Search

Fibroepithelial polyps are benign lesions that may appear in the vulvovaginal region. They usually occur in women of reproductive age and tend to grow up to 5 cm, but there are some rare cases in which they grow up to 20 cm. We report a case of a 22-year-old woman in the third trimester of her first pregnancy with spontaneous bleeding from a pedunculated mass measuring 15 cm in the widest diameter on the right side of the vulva. Features of this case are discussed as well as its implications, especially regarding the decision of labour. Due to the big size of the mass and its propensity to bleed, we decided to perform an elective caesarean section as well as its excision.

Neonatal pertussis can potentially cause severe complications and even death. Mothers have been most frequently identified as the source of neonatal pertussis. Approximately a dozen countries have implemented pertussis vaccination programs for pregnant women to protect neonates; however, in Japan, this has not been implemented. The aim of this questionnaire-based study was to ascertain the willingness of women to be vaccinated during pregnancy and the factors associated with willingness. The subjects were 977 pregnant women who visited either of the two selected hospitals for maternity health checks. Most of the women were in their first pregnancy (96%), and approximately half of them considered a physician to be the most reliable source of information about vaccination (481/977, 49%). "Willingness to receive pertussis vaccination" was significantly associated with the factors "no fear of receiving vaccination" (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 2.21-4.34), "necessary to prevent pertussis" (OR = 8.70, 95% CI: 6.17-12.28), "effective in pregnancy" (OR = 5.46, 95% CI: 3.94-7.56), and "no concern about the side effects after vaccination" (OR = 3.03, 95% CI: 1.66-5.55). Pregnant women are likely to consider vaccination if they have a good understanding of the disease and its outcomes. Physicians are well positioned to improve knowledge and attitudes toward pertussis vaccination during pregnancy.

BACKGROUND: Previous studies report that first pregnancy is associated with persistent decreases in HDL-cholesterol (HDL-C) concentrations. OBJECTIVE: This study evaluated factors associated with declines in HDL-C concentration in parous and nulliparous young women. METHODS: This study leverages data from African-American and white women from the NHLBI Growth and Health Study. Parity-related changes in lipids, BMI and percent body fat were assessed longitudinally. A subset of primiparous and nulliparous women with paired lipid measurements were analyzed regarding changes in HDL-C concentrations. RESULTS: Among 870 women in longitudinal analyses, African-American women had higher parity (p

Obstetric fistula, despite improved obstetric care, remains a real threat to poor women in rural Ethiopia. This study aimed to identify the risk factors that predispose women to obstetric fistula in South-western Ethiopia.An unmatched case-control study design was employed in which 48 cases (women with obstetric fistula) and 188 controls (women without obstetric fistula) were included. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Univariate, bivariate, and multivariate analysis was conducted using SPSS version 20.0. Adjusted odds ratio, 95% confidence level, and p-values were used as the main measure of association.The study revealed that age at pregnancy of18 years (AOR = 5, 95% CI = 2-13), residing in rural areas (AOR = 4, 95% CI 1.6-11), lack of antenatal care (AOR = 5, 95% CI 2-14), no history of modern contraception utilization (AOR = 5, 95% CI = 2-13), post-term pregnancy (AOR = 8, 95% CI 3-22), and duration of labor24 hours (AOR = 4, 95% CI 2-9) were associated with obstetric fistula.The majority of fistula survivors were teenagers who were living in rural areas. Mothers having no antenatal care, not using modern contraception, having a post-term pregnancy, and having prolonged labor were at increased risk of developing obstetric fistula. Thus, delaying the age of first pregnancy, improving access to basic obstetric care, and advocating the use of modern contraceptive methods are crucial for teenage women residing in rural areas.

Introduction Intrauterine devices are the most effective long-acting reversible contraceptives, but in many developing countries, such as Jamaica, these devices remain underutilized. Methods A cross-sectional informative intervention was conducted among women ≥ 18 years of age attending postnatal clinics in western Jamaica from May to August 2018. Data were collected using an investigator-administered questionnaire/pre-test followed by a 12-slide PowerPoint® presentation and a post-test. Results Most of the 299 women who participated were 18–29 years of age, with a mean age of 27.1 (SD ± 6.1) years. Most had their first pregnancy between ages 18 and 24 years, with mean age at first pregnancy of 20.2 (SD ± 4.0) years. Only 3.0% of participants reported current use of an intrauterine device; 3.5% reported using an intrauterine device in the past. For nearly every measure of knowledge of intrauterine devices, there was a significant change in the proportion of participants who got the correct answer from the pre-test to the post-test. The mean summed pre-test knowledge score was 9.54 (SD ± 3.46) and the post-test score was 15.23 (SD ± 1.92); the possible total score is 18. The difference between the mean scores (5.69 points) was also significant. Conclusion The intervention resulted in significant change in knowledge of intrauterine devices among the women and cleared up many misconceptions that may have contributed to reluctance of women to use intrauterine devices. Women of reproductive age in Jamaica should be counseled on contraceptive methods including intrauterine devices so that these devices can be considered in their contraceptive choices.

