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Schreiber H, Cohen G, Shalev-Ram H, Heresco L, Daykan Y, Arbib N, Biron-Shental T, Markovitch O. Vacuum-assisted delivery outcomes: is advanced maternal age a factor? Arch Gynecol Obstet 2024; 309:1281-1286. [PMID: 36867307 DOI: 10.1007/s00404-023-06983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). METHODS This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. RESULTS From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). CONCLUSION Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Shalev-Ram
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heresco
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rodrigues I, Soares H, Rocha G, Azevedo I. Impact of advanced maternal age on neonatal morbidity: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2287981. [PMID: 38016703 DOI: 10.1080/14767058.2023.2287981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE This systematic review aimed to understand the impact of advanced maternal age (AMA) on the neonatal morbidity, based on the available scientific evidence. METHODS A systematic search was conducted on 22 November 2021, using the PubMed and Scopus databases to identify studies that compared the morbidity of neonates delivered to AMA mothers with that of neonates delivered to non-AMA mothers. RESULTS Sixteen studies that evaluated the effect of AMA on the neonatal morbidity were included in this review. Nine of these studies found some association between AMA and increased neonatal morbidity (with two of them only reporting an increase in asymptomatic hypoglycemia, and one only reporting an association in twins), six found no association between AMA and neonatal morbidity and one study found a decrease in morbidity in preterm neonates. The studies that found an increase in overall neonatal morbidity with AMA considered older ages for the definition of AMA, particularly ≥40 and ≥45 years. CONCLUSION The current evidence seems to support a lack of association between AMA and the neonatal morbidity of the delivered neonates. However, more studies focusing on the neonatal outcomes of AMA pregnancies are needed to better understand this topic.
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Affiliation(s)
- Inês Rodrigues
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Soares
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Azevedo
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Tambvekar SE, Adki S, Sheriar NK. Pregnancies in Elderly Mothers over 40 years: What to Expect from the Rising New Age High-Risk Cohort? J Obstet Gynaecol India 2023; 73:358-362. [PMID: 37701086 PMCID: PMC10492723 DOI: 10.1007/s13224-022-01701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/04/2022] [Indexed: 03/29/2023] Open
Abstract
Introduction Elderly women are believed to experience many risks associated with pregnancy. Literature fails to provide a clear consensus on the age group in which there is a rise in risk and pathophysiology contributing. 'Pregnancies over forty' are increasing in society, owing to changing lifestyles and sensibilities of youth and the advent of assisted reproductive techniques. In India, studies on elderly pregnant women above 40 years of age are lacking. The aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women delivering above 40 years. Methods The study group (Group A) comprised of pregnancies in 50 women at age ≥ 40 years on the date of delivery. The control group (Group B) had 50 women who delivered subsequent to the study group and age < 40. Various parameters and outcomes including parity, gestational age, number of gestations, co-existing medical illnesses, the incidence of hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), pre-term labor, mode of delivery, birth weight and obstetric and neonatal outcomes were compared. Chi-square test and independent T test were used for statistical analysis. Results While a good number of patients conceived spontaneously and with basic infertility management, i.e., 84% in the elderly gravid group (Group A) and 96% in the control group (Group B), the number of patients who required ART in Group A were statistically significant (Group A 16% and Group B 4%). Incidence of pre-existing medical diseases like hypertension, diabetes mellitus, thyroid dysfunction, other auto-immune diseases and chronic diseases were noted to be high (26%) in Group A (statistically significant difference). Incidence of HDP, GDM and fetal growth restriction were high in Group A. Tendency to have the presence of fibroid uterus was high in patients in Group A, i.e., 24%, compared to only 8% in the control group; difference was statistically significant. Proportion of pre-term deliveries were high in Group A. Cesarean section rate was high in Group A, though it was not statistically significant. Other perinatal observations and neonatal outcomes were comparable in both groups; differences were not statistically significant. Conclusion The study reveals an association of a high-risk course of pregnancies in women above the age of 40 years. Proportions of IVF pregnancies are higher in elderly women. Interestingly, the proportion of women in elderly group who conceived spontaneously and with basic infertility management including IUI was 84% in the present study. Medical comorbidities and incidence of fibroids were high in elderly women. Obstetric and neonatal outcomes of these pregnancies when managed efficiently are favorable.
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Affiliation(s)
- Sunil E. Tambvekar
- Nowrosjee Wadia Maternity Hospital, Seth G. S. Medical College, Parel, Mumbai, Maharashtra 400706 India
| | - Shilpa Adki
- Indira IVF Centre, Allahabad, Uttar Pradesh India
| | - Nozer K. Sheriar
- Holy Family Hospital, Hinduja Hospital, Breach Candy Hospital, Mumbai, Maharashtra India
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Huang C, Jiang Q, Su W, Lv F, Zeng J, Huang P, Liu W, Lin M, Li X, Shi X, Zheng X. Age-specific effects on adverse pregnancy outcomes vary by maternal characteristics: a population-based retrospective study in Xiamen, China. BMC Public Health 2023; 23:326. [PMID: 36788527 PMCID: PMC9926690 DOI: 10.1186/s12889-023-15235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Advanced maternal age (AMA; ≥35 years) is considered to be a major risk factor for adverse pregnancy outcomes. Along with the global trend of delayed childbearing, and in particular, the implementation of China's second and third-child policy leading to a dramatic increase of AMA in recent years, the association between maternal age and pregnancy outcomes requires more investigation. METHODS A population-based retrospective study was performed. Data were derived from the Medical Birth Registry of Xiamen from 2011 to 2018. Univariate and multivariate logistic regression was used to evaluate the effects of maternal age on pregnancy outcomes. RESULTS A total of 63,137 women categorized into different age groups (< 25 years, 25-29 years, 30-34 years, and ≥ 35 years) were included in this study. Compared with the mothers aged 25-29 years, the univariate regression analysis showed that mothers aged < 25 years had lower risks of gestational diabetes mellitus (GDM) and cesarean. AMA was associated with higher risks of GDM, hypertension, cesarean, preterm birth, low-birth weight (LBW), large-for-gestational-age (LGA), macrosomia, and stillbirth (all P < 0.01). After adjustment for potential confounding factors, increased risks of GDM, hypertension, cesarean, preterm birth, and LBW remained significantly associated with AMA (all P < 0.05), whereas AMA mothers showed a lower risk of macrosomia than their younger counterparts. Additionally, no significant differences were detected in terms of Apgar score < 7. CONCLUSION AMA was associated with adverse pregnancy outcomes including increased risks of GDM, hypertension, cesarean, preterm birth, and LBW. This study confirmed the relationship between AMA and certain adverse maternal and fetal outcomes and emphasizes the necessity for women to be cautious about the age at which they become pregnant.
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Affiliation(s)
- Caoxin Huang
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Qiuhui Jiang
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China ,grid.256112.30000 0004 1797 9307The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian China
| | - Weijuan Su
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Fuping Lv
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Jinyang Zeng
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Peiying Huang
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Wei Liu
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Mingzhu Lin
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Xuejun Li
- grid.412625.6Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian China
| | - Xiulin Shi
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian, China.
| | - Xuanling Zheng
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen Diabetes Prevention and Treatment Center, Fujian Key Laboratory of Diabetes Translational Medicine, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian, China.
