How many maternal deaths are there in Portugal?

Introduction: Maternal mortality is a public health issue, internationally considered an indicator of women’s status in society, indirectly translating access to health facilities. However, it is difficult to measure and is usually underestimated by official records. Methods: Maternal deaths missed by the official statistics in Portugal between 2001 and 2006 were estimated by multiple-recapture methods using three different data sources. An upper limit to the number of deaths was derived from the application of the mortality function of women in reproductive age to the estimated annual number of pregnancies. Results: Maternal mortality decreased from 40 to less than 10 deaths per 100?000 live births between 1978 and 1986. Between 2001 and 2006, it varied from 2.5 to 19 and was underestimated by 9%–26%. Nevertheless, within the same age range, the risk of a pregnant women to die was four times less than a women in the general population. Conclusion: Like in other developed countries, official statistics in Portugal have systematically underestimated maternal deaths. These deaths are a rare event, but the consistent increase in the average age at pregnancy may exacerbate the main causes of death, raising concerns for the future and prompting the need for emergency facilities nearby maternities.     

Does a traumatic birth experience have an impact on future reproduction?

Objective To investigate whether women's experiences of their first birth affects future reproduction.
Design Prospective cohort study.
Setting South Hospital, Stockholm, Sweden.
Population Six hundred and seventeen women who gave birth to their first child 1989–1992.
Methods A global measure of women's experiences of their first birth, assessed two months postpartum, was available from a birth centre trial, together with information on a range of background variables. This information was linked to the Swedish Medical Birth Register, which included information on the number of subsequent births during the following 8–10 years.
Main Outcome Measures Number of births (0 or ≥1) following the first birth.
Results Women with a negative experience of their first birth had fewer subsequent children and a longer interval to the second baby (RR 1.7, 95% CI 1.3–2.3). Being 35 years and older (RR 2.6, 95% CI 1.6–3.7), or single (RR 2.6, 95% CI 1.7–3.9) was also associated with subsequent infertility.
Conclusion A negative birth experience was associated with subsequent infertility, and women's experiences should therefore be considered seriously in the provision of maternity care.     

Is dinoprostone safe? A report of three maternal deaths

We report three maternal deaths which might be in possible association with the use of intravaginal dinoprostone for cervical ripening and induction of labor. All cases occurred at our institution between January 2006 and December 2007. Uterine atony and profuse bleeding followed by disseminated intravascular coagulation (DIC), characterized by severe hypofibrinogenemia developed shortly after delivery of the first two patients. The third patient developed respiratory symptoms in the active labor followed by hemodynamic changes manifested by tetanic uterine contractions and fetal heart rate decelerations. Cardiac arrest developed in all patients shortly after the occurrence of symptoms with no response to any medical intervention. The pharmacologic induction of labor with dinoprostone may be in association with increased risk of maternal death because of increased risk of postpartum DIC and amnionic fluid embolism. Further investigations seem to be needed.     

Does obesity influence gestational hypertension?

EPH gestosis is one from most serious complications stepping out in pregnancy. Reason of occurrence gestosis to this times did not become explained in spite of existences of many theories on theme etiopathogenesis. Stoutness weighty pregnant women in opinion many authors is factor predestinating to occurrences gestosis. Material investigative determined 2 groups: one group--43 healthy weighty pregnant women, and second group--18 pregnant women with gestosis. In each groups investigated one qualified average age of women, MAP, and body mass index (BMI). Our investigations had to answer on following questions: 1. has stoutness influence on course of pregnancy and of childbirth state of new-born child? 2. has stoutness influence on height of arterial pressure in pregnancy? The results shown one ascertained correlation between MAP and BMI in group of weighty pregnant women with EPH gestosis.     

Does a minimally invasive surgery fellowship impact surgical experience among gynecology residents?