Women can have fear of childbirth (FOC) in advance of their first pregnancy and such fear can have implications for reproductive and eventual childbirth choices. This study aims to further our understanding of the role of self-compassion in FOC in young childless women, including possible pathways through which self-compassion might relate to less FOC: through natural and medical birth beliefs.In this correlational study, 316 young childless Australian women completed measures of self-compassion, natural and medical birth beliefs, and FOC.Self-compassion predicted less FOC, and although self-compassion as a total score did not relate to natural birth beliefs, it did relate to lower scores on medical birth beliefs. The indirect effect through medical birth beliefs was supported; greater self-compassion predicted lower scores on medical birth beliefs, which in turn predicted less FOC.The findings, although cross-sectional, support the study of self-compassion in FOC, which is in part because self-compassion predicts less medical birth beliefs. With further research, self-compassion training might be incorporated into public health initiatives targeting FOC in young childless women.

Background Approximately 20% of women with gynecologic cancers are under age 40 and with delayed childbearing, women may be diagnosed before their first pregnancy. Although fertility preservation is a priority for many women, attitudes to conception have not previously been investigated in these patients or their partners. We explored attitudes to conception in partners and young women, following fertility preserving treatment for gynecologic cancers. Methods A total of 16 telephone interviews were conducted with a purposive sample of patients who had had an early stage gynecologic cancer or borderline ovarian tumor treated by fertility sparing surgery in Western Australia between January 1st, 2005 to December 31st, 2016. The interviews were audio recorded, transcribed and thematic analysis was conducted. Results Four main themes were identified: (i) Emotions at diagnosis and perception of information given; (ii) Discussions of fertility and factors affecting childbearing; (iii) Role of partners in decision making and relationship pressures; (iv) Decision for treatment and postoperative regrets. Conclusions Regret and relationship breakdown were commonly reported. Women need appropriate support including inviting their partners to attend clinic appointments and may need several appointments before treatment. Regret was commonly reported by women who opted for completion surgery. .

Objective: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavska Sobota, Slovakia. Methods: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. Results: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. Conclusion: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.

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

Background: The presence of chronic deciduitis (CD) was determined in patients diagnosed with or without chronic endometritis (CE) before pregnancy., Objective: To study the effect of CE on decidua in cases of miscarriage., Methods:Decidual tissue was obtained from the patients who miscarried at the first pregnancy within a year after the diagnosis of the presence or absence of CE. The number and distribution pattern of plasma cells stained with CD138 in decidual tissue in 10 high-power fields (HPFs) was examined. The prevalence of CD diagnosed with four different grade; grade 0, no plasma cell in 10 HPFs, thus Non-CD;grade 1, rare single plasma cells; grade 2, rare clusters or more than 5 single cells total; and grade 3, many plasma cells with more than 5 clusters, were examined and compared between Non-CE and CE., Results:The incidence rate of CD of grade2 + 3 was significantly higher in CE than Non-CE (53.8%; 7/13 vs. 0%; 0/13, P < 0.01). Presence of clusters or a number of plasma cells in 10 HPFs of decidua showed a sensitivity of 53.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68.4% for the diagnosis of CE., Conclusion:Presence of clusters of plasma cells or five or more of plasma cells in decidua was found in more than half of CE, but not found in Non-CE. When CD with cluster or five or more of plasma cells is confirmed histologically in miscarriage decidual tissue, the presence of CE before the pregnancy should be suspected.

