Birth spacing and risk of adverse perinatal outcomes: a meta-analysis

Context  Both short and long interpregnancy intervals have been associated with an increased risk of adverse perinatal outcomes. However, whether this possible association is confounded by maternal characteristics or socioeconomic status is uncertain. Objective  To examine the association between birth spacing and relative risk of adverse perinatal outcomes. Data Sources  Studies published in any language were retrieved by searching MEDLINE (1966 through January 2006), EMBASE, ECLA, POPLINE, CINAHL, and LILACS, proceedings of meetings on birth spacing, and bibliographies of retrieved articles, and by contact with relevant researchers in the field. Study Selection  Included studies were cohort, cross-sectional, and case-control studies with results adjusted for at least maternal age and socioeconomic status, reporting risk estimates and 95% confidence intervals (or data to calculate them) of birth spacing and perinatal outcomes. Of 130 articles identified in the search, 67 (52%) were included. Data Extraction  Information on study design, participant characteristics, measure of birth spacing used, measures of outcome, control for potential confounding factors, and risk estimates was abstracted independently by 2 investigators using a standardized protocol. Data Synthesis  A random-effects model and meta-regression analyses were used to pool data from individual studies. Compared with interpregnancy intervals of 18 to 23 months, interpregnancy intervals shorter than 6 months were associated with increased risks of preterm birth, low birth weight, and small for gestational age (pooled adjusted odds ratios [95% confidence intervals]: 1.40 [1.24-1.58], 1.61 [1.39-1.86], and 1.26 [1.18-1.33], respectively). Intervals of 6 to 17 months and longer than 59 months were also associated with a significantly greater risk for the 3 adverse perinatal outcomes. Conclusions  Interpregnancy intervals shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes. These data suggest that spacing pregnancies appropriately could help prevent such adverse perinatal outcomes.      

双胎妊娠围产儿不良结局的影响因素分析

目的：探讨双胎妊娠围产儿不良结局的原因。方法：选取2013年1月1日至2013年12月31日在重庆市妇幼保健院住院分娩的双胎孕妇251例,回顾性分析孕妇及围产儿的临床资料,对影响围产儿不良结局的因素进行分析比较。结果：（1）251例双胎妊娠中,围产儿不良结局有87例,不良结局发生率高达34.66%,围产儿死亡21例,围产儿死亡率8.37%。（2）单因素分析结果：受孕方式、绒毛膜性、孕妇合并未足月胎膜早破、妊娠期糖尿病双胎妊娠围产儿结局有明显差异（P<0.050）。（3）多因素分析结果：剖宫产分娩是双胎围产儿结局的保护性因素（P=0.000,OR=0.086,95%CI=0.023~0.321）。未足月胎膜早破和单绒毛膜性是双胎妊娠围产儿结局不良的危险因素（P=0.010,OR=2.979;P=0.043,OR=5.689）。结论：单绒毛膜性、孕妇合并未足月胎膜早破双胎是双胎妊娠围产儿结局不良的主要危险因素,而分娩方式剖宫产术是保护性因素。     

妊娠合并慢性肾炎孕妇不良围产结局的危险因素分析

目的寻找妊娠合并慢性肾炎孕妇不良围产结局的危险因素并预测可能的不良结局。方法选择妊娠合并慢性肾炎患者作为试验组,正常孕产妇作为对照组。分析两组临床指标、妊娠及围产结局及预后。结果不良围产结局的发生与孕前尿素氮及血肌酐(SCr)、孕前合并慢性高血压、规律产前检查、孕期并发子痫前期、孕期SCr、尿蛋白分度、妊娠期高血压关系密切(P均<0.05),与不良围产结局密切相关的因素按照OR值从高到低依次为:孕前SCr、孕期并发子痫前期、孕前合并慢性高血压、尿蛋白分度。结论不良围产结局受孕前SCr影响最大。     

The subsequent risk of internal cancer with Bowen's disease. A population-based study