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Cremonese J, Marcon M, Oppi L, Paletti G, Romolo V, Tozzo P, Caenazzo L. An Update on Planned Oocyte Cryopreservation (POC) in Italy: Medical, Epidemiological and Legal Consideration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042371. [PMID: 35206556 PMCID: PMC8872062 DOI: 10.3390/ijerph19042371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
Starting with a brief socioeconomic analysis of the phenomenon of female fertility, this narrative review aims to provide an analysis of the use and possibilities of medically assisted reproductive technology in combating fertility issues, adopting socioeconomic, legal and medical perspectives in Italy. The authors mainly employ data from the annual reports of the National Registry of Medically Assisted Reproduction (PMA Registry) and the Italian Statistical Institute (ISTAT) to understand the evolution of oocyte use in medically assisted reproductive technology in Italy from 2015 to 2018 and in particular to dissect the possibilities of oocyte cryopreservation as a measure to counteract age-related infertility, specifically through Planned Oocyte Cryopreservation (POC), also known as “social freezing”. It seems that the best course of action in the context of medically assisted reproduction would be the use of young and healthy cryopreserved oocytes (autologous or donated), preferably before the age of 40, while encouraging donation of oocytes whenever possible. Italy’s dependence on foreign biobanks for donated oocytes calls for the institution of a national biobank and further specific regulation of gamete donation. For this reason, it would be useful to encourage the acceptance of Planned Oocyte Cryopreservation to allow greater availability of healthy, younger oocytes.
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Affiliation(s)
- Jessica Cremonese
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Marianna Marcon
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Laura Oppi
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Giulia Paletti
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Vincenzo Romolo
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Pamela Tozzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
- Correspondence: ; Tel.: +39-049-827-2235
| | - Luciana Caenazzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
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Kirubarajan A, Lam A, Yu A, Taheri C, Khan S, Sethuram C, Mehta V, Olivieri N. Knowledge, Information Sources, and Institutional Trust of Patients Regarding Medication Use in Pregnancy: A Systematic Review. J Family Reprod Health 2021; 15:160-171. [PMID: 34721607 PMCID: PMC8536826 DOI: 10.18502/jfrh.v15i3.7133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Taheri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Sethuram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vikita Mehta
- Arts and Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Olivieri
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Wang S, Kadeer M, Yusufu R, Niu J, Liu Y, Rouzi P, Sui S, Wang J, Li X, Wang Y, Ren Y, Huang Y. Delayed stillbirth by hysterectomy following early-term uterine rupture with fetal demise in secundigravida. Radiol Case Rep 2021; 16:2081-2085. [PMID: 34158898 PMCID: PMC8203557 DOI: 10.1016/j.radcr.2021.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Uterine rupture and postterm pregnancy pose a number of life-threatening complications to both mother and child, including severe intra-abdominal bleeding and peritonitis, birth injury, hypoxia, and fetal loss. This report presents a rare case of a 20-year-old female experiencing fetal demise at 60 weeks of pregnancy, with uterine rupture and bone tissue discharge from her vagina without severe intra-abdominal bleeding and peritonitis. The mild clinical course despite complete uterine rupture was due to the firm adhesion of the amniotic sac to the uterus caused by inflammation. The adhesion of the intestines to the rupture site prevented dehiscence of the ruptured wound. Suppuration and bone tissue discharge relieved the pressure on the patient's abdominal cavity and prevented subsequent occurrence of severe peritonitis. Radiologists mistakenly regarded the thick amniotic sac wall on the right side of the uterine wall as a right cornual pregnancy with uterine rupture caused by chronic inflammation. This report aims to bring awareness of this rare condition to medical students and radiologists.
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Affiliation(s)
- Shanshan Wang
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Muhetaerjiang Kadeer
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Rouzi Yusufu
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Junqiao Niu
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yan Liu
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Patiman Rouzi
- Department of Obstetrics and Gynecology in hospital of Urumqi Friendship hospital, Xinjiang Uygur Autonomous Region
| | - Shuang Sui
- Department of Obstetrics in hospital of Xinjiang Uygur Autonomous Region
| | - Jia Wang
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Xiaojuan Li
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yan Wang
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yongfang Ren
- Department of Radiology in People's Hospital of Xinjiang Uygur Autonomous Region
| | - Ying Huang
- Department of Obstetrics in hospital of Xinjiang Uygur Autonomous Region
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Spatial pattern of perinatal mortality and its determinants in Ethiopia: Data from Ethiopian Demographic and Health Survey 2016. PLoS One 2020; 15:e0242499. [PMID: 33227021 PMCID: PMC7682862 DOI: 10.1371/journal.pone.0242499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background The perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data. Methods The analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran’s, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6. Results The spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran’s I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners’ educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up. Conclusions In Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner’s education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country.
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Baldwin K. The biomedicalisation of reproductive ageing: reproductive citizenship and the gendering of fertility risk. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1651256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kylie Baldwin
- Centre for Reproduction Research, De Montfort University Leicester, Leicester, UK
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10
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Goisis A, Schneider DC, Myrskylä M. Secular changes in the association between advanced maternal age and the risk of low birth weight: A cross-cohort comparison in the UK. POPULATION STUDIES 2018; 72:381-397. [PMID: 29582702 DOI: 10.1080/00324728.2018.1442584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Existing studies provide contradictory evidence concerning the association between child health and advanced maternal age. A potential explanation for the lack of consensus on this issue is changes over time in the costs and benefits of giving birth at an advanced age. This is the first study to investigate secular changes in the characteristics of older mothers and in the association between advanced maternal age and child health. We use data from four UK cohort studies, covering births from 1958 to 2001, and use low birth weight (LBW) as a marker for child health. We find that across successive birth cohorts, the negative association between advanced maternal age and LBW becomes progressively weaker; and that this pattern is partially explained by secular changes in the characteristics of older mothers. Our results suggest that associations between maternal age and child outcomes are tied to a specific population and point in time.
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Affiliation(s)
- Alice Goisis
- a London School of Economics and Political Science
- b Max Planck Institute for Demographic Research
| | | | - Mikko Myrskylä
- a London School of Economics and Political Science
- b Max Planck Institute for Demographic Research
- c University of Helsinki
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Sugawara Y, Sugiyama K, Tomata Y, Kanemura S, Fukao A, Tsuji I. Age at First Birth and the Risk of Endometrial Cancer Incidence: A Pooled Analysis of Two Prospective Cohort Studies among Japanese Women. J Cancer 2018; 9:4422-4429. [PMID: 30519348 PMCID: PMC6277642 DOI: 10.7150/jca.26242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background: Age at first birth has been increasing among women in developed countries. Meanwhile, endometrial cancer has also been increasing worldwide, being one of the most common female hormone-related cancers. The purpose of this study was to examine the association between age at first birth and the risk of endometrial cancer among Japanese women, and to examine the hypothesis that the recent increase in endometrial cancer incidence can be partly explained by the trend for increasing age at first birth. Methods: We conducted a pooled analysis of two prospective studies among residents in Miyagi Prefecture in rural northern in Japan. The Miyagi Cohort Study started in 1990 and included 21,455 parous women. The Ohsaki Cohort Study started in 1994 and included 17,287 parous women. The subjects responded to a self-administrated questionnaire including reproductive factors such as age at first birth. Incident cases of cancer were identified through linkage to the Miyagi Prefectural Cancer Registry, which covers the study area. Results: In a consortium of two prospective studies with 598,933 person-years, we identified 105 incident case of endometrial cancer. Compared with women aged 22 years or less at first birth, multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of endometrial cancer were 0.79 (0.49-1.26) for women aged 23 to 25 years at first birth, and 0.53 (0.28-1.00) for those aged 26 years and older (p-trend<0.05). Conclusion: This pooled analysis of two prospective studies does not support the hypothesis that the recent increase in the incidence of endometrial cancer can be partly explained by the increase in the age at first birth.