Perinatal loss may deeply affect the attachment relationships of mothers and their next-born children. The aim was to explore the subjective perceptions of mothers, who had fetal death during the first pregnancy, and their adult subsequent firstborn children regarding the impact of the perinatal loss on the mother-child relationship and children’s self-perception. Fifteen mothers who experienced a fetal death during the first pregnancy and their adult subsequent firstborn children were interviewed. A Grounded Theory approach was used. Five main themes were identified: fetal death as a real loss producing prolonged grief; the importance of the communication about the dead sibling; creating and maintaining a relationship with the lost sibling; the mother-subsequent child relationship: between detachment and overprotection; significant effects of fetal death on adult subsequent children’s self-perception. Results highlighted a deep impact of fetal death on the subsequent mother-child relationship, as perceived by both mothers and adult children.

Objective: To describe the frequency of cardiac complications during pregnancy related to parity in women with congenital heart defects. Methods: A retrospective tertiary single-center study at the Adult Congenital Heart Disease Centre that followed 307 women with congenital heart disease during the years 1997–2015 in Gothenburg, Sweden. Ma­ternal cardiac complications were noted for each pregnancy using medical and obstetric records. The CARPREG I and modified WHO (mWHO) risk classifications were used. Twin pregnancies, miscarriages before gestational week 13, and pregnancy terminations were excluded. Results: Five hundred seventy-one deliveries and 9 late miscarriages were analyzed. The mean parity was 1.74 per woman (range 1–8). Eighty-four (14.6%) maternal cardiac complications were experienced; arrhythmia (5.7%) and heart failure (4.4%) being the most prevalent, and there was 1 maternal death. Heart failure occurred during the first pregnancy in 12 women (3.9%), in the second pregnancy in 8 women (4.3%), and in the third pregnancy in 4 women (7.7%). CARPREG I and mWHO scores were associated with an increased risk of having a cardiac complication, while parity per se was not associated. The OR for having a maternally uneventful second pregnancy if the first pregnancy was without cardiac complications was 5.47 (95% CI 1.76–16.94) after controlling for CARPREG I and mWHO scores. Conclusion: The risk of severe maternal cardiac complications during pregnancy in women with congenital heart disease is low. In this largest analysis to date with a focus on parity in 307 women, the risk classification predicts the maternal outcome more than parity per se. If the first pregnancy is uneventful, the OR is 5.5 for an uneventful second pregnancy if CARPREG I and mWHO scores remain unchanged.

Objective To determine women's self-reported knowledge of the association between preeclampsia and cardiovascular disease and to determine if they received appropriate education on the recommendations of the American Heart Association for follow-up and for cardiovascular risk reduction strategies after preeclampsia. Design Cross-sectional descriptive study using an online survey. Setting/Local Problem A survey link was placed on the Facebook pages for two preeclampsia support groups. Participants A total of 241 women who were members of these Facebook groups completed the online survey. Intervention/Measurements An online survey was created using Campus Labs software. Most questions were closed response. Participants were asked to answer survey questions about their first pregnancy with preeclampsia and the education/referrals they received specific to the association between preeclampsia and cardiovascular risk. Results Of all those who responded, 36.9% (n = 89) reported being unaware of the association between preeclampsia and cardiovascular disease. Of those who gave birth since the American Heart Association issued recommendations for follow-up after preeclampsia, 43.9% (n = 61) reported that they received no counseling regarding incorporating healthful lifestyle changes or follow-up after their diagnosis of preeclampsia. Conclusion Women with a history of preeclampsia may not be receiving adequate education on its association with cardiovascular disease. Nurses can work to fill this gap through collaboration with cardiovascular and primary care providers to orchestrate seamless cardioprotective follow-up for this population of women.

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.

Background: The aim of our study was to investigate the prepregnancy characteristics that are risk factors for the development of hypertension (HTN) and identify prepregnancy factors for the development of HTN in women affected by pre-eclampsia in their first pregnancy. Methods: We enrolled 1910 women who had undergone a National Health Screening Examination through the National Health Insurance Corporation between 2002 and 2003, and who had their first delivery affected by pre-eclampsia in 2004. Women were classified as having HTN if they were newly diagnosed with HTN from 2005 through 2012. Results: After 8 years of follow-up, 7.7% (148/1910) of pre-eclamptic women developed HTN. Using the Cox proportional hazards model, old age (hazard ratio [HR] 3.92, 95% confidence interval [CI] 2.47-6.23), a family history of HTN (HR 2.28, 95% CI 1.46-3.58), prepregnancy obesity (HR 3.74, 95% CI 2.50-5.59), and high blood pressure (BP) (HR 2.78, 95% CI 1.85-4.19) were independently associated with the development of HTN. Conclusions: The results show that the development of HTN in pre-eclamptic women is related to prepregnancy factors. Recognizing who subsequently develops HTN postpartum in pre-eclamptic women with these prepregnancy factors could lead to early identification and lifestyle interventions, which could reduce the burden of cardiovascular disease.

