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Background: Amniotic fluid abnormalities may be associated with adverse perinatal outcomes, some of which are endocrine related., Objective: To evaluate whether in utero exposure to amniotic fluid abnormalities is associated with long-term endocrine morbidity in the offspring., Study Design: In this cohort study, the incidence of long-term endocrine disorders was compared between singletons exposed and non-exposed to oligohydramnios or polyhydramnios., Results: During the study period, 195 943 newborns were included in the study, of them 2.0% (n = 4072) and 2.9% (n = 5684) were exposed to oligohydramnios and polyhydramnios, respectively. Long-term endocrine morbidity was higher among children exposed to isolated amniotic fluid disorders, as was also noted in the Kaplan-Meier survival curve (log-rank test p < 0.001). Abnormal amniotic fluid volume was found to be independently associated with long-term endocrine morbidity of the offspring according to a Cox regression model controlled for clinically related confounders., Conclusion: In utero exposure to isolated amniotic fluid abnormalities is independently associated with long-term endocrine morbidity in the offspring.

Objective: To examine the association between routine blood tests during pregnancy and future risk of cardiovascular morbidity., Methods: The present case-control study was conducted among women who delivered at a teaching hospital in Israel between January 1, 2000, and December 31, 2012. The cohort comprised women who were subsequently hospitalized owing to cardiovascular morbidity (case group) and age-matched non-hospitalized women (control group). Blood levels of creatinine, glucose, potassium, urea, and uric acid were measured during pregnancy. Only women with at least one test result available for all five measurements were included. The relationship between upper quartile blood test values and cardiovascular hospitalization was assessed., Results: The study included 4115 women (212 in the case group and 3903 in the control group). Three measures were associated with a future risk of cardiovascular morbidity requiring hospitalization: creatinine (hazard ratio [HR] 1.86, 95% confidence interval [CI] 1.37-2.53; P<0.001); potassium (HR 1.48, 95% CI 1.09-2.01; P=0.013), and urea (HR 1.60, 95% CI 1.17-2.19; P=0.003). The number of blood test results in the upper quartile also increased such risk. The HRs for two tests and at least three tests were 1.65 (95% CI 1.06-2.56; P=0.026) and 3.32 (95% CI 2.19-5.04; P<0.001), respectively., Conclusions: Future cardiovascular morbidity was predicted by routine blood tests during pregnancy., (© 2018 International Federation of Gynecology and Obstetrics.)

Problem: Recurrent pregnancy loss (RPL) potentially involves an abnormal maternal inflammatory response. We investigated whether children of mothers with a history of RPL are at an increased risk for childhood gastrointestinal (GI) morbidity, with a specific focus on inflammatory bowel diseases (IBD)., Method of Study: A population-based cohort analysis comparing the risk for long-term GI morbidity in children born to mothers with and without a history of RPL. Gastrointestinal (GI) morbidity included hospitalizations involving a pre-defined set of ICD-9 codes., Results: During the study period, 242 186 newborns met the inclusion criteria; 5% of which were offspring to mothers with a history of RPL. Gastrointestinal morbidity was significantly more common in the RPL group (6.6% vs 5.3%). Specifically, offspring to mothers with a history of RPL had significantly higher rates of IBD (2.1% vs 1.7%)., Conclusion: Maternal history of RPL is associated with an increased risk for pediatric GI morbidity in the offspring., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The present study was aimed to determine whether high potassium level during pregnancy is an independent risk factor for future atherosclerotic morbidity., Patients and Methods: A case-control study was conducted including women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity after their last delivery (n = 653) and matched controls (n = 4101). The mean follow-up duration was 57.7 ± 36.5 and 78.5 ± 42.3 months, respectively. The cases were further divided into: major events (severe atherosclerotic morbidity; n = 363), minor events (i.e. cardiovascular risk factors; n = 201) and cardiovascular evaluation tests (n = 89). The Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for hospitalizations while controlling for confounders., Results: A Cox proportional hazard model, controlling for confounders such as gestational hypertension, gestational diabetes mellitus, obesity, maternal age, creatinine level and gestational week at index pregnancy showed that K(+ )≥ 5.0 mEq/L during pregnancy was significantly associated with hospitalizations due to severe atherosclerotic morbidity (adjusted HR = 1.55; 95% CI 1.02-2.35; p = 0.039). A non-significant trend was also noted with long-term total hospitalizations for atherosclerotic (adjusted HR = 1.39; 95% CI 0.99-1.94; p = 0.052)., Conclusion: High potassium level during pregnancy is associated with a significant risk for severe atherosclerotic morbidity, as it might be an indication for occult metabolic and renal dysfunction.

