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1.
O'Dwyer V Farah N Fattah C O'Connor N Kennelly MM Turner MJ 《European journal of obstetrics, gynecology, and reproductive biology》2011,158(1):28-32
Objective
This study looked at the association between caesarean section (CS) and Body Mass Index (BMI) in primigravidas compared with multigravidas.Study design
We enrolled women at their convenience, in the first trimester after an ultrasound examination confirmed an ongoing pregnancy. Weight and height were measured digitally and BMI calculated. After delivery, clinical details were again collected from the Hospital's computerised database.Results
Of the 2000 women enrolled, there were 50.4% (n = 1008) primigravidas and 49.6% (n = 992) multigravidas. Of the 2000 8.5% were delivered by elective CS and 13.4% were delivered by emergency CS giving an overall rate of 21.9%. The overall CS rate was 30.1% in obese women compared with 19.2% in the normal BMI category (p < 0.001). In primigravidas the increase in CS rate in obese women was due to an increase in emergency CS (p < 0.005) and in multigravidas the increase was due to an increase in elective CS (p < 0.01). In obese primigravidas 20.6% had an emergency section for fetal distress. In obese multigravidas 17.2% had a repeat elective CS.Conclusion
The influence of maternal obesity on the increase in CS rates is different in primigravidas compared with multigravidas. 相似文献2.
C.H.E. Weimar A.C. Lim H.W. Bruinse 《European journal of obstetrics, gynecology, and reproductive biology》2010,151(1):41-45
Objective
To study risk factors for uterine rupture (UR) in women with one previous caesarean section (CS) undergoing a vaginal birth after CS (VBAC).Study design
A nested case-control study was conducted. Baseline characteristics, general obstetric history, details of the previous CS, current delivery and maternal and neonatal outcome were analysed for 41 cases with a UR and 157 controls (no rupture). Data were extracted from 21 Dutch hospitals.Results
Labour induction was more common in cases than in controls (51% vs. 25% respectively, P = 0.001), and in case of induction therapy especially the use of prostaglandins (PGE2) was more frequent in the case group (86% vs. 46%, P = 0.014 for cases and controls respectively). Patients with UR had a significantly lower Bishop score (median: 2.0 vs. 4.0, P = 0.005) and received more augmentation of labour compared to controls (36% vs. 18%, P = 0.010). In the multivariate analysis induction with PGE2 and oxytocin, induction with PGE2 alone, and augmentation of labour were independent variables affecting the occurrence of UR (respectively OR 13.0, CI 2.3-74.2; OR 4.6, CI 1.9-11.3 and OR 2.7, CI 1.2-6.3). Forty-four percent of the ruptures can be explained by induction of labour with prostaglandins ± oxytocin.Conclusion
Having studied baseline characteristics, general obstetric history, details of the previous CS and of the current delivery, we show that no factors other than the use of PGE2 (±oxytocin) in response to a low Bishop score, and augmentation of labour with oxytocin are associated with an increased risk for UR in women undergoing VBAC after one previous CS. 相似文献3.
Cayrac M Faillie JL Flandrin A Boulot P 《European journal of obstetrics, gynecology, and reproductive biology》2011,157(2):145-149
Objectives
To evaluate the results and risks of a protocol for second- and third-trimester termination of pregnancy after prior caesarean section.Study design
This is a retrospective study, conducted in a level 3 (university hospital) maternity unit between January 2001 and September 2008. 67 women with a history of caesarean section underwent second- and third-trimester termination of pregnancy. The protocol was administration of 600 mg mifepristone the first day and application of laminaria tents the second day. One the third day, 48 h after mifepristone, two 200 μg tablets of misoprostol were given orally every 3 h until delivery. Epidural analgesia was performed routinely. Complications analysed were uterine rupture, labour lasting over 12 h, and bleeding requiring blood transfusion.Results
Delivery was vaginal in 64 cases (95.5%), a median 4 h 20 min (P25: 3 h 5 min, P75: 7 h 7 min) after administration of misoprostol (median number of tablets 2; P25: 2, P75: 4). The median number of tablets of misoprostol was significantly higher for termination of pregnancy than for fetal death in utero (4 vs. 2; p = 0.002). The rate of uterine rupture was 4.8% [95% CI: 1.2-14.2]. Bleeding during delivery requiring a transfusion occurred in 2 cases (3.0%; 95% CI: 0.5-11.3).Conclusion
A high rate of vaginal delivery was achieved at low doses of misoprostol, with a short median induction-to-delivery interval, and a rate of uterine rupture higher than that observed during attempted vaginal delivery at term in a caesarean scar pregnancy. The rate of severe bleeding during delivery was low. 相似文献4.