Objective:Dietary quality (DQ), as assessed by the Alternative Healthy Eating Index for Pregnancy (AHEI-P), and conception and pregnancy outcomes were evaluated.Design:In this prospective cohort study on couples planning their first pregnancy. Cox proportional hazards regression assessed the relationship between AHEI-P score and clinical pregnancy, live birth and pregnancy loss.Setting:Participants were recruited from the Northeast region of the USA.Participants: Healthy, nulliparous couples (females, n 132; males, n 131; one male did not enrol).Results:There were eighty clinical pregnancies, of which sixty-nine resulted in live births and eleven were pregnancy losses. Mean (sd) female AHEI-P was 71·0 (13·7). Of those who achieved pregnancy, those in the highest tertile of AHEI-P had the greatest proportion of clinical pregnancies; however, this association was not statistically significant (P = 0·41). When the time it took to conceive was considered, females with the highest AHEI-P scores were 20 % and 14 % more likely to achieve clinical pregnancy (model 1: hazard ratio (HR) = 1·20; 95 % CI 0·66, 2·17) and live birth (model 1: HR = 1·14; 95 % CI 0·59, 2·20), respectively. Likelihood of achieving clinical pregnancy and live birth increased when the fully adjusted model, including male AHEI-P score, was examined (clinical pregnancy model 4: HR = 1·55; 95 % CI 0·71, 3·39; live birth model 4: HR = 1·36; 95 % CI 0·59, 3·13).Conclusions:The present study is the first to examine AHEI-P score and achievement of clinical pregnancy. DQ was not significantly related to pregnancy outcomes, even after adjustments for covariates.

This article reports the first case of pregnancy after frozen-thawed ovarian tissue transplantation to prevent iatrogenic premature ovarian insufficiency in China.Ovarian tissue cryopreservation was performed in a patient with myelodysplastic syndrome (MDS) before multi-agent chemotherapy and hematopoietic stem cell transplantation. Two years later, she showed complete remission from MDS, and six frozen-thawed ovarian tissue strips were transplanted into the peritoneal pocket.The patient's ovarian activity was restored 3 months after transplantation, and pregnancy occurred spontaneously 27 months after grafting. Until now, the pregnancy has progressed for 30 weeks, and the repeated ultrasound showed normal fetal development.This is the first pregnancy resulting from ovarian tissue cryopreservation and transplantation in China.

A 19-year-old woman, previously fit and well, was admitted 4 days postpartum with a 2-day history of headache, abdominal pain and vomiting. She denied diarrhoea. Her family history was remarkable for her father having lupus and immune thrombocytopenia. This was her first pregnancy and she delivered

The possession of permanent, adipose breasts in women is a uniquely human trait that develops during puberty, well in advance of the first pregnancy. The adaptive role and developmental pattern of this breast morphology, unusual among primates, remains an unresolved conundrum. The evolutionary origins of this trait have been the focus of many hypotheses, which variously suggest that breasts are a product of sexual selection or of natural selection due to their putative role in assisting in nursing or as a thermoregulatory organ. Alternative hypotheses assume that permanent breasts are a by-product of other evolutionary changes. We review and evaluate these hypotheses in the light of recent literature on breast morphology, physiology, phylogeny, ontogeny, sex differences, and genetics in order to highlight their strengths and flaws and to propose a coherent perspective and a new hypothesis on the evolutionary origins of perennially enlarged breasts in women. We propose that breasts appeared as early as Homo ergaster, originally as a by-product of other coincident evolutionary processes of adaptive significance. These included an increase in subcutaneous fat tissue (SFT) in response to the demands of thermoregulatory and energy storage, and of the ontogenetic development of the evolving brain. An increase in SFT triggered an increase in oestradiol levels (E2). An increase in meat in the diet of early Homo allowed for further hormonal changes, such as greater dehydroepiandrosterone (DHEA/S) synthesis, which were crucial for brain evolution. DHEA/S is also easily converted to E2 in E2-sensitive body parts, such as breasts and gluteofemoral regions, causing fat accumulation in these regions, enabling the evolution of perennially enlarged breasts. Furthermore, it is also plausible that after enlarged breasts appeared, they were co-opted for other functions, such as attracting mates and indicating biological condition. Finally, we argue that the multifold adaptive benefits of SFT increase and hormonal changes outweighed the possible costs of perennially enlarged breasts, enabling their further development.