The aim of this study was to examine the association between uric acid (UA) level during pregnancy and future maternal hospitalization for atherosclerotic-related morbidity. A case-control study was conducted including women who delivered between the years 2000 to 2012 and subsequently developed atherosclerotic morbidity at least 1 year after their last delivery (n=588) and controls (n=3645). The mean follow-up duration was 57.8±35.6 months and 77±43.4 months, respectively. Cox proportional hazards models were used to estimate the adjusted hazard ratios for hospitalizations. A significant linear association was documented between UA during pregnancy and long-term maternal-related atherosclerotic morbidity. A Cox proportional hazard model, controlling for the confounders gestational hypertension, gestational diabetes mellitus, obesity, maternal age, creatinine level, and gestational week at index pregnancy showed that UA ≥5.6 mg/dL during pregnancy remained independently associated with long-term total hospitalization (adjusted hazard ratio, 1.47; 95% confidence interval, 1.16-1.86; P<.001). High UA level during pregnancy may predict maternal atherosclerotic morbidity., (© 2015 Wiley Periodicals, Inc.)

We examined the relationship between occupation and clinical characteristics during pregnancy and medical recommendations to stop working. Using a case-control design, we compared 58 working women who had preterm births, with 126 who had delivered at term. All women were interviewed postpartum while still in hospital. There were no differences between the groups with regard to physical activity outside the home, weekly work hours, nor duration of work. Only a small proportion had been exposed to unusually difficult working conditions, to hazardous agents or to a very uncomfortable working environment. Women who had had preterm births were advised more often to leave their jobs or modify their working patterns. Multivariate analysis revealed that the physician's decision to recommend cessation of work was influenced primarily by complications during the current pregnancy. It appears that our patients at risk for preterm birth are probably correctly identified, and receive appropriate guidelines as to working patterns. It is possible that a poor obstetric history or previous abortions may paradoxically have a protective effect, as they influence the physician to recommend cessation of work.

The relationship between physical activity at home and at work during pregnancy and preterm birth was studied. Using a case-control design, 99 women who delivered preterm were compared with 189 women who had term deliveries. The risk of preterm birth was tested in relation to characteristics of work in and outside the home. All women were interviewed post-partum before discharge. There were no statistically significant differences between the groups in relation to sociodemographic and obstetrical factors, but level of education was significantly lower in the study group versus the control group (p = 0.001). Women who delivered preterm had devoted less time 3 months prior to delivery to household chores (mean of 3.7 hours vs. 4.8 hours in the control group, p = 0.002). They also had spent less time walking around the home than the controls (1.2 vs. 1.5 hours, p = 0.02). There were no differences between the groups in relation to physical activity outside the home, not during working hours, nor in duration of work. Significantly fewer women who delivered preterm were active in sports (odds ratio 0.22; 95% confidence interval 0.50-0.65; p = 0.002). A low level of education was significantly related to the risk of preterm birth, which may have resulted from lesser compliance with their physician's recommendations. It appears that in women not used to significant physical activity but who had access to adequate prenatal care, physical effort during pregnancy was not related to a higher risk of preterm birth.

