (N = 43) at 11,13, 20,22, 32,34, 37,38 weeks of gestation, and immediately after delivery. Serum RCAS1 concentration was studied by ELISA, and plasma mRNA was subjected to real-time (RT)-PCR. Results, Serum RCAS1 protein concentration was significantly up-regulated at 11,13 and 20,22 weeks than that at 32,34 weeks and after delivery. RCAS1 mRNA level was significantly increased at 11,13 weeks than that at 37,38 weeks. A significant positive correlation was defined between RCAS1 serum concentration at 11,13 weeks and gestational age at delivery and that between plasma RCAS1 mRNA levels at 37,38 weeks and umbilical cord blood base excess. A significant negative correlation was found between RCAS1 serum concentration at 37,38 weeks and umbilical cord blood pH at delivery. Conclusions, RCAS1 protein might have importance in the development of uncomplicated pregnancies and for the prediction of pregnancy outcome. [source] Levels of soluble HLA-G in amniotic fluid are related to the sex of the offspringINTERNATIONAL JOURNAL OF IMMUNOGENETICS, Issue 2 2003P. M. Emmer Summary Although HLA-G is thought to play a modulatory role in the immune system, its function and expression require to be elucidated. We analysed soluble HLA-G levels in mid-trimester amniotic fluid (n = 64) from uncomplicated pregnancies. We found a decrease in soluble HLA-G levels for female offspring as compared to male offspring (P < 0.007). This may be a consequence of the immuno-modulatory capacity of HLA-G. [source] Women with a recent history of early-onset pre-eclampsia have a worse periodontal conditionJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2007Alina Kunnen Abstract Objective: Pre-eclampsia is a complication of pregnancy characterized by systemic vascular dysfunction and pathological changes in placental arteries. Growing evidence of chronic infection as an aetiological factor in vascular diseases prompted us to study maternal periodontal disease in subjects with early-onset pre-eclampsia (<34 weeks). Methods: A case,control study was carried out on 17 early-onset pre-eclamptic women and 35 controls with uncomplicated pregnancies in a period of 3,28 months postpartum. All were Caucasians. Full-mouth periodontal examinations were performed to determine the periodontal condition. Subgingival-plaque samples were analysed by anaerobic culture techniques for the presence of seven bacterial periodontal pathogens. Potential confounders as age, smoking, educational level and body mass index were determined. Results: Severe periodontal disease was found in 82% of the pre-eclamptic and in 37% of the control group (p=0.009). After adjusting for age, smoking and educational level, the odds ratio was 7.9 (95% CI: 1.9,32.8). The periodontopathic microorganism Micromonas micros was more prevalent in the case group (p=0.040) while Campylobacter rectus was more prevalent in the control group (p=0.047). Conclusion: These results indicate that Caucasian women with a recent history of early-onset pre-eclampsia have a worse periodontal condition, as compared with women with uncomplicated deliveries. [source] Sonographic measurement of the fetal cerebellum, cisterna magna, and cavum septum pellucidum in normal fetuses in the second and third trimesters of pregnancyJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2003Selami Serhatlioglu MD Abstract Purpose Absence of the cavum septum pellucidum (CSP), the cisterna magna (CM), or both, and enlargement of either or both structures are associated with various central nervous system malformations. In an effort to determine normal sizes and relationships between these cranial structures, we measured the CSP and CM in normal fetuses in the second and third trimesters of pregnancy using transabdominal sonography. Methods Women with uncomplicated pregnancies and normal singleton fetuses between 16 and 38 weeks' menstrual age were included in this prospective study. The width and anteroposterior (AP) diameters of the CSP were measured on the transverse transventricular plane, and the AP diameter of the CM was measured on the transcerebellar plane from the posterior aspect of the cerebellar vermis to the inner edge of the cranium. The transverse and AP diameters of the cerebellum were also measured. In addition, we measured the biparietal diameters (BPDs). Results In total, 130 women participated; 64 were examined in their second trimester and 66 in their third trimester. The mean age of the women was 27.4 ± 4.8 years (range, 18,38 years), and the mean menstrual age of the fetuses was 26.9 ± 6.7 weeks (range, 16,38 weeks). The mean BPD was 66.8 ± 18.7 mm (range, 30,96 mm). The mean width and AP diameter of the CSP and the mean AP diameter of the CM differed significantly between the second and third trimesters (p < 0.001). All measured parameters correlated significantly with menstrual age and BPD. Conclusions In normal fetuses, the CSP and CM should be visible on transabdominal sonography between 16 and 38 weeks' menstrual age. Because abnormalities in these cranial structures may be indicative of central nervous system malformations, the availability of mean sonographic measurements from normal fetuses should be helpful in determining the need for additional testing in fetuses with abnormal measurements. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:194,200, 2003 [source] Directed Attention in Normal and High-Risk PregnancyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2006Mary Ann Stark Objective:, To compare the ability to direct attention in women having a high-risk pregnancy with those having an uncomplicated pregnancy. Design:, Descriptive comparative. Setting:, A tertiary-care hospital. Participants:, Women in the 3rd trimester of pregnancy receiving care from perinatologists were recruited for this study and comprised the high-risk group (n= 67). Women in their 3rd trimester of pregnancy with uncomplicated pregnancies and enrolled in prenatal classes were the comparison group (n= 57). Main outcome measures:, Objective measures of directed attention included digit span forward, digit span backward, Trailmaking A, and Trailmaking B. Subjective measures included the Attentional Function Index and Mental Effort in Tasks. Results:, Women having a complicated pregnancy had significantly more difficulty directing attention on all measures than women having normal pregnancies. When all covariates were considered, women having a high-risk pregnancy had significantly more difficulty directing attention as measured by Trailmaking A, Trailmaking B, and Mental Effort in Tasks. Conclusions:, Women having high-risk pregnancies may have more difficulty with activities that require directed attention than women having normal pregnancies. Learning new information and skills, problem solving, and planning may require additional effort for women having complicated pregnancies. JOGNN, 35, 241-249; 2006. DOI: 10.1111/J.1552-6909.2006.00035.x [source] Impact of Alcohol Exposure After Pregnancy Recognition on Ultrasonographic Fetal Growth MeasuresALCOHOLISM, Issue 5 2006Nancy S. Handmaker Background: More than 3 decades after Jones and Smith (1973) reported on the devastation caused by alcohol exposure on fetal development, the rates of heavy drinking during pregnancy remain relatively unchanged. Early identification of fetal alcohol exposure and maternal abstinence led to better infant outcomes. This study examined the utility of biometry for detecting alcohol-related fetal growth impairment. Methods: We obtained fetal ultrasound measures from routine ultrasound examinations for 167 pregnant hazardous drinkers who were enrolled in a brief alcohol intervention study. The fetal measures for women who quit after learning of their pregnancies were compared with measures for women who continued some drinking throughout the course of their pregnancies. Because intensity of alcohol consumption is associated with poorer fetal outcomes, separate analyses were conducted for the heavy (average of ,5 drinks per drinking day) alcohol consumers. Fetal measures from the heavy-exposed fetuses were also compared with measures from a nondrinking group that was representative of normal, uncomplicated pregnancies from our clinics. Analyses of covariance were used to determine whether there were differences between groups after controlling for influences of gestational age and drug abuse. Results: Nearly half of the pregnant drinkers abstained after learning of their pregnancies. When women reportedly quit drinking early in their pregnancies, fetal growth measures were not significantly different from a non,alcohol-exposed group, regardless of prior drinking patterns. Any alcohol consumption postpregnancy recognition among the heavy drinkers resulted in reduced cerebellar growth as well as decreased cranial to body growth in comparison with women who either quit drinking or who were nondrinkers. Amphetamine abuse was predictive of larger cranial to body growth ratios. Conclusions: Alterations in fetal biometric measurements were observed among the heavy drinkers only when they continued drinking after becoming aware of their pregnancies. Although the reliance on self-reported drinking is a limitation in this study, these findings support the benefits of early abstinence and the potential for ultrasound examinations in the detection of fetal alcohol effects. [source] D-dimer levels during delivery and the postpartumJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2005M. EPINEY Summary.,Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. Objectives: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. Patients and methods: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n = 100) or by cesarean section (n = 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. Results: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL,1 at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL,1. Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. Conclusion: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL,1, DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery. [source] Prevalence of factor V G1691A (factor V-Leiden) and prothrombin G20210A gene mutations in a recurrent miscarriage populationAMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2002Ramzi R. Finan Abstract Factor V G1691A (FV-Leiden) and prothrombin G20210A mutations are major inherited risk factors for venous thrombosis. Recently, it was suggested that both mutations, through stimulation of venous and placental thrombosis events, were strongly associated with recurrent idiopathic miscarriages, although other studies disputed such a link. The aim of this study was to determine the prevalence of prothrombin G20210A and factor V G1691A (R506Q, FV-Leiden) mutations in women with recurrent idiopathic abortions and to recommend management for high-risk mutation carriers. One hundred ten women with two or more consecutive unexplained first-trimester miscarriages (mean age ± SD, 32.3 ± 5.3) were compared to 67 parous women with uncomplicated pregnancies (mean age ± SD, 33.9 ±7.3) (P = 0.134) from the same ethnic background. The presence or absence of the prothrombin G20210A and FV-Leiden mutations was assessed by PCR and RFLP analysis, using HindIII and MnlI digestion, respectively. In women with primary habitual abortion, 45 (40.91%) carried the FV-Leiden mutation, of whom 7 were in the homozygote and 38 were in the heterozygote states, and 15 (13.64%) carried the prothrombin G20210A mutation all as heterozygotes, compared to 16.42% and 2.99% carrier rates among controls, respectively, all of whom were heterozygote carriers. Of the other risk factors analyzed, smoking (OR 1.76; 95% CI = 0.79,3.94) was more prevalent in habitual aborters compared to controls. Both FV-Leiden and factor II G20210A mutations are major inherited risk factor associated with primary recurrent miscarriages. Women with a family or personal history of thrombosis should be screened before or early in the pregnancy for FV-Leiden and factor II G20210A mutations. Am. J. Hematol. 71:300,305, 2002. © 2002 Wiley-Liss, Inc. [source] Growth perturbations in a phenotype with rapid fetal growth preceding preterm labor and term birthAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 6 2009Michelle Lampl The variability in fetal growth rates and gestation duration in humans is not well understood. Of interest are women presenting with an episode of preterm labor and subsequently delivering a term neonate, who is small relative to peers of similar gestational age. To further understand these relationships, fetal growth patterns predating an episode of preterm labor were investigated. Retrospective analysis of fetal biometry assessed by serial ultrasound in a prospectively studied sample of pregnancies in Santiago, Chile, tested the hypothesis that fetal growth patterns among uncomplicated pregnancies (n = 3,706) and those with an episode of preterm labor followed by term delivery (n = 184) were identical across the time intervals 16,22 weeks, 22,28 weeks, and 28,34 weeks in a multilevel mixed-effects regression. The hypothesis was not supported. Fetal weight growth rate was faster from 16 weeks among pregnancies with an episode of preterm labor (P < 0.05), declined across midgestation (22,28 weeks, P < 0.05), and rebounded between 28 and 34 weeks (P = 0.06). This was associated with perturbations in abdominal circumference growth and proportionately larger biparietal diameter from 22 gestational weeks (P = 0.03), greater femur (P = 0.01), biparietal diameter (P = 0.001) and head circumference (P = 0.02) dimensions relative to abdominal circumference across midgestation (22,28 weeks), followed by proportionately smaller femur diaphyseal length (P = 0.02) and biparietal diameter (P = 0.03) subsequently. A distinctive rapid growth phenotype characterized fetal growth preceding an episode of preterm labor among this sample of term-delivered neonates. Perturbations in abdominal circumference growth and patterns of proportionality suggest an altered growth strategy pre-dating the preterm labor episode. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc. [source] Early rapid growth, early birth: Accelerated fetal growth and spontaneous late preterm birthAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 2 2009Michelle Lampl The past two decades in the United States have seen a 24% rise in spontaneous late preterm delivery (34,36 weeks) of unknown etiology. This study tested the hypothesis that fetal growth was identical prior to spontaneous preterm (n = 221, median gestational age at birth 35.6 weeks) and term (n = 3706) birth among pregnancies followed longitudinally in Santiago, Chile. The hypothesis was not supported: Preterm-delivered fetuses were significantly larger than their term-delivered peers by mid-second trimester in estimated fetal weight, head, limb, and abdominal dimensions, and they followed different growth trajectories. Piecewise regression assessed time-specific differences in growth rates at 4-week intervals from 16 weeks. Estimated fetal weight and abdominal circumference growth rates slowed at 20 weeks among the preterm-delivered, only to match and/or exceed their term-delivered peers at 24,28 weeks. After an abrupt growth rate decline at 28 weeks, fetuses delivered preterm did so at greater population-specific sex and age-adjusted birth weight percentiles than their peers from uncomplicated pregnancies (P < 0.01). Growth rates predicted birth timing: one standard score of estimated fetal weight increased the odds ratio for late preterm birth from 2.8 