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Affiliation(s)
- Yumi Sugawara
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Kemmyo Sugiyama
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Yasutake Tomata
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Seiki Kanemura
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Japan
| | - Akira Fukao
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
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Cooper S, Laird SM, Mariee N, Li TC, Metwally M. The effect of prednisolone on endometrial uterine NK cell concentrations and pregnancy outcome in women with reproductive failure. A retrospective cohort study. J Reprod Immunol 2018; 131:1-6. [PMID: 30390547 DOI: 10.1016/j.jri.2018.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/19/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
This retrospective study of prospectively collected data examines the effect of prednisolone therapy on raised uterine Natural Killer cell (uNK) concentrations and pregnancy outcomes in women with recurrent miscarriage (RM) and recurrent implantation failure (RIF) after IVF/ICSI treatment. 136 women diagnosed with RRF who had a timed midluteal endometrial biopsy taken for uNK cell analysis were included. Women with high uNK cell concentrations (n = 45) were treated with prednisolone (10 mg/day) for one month, after which a second biopsy was taken for repeat uNK cell analysis. Women for whom prednisolone caused a decrease in uNK cell concentrations continued on prednisolone until 12 weeks of pregnancy. Pregnancy outcomes (live birth, miscarriage and implantation rates) and pregnancy complications were compared for women who received prednisolone and those who did not. Results showed that the prevalence of high uNK cells was 33.1%. Prednisolone significantly decreased the uNK cell concentration (P < 0.001), however reduction to normal limits was achieved in only 48.3% of patients. There was no difference in any of the pregnancy outcomes or complications between women who had received prednisolone and those who had not. In conclusion, this study showed a relatively high prevalence of raised uNK cells in women with recurrent reproductive failure and confirmed the effect of prednisolone on reducing uNK cell concentrations. We found however no evidence for a significant beneficial effect for prednisolone therapy on pregnancy outcomes. Until the results of an adequately powered RCT become available however, these findings should be considered preliminary.
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Affiliation(s)
- Sophie Cooper
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | - Susan M Laird
- Biomolecular Sciences Research Centre, Sheffield Hallam University, City Campus, Sheffield, UK
| | - Najat Mariee
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mostafa Metwally
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK.
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Bintabara D, Nakamura K, Seino K. Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey. BMJ Open 2018; 8:e023013. [PMID: 30209158 PMCID: PMC6144413 DOI: 10.1136/bmjopen-2018-023013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country. DESIGN Population-based cross-sectional survey. SETTING Nationwide representative data for women of reproductive age obtained from the 2015-2016 Tanzania Demographic and Health Survey were analysed. PRIMARY OUTCOME MEASURES A composite variable, 'problems in accessing healthcare', with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively. RESULTS A total of 13 266 women aged 15-49 years, with a median age (IQR) of 27 (20-36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare. CONCLUSION This study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women's problems associated with accessing healthcare.
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Affiliation(s)
- Deogratius Bintabara
- Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Keiko Nakamura
- Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Kiver V, Boos V, Thomas A, Henrich W, Weichert A. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation. J Perinat Med 2018; 46:555-565. [PMID: 28822226 DOI: 10.1515/jpm-2016-0341] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A current descriptive assessment of perinatal outcomes in pregnancies complicated by previable preterm premature rupture of membranes (pPPROM) at <24 weeks of gestation, after expectant treatment. STUDY DESIGN Maternal and short-term neonatal data were collected for patients with pPPROM. RESULTS Seventy-three patients with 93 fetuses were hospitalized with pPPROM at 15-24 weeks' gestation. Among these patients, 27.4% (n=20) chose pregnancy termination, 27.4% (n=20) miscarried and 45.2% (n=33) proceeded to live births. After a median latency period of 38 days, ranging from 1 to 126 days, 24 singletons and 20 multiples were live-born, of whom 79.5% (n=35) survived the perinatal period. The main neonatal sequelae were pulmonary hypoplasia (29.5%; n=13), connatal infection (56.8%; n=25), intraventricular hemorrhage (25%; n=11; resulting in five neonatal deaths) and Potter's syndrome (15.9%; n=7). Nine newborns died, within an average of 2.8 days (range, 1-10 days). The overall neonatal survival rate was 51.5% - including miscarriages but not elective terminations. The intact survival rate was 45.5% of all live-born neonates. CONCLUSIONS Even with limited treatment options, overall neonatal survival is increasing. However, neonatal mortality and morbidity rates remain high. The gestational age at membrane rupture does not predict neonatal outcome.
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Affiliation(s)
- Verena Kiver
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany, Tel.: +49 (030) 450 664487
| | - Vinzenz Boos
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Thomas
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Risk Factors for the Completion of the Cold Loop Hysteroscopic Myomectomy in a One-Step Procedure: A Post Hoc Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8429047. [PMID: 29888280 PMCID: PMC5985071 DOI: 10.1155/2018/8429047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/31/2018] [Indexed: 01/01/2023]
Abstract
Introduction The aim of the study was to analyze which variables influenced the completion of a cold loop hysteroscopic myomectomy in a one-step procedure in a large cohort of patients. Materials and Methods A retrospective cohort study of 1434 cold loop resectoscopic myomectomies consecutively performed. The study population was divided into two groups according to the number of procedures needed to accomplish the treatment. Variables influencing the completion of hysteroscopic myomectomy in a one-step procedure were investigated. Results A total of 1434 resections were performed and 1690 myomas in total were removed. The procedure was accomplished in a one-step procedure in 1017 patients (83.7%), whereas 198 women (16.3%) needed a multiple-step procedure. The multivariate analysis showed that the size, the number of myomas, and the age of patients were significantly correlated with the risk of a multiple-step procedure. No correlation was revealed with the grading of myomas, parity, and the use of presurgical GnRH-agonist therapy. Conclusions In case of multiple fibroids, the intramural development of submucous myomas did not influence the completion of cold loop hysteroscopic myomectomy in a one-step procedure. The size of myomas and the age of patients were significantly correlated with the need to complete the myomectomy in a multiple-step procedure.
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Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N. No 356-Congélation d'ovules pour pallier le déclin de la fertilité lié à l'âge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:369-383. [DOI: 10.1016/j.jogc.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dior UP, Laufer N, Chill HH, Granovsky-Grisaru S, Yagel S, Yaffe H, Gielchinsky Y. Increased incidence of preeclampsia in mothers of advanced age conceiving by oocyte donation. Arch Gynecol Obstet 2018; 297:1293-1299. [PMID: 29435657 DOI: 10.1007/s00404-017-4616-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the risk of preeclampsia in women of advanced age who conceived through donated oocytes as compared with natural conceptions. METHODS A historical prospective study of singleton live births of parturients ≥ 45 years of age at four university hospitals was conducted. For the purpose of the study, the population was divided by the mode of conception into two groups: oocyte donation and natural conception. The main outcome variable in this study was preeclampsia. Secondary outcomes included pregnancy-induced hypertension and Small for Gestational Age. RESULTS Two hundred and seventy pregnancies were achieved naturally and 135 women conceived by oocyte donation. Mean age at delivery for the natural conception and oocyte donation groups was 45.7 and 47.8, respectively. Preeclampsia complicated 3 out of 270 (1.1%) natural conception pregnancies and 17 out of 135 (12.6%) oocyte donation conceptions. After adjusting for confounders, oocyte donation pregnancies were found to be associated with a 12-fold increased risk for preeclampsia (P = 0.001). Among oocyte donation pregnancies, the risk of preeclampsia was not affected by parity or age. CONCLUSIONS A substantially increased risk for preeclampsia was found in oocyte donation pregnancies, suggesting that the foreign oocyte may play a specific biologic role in the development of preeclampsia after the age of 45.