Background: Low birth weight and preeclampsia are both adverse pregnancy and delivery outcomes, with possible influence on future health status. Previous studies have shown that intergenerational factors may be important prognostic information in evaluating women prior to or after conception. Our objective was to evaluate the role of intergenerational factors on the incidence of preeclampsia and low birth weight (LBW).Methods: A retrospective population-based study was conducted. Perinatal information was gathered from 2311 familial triads, comprising mothers (F1), daughters (F2), and children (F3). All births occurred in a tertiary medical center between 1991 and 2013. A multivariate generalized estimating equation logistic regression model analysis was used to study the association between LBW and preeclampsia across generations while controlling for confounders and for clusters of families in the database.Results: A total of 1490 in F1, 1616 in F2, and 2311 in F3 were included. LBW in mothers (F2), adjusted for possible confounders, was found to be a significant predictor for LBW in offspring (OR = 1.6, 95% CI 1.02-2.6, p = .043). Likewise, preeclampsia was also noted as a significant intergenerational factor following adjustments for possible confounders (OR = 2.9, 95% CI 1.4-5.8, p = .004).Conclusions: Maternal LBW and preeclampsia are both independent risk factors for recurrence in the next generation. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to investigate whether maternal bronchial asthma increases the risk for long-term respiratory morbidity of the offspring. Study Design A population-based cohort study compared the incidence of long-term pediatric hospitalizations due to respiratory disease of the offspring of mothers with and without bronchial asthma. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Congenital malformations as well as multiple pregnancies were excluded. Kaplan-Meier's survival curve was used to estimate cumulative incidence of respiratory morbidity. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. Results During the study period, 253,808 deliveries met the inclusion criteria; of which 1.3% were born to mothers with bronchial asthma (n = 3,411). During the follow-up period, children born to women with bronchial asthma had a significantly higher rate of long-term respiratory morbidity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3-1.7; p < 0.001). Specifically, the rate of childhood asthma was higher among offspring of mothers with asthma (OR = 2.3; 95% CI = 1.8-2.9; p < 0.001). Children born to women with asthma had higher cumulative incidence of respiratory morbidity, using a Kaplan-Meier's survival curve (log-rank test; p < 0.001). Using two multivariable GEE logistic regression models, controlling for the time to event, maternal age, and gestational age at delivery, maternal bronchial asthma was found to be an independent risk factor for long-term respiratory disease of the offspring (adjusted OR = 1.6; 95% CI = 1.4-1.9; p < 0.001), and specifically for bronchial asthma (adjusted OR = 2.5; 95% CI = 1.9-3.1; p < 0.001). Conclusion Maternal bronchial asthma is an independent risk factor for long-term respiratory morbidity of the offspring. [ABSTRACT FROM AUTHOR]

