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OBJECTIVE To explore changes in prevalence of anal incontinence (AI) from late first pregnancy to 6 years postpartum, and to evaluate possible risk factors for changes in AI during the 6-year period. DESIGN Prospective longitudinal cohort study. SETTING Two Norwegian health regions. POPULATION OR SAMPLE Women with first deliveries between May 2009 and December 2010. METHODS Participants reported AI in late pregnancy, 6 months, 1 and 6 years after first delivery using postal or digital questionnaires. AI prevalence was calculated, and mixed effects Poisson regression analyses with robust variance were applied. MAIN OUTCOME MEASURES AI from late pregnancy to 6 years postpartum. RESULTS Among 1571 participants, 65% had normal vaginal first deliveries, 20% had vaginal deliveries complicated by instrumental intervention and/or obstetric anal sphincter injury (IVD ± OASIS). Nearly 1 in 10 women reported persistent incontinence during the 6 years. The overall AI prevalence was reduced from late pregnancy to 1 year postpartum for all modes of delivery. At 6 years postpartum, women with IVD ± OASIS had a higher AI prevalence (23%; 95% CI 16-30%) compared with women with caesarean section (8%; 95% CI 2-13%) or normal vaginal delivery (12%; 95% CI 9-16%). Moreover, women who were

The civil war in Burundi (1993–2005) led to the forced displacement of a large part of the population. This study aims to explore how that displacement affected fertility behavior. Using a nationally representative, retrospective survey on birth and residential histories of 4,523 Burundian women, we examine the impact of conflict‐induced displacement on fertility. These unique data enable us to distinguish between remaining‐in‐place, voluntary migration, and forced displacement, as well as to distinguish between periods spent “on the move” versus periods spent in residence in the new site. Adopting a semiparametric regression model, we analyze both the probability of the first pregnancy and the subsequent spacing of higher order pregnancies. We find that the risk of a first pregnancy was higher in the year in which a woman was forcibly displaced and lower in the year a woman migrated voluntarily. Residency in a new site increased the risk of pregnancy for both.

Pregnancy and lactation-associated osteoporosis (PLO) is a rare, severe, early form of osteoporosis in which young women present with fractures, usually multiple vertebral fractures, during late pregnancy or lactation. In studies of idiopathic osteoporosis (IOP) in premenopausal women, we enrolled 78 women with low-trauma fractures and 40 healthy controls, all with normal menses and no secondary cause of bone loss. In 15 of the affected women, the PLO subgroup, fractures had occurred during late pregnancy or lactation. We hypothesized that clinical, bone structural, and metabolic characteristics would differ between women with PLO and those with (non-PLO) IOP and controls. All were evaluated > 12 months postpartum, when structural and remodeling characteristics would be expected to reflect baseline premenopausal status rather than transient postpartum changes. As previously reported, affected subjects (PLO and IOP) had BMD and microarchitectural deficiencies compared to controls. Women with PLO did not differ from those with IOP in terms of age, BMI, body fat, menarcheal age, parity, or age at first pregnancy. However, women with PLO had a more severe clinical presentation than those with IOP: more fractures (5.5 ± 3.3 versus 2.6 ± 2.1; p = 0.005); more vertebral fractures (80% versus 17%; p < 0.001); and higher prevalence of multiple fractures. BMD deficits were more profound and cortical width tended to be lower in PLO. PLO subjects also had significantly lower tissue-level mineral apposition rate and bone formation rates (0.005 ± 0.005 versus 0.011 ± 0.010 mm2 /mm/year; p = 0.006), as well as lower serum P1NP (33 ± 12 versus 44 ± 18 µg/L; p = 0.02) and CTX (257 ± 102 versus 355 ± 193 pg/mL; p = 0.01) than IOP. The finding that women with PLO have a low bone remodeling state assessed more than a year postpartum increases our understanding of the pathogenic mechanism of PLO. We conclude that women with PLO may have underlying osteoblast functional deficits which could affect their therapeutic response to osteoanabolic medications. © 2019 American Society for Bone and Mineral Research.

OBJECTIVES: In many South Asian communities, the majority of women are married during adolescence and reproduce before 20 years. Early reproduction may adversely affect maternal nutrition and linear growth, however whether early marriage has similar effects is unknown. Shorter women might also be preferentially chosen for earlier marriage. We hypothesized that early marriage and early pregnancy may each be associated with women's shorter height, independent of any selection effects. MATERIALS AND METHODS: We analyzed cross-sectional data on 7,146 women aged 20-30 years from rural lowland Nepal. Linear regression models tested associations of early marriage and early reproduction with height, adjusting for women's education and husbands' characteristics (education and wealth) that might index preferential selection of short young women for marriage. RESULTS: Median ages at marriage and first pregnancy were 15 and 18 years, respectively, with 20% pregnant

Objective To compare the efficacy and costs of three different strategies of antenatal rhesus immune globulin (RhIG) administration in a US population. Methods A decision tree analysis was undertaken for universal antenatal RhIG administration based on RhD serologic paternity testing, universal administration without paternity, and selective antenatal RhIG administration using cell free fetal DNA (cfDNA) for RHD fetal typing. Rates of alloimmunization were calculated. Charges were determined for laboratory testing and obstetrical and neonatal treatments for the first pregnancy and cases of alloimmunization in the following pregnancy. Results The largest number of new RhD alloimmunization cases resulted from a strategy of universal RhIG that included paternity. Fewer cases resulted from a selective strategy; the least number of cases were associated with a universal approach that discounted paternity. When the costs of first pregnancies and alloimmunized second pregnancies were combined, a universal strategy that excludes paternity had the least costs followed by a selective strategy followed by a universal strategy that included paternity. Conclusion The use of cfDNA to determine the selective use of antenatal RhIG would not be cost-effective in the United States. Universal antenatal RhIG without paternity is more effective in preventing new cases of alloimmunization than the current ACOG guideline.

Objective The appropriateness of the 1-in-X numerical format to convey quantitative medical probabilities is currently under discussion because of its distortive effect on subjective probability assessment. Previous research, however, always asked participants to imagine a hypothetical scenario. The aim of the present research is to support the existence of the 1-in-X effect in a real setting: when pregnant women have to evaluate their personal risk of Down syndrome according to their maternal age. Method During the first prenatal visit, pregnant women were asked to evaluate their own risk of having a child with Down syndrome according to their age, when such risk was presented either in the 1-in-X or in the N-in-NX format. Then, they were asked to assess their risk of having a child with Down syndrome. Results Results showed a systematic higher risk assessment when pregnant women were presented with the 1-in-X format (mean = 3.57, standard deviation = 1.4) than with the N-in-NX format (mean = 3.03, standard deviation = 1.4), P = 0.007. Whereas the effect was shown to be not moderated by a differential comprehension of the two numerical formats, women with a low educational level and those who were at their first pregnancy were shown to be significantly more vulnerable. Conclusion The present findings corroborate the existence of the 1-in-X effect in a real-world setting, showing that, in pregnant women, the 1-in-X format actually elicits a higher perceived risk of Down syndrome, compared with the N-in-NX format. © 2015 John Wiley & Sons, Ltd.