Caroline S.E. Homer RM Msc. Med. PhD Professor of Midwifery Rebecca Johnston BSc Research Assistant Maralyn J. Foureur RM BA Grad Dip PhD Professor of Midwifery 《Midwifery》2011,27(2):165-169
Objectives
to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality.Design and setting
cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006.Participants
women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria.Measurements
data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400 g birth weight in the state.Findings
over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who ‘attempted a vaginal birth’ also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers ‘attempted’ a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers ‘attempted’ a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small.Key conclusions
rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings.Implications for practice
decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours. 相似文献5.
Nilo Sérgio Nominato Isabela Lauar Laura Maia 《European journal of obstetrics, gynecology, and reproductive biology》2010,152(1):83-85
Objective
To estimate the incidence of scar endometriosis after different surgical procedures.Study design
A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated.Results
Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p < 0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years.Conclusion
Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis. 相似文献6.
Rohna Kearney Myra Fitzpatrick Michael Behan Declan Keane John O.L. DeLancey 《International journal of gynaecology and obstetrics》2010,111(1):19-22
Objective
To compare levator ani muscle injury rates in primiparous women who had a forceps delivery owing to fetal distress with women delivered by forceps for second stage arrest; and to compare these injury rates with a historical control group of women who delivered spontaneously.Methods
Primiparous women who delivered by forceps were recruited retrospectively into 2 groups: forceps for fetal distress with short second stage (25 ± 11 minutes; n = 19); and forceps delivery for second stage arrest (137 ± 26 minutes; n = 19). MR images of the levator ani muscles were compared with a historical control group of women from a previous study who had delivered spontaneously (n = 129).Results
Major defect rates were: 42% for forceps and short second stage; 63% for forceps and second stage arrest; and 6% for spontaneous delivery. The odds ratios for major injury were: 11.0 for forceps and short second stage compared with spontaneous delivery; 25.9 for forceps and second stage arrest compared with spontaneous delivery; and 2.3 for forceps and second stage arrest compared with short second stage (P = 0.07).Conclusion
Women delivered by forceps have a higher rate of levator ani injury compared with spontaneous delivery controls; the difference between the forceps groups did not reach significance. 相似文献7.
Greg A. Pearson Ian Z. MacKenzie 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To determine the range of, and influences on, the incision-delivery interval (IDI) and the impact on neonatal condition at delivery.Study design
Analysis of prospectively collected cohort data from all women delivered by caesarean section over 12 months in an obstetric unit delivering 6000 women per year. Prospective data were collected from clinical records, with factors that influence IDI and relationship to neonatal condition at birth as the main outcome measures.Results
IDI was recorded for 1379 (93%) caesarean sections and ranged between 1 and 37 min; median (IQR) was 6 (5–8) min, and for 3% the interval was longer than 15 min. Category 1 and 2 caesarean sections had shorter IDI than categories 3 and 4 and intrapartum operations had significantly shorter IDI at 5 (3–8) min than antepartum at 7 (5–9) min (P < 0.0001). Factors associated with longer IDI included previous delivery by caesarean section, increased maternal body mass index (BMI), regional anaesthesia, larger neonatal birthweight and technical problems including intraperitoneal adhesions, but did not include fetal malpresentation, multiple pregnancy, grade of surgeon or stage of labour. IDI had no impact on neonatal condition at birth.Conclusions
Prolonged IDI does not adversely affect neonatal outcome, but factors associated with prolonged IDI should be acknowledged when assessing decision-to-delivery interval target times. 相似文献8.
