Epidemiological studies of obstetric ultrasound examinations in Denmark 1989-1990 versus 1994-1995

BACKGROUND: The purpose of the study was to describe number, type, time and place for all obstetric ultrasound examinations that pregnant women in Denmark had performed during their pregnancies. Further, to compare these results with results from a similar national survey performed five years previously. METHODS: During a two-week period in February 1990 and a two-week period in May 1995, all delivery departments in Denmark (1990: 57/1995: 49) participated in two identical designed studies with the aim as described above. For all women who delivered in these periods variables were recorded from the women's case records and after interview. After the exclusion of 108/145 women without complete registrations, the material consisted of 2268/2315 women; approximately 3.7%/3.4% of all deliveries in Denmark 1990/1995. The chi2 and t-test were used for statistical analyses with a statistical significance level of 5%. RESULTS: Of all obstetric ultrasound examinations 99%/96% took place in hospitals. Twenty/seven percent of the women had no examination during their pregnancies. The mean number of obstetric ultrasound examinations was 1.5/1.9 for all women and 1.9/2.1 for women who had at least one examination. In total 40%/54% of the women were offered a screening examination. Women with an offer of screening had a mean number of examinations: 1.8/2.0 and women without an offer: 1.3/1.9 (1990: p<0.05; 1995: non-significant). CONCLUSION: The studies have shown an increasing number of women with an offer of ultrasound screening and in general an increased use of ultrasound examinations in obstetrics during the five year period 1990-1995 in Denmark.     

Intraepithelial squamous cell carcinoma of the vulva, 1972-1989]

We report our experience about intraepithelial squamous carcinoma of the vulva, consisting of 20 cases with clinical and histopathological diagnosis, at the University of Chile Clinical Hospital. Between december 1972 and october 1989. The age of patients was between 30 and 78 years old, median age 57.6 years old. Clinical HPV infection was detected in three cases (15%) 17 patients were submitted to simple total, vulvectomy (94.5%) without operatory mortality. The follow-up was between 3 months and 11 years (mean follow-up 6.5 years). Recurrence was observed in 2 patients (11.1%) of the 18 submitted to treatment.     

U.S. national trends in labor induction, 1989-1998

OBJECTIVE: To examine the epidemiology of labor induction in the United States. STUDY DESIGN: We used U.S. natality data from 1989 to 1998 and examined the rate of labor induction by year, geographic region, maternal characteristics and pregnancy complications. RESULTS: Between 1990 and 1998, the rate of labor induction increased from 9.5% to 19.4% of all births nationwide. However, the induction rate varied widely by state. White race, higher education and early initiation of prenatal care were associated with a higher rate of induction. For all gestational ages, a significantly increased induction rate occurred during the study period. The increase for clinically indicated induction was significantly slower than the overall increase, suggesting that elective induction has risen much more rapidly. CONCLUSION: The rate of induction of labor more than doubled in the U.S. nationwide in the decade from 1989 to 1998. The increased use of labor induction may be attributable to both clinically indicated and elective induction.     

Prenatal diagnosis of cystic hygroma of the neck by echography. Case report. Review of the literature]

The authors report a case of hygroma colli, diagnosed in utero by ultrasonography, in Africa, at the Brazzaville (Congo) Teaching Hospital. The ultrasonographic appearances as well as the differential diagnostic aspects of hygroma colli are defined. Because of the frequent association with chromosomal aberrations, the authors suggest the termination of pregnancy in an African context, since karyotyping is not possible in that part of the world.     

Ovarian cancer in young women in Sweden, 1989-1991.

The present study is an evaluation of the symptoms and gynecological status, at the time of seeking medical advice, among women of reproductive age diagnosed with ovarian malignancies. The study was based on the medical records of all women in Sweden between 15 and 40 years of age who were diagnosed with ovarian malignancies during a 3-year period (1989-1991). The study focused on the diagnosis and panorama of symptoms. These data were compared to the records of more than 10,000 women in this age group during the same period of time who underwent surgery for ovarian changes that resulted in benign diagnoses. The 152 cases of ovarian cancer included only 1 patient who was without symptoms, had normal pelvic status upon manual examination, and a sonographically diagnosed simple cyst. These data support the conclusion that the majority of young women with ovarian cancer have symptoms and/or clinically detectable adnexal masses at the time when medical advice is sought. These studies suggest that diagnosis of ovarian cancer is unlikely in young healthy women lacking subjective symptoms and an adnexal mass upon pelvic examination. In conclusion, programs for the management of simple cysts and development of noninvasive diagnostic methods for ovarian changes found in patients in the reproductive age group are needed in order to reduce the number of patients subjected to operative intervention.     

The Yolo County Midwifery Service. A descriptive study of 496 singleton birth outcomes, 1990.

