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BJOG : An International Journal of... Oct 2015To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy.
DESIGN
A population-based retrospective cohort study and meta-analysis.
SETTING
All maternity units in Scotland.
PARTICIPANTS
A cohort of 128 585 second births, 1999-2008.
METHODS
Time-to-event analysis and random-effects meta-analysis.
MAIN OUTCOME MEASURE
Risk of unexplained antepartum stillbirth in a second pregnancy.
RESULTS
There were 88 stillbirths among 23 688 women with a previous caesarean delivery (2.34 per 10 000 women per week) and 288 stillbirths in 104 897 women who had previously delivered vaginally (1.67 per 10 000 women per week, P = 0.002). When analysed by cause, women with a previous caesarean delivery had an increased risk of unexplained stillbirth (hazard ratio, HR 1.47; 95% confidence interval, 95% CI 1.12-1.94; P = 0.006) and, as previously observed, the excess risk was apparent from 34 weeks of gestation onwards. The risk did not differ in relation to the indication of the caesarean delivery, and was independent of maternal characteristics and previous obstetric complications. We identified three other comparable studies (two in North America and one in Europe), and meta-analysis of these studies showed a statistically significant association between previous caesarean delivery and the risk of antepartum stillbirth in the second pregnancy (pooled HR 1.40; 95% CI 1.10-1.77; P = 0.006).
CONCLUSIONS
Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy.
TWEETABLE ABSTRACT
Caesarean first delivery is associated with an increased risk of unexplained stillbirth in the next pregnancy.
Topics: Adult; Cesarean Section; Cohort Studies; Female; Gestational Age; Gravidity; Humans; Pregnancy; Registries; Retrospective Studies; Risk; Scotland; Stillbirth; Term Birth
PubMed: 26033155
DOI: 10.1111/1471-0528.13461 -
BMJ (Clinical Research Ed.) Apr 2013
Topics: Behavior Therapy; Female; Gravidity; Humans; Postpartum Period; Pregnancy; Sleep
PubMed: 23587748
DOI: 10.1136/bmj.f2344 -
Medical Science Monitor : International... Feb 2018BACKGROUND This study aimed to investigate ovarian reserve in patients of reproductive age with Celiac disease (CD) using anti-Müllerian hormone (AMH) levels, antral...
BACKGROUND This study aimed to investigate ovarian reserve in patients of reproductive age with Celiac disease (CD) using anti-Müllerian hormone (AMH) levels, antral follicle counts (AFCs), and ovarian volume. MATERIAL AND METHODS We included into this study 46 CD female patients and 40 healthy female subjects of reproductive age, ages 18-45 years. Venous blood samples were taken from both groups on days 2-4 of the menstrual cycle, and follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and AMH levels were measured. On the same day, AFCs and ovarian volumes were determined. Data on body mass index (BMI), gravidity/parity/abortions/alive counts, disease duration, and Marsh histological classification were recorded. RESULTS There were no statistically significant differences between CD and control groups in terms of mean age, BMI, or median gravidity/parity/abortions/alive counts (p>0.05). Also, there were no statistically significant differences between the 2 groups in terms of mean FSH, LH, E2, PRL levels, right and left ovarian volumes, and median right and left ovarian AFCs (p>0.05). However, AMH level was significantly lower in the CD group (p=0.032). No statistically significant correlation was found between AMH levels and age, BMI, FSH, LH, E2, PRL levels, right and left ovarian volumes, right and left ovarian AFCs, or Marsh histological classification using the Spearman correlation test (p>0.05). However, an inverse correlation was detected showing that AMH levels decrease with increasing CD duration (r=-0.054, p=0.001). CONCLUSIONS We found that AMH level and ovarian reserve was decreased in CD patients of reproductive age compared to healthy controls, and that AMH level and ovarian reserve decreased with increasing disease duration in CD patients.
Topics: Adolescent; Adult; Anti-Mullerian Hormone; Body Weights and Measures; Celiac Disease; Estradiol; Female; Follicle Stimulating Hormone; Gravidity; Humans; Luteinizing Hormone; Middle Aged; Ovarian Follicle; Ovarian Reserve; Ovary; Parity; Pregnancy
PubMed: 29476685
DOI: 10.12659/msm.909033 -
Journal of Gastroenterology and... Apr 2020The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal...
Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research).
BACKGROUND AND AIM
The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors.
METHODS
This international, noninterventional study enrolled adult patients attending a consultation for hemorrhoidal complaints. The questionnaire completed by physicians established the subjects' demographic and lifestyle characteristics and collected information on HD grade and symptoms and signs of CVD.