Wassim Badiou Philippe-Jean Bousquet Xavier Monroziès Renaud de Tayrac 《European journal of obstetrics, gynecology, and reproductive biology》2010,152(2):168-171
Objective
Our purpose was to determine if prolonged second-stage labour independently increases postpartum anal incontinence.Study design
360 primiparous women were studied retrospectively after vaginal delivery of term cephalic singletons, including a group with short second-stage labour (<30 min, n = 163) and a group with a prolonged second stage (>90 min, n = 197). A quality of life questionnaire on anal incontinence (FIQOL) was sent out at 15 months after delivery.Results
184 women (96 with short second-stage labour and 88 with a prolonged second stage) answered the questionnaire (response rate 51%). Flatus incontinence was reported after prolonged second-stage labour in 9.1% of women vs 15.6% after short second stage (p = 0.18). Fecal incontinence was reported after prolonged second-stage labour in 2.3% vs 5.2% after a short second stage (p = 0.45).Conclusion
We suggest that prolonged second stage of labour should not be associated with an increased risk of postpartum incontinence. 相似文献9.
Lilantha Wedisinghe Maureen Macleod Deirdre J. Murphy 《European journal of obstetrics, gynecology, and reproductive biology》2008
Objective
To establish the views and current practice of obstetricians and anaesthetists with regard to the use of oxytocin to prevent haemorrhage at caesarean section.Study design
A national survey of all lead consultant obstetricians and anaesthetists for the labour ward in the United Kingdom. A postal questionnaire was sent to all clinicians with one subsequent reminder to non-responders. The use of oxytocin bolus and infusion, perceived side effects of intravenous oxytocin, estimated blood loss at caesarean section, and willingness to participate in a future clinical trial were explored.Results
The response rate was 84% (365 respondents). A slow bolus of 5 IU oxytocin was the preferred approach of obstetricians and anaesthetists (153, 86% and 171, 92%, respectively). Oxytocin infusions were used routinely by 72 clinicians (20%) with selective use for particular clinical circumstances by 289 (80%). Most clinicians used either 30 IU (158, 43%) or 40 IU (192, 53%) infusions over 4 h, with a total of 38 different regimens. The perceived risk of side effects with an oxytocin infusion was low. Estimated “average” blood loss varied (150–1500 ml) with 56 clinicians (17%) and 93 (28%) reporting a >20% risk of postpartum haemorrhage for elective and emergency caesarean sections, respectively.Conclusion
There is wide variation in the use of oxytocin at caesarean section reflecting limited research in this area. Excess haemorrhage is considered to occur frequently and the perceived risk of oxytocin bolus and infusion is low. Further research is required addressing the optimal use of oxytocic agents at caesarean section. 相似文献10.
Mary F. Higgins Cathy MonteithMichael Foley Colm O’Herlihy 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
Placenta accreta, morbid adherence to the uterus to the myometrium, is commonest in association with placenta previa in women previously delivered by caesarean section (CS). It has become proportionally a greater cause of major maternal morbidity and mortality as the frequency of other serious obstetric complications has declined. The aim of this study was to examine the incidence of placenta accreta in the context of a rising caesarean delivery rate.Study design
Retrospective review of the incidence of placenta accreta in parous women during the 36 years 1975–2010. Cases were identified from hospital records and then correlated with pathological reports. The incidence of placenta accreta was analysed in the context of women previously delivered by CS.Results
During the 36-year period in our unit, 157,162 multiparous women delivered, of whom 15,151 (9.6%) had a previous CS scar. The institutional incidence of CS rose from 4.1% in 1975 to 20.7% in 2010. Twenty-five parous women, all with a previous CS, had placenta accreta requiring hysterectomy. The overall incidence of placenta accreta was 1.65 per 1000 parous women with a previous CS, but was low (1.06/1000) until 2002. From 2003 to 2010 the incidence rose to 2.37/1000 previous CS deliveries (OR 2.2; 95% CI 1.05–5.1).Conclusion
The frequency of placenta accreta correlated steadily with the CS rate until 2000. Since then, the incidence has nearly doubled in women with previous CS scars, suggesting an additional causative influence on risk. 相似文献11.