STUDY OBJECTIVE: To examine the impact of a minimally invasive surgery (MIS) fellowship on resident experience and to survey the general attitude toward effects of fellowship programs on resident education. DESIGN: Survey (Canadian Task Force classification III). SETTING: An accredited obstetrics and gynecology program in the United States. SUBJECTS: Obstetrics and gynecology residents. INTERVENTION: Residents received a survey regarding the potential impact of a MIS surgery fellowship on resident experience. MEASUREMENTS AND MAIN RESULTS: One year after creation of a MIS fellowship at our institution, we conducted an anonymous survey among residents. We also compared total number of surgical procedures and laparoscopic procedures performed before and after the fellowship commenced. We had a response rate of 70%. The overall impact of the newly established fellowship was regarded as positive. The median approval rating of endoscopic training before and after institution of the fellowship was 3.0 and 4.0, respectively (p < .001). There were no statistically significant changes in caseload between the two periods. CONCLUSION: A fellowship in MIS at an academic institution does not detract from resident experience in gynecologic surgery, with most residents viewing the fellowship positively.     

Is maternal obesity a predictor of shoulder dystocia?

OBJECTIVE: To explore the relationship between maternal obesity and shoulder dystocia while controlling for the potential confounding effects of other variables associated with obesity. METHODS: We performed a case-control study of provincial delivery records audited by the Northern and Central Alberta Perinatal Outreach Program. Risk factors evaluated were selected based on previously published studies. Cases and controls were drawn from 45,877 live singleton cephalic vaginal deliveries weighing more than 2500 g between January 1995 and December 1997. There were 413 cases of shoulder dystocia (0.9% incidence). Controls (n = 845) were randomly chosen from the remainder of the target population to create a 1:2 case/control ratio. Univariate analysis with calculation of odds ratios (ORs) was used to determine which of the chosen risk factors were significantly related to the incidence of shoulder dystocia. Multivariable regression analyses were then used to determine the independently associated variables, and the adjusted ORs were obtained for each relevant risk factor. RESULTS: Maternal obesity was not significant as an independent risk factor for shoulder dystocia after adjusting for confounding variables (adjusted OR 0.9; 95% confidence interval [CI] 0.5, 1.6). Fetal macrosomia was the single most powerful predictor. The adjusted ORs were 39.5 (95% CI 19.1, 81.4) for birth weight greater than 4500 g and 9.0 (95% CI 6.5, 12.6) for birth weight between 4000 and 4499 g. CONCLUSION: The strongest predictors of shoulder dystocia are related to fetal macrosomia. For obese nondiabetic women carrying fetuses whose weights are estimated to be within normal limits, there is no increased risk of shoulder dystocia.     

Does maternal diet affect infantile colic?

Objective: The aim of this study was to investigate the effect of maternal diet on infantile colic without any interventions or food restrictions.

Methods: Thirty colicky and 29 non-colicky infants were included in this prospective study. Mother’s diet and baby crying time were recorded for 1 week by mothers; nutritionist classified contents of mother’s diet and compared the diet of mother in colicky and non-colicky infants.

Results: It was found that mothers of non-colicky infants consumed significantly more grapes and lemons than mothers of colicky infants (p?=?0.044). The crying time was moderately negatively correlated with the percentage of protein in the maternal diet (R?=?–0.45, p?=?0.01) and the presence of potatoes in the maternal diet (R?=?–0.38, p?=?0.034) and positively correlated with the maternal consumption of walnut (R?=?0.38, p?=?0.034), banana (R?=?0.44, p?=?0.01).

Conclusions: Removing bananas from the maternal diet may reduce colic. The consumption of a protein-rich maternal diet, grapes, lemons and potatoes by breastfeeding mothers may protect infants from colic.     

Does maternal hydronephrosis have an impact on urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels?

Objective: To determine urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels and creatinine clearance values in women with different degrees of asymptomatic hydronephrosis during pregnancy.

Methods: A total of 44 pregnant women with different degrees of hydronephrosis and 46 without hydronephrosis were consecutively enrolled in this prospective study. Basic serum and urine parameters, uNGAL levels, and creatinine clearance values were evaluated. All results were compared between the two groups. Regression analysis was used to determine independent predictors, which were mostly related to hydronephrosis.

Results: Demographic data, basal laboratory parameters, and creatinine clearance values were similar, whereas significantly higher uNGAL levels were detected in women with hydronephrosis compared to those without hydronephrosis (45.3 versus 33.2?ng/mL, respectively) (p?=?0.004). An increasing trend in uNGAL levels was detected with increasing degrees of hydronephrosis; as it was not statistically significant (p?=?0.163). Linear regression analysis revealed that the parameter of “pelvic diameter” was found as a significant independent factor influencing uNGAL concentrations (β?=?0.289; 95% CI: 0.522–3.061; p?=?0.006). Other independent variables were not found to influence uNGAL concentrations (p?>?0.05).

