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Background: The probability of pregnancy after in vitro fertilisation (IVF) declines with age in parallel with a reduction in the ovarian reserve. However, there is considerable variation in the ovarian reserve in women of advanced reproductive age; so to give such women accurate advice about the prospects of treatment success, factors other than age must be considered. Anti-Müllerian hormone (AMH) has been shown to be a good indicator of ovarian reserve, and its utility is explored in this paper. Aims: To determine the utility of AMH serum levels for prediction of ovarian response to gonadotropin stimulation and outcome in IVF in women of advanced reproductive age. Methods: The material consists of 127 women with a median age of 42 years (range 39-46) having had their first cycle of IVF/intracytoplasmic sperm injection (ICSI) treatment from November 2006 to December 2008. During this period, a total of 772 oocyte retrievals and 715 embryo transfers were performed at the clinic (median age 36.4 years). AMH was analysed with the Beckman Coulter DSL ELISA. Agonist and antagonist protocols were used and monitored by ultrasound and oestradiol; embryo transfer was performed on day 2, 3 or 5 of culture. Results: The lower the AMH, the higher the risk of cycle cancellation, low oocyte yield and treatment failure. Women with a serum AMH above 8.6 pmol/L had a good chance of achieving live birth after IVF/ICSI treatment. Conclusions: Anti-Müllerian hormone is useful for identifying a good prognosis group in women of advanced reproductive age. [ABSTRACT FROM AUTHOR]

Objective To quantify late-pregnancy weight gain in women with and without gestational diabetes mellitus ( GDM) and to determine factors associated with gestational weight gain. Study design A prospective clinical audit of 212 women (115 GDM and 97 non- GDM) who were weighed at each antenatal visit from 24-32 weeks gestation until delivery. Women received routine antenatal clinical care. For women with GDM, this included a 2-h lifestyle counselling session, capillary blood glucose testing and frequent clinical review. Results Women with GDM gained less weight than nondiabetic women ( GDM: 1.18 kg (1.6%) [range, 3.8-7.1 kg]; non- GDM: 4.0 kg (4.8%) [range, 0.7-18.5 kg]; P < 0.0001). Weight gain was influenced by body mass index and country of birth. Women with GDM showed reduced weight gain at weeks 1-4 postrecruitment, relative to weeks 4-8 (0.04 kg/week vs 0.45 kg/week; P < 0.0001). Nondiabetic women gained weight at a constant rate. GDM status was the only independent predictor of postrecruitment weight gain. Conclusions Application of a model of care for GDM (lifestyle advice and regular clinical review, in addition to home glucose monitoring) may reduce weight gain in women with GDM. The potential for applying a modified version of this model to all women in pregnancy warrants further study. [ABSTRACT FROM AUTHOR]

Background: Several population-based and clinical studies report that stress incontinence has less impact on quality of life (QoL) than urge incontinence and overactive bladder. Aims: This research aimed to determine if this relationship held true for urodynamic diagnoses. Methods: Quality of life was evaluated by the King's Health Questionnaire prior to urodynamic testing in 326 women presenting with lower urinary tract symptoms and who completed a 48-h frequency volume chart. Urodynamic results were categorised as 'normal', 'sensory abnormalities only', 'idiopathic detrusor overactivity (IDO) only', 'urodynamic stress incontinence (USI) only' or 'mixed (IDO and USI)'. QoL data were compared using these diagnostic categories. Results: Women in mixed, USI and IDO categories had significantly worse QoL scores in the domain Severity Measures than women in sensory or normal categories ( P < 0.0001). Incontinence Impact was significantly worse in mixed and IDO categories compared with normal ( P = 0.006) but not compared with women with USI. Sleep/Energy scores were significantly worse for women in mixed and IDO categories compared with women with USI ( P = 0.003). Significant differences between urodynamic categories were also observed in the domains Role Limitations, Social Limitations and General Health. Conclusions: Mixed incontinence had the greatest adverse effect on QoL; however, any abnormal urodynamic diagnosis was associated with a significantly adverse effect. Although a normal urodynamic result was associated with less impact on QoL than an abnormal result, there was still an effect present. The optimal management (eg conservative vs surgical management) of women with a normal urodynamic result is yet to be established. [ABSTRACT FROM AUTHOR]

