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1.
OBJECTIVE: To determine antenatal and intrapartum risk factors for intrapartum stillbirths in a total population. DESIGN: Matched case-control study. SETTING: Western Australia 1980-1983. SUBJECTS: Intrapartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants (controls) individually matched for year of birth, plurality, sex and birthweight of infant and race of mother. RESULTS: Intrapartum stillbirths were more likely than controls to have had placental abruption (OR = 9.55, CI = 2.09-43.69), fetal distress (OR = 4.64, CI = 1.92-11.19), cord prolapse (OR = 10.00, CI = 1.17-85.60) and unhealthy placentas (OR = 2.26, CI = 1.13-4.52), and more likely to have been born by vaginal breech manoeuvre (OR = 3.51, CI = 1.40-8.80) and emergency caesarean section (OR = 2.15, CI = 1.13-4.10); mothers of intrapartum stillbirths were less likely to have had no labour (OR = 0.14, CI = 0.04-0.55) and to have been delivered normally (OR = 0.20, CI = 0.10-0.40). Mothers of cases born by emergency caesarean section had longer labours than mothers of controls born by this method. All intrapartum stillbirths with breech presentation were born by vaginal breech manoeuvre compared with only 53% of the controls; the remainder of the controls were born by caesarean section. CONCLUSIONS: Results indicate that little could have been done early in pregnancy to prevent the intrapartum stillbirths as no antenatal risk factors predicted these deaths. Most of the risk factors identified related to labour and delivery problems. Considering cases born by emergency caesarean section, delivery of the mother earlier in labour may have prevented some of the deaths.  相似文献   

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A case-control study of unexplained antepartum stillbirths.   总被引:1,自引:0,他引:1  
OBJECTIVE: To ascertain factors that will identify women who are at increased risk of unexplained antepartum stillbirth. DESIGN: Matched case-control study. The cases and controls were initially analysed as a whole group and again after dichotomizing into those of low birthweight (< 2500 g) and those of normal birthweight (> or = 2500 g). SETTING: Western Australia 1980-1983. SUBJECTS: Unexplained antepartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants individually matched for year of birth, plurality, sex and birthweight of infant and race of mother (controls). RESULTS: The case pregnancies had more polyhydramnios (OR 10.83, 95% CI 2.41-48.69) and cord problems (OR 6.57 95% CI 1.36-31.75) than the controls but, paradoxically, other obstetric and medical complications were less common in the cases. The association with polyhydramnios persisted when the analysis was confined to those with low birthweight. With normal birthweight fetal distress was more frequent in the cases (OR 3.65 95% CI 1.36-9.80) but there were few other differences. CONCLUSIONS: The clinical and diagnostic systems currently in use are unable to identify many fetuses at risk of death. Decreases in the rate of unexplained antepartum stillbirths await the discovery of new preventable causes, or of innovations in clinical or laboratory aspects of obstetric care.  相似文献   

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The aim of this study was to assess the recurrent risk of an unexplained stillbirth at term. A total of 75 women who delivered stillbirths were matched for maternal age and parity with 75 controls. After excluding explained stillbirths, matched cases and controls were compared for maternal age, length of gestation, birth weight and 'interval to next birth'. The main outcome measure was the frequency of recurrence of a stillbirth. Both groups were similar for maternal age and length of gestation. Birth weight was marginally different (odds ratio (OR) = 0.997, 95% confidence interval (CI) 0.996, 0.999) and 'interval to next birth' was longer (OR = 1.08, 95% CI 1.00, 1.17). There were no stillbirths in cases and controls at follow-up. We conclude that a woman who has had an unexplained stillbirth at term has no greater risk of recurrence than a matched control. However, the 'interval to next birth' was significantly longer.  相似文献   

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No morphologic cause of death was found in 67.8% of 33 perinatal deaths. The mothers had experienced a previous loss in 48% of cases. Inflammation occurred in 65.6% of the cases of perinatal death compared to 4% of a control group (p less than 0.001) and in 73.1% of organism-positive cases of perinatal death compared to 7.1% of organism-positive cases of the control group (p less than 0.001). Incidence of maternal fever or prolonged membrane rupture was not statistically significant. Bacteria were present in 33.3% of the cases of perinatal death (not significant), with more pathogenic strains occurring in this group (p = 0.0028); 75.0% had inflammation compared to 0% of the control group (not significant). Genital mycoplasmas were detected in 78.8% of cases of perinatal death compared to 32.3% of control cases (p less than 0.001). Positive cultures (p = 0.0142) and elevated antibody titers in the fetus or neonate (p = 0.00052) or in the mother (p = 0.0122) occurred significantly more often than in control cases. Inflammation occurred in 78.9% of mycoplasma cases (p = 0.00032); incidences of maternal fever and prolonged membrane rupture were not significantly different. In perinatal death cases 20% had evidence of viruses, and 3.2% had evidence of chlamydia. Evidence of mixed microorganisms occurred in 46% of cases of perinatal death. However, 78.6% (11 of 14) with only one organism had Ureaplasma urealyticum (33.3% overall). Of the Ureaplasma-positive cases, 72.7% had inflammation, 45.5% had fever, and only 18.2% had prolonged membrane rupture compared to 28.6%, 0%, and 16.6%, respectively, in a negative-microorganism group with perinatal deaths. Our observations strongly support the concept that infection is a major cause of perinatal death and that genital mycoplasmas play a significant role.  相似文献   

