Serum adiponectin is a potential biomarker for metabolic syndrome in peri-and postmenopausal women

Abstract

Metabolic syndrome (MetS) increases its prevalence during menopausal period and there is no appropriate marker for screening before the cardiovascular damage begun. This study aims to find the diagnostic accuracy and the appropriate cutoff level of serum adiponectin for the screening of MetS in peri- and postmenopausal women. Women aged at least 40?years old attending health checkup clinic were recruited. Anthropometric measurements, blood pressure, MENQOL, and blood chemistry (glucose, adiponectin, HDL-C, LDL-C, and TG) were recorded. MetS was defined by JIS 2009 criteria. 290 peri-and postmenopausal women mean age 54.25?±?8.6?years were recruited. 66% was postmenopause and 21.4% of them has MetS. The socioeconomic and lifestyle factors seem similar among women with and without MetS. In the participants with MetS, the prevalence of abdominal obesity was higher (96.8% vs 49.6%, p?<?.001, respectively) and more prevalence of android fat distribution pattern was observed (76.2% vs 36%, p?<?.001, respectively). Serum adiponectin was significantly lower in women with MetS (6.0?±?4.6 vs 9.2?±?5.2?μg/mL, p?<?.001 in MetS and non-MetS, respectively). Serum adiponectin is a good biomarker for MetS and we recommend the cutoff level of serum adiponectin lower than 7.15?μg/mL for screening of MetS (AUC (95% CI) of = 0.72 (0.64–0.79), p?<?.001).     

Clinical factors associated with pregnancy outcome in women with recurrent pregnancy loss

Abstract

The aim of this prospective cohort study was to evaluate clinical factors associated with pregnancy outcomes in women with recurrent pregnancy loss (RPL). Women with a history of two or more pregnancy losses underwent workups for clinical factors of RPL and their pregnancies were followed-up with informed consent. Two hundred eleven (81.5%) of 259 women with RPL became pregnant. The multivariable analyses demonstrated that age (p?<?.01, OR 0.9, 95%CI 0.97–0.83), uterine abnormality (p?<?.05, OR 0.3, 95%CI 0.11–0.8), and protein C (PC) deficiency (p?<?.01, OR 0.14, 95%CI 0.03–0.6) were independent factors for becoming pregnancy in women with RPL. The number of previous pregnancy loss (p?<?.01, OR 0.57, 95%CI 0.43–0.75) and natural killer (NK) cell activity ≥33% (p?<?.01, OR 0.31, 95%CI 0.13–0.73) were independent factors for live birth in the subsequent pregnancy. Advanced age, the presence of uterine abnormality, and PC deficiency were risk factors for reduced pregnancy rate in women with RPL. Increased number of previous pregnancy loss and high NK cell activity were risk factors for miscarriage in the subsequent pregnancy. These results involve important information and are helpful for clinical practitioners.     

Different tools for estimating cardiovascular risk in Brazilian postmenopausal women

Abstract

Objective: To compare estimation of cardiovascular risk using the Framinghan Risk Score (FRS) and the presence of the metabolic syndrome (MetS) in postmenopausal women to prevent primary cardiovascular disease (CVD).

Methods: This cross-sectional study included 497 Brazilian women (aged ≥45 years and amenorrhea >12months). Cardiovascular risk was calculated using the FRS that includes age, total cholesterol, HDL, systolic blood pressure and smoking status. Women showing three or more of the following criteria were diagnosed with MetS: waist circumference (WC) >88?cm, blood pressure ≥130/85?mmHg, triglycerides ≥150?mg/dl, HDL?<?50?mg/dl and glucose ≥100?mg/dl. For statistical analysis, the Chi-square, Fisher’s exact, and logistic regression (odds ratio-OR) were used.

Results: The mean age was 55.3?±?7.0 years and time since menopause 7.2?±?5.9 years. Based on FRS, 72.4% of women were classified as low-risk, 16.5% moderate risk and 11.1% a high-risk. MetS was identified in 40% of the women, and 46.2% were considered of moderate risk for CVD, while 84.9% of those without MetS were classified as low-risk (p?<?0.001). The risk for CVD increased significantly with age at menopause (OR1.10; 95% CI, 1.04–1.17), time since menopause (OR1.13; 95% CI, 1.08–1.18), elevated triglycerides (OR1.03; 95% CI, 1.0–1.10) and presence of MetS (OR1.72; 95% CI 1.48–1.84).