OBJECTIVE--To address the subsequent risk of internal cancer in a population-based cohort of patients with Bowen's disease. DESIGN--Incident cases of skin cancers other than malignant melanoma occurring in a defined population were classified as basal cell carcinoma, squamous cell carcinoma, or Bowen's disease. Through medical records, all patients were followed up for the development of subsequent internal cancer until they died, moved from Rochester, Minn, or January 1, 1986, whichever came first. Incidence rates of skin cancer and subsequent cancer were computed; the subsequent rate of internal cancer was compared with that prevailing in the community. PATIENTS--Enrolled were all permanent residents in the population base of Rochester, Minn, who developed basal cell carcinoma (n = 657), squamous cell carcinoma (n = 169), or Bowen's disease (n = 71) on the basis of pathologic examination and clinical presentation from 1976 through 1984. MAIN OUTCOME MEASURE--The relative risk of subsequent internal cancer among patients with Bowen's disease compared with that of the population base from which they arose was 1.1 (95% confidence limits, 0.5, 1.6). RESULTS--Annual incidence rates, adjusted to the 1980 US white population, were 14.9 per 100,000 for Bowen's disease, 38.8 for squamous cell carcinoma, and 146 for basal cell carcinoma. The estimated relative risk for subsequent cancer was 0.9 (95% confidence limits, 0.5, 1.6) among patients with squamous cell carcinoma and 1.0 (95% confidence limits, 0.7, 1.3) for patients with basal cell carcinoma. These risks were not significantly different for various durations of follow-up or for sun-exposed vs sun-protected sites. CONCLUSIONS--We find no evidence in these population-based cohort data of and increased risk of subsequent internal cancer associated with Bowen's disease or other forms of nonmelanomatous skin cancer.     

产钳助产围产结局及其产后出血高危因素分析

目的 分析产钳助产围产结局及其发生产后出血的高危因素.方法 回顾性分析2018年9月至2020年12月安徽医科大学第一附属医院经阴道分娩5044例产妇的临床资料,根据第二产程是否产钳助产,分为正常阴道分娩组(n=4858)与产钳助产组(n=186),并根据产钳助产产妇是否发生产后出血,分为产后出血组(n=54)与非产后出血组(n=132),采用logistic回归分析产后出血的高危因素.结果 产钳助产组产后出血、严重会阴裂伤、尿潴留、新生儿窒息、颜面部擦伤夹痕及新生儿转重症监护室发生率高于正常阴道分娩组,差异有统计学意义(P<0.05).助产胎方位、凝血功能异常和软产道裂伤是产钳助产发生产后出血的高危因素(P<0.05).结论 早期识别产钳产后出血的高危因素,积极防治,可有效降低产后出血发生率.     

Nuchal cord and perinatal outcome

Objective: to find out the incidence of nuchal cord at delivery, intrapartum complication and perinatal outcomes in the cases with nuchal cord. Materials and methods: A prospective, cross-sectional, comparative study done at Kathmandu Medical College Teaching Hospital (KMCTH) between March 2006 to September 2006. Total 512 deliveries occurred during this period that were enrolled in the study and were analyzed for presence of nuchal cord at the time of delivery, number of coils whether loose or tight, intrapartum complications and perinatal outcome. The cases with nuchal cord at the time of delivery were taken as study group and the cases without nuchal cord served as control group. Outcome variables between the two groups were compared. Outcome variables used were meconium staining of liquor, rate of instrumental and caesarean delivery, intrapartum fetal heart rate (FHR) irregularities. As a measure of perinatal outcome Apgar score < 7at 1 minute and 5 minutes and incidence of neonatal unit admission was taken. Results: Incidence of nuchal cord at the time of delivery was 22.85%. Incidence of single nuchal cord was highest (18.95%). Intrapartum complications like FHR irregularities and meconium staining of liquor were increased in nuchal cord group but statistically not significant. Instrumental delivery rate was high in nuchal cord group but statistically not significant (0.108). However, caesarean section rate was high in the group without nuchal cord (p=0.029). Apgar score < 7 at 1 minute was significantly low in nuchal cord group (p=0.010) but apgar score at 5 minutes and admission to neonatal unit was not more common. Conclusion: Nuchal cord is not associated with adverse perinatal outcome.     