It is unclear whether pregnancy is a trigger or accelerant for idiopathic pulmonary arterial hypertension (PAH). Alternatively, its frequency close to the onset of symptoms and diagnosis in the idiopathic PAH population may represent a coincidence in a disease that predominates in young women. We describe a carrier of a BMPR2 gene mutation who had an uneventful first pregnancy but had aggressive PAH during her second pregnancy and now has ongoing heritable PAH. The possible role of pregnancy as a trigger in this vulnerable patient is discussed. Databases of patients with heritable PAH should be explored to see whether pregnancy is related to overt manifestation of the disease.

Objectives To evaluate the reliability of measurements of the levator hiatus and levator–urethra gap (LUG) using three/four-dimensional (3D/4D) transperineal ultrasound in women during their first pregnancy and 6 months postpartum, and to assess the learning process for these measurements. Methods An inexperienced observer was taught to perform measurements of the levator hiatus and LUG by an experienced observer. After training, 3D/4D ultrasound volume datasets of 40 women in the first trimester were analyzed by these two observers. Another training session then took place and both observers repeated the analyses of the same volume datasets. Finally, analyses of 40 volume datasets of the women 6 months postpartum were performed by both observers. Intra- and interobserver reliability were determined by intraclass correlation coefficients (ICC) with 95% CIs. Results For levator hiatal measurements, in the women during their first pregnancy the interobserver reliability was substantial to almost perfect after both the first and second training session (ICC, 0.62–0.83 and 0.71–0.89, respectively, for anteroposterior diameter, transverse diameter and area at rest, on contraction and on Valsalva) and the intraobserver reliability was substantial to almost perfect for both observers. For these measurements performed once the women had delivered, interobserver reliability was moderate to almost perfect. For LUG measurements performed during pregnancy, interobserver reliability was slight to moderate after the first training session (ICC, 0.14–0.54), but improved after the second training session (ICC, 0.38–0.71), and intraobserver reliability was moderate to substantial for the experienced observer and slight to moderate for the inexperienced observer. For these measurements performed when the women had delivered, interobserver reliability was fair to moderate. Conclusions The levator hiatus and LUG can be measured reliably using 3D/4D ultrasound in primigravid and primiparous women. The technique to measure dimensions of the levator hiatus requires limited teaching, but LUG measurements are more difficult and require more extensive training. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

Objectives: Although a large literature has shown links between “father absence” during early childhood, and earlier puberty and sexual behavior in girls in Western populations, there are only a few studies which have looked at timing of reproduction, and only one of these fully incorporated childless respondents to investigate whether father absence is associated with increased hazard of becoming a parent at one time point (early) more than another. Here we sought to clarify exactly when, if at all, father absence increased the likelihood of first birth in a Western sample. Methods: An online sample of 954 women reported on their childhood living circumstances, their age of menarche, first coitus, first pregnancy, and first birth. Results: Cox regression and Kaplan–Meier plots showed an increased risk of becoming a parent for father absent women in their 20s, but no overall greater likelihood of parenthood. Conclusion: These data support the suggestion that father absence is associated with an acceleration of reproductive behavior in Western samples, rather than a simple increase in likelihood of reproduction.

Objective To assess the outcomes of pregnancy following postpartum haemorrhage (PPH) in the first pregnancy. Design Cohort study. Setting Aberdeen Maternity Hospital, Scotland, UK. Population All women with first deliveries recorded in the Aberdeen Maternity and Neonatal Databank (AMND) between 1986 and 2005. Methods All women identified from the AMND were classified into exposed and unexposed cohorts, according to whether or not they had PPH in their first delivery. They were then linked to any records of a second pregnancy. Main outcome measures Any second pregnancy, time to second pregnancy, early or late pregnancy loss, and prevalence of PPH in the second pregnancy. Results Out of 34 334 women, 10% had a PPH in their first pregnancy. There was no statistically significant difference in the time to a second pregnancy, nor in the outcome of that second pregnancy, between women who had experienced a PPH in their first pregnancy and women who had not. For women with a caesarean delivery, there was a significant reduction in the proportion conceiving again, comparing the exposed and unexposed cohorts. Conclusions From this cohort study we can conclude that if a PPH occurs in a first pregnancy, there is no delay in achieving a second pregnancy, and no detrimental effect on the outcome of that pregnancy. Significantly fewer women conceive a second pregnancy if they have a caesarean section in their first pregnancy that is complicated by PPH.

Neonatal alloimmune thrombocytopenia (NAIT), with an incidence of one in 1000 live births, is the most common cause of severe thrombocytopenia and intra-cerebral haemorrhage in term neonates. NAIT results from trans-placental passage of maternal antibodies against a paternally derived fetal platelet alloantigen. Clinical presentation varies from unexpected thrombocytopenia on a blood film in a well newborn to intracranial haemorrhage (ICH). In contrast to haemolytic disease of the newborn, NAIT can present in a first pregnancy, and subsequent pregnancies are usually more severely affected. The role of antenatal screening for maternal alloantibodies instead of fetal blood sampling to identify at-risk fetuses remains uncertain, but there is a trend towards less invasive maternally directed treatment for at-risk pregnancies. Neonatal management is aimed at preventing or limiting thrombocytopenic bleeding with transfusion of antigen-matched platelets.

Background and Objectives The Colton blood group antigens are carried by the AQP1 water channel. AQP1−/− individuals, also known as Colton-null since they express no Colton antigens, do not suffer any apparent clinical consequence but may develop a clinically significant alloantibody (anti-CO3) induced by transfusion or pregnancy. Identification and transfusion support of Colton-null patients are highly challenging, not only due to the extreme rarity of this phenotype, the lack of appropriate reagents in most laboratories, as well as the possibility of confusing its with the recently described CO:-1,-2,3,-4 phenotype where AQP1 is present. This study investigated a new Colton-null case and evaluated three commercially available anti-AQP1s to identify Colton-null red blood cell samples.

Aims To investigate the impact of the first pregnancy and delivery on the prevalence and types of urinary incontinence during pregnancy and 1 year after delivery. Methods The study was a prospective cohort study with a control group. Primiparous women, who delivered in our department from June 2003 to July 2005, participated. The women filled out a questionnaire 2–3 days after the delivery and a new questionnaire after 1 year. The questionnaires comprised basic characteristics and symptoms of urinary incontinence. An attempted age-matched control group of nulliparous women was included, and filled out similar questionnaires. Prevalences and types of urinary incontinence, and a combined severity- and bother-score (ICIQ-SF score) among the incontinent women, were calculated and compared. Results The two groups differed significantly in age and most basic characteristics. During pregnancy, the prevalence of any type of urinary incontinence in the primiparous group was 32.1%, compared to 13.8% in the control group. Adjusted OR = 3.3 (95%CI = 2.4–4.4). One year after delivery, the prevalence in the primiparous group was 29.3%, compared to 16.6% in the control group. Adjusted OR = 2.5 (95%CI = 1.8–3.5). ICIQ-SF mean scores among the incontinent women varied insignificantly between 5.8 and 6.2. Conclusions The prevalence of urinary incontinence during pregnancy was 3.3 times higher compared with a control group of nulliparous women. After 1 year, the difference was reduced, but still 2.5 times higher in the primiparous group. The symptoms and impact on quality of life seemed to be mild to moderate in both groups. Neurourol. Urodynam. 31:475–480, 2012. © 2012 Wiley Periodicals, Inc.