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Affiliation(s)
- Uri P Dior
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Neri Laufer
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Henry H Chill
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Sorina Granovsky-Grisaru
- Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center and Hebrew University Medical School, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Haim Yaffe
- Department of Obstetrics and Gynecology, Sheere-Zedek Medical Center City Campus, Bikur-Holim Hospital, Jerusalem, Israel
| | - Yuval Gielchinsky
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
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Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N. No. 356-Egg Freezing for Age-Related Fertility Decline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:356-368. [PMID: 29223749 DOI: 10.1016/j.jogc.2017.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a comprehensive review and evidence based recommendations for Canadian fertility centres that offer social egg freezing. OUTCOMES In social egg freezing cycles we evaluated thawed oocyte survival rates, fertilization rates, embryo quality, pregnancy rates, and live birth rates. We also review how these outcomes are impacted by age, ovarian reserve, and the number of eggs cryopreserved. Finally, we discuss the risks of social egg freezing, the alternatives, the critical elements for counselling and informed consent, and future reporting of egg freezing outcome data. EVIDENCE Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and using key words ("oocyte cryopreservation," "egg freezing," "egg vitrification," "social egg freezing," and "elective egg freezing"). Results included systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. Expert opinion based on clinical experience, descriptive studies, or reports of expert committees was also included to discuss aspects of egg freezing not currently rigorously studied. VALUES The evidence obtained was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committees of the Canadian Fertility and Andrology Society (CFAS) under the leadership of the principal authors. BENEFITS, HARMS, AND COSTS Implementation of this guideline should assist the clinician to develop an optimal approach in providing counselling for egg freezing while minimizing harm and improving patient outcomes during treatment. VALIDATION These guidelines have been reviewed and approved by the membership of the CFAS and by the CPG Committees of CFAS and The Society of Obstetricians and Gynaecologists of Canada (SOGC). SPONSORS CFAS and SOGC. RECOMMENDATIONS
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Affiliation(s)
- Julio Saumet
- ART Center, CHU Sainte-Justine Hospital, Montréal, QC
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Munan R, Kakudji Y, Nsambi J, Mukuku O, Maleya A, Kinenkinda X, Kakudji P. [Childbirth among primiparous women in Lubumbashi: maternal and perinatal prognosis]. Pan Afr Med J 2017; 28:77. [PMID: 29255547 PMCID: PMC5724725 DOI: 10.11604/pamj.2017.28.77.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 09/23/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Childbirth in primiparous women is associated with many complications and, therefore, primiparous women are considered high risk due to maternal and fetal concerns. This study aims to determine birth rate in primiparous women in our environment, to identify factors associated with delivery by cesarean section and to assess maternal and perinatal morbi-mortality from childbirth in primiparous women living in Lubumbashi. METHODS We conducted a cross-sectional, analytical study of singleton births in 10 referral maternity hospitals in Lubumbashi over the period December 2013-May 2014. Primiparous births were compared to multiparous births. Maternal sociodemographic parameters as well as maternal and perinatal morbi-mortality were analyzed. The odds ratio and its confidence interval were calculated. Threshold significance level was set at p < 0.05. RESULTS Primiparity rate was 19.9%. Compared to multiparous births, primiparous births were mainly observed in adolescents (OR=11. 27, (7.98-15.91)), in students (OR = 5.61 (3.33-9.45)) and in women living alone (OR=7.62 (4.36-13.30)). Risk factors associated with delivery by cesarean section in primiparous women included obstetric evacuation (OR = 9.69 (4.75-19.74)), the lack of prenatal monitoring (OR=2.57, (1.32-5.01)), size ≤ 150 cm (OR = 2.42 (1.04-5.65)), uterine height > 34 cm (OR = 2.33 (1.32-4.10)) and malpresentation (OR = 6.37 (2.92-13.87)). With regard to maternal prognosis, we observed that high blood pressure (OR = 1.91 (1.32-2.74)), malpresentation (OR = 1.95 (1.16-3.17)), oxytocin use (OR = 2.03 (1.64-2.52)), cesarean section (OR = 2.04 (1.47-2.83)), episiotomy (OR=11.89 (8.61-16.43)) and eclampsia (OR = 4.21 (1.55-11.44)) were significantly associated with primiparity. The rates of low 5th minute Apgar score (OR = 1.55 (1.03-2.32)) and of deaths occurred during early neonatal period (OR=1.80 (1.08-2.98)) were significantly higher in primiparous women than in multiparous women. CONCLUSION This study shows that primiparous birth is a problem in Lubumbashi. Hence improvement in mother-child care during primiparous childbirth includes the development of protocols for adequate management of childbirths.
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Affiliation(s)
- Roger Munan
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Yves Kakudji
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Joseph Nsambi
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, République Démocratique du Congo
| | - Amani Maleya
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Xavier Kinenkinda
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Prosper Kakudji
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
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Abstract
PURPOSE OF REVIEW Although pregnancy-related deaths are rare in the USA, they are on the rise and have more than doubled in the last 20 years. A substantial portion of these deaths are related to cardiovascular disease, specifically hypertensive disorders of pregnancy (HDP). In this review, we will discuss the definitions and proposed pathophysiology of HDP as well as its potential role in cardiovascular morbidity and mortality. RECENT FINDINGS Placental hypoperfusion may lead to an imbalance in proangiogenic and antiangiogenic factors, notably an increase in soluble fms-like tyrosine kinsase-1 (sFlt-1), thereby leading to endothelial dysfunction. Progress has been made in terms of determining the factors which lead to preeclampsia. Potential novel biomarkers for predicting preeclampsia risk have been identified through this research. Preeclampsia not only has important implications for the health during pregnancy but also for future cardiovascular risk. However, the exact mechanism by which it increases cardiovascular risk and the degree of risk it portends are yet to be elucidated.
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Rendtorff R, Hinkson L, Kiver V, Dröge LA, Henrich W. Pregnancies in Women Aged 45 Years and Older - a 10-Year Retrospective Analysis in Berlin. Geburtshilfe Frauenheilkd 2017; 77:268-275. [PMID: 28392580 DOI: 10.1055/s-0043-100105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Improved fertility treatment options and a change in the socio-cultural concept of family planning, especially in industrialized regions, has led to an increasing number of births by women of advanced maternal age, which is associated with a higher rate of complications. The aim of this study was to analyze pregnancy outcomes in women aged ≥ 45 years in an inner-city German hospital and to compare these results to those of a younger cohort. Materials and Methods Over a 10-year period from January 2004 to May 2015, the pregnancy outcomes of all 186 women aged ≥ 45 years who delivered in our hospital were compared in a 1 : 1 ratio to those of a cohort of 29-year old women. Results The rates of assisted reproduction (34 vs. 3 %), multiple pregnancies (16 vs. 5 %) and cesarean section (59 vs. 29 %) were significantly increased in the study group. There was an increased risk of preterm delivery (28 vs. 11 %), preeclampsia, gestational diabetes and premature rupture of membranes in the advanced maternal age group. Conclusion Advanced maternal age leads to higher rates of fetal and maternal complications. These findings should be taken into account when planning assisted reproduction and obstetrical care in women with advanced maternal age.
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Affiliation(s)
- Rosa Rendtorff
- Charité Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Germany
| | - Larry Hinkson
- Charité Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Germany
| | - Verena Kiver
- Charité Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Germany
| | - Lisa Antonia Dröge
- Charité Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Germany
| | - Wolfgang Henrich
- Charité Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Germany
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Hviid MM, Skovlund CW, Mørch LS, Lidegaard Ø. Maternal age and child morbidity: A Danish national cohort study. PLoS One 2017; 12:e0174770. [PMID: 28380000 PMCID: PMC5381873 DOI: 10.1371/journal.pone.0174770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/15/2017] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The mean age at delivery has increased over the latest half of a century. Women of advanced maternal age have increased obstetrical risks and increased risk of chromosomal abnormalities and some other specified diagnoses in the offspring. The aim of this study was to assess the association between maternal age and overall child morbidity according to main diagnosis groups. MATERIAL AND METHODS We conducted a national cohort study including 352 027 live firstborn singleton children. The children were born between Jan 1994 and Dec 2009 and followed to Dec 2012. Children were divided into groups according to maternal age: 15-24, 25-29, 30-34, and 35+ years. Poisson regression analyses calculated adjusted incidence rate ratios (IRR) of child morbidities according to main diagnoses groups A-Q of the International Classification of Disease 10 with adjustment for year of birth, body mass index, smoking, and mother's level of education. RESULTS Average follow-up time was 11 years. Compared to children born to women 25-29 years, firstborn children to mothers aged 35+ had higher child morbidity in 8 of 19 main diagnosis groups and firstborn children to mothers 15-24 years had higher child morbidity in 12 of 19 main diagnosis groups. Thus, for a majority of diseases a U-shaped correlation was found, with lowest rates in women 25-29 years. CONCLUSION Firstborn children to both older and younger mothers have higher overall morbidity as compared to children born by mothers 25-29 years.