prior to 23 weeks, to 3.6 (95% confidence interval, 1.82,7.11, P < 0.05) between 23 and 27 weeks. After 27 weeks, increasing size was protective (OR: 0.56, 95% confidence interval, 0.38,0.82, P = 0.003). These data document, for the first time, a distinctive fetal growth pattern across gestation preceding spontaneous late preterm birth, identify the importance of mid-gestation for alterations in fetal growth, and add perspective on human fetal biological variability. Am. J. Hum. Biol., 2009. © 2008 Wiley-Liss, Inc. [source] Maternal serum leptin concentration during the second trimester of pregnancy: association with fetal chromosomal abnormalitiesPRENATAL DIAGNOSIS, Issue 3 2002Demetrios Rizos Abstract Recent studies suggest that leptin, the product of the obese gene, is produced by the placenta during pregnancy. The present study addressed the question whether second trimester maternal serum leptin could be altered by fetal Down syndrome or Edwards syndrome. Maternal serum leptin concentrations were measured in 18 pregnancies complicated with Down syndrome, six pregnancies complicated with Edwards syndrome and 183 uncomplicated pregnancies during the second trimester of pregnancy. The present results demonstrate that leptin concentrations in uncomplicated pregnancies slightly decrease from the 16th week of pregnancy, reaching a minimum of 18.8,ng/ml around the 20th week, and then rapidly increase to 28.2,ng/ml by the 24th week. Leptin correlation with maternal body weight decreases from r=0.695 at 16,17 week of gestation to r=0.544 at >22 weeks of gestation. There was no significant difference between the mean MoMs of Down syndrome- (0.926) or Edwards syndrome- (0.960) affected pregnancies and normal pregnancies (1.002). A weak correlation (r=0.18, p<0.02) was observed between corrected leptin MoMs and human chorionic gonadotrophin (hCG) MoMs in normal pregnancies. It is assumed that around the 20th week of pregnancy placental leptin production is activated or at least is accelerated and it is added to the amount of leptin produced by maternal adipose tissue. Fetal Down syndrome or Edwards syndrome does not seem to alter maternal leptin concentration and therefore leptin cannot be used as a marker for these chromosomal abnormalities in the early second trimester of pregnancy. Copyright © 2002 John Wiley & Sons, Ltd. [source] ORIGINAL ARTICLE: Maternal Blood Serum and Plasma Human Tumor-Associated Antigen RCAS1 During the Course of Uncomplicated Pregnancies: A Prospective StudyAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2010Ekaterine Tskitishvili Citation Tskitishvili E, Sharentuya N, Tsubouchi H, Kinugasa-Taniguchi Y, Kanagawa T, Shimoya K, Tomimatsu T, Kimura T. Maternal blood serum and plasma human tumor-associated antigen RCAS1 during the course of uncomplicated pregnancies: a prospective study. Am J Reprod Immunol 2010; 64: 218,224 Problem, We aimed to investigate the expression of the tumor-associated RCAS1 protein in maternal blood of uncomplicated pregnancies. Method of study, Maternal blood was obtained from women with uncomplicated pregnancies (N = 43) at 11,13, 20,22, 32,34, 37,38 weeks of gestation, and immediately after delivery. Serum RCAS1 concentration was studied by ELISA, and plasma mRNA was subjected to real-time (RT)-PCR. Results, Serum RCAS1 protein concentration was significantly up-regulated at 11,13 and 20,22 weeks than that at 32,34 weeks and after delivery. RCAS1 mRNA level was significantly increased at 11,13 weeks than that at 37,38 weeks. A significant positive correlation was defined between RCAS1 serum concentration at 11,13 weeks and gestational age at delivery and that between plasma RCAS1 mRNA levels at 37,38 weeks and umbilical cord blood base excess. A significant negative correlation was found between RCAS1 serum concentration at 37,38 weeks and umbilical cord blood pH at delivery. Conclusions, RCAS1 protein might have importance in the development of uncomplicated pregnancies and for the prediction of pregnancy outcome. [source] ORIGINAL ARTICLE: Soluble Human Leukocyte Antigen-G Isoforms in Maternal Plasma in Early and Late PregnancyAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2009Roberta Rizzo Problem Human Leukocyte Antigen (HLA)-G is a class Ib gene located in the human major histocompatibility complex (MHC). Several lines of investigation indicate that the HLA-G molecule is involved in the maternal acceptance of the semi-allogenic fetus during pregnancy and in the development of tolerance. Expression of soluble HLA-G (sHLA-G) is positively correlated with successful in vitro fertilization (IVF) treatments, and aberrant expression of HLA-G in certain complications of pregnancy, such as pre-eclampsia and spontaneous abortion, has been reported. The main purpose of this study was to investigate the levels of different soluble HLA-G isoforms in maternal plasma in early and late pregnancy. Method of study Soluble HLA-G (sHLA-G) can be detected in maternal blood, and in this study, two different isoforms of sHLA-G, namely sHLA-G1 generated by shedding of membrane-bound HLA-G1 and HLA-G generated by specific HLA-G transcripts, have been investigated early [median of 16.4 weeks of