Please cite this paper as: August E, Salihu H, Weldeselasse H, Biroscak B, Mbah A, Alio A. Infant mortality and subsequent risk of stillbirth: a retrospective cohort study. BJOG 2011;118:1636–1645. Objective To examine the association between infant mortality in a first pregnancy and risk for stillbirth in a second pregnancy. Design Population-based, retrospective cohort study. Setting Maternally linked cohort data files for the state of Missouri. Population Women who had two singleton pregnancies in Missouri during the period 1989–2005 (n = 320 350). Methods Women whose first pregnancy resulted in infant death were compared with those whose infant from the first pregnancy survived the first year of life. The Kaplan–Meier product limit estimator was employed to compare probabilities for stillbirth in the second pregnancy between both groups of women. Adjusted hazard ratios (AHRs) and 95% confidence intervals (95% CIs) were generated to assess the association between infant mortality in the first pregnancy and stillbirth in the second pregnancy. Main outcome measures Exposure was defined as infant mortality in the first pregnancy, and the outcome was defined as stillbirth in the second pregnancy. Results Women with prior infant deaths were about three times as likely to experience stillbirth in their subsequent pregnancy (AHR 2.91; 95% CI 2.02–4.18). White women with a previous infant death were nearly twice as likely to experience a subsequent stillbirth, compared with white women with a surviving infant (AHR 1.96; 95% CI 1.13–3.39). Black women with a previous infant death were more than four times as likely to experience subsequent stillbirth, compared with black women with a surviving infant (AHR 4.28; 95% CI 2.61–6.99). Conclusions Previous infant mortality results in an elevated risk for subsequent stillbirth, with the most profound increase observed among black women. Interconception care should consider prior childbearing experiences to avert subsequent fetal loss.

Summary We report upon an ageing Thoroughbred mare which showed remarkably similar and abnormally prolonged profiles of equine Chorionic Gonadotrophin (eCG) in her bloodstream during successive pregnancies sired by the same stallion. The first pregnancy was aborted at Day 75 after ovulation in conjunction with a precipitous decline in eCG concentrations which occurred immediately after the peak level had been reached. The second pregnancy, which proceeded safely to term, also involved a similar sharp fall in eCG concentrations after attainment of the peak values. Possible causes of the extended lifespan of the eCG-secreting endometrial cups in this animal are discussed.

Zusammenfassung Das Trockenstehen einzelner Euterviertel war bedingt durch Verlegung der Zisterne, der ausfuhrenden Milchgange und durch Veranderungen im Drusengewebe. Die Obliteration der Zisterne, bzw. der ausfuhrenden Milchgange wurde bei 16 Kuhen in 20 Eutervierteln beobachtet, war in erster Linie durch eine proliferative Entzundung bedingt, ging zuweilen mit Epithelmetaplasie einher und war zweimal durch Abszesbildung kompliziert. Die obliterierenden Prozesse gingen einher in 7 Eutervierteln mit Pyogenes-Mastitiden, in 5 Eutervierteln mit unspezifischen Euterentzundungen, in 4 Vierteln mit Traumen an der Zitze, in einem Viertel mit Galtstreptokokkenmastitis und einem Viertel mit jauchig-eitriger Entzundung. In 2 Vierteln von einer erstgebarenden Kuh lag eine atiologisch nicht geklarte Storung in der Entwicklung des Euters wahrend der ersten Trachtigkeit vor. Der Zisternenverschlus fuhrte im zugehorigen Euterviertel meistens zur Verkleinerung der Drusenlappchen und ruckbildung der Alveolen in nicht sezernierende tubulose Drusenendstucke. Die ruckbildung erfolgte mit und ohne entzundliche Prozesse im Eutergewebe. — In einzelnen Fallen war zu Beginn der Laktation uber der verschlossenen Zisterne sezernierendes Drusengewebe zu beobachten. — Sekretstauung und besonders Ansammlung von eitriger Flussigkeit hatten zuweilen zur Dilatation der Milchgange gefuhrt. Bei 6 Kuhen war in 8 Vierteln mit weiter Zisterne und offenen Milchgangen das Aufhoren der Milchsekretion durch Veranderungen im Euterdrusengewebe bedingt. Dabei lag vor in je einem Viertel nekrotisierende Mastitis, jauchig-eitrige Mastitis, Pyogenes-Mastitis, Adenombildung sowie in 4 Vierteln Galtstreptokokkenmastitis. Beim Gait zeigten sich eigenartige Gestaltsveranderungen der Drusenendstucke und Umwandlung der Epithelien, die als Fehlregeneration gedeutet wurden. Summary The Pathology of Disturbances of Milk Secretion, and Milking, in Cows with 1, 2, or 3 Quarters Drying up of one or more quarters was produced by obliteration of the galactophorous sinus, or the milk ducts, or by pathological changes in the glandular tissue. Blockage of the sinus or ducts was observed in 16 cows, and involved 20 quarters. It Was mainly due to a proliferative inflammation, sometimes accompanied by epithelial metaplasia, and on two occasions was complicated by abscess formation. In 7 quarters the obliterative process was associated with a C. pyogenes mastitis, in 5 quarters with non-specific inflammation, in 4 quarters with teat injury, in 1 quarter with streptococcal mastitis and in 1 quarter with a gangrenous inflammation. In 2 quarters of a primiparous cow there occurred an error of development of unknown origin in the udder during the first pregnancy. Blockage of the sinus usually caused atrophy of the gland lobules and conversion of the alveoli into non-secreting tubular glands. This involution occurred with or without inflammatory changes in the udder. Occasionally there were some signs of activity at the beginning of lactation in the glandular tissue, in spite of the blockage of the sinus. Stasis of secretion and especially the accumulation of purulent fluid sometimes caused dilatation of the milk ducts. In six cows there were 8 quarters which showed no stenosis of the sinus or ducts, but in which secretion had caused lesions of the mammary tissue. These lesions comprised necrotising mastitis, gangreno-purulent mastitis, C. pyogenes mastitis and adenomatous change formation, each affecting 1 quarter, as well as 4 quarters affected with streptococcal mastitis. In streptococcal mastitis, the acini showed a special deformation and a transformation of their epithelium which was interpreted as being a failure of regeneration. Resume La pathologie des troubles de la secretion lactee et de l'ecoulement du lait chez des vaches n'ayant que 1, 2 ou trois trayons Le tarissement d'un ou de plusieurs quartiers etait provoque par l'obliteration du sinus galactophore ou des conduits et par des lesions du tissu glandulaire. L'obliteration du sinus et des conduits galactophores fut observee chez vingt vaches et vingt quartiers. Elle etait produite le plus souvent par une inflammation proliferative, accompagnee parfois d'une metaplasie epitheliale et se trouva deux fois compliquee d'abces. Les processus obliterants furent provoques dans 7 quartiers par une mammite pyobacillaire, dans 5 quartiers par des mammites non specifiques, dans 4 quartiers par un traumatisme du trayon, dans un quartier par une mammite streptococcique et une fois par une inflammation putride. Dans deux quartiers d'une vache primipare, on constata un trouble du developpement de la mammelle survenu pendant la premiere periode de la gestation et d'origine inconnue. L'obliteration du sinus galactophore provoquait generalement dans le quartier correspondant une atrophie des lobules glandulaires et une involution des acini ne secretant plus. L'involution se produit avec ou sans processus inflammatoires du tissu mammaire. Dans quelques cas isoles, on put observer au debut de la lactation du tissu glandulaire en activite malgre l'obliteration du sinus galactophore correspondant. Une stase des secreta et surtout des amas de liquide purulent provoquerent parfois une dilatation des conduits galactophores. Chez 6 vaches et dans 8 quartiers ne presentant aucune stenose du sinus galactophore ou des conduits, l'arret de la secretion lactee fut provoque par des lesions du tissu mammaire. Les lesions observees furent: chaque fois dans un quartier une mammite necrotisante, une mammite putride, une mammite pyobacillaire et une formation adenomateuse. Dans 4 quartiers on diagnostiqua une mammite streptococcique. Dans la mammite streptococcique les acini presentaient une deformation speciale et une transformation des epitheliums qui pouvait etre interpretee comme un essai manque de regeneration. Resumen Patologia de las alteraciones de secrecion y salida de la leche en vacas con mamitis que interesan uno, dos o tres cuarterones La desecacion de los diversos cuarterones se debia a la obstruccion de la cisterna, conductos galactoforos y a alteraciones en el tejido glandular. La obliteracion de la cisterna o bien de los conductos galactoforos se observo en 20 cuarterones de 16 vacas, debiendose en primer a instancia a una inflamacion proliferativa y estando esta a veces acompanada de metaplasia epitelial y, en dos ocasiones, complicada con la formacion de abscesos. Los procesos obliterantes estaban ligados a mastitis por Str. pyogenes en 7 cuarterones, en 5 cuarterones complicados con mamitis inespecificas, por traumatismos en el pezon en 4 cuarterones, en 1 cuarteron con mamitis estreptococica y en otro cuarteon estaba complicado por una inflamacion icoroso-purulenta. En 2 cuarterones de una vaca primipara nos hallamos ante una alteracion sin definir etiologicamente en el desarrollo de la mama durante la primera gestacion. — La oclusion de la cisterna casi siempre condujo en el cuarteron correspondiente a una disminucion de los lobulillos glandulares y regresion de los alveolos en los tramos glandulares tubulosos finales sin secrecion. La regresion sobrevino con y sin procesos inflamatorios en el tejido glandular. — En algunos casos, al comienzo de la lactacion pudo observarse tejido glandular secretor por encima de la cisterna obstruida. — El extasis de la secrecion y, sobre todo, el acumulo de liquido purulento condujeron incluso a dilatar las vias galacticas. En 6 vacas, 8 cuarterones con cisterna dilatada y vias galacticas abiertas tenian condicionada la terminacion de la secrecion lactea a alteraciones en el tejido glandular mamario. Entre las mismas se encontraban: en un cuarteron cada vez, mastitis necrotizante, mamitis icoroso-purulenta, mastitis por Str. pyogenes, formacion de un adenoma, asi como mamitis estreptococicas en 4 cuarterones. En las mastitis producidas por el Str. agalactiae se presentaron alteraciones morfologicas singulares en los tramos finales de la glandula y transformacion de los epitelios, las cuales se senalaron como regeneraciones defectuosas.