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Affiliation(s)
| | | | - Lina Steinrud Mørch
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Sakai T, Sugawara Y, Watanabe I, Watanabe T, Tomata Y, Nakaya N, Tsuji I. Age at first birth and long-term mortality for mothers: the Ohsaki cohort study. Environ Health Prev Med 2017; 22:24. [PMID: 29165118 PMCID: PMC5664584 DOI: 10.1186/s12199-017-0631-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/16/2022] Open
Abstract
Background Although maternal age at first birth has been rising in many developed countries, its long-term effects on the health of the mothers themselves are unclear. In this study, we investigated the relationship between maternal age at first birth and long-term mortality. Methods We conducted a cohort study of 20,624 parous Japanese women aged between 40 and 79 years in 1994 and followed up their survival for 14 years. Based on maternal age at first birth, the women were divided into four groups: ≤19 years, 20–24 years, 25–29 years, and ≥30 years. Using the 20–24 years group as a reference, hazards ratios (HRs) for all-cause and cause-specific mortality were calculated. Results Multivariate HRs for all-cause mortality were 1.17 in the ≤19 years group, 1.09 in the 25–29 years group, and 1.33 in the ≥30 years group. A U-shaped relationship was apparent between maternal age at first birth and mortality. This relationship was also observed for mortality attributable to cancer, cardiovascular disease and other diseases. This U-shaped relationship was observed only for women born before 1935 and the birth year of the first child before 1960. Conclusion A U-shaped relationship was apparent between maternal age at first birth and mortality. As maternal age at first birth is rising worldwide, the risk it imposes appears to have significance in the context of public health.
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Affiliation(s)
- Taichi Sakai
- Juntendo University Faculty of Health Sciences and Nursing, 3-7-33 Omiyacho, Mishima, Shizuoka, 411-8787, Japan.
| | - Yumi Sugawara
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Ikue Watanabe
- Department of Nursing, Faculty of Health Science, Tohoku Fukushi University, Sendai, Japan
| | - Takashi Watanabe
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Yasutake Tomata
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Naoki Nakaya
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan.,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
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Qureshi AI, Saeed O, Malik AA, Suri MFK. Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women's Health Initiative Study. Am J Obstet Gynecol 2017; 216:409.e1-409.e6. [PMID: 27956201 DOI: 10.1016/j.ajog.2016.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/14/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of pregnancy in advanced age among women is increasing because of the availability of assisted reproduction, although the long-term health consequences are not known. OBJECTIVE The purpose of this study was to determine the effect of pregnancy in advanced age on the occurrence of cardiovascular events in a large cohort of postmenopausal women. STUDY DESIGN We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative study. We determined the effect of pregnancy in advanced age (last pregnancy at age ≥40 year) on the risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period (±standard deviation) of 12±1 years using Cox Proportional Hazards analysis after adjusting for potential confounders. RESULTS A total of 3306 of the 72,221 participants (4.6%) reported pregnancy in advanced age. Compared with pregnancy in normal age, the rates of ischemic stroke (3.8% vs 2.4%), hemorrhagic stroke (1.0% vs 0.5%), and cardiovascular death (3.9% vs 2.3%) were significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 50% more likely to experience a hemorrhagic stroke (hazard ratio, 1.5; 95% confidence interval, 1.0-2.1) after adjustment for age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use, and cigarette smoking. There was no significant difference in the risk of ischemic stroke, myocardial infarction, and cardiovascular death among women with pregnancy in advanced age after adjustment for potential confounders. CONCLUSION Women with pregnancy at an advanced age have a higher risk for hemorrhagic stroke in the postmenopausal period.
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Parkington HC, Sheehan PM, Coleman HA, Brennecke SP. Mother Nature versus Father Time. J Physiol 2017; 595:1849-1850. [PMID: 28105704 DOI: 10.1113/jp273914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Helena C Parkington
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Penelope M Sheehan
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, 3052, Australia
| | - Harold A Coleman
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Shaun P Brennecke
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, 3010, Australia
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Cakmak Celik F, Aygun C, Kucukoduk S, Bek Y. Maternal and neonatal outcomes in advanced maternal age: a retrospective cohort study. J Matern Fetal Neonatal Med 2016; 30:2452-2456. [PMID: 27806665 DOI: 10.1080/14767058.2016.1253058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe the effect of extremely advanced maternal age (EAMA) on maternal/neonatal outcomes. METHODS This was a case-control study in which 127 women ≥40 years at the time of delivery out of 2853 singleton hospital deliveries in Ondokuz Mayis University between 1 January 2008 and 31 August 2010 constituted the study group. One hundred and twenty-seven else were chosen randomly out of 2412, 21-35 years old women, via a computer system as controls. Demographic features of 254 mothers and infants as well as maternal and neonatal complications were recorded. RESULTS Mean maternal age was 41.5 ± 1.9 (40-49) years in EAMA group and 28.9 ± 4.2 (21-35) years in controls. Primigravidity was 19.6% in the EAMA group, whereas 37.8% in controls (p = 0.003). No difference was found between groups according to route of delivery, stillbirth, preterm birth, congenital abnormalities, gender of babies, NICU admission and respiratory problems (for all p > 0.05). A 5th min Apgar score <7 was more frequent in babies born to EAMA mothers compared to controls (9.8% versus 4.9%, p = 0.004). CONCLUSION The present study shows that EAMA mothers and their offsprings have similar peri and neonatal risks compared to younger mothers, except lower 5th minute Apgar scores. We conclude that with good perinatal care, EAMA women and their babies can pass through the perinatal period with similar risks of younger women.
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Affiliation(s)
- Fatma Cakmak Celik
- a Faculty of Medicine , Department of Pediatrics, Neonatalogy Division and
| | - Canan Aygun
- a Faculty of Medicine , Department of Pediatrics, Neonatalogy Division and
| | - Sukru Kucukoduk
- a Faculty of Medicine , Department of Pediatrics, Neonatalogy Division and
| | - Yuksel Bek
- b Faculty of Medicine , Department of Biostatistics, Ondokuz Mayis University , Samsun , Turkey
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Almeida N, Pedreira C, Almeida R. Impact of maternal education level on risk of low Apgar score. Public Health 2016; 140:244-249. [DOI: 10.1016/j.puhe.2016.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/01/2015] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
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Fortpflanzung im höheren Alter. GYNAKOLOGISCHE ENDOKRINOLOGIE 2016. [DOI: 10.1007/s10304-016-0062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Komoto S, Motoya S, Nishiwaki Y, Matsui T, Kunisaki R, Matsuoka K, Yoshimura N, Kagaya T, Naganuma M, Hida N, Watanabe M, Hibi T, Suzuki Y, Miura S, Hokari R. Pregnancy outcome in women with inflammatory bowel disease treated with anti-tumor necrosis factor and/or thiopurine therapy: a multicenter study from Japan. Intest Res 2016; 14:139-45. [PMID: 27175114 PMCID: PMC4863047 DOI: 10.5217/ir.2016.14.2.139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Anti-tumor necrosis factor drugs (anti-TNF) and thiopurines are important treatment options in patients with inflammatory bowel disease (IBD), including during pregnancy. However, there are limited data on the benefit/risk profile of anti-TNF and thiopurines during pregnancy in Asia. The aim of this study was to analyze pregnancy outcomes of female Japanese IBD patients treated with anti-TNF and/or thiopurines. Methods This cross-sectional study assessed pregnancy outcomes in 72 women with IBD. Pregnancy outcomes were compared among 31 pregnancies without exposure to infliximab (IFX), adalimumab (ADA), or thiopurines; 24 pregnancies with exposure to anti-TNF treatment (23 IFX, 1 ADA); 7 pregnancies with exposure to thiopurines alone; and 10 pregnancies with exposure to both IFX and thiopurines. Results Thirty-five of the 41 pregnancies (85.3%) that were exposed to anti-TNF treatment and/or thiopurines resulted in live births after a median gestational period of 38 weeks. Of the 35 live births, 3 involved premature deliveries; 7, low birth weight; and 1, a congenital abnormality. There were 6 spontaneous abortions in pregnancies that were exposed to anti-TNF treatment (17.7%). Pregnancy outcomes among the 4 groups were similar, except for the rate of spontaneous abortions (P =0.037). Conclusions Exposure to anti-TNF treatment or thiopurines during pregnancy was not related to a higher incidence of adverse pregnancy outcomes in Japanese IBD patients except for spontaneous abortion.