Conclusions: By using only FRS to estimate cardiovascular risk, a substantial number of postmenopausal women showing evidence of MetS were not identified, even though women with MetS are at higher risk of CVD.     

The relationship between serum uric acid and metabolic syndrome in premenopausal and postmenopausal women in the Jinchang Cohort

The aim of the study was to explore the association between serum uric acid (SUA) and metabolic syndrome (MetS) in premenopausal and postmenopausal women in the Jinchang Cohort. We studied 3808 female Jinchuan Nonferrous Metals Corporation workers aged 40–60 years. Cohort data from epidemiological surveys and medical exams were used. MetS was defined using the 2009 Joint Interim Society criteria. The relationship between SUA and MetS was evaluated using multiple logistic regression after adjusting for potential confounders. MetS and hyperuricemia were more prevalent in postmenopausal women than premenopausal ones (35.3% versus 15.2% and 9.2% versus 4.2%, respectively). Premenopausal and postmenopausal women with hyperuricemia had 2.81 (95% CI: 1.72–4.61) and 2.10 (95% CI: 1.44–3.08), respectively, times the odds of having MetS than their counterparts without hyperuricemia. Even within normal SUA quartiles, only premenopausal women in the highest and second-highest quartile had 3.57 (95% CI: 2.24–5.68) and 2.78 (95% CI: 1.71–4.50), respectively, times the odds of having MetS than those in the lowest quartile. Even in the normal range, the odds ratios for MetS increased gradually according to SUA levels in all women (P_trend?<_?0.001). In conclusion, there was a significant correlation between SUA levels and MetS, and the association was stronger in premenopausal women than postmenopausal ones.     

Inducible nitric oxide inhibitor aminoguanidine,ameliorated oxidative stress,interleukin-6 concentration and improved brain-derived neurotrophic factor in the brain tissues of neonates born from titanium dioxide nanoparticles exposed rats

Abstract

Introduction: An interaction between oxidative stress, neuroinflammation, and nitric oxide (NO) has been suggested to have a role neurotoxicity. The aim of current research was to investigate the effect of aminoguanidine (AG) as an inducible NO synthase (iNOS) inhibitor, on brain-derived neurotrophic factor (BDNF), oxidative stress, and interleukin-6 (IL-6) concentrations in the brain tissues of neonates born from the rats exposed to titanium dioxide nanoparticles (TiO2 NPs) during gestation.

Methods: The pregnant rats were grouped into three and received: (1) saline, (2) TiO2 (200?mg/kg, gavage), and (3) TiO2-AG [200?mg/kg intraperitoneal (IP)]. The treatment was started since the second gestation day up to the delivery time. The neonates born from the rats were deeply anesthetized, sacrificed, and the brains were collected for biochemical evaluations.

Results: The neonates born from the rats exposed to TiO₂ showed a lower BDNF (p?<?.001) but a higher IL-6 (p?<?.01) concentrations in their hippocampal tissue. TiO₂ exposure also increased malondialdehyde (MDA) (p?<?.001) and NO metabolites (p?<?.001), while diminished thiol (p?<?.001), superoxide (SOD) (p?<?.001), and catalase (CAT) (p?<?.001) in all hippocampal, cortical, and cerebellar tissues. Administration of AG improved BDNF (p?<?.01) but attenuated IL-6 (p?<?.01) concentrations in the hippocampal tissue. AG also decreased MDA (p?<?.001) and NO metabolites (p?<?.01–p?<?.001), while increased thiol (p?<?.01–p?<?.001), SOD (p?<?.001), and CAT (p?<?.05–p?<?.001) in all cerebellar, hippocampal, cortical, and tissues.

Conclusion: The results of the current research revealed that iNOS inhibitor AG, ameliorated oxidative stress, IL-6 concentration, and improved BDNF in the brain tissues of neonates born from TiO₂ NPs exposed rats.     

Misconceptions and current use of contraception among women of reproductive age in six major cities in Nigeria

Abstract

Objectives: The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods.

Methods: We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15–49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use.