不良妊娠结局环境危险因素的病例对照研究

目的：研究不良妊娠结局的环境危险因素,为进一步探讨其病因及预防措施提供科学依据。方法采用1∶1配比的病例对照研究,对按全国统一诊断标准明确诊断的803例不良妊娠结局的孕产妇匹配对照后进行单因素和多因素条件logistic回归分析。结果单因素分析共筛选出14个变量是发生不良妊娠结局的危险因素;然后经过条件logistic回归分析,发现接通移动电话次数、室内装修、视频显示终端作业、被动吸烟、住房环境电磁辐射、接触振动或做剧烈运动及烹调油烟是不良妊娠结局的危险因素。结论不良妊娠结局的环境危险因素很多,应加强优生保健,减少不良妊娠结局的发生。     

A population-based study of school scoliosis screening.

CONTEXT: Although school-based screening programs for adolescent idiopathic scoliosis are mandated in 26 states in the United States, few program outcomes data exist regarding the effectiveness of such programs. OBJECTIVE: To determine the effectiveness of a community-based school scoliosis screening program. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of children who attended kindergarten or first grade at public or private schools in Rochester, Minn, during 1979-1982. Children were followed up until age 19 years or until they left the school district. MAIN OUTCOME MEASURES: Number of children diagnosed and treated for scoliosis, based on results from scoliosis screenings performed annually in grades 5 through 9, linked to community medical records data; performance characteristics of the screening program. RESULTS: Of the 2242 children screened, 92 (4.1 %) were referred for further evaluation. Of these, 68 (74%) had documented medical or chiropractic evaluation of scoliosis. School screening identified 5 of the 9 children treated for scoliosis but resulted in referrals for another 87 children who were not treated. The cumulative incidence of diagnosed scoliosis in this population was 1.8% (95% confidence interval [CI], 1.2%-2.3%) for curves of more than 10 degrees, 1.0% (95% CI, 0.6%-1.5%) for curves of at least 20 degrees, and 0.4% (95% CI, 0.1 %-0.6%) for curves of 40 degrees or more; 0.4% (0.5% of girls and 0.3% of boys) were treated for scoliosis. The positive predictive value of the school screening program for the identification of treated scoliosis was 0.05 (95% CI, 0.048-0.052), with 448 children needed to screen to identify 1 child who subsequently received treatment. The percent positive agreement across consecutive years of screening varied from 7% to 30%. CONCLUSION: In this population, school scoliosis screening identified some children who went on to receive treatment but referred many more who did not. These data should be considered in making decisions regarding school scoliosis screening.     

Asymptomatic microhematuria and urologic disease. A population-based study

Asymptomatic microhematuria is a common finding, occurring in 13% of adult men and postmenopausal women in Rochester, Minn. Previous recommendations to perform cystoscopic and excretory urographic examinations on all patients with this finding were based on findings in referred patients. In the present population-based study, the frequency of serious urologic disease in patients with asymptomatic microhematuria was 2.3%; only 0.5% had bladder or renal cell carcinoma. Urologic malignant lesions occurred more frequently in the elderly. There was a trend toward more serious diseases in those with higher grades of hematuria. Complete urologic investigation of all patients with any degree of asymptomatic microhematuria cannot be recommended. The presence of other risk factors should be considered in opting for further evaluation.     

IVF/ICSI助孕的ICP患者围产儿不良结局危险因素预测

目的通过探索辅助生殖技术获得妊娠并发孕期肝内胆汁淤积患者中围产儿不良结局的相关危险因素,为尽可能减少ART子代不良结局的发生提供依据。方法收集通过体外受精-胚胎移植和卵细胞浆内单精子注射助孕住院并发ICP的病例。回顾性分析2012年1月IVF/ICSI助孕的ICP患者围产儿不良结局危险因素预测2017年1月在我院79例患者的高危因素与围产儿不良结局之间的关系。经单因素Logistic回归分析筛选不良结局的相关因素,建立多因素Logistic回归模型来预测。结果单因素分析发现家庭年收入、既往ICP病史、诊断ICP孕周、熊去氧胆酸的使用、有无瘙痒症状、新生儿体重及出生时即刻血糖、妊娠合并、谷丙转氨酶、谷草转氨酶、胆汁酸、总胆红素、早产差异均有统计学意义(P0.05)。经多因素分析显示:新生儿出生即刻血糖、ALT、AST、TBiL与不良结局相关:新生儿血糖,OR=8.153,95%CI=2.267~29.318,P=0.001;ALT,OR=0.942,95%CI=0.900~0.987,P=0.011;AST,OR=0.934,95%CI=0.877~0.995,P=0.033;Tbi L,OR=0.948,95%CI=0.904~0.994,P=0.027。结论经校正混杂因素后,新生儿出生即刻血糖、谷丙转氨酶、谷草转氨酶、总胆红素为围生儿不良结局的危险因子,助孕相关因素不影响围产儿结局。     