A previously healthy 22-year-old woman was in the second trimester of her first pregnancy when she developed new lower extremity edema. Her pregnancy course had been unremarkable, and she was receiving routine obstetric care from her family physician. One week prior to admission she developed progressive swelling in her legs.

Objectives: The effect of pregnaSSncy on the course of inflammatory bowel disease (IBD) remains controversial. We aimed to describe the disease course before and after a first pregnancy in IBD patients. Methods: We analyzed data from a prospectively followed-up pregnancy cohort (minimal follow-up of 7 years), with clinical, biochemical and endoscopic characteristics obtained pre-pregnancy, during pregnancy and post-pregnancy. Possible factors associated with relapse (disease activity during pregnancy, maternal age, smoking, alcohol use, pre-pregnancy BMI, mode of delivery, thiopurine use during pregnancy, biological use during pregnancy, combination of thiopurine and biological use during pregnancy, breastfeeding, IBD diagnosis, endoscopic scores) were scored. Results: One hundred twenty six patients (95 Crohn’s Disease [CD; 75%] and 31 Ulcerative Colitis/IBD unclassified [UC/IBD-U; 25%]) were enrolled, with one hundred pregnancies occurring in 100 primigravida patients. All pregnancies resulted in live birth. Twenty patients (20%) had a relapse during pregnancy. The median number of relapses/patient/year was 0.25 (IQR 0.5) and 0 (IQR 0.43) respectively before and after pregnancy (p =.00). For CD patients the median relapses/person/year was 0.25 (IQR 0.5) before and 0 (IQR 0.25) after delivery (p =.00), for UC/IBD-U patients there was no significant difference. In the post-partum period more UC patients relapsed compared to CD patients (68% vs 30.7%, p =.01). Seven-year IBD-course was unchanged in the 26 women who did not become pregnant. Conclusion: In this prospective observational cohort study, we found a lower rate of relapses in the 4 years after delivery compared to the 3 years prior to a first pregnancy. Post-partum, more UC patients experienced a relapse compared to CD patients.

Introduction: The impact of early pregnancy complications on completed family size is unknown. Here, we hypothesize that early pregnancy complications and adverse outcomes may influence family size. Material and methods: In this nationwide, registry-based study we included all 458 475 women born 1957–1972 who lived in Denmark from age 20–45 years with at least one registered pregnancy. The main outcome of the study was number of children per woman by age 45, estimated using a Generalized Linear Mixed Model. Exposures were: (a) total number of pregnancy losses experienced (0, 1, 2, ≥3); (b) highest number of consecutive pregnancy losses (0, 1, 2, ≥3); (c) sex of firstborn child; (d) outcome of first pregnancy (live birth, stillbirth, pregnancy loss, ectopic pregnancy, or molar pregnancy). Results: Number of live births was negatively influenced by maternal age and adverse first pregnancy outcomes, especially ectopic pregnancies. A 30-year-old woman with a first ectopic pregnancy was expected to have 1.16 children (95% CI 1.11–1.22) compared with 1.95 children (95% CI 1.86–2.03) with a first live birth. Three or more consecutive losses also decreased number of live births significantly: 1.57 (95% CI 1.50–1.65) compared with 1.92 (95% CI 1.84–2.0) with only live births. The total number of pregnancy losses had no effect before the age of 35 years. Sex of firstborn had no effect. Conclusions: Previous pregnancy history has a significant effect on number of children per woman, which is important at both individual and societal levels. Pathophysiological research of adverse pregnancy outcomes should be an urgent priority as the causes remain poorly understood.