Results: Catholic women were significantly more likely to have misconceptions compared with Muslim women (β?=?1.09; 95% confidence interval [CI] 0.58, 1.60; p?<?.001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (β=??0.06; 95% CI ?0.96, ?0.29; p?<?.001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p?>?.05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p?<?.001).

Conclusion: These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.     

Dehydroepiandrosterone sulfate/free androgen index ratio predicts a favorable metabolic profile in patients with polycystic ovary syndrome

Potential effect of hyperandrogenemia on metabolic disturbances in polycystic ovary syndrome (PCOS) has always been a matter of interest. We analyzed the records of 125 patients with PCOS and 54 age-matched healthy women. All participants underwent biochemical and hormonal assessment and a 75?g oral glucose tolerance test was performed. PCOS and control groups were comparable in terms of age. Dehydroepiandrosterone sulfate/free androgen index (DHEAS/FAI) ratio was negatively correlated with body mass index (BMI) (p?<?.001), fasting glucose (p?=?.02), area under the curve (AUC) of glucose (p?=?.03), AUC of insulin (p?=?.001), homeostasis model assessment-estimated insulin resistance (HOMA-IR) (p?<?.001), and triglycerides (TG) (p?=?.009), and positively correlated with insulin sensitivity index (ISI) (p?<?.001) and high-density lipoprotein cholesterol (HDL-C) (p?<?.001) among PCOS patients. In logistic regression analysis, higher DHEAS/FAI ratio levels were associated with lower risk of low HDL-C [RR(95%CI); 0.97(0.95–0.98); p?<?.001] as well as atherogenic dyslipidemia (TG/HDL-C) [RR(95%CI); 0.97(0.94–0.99); p?=?.035] even after adjustment for BMI in the PCOS group. Androgens, DHEAS and FAI act differently on metabolic parameters. Our results demonstrate that high DHEA-S/FAI ratio levels are associated with a more favorable metabolic profile.     

It’s not as bad as you think: menopausal representations are more positive in postmenopausal women

Introduction: The menopausal transition is associated with underlying hormonal changes that can contribute to a range of physical and emotional symptoms. Psycho-social factors including attitudes and internal representations play a central role in women’s experience of the menopause, but very little is known about how representations might differ across menopausal stages.

Methods: A sample of 387 women aged 40–60 completed a postal questionnaire that included the menopausal representations questionnaire, the emotional representation subscale adapted from the illness perception questionnaire, and data on menopausal status.

Results: Significant differences across menopausal stages were found for both cognitive [F(2, 381)?=?4.32, p?<?.05, η²?=?0.022], and emotional [F(2, 381)?=?9.70, p?<?.01, η²?=?0.048] menopausal representations. Postmenopausal women had a significantly more positive cognitive representations of the menopause relative to perimenopausal women (standardised mean difference?=?0.25, p?>?.05). Postmenopausal women held a significantly more positive emotional representation of the menopause than both premenopausal (standardised mean difference?=?0.56, p?<?.05) and perimenopausal (standardised mean difference?=?0.43, p?<?.05) women.

Discussion: Women’s emotional and cognitive representations of the menopause are more positive among postmenopausal women, compared to women in the late premenopausal stage. This is consistent with the affective forecasting theory, which proposes the tendency to overestimate the intensity and duration of emotional reactions to future events. Given the association between representations and bothersomeness of menopausal symptoms, clinicians should educate women about their expectations, and challenge their negative beliefs about the menopause.     

Association between bile salt export pump polymorphisms and intrahepatic cholestasis of pregnancy susceptibility: a meta-analysis of case-control studies

The purpose of this meta-analysis was to investigate the relationship between bile salt export pump (BSEP) polymorphisms and intrahepatic cholestasis of pregnancy (ICP) susceptibility. Retrieved studies from Pubmed, EMBASE, Web of Science, Cochrane Library and CBM databases about BSEP polymorphisms and ICP susceptibility were included. Odds ratio (OR) and 95% confidence interval (CI) and publication bias were calculated. Ten related case-control studies on BSEP polymorphisms and ICP susceptibility were included. The pooled results showed a significant association between BSEP rs2287622 polymorphism and ICP risk in Asian population (OR >1, p?<?.01 for A vs. a and AA vs. Aa/aa) and general population (OR >1, p?<?.05 for A vs. a, Aa vs. aa, AA/Aa vs. aa), and a borderline statistical significance was found between BSEP rs473351 polymorphism and ICP susceptibility (OR?=?1.66, p?<?.05), and no statistical significance was found in D482G or rs853782 polymorphisms and ICP risk (all p?>?.05). Additionally, no publication bias was found in these studies (all p?>?.05). Our current meta-analysis indicated that BSEP rs2287622 polymorphism could increase the susceptibility of ICP in Asians and in general populations, while rs473351, D482G, and rs853782 polymorphisms were not obviously associated with ICP risk, but it needs further larger study with ethnicity and various etiologies.     