ummary For many years, epizootic bovine abortion in California has been recognized as the cause of extensive calf losses, particularly among heifers in their first pregnancy. Fetal pathology revealed subcutaneous edema, ascites, generalized hemorrhage, and hepatopathy. Earlier workers excluded all known bacterial causes of abortion. Five viral isolates were recovered from various tissues of aborted fetuses originating from herds in widely separated areas. Cultures of bovine embryonic kidney cells and embryonated chicken eggs were employed as the means for isolation. Four isolates were studied comparatively. The behavior in chicken embryos, mice, and guinea pigs identified these isolates as members of the Psittacosis-Lymphogranuloma-Venereum group. Smears showed typical elementary bodies after staining by the Macchiavello, Castaneda, Giemsa and the Stamp technique. Electronmicroscopic observations and serological investigations confirmed these findings. A disease similar to epizootic bovine abortion was reproduced experimentally by inoculating cows in various stages of pregnancy by the intrafetal, intravenous, intramuscular, and subcutaneous exposure. After aerosal exposure of a pregnant cow the EBA-agent was recovered from the fetus at slaughter 18 days later. Oral administration of the agent and contact with infected animals were without effect. The inoculated cows aborted or gave birth to weak calves 11 to 126 days after inoculation. The virus was reisolated from uterine contents, and from the internal organs of the fetuses. Intrauterine infection of the fetuses was thus demonstrated. Cows were bred and conceived after experimentally produced abortion. The immunity of two of these cows was challenged. Virus was not recovered either from uterine contents or fetal tissues subsequently, although these animals, as well as others that recovered from experimental abortion, responded with fever to the challenge exposure. Comparative studies in one cow with Miyagawanella bovis were carried out. They revealed certain differences in the response of the cow to the agent. Intrauterine infection of the calf could be demonstrated 84 days after inoculation. It is recommended that the agent isolated from epizootic bovine abortion be considered a separate entity until exact antigenic analysis reveals its relation to other agents of this group associated with cattle infections. Zusammenfassung Atiologische Studien am epizootischen Abort der Rinder Seit vielen Jahren auftretendes Verkalben bei Rindern mit betrachtlichen Verlusten an Kalbern, besonders bei Erstlingsfarsen, wurde in Kalifornien als epizootischer Abort der Rinder bezeichnet. Fotale pathologische Veranderungen waren subkutanes Odem, Aszites, generalisierte petechiale Blutungen und Hepatopathie. Andere Bearbeiter hatten fruher die bekannten bakteriellen Ursachen von Aborten bei Rindern ausgeschlossen. Funf Virusstamme wurden von Organen abortierter Kalber, die aus geographisch weit getrennten Herden stammten, mittels embryonaler Rindernierenzellen und Huhnerembryonen isoliert. Vier Stamme wurden vergleichend untersucht. Das Verhalten im embryonierten Huhnerei, in Mausen und in Meerschweinchen sowie elektronenmikroskopische und serologische Befunde charakterisierten diese Stamme als zur Psittakose-Lymphogranuloma-Venereum-Gruppe gehorend. Eine dem epizootischen Rinderabort ahnliche Krankheit wurde experimentell erzeugt durch intrafotale, intravenose, intramuskulare und subkutane Inokulation von Kuhen in verschiedenen Trachtigkeitsstadien. Aerosolinfektion einer Kuh fuhrte zur Infektion ihres Fotus, wahrend orale Verabreichung des Virus und Kontakt mit infizierten Tieren ohne klinische Folgen blieben. Die inokulierten Tiere verkalbten oder hatten lebensschwache Kalber 11 bis 126 Tage nach der Injektion. Intrauterine Infektion wurde durch Virusisolierung vom Uterusinhalt und von den inneren Organen der Kalber nachgewiesen. Kuhe, die nach experimenteller Infektion verkalbten, wurden wieder tragend. Die Immunitat zweier dieser Tiere wurde gepruft. Virus wurde weder vom Uterusinhalt noch von fotalen Geweben isoliert, obwohl diese Tiere wie auch andere, die sich vom experimentellen Abort erholt hatten und nicht tragend waren, mit Fieber auf die Testinfektion reagierten. Vergleichende Studien an einer tragenden Kuh mit Miyagawanella bovis zeigten eine mildere Erkrankung dieser Kuh nach der Inokulation, doch konnte 84 Tage spater intrauterine Infektion ihres Kalbes nachgewiesen werden. Resume Etudes sur l'etiologie d'un avortement epizootique des bovides Un avortement observe depuis plusieurs annees chez des bovins et provoquant une perte considerable en veaux, surtout chez les primipares est appele en Californie “avortement epizootique bovin”. A l'autopsie du foetus on trouve un oedeme sous-cutane, une ascite, des hemorragies petechiales generalisees et une hepatopathie. D'autres auteurs ont exclu dans de precedents travaux les causes bacteriennes connues de l'avortement chez les bovins. Cinq souches de virus furent isolees des organes des veaux nes avant terme provenant de troupeaux geographiquement eloignes les uns des autres, au moyen de cellules renales bovines embryonales et sur des embryons de poulet. Quatre souches furent l'objet d'une etude comparee. Leur comportement dans l'oeuf embryonne de poulet, chez la souris et le cobaye ainsi que les resultats obtenus au microscope electronique et l'etude serologique caracteriserent ces souches comme appartenant au groupe psittacose-lymphogranuloma-venereum. Une maladie analogue a “l'avortement epizootique bovin” put etre reproduite experimentalement par inoculation intrafoetale, intraveineuse, intramusculaire et sous-cutanee chez des vaches a differents stades de gestation. Une infection par aerosol chez une vache provoqua l'infection du foetus tandis que l'administration orale du virus et le contact avec des animaux infectes resta sans consequences cliniques. Les animaux inocules avorterent ou donnerent naissance a des veaux debiles 11–126 jours apres l'injection. Des infections intrauterines furent mises en evidence par l'isolement du virus dans le contenu uterin et dans les visceres. Des vaches ayant avorte apres l'infection experimentale devinrent a nouveau portantes. L'immunite de deux de ces animaux fut verifiee. On ne put isoler le virus ni dans le contenu uterin ni dans les tissus du foetus, bien que ces animaux comme ceux qui avaient surmonte un avortement experimental et ne portaient pas reagirent par une poussee de fievre a l'infection test. Des etudes comparees effectuees sur une vache portante avec Miyagawanella bovis montrerent une maladie plus benigne chez cette vache apres l'inoculation, mais on put mettre en evidence 84 jours plus tard une infection intrauterine chez le veau qu'elle portait. Resumen Estudios etiologicos sobre el aborto epizootico del ganado vacuno En California se denomina aborto epizootico del ganado vacuno a un tipo de aborto en vacas que desde hace muchos anos viene ocasionado grandes perdidas entre las terneras, sobre todo en novillas. Las alteraciones patologicas fetales eran edema subcutaneo, ascitis, hemorragicas petequiales generalizadas y hepatopatia. Otros autores ya habian excluido con anterioridad las conocidas causas bacterianas de abortos en vacas. Se aislaron 5 cepas de virus de organos de terneras abortadas, procedentes de vacadas geograficamente bastante distantes entre si, mediante cultivos en celulas embrionarias de rinones vacunos y embriones de pollo. 4 cepas se estudiaron comparativamente. El comportamiento en el huevo embrionado de gallina, en ratones y en cobayas, asi como los hallazgos electonicomicroscopicos y serologicos caracterizaban a estas cepas como pertenecientes al grupo de la psitacosis-linfogranuloma venereo. Una enfermedad semejante al aborto epizootico vacuno se produjo experimentalmente por medio de inoculacion intrafetal, intravenosa, intramuscular y subcutanea de vacas en diversos estadios de gestacion. La infeccion aerosolica de una vaca condujo a la infeccion de su feto, mientras que la administracion oral del virus y el contacto con animales infectados quedaron sin consecuencias clinicas. Los animales inoculados abortaron o tenian terneras con escasa vitalidad a los 11–126 dias despues de la inyeccion. La infeccion intrauterina se comprobo mediante aislamiento del virus del contenido uterino y de ios organos internos de las terneras. Las vacas que abortaron tras la infeccion experimental, volvieron a concebir. Se comprobo la inmunidad en dos de estos animales. Del contenido uterino y de los tejidos fetales no se aislo virus alguno, aunque estos animales, al igual que otros que se habian recuperado del aborto experimental y no estaban gestantes, reaccionaban con fiebre frente a la infeccion patron. Estudios comparativos en una vaca gestante con Miyagawanella bovis presentaban una enfermedad benigna de esta vaca tras la inoculacion, pero al cabo de 84 dias se pudo identificar la infeccion intrauterina de su ternera.

