The outcome of pregnancy in an immigrant Ethiopian population in Israel

To study the assumption that obstetric risk factors would change over time in an immigrant Ethiopian population, a retrospective study of the records of singleton births among the Ethiopian immigrants between 1981–88 was undertaken and compared to a similar study of the general population. The Ethiopian immigrants were characterized by pregnancies at age extremes, a greater incidence of preeclampsia and premature deliveries, and a lower incidence of premature rupture of membranes. There was over time an increase in maternal weight gain among the Ethiopians as well as an increase in the incidence of preeclampsia and perinatal mortality.     

Comparison of intrapartum outcome among immigrant women from Ethiopia and the general obstetric population in Israel

ObjectiveTo compare intrapartum outcome between ethnic Ethiopian women and the general obstetric population in Israel.MethodsIn a retrospective study, computerized data from all Ethiopian women who delivered between January 2004 and August 2011 at a university teaching hospital in Afula, Israel, were assessed. The control group comprised non-Ethiopian Israeli women, who were matched at a ratio of 1:2 on the basis of deliveries that took place immediately before and after delivery by an Ethiopian woman. The primary outcome was incidence of operative delivery.ResultsDuring the study period, 576 Ethiopian women delivered along with 1152 matched control women. Ethiopian women had a higher incidence of pre-eclampsia (6.8% versus 4.0%, P = 0.01) and early postpartum hemorrhage (4.3% versus 1.6%, P = 0.003) than control women. After adjustment for potential confounders, the incidence of vacuum or cesarean delivery was significantly higher among Ethiopian than among control women (odds ratio, 1.68; 95% confidence interval, 1.28–2.20; P = 0.002). The incidence of composite major perinatal morbidity, including Erb palsy and cord pH less than 7.1, tended to be higher among Ethiopian women than among control women (2.3% versus 1.1%; P = 0.053).ConclusionAlthough prepartum and intrapartum care are standardized, Ethiopian women had a less favorable intrapartum outcome.     

Vaginal bleeding and early pregnancy outcome in an infertile population

Objective: Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding. Study Design: This was a cohort study of pregnancies obtained using either assisted reproductive technology (ART) or routine infertility treatment (RIT). Two hundred twenty-eight pregnant women were divided into two groups based on the presence or absence of vaginal bleeding. Successive measurements of -hCG levels were obtained every 2 days, starting on day 14 after ovulation or embryo transfer. All pregnancies underwent weekly transvaginal ultrasound (UTZ) examinations beginning on day 21. The occurrence of vaginal bleeding was monitored weekly. Results: Seventy of the 228 patients (31%) had bleeding in early pregnancy, resulting in 31 (44%) pregnancy losses. Only 22 pregnancy losses (14%) were observed in 158 patients who did not have bleeding (P<0.001). The abortion rate for the bleeding versus nonbleeding groups was 35 and 9%, respectively (P<0.001). Vaginal bleeding was associated with a higher abortion rate in pregnancies following RIT than ART (51 vs 8%; P<0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleeding was also associated with a higher abortion rate than that in the nonbleeding group (17 vs 4%; P<0.001). However this higher incidence was observed only in pregnancies following RIT, not ART (28 vs 5%; P<0.001). Conclusions: Although bleeding significantly decreased the chance of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. However, the predictive value of fetal cardiac activity was reduced in the presence of vaginal bleeding in an infertile population treated with RIT.     

Maternal and neonatal characteristics of an immigrant population in an Italian hospital

Objective.?The objective of this study was to evaluate clinical and epidemiological characteristics of the maternal and neonatal immigrant population and to compare it with the Italian population in the Agostino Gemelli Hospital (Rome).

Methods.?This study was a prospective population-based study. We compared 595 newborns from immigrant mothers with 2413 newborns from Italian mothers. Neonatal characteristics included in this study were sex, gestational age, birth weight, Apgar score, transfer to pathology units, minor pathologies, and type of breastfeeding at discharge. Maternal characteristics included nationality, age, parity, type of delivery, twin birth, and pathology during the pregnancy.

Results.?Immigrant newborns comprised 20% of the total births included in the study. No statistically significant differences were found between immigrant and Italian newborns in gestational age, birth weight, or Apgar score. Immigrant newborns were transferred to the Paediatric Infectious Disease Unit more frequently than Italian newborns, had a significantly higher incidence of hyperbilirubinemia and a higher rate of exclusive and prevalent breastfeeding at discharge. Immigrant mothers came predominantly from Eastern Europe, were younger and had caesarean sections less frequently than Italian mothers.

Conclusion.?No significant differences in biological and clinical characteristics or in medical practice were found between groups, except for a higher frequency of neonatal hyperbilirubinemia and an inclination among immigrant mothers toward breastfeeding.     

