730例育龄妇女死亡原因及相关因素分析

目的:分析影响韶关市城区育龄妇女死亡的相关因素,探讨相应的干预措施。方法:对韶关市城区常住人口1998~2006年的育龄妇女死亡资料进行回顾性分析。结果:育龄妇女死亡730例,恶性肿瘤(39.32%)与意外死亡(29.32%)是育龄妇女死亡的主要原因。在恶性肿瘤死因中,居前3位的分别是消化系肿瘤、呼吸系肿瘤和乳腺癌,但居首位的单一疾病却是乳腺癌。交通事故和自杀是意外死亡的主要原因。不同年龄的育龄妇女恶性肿瘤和意外死亡的构成比在统计学上有显著性差异(P<0.001)。结论:降低恶性肿瘤和意外死亡的发生率,是降低育龄妇女死亡的关键。在开展健康教育时,对年龄偏大的育龄妇女,应普及自身防癌知识,尤其是乳腺的"自我检查",并加强对肿瘤的防治;对年龄偏小者以开展人生观和道德观教育为主,培养其良好的心理素质,降低意外事故的发生率。     

Psychosocial conditions and suicidal behavior in pregnant teenagers

Objective  To compare the psychosocial profile and suicidal behavior of 110 pregnant teenagers (PT) with 110 non-pregnant teenagers (NPT). Method  Subjects were matched by age and residential district. The research instruments used were a structured clinical interview and a self-reporting questionnaire based on psychometric scales whose answers were subjected to univariate and multivariate logistic regression. Results  Prevalence in the PT and the NPT groups were found to be as follows: attempted suicide (20.0 vs. 6.3%); depression (26.3 vs. 13.6%); anxiety (43.6 vs. 28.0%). Univariate analysis revealed the following significant associations with pregnancy: relocation in the previous 3 years (odds ratio (OR) = 6); years of schooling ≤7 (OR = 3.4); repeating a year in school (OR = 2.4); dropping out of school (OR = 5.2); death of a parent during childhood (OR = 2.9); use of alcohol/drugs in the family (OR = 2.5); previous attempted suicide (OR = 3.6); suicide by a relative (OR = 2.1); threats of physical/sexual abuse (OR = 3.5); depression (OR = 2.2); low level of social support (OR = 4.2); traumatic events (OR = 5.1) and psychosocial difficulties (OR = 4.4); prior use of tobacco and marijuana (OR = 4.0 and 4.8 respectively); weekly intake of alcohol over the previous 12 months (OR = 4.2). Multivariate analysis identified the following associations: relocation (OR = 6.4); prior use of tobacco (OR = 2.9); dropping out of school for a period in excess of 6 months (OR = 2.3); suicide by a social acquaintance (OR = 2.5). Conclusion  The PT case group exhibited a psychosocial profile whose characteristics clearly differentiate this group from the NPT control group. Preventive mental health care is needed to help PT because their behavioral pattern exposes them to high risk for suicide.     

'With woman' philosophy: examining the evidence, answering the questions

'With woman', 'woman centred' and 'in partnership with women' are new terms associated with midwifery care in Australia, and the underlying philosophy has emerged both as an antidote to the medicalisation of pregnancy and in a bid to reacquaint women with their natural capacity to give birth successfully and without intervention. A reorientation of midwifery services in the 1990s, a shift towards midwifery-led care (MLC) and the subsequent introduction of direct entry midwifery programs all contributed to this new direction. Central concepts are a focus on the childbearing woman and a valuing of women's experiences. While this philosophical re-alignment has been applauded by many midwives in terms of maternal empowerment and improved autonomy for midwives, there are nonetheless some concerns that, with its emphasis on normality, midwifery-led care is in danger of becoming an exclusionary model. Particular concerns include meeting the needs of a growing cohort of women, those with 'high risk' pregnancies, and the educational adequacy of direct entry midwifery programs. To date, there has been no thorough evaluation of this emerging midwifery philosophy in Australia. In order to open the debate, this paper aims to initiate a discussion of 'with woman' midwifery care as it applies to Australian practice.     