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OBJECTIVE: Quinolones, mainly nalidixic acid, are frequently used in Hungary to treat bacterial infections in pregnant women, but so far no controlled epidemiological studies of congenital abnormalities among infants born to women treated with nalidixic acid during pregnancy have been reported. METHODS: The analysis of oral nalidixic acid use during pregnancy in the mothers of cases with congenital abnormalities and in their matched population controls without congenital abnormality was carried out in the population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. The study included 22865 women who had newborns or fetuses with congenital abnormalities, and 38151 pregnant women who had newborn infants without any defects (controls). RESULTS: In the case group, 242 (1.1%) and in the control group, 377 (1.0%) pregnant women were treated with nalidixic acid (crude OR: 1.1 with 95% CI: 0.9-1.3). Seventeen different congenital abnormality groups were evaluated and a higher prevalence of pyloric stenosis was found in seven case infants born to mothers who received nalidixic acid treatment during the last months of pregnancy (adjusted OR: 11.0 with 95% CI: 1.3-91.4). CONCLUSIONS: Treatment with nalidixic acid during pregnancy may increase the risk of pyloric stenosis, though the chance effects cannot be excluded.  相似文献   

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A case-control analysis was done of 19 cases of uterine perforations which occurred during laparoscopic sterilization at Gardy Memorial Hospital in Atlanta, between February 1, 1974, and January 31, 1976. The over-all perforation rate, 30.4 per 1,000 procedures, is three to 30 times that commonly reported for dilatation and suction or sharp curettage (D&C) of the uterus. Case women were 10.4 times more likely than control women to combine two of the following three characteristics: age greater than 34, parity greater than 4, and obesity greater than 20 per cent above the ideal body weight for height. Surgeons with fewer months of formal Ob/Gyn training were no more likely than their relatively more experienced colleagues to perforate the uterus. No other risk factors were delineated. It is believed that the perforation rate, higher in this study than in earlier ones, reflects better ascertainment of perforations. The bleeding site was always visualized with the laparoscope in this series.  相似文献   

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BACKGROUND: The aim of this study was to evaluate the efficacy and tolerability of vaginal irrigations with arsenical-ferruginose water from the spa at Terme di Levico in chronic cervico-vaginitis in order to assess the validity of balneotherapy in improving the symptoms and quality of life of patients. METHODS: An open comparative study was performed in 30 patients with symptoms attributable to aspecific chronic vaginitis (in child-bearing age) or vulvovaginal dystrophy (perimenopausal age). Twenty patients (Group A) received balneotherapy and 10 (Group B) were treated with placebo vaginal suppositories. All patients were required to fill in a questionnaire on symptoms. A thorough gynecological examination was performed, together with a Pap-test and vaginal secretion sample for bacterioscopic and microbiological tests. The same tests were repeated at the end of treatment. RESULTS: Post-treatment results showed a general reduction in the extent of gynecological symptoms reported by patients. A statistically significant reduction was only observed in patients receiving balneotherapy for the following symptoms: vaginal burning , vulvar burning , vaginal itch , vulvar itch , leukorrhea . An analysis of the cytological tests performed in patients enrolled in the study highlighted a high prevalence of phlogistic type findings, often in association with varying degrees of atrophy in postmenopausal patients. Those patients suffering from chronic vaginitis undergoing balneotherapy showed a reduction in the prevalence of phlogistic findings after treatment. CONCLUSIONS: Treatment with arsenical-ferruginose water led lo a marked reduction in the subjective symptoms reports by the study population (particular evident in patients with chronic leukorrhea), as was confirmed by objective signs (clinical, cytological and microbiological) of phlogosis. This was accompanied by excellent tolerability. These results justify the use of balneotherapy, according to the classic techniques and methods, in chronic cervicovaginal phlogistic processes.  相似文献   