Vincent Lavoué Laure Voguet Bruno Laviolle Caroline Piau Marie Pascale Beaumont Laure-Anne Haumont Hélène Isly Linda Lassel Estelle Bauville Karine Morcel Patrick Pladys Patrice Poulain Pierre Bétrémieux Claude Bendavid 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objectives
The incidence of neonatal respiratory morbidity following an elective caesarean section is 2–3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in new-borns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks’ gestation.Study design
The files of 136 women who had undergone amniotic microviscosity studies during elective caesarean deliveries at term were anonymised. Amniotic fluid immaturity (AFI) was defined as a Fluorescence Polarisation Index higher than 0.335.Results
Respiratory morbidity was observed in 10 babies (7.3%) and was independently associated with AFI (OR: 6.11 [95% CI, 1.20–31.1] with p = 0.029) and maternal body mass index (OR: 1.12 [95% CI, 1.02–1.22] with p = 0.019). Gestational age at the time of caesarean delivery was inversely associated with AFI (odds ratio, 0.46 [95% confidence interval, 0.29–0.71], p < 0.001), especially before 39 weeks, and female gender was associated with an increased risk (odds ratio, 3.29 [95% confidence interval, 1.48–7.31], p = 0.004).Conclusions
AFI assessed by amniotic microviscosity was significantly associated with respiratory morbidity and independently correlated with shorter gestational age especially before 39 weeks. This finding provides a physiological rationale for recommending delaying elective caesarean section delivery until 39 weeks of gestation to decrease the risk for respiratory morbidity. 相似文献12.
Jara Ben-Nagi Amy Walker Joseph Yazbek 《International journal of gynaecology and obstetrics》2009,106(1):30-34
Objective
To compare endometrial tissue samples from cesarean scar (CS) sites and from the posterior uterine wall to better understand the pathophysiology of implantation into a CS.Methods
Endometrial samples were taken from both a CS site and the posterior wall in premenopausal women with CSs, and from the posterior wall in premenopausal women who had spontaneous vaginal deliveries (SVDs) only.Results
In the secretory phase, there were significantly fewer leukocytes at CS sites than in the endometrium of women who had SVDs only (P < 0.05). Significant differences in leukocytic infiltration and cell proliferation between the proliferative and secretory phases were only found in women who had SVDs only (P < 0.05).Conclusion
Leukocyte recruitment to the endometrium during the secretory phase may be affected by the presence of a CS. 相似文献13.
Tullio Ghi Michela Nanni Luca Pierantoni Federica Bellussi Maria Letizia Bacchi Reggiani Giacomo Faldella Nicola Rizzo 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre-labour caesarean section.Study design
Uncomplicated pregnancies delivered by prelabor caesarean section at 34 + 0 to 37 + 6 weeks’ gestation were retrospectively selected. For both singletons and twins caesarean delivery was undertaken electively only after amniocentesis and if the lecithin/sphingomyelin ratio was ≥2. Neonatal respiratory morbidity was compared in twins versus singletons.Results
241 singletons and 100 twin neonates were included. Overall neonatal respiratory morbidity was comparable between the two groups (25/241 (11.7%) versus 7/100 (7%), p = .331). Between 34 + 0 and 36 + 6 weeks, however, the risk was higher among singleton than twins (15/46 (32.6%) versus 6/72 (8.3%), p < .001). At multiple regression, dichorionicity, gestational age at delivery ≥37 weeks and female sex independently decreased the risk of neonatal respiratory morbidity.Conclusion
The risk of neonatal respiratory morbidity after elective caesarean section seems lower among twins, especially prior to 37 + 0 weeks. 相似文献14.