Association of Chlamydia trachomatis serology with tubal infertility in Nigerian women

AIM: To determine the association between tubal infertility and Chlamydia trachomatis in Nigerian women. METHODS: This case-control study is from the Departments of Obstetrics and Gynecology of two tertiary hospitals in Nigeria. One hundred and sixty-two infertile patients with tubal occlusion had 162 pregnant women matched for age as controls. Information on sociodemographic variables, sexual and reproductive risk factors, and history of previous pelvic infections were elicited using a study protocol. The prevalence of Chlamydia Trachomatis antibody was determined for cases and controls. RESULTS: The prevalence of serum Chlamydia antibody was significantly higher in cases (65.8%) compared with controls (17.3%; P < 001). The effects of Chlamydia antibodies on infertility were strengthened in the multivariate model controlling for Chlamydia antibodies and gynecologic symptoms, compared to the univariate model. However, the association was attenuated and non-significant when the effects of gynecologic symptoms, sociodemographic characteristics, contraceptive and sexual history were controlled in the conditional logistic regression model. The strongest independent predictors of infertility in the model were vaginal discharge, education less than tertiary and more than three lifetime sexual partners (proxies of sexually transmitted infections). CONCLUSIONS: There was no strong independent association between Chlamydia antibodies and the risk of being infertile in Nigerian women. By contrast, the proxies of sexually transmitted infections were significant predictors of infertility in the women. Efforts to address these factors, which are proxies of sexually transmissible infections, Chlamydia infection, and health-seeking behavior for these infections, will likely contribute to reducing the burden of infertility in Nigerian women.     

Residential mobility in a cohort of primiparous women during pregnancy and post-partum

OBJECTIVE: To quantify the residential mobility rate in a population of pregnant women expecting their first baby. METHOD: We verified residential mobility in a cohort of 585 primiparous Australian women who were enrolled in late pregnancy and had participated in a randomised controlled trial and followed-up to at least 16 weeks post-partum. RESULTS: We found a residential mobility rate of 19%. Movers and non-movers differed by socio-demographic factors, with movers more likely be younger, relative risk (RR)=2.14 (95% confidence interval (CI) 1.41-3.13), and not living with a partner RR=2.46 (95% CI 1.60-3.77). CONCLUSION: Most prospective epidemiological studies can expect some attrition in the study population. The family formation period is acknowledged as a highly mobile time and this mobility may contribute to loss to follow-up. Implications: Researchers planning prospective studies in pregnant populations should consider the impact of residential mobility, especially differential mobility, and implement strategies to reduce attrition and optimise response rates.     

Experimentally induced citrinin and endosulfan toxicity in pregnant Wistar rats: histopathological alterations in liver and kidneys of fetuses

In the present investigation, citrinin (CIT) (10 mg kg(-1) feed) and endosulfan (1 mg kg(-1) body weight) were administered orally alone and in combination to pregnant Wistar rats from gestational day 6 to 20 and their fetuses were collected to evaluate the histopathological alterations in hepatic and renal tissues. In CIT-fed group fetal liver, the changes were less marked, showing only sinusoidal dilation and mild vacuolar degeneration, whereas the consistent changes in the fetal kidney included tubular degeneration, medullary tubular necrosis, cystic dilatation of tubules, distortion of glomerulur capillary tuft and interstitial fibroblastic proliferation which separated clusters of tubules. In the endosulfan group, the liver was predominantly affected, showing vacuolar degeneration, karyomegaly and severe sinusoidal dilation, whereas the renal changes were mainly confined to tubular degeneration and varying degree of interstitial fibrosis. In the combination group, the hepatic and renal histopathological alterations in the fetus, though of similar nature to those of the individual groups, were more severe.     