Summary. A study of the vaginal yeast flora in pregnant women living in Cusco and in its region (Peru), located approximately 3000 m above sea level, is reported. We observed 300 pregnant, healthy and non-diabetic women who attended a gynaecological clinic in the Lorena, Regional or IPSS (Institute Peruano de Seguridad Social) hospitals in Cusco. A comprehensive clinical history was obtained from each patient. It included age, work, parity, time of pregnancy, use of contraceptives or antibiotics, type of vaginal symptoms, type and amount of vaginal secretion. The yeasts were isolated from 44.3% of the cases. The positive cases were more frequently found in the following categories: 20–30 year-old patients (69.2%), ninth month of pregnancy (49.6%), first pregnancy (41.4%), no delivery (58.7%) and no abortion (66.9%). Most women complained of leukorrhea (75.9%) with mucus, scarce without odour (18.8%) or lumpy, regular, without odour (15.8%) secretion. The yeasts isolated were Candida albicans (66.2%), other Candida species (12.8%), Torulopsis glabrata (8.3%) or other Torulopsis species (2.2%), Saccharomyces cerevisiae (7.5%), Rhodotorula sp. (1.5%) and Tricho-sporon cutaneum (1.5%). Zusammenfassung. Es wird uber die vaginale Hefeflora bei Schwangeren in Cusco, Peru, und Umgebung berichtet, einer Region, die etwa 3000 m uber dem Meeresspiegel liegt. In die Studie eingeschlossen wurden 300 schwangere, nicht-diabetische, anderweitig gesunde Frauen, die die gynakologische Kliniken in Cusco oder in der Lorena-Region aufsuchten. Von jeder Patien-tin wurde ein ausfuhrlicher klinischer Bericht aufgenommen, der Alter, Beschaftigung, Zahl der Schwangerschaften, Schwangerschaftsstatus, fru-here Anwendung von Kontrazeptiva und Anti-biotika, Art der vaginalen Symptomatik sowie Typ und Ausmas der Vaginalsekretion umfaste. Von 44.3% der Patientinnen wurden Hefen iso-liert. Hefepositivitat wurde haufiger in folgenden Kategorien gefunden: 20-30 Jahre alte Patientinnen (69.2%), neunter Schwangerschaftsmonat (49.6%), Erstschwangerschaft (41.4%), Frauen ohne bisherige Entbindung (58.7%), Frauen ohne bisherigen Abort (66.9%). Die meisten Frauen klagten uber Leukorrhoe (75.9%) mit Schleimflus, wenig Ausflus jedoch mit Geruch (18.8%) oder klumpige regelmasige Sekretion ohne Geruch (15.8%). Die isolierten Hefearten waren Candida albicans (66.2%), andere Candida-Arten (12.8%), Torulopsis glabrata (8.3%), andere Torulopsis-Arten (2.3%), Saccharomyces cerevisiae (7.5%), Rhodotorula-Arten (1.5%) und Trichospo-ron cutaneum (1.5%).

