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We studied 500 women who conceived after investigation and treatment for different infertility problems and compared the outcome of the 5 infertility groups (Group 1 to 5), the ovulatory dysfunction (Group 1), male infertility (Group 2), A.I.D. (Group 3), tubal surgery and IVF (Group 4) and no treatment (Group 5) with the outcome in the hospital group during a period of 3 years. The incidence of abortion in Group 3 is significantly higher (13.8%), the incidence of ectopic pregnancy is significantly higher in Group 4 (21.7%) as compared with the incidence in the hospital group (P less than 0.01). The rate of pre-existing hypertension and gestational diabetes is significantly higher in all the 5 infertility groups as compared with the incidence in the hospital group (P less than 0.05). The incidence of preterm labor in general is less in the infertility group as compared with the incidence in the hospital group (P greater than 0.05). The incidence of older women, multiple pregnancy, induction of labor, operative deliveries, fetal distress, low Apgar score, babies with birth weight below the tenth centile were higher in the infertility groups (P less than 0.05). But the perinatal mortality or major or minor fetal anomalies were not significantly different in the infertility groups as compared with the rate in the hospital groups (P greater than 0.05).
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PMID:Outcome of pregnancy following investigation and treatment of infertility. 288 35

A retrospective analysis of 646 Arab grandmultiparas who booked for hospital confinement at the King Abdul Aziz University Hospital in Riyadh, Saudi Arabia between 1983 and 1985 was carried out. Results were compared with that of nongrandmultiparas during the same period. In the grandmultiparas, the incidences of gestational diabetes, hypertension, rheumatic heart disease, antepartum, pospartum hemorrhage, and macrosomic infants were increased. However, contrary to some previous reports the incidences of anemia, cesariean sections, induced labor, dysmaturity and perinatal deaths were decreased. This is thought to be due to the provision of modern specialist perinatal care and improved socioeconomic standards. In communities where poor socioeconomic standards and inadequate health services still prevail, grandmultiparity is to be regarded as a risk factor associated with increased maternal and fetal morbidity and mortality. Under the improved conditions of present day obstetrics, including competent clinical staff, the grandmultipara faces the same risk to her life during pregnancy as the woman with lesser parity. The sample in this analysis ranged in age from 18 to 43 years with mean age at 33 years. 195 (30%) were older than 35 years. This is a similar age distribution to other centers in Saudi Arabia and in Malay and Indian grandmultipara of Singapore.
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PMID:The problem of grandmultiparity in current obstetric practice. 290 Jan 62

While an abnormal oral glucose tolerance test (GTT) is known to be associated with an increased risk of pregnancy complications, the impact of one abnormal value is not clear. In 1986 we screened 4618 pregnant women for gestational diabetes at 24-28 weeks' gestation. Eighty-seven percent had normal results; of the 13% with abnormal screening tests, 139 had one abnormal value on the subsequent 3-hour oral GTT. These women were then compared with 725 randomly selected patients with a normal screening test. The frequency of chronic hypertension, cesarean section, 5-minute Apgar score below 7, preterm delivery, shoulder dystocia, congenital malformations, and perinatal mortality did not differ significantly between the groups. The incidence of macrosomia (birth weight above 4000 g) was significantly greater in the study group (18.0%) than in the control group (6.6%) (odds ratio 2.18; 95% confidence interval 1.77-5.37), a relationship that persisted after controlling for confounding risk factors by logistic regression modeling (odds ratio 2.55; 95% confidence interval 1.44-4.52). The incidence of preeclampsia/eclampsia was significantly greater in the study group (7.9%) than in the control group (3.3%) (odds ratio 2.51; 95% confidence interval 1.14-5.52), which also persisted after controlling for confounding risk factors using logistic regression modeling (odds ratio 2.81; 95% confidence interval 1.26-6.28). Our results suggest that patients with one abnormal value on an oral GTT during pregnancy are at risk for delivering macrosomic infants and developing preeclampsia/eclampsia.
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PMID:The relationship of one abnormal glucose tolerance test value and pregnancy complications. 290 30

A case is presented of a healthy, 36-year-old woman with leiomyomas of the uterus to illustrate the broad dimensions of choosing an appropriate contraceptive method. Additionally, this woman had a history of pregnancy-induced hypertension, gestational diabetes, and a family history of breast and endometrial cancer. The woman presented for contraceptive advice 5 days after a regular, normal menstruation. She reported that she generally had been healthy, with no current medical problems and had used several barrier methods of contraception. The woman found the barrier methods to be unreliable as well as somewhat difficult to use. The clinical problem was how best to provide this woman with contraception. The patient was divorced and sexually active, and she wanted to remarry and to have more children. As this patient was parous and had not experienced previous problems with excessive menstrual blood loss or dysmenorrhea, she might have tolerated an IUD well. However, women with leiomyomas, especially the kind that produce an irregular cavity, should not use an IUD. Additionally, IUDs have been linked to an increased incidence of pelvic inflammatory disease, particularly in women with multiple partners. Consideration was given to steroid contraceptives -- oral (OCs), injectable, and implantable -- for this patient. The last 2 modalities were potential options as the patient had no immediate plans for conception. Various aspects of the patient's family history as well as the physical findings needed to be evaluated in relation to the use of hormones. In this context, the familial predisposition to breast cancer was considered. As the results of the Centers for Disease Control and the National Institute of Child Health and Human Development Cancer and Steroid Hormone Study showed no change in risk of breast cancer in OC users, regardless of age at 1st use or subsequent duration of use and other large epidemiologic studies have confirmed these findings, the patient's family history of breast cancer was not a contradindication to OC use. The somewhat remote family history of endometrial carcinoma was not epidemiologically significant. The fact that no adverse effect of high dose contraceptives on existing tumors has surfaced in 2 decades of OC use by millions of women is reassuring. A large body of clinical information concludes that there is no contraindication to prescribing OCs for women with gestational diabetes. Concerns about the cardiovascular effects of OCs stemming from reports in the 1960s and 1970s remain questionable and are not likely to be relevant to contemporary OCs. Injectable medroxyprogesterone, which is remarkably free of adverse reactions, proved or suspected, after 2 decades of use, was chosen as an appropriate contraception option for the patient described.
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PMID:Medical aspects of contraception. 310 32