Aim o examine the association between glucose level during pregnancy and the subsequent development of long-term maternal atherosclerotic morbidity. Methods A retrospective case-control study was conducted. The study included all women who had at least one glucose measurement during their pregnancies. Cases were all women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity ( n = 815). Controls were randomly matched by age and year of delivery ( n = 6065). The atherosclerotic morbidity group was further divided by severity: major events (cardiovascular, cerebrovascular disease, chronic renal failure), minor events (hypertension, diabetes mellitus and hyperlipidaemia without target organ damage or complications) and cardiac evaluation tests (such as coronary angiography without records of atherosclerosis, cardiac scan and stress test). The mean follow-up duration for the study group was 74 months. Cox proportional hazards model was used to control for confounders. Results A significant linear association was found between glucose levels during pregnancy and long-term maternal atherosclerotic morbidity. Among the cases with severe atherosclerotic morbidity, the proportion of women with a high glucose level (> 5.5 mmol/l) was the highest, whereas in controls it was the lowest ( P < 0.001). In a Cox proportional hazard model, adjusted for atherosclerotic confounders such as gestational diabetes, pre-eclampsia and obesity, a glucose level of > 5.5 mmol/l was noted as an independent risk factor for hospitalizations later in non-pregnant life (hazard ratio = 1.3, 95% confidence interval 1.1-1.5, P < 0.003). Conclusion A high glucose level during pregnancy, even if within the range of slight glucose intolerance, may serve as a marker for future maternal atherosclerotic morbidity. Further long-term studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Abstract: Doppler velocimetry is the ideal clinical tool to assess placental performance in high-risk pregnancies. It also has value in predicting later complications and outcome in pregnancies which appear uncomplicated. All three circulations (fetal, placental and maternal) may be interrogated by Doppler technology. In the following review, we present basic physics aspects of Doppler and discuss mainly Doppler investigation of the fetal–placental circulation (umbilical artery, intraplacental circulation) as well as the uterine arteries. The assessment of umbilical blood flow provides information on blood perfusion of the fetal–placental unit. The diastolic blood flow velocity component in umbilical artery increases with advancing gestation. In pregnancies complicated by placental dysfunction, there may be a reduction in the number of functional villi and/or small blood vessels with, as a result, increased impedance, reflected, mainly, by a decrease in end-diastolic velocity. When the resistance increases even more, there is no diastolic forward velocity (absent end-diastolic velocity). Further increase in the resistance causes reversed end-diastolic velocity, which is considered a late step in the cascade of events leading to intrauterine fetal demise. Doppler assessment of the umbilical arteries was found to improve outcome of high-risk pregnancies, and reduce hospital admissions. On the contrary, routine Doppler ultrasound in low risk or unselected populations does not seem to confer benefit on mother or newborn. Uterine artery Doppler is a useful test in predicting pregnancies at high risk of developing complications related to uteroplacental insufficiency. It identifies women who may benefit from increased antenatal surveillance or prophylactic therapy. Three-dimensional power Doppler sonography can provide new insights into placental pathophysiology. [Copyright &y& Elsevier]

Objective. To investigate pregnancy outcome in women suffering from idiopathic vaginal bleeding (IVB) during the second half of pregnancy. Methods. A comparison between patients admitted to the hospital due to bleeding during the second half of pregnancy and patients without bleeding was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the analysis. Stratified analyses using the Mantel-Haenszel technique and a multiple logistic regression model were performed to control for confounders. Results. During the study period, 173 621 singleton deliveries occurred at our institute. Of these, 2077 (1.19%) were complicated with bleeding upon admission during the second half of pregnancy. After excluding cases with bleeding due to placental abruption, placenta previa, cervical problems, etc., 67 patients were classified as having IVB (0.038%). Independent risk factors associated with IVB, using a backward, stepwise multivariable analysis were oligohydramnios (OR=6.2; 95% CI 3.1-12.7; p < 0.001), premature rupture of membranes (OR=3.4; 95% CI 1.8-6.2; p < 0.001), intrauterine growth restriction (IUGR, OR 5.6; 95% CI 2.5-12.2; p < 0.001), and Jewish ethnicity (OR=1.9; 95% CI 1.0-3.5; p=0.036). These patients subsequently were more likely to deliver preterm (<37 weeks, 56.7% vs. 7.3%; mean gestational age of 33.6±5.7 weeks vs. 39.2±2.1 weeks; p < 0.001) and by cesarean delivery (CD, 35.8% vs. 12.1%, OR=4.0; 95% CI 2.4-6.6; p < 0.001). Higher rates of low Apgar scores (<7) at 1 and 5 minutes were noted in these patients (OR=10.3; 95% CI 5.9-17.8; p < 0.001 and OR=17.8; 95% CI 7.1-44.5; p < 0.001, respectively). Moreover, perinatal mortality rate among patients admitted due to idiopathic bleeding was significantly higher as compared to patients without bleeding (9.6% vs. 1.2%, OR=8.4; 95% CI 3.3-21.2; p < 0.001). However, when controlling for preterm delivery, using the Mantel-Haenszel technique, the association lost its significance. Conclusion. Idiopathic vaginal bleeding during the second half of pregnancy is a risk factor for adverse perinatal outcome, mostly due to its significant association with preterm delivery. Careful surveillance, including fetal monitoring, is suggested in these cases in order to reduce the adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