Aim To clarify whether maternal characteristics or laboratory parameters could help predict the onset of recurrent gestational diabetes mellitus (GDM). Methods We enrolled 615 women with consecutive singleton deliveries at or after 28 GW from two perinatal medical centers between 2011 and 2019 and divided them into four groups according to whether they had GDM in the first and second pregnancies. The outcome of this study was to clarify the incidence and the predictors of recurrent GDM. Results We found that among 72 women (11.7%) who had GDM during their first pregnancy, the rate of recurrent GDM was 47.2%. The 34 women (5.5%) with recurrent GDM gained significantly less weight in the first and second pregnancies and lost less weight between the first delivery and the second conception compared with those women without GDM in both pregnancies. Of women with GDM during the first pregnancy, 21 scored 2 or 3 (multiple) positive points on a 75-g oral glucose tolerance test (OGTT) during their first pregnancies; the GDM recurrence rate among these women (66.7%) was significantly higher than that among the 51 women who scored 1 positive point (39.2%; p = 0.0411). During the first pregnancy, insulin administration therapy was significantly more frequent in women with recurrent GDM than in women without recurrent GDM (23.5% vs. 5.3%, p = 0.0396, respectively). Conclusion A predictor of recurrent GDM onset was a score of 2 or 3 positive points on the OGTT during the first pregnancy.

Study Objective: To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. Results: Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. Conclusion: This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.

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

Cesarean section (CS) is one of the most commonly performed surgical operations in the world and has resulted in improved maternal and neonatal morbidity and mortality rates internationally. However, concerns have been raised regarding the ever increasing CS rates to what has been described as ‘epidemic’ proportions. Global CS rates have increased from 6.7% in 1990 to 19.1% in 2014. However, there is a vast variation in the CS rates between countries with CS rates of 44.3% reported across Latin America & the Caribbean and CS rates as low as 4.1% in central and West Africa. There is much controversy regarding the optimal figure for CS in a population. The optimal CS rates for a population have been recommend in various studies, ranging from 10% to 19%, above which no reported improvement in maternal and neonatal mortality rates is observed. This review examines the evolution of the changing indications for CS and increasing CS rates in a world where family sizes are reducing and maternal age at first pregnancy is increasing. Efforts must be made to agree on an appropriate classification system whereby CS rates can be compared accurately between units and countries as a useful tool to audit and monitor our practice. Obstetricians should consider the indications for each CS performed, be conscious of the CS rate in our own countries and institutions and most importantly, be cognizant of how the CS rate impacts the maternal and perinatal morbidity and mortality rates and adjust our practice accordingly, to minimize harm.

Pregnancy largely affects disease activity and clinical course in women with immune-mediated neurological disorders. Chronic inflammatory demyelinating polyneuropathy (CIDP) is rare but the most common chronic immune-mediated neuropathy; however, the effects of pregnancy on CIDP have never been investigated except case reports or series. We here provide a systematic review of the literature from 1 January 1969 to 30 June 2020 that revealed 24 women with CIDP, who had onset or relapse during pregnancy. Of these, 17 (71%) developed CIDP during the first pregnancy, and 8 (47%) had a relapse during subsequent pregnancies. Of the 17 patients, in whom the CIDP subtypes were determined, all of them had typical CIDP. First-line treatments for CIDP, such as corticosteroids, immunoglobulin and plasma exchange were efficacious and safe. We suggest that pregnancy can trigger typical CIDP in some women, and women with CIDP have a higher risk of relapse during pregnancy. The onset or relapse of CIDP during pregnancy is a rare but challenging constellation for physicians.

Objective To measure serum levels of podocalyxin (PODXL) in recurrent miscarriages as a marker of vascular endothelial dysfunction. Study design In this case-control study, women who were hospitalized for singleton first-trimester pregnancy terminations due to missed abortion, anembryonic pregnancy, and inevitable abortion were included. There were 24 patients who were admitted for the first pregnancy termination, 39 patients who were admitted for recurrent pregnancy loss (RPL), and 25 fetal cardiac activity positive patients as the control group. Demographic features, medical and obstetric histories were recorded. The measurements of serum PODXL were done by a human enzyme-linked immunosorbent assay kit. Results Serum PODXL levels were found to be significantly higher in the RPL group than the control group and the first time miscarriage group (13.82 [10.09−113.54] vs. 11.78 [9.25−48.80], p = 0.016 and 13.82 [10.09–113.54] vs. 11.99 [8.20–20.47], p = 0.003; respectively). Serum PODXL levels were not statistically significantly different between the first miscarriage and the control group (p = 0.62). There were positive correlation between serum PODXL levels and the number of gravida and the number of miscarriages (r = 0.217, p = 0.042, and r = 0.291, p = 0.006; respectively). Conclusion Recurrent miscarriage patients had higher serum levels of PODXL than both normal pregnancies and first-time miscarriages. Our results suggest that maternal endothelial dysfunction might have a role in recurrent pregnancy losses.

