A qualitative study of the experiences of Taiwanese women having their first baby after the age of 35 years

OBJECTIVE: to explore the experiences of Taiwanese women who become pregnant for the first time after the age of 35 years. DESIGN, SETTING AND PARTICIPANTS: a phenomenological method was used to collect data by interviews. This study was undertaken in a 1600-bed university hospital in southern Taiwan, with a purposive sampling of 10 first-time pregnant women aged 35-44 years. The interviews were tape-recorded and transcribed to develop data categories. FINDINGS: participants amply demonstrated that the core experience was 'jubilant apprehension' (Yu-Shee-Zhun-Ben in Mandarin). Five subcategories were expressed among pregnant women over 35 years of age. These were 'surprise and worry about childbirth outcomes;' 'embarrassment about being outside the societal age norm for pregnancy;' 'ambivalence about impending lifestyle changes;' 'loneliness and lack of support;' and 'concern about the safety of pregnancy and childbirth'. CONCLUSION AND IMPLICATIONS FOR PRACTICE: although pregnancy was a pleasant surprise for these women, they were concerned that their childbearing was beyond the social expectation for their age. We highlight new aspects of midwifery professionalism that should address the childbearing experience of women over 35 years of age, and provide a basis for care of this group.     

A prospective study on the perinatal outcome in Mozambican pregnant women with preterm rupture of membranes using two different methods of clinical management.

Antenatal care of women with preterm rupture of membranes is controversial, particularly in countries with high prevalence figures for sexually transmitted diseases and other genital infections. In order to assess the value of conservative and active management routines, 92 women with singleton pregnancies and gestational lengths between 27 and 34 weeks were adopted into the two respective groups. The first group comprised 40 cases who were treated conservatively and the second comprised 52 cases who were treated actively with induction. The first group received amoxicillin (100 mg) and metronidazole (500 mg), both drugs given three times daily. All patients were also routinely treated with an antimalarial dose of chloroquine. The second group was not given any pharmaceutical treatment, and labor was induced 3-24 h after membrane rupture. The two groups differed significantly regarding birth weight, the average birth weights being 2,168 and 1,780 g in the first and second groups, respectively (p less than 0.05). While the intrauterine mortality was approximately the same in both groups, the neonatal mortality differed significantly (2.6 vs. 19.2%; p less than 0.05). It is concluded that an expectant attitude, rather than an active and induction-oriented one, is most favorable in cases with preterm rupture of membranes, also in settings in which prevalence figures of sexually transmitted diseases and other genital infections are high.     

Patterns of free fatty acids, glycerol, D-beta-hydroxybutyrate and insulin in pregnant women and their newborn infants. Effects of a low and a high insulin response to glucose in the mothers.

Twenty-eight healthy women, 17 with high and 11 with low insulin response to glucose but with normal glucose tolerance, were followed throughout pregnancy. Plasma FFA, glycerol and D-beta-hydroxybutyrate as well as plasma insulin and glucose in blood were determined before and during a glucose infusion test (GIT) in each trimester and after pregnancy. In 13 infants of high insulin responders (IHR) and 10 infants of low responders (ILR) an intravenous glucose tolerance test (IVGTT) was performed, and the above lipid parameters were studied at birth and during the IVGTT. The low responder group was postulated to consist mainly of prediabetic individuals (8). Their infants have previously been shown to have an increased glucose assimilation rate at IVGTT (12, 13), as has been shown for infants of diabetic mothers. There was little difference between the two groups of mothers except for the insulin levels during the GIT in non-pregnant and early pregnant subjects, which were considerably lower in the low responders. They all had decreased fasting levels of FFA, glycerol, and D-beta-hydroxybutyrate in mid-pregnancy and normal values in late pregnancy. The ILR showed the same changes in FFA and glycerol as the IHR, but their D-beta-hydroxybutyrate levels were higher at birth than those of the IHR and lower after birth. Another difference found, was the correlation between birth weight and fasting insulin (and to some extent the insulin level at birth) in the ILR group, which was not found in the IHR. Apart from those differences the ILR and the IHR seemed to handle their fat metabolism in a similar way in the early neonatal perinatal period.