The epidemiology of pregnancy complications and outcome in a Norwegian twin population.

OBJECTIVE: To measure the contribution of genetic factors to selected pregnancy complications, including miscarriage, twinning, hypertension-toxemia, and nausea-vomiting. METHODS: Information on 22,241 pregnancies of 8675 female twins or spouses of male twins was obtained by questionnaire from members of the population-based Norwegian Twin Panel. Comparisons of observed tetrachoric correlations were used to assess the importance of genetic influences on the variables examined. RESULTS: Pregnancy history information was provided by both members of 830 monozygotic and 902 dizygotic female twin pairs and by the spouses of both members of 459 monozygotic and 464 dizygotic male twin pairs. The incidence of twin pregnancy in general, and of opposite-sexed twins in particular, found among dizygotic twin women was nearly twice that observed for any other group. Monozygotic female twin pairs were more concordant than dizygotic female twin pairs for the occurrence of miscarriage, nausea or vomiting during pregnancy, and hypertension or overt toxemia. A similar pattern of twin similarity was observed for the use of certain medications during pregnancy including vitamins, aspirin, and nausea medication. CONCLUSIONS: Maternal genetic factors make an important contribution to a predisposition for dizygotic twinning, contribute to the risk of miscarriage, and appear to determine, in part, whether a woman experiences nausea-vomiting or hypertension-toxemia during pregnancy. In addition, health-seeking behaviors of women during pregnancy, as reflected by the use of several classes of medication, appear to be influenced somewhat by genetic factors.     

Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian population

Despite a rising prevalence worldwide, there is limited data on pregnancy outcome among African women with prepregnancy or early pregnancy obesity. This was a case-control study to determine the prevalence of maternal obesity in early pregnancy and compare the subsequent pregnancy outcome between 201 women with obesity and 201 non-obese controls in a University Teaching Hospital in Nigeria. The prevalence of obesity in early pregnancy was 9.63%. Obesity was significantly associated with advanced maternal age and parity > or =1. It was also a risk factor for pregnancy induced hypertension, admissions during pregnancy, caesarean delivery and associated with 5th minute apgar score < or =3 (0.044). Obesity in early pregnancy is a risk factor for adverse pregnancy outcome among pregnant Nigerian women. This information should be utilised by physicians to improve the outcome of pregnancy and promote safe motherhood.     

Effect of sperm antibodies on pregnancy outcome in a subfertile population

The relationship between sperm antibodies, conception, and miscarriage was examined in 109 infertile couples. Antibodies present on the surface of husbands' ejaculated sperm and antibodies in husbands' or wives' sera that reacted with a purified population of the husbands' motile spermatozoa were detected by an enzyme-linked immunosorbent assay. During an 18-month period, conception occurred in 33 (30.3%) of the couples; 16 (14.7%) women subsequently suffered a spontaneous miscarriage during the first trimester, whereas 17 (15.6%) women maintained their pregnancies past this time period. Antisperm antibodies were present in sera from only two of 17 (11.8%) women with successful pregnancies, whereas seven of 16 (43.8%) women who miscarried and 29 of 76 (38.2%) who did not conceive had these antibodies in their sera. IgG (22.4%) and IgM (21.1%) antisperm antibodies predominated in sera of women who did not conceive, whereas IgA (37.5%) and IgG (37.5%) antibodies were most prevalent in sera of women with miscarriages. In men, the presence of antisperm antibodies in sera was unrelated to fertility. However, there was a correlation between sperm surface antibodies and an inability to conceive. IgG was identified on ejaculated spermatozoa from eight of 76 (10.5%) men whose wives failed to conceive and in none of 33 men whose wives conceived. Similarly, IgA was present on spermatozoa from 16 (21.1%) infertile and two (6.1%) fertile men. Thus antisperm antibodies in female sera and on ejaculated spermatozoa were associated with a failure to conceive and first-trimester miscarriage.     