Background: Women with a history of hypertensive disorders of pregnancy (HDP) are known to be at increased risk of subsequent hypertension and cardiovascular disease. Aims: In this study, we aimed to assess whether the long-term follow-up, diagnosis and treatment of hypertension in these women is adequate. Methods: Prospective study of 2112 women who were part of a Birth Cohort Study - The Mater University of Queensland Study of Pregnancy, who received antenatal care at a major public hospital in Brisbane between 1981 and 1983 and were followed up at 21 years. Results: Of the 191 women who had HDP, 62 (32.46%) were hypertensive (29 adequately treated, 33 inadequately identified or managed). Of the 1921 women without HDP, 280 (14.58%) were hypertensive (113 adequately treated, 167 inadequately identified or managed). Women with HDP were at higher risk of hypertension (OR 4.09, 95% CI 2.76, 6.07). Women with a history of HDP were more likely to have hypertension that was inadequately identified or managed (OR 3.56, 95% CI 2.06, 5.97). Conclusion: Women with HDP are at increased risk of undiagnosed or undertreated hypertension. Attention needs to be given to appropriate follow-up of women who have a pregnancy complicated by hypertensive disorders. [ABSTRACT FROM AUTHOR]

Background: Most women use medications at some stage in their pregnancy. Medication nonadherence during pregnancy could be detrimental to both mother and fetus. Aims: To study the extent and nature of the use of prescribed medications during pregnancy and factors associated with medication nonadherence. Methods: All women ≥18 years presenting for their 36th week antenatal visit at the pregnancy clinic of a maternity hospital were invited to complete an anonymous questionnaire that contained 61 items, including the Morisky scale. Factors associated with nonadherence were identified in univariate analysis; factors with P < 0.1 were further analysed in a binary logistic regression model. Results: The participants ( n = 819) had a mean age of 30.8 ± 5.3 years. Most participants were born in Australia, lived with a partner, had university education, were nulliparous, carried one fetus and were nonsmokers. Of these participants, 322 (39.3%) reported a chronic health condition during pregnancy, the most common being asthma (104; 12.7%). Two hundred and seventeen (26.5%) were using prescribed medications, which included anti-anaemics (68; 8.3%), medicines for chronic airway conditions (64; 7.8%), vitamins and minerals (59; 7.2%) and anti-diabetics (43; 5.2%). Nonadherence was reported by 107 (59.1%) participants, mainly because of forgetting (79; 43.6%). Factors associated with nonadherence were having asthma (OR 0.26 (95% CI 0.095 - 0.72), P = 0.009) and using nonprescription dietary minerals (0.30 (0.10 - 0.87), P = 0.027). Conclusions: Adherence to prescribed medicines during pregnancy is alarmingly low. Health professionals should be more proactive in promoting adherence and assisting women avoid potential fetal harm because of nonadherence. [ABSTRACT FROM AUTHOR]

Objective: Absence or hypoplasia of the nasal bone is commonly reported in Down syndrome fetuses. We define normal ranges and the 2.5th centile for fetal nasal bone length (NBL) in a multiethnic Australian population at 18-20 weeks of gestation. Methods: A prospective cohort study of women attending for a routine anomaly scan. Ethnicity of the patient and their partner was recorded, and the nasal bone was measured three times. Two methods of nasal bone assessment were used to define normal ranges: a single (first) measurement and the mean value of three measurements. Mixed-effects regression models were employed to account for interoperator differences treating sonographers as random effects. Nonparametric methods were used to define the 2.5th centile for gestational age. Results: A total of 1199 women were included with a mean gestational age 19.1 (SD 0.4; range 18-20) weeks. There is significant linear relationship between NBL and gestational age ( P < 0.001). The mean of three nasal bone measurements had a smaller standard deviation than single nasal bone measurements. Nonparametric assessment was used to define the 2.5th centile, which is 4.4 mm at 18 weeks and 5.0 mm at 20 weeks of gestation. Conclusions: This study provides a reference range for fetal NBL at 18-20 weeks of gestation in an unselected multiethnic Australian population. Whilst NBL increases linearly from 18 to 20 weeks, the data are not normally distributed and nonparametric techniques are required to define the 2.5th centile. The mixed-effects model also accounts for variation in sonographer measurements. [ABSTRACT FROM AUTHOR]

Many women with problems in early pregnancy such as vaginal bleeding or abdominal pain present to the emergency department (ED). To describe demographic, service delivery and diagnostic characteristics of women who presented to the ED with a problem in early pregnancy. Data were reviewed for all electronically available ED presentations in 2008 in NSW, Australia according to diagnostic codes related to problems in early pregnancy ( N = 12,061). Descriptive statistics were used to illustrate relevant characteristics, and adjusted odds ratios were used to highlight the predictors of key service delivery outcomes. Women who presented to the ED for a problem in early pregnancy accounted for 1.2% of all ED presentations for women. The average age of women who presented to the ED for a problem in early pregnancy was 29.3 years, with 25% aged 35 years or older. Over a fourth (28%) of women presented to the ED on a weekend and over a third (37%) presented after-hours. Most (70%) women were seen according to their triage category, and the median length of stay in the ED was just under 4 h. One-fourth of women were admitted to hospital, which was 3.8 times more likely among women with an ectopic pregnancy. The findings of this research may be useful for hospitals and clinicians to review and improve their current service delivery models for women who present to the ED with a problem in early pregnancy. [ABSTRACT FROM AUTHOR]