Conclusion: The results obtained from this study indicate a significant increase of urinary concentration of NGAL in the presence of asymptomatic maternal hydronephrosis. This impact is likely to be more profound in those with severe hydronephrosis although this has not been specifically investigated. This theory needs to be validated in larger populations.     

Does obesity affect the vaginal hysterectomy outcomes?

Objective  

To evaluate the effects of obesity on the perioperative outcomes in women who underwent vaginal hysterectomy.     

How do maternal factors impact preeclampsia prediction in Brazilian population?

Objective: To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation’s 2012 algorithm (FMF2012) in a Brazilian population.

Methods: All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p?Results: Of the 1934 cases considered for study inclusion, the final sample consisted of 1531 cases. The sample included 120 (7.8%) cases of PE, of which 26 (1.7%) were preterm PE (PE?p?Conclusions: The significance and magnitude of associations of maternal factors in our sample differed from those incorporated in the FMF2012 model, implying the need to derive a fitted model for our population.     

Does external tocodynamometry increase maternal perception of uterine contractions?

A prospective study was performed on 63 women at risk for preterm delivery who recorded maternally perceived contractions for 1 hour before and after placement of an external tocodynamometer. Fifteen women had an increase, 11 had a decrease, and 37 had no change (P not significant) in the number of perceived contractions after placement of the tocodynamometer.     

Does obesity complicate perioperative course in patients undergoing abdominal hysterectomy?

Aim

Obesity is traditionally believed to increase the incidence of perioperative complications in abdominal surgery. Recently this paradigm has been challenged mainly by observations from surgical specialties other than gynecology. Our aim was to assess the impact of obesity on perioperative course in women undergoing total abdominal hysterectomy.

Methods

We analyzed medical charts of 126 patients who underwent total abdominal hysterectomy for benign gynecological conditions through a low transverse incision in the Department of Obstetrics and Gynecology of the Provincial Specialist Hospital in Czestochowa, Poland. Perioperative course was compared between obese [n?=?55; body mass index (BMI)????30?kg/m²: mean 32.6?±?3.2?kg/m²] and non-obese patients (n?=?71; mean BMI 24.3?±?3?kg/m²).

Results

The mean operative time in obese women was significantly prolonged (112?±?32 vs. 100?±?31?min, P?=?0.036). However, complication rates and other perioperative outcomes were comparable between the groups.

Conclusion

In our study, mild obesity does not significantly affect the perioperative course in women undergoing total abdominal hysterectomy.     

Does obesity compromise ovarian reserve markers? A clinician’s perspective

Objective

The aim of the study was to ascertain if increasing body mass index (BMI) adversely affects ovarian reserve among infertile women of Asian origin undergoing in vitro fertilization (IVF).

Materials and methods

This prospective study on 183 women was carried out in the infertility clinic of All India Institute of Medical Sciences, New Delhi, India. Blood hormonal assay in all patients including follicle-stimulating hormone (FSH), luteinizing hormone (LH) and inhibin B was performed on day 2/3 of a spontaneous cycle. A transvaginal ultrasonographic examination on day 2–5 of the menstrual cycle was done for antral follicle count (AFC) and ovarian volume. A correlation between BMI and ovarian reserve parameters like FSH, LH, inhibin B, antral follicle count and ovarian volume was noted.

Results

Age was comparable in the three BMI groups. The mean duration of infertility was 8.38 years. Compared to the normal weight, the overweight and obese women had a statistically significantly low inhibin B (p < 0.0259). The AFC when taken together on both sides was not statistically significant between the groups; however, the overweight and obese women had a significantly low AFC (p < 0.0129) on the right side.

Conclusion

Incorporating anti-mullerian hormone, a newer marker for ovarian reserve, may benefit these obese infertile women. Further work is required to elucidate the mechanisms underlying the effect of obesity on inhibin B as a marker of ovarian reserve in infertile women. The best marker to check the ovarian reserve is perhaps the woman’s performance during an IVF cycle. However, considering the psychological and financial stress of the procedure, it may seem wise to consider counseling of obese women on their expected performance in the first cycle of IVF through such studies.