Magnesium intake and status and pregnancy outcome in a Danish population

OBJECTIVE--To investigate the relation between pregnancy outcome and magnesium intake and status. DESIGN--A prospective observational study in which the estimate of nutrient intake and serum samples were obtained before the final outcome of pregnancy was known. A second part of the investigation was a cross-sectional comparison of magnesium status of normal pregnant women and women with certain pathological pregnancies. SETTING--Antenatal clinic associated to the University Clinic of Obstetrics and Gynaecology, University of Aarhus, Denmark. SUBJECTS--1203 consecutive women in the 30th week gestation were invited to participate in the study, 991 (82.4%) accepted and records for 965 (80.2%) were available for analysis. DATA--Food intake data were collected by a combination of a self administered questionnaire and a structured interview of a dietary history type. Serum samples were obtained from blood withdrawn in the 30th and 37th week gestation. Obstetric data were collected from the midwifery and hospital records. For a second part of the investigation, biopsies from the uterus and the abdominal rectus muscle were obtained from women delivered by caesarean section. RESULTS--In the women with normal pregnancies and in the three groups of pathological pregnancies (pre-eclampsia, SGA-infants and preterm labour) the average magnesium intake was within the range of 200 to 208 mg per 1000 kcal per day (SD 32) and there were no differences between the groups. Neither were differences in serum magnesium observed. Birthweight for gestational age was not influenced by magnesium intake. No differences in magnesium status as assessed by determination of magnesium content in muscle biopsies were found between the normal pregnancies and women with pre-eclampsia, SGA-infants or preterm labour. CONCLUSION--The intake of magnesium seemed adequate, and pre-eclampsia, SGA-infants, or preterm labour did not seem associated with a low dietary intake of magnesium or magnesium deficiency. Routine magnesium supplementation during pregnancy is not recommended for populations of relative good socio-economic status.     

The economic implication in pregnancy outcome

The economic implication in pregnancy outcome is evaluated in a Spanish homogeneous population. The potential risk is assessed for: prematurity, intrauterine growth retardation, perinatal mortality and major malformation. The husband's employment appears worthless as an economic parameter. The best estimators of economic level in our population are the total income per capita and the monthly food allowance per capita. Study results clearly support the relationship between poverty and prematurity, intrauterine growth retardation and major malformation. No correlation is found between perinatal mortality and lower economic conditions, which differs from previous reports. The author suggests that perinatal problems be differentiated from each other in studies of risk factors.     

The outcome of pregnancy in Kell alloimmunisation

Objective To assess management and outcome of pregnancies with anti-Kell in the West Midlands in the UK over 13 years.
Design A retrospective review of casenotes.
Setting A regional referral clinic for red cell alloimmune disease and fetal medicine unit at a university hospital.
Population Sixty-five pregnancies were identified in 52 Kell-sensitised women with Kell positive partners from the records of the Birmingham Blood Transfusion Centre.
Methods Information from the casenotes was entered on a database and comparisons were made using the SPSS for Windows statistics package.
Main outcome measures Mode of sensitisation, degree of fetal or neonatal anaemia, need for transfusion, gestation at delivery, birthweight and pregnancy outcome.
Results Alloimmunisation was transfusion-related in 29 pregnancies and pregnancy-induced in 33. The cause could not be identified in three cases. There were 22 proven Kell positive fetuses, of which 18 were affected, in which alloimmunisation was pregnancy-related in 12 cases and transfusion-related in five. Antibody titres and amniotic fluid OD₄₅₀ were not helpful in management. Severe or very severe disease occurred in 50% of the affected pregnancies (9/18). There was no difference in pregnancy outcome between transfusion or pregnancy induced sensitisation.
Conclusions Anti-Kell alloimmunisation is an uncommon cause of serious anaemia in a significant proportion of affected pregnancies. There appears to be no difference between that caused by pregnancy or transfusion. Estimation of fetal haemoglobin concentration by cordocentesis is recommended, as antibody titres and amniocentesis are not helpful.     

The role of mycoplasmas in pregnancy outcome

Mycoplasma hominis was isolated from a Bartholin's gland abscess 70 years ago, and ureaplasmas were isolated from the genital tract about 20 years later. Subsequently, reports incriminating mycoplasmas in the known adverse outcomes of pregnancy have been legion. Without doubt these genital mycoplasmas are able to invoke an inflammatory response and take part in the cascade of events that culminates in preterm birth. Their role in this and other conditions is becoming clearer, but controversy remains due mainly to investigators often ignoring bacterial vaginosis, with its complex of bacteria, and failing to disentangle their role from that of the genital mycoplasmas. This is a theme that will be highlighted in this chapter, in which an attempt is made to indicate what is indisputable (surprisingly little) and what is not, and where further research would be helpful.     

Viral hepatitis during pregnancy in Israel

Epidemiological, clinical and laboratory data were obtained relating to 89 pregnant women who suffered from viral hepatitis during the period 1967-1977 in Israel. The obstetrical data, course of labor and details about the newborn, were all compared with the accepted obstetrical standards in Israel and abroad. A follow-up study was made of the 89 women and 69 of the offspring from these pregnancies, covering a period of from 2 to 10 years. The data of the present study demonstrate that during the last decade, a period of generally rising socio-economic status in Israel, viral hepatitis in pregnant women, ran a more favorable course than that previously reported. The incidence of hepatitis is equal in all trimesters of pregnancy, and a favorable outcome may usually be anticipated for the mother and the newborn.     