The development of safe and effective techniques for second-trimester abortion (associated or not with fetal death) has become a major clinical challenge. To compare the efficacy and safety of sublingual versus vaginal misoprostol for mid-trimester pregnancy termination. We conducted a meta-analysis of published randomised controlled trials that compared sublingual and vaginal routes. Primary outcome measures were complete abortion rate at 24 and 48 h and induction-abortion interval, and the secondary outcome measures were side effects and patients' preference for the route. Pooled risk ratios were calculated for categorical variables, and continuous variables were compared by means of weighted mean differences. Both routes' efficacy was similar following 24 h of treatment (pooled RR 1.04, 95% CI 0.93-1.7). Successful induction percentage after 24 h was significantly higher in nulliparous women with vaginal misoprostol (pooled RR 0.78; 95% CI 0.71-0.87). The efficacy after 48 h was significantly greater with vaginal misoprostol in the general population (pooled RR 0.96; 95% CI 0.93-0.99) and in nulliparous women (pooled RR 0.89; 95% CI 0.86-0.95). The sublingual route shortened the induction-fetal expulsion interval (WMD −4.54, 95% CI −8.03 to −1.05) and was the route preferred among women. No statistically significant differences between treatment groups were observed for placental retention or for any side effect except for fever, which was more common in the vaginal group. Sublingual and vaginal misoprostol are safe and effective for mid-trimester pregnancy termination. The differences obtained between both routes probably do not have clinical consequences. [ABSTRACT FROM AUTHOR]

Background: Much is known about severe maternal morbidity during pregnancy, but there has been little attention paid to the impact of pregnancy itself on women's general health and well-being. Aim: To investigate women's general health and well-being in early pregnancy and examine the relationship between maternal age and women's physical and mental health. Method: Cross-sectional analysis of baseline data from a multicentre, prospective nulliparous pregnancy cohort study. The baseline questionnaire included the SF-36 health status measure and individual items assessing a range of common maternal health issues. Results: A total of 1507 eligible women returned baseline questionnaires in early pregnancy (mean gestation 15 weeks, range 6-24 weeks) ranging from 18 to 49 years of age (mean age 30.1 years). Study participants reported significantly poorer health compared with age and gender-standardised population means on all SF-36 scales except general health. Two-thirds of women (68%) reported three or more health issues, the most common being exhaustion (87%), nausea (64%), back pain (46%), constipation (44%) and severe headaches/migraines (30%). Younger women (18-24 years) had significantly lower SF-36 scores (poorer self perceived health) compared with women ≥35 ( P ≤ 0.03). After adjusting for socio-demographic factors, maternal age remained significantly positively associated with women's mental and physical component scores. Younger women reported significantly more health issues than women ≥35 (4.39 and 3.27, mean difference = 1.12, 95% CI 0.75-1.79, P < 0.001). Conclusions: Common pregnancy symptoms have a marked impact on women's physical and mental health in early pregnancy, with the greatest impact apparent for younger women. [ABSTRACT FROM AUTHOR]

Aims: To determine risk factors for miscarriage. Methods: A case control study was carried out at the gynaecological wards and antenatal clinics of the De Soysa Maternity Hospital in Sri Lanka. A case was defined as that of mothers with a confirmed diagnosis of partial or full expulsion of the fetus during the first 28 weeks of gestation. Controls comprised ante-natal clinic attendees whose period of gestation was <28 weeks and carrying a viable fetus. Two hundred and thirty cases and 504 controls were selected. A pre-tested interviewer-administered questionnaire and modified life events inventory were used to gather data. Multivariate logistic regression was applied separately for first and second trimester miscarriages and the results were expressed as odds ratios (OR) and as 95% confidence intervals (95%CI). Results: Sleeping ≤8 h/day (OR:3.80, 95%CI:1.01–14.3) was found to be a risk factor for first trimester miscarriage controlling for the effect of period of gestation. Sleeping ≤8 h/day (OR:2.04, 95%CI:1.24–3.37), standing ≤3 h/day (OR:1.83, 95%CI:1.08–3.10), exposure to cooking smoke (OR:3.83, 95%CI:1.50–9.90) and physical trauma during the pregnancy (OR:43.2, 95%CI:4.55–411.4) were found to be risk factors for second trimester miscarriage controlling for the effect of period of gestation. Conclusions: Sleep deprivation, a sedentary lifestyle, exposure to cooking smoke and physical trauma during pregnancy were risk factors for miscarriage. Most of the risk factors are therefore modifiable. [ABSTRACT FROM AUTHOR]