Dysglycaemia in small-for-gestational-age neonates: a matched case–control study in monochorionic twins

Objective: Small-for-gestational-age (SGA) neonates (birth weight <10th centile) are at higher risk of altered glucose homeostasis compared to appropriate for gestational age (AGA) neonates. The aim of this matched case–control study was to estimate the incidence of hypoglycaemia and/or hyperglycaemia in monochorionic (MC) twins with selective intrauterine growth restriction (sIUGR).

Methods: We included all MC twins with sIUGR (2002–2013). Neonates in the SGA group were matched with their AGA co-twin. We recorded the occurrence of hypoglycaemia and hyperglycaemia in the first 48?h after birth and studied the association with SGA.

Results: In this retrospective study were 126 twin pairs included. The incidence of hypoglycaemia in the SGA group and AGA group was 29.6% and 17.4%, respectively, hyperglycaemia occurred in 8.7% of the SGA neonates and in 2.6% of the AGA co-twins. Multivariate analysis showed an independent association of SGA with hypoglycaemia (OR 1.97, CI 1.23–3.18, p?≤?0.01), but not with hyperglycaemia (OR 2.57, CI 1.64–10.28, p?=?0.182). Low gestational age (GA) at birth (OR 1.65, CI 1.09–2.48, p?=?0.02) showed an independent association with hyperglycaemia.

Conclusions: The risk of hypoglycaemia is almost twofold higher in SGA neonates compared to their MC AGA twins. Low GA appeared to be an independent risk factor for hyperglycaemia in SGA neonates.     

Does minor trauma in pregnancy affect perinatal outcome?

Purpose

To investigate pregnancy outcome after minor trauma and to identify risk factors at admission that may predict adverse pregnancy outcome.

Methods

A retrospective study held between January-2005 and December-2011. Pregnant women at 23 weeks or more, who were admitted due to minor trauma, were included. A standard protocol was applied: physical examination, lab tests and a fetal heart rate monitoring (FHRM) and tocometer for 1 h. In cases of symptomatic women, abnormal FHRM or presence of uterine contractions, the length of monitoring was extended. All women were admitted for 24 h of observation. The primary outcome was a composite adverse outcome that included at least one of the following: placental abruption, preterm birth and birthweight <2,500 g. To investigate pregnancy outcome and identify risk factors that may predict pregnancy outcome, matched (1:2) non-trauma controls were included. Risk factors examined included maternal obstetric variables, complaints at admission, clinical findings, lab test results, FHRM and tocometer findings.

Results

A total of 512 women with minor trauma and 1,024 non-trauma controls were included. Composite outcome occurred in 48 (9.4 %) and 131 (12.9 %) of the study and the control groups, respectively (p = 0.04; OR 0.71; 95 % CI, 0.5–0.99). None of the parameters examined at admission predicted the occurrence of the composite outcome.

Conclusion

Pregnant women after minor trauma have a favorable pregnancy outcome. None of the parameters examined at admission were predictive of adverse outcome. Extensive evaluation at admission and observation for 24 h are probably unnecessary following minor trauma, particularly for asymptomatic women.     

Does parity affect pregnancy outcomes in the elderly gravida?

To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared. This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history. During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30–0.64, P < 0.001), as was the incidence of delivery prior to 34 weeks (6.1% of the primiparas versus 2.9% of the multiparas, P < 0.001, OR 2.16, 95% CI 1.75–2.68); hypertensive disorders (3.9% versus 1.7%, P < 0.001, 95% CI 0.33–0.57); diabetes (4.6% versus 3.2%, P = 0.003, 95% CI 0.55–0.88); and IUGR (10.5% versus 4.7%, P < 0.001, 95% CI 0.35–049), respectively. The increased risk for pre-term delivery, hypertensive disorders, diabetes, and IUGR was maintained after logistic regression analysis. We found that pregnancy complications typical to older parous women are significantly more common among primiparas, indicating that not only older age, but also having a first child relatively late in the reproductive period contributes to adverse pregnancy outcomes.     

Does hysterectomy affect genital sensation?