Changes in circulating levels of carboxymethyllysine,soluble receptor for advanced glycation end products (sRAGE), and inflammation markers in women during normal pregnancy

Abstract

Objective: To determine the circulating levels of insulin, Nε-carboxymethyllysine (CML), soluble receptor for advanced glycation end products (sRAGE), and markers of inflammation and oxidative stress (OS) in maternal and umbilical cord blood in a cohort of healthy women with normal pregnancy.

Methods: We conducted an observational longitudinal study in a group of women (n?=?31; age range 18–39 years) with healthy pregnancy starting at 30 weeks of gestation and finishing at the time of delivery. We collected weight and height in the participants and their neonates and calculated body mass index (BMI). Blood from each patient was collected at 30th week of pregnancy and at delivery when a sample of cord blood was also obtained. Glucose, lipid profile, CML, sRAGE, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), highly sensitivity C-reactive protein (hsPCR), and insulin were determined. The study was approved by the University of Guanajuato Institutional Ethics Committee.

Results: All pregnancies reached term (mean gestational time 38.9?±?0.83 weeks) and there were no maternal complications. Mean age was 27.6 years. Lipid profile values were higher in the group compared with our values in nonpregnant women. During pregnancy, levels of insulin increased (p?<?.0006), CML (p?<?.0001) and sRAGE (p?<?.01) decreased, levels of MDA did not change, while those of TNF-α and hsPCR tended to increase. In the neonates, we found lower levels of CML (p?<?.003), hsPCR (p?<?.004), and insulin (p?<?.004) and higher levels of sRAGE (p?<?.013) and TNF-α (p?<?.022) compared to their mothers at delivery. In the total group, we found association of CML of the mother at baseline with the CML (p?<?.0006) and MDA (p?<?.002) in neonates, while maternal sRAGE at the end of pregnancy was associated with CML (p?<?.004) of their neonates.

Conclusions: Our study confirms that normal pregnancy is accompanied by insulin resistance (IR) and significant increase in lipid profile, and demonstrates that circulating levels of CML and sRAGE decreased significantly at the end of pregnancy. The lack of association between the course of insulin levels and those of CML probably results from the predominant role of placental factors in the pathogenesis of IR in pregnancy. sRAGE levels in the neonates are markedly increased compared to their mothers suggesting a placental origin of this compound which may have a protective effect on the fetus since sRAGE restricts Advanced glycation end product (AGE) effects and may exert anti-inflammatory effects.     

The ultrasonographic detection of follicular rupture at the time of intrauterine insemination: is it really decisive?

Abstract

Our aim is to assess the impact of the ultrasonographic detection of follicular rupture on the intrauterine insemination success. A total of 313 women undergoing ovarian stimulation for intrauterine insemination were enrolled. Transvaginal ultrasonography was performed to check whether the dominant follicle had ruptured and according to that the patients were divided into two groups. The ultrasound detection of follicular rupture was observed in 156 patients (54%). The independent variables favoring follicular rupture were: Age (t: 7.646, p?<?0.0005), FSH value (t: ?5.637, p?<?0.0005), duration of infertility (t: ?4.265, p?<?0.0005), menstrual cycle length (t: ?4.927, p?<?0.0005). Moreover, the logistic regression analysis demonstrated that the predictive variables for follicular rupture were: FSH value (OR 1.7, CI 95% 1.3–2.3, p?<?0.0005), duration of infertility (OR 2.6, CI 95% 1.6–4.2, p?<?0.0005) and menstrual cycle length (OR 2.4, CI 95% 1.7–3.4, p?<?0.0005). Pregnancy occurred in 23 patients of the group A (14.7%) and in 22 patients of the group B (16.5%) without a significant difference (p?=?0.6). The logistic regression analysis confirmed that neither the evidence of follicular rupture nor any other variables influenced the pregnancy rate.     