A pilot study was conducted to explore the dietary quality and maternal psychosocial status during the early weeks of pregnancy in a convenience sample of women (N = 13) recruited from two Planned Parenthood Clinics. Women were between 19 and 31 years of age, having their first pregnancy, and were on average 7 weeks pregnant. Average caloric intake was 2653 kcal/day consisting of 34% fat. Six of the women had inadequate intake of calcium (x = 800 mg) and 11 had low iron intake (x = 20 mg). Dietary Quality Index-Pregnancy scores were below recommendations and six women had scores indicating a major depression. Dietary intakes of these low-income women early in pregnancy did not meet recommendations for pregnancy. Identifying factors that are related to poor dietary intake, such as low-income and the presence of depression, in early pregnancy may promote timely recognition of women in need of comprehensive monitoring throughout the pregnancy.

Since the first pregnancy in a transplant recipient in 1958, pregnancy in recipients of solid organ transplants has become increasingly common. Although previously considered a hazardous event, data collected over the last 50 years demonstrate that despite an increased risk of maternal and fetal complications, pregnancy in transplant recipients can have a successful outcome. As of 2006, there were over 3000 female liver transplant recipients of childbearing age in the USA. Two hundred and two pregnancies and 205 outcomes were reported in 121 liver transplant recipients in the National Transplantation Pregnancy Registry. Children born to female liver recipients have a greater risk of prematurity and low birth weight than the general population, but no malformation patterns have been observed. Mothers are more likely to experience pregnancy-induced hypertension, pre-eclampsia and caesarian section, but overall mortality is not worse. Rates of acute rejection and graft loss are similar to nonpregnant liver recipients. The optimal timing of conception post-transplant is controversial, but current recommendations suggest waiting for at least 1 year after transplantation. Choice of contraception is also debatable, although barrier methods have traditionally been preferred. Many medications used for post-transplant immunosuppression have potential effects during pregnancy and breast-feeding. The risks and benefits of each medication should be reviewed with patients contemplating pregnancy, and regimens should be tailored accordingly.

Background: Women's experiences of childbirth may affect their future reproduction, and the model of care affects their experiences, suggesting that a causal link may exist between model of care and future reproduction. The study objective was to examine whether the birth center model of care during a woman's first pregnancy affects whether or not she has a second baby, and on the spacing to the next birth. Methods: Between October 1989 and July 1993, a total of 1860 women at low medical risk in early pregnancy, who participated in a randomized controlled trial of in-hospital birth center care versus standard care, gave birth. The 1063 primiparas in the trial, 543 in the birth center group and 520 in the standard care group, were included in a secondary analysis in which women's personal identification codes were linked to the Swedish National Birth Register, which included information about their subsequent birth during the following 7 to10 years. Time to an event curves were constructed by means of the Kaplan Meier method. Results: The observation period after the first birth was on average 8.8 years in the birth center group and 8.7 years in the standard care group. No statistical difference was found between the groups in time to second birth, which was 2.85 and 2.82 years, respectively (median; log-rank 1.26; p=0.26). Conclusion: A woman's model of care, such as birth center care, during her first pregnancy does not seem to be a sufficiently important factor to affect subsequent reproduction in Sweden. (BIRTH 29:3 September 2002)

In Alabama, low birth weight (LBW) infants are about 20 times more likely to die before their first birthday compared to normal birth weight infants. While the rate of LBW has been consistently higher among African Americans compared to whites, there has been a gradual increase in LBW for both African Americans and whites over the last 15 years. In an attempt to identify modifiable risk factors for LBW, we have previously reported that a pregnant woman's poor periodontal health may be an independent risk factor for low birth weight.A predominantly African American and socioeconomically homogeneous group of 448 women was followed from the second trimester of their first pregnancy. Thirty-nine LBW cases were observed at the end of follow-up. Using 17 preterm LBW cases and 63 randomly selected controls from the above cohort, the periodontal pathogen-specific maternal serum IgG levels during the second trimester of pregnancy were evaluated in relation to birth weight of the infant, while controlling for known risk factors for LBW.Porphyromonas gingivalis (P.g.)-specific maternal serum IgG levels were higher in the LBW group (mean 58.05, SE = 20.00 microg/ml) compared to the normal birth weight (NBW) group (mean 13.45, SE = 3.92 microg/ml; P= 0.004). Women with higher levels of P.g.-specific IgG had higher odds of giving birth to LBW infants (odds ratio [OR] = 4.1; 95% confidence interval [CI] for odds ratio = 1.3 to 12.8). This association remained significant after controlling for smoking, age, IgG levels against other selected periodontal pathogens, and race.Low birth weight deliveries were associated with a higher maternal serum antibody level against P. gingivalis at mid-trimester.

We present a woman in her first pregnancy, with known aortic stenosis prior to conception, who successfully underwent regional anaesthesia for an elective Caesarean section using a subarachnoid microcatheter. The anaesthetic management of patients with aortic stenosis requiring noncardiac surgery is a complex and contentious matter, particularly when the situation is compounded by the physiological changes accompanying pregnancy and delivery. This is the first reported use of a subarachnoid microcatheter in such a patient. The choice of technique is discussed and compared with other options for providing anaesthesia.

We report on a woman with incontinentia pigmenti (IP), who had two successive term pregnancies. The first pregnancy ended in the birth of a male infant, who is alive and well at 2 years. A second liveborn male had early postnatal distress and died after 1 day of life, after a fulminating clinical course. Polymorphic microsatellite markers, closely linked to the IP gene on the X chromosome, showed that each son inherited a different X chromosome from his mother. Although in most instances IP appears to be prenatally lethal for the male, the phenotype is not completely known. We propose that the neonatal phenotype may be characterized by lethal disturbances in the hematopoietic and immunologic systems.

Objective: To assess the prevalence of cesarean sections (CSs) and women's reasons for requesting the procedure in a developing country. Method: Pregnant women scheduled for elective CS were interviewed to determine whether the procedure was requested by them or suggested by a physician. The women who personally requested a CS filled out questionnaires before surgery and at the postnatal visit 6 weeks later, and their answers were analyzed. Results: The prevalence of CS on request was 4.4%. Previous infertility and advanced maternal age at first pregnancy were the most common reasons for requesting a CS, but most women said they would prefer a vaginal delivery in subsequent pregnancies. Conclusion: The women who requested a CS in this study did so for reasons different from those put forth by women in developed countries. The view that a CS is the surest way toward a live birth was the critical factor underlying their choice.