The Yolo County Midwifery Service was begun in January 1989 to serve pregnant low-income women who were denied care by local obstetricians. In 1990, 58% of women served were Latina and 33% were Anglo-white. Their mean age was 24.5 +/- 5.5 years, and their mean level of education was 9.9 +/- 3.5 years. Thirty-seven percent were nulliparous. All deliveries were at the only hospital in the county with a maternity service. To evaluate the effectiveness of nurse-midwifery care in this sample, a prospective study of the service's 496 singleton birth outcomes during 1990 was undertaken. Although the cesarean rate in 1990 for the obstetricians not associated with the midwifery service at this hospital was 20.6%, the midwifery clients experienced a primary cesarean birth rate of 3.7% and a total rate of 6.7%. Instrument-assisted deliveries took place for 1.0% of births. The success rate for women attempting vaginal birth after cesarean was 87.2%. Delivery over an intact perineum occurred for 51.8%. Preterm birth was experienced by only 1.0% of the women. A newborn birth weight of < 2,500 g occurred in 2.4% of births. Occult cord prolapse preceded a single neonatal death, resulting in a perinatal and neonatal death rate of two per 1,000. These data add to the growing body of information about nurse-midwifery in which that care is found to be a safe, well-accepted, and cost-effective adjunct to existing obstetric care services.     

Favourable outcome in 33 triplet pregnancies managed between 1985-1990.

In this paper, we describe the outcome of 33 triplet pregnancies referred to us between 1985 and 1990. They were managed as follows: management at home as soon as the diagnosis was made, then hospitalization at 28 weeks' gestation. Progesterone and beta-mimetics were administered daily, a cesarean section was always performed. One late abortion occurred at 21 weeks. The rate of prematurity was 90.6%, mean gestational age at delivery was 34.1 +/- 3 weeks, and 62.5% of deliveries occurred between 34 and 37 weeks. Ninety-four fetuses were delivered alive. Mean birth weight was 1880 +/- 410 g. Fetal growth retardation rate was 61.8%, including 28 infants under the third centile and 31 under the 10th centile. Perinatal death rate was 4.16% including 2 in utero deaths and 2 neonate deaths. All infants are healthy except for one child with severe mental retardation. These results show that triplet pregnancies can be safely managed, and that selective first-trimester reduction in triplet pregnancies does not appear to be necessary.     

Birth-weight-specific perinatal mortality in Japan, 1989-1993: singleton versus multifetal pregnancies.

OBJECTIVE: To investigate the relation between birth weight and perinatal mortality in multifetal pregnancies, which is more than 5 times higher than for singleton infants. METHODS: We assessed the incidence of perinatal deaths based on birth weight in 89,566 infants of multifetal pregnancies and 6,025,199 infants of singleton pregnancies in Japan. Perinatal death was defined as stillbirth and early neonatal death (death <1 week of age). RESULTS: The incidence of perinatal death was consistently lower for infants of multifetal pregnancies than for infants of singleton pregnancies at birth weights of 500-2,499 g. However, the incidence of infants of multifetal pregnancies with birth weights >/=2,500 g consistently exceeded that in singleton infants weighing >/=2,500 g. The relative risk (95% CI) of perinatal death among infants of multifetal pregnancies compared with singleton infants in the same category of birth weight was 0.88 (0.84-0.93) at 500 g. The relative risk decreased to 0.31 (0.25-0.39) at 1,900 g, increased to >1.0 at 2,500 g, to 3.7 (2.2-6.1) at 3,000 g, and to 14.9 (7.8-28.4) at >/=3,500 g. CONCLUSIONS: Japanese infants of multifetal pregnancies reaching >/=2,500 g in body weight have a significantly higher risk of perinatal death than singleton infants in the same category of body weight. Increased monitoring of fetuses of multifetal pregnancies who weigh >/=2,500 g may be helpful in reducing the incidence of perinatal mortality.     

Mechanical resistance of intrauterine devices. Experimental evaluation]

In view of the possible intracavitary breakage of an IUD, an experimental model was created to evaluate resistance to mechanical stress in new IUDs and IUDs which had been used for varying periods (6-12-24 months). The results of the study showed that, in addition to a slight inhomogeneity of the product which is probably due to incorrect industrial manufacturing procedures, there is also a correlation between the risk of breakage and intrauterine ageing which is particularly evident in some IUDS.     

Maternal race/ethnicity and twinning rates in the United States, 1989-1991.

OBJECTIVE: To utilize United States birth certificate data (years 1989-1991) to examine the effects of race/ethnicity on twinning rates. STUDY DESIGN: We used a database of birth certificate data for the United States (years 1989-1991) available on CD-ROM from the United States National Center for Health Statistics. This linked birth/infant death data set included a total of 12,036,234 birth records, of which 279,073 were twins. Excluded from the analysis were 15,086 twin birth records (5.4%) based upon previously described exclusion criteria. Statistical analysis included a series of univariate analyses to determine the rates of twinning between different racial/ethnic groups correlated with maternal age, education, marital status and place of birth. Comparisons were analyzed using the chi 2 test, with significance at P < .05. RESULTS: The overall twinning rate was 2.26%, with the lowest rate observed in the group denoted non-Hispanic other (1.67%) and highest among non-Hispanic blacks (2.69%). Twinning rates within various groups representing Hispanics ranged from 1.76% to 2.08%. The twinning rate was significantly higher among U.S.-born as compared to non-U.S.-born women (2.34% vs. 1.88%, P < .005) except for Puerto Ricans, Cubans and Central/South Americans, for whom the reverse was true. Women aged 35-39 had the highest twinning rate (3.05%), whereas women aged 15-19 had the lowest; that trend persisted in all racial/ethnic groups. The study showed a nonsignificant relationship between marital status or education and twinning rate. CONCLUSION: Race/ethnicity studies can be useful in designing programs that may maximize health outcomes of twins in a racially diverse population.