Fracture risk assessment in postmenopausal women with diabetes: comparison between DeFRA and FRAX tools

This study aimed to compare the performance of Fracture Risk Assessment Tool (FRAX) with that of Derived FRAX (DeFRA) in estimating fracture risk in a cohort of type-2 diabetes mellitus (T2DM) postmenopausal women. One hundred nineteen T2DM postmenopausal women and 118 consecutive healthy postmenopausal women were enrolled. Fracture risk was assessed with FRAX (adjusted or non- for trabecular bone score, TBS) and DeFRA. Bone mineral density (BMD) and TBS were evaluated by dual-energy X-ray absorptiometry (DXA). The outcome was the presence of vertebral/non-vertebral fragility fractures (FFs). T2DM women showed higher spinal BMD T-score (p?p?p?p?相似文献   

Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study

Abstract

This cross-sectional study included postmenopausal women, aged 45–75?years, with the aim to assess the presence of vulvovaginal atrophy (VVA) confirmed by a clinical assessment in the Italian population attending menopausal/gynecological centers. Apart from baseline variables, women scored vaginal, vulvar and urinary VVA symptoms. Impact of VVA on sexual function and quality of life (QoL) was assessed thorough EuroQoL questionnaire (EQ5D3L), Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-revised (FSDS-R). A physical examination was carried out in accordance with routine gynecological practice. VVA was confirmed in 90% of the 1226 evaluable patients (aged 59.0?±?7.3?years). The prevalence of postmenopausal women with VVA confirmed by gynecological clinical assessment was 75.3%. The patients with VVA confirmed (n?=?926) had more severe symptoms (p?<?.0005), lower QoL (EQ-visual analog scale, p?=?.008 and DIVA, p?<?.0005) and worsened sexual function (FSFI and FSDS-R, p?<?.0005 for both) when compared with the patients having nonconfirmed VVA (n?=?140). VVA is highly prevalent among postmenopausal Italian women. The objective of VVA confirmation is associated with severe symptoms and impaired QoL and sexual function. A proactive approach of Italian clinicians to promote regular and early gynecological evaluation should be performed in order to delay the advancing of the disorder.     

Neurovegetative disorders of perimenopausal women treated with docosahexaenoic acid (DHA, 625 mg)

The study evaluated the effect of DHA 625?mg in women who experience menopausal symptoms, on sexuality and quality of life (QoL), and on the auditory brainstem response (ABR). Forty-two perimenopausal women were enrolled. The Kupperman Index (KI) was used to evaluate menopause symptoms. The Short Form-36 (SF-36), Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function, and sexual distress, respectively. Auditory evoked potentials to measure the ABR. The study had one follow-up at 6 months. The women reported an improvement in the KI total score (p?p?p?=?NS). FSFI and FSDS total scores increased (p?p?p?p?p?相似文献   

Comparison Of Cimicifuga foetida extract and different hormone therapies regarding in causing breast pain in early postmenopausal women

This study aimed to compare the influence between Cimicifuga foetida extract and different hormone therapies on breast pain in early postmenopausal women. A prospective, randomized, controlled clinical trial was conducted among 96 early postmenopausal women. Participants were randomly assigned to three groups: group A received 1?mg/day estradiol valerate plus 4?mg/day medroxyprogesterone acetate on days 19–30; group B received 1?mg/day estradiol valerate plus 100?mg/day micronized progesterone on days 19–30; group C received C. foetida extract, 1talet (contains 33.3?mg extract), t.i.d. Breast pain diary and numerical rating scale was used to access the breast pain. For 6 months’ treatment, the total incidence of breast pain in group A and B was significantly higher than that in group C (p?<?.05). The duration (day) of breast pain in each month decreased over time in group A and B while it was continuously low and without significant change in group C (p?>?.05). The intensity of breast pain was mild in most participants and did not differ among three groups (p?>?.05). During treatment of early postmenopausal women with C. foetida extract for 6 months, the incidence and duration of breast pain were lower than upon treatment with E2 plus cyclic MPA or m-P and did not change over time.     