Presence of the stud male prevents the novel male-induced block to early pregnancy in mice, while reexposure to the stud male after the pregnancy block induces pseudopregnancy in the females. These two phenomena involve luteotrophy in the female, and a (luteotrophic) memory of the stud male characteristics formed in her is necessary for such a luteotrophic response. Two experiments were conducted to evaluate the effective duration of the "luteotrophic memory" of the stud male odors formed in the female mouse. The first experiment investigated whether exposure to excreta of the stud male at different intervals will induce pseudopregnancy in pregnancy-blocked females; some females mated with a second male and experienced a second consecutive pregnancy failure before the exposure to the excreta of the first stud male. The females, mated once or twice, failed to exhibit pseudopregnancy when exposure to the excreta of the first stud male was begun 8 or 9 days after the first mating. In the second experiment, each pregnancy-blocked female was mated with the (alien) male that induced failure of the first pregnancy and then housed with simultaneous access to the excreta of another alien male and that of the first stud male. Excreta of the first stud male did not prevent failure of the second pregnancy. The results indicate that the (luteotrophic) memory of the stud male-originating olfactory cues formed in the female or its effectiveness in reactivating the luteotrophic system (when the female is reexposed to the odors of the first stud male) lasts only up to about day 7 postcoitum. The present results also show that exposure to only the excreta of the stud male can prevent the pheromonal block to pregnancy or induce pseudopregnancy after pregnancy block in the female mouse.

Lifetime industrial and occupational histories of women with a medically-confirmed diagnosis of infertility (n = 281) were compared to a group of postpartum women (n = 216) for risks of infertility. Controlling for age of first pregnancy or self-report of infertility, date of outcome, cigarette use, and employment in other types of industries, women were at increased risk of infertility if they had worked in industries associated with agriculture (OR = 7.0, 95% CI 2.3–20.8; cases = 11.7%, controls = 1.9%). Among the occupations in which women worked prior to outcome, only those in agriculture were at significantly elevated risk (adj. OR = 11.3, CI 2.6–18.8; cases = 10.0%, controls = 0.9%). Among those who resided on a farm, the risk of infertility was significantly increased (adj. OR = 1.8, CI 1.2–2.7; cases = 37.4%, controls = 25.8%) although yearly duration of farm residence was not (adj. OR = 0.99. CI 0.95–1.03). Farm residence did not alter the OR seen in agricultural industries or occupations. The risk of being diagnosed with an ovulatory or tubal factor increased 4–16-fold among those who had worked in agricultural industries or occupations. These data suggest that, as has been established in men, agriculturally-related exposures may be a significant risk for infertility in women. Am. J. Ind. Med. 31:445–451, 1997. © 1997 Wiley-Liss, Inc.

Summary A radiological follow-up study of osteochondrotic lesions in the distal ulna was carried out in 58 Danish Landrace breeding sows for a period of 15 months (October 1992 to December 1993). This was part of a major project involving the radiological investigation of articularepiphyseal and physeal development to investigate osteochondrotic lesions in pigs. The radiological lesions were graded from 1 to 5 with increasing severity. It was observed that not all pigs passed through all grades. Only 21% of the pigs had no radiological osteochondrotic lesions (grade 1) during the first radiography series. After 5–7 months, the number of pigs without osteochondrotic radiological lesions were observed to have increased dramatically (21–69%), but the converse was true for grades 2 (mild), 3 (moderate), 4 (severe) and 5 (very severe): (33–17%), (21–9%), (19–5%) and (7–0%) respectively. This was observed with increasing age and weight. The 3rd radiography series indicated that the percentage of pigs without osteochondrotic lesions increased up to 82%, and that grades 2, 3, and 4 had fallen to 14%, 2% and 2% respectively, while grade five remained at 0%. This indicated that the distal ulna osteochondrotic lesions can be important in breeding pigs during the period of growth before first pregnancy. During the first pregnancy the osteochondral ossification fault can be corrected, and the lesions heal. The ulna growth plates were not closed at the second, but mostly closing during the third radiography series.

The possible influence of the expectant mother's knowledge of childbirth on the outcome and experience of pregnancy and labour was investigated by means of a postpartum questionnaire in 1238 primiparae. The mothers were divided into two groups according to their basic childbirth knowledge. At birth, the conditions of newborns were equal in both groups when judged by Apgar scores. The low knowledge level group had small-for-gestational-age babies more frequently and these babies were also treated in the paediatric ward more frequently than those in the high knowledge group. The latter group was significantly more critical towards the staff of the delivery room and the postnatal ward; the fathers of this group were also present at delivery significantly more frequently. The low knowledge level group was significantly more unwilling to have another pregnancy in the near future or ever. The results indicate that low childbirth knowledge is associated with a poorer pregnancy outcome. It is a message to antenatal care staff of the need for support, supplementary education and careful obstetric surveillance. Low childbirth knowledge may imply a set of problems, including those in interparental relationship, socio-economic situation and need for close surveillance and improved education.

This paper examines the association between menarcheal age and risk of spontaneous abortion with a data set collected in Limon, Costa Rica. The Limonense sample differs from those previously reported in terms of age, socioeconomic and ethnic background. Thus, the sample is excellent to test whether menarcheal age and risk of miscarriage are associated in a nonindustrialized group as they appear to be in industrialized samples. Females who experienced one or more miscarriages have a significantly earlier age at first menses than those who did not. The results also indicate that a possible reason for this association is that early maturers tend to experience first pregnancy at an earlier age than do late maturers.

Purpose: Corneal collagen crosslinking can arrest the progression of LASIK-induced keratectasia. We report a patient who developed bilateral iatrogenic keratectasia only during her first pregnancy at three years after initial LASIK. We performed bilateral corneal collagen crosslinking. In the following two consecutive years, keratectasia remained stable and even regressed. Upon her second pregnancy at two years after crosslinking, keratectasia exacerbated again. Methods: We performed corneal collagen crosslinking with riboflavin and UVA in March 2005 (right eye) and April 2005 (left eye) as described previously. Results: UV-induced crosslinking led to an arrest and regression of keratectasia progression over a postoperative follow-up period of 22 months, which was demonstrated by stable pre- and postoperative corneal topography and reduction of maximal K readings. However, in the fifth month of the patient’s second pregnancy, keratectasia exacerbated again. Conclusions: We report the first case of exacerbation of keratectasia after corneal collagen crosslinking. Remarkably, exacerbation occurred during pregnancy indicating that hormonal changes might affect biomechanical stability of the cornea.

Perlman syndrome is a rare disease with a poor prognosis. Until now, the specific antenatal diagnostic criteria of this syndrome have not been documented. We report on two pregnancies with Perlman syndrome, in the same woman, in which karyotyping and ultrasound examination were performed. In the first pregnancy, the final diagnosis was made only postnatally, whereas, in the second affected pregnancy, nuchal translucency was seen at 11 weeks. From 23 weeks onwards the classical signs of renal and abdominal enlargement were observed. The impact of non-specific early ultrasound markers on decision-making in pregnancies with family risks, where specific tests are not yet available, must be evaluated.