脐血液动力学指标在围产儿预后预测中的意义

目的：探讨脐血流阻力指标(S／D、PI、RI)在正常与高危妊娠中的变化及其与围产儿预后的关系。方法：1998年3月至1999年3月住院的正常与高危产妇共计110例,均于产前1周内行多普勒超声检查,并统计相关临床资料。结果：高危妊娠时脐血流阻力指数较正常时明显升高,各组中S／D值超过警戒值(2.20)及危险值(2.66)者围产儿预后不良发生率较S／D值正常者显著升高。结论：彩色多普勒超声测定脐血流阻力指数是一种简便、无创、有效的围产期监测手段,以S／D值2.20为警戒线;S／D值2.66为危险线可能更有助于胎儿缺氧的早期诊断,确保围产儿安全。     

儿童化脓性脑膜炎后遗症的随访及其预后不良危险因素的探讨

目的了解化脓性脑膜炎患儿常见后遗症的种类及发生率,探讨可能导致化脓性脑膜炎患儿预后不良的高危因素。方法选取129例化脑性脑膜炎患儿,患儿分为预后不良组及预后良好组,统计各种后遗症的发生率,并寻找预后不良的危险因素。结果随访的80例患儿中,有较轻后遗症者12例,有严重后遗症者13例,包括智力低下11例,运动障碍8例,双侧听力障碍4例,继发性癫痫4例,10例患儿合并有两种或以上严重后遗症,最常见为智力低下合并运动障碍。行为问题共检查48例患儿,有行为问题患儿17例。预后不良组和预后良好组在发热总时间>7天、入院后反复抽搐≥3次、昏迷(Glasgow昏迷评分<8分)、感染性休克、瞳孔异常、肢体活动障碍为出现预后不良的危险因素,两组比较差异有统计学意义(P<0.05)。结论本研究发现,化脓性脑膜炎患儿的后遗症表现多种多样,提示患儿应该进行系统的随访;同时,本研究还发现昏迷、感染性休克等临床症状是导致预后不良的危险因素。早期识别这些症状,并给予早期干预,将对患儿的预后有着重要意义。     

Long-term follow-up of adolescent depression. A population-based study

Abstract

Adolescent depression is common. Earlier studies indicate that relapses and recurrences are common. But many questions are still unanswered. The aim of the present study has been to follow subjects with adolescent depressions, identified in a population-based study, over a 15-year period. Subjects with adolescent depression (n = 362) and a comparison group (n = 250) were followed in the National Swedish registers.

The formerly depressed females had significantly more out-patient visits, and a significantly higher proportion (78.4% versus 69.6%) had at least one out-patient visit. Among the males, no significant differences were found as concerns out-patient visits. The formerly depressed females had significantly more in-patient stays (3.6 versus 2.4) and a significantly higher total number of in-patient days (27.4 versus 10.1). A significantly higher proportion had in-patient days due to mental disorders (9.5% versus 4.6%), in particular anxiety disorders (4.9% versus 1.0%). As concerns the males, a significantly higher proportion had in-patient days due to mental disorders (16.5% versus 1.8%), in particular alcohol and drug abuse (7.6% versus 0%).

Among the formerly depressed females there were no significant differences against the comparison group as concerns the proportion of being a mother, number of children per woman, or age at first child. However, a significantly higher proportion of the formerly depressed females had had different, usually mild, disorders related to pregnancy (8.6% versus 0.6%). The children of the women with adolescent depressions were not affected.     