The relationship between gestational diabetes mellitus and selenoprotein-P plasma 1 (SEPP1) gene polymorphisms

Our aim is to demonstrate any correlation between gestational diabetes mellitus (GDM) and polymorphism of the selenoprotein P (SEPP1) gene encoding the SEPP1 protein, having a role in the insulin resistance in GDM. Forty pregnant women with GDM and 40 healthy pregnant women were included in the study. In both groups, single nucleotide polymorphisms (SNPs), specifically, rs4987017, rs13154178, rs146125471, rs28919926, and rs16872762 were studied. There was no difference between the groups in terms of polymorphism rs146125471, rs28919926, or rs16872762 (p?>?.05). There was a significant difference in SNP rs13154178 polymorphism between the two groups (p?<?.01). When rs13154178 gene polymorphism was compared with AA homozygous individuals, fasting blood glucose levels were significantly higher in carriers of either polymorphism than in those with no polymorphism (p?<?.001). We suggest rs13154178 gene polymorphism may lead to GDM in the Turkish society.     

Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length

Objective.?To examine the effect of pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index (BMI) on the possibility of successful delivery in women undergoing induction of labor.

Methods.?In 822 singleton pregnancies, induction of labor was carried out at 35 to 42^?+?6 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. The effect of cervical length, parity, gestational age, maternal age and BMI on the interval between induction and vaginal delivery within 24?hours was investigated using Cox's proportional hazard model. The likelihood of vaginal delivery within 24?hours and risk for cesarean section overall and for failure to progress was investigated using logistic regression analysis.

Results.?Successful vaginal delivery within 24?hours of induction occurred in 530 (64.5%) of the 822 women. Cesarean sections were performed in 161 (19.6%) cases, 70 for fetal distress and 91 for failure to progress. Cox's proportional hazard model indicated that significant prediction of the induction-to-delivery interval was provided by the pre-induction cervical length (HR?=?0.89, 95 % CI 0.88–0.90, p?<?0.0001), parity (HR?=?2.39, 95% CI 1.98–2.88, p?<?0.0001), gestational age (HR?=?1.13, 95% CI 1.07–1.2, p?= <?0.0001) and birth weight percentile (HR?=?0.995, 95% CI 0.99?– 0.995, p?=?0.001), but not by maternal age or BMI. Logistic regression analysis indicated that significant prediction of the likelihood of vaginal delivery within 24?hours was provided by pre-induction cervical length (OR?=?0.86, 95% CI 0.84–0.88, p?<?0.0001), parity (OR?=?3.59, 95% CI 2.47–5.22, p?<?0.0001) and gestational age (OR =?1.19, 95% CI 1.07–1.32, p?= <?0.0001) but not by BMI or maternal age. The risk of cesarean section overall was significantly associated with all the variables under consideration, i.e., pre-induction cervical length (OR?=?1.09, 95% CI 1.06–1.11, p?<?0.0001), parity (OR?=?0.25, 95% CI 0.17–0.38, p?<?0.0001), BMI (OR?=?1.85, 95% CI 1.24–2.74, p?=?0.0024), gestational age (OR?=?0.88, 95% CI 0.78–0.98, p?=?0.0215) and maternal age (OR?=?1.04, 95% CI 1.01–1.07, p?=?0.0192). The risk of cesarean section for failure to progress was also significantly associated with pre-induction cervical length (OR?=?1.11, 95% CI 1.07–1.14, p?<?0.0001), parity (OR?=?0.26, 95% CI 0.15–0.43, p?<?0.0001), gestational age (OR?=?0.83, 95% CI 0.73–0.96, p?=?0.0097) and BMI (OR?=?2.07, 95% CI 1.27–3.37, p?=?0.0036).

Conclusion.?In women undergoing induction of labor, pre-induction cervical length, parity, gestational age at induction, maternal age and BMI have a significant effect on the interval between induction and delivery within 24?hours, likelihood of vaginal delivery within 24?hours and the risk of cesarean section.     

Peripartum cesarean hysterectomy: critical analysis of risk factors and trends over the years

Objective.?To investigate time trends and risk factors for peripartum cesarean hysterectomy.

Methods.?A population-based study comparing all deliveries that were complicated with peripartum hysterectomy to deliveries without this complication was conducted. Deliveries occurred during the years 1988–2007 at a tertiary medical center. A multiple logistic regression model was constructed to find independent risk factors associated with peripartum hysterectomy.