This double-blind, controlled study assessed the effect of low-dose aspirin on bleeding times. Thirty patients, in the last trimester of their first pregnancy, who were also taking part in a trial to evaluate the effect of low-dose aspirin on the development and progress of pregnancy-induced hypertension, had their bleeding times measured using the Simplate 11 Bleeding Device. Our study showed there was no significant difference between the bleeding times of the two groups and all measurements fell within the normal range.

Four oestrous cycles of a female sheep-goat chimaera were monitored by using a vasectomised ram. The mean (+/- se) length of the cycle was 18.5 +/- 0.64 days with a range from 17 to 20 days. The chimaera was superovulated twice, bred to fertile rams, and the embryos recovered by laparotomy 13 or five days after oestrus, so that karyotype analysis could reveal the genotype of the oocyte. After the first superovulation one ovine day-13 embryo was collected; two fragments of another embryo (or embryos) were also collected, but readable chromosome spreads were not obtained from these embryos or from the two four-cell embryos that were collected five days after the second superovulation. Two surgical embryo transfers to the chimaera resulted in pregnancies. The first transfer involved an eight-cell ovine embryo and two caprine morulae and ended in the abortion of an ovine fetus between days 110 and 130. The second pregnancy occurred after the transfer of two ovine and two caprine morulae. A healthy lamb was born on day 147 of pregnancy. Both placentae had small numbers of cotyledons. A histological evaluation of the cotyledons revealed an abnormal placentome structure in the first pregnancy but not in the second.

Between 1999 and 2005 116 women with obstetric fistulas were treated at 6 "fistula camps" in rural Sindh Pakistan. This report provides detail on the characteristics of these patients and the results of treatment. A gynecologic team from the cities where treatments would be performed visited surrounding rural areas 3 months prior to the camps. Patients were examined appointments were made for surgery and any needed preoperative therapy such as iron supplementation for anemia was initiated. The types and causes of the fistulas are shown in Table 2. The main surgical cause was hysterectomy and of the 2 ureteric fistulas one was associated with ureterolithotomy and the other with cesarean section. The fistula followed a first pregnancy in 39.4% of cases a rate lower than those reported in a series from Africa. (excerpt)

Congenital non-syndromal hydrocephalus due to isolated obstruction of the third ventricle as a hereditary entity is very rare and has been previously described in only a brother and sister who presented in the neonatal period with hydrocephalus. In this report three consecutive female fetuses of a consanguineous Turkish family affected by autosomal recessive hydrocephalus due to third ventricle obstruction are presented. In the first pregnancy fetal hydrocephalus had been diagnosed at term and a female infant weighing 4500 g had been delivered by cesarean section at another institution in Turkey. The hydrocephalic infant had died 3 days after birth and autopsy examination had not been performed. In the second and third pregnancies the diagnosis was made at our institution at 22 and 21 weeks of gestation respectively. Maternal serum TORCH screen was negative and fetal karyotype was normal in both of these pregnancies. (excerpt)

We present an asymptomatic case of osseous metaplasia of the uterus, diagnosed 20 days after a spontaneous delivery, in a 25-year-old woman (para 1, gravida 2). Her first pregnancy ended in a mid trimester termination. The short interval between delivery and diagnosis, and the histological features of the lesion suggested that the intrauterine bone was already present before the second pregnancy was conceived. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

The connection between smoking and cervical neoplasia has been questioned. The association demonstrated has been suspected to depend on a correlation between smoking and sexual behavior or other risk factors for cervical neoplasia. This case-control study included 140 women with cervical intraepithelial neoplasia diagnosed during pregnancy. For each case, 2 healthy, age-matched women, who simultaneously attended for a pregnancy check at the same maternity clinic, served as controls. Information was obtained on obstetrical and gynecological history, sexual behavior, contraceptive methods, female and male smoking habits and socioeconomic status, using both an interview and a questionnaire. The patients were significantly younger at first intercourse and first pregnancy, had more sexual partners, showed a higher frequency of both female and male smokers and had a different pattern of contraceptive use vis-a-vis the controls. Analyses of covariance were used to identify and check for possible confounding before a log-linear regression analysis was ultimately carried out. Two factors remained closely associated with cervical intraepithelial neoplasia: number of sexual partners, and female smoking. We conclude that smoking seems to be a genuine risk factor for cervical intraepithelial neoplasia.

Female primates have been thought to be reproductively dis-advantaged during their early reproductive years. In order to assess the effects of first pregnancy on a female's subsequent reproductive activity, the breeding records of female rhesus monkeys (Macaca mulatta) living in provisioned, outdoor-housed, social groups were examined with respect to age of sexual maturity. Of the 78 colony-born females contributing to the analysis, 20.5% had their first parturition at 36 months of age. The majority of females, 73.1%, had first parturition at 48 months; 6.4% did so at 5 years of age. Of the early-maturing females, 75% were from high-ranking matriarchies. But high social rank did not guarantee early first parturition, as 55.6% of the females from high-ranking matriarchies had first birth at 48 months. An examination of outcomes of successive pregnancies revealed that both early- and typical-maturing females experienced a significant decline in live births, owing to a significant increase in sterile years, for the reproductive year following a successful first parturition. This decline was even more pronounced for early-maturing females. The frequency of birth tragedies remained constant throughout the second and succeeding pregnancies. Thus, the capacity to conceive was reduced for some females in the reproductive year following their first pregnancy. Those females that did conceive in the year following a successful first pregnancy had a significantly longer interbirth interval between their first and second parturitions than between subsequent parturitions. Sex of offspring at first parturition did not influence reproductive outcome in the following year. The nutritional costs of lactation associated with a successful first pregnancy may preclude or delay ovulation the following year, and this effect may be greater for young females that are still in a growth phase at first pregnancy. Although these early-maturing females had proportionally fewer live births during their second reproductive year, they were equal to their age-mates when compared on the basis of offspring produced by a female at any given age. In addition, since early-maturing females have offspring entering the breeding pool a full year earlier, they may not necessarily be reproductively disadvantaged.

A previous publication has shown that there has been a great increase in the incidence of breast cancer in Iceland. The present study was undertaken to evaluate the importance of known risk factors connected with the reproductive history of the women. In a prospective investigation of a cohort of 31,453 women we confirmed previous findings of the increased risk following higher age at first pregnancy and for nulliparous women. The age at first pregnancy and the proportion of nulliparous women have decreased with time in the Icelandic population so that these factors should have tended to decrease the risk, making the found increase still more important. The effect of parity is that the risk decreases with larger number of children and this effect is independent of the effect of age at first pregnancy. Lower age at menarche increases the breast cancer risk, but the contribution of that factor to the overall risk is negligible.

The clinical fertility of 1077 men investigated with semen analysis including detection of morphologically abnormal spermatozoa during the years 1950-52 was studied 20 years later using a questionnaire replied to by 785 (72.9%). There was a significant correlation (P less than 0.01) between increasing number of abnormal spermatozoa and decreasing chance of getting living children, but no relation to abortions and pathological pregnancies. Moreover, there was a significant correlation (P less than 0.01) to time-interval to first pregnancy. Median values for those obtaining living children was 25% abnormal spermatozoa compared with 28% for those not doing so. Up to 60% abnormal spermatozoa, fertility was not reduced, and the borderline between normal and reduced male fertility is therefore defined to be 60% morphologically abnormal spermatozoa.