gestation (GW)] and late (median: 38.9 GW) in pregnancy in an original cohort of 580 pregnant Caucasian women. Results Lower concentrations of sHLA-G1 were found late in pregnancy (>32 GW) in a group of women with severe pre-eclampsia compared with controls with uncomplicated pregnancies (P = 0.029, PC = 0.09; Mann,Whitney; Logistic regression analysis: P = 0.024, OR = 0.920, 95% CI: 0.855,0.989). However, this was not the case with HLA-G5, and significantly more of the cases with severe pre-eclampsia had detectable plasma HLA-G5 compared with that of the control group (P = 0.013, PC = 0.04; Mann,Whitney). Similar findings were not observed in women with gestational hypertension or existing hypertension continuing into pregnancy. Furthermore, there was a trend toward lower maternal plasma sHLA-G1 in a group of women with premature birth (<37 GW) compared with that of the control group (P = 0.028, PC = 0.17; Mann,Whitney). On the contrary, HLA-G5 was lower in the control group compared with that in the premature group (P = 0.004, PC = 0.02; Mann,Whitney). Conclusion This study shows in line with other published studies that a high, detectable soluble HLA-G concentration in maternal plasma or serum is not mandatory for a successful pregnancy. However, complications during pregnancy, such as (severe) pre-eclampsia, spontaneous abortion, IUGR, and premature birth, are associated with a low or undetectable level of soluble HLA-G in the maternal blood circulation. Also, this study indicates that sHLA-G1 is the interesting soluble HLA-G isoform in pre-eclampsia, and that low or undetectable levels of HLA-G5 at the end of pregnancy seem to be associated with an uncomplicated normal pregnancy, whereas in severe pre-eclampsia and possibly other pregnancy complications, such as preterm birth and IUGR, the level of HLA-G5 is higher. [source] Is there a correlation between bacterial vaginosis and preterm labour in women in the Otago region of New Zealand?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Kah Heng LIM Context:, While an association between bacterial vaginosis and preterm labour has been established, the relative contribution of this condition remains controversial. Objective:, To determine whether bacterial vaginosis is likely to be an important contributing factor in preterm births in Otago, New Zealand, a region with a historically high rate of such births. Design and setting:, Women receiving antenatal care from Queen Mary Maternity Services were studied prospectively. Cases were women presenting with preterm labour or premature rupture of membranes. Controls had uncomplicated pregnancies and delivered at term. Patients and methods:, Vaginal swabs from 44 cases and 72 controls were examined by amplification of bacterial 16S rRNA genes followed by denaturing gel gradient electrophoresis. Atopobium vaginae, a bacterial vaginosis-associated bacterium, was detected in a separate polymerase chain reaction. Nugent Gram stain scoring of vaginal swabs from 44 cases and 69 controls was also carried out. Results:, Denaturing gel gradient electrophoresis revealed three major types of band profiles corresponding to normal, intermediate and bacterial vaginosis microflorae. There were significantly more cases with bacterial vaginosis band profiles compared with controls (P = 0.024). More cases had intermediate or bacterial vaginosis Nugent scores compared with controls (P = 0.022). Conversely, controls were more likely to have normal scores than cases (P = 0.022). Atopobium vaginae was equally distributed between the cases and controls. Conclusions:, Women in the Otago region undergoing preterm labour were approximately twice as likely to have a bacterial vaginosis type vaginal microflora as controls. In preterm labour, the incidence of bacterial vaginosis was comparable with that found elsewhere, suggesting that current guidelines for treatment and detection of this condition are appropriate. [source] Birth Centers in Australia: A National Population-Based Study of Perinatal Mortality Associated with Giving Birth in a Birth CenterBIRTH, Issue 3 2007Sally K Tracy DMid ABSTRACT: Background: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data. Methods: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. Results: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. Conclusions: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity. (BIRTH 34:3 September 2007) [source] Influence of mode of delivery on neonatal mortality in the second twin, at and before termBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008A Herbst Design, To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting, Sweden, 1980,2004 Population, Twins born during 1980,2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods, Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures, Neonatal mortality. Results, Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19,0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17,0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10,1.79). Conclusions, Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode. [source] Serum CA125 at 11,14 weeks of gestation in women with morphologically normal ovariesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2000Naaila Aslam Research Fellow In a number of pregnant women ovarian cysts are found incidentally during the routine first trimester scan. These cysts may pose diagnostic difficulties, and the measurement of serum CA125 levels can be used to aid management. In this study we measured maternal serum CA125 levels in 188 women with uncomplicated pregnancies between 11,14 weeks of gestation. All women had morphologically normal ovaries observed on ultrasound examination. The median serum CA125 levels were 23.4 U/mL (range 2.2,166.3 U/mL, 95% reference interval 5.28,70.15) and did not change significantly with gestation. We conclude that CA125 levels are increased at 11,14 weeks of gestation and cut off values which are used to assess the nature of ovarian cysts in nonpregnant women cannot be applied to pregnant women at this gestation. [source] Cord plasma concentrations of adiponectin and leptin in healthy term neonates: positive correlation with birthweight and neonatal adiposityCLINICAL ENDOCRINOLOGY, Issue 1 2004Po-Jung Tsai Summary objective, Adiponectin is negatively associated with leptin, insulin and obesity in children and adults. Whereas increases in fetal insulin and leptin are associated with increased weight and adiposity at birth, the role of adiponectin in fetal growth has not yet been determined. The aims of this study were to examine the relationships between adiponectin and insulin, leptin, weight and adiposity at birth in healthy term infants. design and methods, Anthropometric parameters including weight, length, circumferences and skinfold thickness were measured, and plasma lipid profiles, insulin, leptin and adiponectin concentrations in cord blood samples from 226 singleton infants born at term after uncomplicated pregnancies were assayed. results, Cord plasma adiponectin, leptin and insulin levels correlated significantly and positively with birthweight (P = 0·001, P < 0·001, P < 0·001, respectively) and the sum of skinfold thicknesses (P < 0·001, P < 0·001, P < 0·001, respectively). Mean cord plasma adiponectin and leptin levels, but not insulin level, were significantly higher in large-for-gestational-age (LGA) infants compared with appropriate-for-gestational-age (AGA) infants. Cord plasma leptin concentration, but not adiponectin concentration, was significantly higher in female infants than in male infants (P = 0·003 and P = 0·94, respectively). Cord plasma adiponectin concentration correlated positively with leptin level (P = 0·007) but not with insulin level (P = 0·78). conclusions, High adiponectin levels are present in the cord blood. Cord plasma adiponectin and leptin levels are positively correlated with birthweight and adiposity. This suggests that adiponectin may be involved in regulating fetal growth. [source] Safety of rituximab therapy during the first trimester of pregnancy: a case historyEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2004Eva Kimby Abstract: The optimal treatment of non-Hodgkin's lymphoma (NHL) during pregnancy is currently undefined. The potential teratogenic effects of conventional chemotherapy preclude its use during the first trimester of pregnancy. We report the case of a pregnant woman with relapsed indolent follicular NHL who was treated with rituximab (unintentionally) during the first trimester. The treatment stabilised the disease. Following an uncomplicated pregnancy, a healthy child was born at full term and careful haematological and immunological monitoring has revealed no adverse effects resulting from exposure to rituximab. Data of using rituximab during pregnancy are scarce, but the present case shows that rituximab may be one option for treatment of NHL in early pregnancy. [source] Directed Attention in Normal and High-Risk PregnancyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2006Mary Ann Stark Objective:, To compare the ability to direct attention in women having a high-risk pregnancy with those having an uncomplicated pregnancy. Design:, Descriptive comparative. Setting:, A tertiary-care hospital. Participants:, Women in the 3rd trimester of pregnancy receiving care from perinatologists were recruited for this study and comprised the high-risk group (n= 67). Women in their 3rd trimester of pregnancy with uncomplicated pregnancies and enrolled in prenatal classes were the comparison group (n= 57). Main outcome measures:, Objective measures of directed attention included digit span forward, digit span backward, Trailmaking A, and Trailmaking B. Subjective measures included the Attentional Function Index and Mental Effort in Tasks. Results:, Women having a complicated pregnancy had significantly more difficulty directing attention on all measures than women having normal pregnancies. When all covariates were considered, women having a high-risk pregnancy had significantly more difficulty directing attention as measured by Trailmaking A, Trailmaking B, and Mental Effort in Tasks. Conclusions:, Women having high-risk pregnancies may have more difficulty with activities that require directed attention than women having normal pregnancies. Learning new information and skills, problem solving, and planning may require