Abstract: Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities. [Copyright &y& Elsevier]

Abstract: Maurice Panigel demonstrated by X-rays, almost 40years ago, placental maternal blood jets in non-human primates. Although to researchers the importance of the placenta is evident, in clinical obstetrical imaging, the fetus takes precedence. The placenta is imaged almost as an after thought and mostly to determine its location in the uterus. In animal species, the placenta was imaged with techniques which would be considered too invasive (or too costly for routine use) in humans, many pioneered by Panigel: radioangiography, radioisotopes scintigraphy, thermography, magnetic resonance imaging (MRI) and spectroscopy, positive emission tomography (PET) and single photon emission computed tomography (SPECT). Ultrasound allows for detailed, and, as far as is known, safe analyses of not only placental structure in the human but also its function. Earlier, only 2-dimensional grey-scale was available and more than 20years ago, placental grading was popular. Later, colour imaging and spectral Doppler analysis of blood velocity both in the umbilical artery and within the placenta as well as the uterus and fetal vessels became essential and, more recently, the use of ultrasound contrast agents has been described, albeit not yet in a clinical setting. Three-dimensional ultrasound permits evaluation of the placenta in several planes, more precise depiction of internal vasculature as well as more accurate volume assessment. Several medical disorders of the pregnant woman or her fetus begin or end in the placenta, and ultrasound is the optimal investigation method. Obvious examples include pre-eclampsia and other forms of hypertension in pregnancy, less than optimal fetal growth (i.e. intrauterine growth restriction), triploidy (and its placental manifestation: partial mole), non-immune hydrops as well as several infectious processes. Ultrasound is also particularly suited to evaluate specific placental conditions, such as abnormal placentation (placenta previa and accrete for instance), gestational trophoblastic disease and placental tumors (e.g. chorioangioma). [Copyright &y& Elsevier]

Abstract: Objective: To identify risk factors for early wound infection (diagnosed prior to discharge) following cesarean delivery. Methods: A population-based study comparing women who have and have not developed a wound infection prior to discharge from Soroka University Medical Center, Ben Gurion University of the Negev, between 1988 and 2002. Results: Of the 19,416 cesarean deliveries performed during the study period, 726 (3.7%) were followed by wound infection. Using a multivariable logistic regression model, the following risk factors were identified: obesity (odds ratio [OR]=2.2; 95% confidence interval [CI], 1.6–3.1); hypertensive disorders (OR=1.7; 95% CI, 1.4–2.1); premature rupture of membranes (OR=1.5; 95% CI, 1.2–1.9); diabetes mellitus (OR=1.4; 95% CI, 1.1–1.7); emergency cesarean delivery (OR=1.3; 95% CI, 1.1–1.5); and twin delivery (OR=1.6; 95% CI, 1.3–2.0). Combined obesity and diabetes (gestational and pregestational) increased the risk for wound infection 9.3-fold (95% CI, 4.5–19.2; P &#60;.001). Conclusion: Independent risk factors for an early wound infection are obesity, diabetes, hypertension, premature rupture of membranes, emergency cesarean delivery, and twin delivery. Information regarding higher rates of wound infection should be provided to obese women undergoing cesarean delivery, especially when diabetes coexists. [Copyright &y& Elsevier]

Objective: To determine the risk factors and pregnancy outcome of patients with chronic hypertension during pregnancy after controlling for superimposed preeclampsia. Method: A comparison of all singleton term (>36 weeks) deliveries occurring between 1988 and 1999, with and without chronic hypertension, was performed. Stratified analyses, using the Mantel–Haenszel technique, and a multiple logistic regression model were performed to control for confounders. Results: Chronic hypertension complicated 1.6% (n=1807) of all deliveries included in the study (n=113 156). Using a multivariable analysis, the following factors were found to be independently associated with chronic hypertension: maternal age >40 years (OR=3.1; 95% CI 2.7–3.6), diabetes mellitus (OR=3.6; 95% CI 3.3–4.1), recurrent abortions (OR=1.5; 95% CI 1.3–1.8), infertility treatment (OR=2.9; 95% CI 2.3–3.7), and previous cesarean delivery (CD; OR=1.8 CI 1.6–2.0). After adjustment for superimposed preeclampsia, using the Mantel–Haenszel technique, pregnancies complicated with chronic hypertension had higher rates of CD (OR=2.7; 95% CI 2.4–3.0), intra uterine growth restriction (OR=1.7; 95% CI 1.3–2.2), perinatal mortality (OR=1.6; 95% CI 1.01–2.6) and post-partum hemorrhage (OR=2.2; 95% CI 1.4–3.7). Conclusion: Chronic hypertension is associated with adverse pregnancy outcome, regardless of superimposed preeclampsia. [Copyright &y& Elsevier]