OBJECTIVES: To evaluate vaginal and clitoral sensation before and after hysterectomy and to assess pre- and post-surgery changes in sexual function. STUDY DESIGN: Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day prior to and 3 months following surgery. A survey was performed 18 months following operation to evaluate long-term changes in sexual function. PARTICIPANTS: Twenty-seven women, aged 30-57 years, who were admitted for elective hysterectomy. MAIN OUTCOME MEASURES: Genital sensation and reported sexual function. RESULTS: There was significant deterioration in sensation to cold and warm stimuli at the anterior and posterior vaginal wall after surgery. Vaginal vibratory sensation thresholds tended to increase. Clitoral thermal and vibratory sensation thresholds remained unchanged before and after surgery. Of the 22 patients who participated in the follow-up survey, 17 did not report any decline in sexual function, while 4 patients reported deterioration in genital sensation and in sexual function. CONCLUSION: The results demonstrate quantifiable sensory loss in the vagina after hysterectomy, with preservation of clitoral sensation. Only a minority of patients reported a decline in their sexual function. These findings highlight the relative importance of clitoral as compared to vaginal sensation in sexual function.     

Does day care affect development?

Abstract

Much research has been directed towards the question, does day care affect development. This question oversimplifies the issue. The definition of terms is critical in how this question is interpreted. The implicit assumptions and problems of this question are considered using data from a recent study to illustrate points to be made.     

Does the size of the vaginal probe affect measurement of pelvic floor muscle strength?

BACKGROUND: The most commonly used method to measure pelvic floor muscle (PFM) strength is vaginal squeeze pressure. There are, however, several apparatuses available for this purpose, and sizes of the probes differ significantly. The aim of the present investigation was to assess whether the size of two commonly used vaginal probes influences measurement of PFM strength. METHODS: Twenty female physical therapy students, mean age 25.1 years (range 21-38), participated in the study. All were able to contract the PFM, as assessed by means of vaginal palpation and observation of inward movement of the perineum. Two measuring devices with different lengths and diameters, the Peritron and the Camtech, were used in order to assess vaginal squeeze pressure. Each woman performed six contractions with each apparatus. RESULTS: Mean maximum squeeze pressure for the whole group with the Camtech was 19.7 cm H(2)O (95% CI: 16.5-22.9) and with the Peritron 36.5 cm H(2)O (95% CI: 31.7-41.3), P < 0.01. Nine women preferred the Camtech, four preferred the Peritron, and seven did not have any specific preferences. CONCLUSIONS: Measurements of vaginal squeeze pressure differ depending on the vaginal probe used. Results from published studies using various probes should, therefore, not be compared or combined in systematic reviews or meta-analysis.     

Does axillary dissection affect prognosis in T1 breast tumors?

BACKGROUND: The treatment of patients with breast cancer has undergone many revisions over recent decades. The current trend is toward limited resections and breast conservation. Some authors advocate the abandonment of axillary lymph node dissection (ALND) for small tumors. While it is accepted that ALND has no therapeutic effect in breast cancer patients, its prognostic significance for small tumors is debated. Eligibility criteria for surgical treatment without axillary dissection are evolving. METHODS: Considering that problem, we retrospectively reviewed the charts of 100 patients with T1 invasive carcinoma of the breast treated at Hippokration Hospital of Athens between 1986 and 1987. Patients were divided into two groups: those that underwent ALND (n=76) and those that did not (n=24). The following data were recorded: age, tumor size, grade, hormone receptor status and postoperative treatment. The ten-year overall and disease-free survival were analysed. A multivariate analysis was used to identify prognostic variables. RESULTS: There was no statistically significant difference in the ten-year overall and disease-free survival between the two groups. The univariate analysis showed that tumor size predicts both recurrence and survival. In the multivariate analysis tumor size was found to be an independent prognostic factor for overall survival. CONCLUSIONS: ALND did not influence the ten-year survival or the recurrence rate. Tumor size was the only statistically significant and independent prognostic factor for T1 breast cancer patients.     

Does the antenatal detection of small-for-gestational-age babies influence their two-year outcomes?

The aim of this paper is to determine whether antenatal detection of small-for-gestational-age (SGA) babies influences 2-year outcomes. All low-birth-weight (<2,500g) infants born in South-EastThames region, England from September 1, 1992 to August 31, 1993 were identified at birth. Antenatal "suspicion" and ultrasound assessment confirming growth restriction was categorized as "detection" of SGA. Postnatally, infants were classified as SGA if they had a birth weight for given gestation below the 10th centile. At 2 years, those below 32 weeks' gestation and a random 25% sample of infants of 32 weeks' gestation or more underwent pediatric assessments. Of 49,787 births, 3,456 (6.9%) were of low birth weight. One thousand four hundred and fifty one (42.5%) were SGA, of whom 611 (42%) were detected antenatally by ultrasound scan. At 2 years, 1,008 (75.8%) of 1,358 expected infants were assessed, 379 (37.6%) were SGA at birth, and 188 (49.6%) were confirmed antenatally. Although undetected infants had higher mean birth weights and gestational ages, they had a higher proportion of perinatal deaths (12.6 vs. 6.4%, RR 1.96: CI 1.32-2.86) than detected infants. At 2 years, detected SGA infants had smaller head circumferences (p = 0.026), a higher prevalence of febrile convulsions (8.0 vs. 3.1 %: p = 0.040) and lower scores on the locomotor (DQA) scale of Griffith's developmental test (p = 0.021) compared with undetected SGA infants. Despite detected SGA fetuses having lower weights and gestation at birth than undetected fetuses, they had significantly lower mortality without a parallel increase in severe 2-year neuro-developmental, clinical, or growth morbidity.     