Results.?Emergency peripartum cesarean hysterectomy complicated 0.06% (n?=?125) of all deliveries in the study period (n?=?211,815). The incidence of peripartum hysterectomy increased over time (1988–1994, 0.04%; 1995–2000, 0.05%; 2001–2007, 0.095%). Independent risk factors for emergency peripratum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR?=?487; 95% CI 257.8–919.8, p?<?0.001), placenta previa (OR?=?66.4; 95% CI 39.8–111, p?<?0.001), postpartum hemorrhage (PPH) (OR?=?40.8; 95% CI 22.4–74.6, p?<?0.001), cervical tears (OR?=?22.3; 95% CI 10.4–48.1, p?<?0.001), second trimester bleeding (OR?=?6; 95% CI 1.8–20, p?=?0.003), previous cesarean delivery (OR?=?5.4; 95% CI 3.5–8.4, p?<?0.001), placenta accreta (OR?=?4.7; 95% CI 1.9–11.7, p?=?0.001), and grand multiparity (above five deliveries, OR?=?4.1; 95% CI 2.5–6.6, p?<?0.001). Newborns of these women had lower Apgar scores (<7) at 1 and 5?min (32.7% vs.4.4%; p?<?0.001, and 10.5% vs. 0.6%; p?<?0.001, respectively), and higher rates of perinatal mortality (18.4% vs. 1.4%; p?<?0.001) as compared to the comparison group.

Conclusion.?Significant risk factors for peripartum hysterectomy are uterine rupture, placenta previa, PPH, cervical tears, previous cesarean delivery, placenta accreta, and grand multiparity. Since the incidence rates are increasing over time, careful surveillance is warranted. Cesarean deliveries in patients with placenta previa-accreta, specifically those performed in women with a previous cesarean delivery, should involve specially trained obstetricians, following informed consent regarding the possibility of peripartum hysterectomy.     

Intrapartum fever and the risk for perinatal complications – the effect of fever duration and positive cultures

Objective: To estimate the association between intrapartum fever and adverse perinatal outcome.

Methods: A retrospective cohort study of women attempting vaginal delivery at term in a tertiary hospital (2012–2015). Perinatal outcome of deliveries complicated by intrapartum fever (≥38.0?°C) were compared to women with no intrapartum fever matched by parity and gestational age at delivery in a 1:2 ratio. Maternal outcome included cesarean section (CS), operative vaginal delivery (OVD), retained placenta or post-partum hemorrhage. Neonatal outcome included 5-minute Apgar score <7, umbilical artery pH <7.1, meconium aspiration syndrome, need for mechanical ventilation or hypoxic ischemic encephalopathy.

Results: Overall, 309 women had intrapartum fever and 618 served as controls. Women with intrapartum fever had higher rates of OVD (34.3 versus 19.6%, p?p?p?p?p?=?.01).

Conclusions: Intrapartum fever was associated with adverse perinatal complications. The duration of intrapartum fever, maternal bacteremia, and positive cultures further increase this risk.     

The prevalence of metabolic syndrome in premenopausal and postmenopausal women in Southern Thailand

Objective: To assess the prevalence of metabolic syndrome (MetS) in premenopausal and postmenopausal women in Southern Thailand.

Methods: A cross-sectional study was conducted with 361 healthy women (218 premenopausal women and 143 postmenopausal women) in Southern Thailand. Blood pressure, anthropometric indices, fasting plasma glucose and serum lipid levels were measured. MetS was defined according to criteria of the “National Cholesterol Education Program Adult Panel Treatment III” (NCEP ATPIII). Logistic regression analysis was used to evaluate factors associated with MetS.

Results: Waist circumference, systolic blood pressure, diastolic blood pressure, and levels of total cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) were significantly higher in postmenopausal women, when compared with premenopausal women (p?p?=?0.005). The most frequent component of MetS in postmenopausal women was central obesity (58.74%), followed by hypertension (58.04%), high triglyceride (27.97%), low HDL-C (23.08%), and high FPG (11.19%). Multivariate analysis revealed that age and higher body mass index (BMI) increased the risk of developing MetS.

Conclusion: The prevalence of MetS is higher in postmenopausal women than in premenopausal women, and its significant predictors include age and BMI.