前置胎盘的危险因素与妊娠结局病例对照研究

目的探讨前置胎盘发生的高危因素及其对妊娠结局的不良影响。方法采用病例对照研究,随机抽取105例前置胎盘病例作病例组,随机抽取同期105例正常病例作对照组。结果高龄、中学以下文化程度、多次流产、经产妇、剖宫产史是前置胎盘的危险因素。前置胎盘易致产前出血、胎盘粘连、产后出血及贫血,增加了剖宫产和输血的机会,易致早产和新生儿窒息,增加了围生儿死亡的危险。结论防治前置胎盘要从计划生育源头抓起,加强高危妊娠管理,早发现、早诊断和早处理。     

Risk factors for ectopic pregnancy. A population-based study

To evaluate the association between ectopic pregnancy and 22 potential risk factors, we conducted a population-based case-control study. The investigation included 274 cases diagnosed from 1935 through 1982 in residents of Rochester, Minn, and 548 matched controls selected from live-birth deliveries. Risk factor information documented prior to the last index menstrual period was obtained via medical record abstract. Univariate matched analyses revealed nine variables associated with a significantly elevated relative risk of ectopic pregnancy. Following conditional logistic regression, four variables remained as strong and independent risk factors for ectopic pregnancy: current intrauterine device use (relative risk, 13.7; 95% confidence interval, 1.6 to 120.6), a history of infertility (relative risk, 2.6; 95% confidence interval, 1.6 to 4.2), a history of pelvic inflammatory disease (relative risk, 3.3; 95% confidence interval, 1.6 to 6.6), and prior tubal surgery (relative risk, 4.5; 95% confidence interval, 1.5 to 13.9). Theoretically, any condition that prevents or retards migration of the fertilized ovum to the uterus could predispose a woman to ectopic gestation. Further research is needed to clarify the impact of other potential risk factors in the etiology of ectopic pregnancy.     

羊水过少对围生期结局的影响

目的探讨晚期妊娠羊水过少对围生期结局的影响。方法2001年6月～2006年10月该院住院治疗的羊水过少孕妇113例。对这些孕妇临床情况及围生期结局进行分析。结果羊水过少患者高发于孕40～42周,占7.47%。羊水过少患者中合并胎儿生长受限、妊娠高血压疾病、妊娠期肝内胆汁淤积症及其他疾病的发生率为43.36%(49/113),明显高于无妊娠合并症羊水过少组,差异具有显著性(P<0.05和P<0.01)。孕妇羊水量越少,胎儿宫内窘迫、羊水粪染及新生儿窒息发生率越高。B超测定羊水指数诊断羊水过少的准确率为93.94%。结论羊水过少严重威胁围生儿生命,应根据综合检查结果及是否合并高危因素选择最佳分娩方式,及时终止妊娠,有利于改善围生儿预后。     

Cardiac disease in pregnancy--maternal and perinatal outcome

To assess the maternal and perinatal outcome in pregnant women with cardiac disease, a prospective study was carried out among 51 pregnant women with cardiac disease between January 2006 and August 2008 at a tertiary care centre at BJ Medical College, Ahmedabad, Gujarat. Rheumatic cardiac disease (68.62%) with mitral valve involvement (88.57%) was the commonest cardiac disease. In congenital cardiac disease (21.57%) group septal defect was found as the predominant form. Cardiac surgeries were performed in 11 women before pregnancy out of which 7 had balloon valvotomies, 3 had valve replacements and one had corrective tetrology of Fallot surgery. Two valvotomies were safely done during pregnancy. Out of 51 total patients, two women had opted for termination and two were lost to follow-up. Cardiac complications developed in 17.02% of the women, most common being congestive cardiac failure. It was found more in New York Heart Association grades III and IV (p = 0.00001). A total of 68.08% women delivered vaginally and 31.91% delivered by caesarean section. Complication rate was high (33.33%) in caesarean section group (p = 0.05). Maternal and perinatal outcome was good in general with no maternal death and three perinatal deaths. There were more preterm babies (27.7%; p = 0.03) and babies with intra-uterine growth restriction (48.9%; p = 0.65). None of the newborns of the women who had received anticoagulants had any congenital malformation. Rheumatic heart disease still constitutes the major type of heart disease in our country. Maternal and perinatal morbidity increases with increase in New York Heart Association grade. Surgically treated women tolerate pregnancy well. Vaginal delivery is safer and caesarean section should be reserved only for obstetric indications. Maternal and perinatal outcome can be improved by team approach at tertiary care centre.