RESULTS
A total of 5617 patients were analyzed. Symptoms commonly reported were bleeding (71.8%), pain (67.4%), swelling (55.0%), itching (44.1%), and prolapse (36.2%). Multivariate analysis revealed the variables with the strongest association with HD severity were older age, higher CVD CEAP (Clinical manifestations, Etiologic factors, Anatomic distribution of disease, and underlying Pathophysiology) class, constipation, and male gender (all P < 0.0001). Elevated BMI was a risk factor for HD recurrence. Among women, number of births had a significant association with both HD grade and recurrence. The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P < 0.0001). Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%).
CONCLUSIONS
CHORUS provides a snap shot of current profiles, risk factors, and treatments of patients with HD across the globe. The coexistence of HD and CVD in more than half the study population highlights the importance of examining for CVD among patients with a hemorrhoid diagnosis, particularly when shared risk factors are present.
Topics: Adolescent; Adult; Aged; Body Mass Index; Chronic Disease; Comorbidity; Constipation; Dietary Fiber; Female; Gravidity; Hemorrhoids; Humans; Life Style; Male; Middle Aged; Risk Factors; Severity of Illness Index; Sex Factors; Surveys and Questionnaires; Vascular Diseases; Vasoconstrictor Agents; Young Adult
PubMed: 31512275
DOI: 10.1111/jgh.14857 -
Clinical and Experimental Reproductive... Sep 2019To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease.
OBJECTIVE
To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease.
METHODS
Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed.
RESULTS
Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12-3.63; p= 0.040).
CONCLUSION
These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.
PubMed: 31370113
DOI: 10.5653/cerm.2018.00416 -
Journal of Reproductive Immunology Feb 2017Pregnancy is an immune challenge to the maternal immune system. The effects of pregnancy on maternal immunity and particularly on memory T cells during and after... (Observational Study)
Observational Study
Pregnancy is an immune challenge to the maternal immune system. The effects of pregnancy on maternal immunity and particularly on memory T cells during and after pregnancy are not fully known. This observational study aims to show the short term and the long term effects of pregnancy on the constitution, size and activation status of peripheral human memory T-lymphocyte populations. Effector memory (EM) and central memory (CM) T-lymphocytes were analyzed using flow cytometry of peripheral blood from 14 nulligravid, 12 primigravid and 15 parous women that were on average 18 months postpartum. The short term effects were shown by the significantly higher CD4+ EM cell and activated CD4+ memory cell proportions in primigravid women compared to nulligravid women. The persistent effects found in this study were the significantly higher proportions of CD4+ EM, CD4+ CM and activated memory T cells in parous women compared to nulligravid women. In contrast to CD4+ cells, activation status of CD8+ memory cells did not differ between the groups. This study shows that pregnancy persistently affects the pre-pregnancy CD4+ memory cell pool in human peripheral blood. During pregnancy, CD4+ T-lymphocytes might differentiate into EM cells followed by persistent higher proportions of CD4+ CM and EM cells postpartum. The persistent effects of pregnancy on memory T cells found in this study support the hypothesis that memory T cells are generated during pregnancy and that these cells could be involved in the lower complication risks in multiparous pregnancies in humans.
Topics: Adult; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Cell Differentiation; Cell Proliferation; Cells, Cultured; Female; Gravidity; Humans; Immunologic Memory; Lymphocyte Activation; Lymphocyte Count; Middle Aged; Pregnancy; T-Lymphocyte Subsets
PubMed: 27863266
DOI: 10.1016/j.jri.2016.11.004 -
Cureus May 2023Introduction In recent years, the refugee crisis has become one of the most serious problems. It is well-known that women, individuals aged under 18 years, and pregnant...
Introduction In recent years, the refugee crisis has become one of the most serious problems. It is well-known that women, individuals aged under 18 years, and pregnant refugees are particularly vulnerable to adverse conditions. In this study, we aimed to determine the characteristics of pregnant refugee women aged under 18 years. Methodology Data for pregnant women were recorded prospectively from 2019 to 2021, and pregnant refugee women aged ≤18 years were enrolled in the study. Sociodemographic characteristics of women, gravidity and parity status, the status of regular antenatal care visits and antenatal care visit any time until birth, type of birth, causes for cesarean section, presence of maternal comorbidities, obstetric complications, and baby-related characteristics were recorded. Results A total of 134 pregnant refugees were enrolled in the study. A total of 31 (23.1%) women had completed primary school, and two (1.5%) women had completed middle school or high school. Additionally, only 3.7% of women had a regular job, and 64.2% of the refugees had a total family income below the minimum wage. Also, 10.4% of women lived with more than three people outside the nuclear family. Gravidity numbers were one for 65 (48.5%) women, two for 50 (37.3%) women, and more than two for 19 (14.2%) women, respectively. The proportion of women with regular antenatal care visits was 19.4% (26), and 45.5% (61) had irregular antenatal care visits. Anemia and urinary tract infections were detected in 52 (28.8%) patients and seven (5.2%) patients, respectively. The proportion of preterm delivery was 8.9%, and 10.5% of infants had low birth weight. A total of 16 (11.9%) babies required neonatal intensive care unit support. Conclusions The present study demonstrated that pregnant women who are refugees and aged under 18 years have low education levels, insufficient family income, and often live in crowded families and even as the second wife of a husband. Moreover, although the birth rate was high in pregnant refugees, the rate of regular antenatal follow-up was low. Finally, this study showed that maternal anemia, preterm birth, and low birth weight were common in pregnant refugees.