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 female age affect embryo morphology?

Deteriorating oocyte quality is commonly believed to be the primary determinant of the decreased implantation potential in older women. We assessed the influence of age on embryo morphology in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) modalities. All 6350 consecutive embryos (2990 IVF, 3360 ICSI) obtained in our Assisted Reproductive Technology Unit from January 1996 through June 1997 were included. High quality embryos were defined as those with equal-sized blastomeres and < 10% fragmentations and a cleavage rate of four cells on day 2 or eight cells on day 3 transfers. The results were analyzed for the standard IVF group, the ICSI group, and the ICSI subgroup with severe male factor infertility (< or = 1 x 10(6) total motile spermatozoa in the ejaculate). For standard IVF, a positive association was observed between female age and increased proportion of good quality embryos. No such association was detected for the ICSI cycles (whole group or subgroup). We conclude that in standard IVF, embryo quality, as reflected by embryo morphology, does not deteriorate with increased maternal age.     

Does erythropoietin affect motility of spermatozoa?

Introduction  

Erythropoietin, which is a hematopoietic growth factor, has been found to play a role in various physiologic processes within the body including testicular steroidogenesis and spermatogenesis. However, it is not known whether erythropoietin is also essential for the normal physiology of mature sperm cells. In this study, the effects of recombinant human erythropoietin beta (rEPO) on sperm motility were investigated.     

Does air travel affect pregnancy outcome?

Introduction Primary ovarian carcinoid tumours are uncommon neoplasias. There are distinct histological types with different behaviours: insular, trabecular, mucinous and mixed. The trabecular subtype is very rare and unlike other carcinoid subtypes, it is characterised by the absence of a clinical carcinoid syndrome and has been related with a better prognosis than the others. No distant metastases have yet been reported. Case report We present a case of a 76-year-old woman diagnosed with a left ovarian tumour. She underwent a radical hysterectomy with bilateral salpingo-oophorectomy and regional lymph node clearance. Histology revealed an ovarian trabecular carcinoid tumour and no adjuvant treatments were performed. The patient is alive and free of disease 70 months following diagnosis. Discussion Immunohistochemical staining for p53 protein, and a comparative study with other subtypes of ovarian carcinoid tumours (insular and mucinous) is discussed in this report.     

Does pregnancy affect pelvic organ mobility?

BACKGROUND: It is generally accepted that parity is a strong predictor of pelvic organ prolapse and incontinence. However, controversy persists as to whether this effect is due to pregnancy itself or parturition. AIMS: To define the contribution of early and late pregnancy to bladder mobility. METHODS: Case control series, using 88 non-pregnant control subjects recruited for a heritability study on urinary incontinence and prolapse, matched for age and ethnicity with 28 pregnant women seen at 10-17 weeks and again at 32-39 weeks' gestation. Main outcome parameters were ultrasound measures of anterior, central and posterior compartment descent as well as joint mobility measurements. RESULTS: Patients in early pregnancy showed higher values for bladder mobility in comparison with non-pregnant controls, although this did not reach significance for all parameters. However, when late pregnancy data were tested against non-pregnant controls, this difference reached significance for all tested parameters. Uterine and rectal descent did not show any significant differences between groups. Results for joint mobility were inconsistent. CONCLUSIONS: This study supports the hypothesis that bladder and urethral mobility increase in pregnancy. This effect is already noticeable at 6-18 weeks. As similar changes are also seen in elbow hyperextension, a generalised effect on connective tissue biomechanics, likely hormonal, can be hypothesised.     

Does raloxifene therapy affect mammographic breast cancer screening in postmenopausal patients?