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Affiliation(s)
- Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Satoshi Motoya
- IBD Center, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Toshiyuki Matsui
- Department of Gastroenterology and Hepatology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Reiko Kunisaki
- IBD Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuyoshi Matsuoka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Yoshimura
- Department of Internal Medicine, Division of IBD, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Takashi Kagaya
- Department of gastroenterology, Kanazawa University Hospital, Ishikawa, Japan
| | - Makoto Naganuma
- Department of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Hida
- Division of Internal Medicine, Department of IBD, Hyogo College of Medicine, Hyogo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Tokyo, Japan
| | - Yasuo Suzuki
- Department of Internal medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Soichiro Miura
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Argyle CE, Harper JC, Davies MC. Oocyte cryopreservation: where are we now? Hum Reprod Update 2016; 22:440-9. [DOI: 10.1093/humupd/dmw007] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/15/2016] [Indexed: 11/15/2022] Open
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Demirci A, Kartal M. The prevalence of developmental delay among children aged 3-60 months in Izmir, Turkey. Child Care Health Dev 2016; 42:213-9. [PMID: 26493366 DOI: 10.1111/cch.12289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/18/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Developmental delay is defined as delays in speech and language development, motor development, social-emotional development and cognitive development. On a global scale, the prevalence estimations in paediatric population range between 5% and 15%. However, no prevalence studies on developmental delay have been conducted in primary care in Turkey. The aim of this study was to determine the prevalence of developmental delay among children aged 3-60 months in Izmir. METHODS This cross-sectional, descriptive study involved 1514 children aged 3-60 months, who were at 12 primary health centres for various reasons in Izmir between 1 November 2013 and 31 January 2014. The questionnaire and age-specific Turkish version of the Ages and Stages Questionnaires were applied to mothers via face-to-face interview. RESULTS The prevalence of developmental delay was 6.4% (95% confidence interval 5.2-7.7). The prevalence for age groups varied between 3.3% and 12.1%. Significant associations were found between developmental delay and maternal age, maternal/paternal education, socio-economic level of the family and the presence of consanguineous marriage. CONCLUSIONS Identifying developmental delay in children earlier by a validated, reliable, parent-completed questionnaire like Ages and Stages Questionnaires and detecting risk factors for delay are crucial for primary care where their growth and development are monitored. Identifying developmental delay and early referral to rehabilitation services may help improve children's quality of life.
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Affiliation(s)
- A Demirci
- Department of Family Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - M Kartal
- Department of Family Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Okunade KS, Okunola H, Oyeneyin L, Habeeb-Adeyemi FN. Cross-sectional study on the obstetric performance of primigravidae in a teaching hospital in Lagos, Nigeria. Niger Med J 2016; 57:303-306. [PMID: 27833251 PMCID: PMC5036303 DOI: 10.4103/0300-1652.190595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: A woman carrying her first pregnancy is starting a new life, and this is a crucial time in her obstetric career. This study was aimed to compare the obstetric performance of primigravidae to that of the multigravidae with a view to suggesting ways of preventing the associated complications. Patients and Methods: The study was a cross-sectional case-control study carried out among women who delivered in the study center over a year period. Relevant data of primigravid parturients who delivered in the hospital were retrieved from the labor ward register, and an equal number of multigravidae who delivered during the same study were selected by simple random sampling as the control group. Results: Primigravidae constituted 15.3% of the total number of parturients seen during the study period. The age range of the primigravidae was 20–48 years and with a mean age of 28.24 ± 4.28 years. The obstetric complications seen in statistically significant proportion among the primigravidae case group include hypertensive disorder (P = 0.048), prolonged pregnancy (P = 0.039), prolonged labor (P = 0.006), oxytocin augmentation (P = 0.022), cephalopelvic disproportion (P = 0.001), obstructed labor (P = 0.008), instrumental delivery (P = 0.035), cesarean delivery rates (P = 0.011), and increased neonatal unit admission rate (P = 0.002). Conclusion: Primigravidity is a high-risk pregnancy with several associated obstetric complications. Primigravidae should, therefore, be managed by specialists in well-equipped hospitals that will provide comprehensive antenatal and intrapartum care which will eventually result in a satisfactory obstetric outcome.
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Affiliation(s)
| | - Halimat Okunola
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Lawal Oyeneyin
- Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure, Ondo State, Nigeria
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Almeida NKO, Almeida RMVR, Pedreira CE. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births. J Pediatr (Rio J) 2015; 91:493-8. [PMID: 26054772 DOI: 10.1016/j.jped.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34. METHODS Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia. RESULTS For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years), and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births), of low Apgar score at 5 min (for term births), of macrosomia (for non-primiparous women), and of asphyxia. CONCLUSION As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.
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Affiliation(s)
- Núbia Karla O Almeida
- Department of Statistics, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Renan M V R Almeida
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
| | - Carlos Eduardo Pedreira
- Electrical Engineering Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Medicine Scholl, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Programa de Engenharia de Sistemas e Computação (PESC), Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Adverse perinatal outcomes for advanced maternal age: a cross‐sectional study of Brazilian births. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Valent AM, Newman T, Chen A, Thompson A, DeFranco E. Gestational age-specific neonatal morbidity among pregnancies complicated by advanced maternal age: a population-based retrospective cohort study. J Matern Fetal Neonatal Med 2015; 29:1485-90. [PMID: 26043643 DOI: 10.3109/14767058.2015.1051955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Compare significant neonatal morbidity frequency differences in advanced maternal age (AMA) versus non-AMA pregnancies, assessing which gestational week is associated with the lowest morbidity risk. METHODS Population-based retrospective cohort study. Adverse neonatal outcome frequency differences were stratified by each week of gestation. Multivariate logistic regression estimated the relative risk (RR) of composite neonatal morbidity for women aged 35-39, 40-44, 45-49 and 50-55 versus 18-34 years, adjusted sequentially for relevant risk factors. RESULTS Neonatal morbidity decreased with each advancing week of term gestation, lowest at 39 weeks for all the groups. Adverse neonatal outcome risk for births to AMA women increased at 40 weeks: 35-39 years adjRR 1.12 [1.01-1.24] and ≥40 years 1.24 [1.01-1.52]. Each older maternal age category had increased risk for overall neonatal morbidity: 35-39 years adjRR 1.11 [95% CI 1.08-1.15], 40-44 years 1.21 [95% CI 1.14-1.29] and 45-49 years 1.34 [95% CI 1.05-1.69]. CONCLUSIONS Lowest neonatal morbidity risk is at 39-week gestation with a significantly increased risk observed thereafter, especially in women ≥40 years.
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Affiliation(s)
| | | | - Aimin Chen
- b Department of Environmental Health , University of Cincinnati , Cincinnati , OH , USA , and
| | | | - Emily DeFranco
- a Department of Obstetrics and Gynecology , and.,c Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
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Yazdani M, Amirshahi E, Shakeri A, Amirshahi R, Malekmakan L. Prenatal and Maternal Outcomes in Advanced Maternal Age, a Comparative Study. WOMEN’S HEALTH BULLETIN 2015. [DOI: 10.17795/whb-23092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Benli AR, Cetin Benli N, Usta AT, Atakul T, Koroglu M. Effect of maternal age on pregnancy outcome and cesarean delivery rate. J Clin Med Res 2014; 7:97-102. [PMID: 25436026 PMCID: PMC4245060 DOI: 10.14740/jocmr1904w] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 11/16/2022] Open
Abstract
Background The aims of this retrospective study were to evaluate the maternal and prenatal outcomes between 35 years and older pregnancies and younger pregnancies, and the effects of the age of pregnancy, mother and newborn. Methods Pregnant women who gave birth in Vakif Gureba Training and Research Hospital, Clinic of Obstetrics and Gynecology in 2006 were retrospectively screened. Pregnant women aged 35 years and over were included in this study and the pregnant women between age range of 30 - 34 years were included in the control group. Results Pregnancy rate was found as 7.1% in 35 years and older women in all the deliveries, cesarean delivery rate was found as 46.1% in this group at 1 year period. However, cesarean delivery rate was 40.9% in the control group. Cesarean delivery rate was found as 31.6% in all the deliveries. The most common cause of cesarean section indication was fetal distress in advanced maternal age (AMA) (11.7%), whereas previous cesarean section was found as the most common cause in the control group (15.1%). Conclusion No significant difference was found between AMA group and normal pregnancies in terms of preterm labor, caesarian section, morbidity, mortality and chronic diseases such as hypertension and diabetes mellitus.