Objectives: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. Methods: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. Results: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n=121 227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1–6.3), hydramnios (OR=3.0; 95% CI 2.3–3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8–5.1), preterm delivery (OR=2.1; 95% CI 1.6–2.8), induction of labor (OR=2.2; 95% CI 1.7–2.8), grandmultiparity (>five deliveries, OR=1.9; 95% CI 1.5–2.3), lack of prenatal care (OR=1.4; 95% CI 1.02–1.8), and male gender (OR=1.3; 95% CI 1.1–1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR=11.9, 95% CI 7.9–17.9), and had longer hospitalizations (mean 5.4±3.5 days vs. 2.9±2.1 days; P<0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5–9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. Conclusions: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality. [Copyright &y& Elsevier]

Objective: To define obstetrical risk factors for arrest of descent during the second stage of labor and to determine perinatal outcome. Study design: All singleton, vertex, term deliveries with an unscarred uterus, between the years 1988 and 1999 were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor and the perinatal outcome. Results: The study included 93 266 deliveries, of these 1545 (1.7%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: nulliparity (OR=7.8, 95% CI=6.9–8.7; P<0.001), birth weight >4 kg (OR=2.3, 95% CI=1.9–2.8; P<0.001), epidural analgesia (OR=1.8, 95% CI=1.6–2.0; P<0.001), hydramnios (OR=1.6, 95% CI=1.3–2.0; P<0.001), hypertensive disorders (OR=1.5, 95% CI=1.3–1.8; P<0.001), gestational diabetes A1 and A2 (OR=1.5, 95% CI=1.2–1.8; P<0.001), male gender (OR=1.4, 95% CI=1.2–1.5; P<0.001), premature rupture of membranes (PROM, OR=1.3, 95% CI=1.04–1.6; P=0.021), and induction of labor (OR=1.2, 95% CI=1.02–1.4; P=0.030). Deliveries complicated by arrest of descent resulted in cesarean section in 20.6%, vacuum extraction in 74.0%, and forceps delivery in 5.4%. Newborns delivered after arrest of descent during the second stage of labor had significantly higher rates of low Apgar scores (<7) at 1 and 5 min, as compared to the controls (12.7 vs. 2.1%, P<0.001; and 0.9 vs. 0.2%, P<0.001, respectively). Nevertheless, no significant differences were noted between the groups regarding perinatal mortality (0.38 vs. 0.44%; P=0.759). Conclusions: Major risk factors for arrest of descent during the second stage of labor were nulliparity, fetal macrosomia, epidural analgesia, hydramnios, hypertensive disorders and gestational diabetes mellitus. These risk factors should be carefully evaluated during pregnancy in order to actively manage high-risk pregnancies. [Copyright &y& Elsevier]