Daly N Brennan D Foley M O'Herlihy C 《European journal of obstetrics, gynecology, and reproductive biology》2011,154(1):57-61
Objective
This study was planned to screen polycystic ovary syndrome (PCOS) women for albuminuria and to evaluate the association between urinary albumin excretion (UAE) and metabolic disturbances of PCOS. In addition, this is the first study in the literature evaluating the association between UAE and carotid intima-media thickness (CIMT) in PCOS cases.Study design
The study population consisted of 65 PCOS women. The study was prospectively designed and performed in a university hospital. The diagnosis of PCOS was made according to the Rotterdam criteria: exclusion criteria were hyperprolactinemia, thyroid dysfunction, adrenal dysfunction, diabetes mellitus, hypertension, and pregnancy. Blood samples were collected in the follicular phase of a menstrual cycle and serum samples were analyzed for fasting glucose, insulin, and hormone and lipid profiles. Twenty-four hour urine specimens were collected for the detection of UAE. CIMT was estimated by visual assessment of the distance between the lumen-intima and intima-adventitia interfaces.Results
The mean age and BMI were 23 years and 23 kg/m2, respectively. The median UAE was 7 mg/day (range: 0.3-154 mg/day). The median UAE as micrograms of albumin per milligram of creatinine (uACR) was 5.6 (0.28-159). Regarding the uACR cutoff value (>6.93 μg/mg), significantly higher levels of triglycerides, 17 OH-progesterone, insulin resistance (HOMA index > 2.1) and increased CIMT were present in these cases. Microalbuminuria (uACR > 25 μg/mg) was present in 6.2%. In the regression analyses serum HDL-C levels were found to be independent predictor for uACR > 2 μg/mg (OR: 0.85) and estradiol levels were the independent predicting factor for uACR > 6.93 μg/mg even after adjustments for age and BMI were performed (OR:1.02).Conclusions
UAE, expressed as uACR > 6.93 μg/mg, seems to be an associated sign of metabolic problems which might help in discriminating PCOS at risk of future CVD. Further studies are needed before routine use of albuminuria in PCOS cases for the detection of CVD risk. 相似文献15.
Jiang T Liu G Huang L Ma H Zhang S 《European journal of obstetrics, gynecology, and reproductive biology》2011,156(2):209-211
Objectives
Caesarean scar pregnancy (CSP) is a very rare and dangerous form of pregnancy because of the increased risk of rupture and excessive hemorrhage. There is currently no consensus on the treatment. We studied if methotrexate (MTX) therapy followed by suction curettage followed by Foley tamponade was a viable treatment for patients with CSP.Study design
Forty-five patients with CSP in our hospital received a single dose of 50 mg/m2 MTX by intramuscular injection. If gestational cardiac activity was seen on transvaginal ultrasound, local injection of MTX was given. After 7 days, suction curettage was performed to remove the retained products of conception and blood clot (CSP mass) under transabdominal sonography (TAS) guidance. After the suction curettage, a Foley catheter balloon was placed into the isthmic portion of cervix.Results
Forty-two subjects were successfully treated and 3 subjects failed treatment. The mean estimated blood loss of all 45 patients was 706.89 ± 642.08 (100-3000) ml. The resolution time of the serum β-hCG was 20.62 ± 5.41 (9-33) days. The time to CSP mass disappearance was 12.57 ± 4.37 (8-25) days.Conclusions
MTX administration followed by suction curettage followed by Foley tamponade was an effective treatment for caesarean scar pregnancy. 相似文献16.