additional effort for women having complicated pregnancies. JOGNN, 35, 241-249; 2006. DOI: 10.1111/J.1552-6909.2006.00035.x [source] Helicobacter pylori infection detected by 14C-Urea breath test is associated with iron deficiency anemia in pregnant womenJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2008s Mulayim Abstract Aims:, To determine whether there is a relationship between Helicobacter pylori (H. pylori) infection, iron deficiency anemia and thrombocytopenia in pregnant women. Methods:, Hemoglobin and ferritin levels and platelet counts of pregnant women were measured during the third trimester. H. pylori infection was determined using a 14C-urea breath test (14C-UBT) after delivery. Statistical analyses were determined with a Mann,Whitney U -test and the ,2 test. Statistical significance was determined with a P -value less than .05. Results:, Seventy-two of 117 women had positive results on the 14C-UBT. Overall, 27 of 117 pregnant women had anemia (23.1%), and all them were in the H. pylori -positive group; 18 of 27 (66.7%) had iron deficiency anemia. Median hemoglobin levels and neonatal body weights were 12.0 g/dL vs 12.0 g/dL and 3320.0 grams vs 3520.0 grams in the H. pylori -positive and negative groups, respectively. Serum hemoglobin and ferritin levels and neonatal body weight were found to be lower in the anemic group compared with the non-anemic group among H. pylori -infected women (P = 0.0001, P = 0.02, P = 0.008, respectively). There were no statistically significant differences with regard to gestational thrombocytopenia between the H. pylori -positive and H. pylori -negative groups (P = 0.532). Conclusions:, Our study indicates that there is a strong relationship between H. pylori infection and iron deficiency anemia in women with uncomplicated pregnancy. However, an association between H. pylori infection and thrombocytopenia was not found. [source] Preeclampsia and its interaction with common variants in thrombophilia genesJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 9 2004M. P. M. De Maat Summary., Recently, it has been proposed that abnormalities in coagulation and fibrinolysis contribute to the development of preeclampsia by increasing the thrombotic tendency. This hypothesis was tested in women who have had preeclampsia (cases) compared with matched controls. Polymorphisms in the thrombophilia genes {plasminogen activator inhibitor type 1 [PAI-1 ,675(4G/5G)], thrombin activatable fibrinolysis inhibitor (TAFI ,438G/A and 1040C/T), methylenetetrahydrofolate reductase (MTHFR 677C/T), factor V (FV Leiden R/Q506), prothrombin (FII 20210G/A) and factor XIIIA (FXIIIA V/L34)} were determined in 157 women with preeclampsia and 157 women with uncomplicated pregnancy. The associated risk of preeclampsia was analyzed using logistic regression methods. The frequency distributions of the genotypes of these six polymorphisms in thrombophilia genes were similar in the case and control groups. We found no differences in the prevalence of genetic risk factors of thrombosis in women with preeclampsia compared with controls, which makes it unlikely that these polymorphisms are risk factors for preeclampsia. [source] Fetal dilated cardiomyopathy: an unsuspected presentation of methylmalonic aciduria and hyperhomocystinuria, cblC type,PRENATAL DIAGNOSIS, Issue 3 2009Isabelle De Bie Abstract Objective To report the prenatal presentation with dilated cardiomyopathy of methylmalonic aciduria and homocystinuria, cblC type [cobalamin C (cblC) deficiency] (MIM 277400). Method We describe a boy with cblC deficiency who presented prenatally with fetal ultrasound findings of dilated cardiomyopathy and growth restriction. Results Dilated cardiomyopathy and growth retardation were detected in the third trimester of an initially uncomplicated pregnancy. Investigations were negative for chromosomal and other known causes. Growth restriction persisted but fetal heart function improved. Postnatal biochemical evaluation revealed combined methylmalonic acidemia and homocystinemia. Molecular investigations confirmed cblC deficiency. Initiation of treatment was followed by rapid clinical improvement. Conclusion Prenatal dilated cardiomyopathy can be the presenting sign of cblC deficiency. Inborn errors of metabolism should be considered in the investigation of prenatally diagnosed dilated cardiomyopathy in view of the possible impact on treatment and future reproductive options, in some of these conditions. Copyright © 2009 John Wiley & Sons, Ltd. [source] ORIGINAL ARTICLE: Profile of Peripheral Blood Neutrophil Cytokines in Diabetes Type 1 Pregnant Women and its Correlation with Selected Parameters in the NewbornsAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2010Magdalena Perty, ska-Marczewska Citation Perty,ska-Marczewska M, G,owacka E, Grodzicka A, Sobczak M, Cypryk K, Wilczy,ski JR., Wilczy,ski J. Profile of peripheral blood neutrophil cytokines in diabetes type 1 pregnant women and its correlation with selected parameters in the newborns. Am J Reprod Immunol 2010; 63: 150,160 Problem, Interleukin (IL)-12, IL-10, tumor necrosis factor-, (TNF-,), IL-6 and IL-8 alter as pregnancy progresses, implying continuous immune