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BACKGROUND: Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub-optimal factors in stillbirths were more frequent among non-western than western women. METHODS: Population-based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998-2003 (4.2 per 1,000 deliveries); of these 31% were born to non-western women. By audit, the stillbirths were attributed to optimal or sub-optimal care factors. Multivariate methods were used to analyse the data. RESULTS: Sub-optimal factors were identified in 37% of the deaths. When compared to western women, non-western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3-3.8), and an increased risk of sub-optimal care (OR: 2.4; 95% CI: 1.5-3.9). More often, non-western women received sub-optimal obstetric care (p<0.001), as e.g. failure to act on non-reassuring fetal status or incorrect assessment of labour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non-western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non-western mothers; an interpreter was used in 29% of these cases. CONCLUSIONS: Non-western women constituted a risk group for sub-optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non-western women.  相似文献   

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OBJECTIVE: Confidential panel enquiry into sub-optimal factors relating to stillbirths. METHOD: All 121 stillbirths in KK Women's and Children's Hospital in the years 1995 and 1996 were studied. Three assessors reviewed the case records of each death, and panel consensus was reached regarding sub-optimal antenatal care and factors leading to stillbirths. RESULT: The incidence rate of stillbirth was 4.04 per 1000 deliveries. A total of 76 cases (62.8%) were found to have grade II and III sub-optimal factors in their management. Patients themselves were involved in the sub-optimal management of their own pregnancy in 52.9% of the stillbirths. Primary healthcare givers were involved in 8.3% of all stillbirths, specialist caregivers 12.4% and antenatal care system 4.1%. CONCLUSION: The study has identified sub-optimal antenatal management in over 60% of cases. As patients' factors form the major contribution towards sub-optimal care, management strategy aimed towards improving patients' education and compliance to antenatal care should be a priority.  相似文献   

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A case-control study of epithelial ovarian cancer   总被引:4,自引:0,他引:4  
With data from a study of 296 patients with primary epithelial ovarian cancer and 343 patients hospitalized because of other conditions, we estimated ovarian cancer risk in accordance with reproductive and other factors. Risk was greatest among women of lower parity, especially among women who said they planned to have children but could not. The protective effect of oral contraceptives seen in other studies was observed only in subgroups of our study population. Women who had breastfed their children had decreased risk, but the number of months of breastfeeding was not related to risk. Incomplete pregnancies did not provide the protection seen for live births. A family history of ovarian cancer and a medical history of breast cancer were both strong risk factors. None of the nonreproductive factors that we examined, including childhood illnesses, tobacco and alcohol consumption, obesity, and selected adult diseases, was convincingly associated with risk.  相似文献   

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Diffuse vascular endothelial dysfunction, secondary to oxidative stress, is an important pathological feature of preeclampsia. Oxidative conversion of low density lipoproteins (LDL) to oxidized-LDL (Ox-LDL) is considered an important step in transforming macrophages into lipid-laden foam cells destined to develop into early atherosclerotic-like lesions. In our study of 95 women with preeclampsia and 100 controls, we evaluated the association between maternal plasma Ox-LDL concentrations and preeclampsia risk. Ox-LDL concentrations were measured using a solid phase two-site enzyme immunoassay. Plasma lipids were measured using standard enzymatic procedures. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for confounders. Plasma Ox-LDL concentrations were positively correlated with cholesterol, triglyceride (TG), and LDL concentrations in cases and controls, (Spearman's r ranging from 0.39-0.48, p-values all <0.01). There was no evidence of an increased risk of preeclampsia across increasing quartiles of Ox-LDL. The ORs for successive quartiles, with the lowest as the reference group, were as follows: 1.0, 1.1, 0.6, and 1.2. Women with extremely high concentrations of Ox-LDL (> or =73 U/L, the upper decile), as compared with those with lower values (<73 U/L) had a 2.7-fold increased risk of preeclampsia (95% CI 1.0-6.8). Women with high Ox-LDL and high TG concentrations (> or =284 mg/dl), as compared with those without these two factors, had a 9.6-fold increased preeclampsia risk (95% CI 2.0-45.6). Elevated Ox-LDL, particularly in conjunction with elevated TG, appears to be a risk factor of preeclampsia.  相似文献   

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Background  

In Brazil, a Ministry of Health report revealed women who underwent an abortion were predominantly in the use of contraceptive methods, but mentioned inconsistent or erroneously contraceptive use. Promoting the use of contraceptive methods to prevent unwanted pregnancies is one of the most effective strategies to reduce abortion rates and maternal morbidity and mortality. Therefore, providing post-abortion family planning services that include structured contraceptive counseling with free and easy access to contraceptive methods can be suitable. So the objective of this study is to determine the acceptance and selection of contraceptive methods followed by a post-abortion family planning counseling.  相似文献   

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