Fertility after ectopic pregnancy in an African population

Cases of ectopic pregnancy were studied retrospectively at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, for the period from January 1, 1977 to June 30, 1987. The records of 108 patients who had at least 1 year of follow-up were reviewed to determine their subsequent reproductive performance. Thirty-eight patients (35.9%) subsequently conceived, 15 (13.9%) had recurrent ectopic pregnancy, 21 (19.4%) delivered at term, and 40 (37%) remained secondarily infertile. Thirty patients were sterilized or using contraception.     

Early recognition of ectopic pregnancy in an infertility population

On an infertility service, 170 patients were evaluated for possible ectopic pregnancy using tests for beta-human chorionic gonadotropin levels, ultrasound, and clinical examination. Thirty-four (20%) of those evaluated underwent laparoscopy, of whom 31 (91%) were found to have ectopic pregnancies. Only three of the ectopic pregnancies were ruptured; only two women had significant hemoperitoneum and only two required transfusion. Subsequent intrauterine pregnancy occurred in 5 of 11 patients who underwent salpingectomy (45%) and in 1 of 15 patients who underwent salpingotomy (7%). There were no subsequent pregnancies in five patients after expression of the ectopic from the tube. Early intervention in an infertile population decreases morbidity and may favor conservative tubal surgery, although our series could not confirm the benefits of such surgery.     

The incidence and outcome of asymptomatic herpes simplex genitalis in an obstetric population

In a prospective study of an obstetric population, 28 of 488 (4%) routine asymptomatic patients had positive cultures for herpes simplex virus from their genital tract. Cesarean section was carried out if the virus was present in the genital tract at the time of delivery. In one instance, a culture which had reverted to negative became positive again. No cases of neonatal herpes were reported in the time of the study. As yet, the infectivity of these subclinical cases is unclear, and the incidence of neonatal herpes is not as high as would be expected from the study. Further studies need to be carried out to evaluate the exact risk of the asymptomatic herpesvirus shedder to the infant at birth.     

Diabetes mellitus in pregnancy in an African population.

OBJECTIVES: To compare the pregnancy outcome among diabetic and non-diabetic Nigerian women. METHODS: A retrospective case record review of 200 pregnant diabetic patients and control was carried out over a 10-year period (1990-1999) at the Maternity unit of the University of Nigeria Teaching Hospital Enugu, Nigeria. RESULTS: The prevalence of diabetes mellitus among pregnant mothers was 1.7%. Pre-gestational diabetes mellitus accounted for 39% of cases while gestational diabetes was responsible for 61% of them. Late antenatal booking and poor control of diabetes mellitus were common features, while maternal and fetal morbidity was high. Hypertension, vulvovaginitis, premature labor, polyhydramnios and ketoacidosis were significantly higher among diabetic mothers than controls. The perinatal mortality was also higher among diabetics than controls (12.5% vs. 3.5%) with stillbirth being the major contributor. Patients with gestational diabetes were at increased risk of fetal macrosomia than controls (28.7% vs. 5.5%). The overall cesarean section rate was high (36%) among diabetics with previous cesarean section and cephalopelvic disproportion being the commonest indications. CONCLUSIONS: Health education and provision of modern affordable methods of management of diagnosed cases such as uristix and hemastix will improve maternal and fetal outcome in pregnant diabetics in Africa.     

The risks and outcome of pregnancy in an advanced maternal age in oocyte donation cycles

Abstract

The maternal age at the first and repeated deliveries constantly rises in developed countries due to current social trends that favor values of personal achievements upon procreation. Assisted reproduction technologies and especially the availability of oocyte donation programs extend the age of fecundity to the fifth and sixth decades of life. The ability to conceive and deliver at such age raises serious medical, moral, social and legal concerns regarding the health and welfare of the mother and child will be presented and discussed here.     

Occurrence of antinuclear antibodies in an unselected pregnancy population.

The occurrence of antinuclear antibodies (ANA) in an unselected population of pregnant women was studied by an indirect immunofluorescence method. Six women out of 116 were ANA-positive (5.2%), 2 of them having a moderately high titre (1:160 and 1:320) and 1 complement-fixing ANA. The antigenic specificity of ANA was anti-single-stranded DNA in 2 cases and RNAase-sensitive anti-extractable nuclear antigen in 1 case. Two of the ANA-positive women had pre-eclampsia laevis and 1 had a premature delivery. None of the infants of the ANA-positive women had symptoms of connective tissue disease. The occurrence of ANA among pregnant women was not significantly higher than among 70 non-pregnant female control subjects (7.1%).