Ribak R Harlev A Ohel I Sergienko R Wiznitzer A Sheiner E 《European journal of obstetrics, gynecology, and reproductive biology》2011,158(1):33-36
Objective
To assess pregnancy outcome in women who initially refused medically indicated caesarean delivery (CD) in cases of non-reassuring fetal heart rate (FHR) patterns.Study design
A retrospective cohort study, comparing patients who refused and did not refuse caesarean delivery (CD) due to non-reassuring FHR tracings, was conducted. Deliveries occurred between the years 1988 and 2009 in a tertiary medical center. Multivariate analysis was performed to control for confounders.Results
Out of 10,944 women who were advised to undergo CD due to non-reassuring FHR patterns, 203 women initially refused CD. Women refusing medical intervention tended to be older (30.6 ± 6.9 vs. 28.29 ± 6.1, P < 0.001) and of higher parity (46.8% vs. 19.9% had more than 5 deliveries; P < 0.001) as compared to the comparison group. Refusal of CD was significantly associated with adverse perinatal outcome. Using a multiple logistic regression model controlling for confounders such as maternal age, refusal of treatment was found as an independent risk factor for perinatal mortality (adjusted OR = 3.3, C.I. 95% 1.8-5.9, P < 0.001). A non-significant trend towards higher rates of adverse perinatal outcome was found when refusal latency time was longer than 20 min (OR = 2, 95% CI 0.36-11.95; P = 0.29).Conclusion
Refusal of CD in cases of non-reassuring FHR tracings is an independent risk factor for perinatal mortality. 相似文献17.
Lena Dain Ron Auslander Talma Rosen Yakir Segev Eyal Goldschmidt Yoram Abramov 《International journal of gynaecology and obstetrics》2010,111(2):119-121
Objective
To determine whether obstructive voiding symptoms in women with advanced pelvic organ prolapse (POP) were associated with objective bladder outflow tract obstruction.Methods
We reviewed preoperative data from patients with advanced POP who underwent surgical correction at the Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, between December 1, 2005, and November 30, 2007. Obstructive voiding symptoms were recorded from Pelvic Floor Distress Inventory-20 questionnaires.Results
Of the 81 women aged 44-80 years who were included in the study, 40 (49.4%) reported incomplete bladder emptying preoperatively. There was no significant difference between these women and asymptomatic women in terms of demographic and clinical parameters such as age, parity, and stage of prolapse. Furthermore, there was no significant difference with regard to postvoid residual bladder volume (52.8 ± 65.8 vs 41.6 ± 41.2 mL), maximal (23.8 ± 11 vs 21.9 ± 9.6 mL/second) and average (10.3 ± 6.2 vs 9.3 ± 4 mL/second) urinary flow velocities, prevalence of increased postvoid residual volume (10.0% vs 4.8%), or obstructive urinary flow (17.5% vs 7.3%).Conclusion
Almost half of all women with advanced POP experienced incomplete bladder emptying; however, this symptom did not correlate with objective urodynamic bladder outflow tract obstruction. 相似文献18.
Aristidis Mantakas Tom Farrell 《European journal of obstetrics, gynecology, and reproductive biology》2010,153(1):43-46
Objective
The aim of the study was to demonstrate the influence of BMI in pregnancy on rates of adverse pregnancy outcome in overweight nulliparous women.Study design
The study was a retrospective review of data from the local hospital database held at the Jessop Wing of the Royal Hallamshire Hospital in Sheffield. We reviewed all nulliparous women with recorded BMI at booking between January 2001 and November 2008 who delivered singleton babies. All the women were stratified into five groups (underweight, normal, overweight, obese, and morbidly obese). The different BMI range groups were compared with the group of women with a normal BMI (20-25). SPSS v15 was used for statistical analysis.Results
The caesarean section rate rose from 18.2% in women of normal BMI to 40.6% in the morbidly obese women (RR 2.2 - CI 1.7-2.8). Morbidly obese women had three times that risk of macrosomia compared with normal BMI women (RR 3.1 - CI 2.1-4.8). The stillbirth rate was associated with increasing obesity with RR 16.7 (CI 4.9-56) for the morbidly obese women.Conclusions
Increasing degrees of obesity are associated with increases in the incidence of caesarean section, fetal birth weight and adverse pregnancy outcomes. The increased risk shows an increment in a stepwise fashion among the different BMI groups. 相似文献19.
20.
Tanner EJ Leitao MM Garg K Chi DS Sonoda Y Gardner GJ Barakat RR Jewell EL 《Gynecologic oncology》2011,123(3):548-552