regulation associated with the maintenance of pregnancy. We aimed to evaluate the peripheral blood neutrophil-derived production of these cytokines in the course of pregnancy complicated by type 1 diabetes. Method of study, These parameters were measured in samples from healthy non-pregnant (C), diabetic non-pregnant (D), healthy pregnant (P) and pregnant diabetic (PD) women. Results, Neutrophil-derived secretion of TNF-, and IL-12 increased along with progression of pregnancy in PD and P groups. The concentration of IL-10 from lipopolysaccharide (LPS)-stimulated neutrophils increased during the course of uncomplicated pregnancy but decreased in diabetic pregnancy. Concentration of IL-8 decreased with the advancing gestational age in P and PD groups. LPS-stimulated neutrophil-derived IL-6 concentration increased only in PD patients. Conclusion, Our results show that diabetes creates pro-inflammatory environment thus potentially influencing the outcome of pregnancy. We conclude that neutrophil-derived cytokine production could contribute to the complications seen in pregnant women with type 1 diabetes. [source] A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery RatesBIRTH, Issue 2 2008Susan K. McGrath PhD ABSTRACT: Background: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. Methods: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner. Results: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively. Conclusions: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula. (BIRTH 35:2 June 2008) [source] Maternal Position at Midwife-Attended Birth and Perineal Trauma: Is There an Association?BIRTH, Issue 3 2005Barbara Soong RM, IBCLC ABSTRACT:,Background: Most women will sustain some degree of trauma to the genital tract after vaginal birth. This study aimed to examine the association between maternal position at birth and perineal outcome in women who had a midwife-attended, spontaneous vaginal birth and an uncomplicated pregnancy at term. Methods: Data from 3,756 births in a major public tertiary teaching hospital were eligible for analysis. The need for sutures in perineal trauma was evaluated and compared for each major factor studied (maternal age, first vaginal delivery, induction of labor, not occipitoanterior, use of regional anesthesia, deflexed head and newborn birthweight >3,500 g). Birth positions were compared against each other. Subgroup analysis determined whether birth positions mattered more or less in each of the major factors studied. The chi-square test was used to compare categorical variables. Results: Most women (65.9%) gave birth in the semi-recumbent position. Of the 1,679 women (44.5%) who required perineal suturing, semi-recumbent position was associated with the need for perineal sutures, whereas all-fours was associated with reduced need for sutures; these associations were more marked in first vaginal births and newborn birth weight over 3,500 g. When regional anesthesia was used, semi-recumbent position was associated with a need for suturing, and lateral position associated with a reduced need for suturing. The four major factors significantly related to perineal trauma included first vaginal birth, use of regional anesthesia, deflexed head, and newborn weight more than 3,500 g. Conclusions: Women should be given the choice to give birth in whatever position they find comfortable. Maternity practitioners have a responsibility to inform women of the likelihood of perineal trauma in the preferred birth position. Ongoing audit of all clinicians attending births is encouraged to further determine effects of maternal birth position and perineal trauma, to investigate women's perception of comfortable positioning at birth, and to measure changes to midwifery practice resulting from this study. [source] Haemodynamic changes in the brain after vaginal delivery and caesarean section in healthy term infantsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2002C. Dani Objective To investigate whether the mode of delivery may affect neonatal cerebral haemodynamics during the first hour of life. Design Prospective study. Sample Healthy infants with gestational age ,37 weeks and birthweight appropriate for gestational age, born after uncomplicated pregnancy by vaginal delivery or elective caesarean section, two to five hours after the delivery. Methods Near infra-red spectroscopy was used to measure changes of oxygenated haemoglobin, deoxygenated haemoglobin, oxidized-reduced cytochrome aa3, and mean cerebral oxygen saturation (mixed cerebral oxygen saturation = oxygenated haemoglobin/total haemoglobin). Changes in cerebral blood volume were calculated. Results Near infra-red spectroscopy data did not show significant differences between infants born by vaginal delivery or by caesarean section. There was a significant decrease of oxygenated haemoglobin and change of cerebral blood volume values at 120 and 180 minutes in both the groups, while deoxygenated haemoglobin and oxidized-reduced cytochrome aa3 were unchanged. Conclusions A decrease of cerebral blood volume occurs after birth and this occurs both in infants born by vaginal delivery and by caesarean section. [source] | ||||||||||||||||||||||||||||