We set out to examine pregnancy outcome of women who utilised prenatal care facilities and those who did not, within two different ethnic groups living in the same region and sharing basically the same medical facilities. The study population consisted of all singleton deliveries occurring between the years 1990-97 (n = 78 955). The analysis was based on a comparison of births to Jewish and Bedouin women who did not have prenatal care (defined as less than three visits at any prenatal care facility during the pregnancy) and those who had prenatal care (at least three visits at any prenatal care facility). Lack of prenatal care was found in 0·98% of the Jewish mothers and in 20·95% of the Bedouin women. Bedouin women receiving prenatal care had significantly higher rates of perinatal mortality (OR = 1·8, 95% CI 1·6-2·2; P < 0·001) and newborns weighing less than 2500 g (OR = 1·2, 95% CI 1·2-1·3; P < 0·001) compared to their Jewish counterparts. However, in the comparison of women lacking prenatal care, no statistically significant differences were found between the groups with regard to those variables. In spite of the overwhelming cultural and socioeconomic differences between these societies, lack of prenatal care crossed social borders and a similar poor pregnancy outcome was found to be common in the two groups. Attempts should be made in order to remove barriers to prenatal care and to increase adequate utilisation of prenatal care in all societies in general and in ethnic minorities in particular. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of early amniotomy in term gestation on the mode of delivery and pregnancy outcome in comparison with premature rupture of membranes (PROM) and oxytocin induction.Study Design: The study population consisted of 60 consecutive parturients induced by early amniotomy. The two comparison groups were 147 women admitted with term PROM and 65 patients induced by oxytocin. All study participants were evaluated prospectively and had unfavorable cervical scores.Results: The duration of the first stage of labor was significantly longer in the PROM group (987.8 +/- 572.3 min) as compared with the early amniotomy group (615.0 +/- 389.6 min) and the oxytocin induction group (650.9 +/- 349.5 min, P<0.001). Higher rates of CS were found in the study group (26.7%) as compared to the controls (11.6% in the PROM and 16.9% in the oxytocin groups, p=0.012). Neonatal outcome was similar in all groups. A stratified analysis comparing the risk of CS while controlling for a previous one did not show a significant difference between the early amniotomy and the oxytocin administration groups.Conclusions: Early amniotomy is associated with a higher rate of CS. While controlling for a previous CS, both ways of induction were comparable. In order to decrease the CS rates, induction should probably start with cervical ripening techniques in order to improve the Bishop scores. [ABSTRACT FROM AUTHOR]

We present our data concerning a single clone bearing chromosomal aberration obtained by routine amniocentesis in 2340 parturients. Single clone chromosomal aberrations in amniocytes were more commonly observed in chromosomes 8,18,21,22,X and as supernumeric marker chromosome. No correlation has been found between the incidental chromosomal changes observed in one or two cells of the cultured amniocytes and obstetrical and demographic parameters. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the study was to determine whether 1 previous miscarriage is associated with an increased rate of adverse pregnancy outcomes in the following pregnancy. STUDY DESIGN: Second pregnancies of women with and without a miscarriage in their initial pregnancy were compared. Multivariable logistic regression models were constructed to control for confounders. RESULTS: Of 35,125 singleton deliveries in the second pregnancy, 5777 (16.4%) were of patients with an initial miscarriage. Multivariable analysis showed a significant association between a previous miscarriage and the following adverse pregnancy outcomes including premature rupture of membranes (odds ratio [OR], 2.22; 95% confidence interval [CI], 2.01-2.44), preterm delivery (OR, 1.34; 95% CI, 1.21-1.48), intrauterine growth restriction (OR, 1.24; 95% CI, 1.04-1.47), hypertensive disorders (OR 1.41; 95% CI 1.07-1.85), preeclampsia (OR, 1.63; 95% CI, 1.22-2.18), and cesarean delivery (OR, 1.59; 95% CI, 1.46-1.73). Perinatal mortality was significantly higher among women with an initial miscarriage (1.6% vs 1.0%; P < .001). CONCLUSION: An initial miscarriage is independently associated with adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Anemia, the decrease of the hemoglobin concentration with a consequent decrease in the hematocrit level, is a common disorder complicating pregnancies and is mostly due to iron deficiency. The increase of iron requirements, plasma volume, and the poor intake of iron constitute the principal causes of this deficiency. The present review summarizes the current literature regarding anemia during pregnancy and the parenteral iron therapy options. [Copyright &y& Elsevier]