The recovery of fertility after discontinuation of NORPLANT implant use was assessed in ninety women who stated a desire for a new child at the time of removal. Three subjects were lost to follow-up after removal. The cumulative probability of conception in the remaining 87 women was 25, 49, 73 and 86 percent at one, three, six and twelve months after removal, respectively. Nine observations were censored either because of the use of a contraceptive method soon after removal of the implants (n = 7) or separation (n = 2). All other cases were pregnant at the end of two years with exception of three subjects where a male factor for infertility was present. There was no significant correlation between the length of NORPLANT use and the length of the interval from removal to conception. A significantly higher frequency of intervals longer than 6 months was observed among women older than 30 years as compared to younger women. Pathology during pregnancy was cholestasia (n = 5), hypertension (n = 1) and gestational diabetes (n = 1). The outcome was term delivery in 59 cases, premature delivery in 4 cases, and spontaneous abortion in 7 cases. One woman is still pregnant and the outcome is unknown in 4 cases. One premature infant died. A contemporary control group of Copper T users enrolled under the same criteria as NORPLANT implant users provided 44 women who had the device removed to become pregnant. The cumulative probability of pregnancy was 27, 69, 84 and 89 at one, three, six and twelve months and all were pregnant by the end of the second year. Six censored observations occurred because of the use of another contraceptive method after removal (n = 3) or loss to follow-up (n = 3). The outcome of pregnancy was term delivery in 23 cases and abortion in 7 cases. Recovery of fertility occurred at a normal rate after NORPLANT implant removal and the incidence of problems detected in the ensuing pregnancy were within the expected range for Chilean women.
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PMID:Recovery of fertility and outcome of planned pregnancies after the removal of Norplant subdermal implants or Copper-T IUDs. 311 91

The amniotic fluid lecithin/sphingomyelin (L/S) ratio from 128 cases of high risk pregnancies were measured by using high performance liquid chromatography (HPLC). The L/S ratio was found to be increased in patients with pre-eclampsia, hypertension, intrauterine growth retardation (IUGR), prolonged rupture of membranes (PROM), and twin gestation, but decreased in patients with diabetes from gestational diabetes to class C. In patients with placenta previa, the L/S ratio was not affected.
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PMID:Amniotic fluid lecithin/sphingomyelin ratio in high risk pregnancy. 324 20

Currently, gestational diabetes is often defined by the criteria of O'Sullivan, with those patients not included as gestationally diabetic being considered normal. Recently, Tallarigo and coworkers reported that serum glucose variations within the normal range could affect the birthweight of the neonate and also could relate to the frequency of complications often associated with diabetes in pregnancy. This study confirms the correlation between the plasma glucose concentration at 2 hours on the 100 gm, 3-hour glucose tolerance test and birthweight. When women demonstrating 2-hour glucose values of 139 mg/dl or less are compared with those demonstrating values 140 mg/dl or greater, fetuses from the group with higher plasma glucose values had higher birthweights (+211 gm) and were more often macrosomic (24.4 versus 8.6%). We were unable to identify any relationship between these small variations of glucose tolerance and pregnancy complications, such as delivery by cesarean section, birth trauma, pregnancy-induced hypertension, or congenital anomalies.
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PMID:Glucose tolerance, fetal growth, and pregnancy complications in normal women. 334 63

The health and well-being of every child is affected by both the quality and quantity of food, but when does nutrition first begin to be important? Is it after the birth or from the moment of conception, or perhaps even before this? This paper will focus on the nutritional status of the mother, before as well as during pregnancy, and its relationship to the birth weight and subsequent health of the child. Pre-pregnant weight is a major factor affecting birth weight; underweight women may be at increased risk of delivering a low birthweight infant and of complications of pregnancy, whilst those who are excessively obese are at greater risk of gestational diabetes and hypertension. Animal studies have demonstrated that severe vitamin and mineral deficiencies have dramatic effects on reproductive outcome, and there is now growing evidence that even marginal deficiencies in women may have deleterious effects on pregnancy outcome. Nutrition interventions which involve low-risk women appear to have little effect but beneficial effects have been demonstrated in interventions directed at high-risk women. Information about nutrition should be the mainstay of any advice given to prospective parents.
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PMID:Feeding children: in the beginning--nutrition and pregnancy. 353 55

A 27 year old woman with a fourth cadaveric renal transplant successfully completed a 33 week pregnancy whilst taking cyclosporin A and prednisolone. Her renal function remained stable despite recurrent urinary tract infections, hypertension, gestational diabetes, and Clostridium difficile associated diarrhea. The infant, delivered electively at 33 weeks, was small for gestational age but otherwise normal.
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PMID:Successful pregnancy in a renal transplant recipient taking cyclosporin A. 355 3

We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation. Certain operative complications were also more common in obese women undergoing cesarean section including estimated blood loss of more than 1,000 milliliters, operating time of more than two hours and wound infection postoperatively. These differences remained significant after controlling for appropriate confounding variables. We conclude that maternal obesity should be considered a high risk factor.
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PMID:Maternal obesity and pregnancy. 357 19


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