PubMed: 37378129
DOI: 10.7759/cureus.39169 -
Acta Obstetricia Et Gynecologica... Aug 2023Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during...
INTRODUCTION
Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum.
MATERIAL AND METHODS
This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs).
RESULTS
At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5).
CONCLUSIONS
This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.
Topics: Pregnancy; Female; Humans; Fecal Incontinence; Prospective Studies; Pelvic Floor; Delivery, Obstetric; Gravidity; Surveys and Questionnaires
PubMed: 37338103
DOI: 10.1111/aogs.14614 -
PloS One 2013Parity increases the risk for coronary heart disease; however, its association with metabolic syndrome among women in low-income countries is still unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Parity increases the risk for coronary heart disease; however, its association with metabolic syndrome among women in low-income countries is still unknown.
OBJECTIVE
This study investigates the association between parity or gravidity and metabolic syndrome in rural Bangladeshi women.
METHODS
A cross-sectional study was conducted in 1,219 women aged 15-75 years from rural Bangladesh. Metabolic syndrome was defined according to the standard NCEP-ATP III criteria. Logistic regression was used to estimate the association between parity and gravidity and metabolic syndrome, with adjustment of potential confounding variables.
RESULTS
Subjects with the highest gravidity (> = 4) had 1.66 times higher odds of having metabolic syndrome compared to those in the lowest gravidity (0-1) (P trend = 0.02). A similar association was found between parity and metabolic syndrome (P(trend) = 0.04), i.e., subjects in the highest parity (> = 4) had 1.65 times higher odds of having metabolic syndrome compared to those in the lowest parity (0-1). This positive association of parity and gravidity with metabolic syndrome was confined to pre-menopausal women (P(trend) <0.01). Among the components of metabolic syndrome only high blood pressure showed positive association with parity and gravidity (P(trend) = 0.01 and <0.001). Neither Parity nor gravidity was appreciably associated with other components of metabolic syndrome.
CONCLUSIONS
Multi parity or gravidity may be a risk factor for metabolic syndrome.
Topics: Adolescent; Adult; Aged; Bangladesh; Cross-Sectional Studies; Female; Gravidity; Humans; Metabolic Syndrome; Middle Aged; Parity; Pregnancy; Prevalence; Risk Factors; Rural Population; Young Adult
PubMed: 23936302
DOI: 10.1371/journal.pone.0068319 -
International Journal of Gynaecology... Jun 2020To examine the effects of socioeconomic and demographic conditions on the prevalence of preterm birth in a local community.
OBJECTIVE
To examine the effects of socioeconomic and demographic conditions on the prevalence of preterm birth in a local community.
METHODS
Pregnant women (aged ≥16 years) willing to provide informed consent in one of the two languages of the community were recruited in South Africa between August 2007 and January 2015. Specifically designed case report forms collected information and measurements prospectively.
RESULTS
After reviewing the medical records of 5806 women, it was possible to identify those who had spontaneous preterm birth (SPTB), induced preterm birth (IPTB), or spontaneous term birth (STB). Women with IPTB (vs SPTB) were more obese and had higher education levels and household incomes; more had telephones and running water at home. They enrolled earlier and more developed hypertension and pre-eclampsia. Women with SPTB (vs STB) were less obese, shorter, had smaller arm circumferences and higher gravidities and Edinburgh Depression Scores, lower education, fewer telephones, and less running water at home. More women with SPTB used methamphetamine, cigarettes, and were heavier smokers.
CONCLUSION
SPTB and IPTB should not be conflated. Programs to reduce the high prevalence of SPTB should include improving education, lifestyle, and socioeconomic conditions. Addressing hypertension should help reduce preterm inductions.
Topics: Adolescent; Adult; Female; Humans; Infant, Newborn; Labor, Induced; Pregnancy; Premature Birth; Prevalence; Risk Factors; Social Class; South Africa; Young Adult
PubMed: 32176323
DOI: 10.1002/ijgo.13143