OBJECTIVE: The aim of the study was to determine mammographic breast density changes during raloxifene therapy in postmenopausal patients MATERIALS AND METHODS: Fifty-five cases who were using raloxifen therapy were included in this retrospective analysis. Raloxifene was given for osteopenia and osteoporosis according to low bone mineral density measured by dual-energy X-ray absorptiometry (DEXA). None of the patients were using hormone replacement therapy 12 months before the initiation of raloxifene treatment or during the study. Mammographic breast density was determined by mammography before the initiation of raloxifene treatment (baseline) and after 12 to 16 months of therapy. The Breast Imaging Reporting and Data System (BI-RADS) breast density score was used for the evaluation of mammographic density. RESULTS: There was no change in mammographic breast density when the baseline and the first mammography taken after the initiation of therapy were compared (p = 0.32). There was no significant correlation between the duration of raloxifene treatment and mammographic density measured after raloxifene treatment (r = -0.158, p = 0.25). Only in one patient did the BI-RADS classification of 2 change to 3 after 12 months of therapy. CONCLUSIONS: In conclusion, raloxifene therapy for 12 to 16 months does not increase mammographic breast density in postmenopausal women with low bone mass.     

Does educational intervention affect resident competence in sonographic cervical length measurement?

Objective: To determine if a structured teaching module improves resident competency in transvaginal sonographic cervical length measurements.

Methods: This was a prospective cohort study involving obstetrics and gynecology residents at a single institution. Residents collected 10 transvaginal cervical images from patients with threatened preterm labor presenting to Labor and Delivery. After initial image acquisition, residents participated in a lecture-based teaching module involving a pre- and post-intervention assessment. Following the didactic session, they collected 10 additional images. All the images were scored independently by two Maternal–Fetal Medicine attending physicians based on the quality and accuracy of the measured cervical length. Pre-and post- intervention test results were compared, as well as pre- and post- intervention image scores. Parametric and nonparametric tests were used as appropriate with p?<?0.05 considered significant.

Results: Ninety-three percent of the residents (14/15) improved their scores from pre-test to post-test or maintained an already perfect score (p?<?0.01). Improvement was most significant with the junior residents. Seventy-nine percent of the residents (11/14) improved their cervical image scores after the educational session. Mean score for total residents was 73.7?+?12.6 pre-intervention and 90.2?+?9.9 post-intervention (p?<?0.01) out of a total of 120.

Conclusions: There is an improvement in the competence of resident measured cervical lengths via transvaginal ultrasound when a structured educational module is implemented for resident education.     

Does ovulation induction and intrauterine insemination affect perinatal outcomes in singletons?

Aim: To evaluate the effect of solely intrauterine insemination on perinatal outcomes.

Methods: A total of 3830 OI/IUI cycles between January 2007 and December 2012 were included in the study. Three hundred and fifty-eight pregnancies following intrauterine insemination were encountered during the study period. Data from 246 pregnancies conceived through OI/IUI treatment were available. A total of 438 singletons with no maternal risk constituted the control group. The two groups were compared according to perinatal outcomes.

Results: There was a statistically significant difference between the groups in first trimester abortion and intrauterine demise. At least one or more perinatal adverse outcomes occurred in study and control groups with the rates of 38.4% and 18.5%, respectively. There were significant differences in preterm delivery rate and oligohydramnios between the groups. There were also significant differences in the rate of neonates with a birth weight Conclusion: In general, women’s health perspective, to have a pregnancy is the main target in infertility work-ups, but physicians should be aware of the risks and couples should be counseled that pregnancies after OI/IUI treatment even if singleton carries a risk of adverse perinatal outcome for both the mother and baby.     

Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer

OBJECTIVE: To determine whether tumor size or morphology is predictive of extrauterine disease and/or recurrence risk in endometrial cancer and therefore guide decisions about the necessity of complete surgical staging and adjuvant therapy. METHODS: All women with surgically treated endometrial carcinoma between 1 January 1990 and 1 January 2000 were eligible. 345 patients were eligible for retrospective chart review. Univariate and multivariate logistic regression models were used to determine the predictors of nodal metastasis and recurrence. RESULTS: As tumor size increased, the risk of nodal metastasis increased. However, a risk of nodal metastasis remained even with small lesions less than or equal to 2 cm (6.3% risk). Patients with tumor size greater than 2 cm had a 26.3% incidence of nodal metastasis. In univariate analysis, the odds ratio (OR) for tumor size as a predictor of extrauterine disease was 1.4 (95% CI 1.2-1.6). In multivariate analysis, tumor size was not statistically significant. Only the lesions greater than or equal to 8 cm confer a risk that approaches previously identified well-known predictors. Tumor size was not found to be a statistically significant predictor of recurrence OR 1.3 (1.0-1.8). CONCLUSIONS: Tumor size correlates with extrauterine disease, but it is not an independent prognostic variable. Although the risk of extrauterine disease increases with tumor size, the risk of nodal metastases remains even for those patients with very small tumors, underscoring the need for routine complete surgical staging. Tumor size does not appear to be an independent predictor of recurrence.