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Affiliation(s)
- Ali Ramazan Benli
- Department of Family Medicine, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | | | - Abdullah Taner Usta
- Department of Gynecology and Obstetrics, Bagcilar Education and Research Hospital, Istanbul, Turkey
| | - Tolga Atakul
- Department of Gynecology and Obstetrics, Karabuk Education and Research Hospital, Karabuk, Turkey
| | - Mustafa Koroglu
- Department of Hematology, Karabuk Education and Research Hospital, Karabuk, Turkey
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Abstract
INTRODUCTION Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception. METHOD A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths. CONCLUSION Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families.
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Affiliation(s)
- Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Schimmel MS, Bromiker R, Hammerman C, Chertman L, Ioscovich A, Granovsky-Grisaru S, Samueloff A, Elstein D. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet 2014; 291:793-8. [DOI: 10.1007/s00404-014-3469-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 09/10/2014] [Indexed: 11/28/2022]
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Trolice MP. Live birth from a 46-year-old using fresh autologous oocytes through in vitro fertilization. Fertil Steril 2014; 102:96-8. [PMID: 24796763 DOI: 10.1016/j.fertnstert.2014.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report a live birth with IVF from a 46-year-old woman using autologous oocytes. DESIGN Case report. SETTING Reproductive endocrinology and infertility private practice and ambulatory IVF center. PATIENT(S) One 46-year-old nulligravid woman. INTERVENTION(S) IVF with fresh ET. MAIN OUTCOME MEASURE(S) Live birth after IVF. RESULT(S) A 46-year-old with antimullerian hormone (AMH) level less than 0.16 conceived through IVF using autologous oocytes. A total of seven oocytes were retrieved, from which four embryos were transferred at the cleavage stage, resulting in a pregnancy and delivery of a healthy male infant weighing 1,580 g at 31 and 3/7 weeks' estimated gestational age. CONCLUSION(S) The prognosis for a live birth from IVF in a patient with very advanced reproductive age, particularly with an undetectable AMH level using autologous oocytes, remains extremely poor. This case should be interpreted with caution so as to not provide false hope to women aged 45 and above.
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Affiliation(s)
- Mark P Trolice
- Fertility Center of Assisted Reproduction and Endocrinology, Winter Park, Florida.
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Orbach-Zinger S, Aviram A, Ioscovich A, Listengart M, Reuveni A, Fein S, Eidelman LA, Yogev Y. Anesthetic considerations in pregnant women at advanced maternal age. J Matern Fetal Neonatal Med 2014; 28:59-62. [PMID: 24593845 DOI: 10.3109/14767058.2014.900751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate anesthetic considerations in pregnancy for women at advanced maternal age (≥40 years). METHODS A retrospective cohort study of laboring women aged 40 years or above comparing women aged 40-44 years old with those aged ≥45 years, in a single, tertiary, university affiliated medical center. RESULTS Overall, 39,006 women delivered in our institution during the study period, of them 376 (1%) were eligible for analysis: 278 (74%) were 40-44 years old (control group) and 98 (26%) were 45 years old and above (study group). No differences were found between the groups with regards to analgesia or anesthesia management during labor. Differences were found in obstetrical characteristics such as higher rates of primiparity, preeclampsia, need for magnesium sulphate therapy and chronic hypertension among parturients aged ≥45 years. Of note, parturients aged ≥ 45 years had an approximately eight-fold risk for postpartum hemorrhage. CONCLUSION Anesthesia management of parturients aged 45 years and above is comparable to the management of women aged 40-44 years. However, parturients≥45 are more susceptible to bleeding complications.
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Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol 2014; 122:1184-95. [PMID: 24201681 DOI: 10.1097/aog.0000000000000017] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To delineate adverse obstetric and neonatal outcomes as well as indications for cesarean delivery by maternal age in a contemporaneous large national cohort. METHODS This was a retrospective analysis of electronic medical records from 12 centers and 203,517 (30,673 women aged 35 years or older) women with singleton gestations stratified by maternal age. Logistic regression was performed to investigate maternal and neonatal outcomes for each maternal age strata (referent group, age 25.0-29.9 years), adjusting for race, parity, body mass index, insurance, pre-existing medical conditions, substance and tobacco use, and site. Documented indications for cesarean delivery were analyzed. RESULTS Neonates born to women aged 25.0-29.9 years had the lowest risk of birth weight less than 2,500 g (7.2%; P<.001), admission to neonatal intensive care unit (11.5%; P<.001), and perinatal mortality (0.7%; P<.001). Hypertensive disorders of pregnancy were higher in women aged 35 years or older (cumulative rate 8.5% compared with 7.8%; 25.0-29.9 years; P<.001). Previous uterine scar was the leading indication for cesarean delivery in women aged 25.0 years or older (36.9%; P<.001). For younger women, failure to progress or cephalopelvic disproportion (37.0% for those younger than age 20.0 years and 31.1% for those aged 20.0-24.9-years; P<.001) and nonreassuring fetal heart tracing (28.7% for those younger than 20.0 years and 21.2% for those aged 20.0-24.9-years; P<.001) predominated as indications. Truly elective cesarean delivery rate was 20.2% for women aged 45.0 years or older (adjusted odds ratio 1.85 [99% confidence interval 1.03-3.32] compared with the referent age group of 25.0-29.9 years). CONCLUSIONS Maternal and obstetric complications differed by maternal age, as did rates of elective cesarean delivery. Women aged 25.0-29.9 years had the lowest rate of serious neonatal morbidity. LEVEL OF EVIDENCE : II.