正常孕妇外周血及新生儿脐血中的抗血友病因子活性的检测与分析

目的:了解正常孕妇外周静脉血及其新生儿脐血中的抗血友病因子活性水平,为开展产前诊断新生儿血友病奠定基础。方法:应用国际通用的一期法检测正常孕妇外周静脉血及其新生儿脐血中的凝血因子Ⅷ活性(FⅧ:C)和凝血因子Ⅸ活性(FⅨ:C),随机选择正常女性献血者作为对照组。结果:正常孕妇外周血中FⅧ:C浓度为135.0％±33.0％(54.4％～200.0％);FⅨ:C浓度为127.1％±29.5％(85.6％～200％)。新生儿脐血中的FⅧ:C浓度为对77.9％±15.0％(38.5％～192.0％);FⅨ:C浓度为63.1％±15.4％(32.2％～149.0％)。正常女性献血者(正常未孕妇)FⅧ:C浓度为94.6±26.2％(50.4％～181.4％);FⅨ:C浓度为98.6％±29.2(64.9％～156.0％)。结论:新生儿脐血中的FⅧ:C和FⅨ:C含量显著低于正常女性献血者和正常孕妇外周血中的含量,处于低凝状态。正常孕妇外周血中的FⅧ:C和FⅨ:C含量显著高于正常女性献血者中的含量,处于高凝状态。     

Self-Reported Exposure to Second-Hand Smoke and Positive Urinary Cotinine in Pregnant Nonsmokers

Purpose

This cross-sectional study aimed to examine the association between self-reported exposure status to second-hand smoke and urinary cotinine level in pregnant nonsmokers.

Materials and Methods

We recruited pregnant nonsmokers from the prenatal care clinics of a university hospital and two community health centers, and their urinary cotinine concentrations were measured.

Results

Among a total of 412 pregnant nonsmokers, the proportions of self-reported exposure to second-hand smoke and positive urinary cotinine level were 60.4% and 3.4%, respectively. Among those, 4.8% of the participants who reported exposure to second-hand smoke had cotinine levels of 40 ng/mL (the kappa value = 0.029, p = 0.049). Among those who reported living with smokers (n = 170), "smoking currently permitted in the whole house" (vs. not permitted at home) was associated with positive urinary cotinine in the univariable analysis. Furthermore, this variable showed a significant association with positive urinary cotinine in the stepwise multiple logistic regression analysis [Odds ratio (OR), 15.6; 95% Confidence interval (CI) = 2.1-115.4].

Conclusion

In the current study, the association between self-reported exposure status to second-hand smoke and positive urinary cotinine in pregnant nonsmokers was poor. "Smoking currently permitted in the whole house" was a significant factor of positive urinary cotinine in pregnant nonsmokers. Furthermore, we suggest that a complete smoking ban at home should be considered to avoid potential adverse effects on pregnancy outcomes due to second-hand smoke.     

Dietary aspects of pregnant women in rural areas of Northern India

The aim of this article is to document the current dietary profile of pregnant women in rural areas of Delhi. In order to explore the diet the combination of quantitative (24-h recall method) and qualitative methods (food frequency method) were used. The mean intake of macronutrients and micronutrients, namely, iron, folic acid and Vitamin C which play an important role in the pathophysiology of nutritional anaemia during pregnancy was calculated from the foodstuffs, using Nutritive Value of Indian Foods. The preferences and avoidance of various foods by the pregnant women were also elicited. The data were analysed using Epi Info 3.4. The intake of calories, protein, iron, folic acid and Vitamin C was found to be less than the recommended dietary allowance in 100%, 91.2%, 98.2%, 99.1% and 65.8% of pregnant women respectively. Folic acid intakes were significantly lower in younger, primiparous and poorly educated women from low-income families. Vitamin C intake was lower among non-Hindus only. The overall data suggested the presence of food gap rather than isolated deficiency of any particular nutrient.