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Lassi ZS, Bhutta ZA. Risk factors and interventions related to maternal and pre-pregnancy obesity, pre-diabetes and diabetes for maternal, fetal and neonatal outcomes: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.841453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Shufaro Y, Schenker JG. The risks and outcome of pregnancy in an advanced maternal age in oocyte donation cycles. J Matern Fetal Neonatal Med 2014; 27:1703-9. [DOI: 10.3109/14767058.2013.871702] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mutz-Dehbalaie I, Scheier M, Jerabek-Klestil S, Brantner C, Windbichler GH, Leitner H, Egle D, Ramoni A, Oberaigner W. Perinatal Mortality and Advanced Maternal Age. Gynecol Obstet Invest 2014; 77:50-7. [DOI: 10.1159/000357168] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 11/08/2013] [Indexed: 11/19/2022]
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Kawwass JF, Monsour M, Crawford S, Kissin DM, Session DR, Kulkarni AD, Jamieson DJ. Trends and outcomes for donor oocyte cycles in the United States, 2000-2010. JAMA 2013; 310:2426-34. [PMID: 24135860 PMCID: PMC4307377 DOI: 10.1001/jama.2013.280924] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The prevalence of oocyte donation for in vitro fertilization (IVF) has increased in the United States, but little information is available regarding maternal or infant outcomes to improve counseling and clinical decision making. OBJECTIVES To quantify trends in donor oocyte cycles in the United States and to determine predictors of a good perinatal outcome among IVF cycles using fresh (noncryopreserved) embryos derived from donor oocytes. DESIGN, SETTING, AND PARTICIPANTS Analysis of data from the Centers for Disease Control and Prevention's National ART Surveillance System, to which fertility centers are mandated to report and which includes data on more than 95% of all IVF cycles performed in the United States. Data from 2000 to 2010 described trends. Data from 2010 determined predictors. MAIN OUTCOMES AND MEASURES Good perinatal outcome, defined as a singleton live-born infant delivered at 37 weeks or later and weighing 2500 g or more. RESULTS From 2000 to 2010, data from 443 clinics (93% of all US fertility centers) were included. The annual number of donor oocyte cycles significantly increased, from 10,801 to 18,306. Among all donor oocyte cycles, an increasing trend was observed from 2000 to 2010 in the proportion of cycles using frozen (vs fresh) embryos (26.7% [95% CI, 25.8%-27.5%] to 40.3% [95% CI, 39.6%-41.1%]) and elective single-embryo transfers (vs transfer of multiple embryos) (0.8% [95% CI, 0.7%-1.0%] to 14.5% [95% CI, 14.0%-15.1%]). Good perinatal outcomes increased from 18.5% (95% CI, 17.7%-19.3%) to 24.4% (95% CI, 23.8%-25.1%) (P < .001 for all listed trends). Mean donor and recipient ages remained stable at 28 (SD, 2.8) years and 41 (SD, 5.3) years, respectively. In 2010, 396 clinics contributed data. For donor oocyte cycles using fresh embryos (n = 9865), 27.5% (95% CI, 26.6%-28.4%) resulted in good perinatal outcome. Transfer of an embryo at day 5 (adjusted odds ratio [OR], 1.17 [95% CI, 1.04-1.32]) and elective single-embryo transfers (adjusted OR, 2.32 [95% CI, 1.92-2.80]) were positively associated with good perinatal outcome; tubal (adjusted OR, 0.72 [95% CI, 0.60-0.86]) or uterine (adjusted OR, 0.74 [95% CI, 0.58-0.94]) factor infertility and non-Hispanic black recipient race/ethnicity (adjusted OR, 0.48 [95% CI, 0.35-0.67]) were associated with decreased odds of good outcome. Recipient age was not associated with likelihood of good perinatal outcome. CONCLUSIONS AND RELEVANCE In the United States from 2000 to 2010, there was an increase in number of donor oocyte cycles, accompanied by an increase in good outcomes. Further studies are needed to understand the mechanisms underlying the factors associated with less successful outcomes.
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Affiliation(s)
- Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia2Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lao TT, Sahota DS, Cheng YKY, Law LW, Leung TY. Advanced maternal age and postpartum hemorrhage – risk factor or red herring? J Matern Fetal Neonatal Med 2013; 27:243-6. [DOI: 10.3109/14767058.2013.807240] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ngowa JDK, Ngassam AN, Dohbit JS, Nzedjom C, Kasia JM. Pregnancy outcome at advanced maternal age in a group of African women in two teaching Hospitals in Yaounde, Cameroon. Pan Afr Med J 2013; 14:134. [PMID: 23734279 PMCID: PMC3670197 DOI: 10.11604/pamj.2013.14.134.2315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/09/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Women older than 40 years have been termed “advanced maternal age” and considered to be at risk of adverse pregnancy outcome. This study aimed to examine the obstetrical outcomes among primiparous and multiparous African advanced maternal age women. Methods We conducted a retrospective cohort study study at two teaching hospitals at Yaounde, Cameroon. From the hospital records, obstetrical characteristics of 585 consecutive women aged 40 or above who delivered from January 2007 to December 2011 were compared with those of 1816 younger mothers aged 20 to 29 years as control cases. Associations between maternal age and selected obstetrical variables were assessed with the contigency X2 test or two-tailed Fisher exact test. Results Primiparous and multiparous advanced maternal age were more likely to undergo cesarean delivery than were their younger counterparts (38.5% vs 13.5%, RR=2.85, p<0.05 and 16.1% vs 9.1%, RR=1.76, p<0.05). Older primiparous women had similar perinatal outcomes than their younger counterparts. Older multiparous women had increased incidence of preeclampsia/eclampsia (2.4% vs 0.6%, RR=4, p<0.01); antepartum hemorrhage (1.8% vs 0.8%, RR=2.25, p<0.01); fetal distress (3.5% vs 1.3%, RR=2.69, p<0.01); fetal death (3.5% vs 1.6%, RR= 2.18, p<0.05); postpartum hemorrhage (2.4% vs 1.2%; RR=2, p<0.05); preterm delivery (12% vs 9.2%, RR=1.30, p<0.05); low birth weight (11% vs 7.7%, RR=1.42, p<0.05); admission to special care neonatalogy unit(14.1% vs 10.2%, RR=1.38, p<0.05); low Apgar scores at 1min and 5min; and perinatal mortality (3.5% vs 1.6, RR=2.18, p<0.05). Conclusion Advanced maternal age women are at higher risk to cesarean delivery. Increased risk of antepartum and intra partum complications among multiparous advanced maternal age women were associated to adverse perinatal outcome. Our results are in concordance with the view that increased risk of adverse perinatal outcome with advanced maternal age is indirectly related to age through the increased risk of obstetrical complications associated with age.
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Ooki S. Maternal age and birth defects after the use of assisted reproductive technology in Japan, 2004-2010. Int J Womens Health 2013; 5:65-77. [PMID: 23450007 PMCID: PMC3581291 DOI: 10.2147/ijwh.s32296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older mothers are becoming more common in Japan. One reason for this is the widespread use of assisted reproductive technology (ART). This study assesses the relationship between maternal age and the risk of birth defects after ART. METHODS Nationwide data on ART between 2004 and 2010 in Japan were analyzed. Diseases that were classified as code Q00-Q99 (ie, congenital malformations, deformations, and chromosomal abnormalities) in the International Classification of Diseases, tenth edition, were selected. There were 219,185 pregnancies and 153,791 live births in total ART. Of these, 1943 abortions, stillbirths, or live births with birth defects were recorded. Percentage of multiple birth defects in total birth defects, the prevalence, crude relative risk and 95% confidence interval per 10,000 pregnancies and per 10,000 live births were analyzed according to the maternal age class (ie, 25-29, 30-34 (reference), 35-39, and 40+ years). RESULTS Multiple birth defects were observed among 14% of the 25-29 year old class, and 8% among other classes when chromosomal abnormalities were excluded. The prevalence of chromosomal abnormalities per pregnancy and per live birth became significantly and rapidly higher in mothers in the age classes of 30-35 and 40+ years. Nonchromosomal birth defects per pregnancy decreased linearly with advanced maternal age, while the number of nonchromosomal birth defects per live birth formed a gradual U-shaped distribution. The prevalence per pregnancy of congenital malformations of the nervous system was significantly lower with advanced maternal age. The relative risk per live birth was significant regarding congenital malformations of the circulatory system for a maternal age of 40+ years. Some other significant associations between maternal age and birth defects were observed. CONCLUSION Maternal age is associated with several birth defects; however, older maternal age in itself does not produce noticeable extra risk for nonchromosomal birth defects overall.
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Affiliation(s)
- Syuichi Ooki
- Department of Health Science, Ishikawa Prefectural Nursing University, Ishikawa, Japan
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Gerli S, Favilli A, Giordano C, Bini V, Di Renzo GC. Single indications of induction of labor with prostaglandins and risk of cesarean delivery: A retrospective cohort study. J Obstet Gynaecol Res 2013; 39:926-31. [DOI: 10.1111/jog.12000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 09/29/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sandro Gerli
- Department of Obstetrics and Gynecology; University of Perugia; Perugia Italy
| | - Alessandro Favilli
- Department of Obstetrics and Gynecology; University of Perugia; Perugia Italy
| | - Claudia Giordano
- Department of Obstetrics and Gynecology; University of Perugia; Perugia Italy
| | - Vittorio Bini
- Department of Obstetrics and Gynecology; University of Perugia; Perugia Italy
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology; University of Perugia; Perugia Italy
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