A 26-year-old newlywed woman attended our clinic with gigantic breasts associated with neck and back pain, and severe bleeding from breast ulcers. Her breasts had enlarged rapidly within the first 2 months of her first pregnancy, causing approximately 25 kg of weight gain and later, swelling over both the lower limbs. Medical therapy was instituted, but failed to halt breast tissue growth or relieve symptoms. Ultimately, she underwent an abortion at the end of the first trimester of pregnancy, which finally stopped breast enlargement. However, bleeding …

OBJECTIVE: Determine the risk of hypertensive disorders of pregnancy (HD) in women with a history of spontaneous preterm birth (SPTB).STUDY DESIGN: Longitudinal linked national cohort study within the Dutch Perinatal Registry (1999-2009) on linked data among 349,291 women with a first and second singleton pregnancy in the Netherlands.MAIN OUTCOME MEASURES: The incidence of HD, small for gestational age (SGA) and placental abruption in the second pregnancy.RESULTS: Out of 349,291 women with a singleton first pregnancy, 19,991 (5.7%) had a SPTB. The incidence of HD in the second pregnancy was 8.1% in women with a previous SPTB, as compared to 5.6% in women with a previous term birth (aOR 1.49 (CI 1.41-1.57)). Also after excluding HD, SGA and/or placental abruption in the first pregnancy, women with a history of SPTB had a higher risk of HD in their second pregnancy compared to women with a previous term birth (4.6% versus 2.7%, aOR 1.77 (CI 1.64-191)). Similarly, the incidence of SGA and placental abruption was higher in the second pregnancy in women with a history of SPTB compared to term birth in the first pregnancy.CONCLUSIONS: Women with a history of SPTB are at elevated risk of HD in the subsequent pregnancy. These results support shared pathophysiology between SPTB and HD.

Introduction Anxiety is a common feeling in cesarean section and lack of attention to it is associated with negative consequences for health of mother and child. Reflexology is a way to reduce anxiety. So far, the effect of reflexology on pre-cesarean anxiety has not been evaluated. Therefore, we aimed to evaluate the effect of pre-cesarean foot reflexology massage on the anxiety of women during their first pregnancy. Materials and Methods This study is a three-group clinical trial that was conducted in 2019. The study sample consisted of 90 pregnant women hospitalized for cesarean section in Zahedan who were randomly divided into three groups of 30 women. The subjects completed the state section of Spielberger anxiety questionnaire. The control group did not receive any intervention. For two groups, 1 h before surgery, a group received reflexive massage, and the another group simple massage. Duration of massage for each group was 30 min. After 30 min, the subjects completed the state section of Spielberger questionnaire again. Statistical analysis was performed by SPSS software program, version 21.0. ANOVA and ANCOVA tests were used to compare between groups and paired t-test was used for intra-group comparisons. Results The results showed that the level of anxiety was significantly reduced in the reflexology massage group (from 55 ± 8 to 40 ± 7) as well as simple massage group (from 51 ± 10 to 47 ± 7) (p0.001 and p>0.001,respectively). Reflexive massage significantly reduced anxiety scores (p>0.001) as compared to simple massage. Conclusion The results of this study revealed the positive effect of reflexology massage on pre-cesarean anxiety. Because reflexology massage is an inexpensive, simple, and easy approach, the use of this non-pharmaceutical method is recommended to reduce pre-cesarean anxiety.

Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia. The first author received a PhD grant from UiT The Arctic University of Norway to carry out the study.

This study aims to quantify the prevalence of forced sex, pressured sex, and related pregnancy among adolescent girls and young women in five low- and middle-income countries. Nationally representative, cross-sectional household surveys were conducted in Haiti, Malawi, Nigeria, Zambia, and Uganda among girls and young women aged 13 to 24 years. A stratified three-stage cluster sample design was used. Respondents were interviewed to assess prevalence of sexual violence, pregnancy related to the first or most recent experience of forced or pressured sex, relationship to perpetrator, mean age at sexual debut, mean age at pregnancy related to forced or pressured sex, and prevalence of forced/coerced sexual debut. Frequencies, weighted percentages, and weighted means are presented. The lifetime prevalence of forced or pressured sex ranged from 10.4% to 18.0%. Among these adolescent girls and young women, the percentage who experienced pregnancy related to their first or most recent experience of forced or pressured sex ranged from 13.2% to 36.6%. In three countries, the most common perpetrator associated with the first pregnancy related to forced or pressured sex was a current or previous intimate partner. Mean age at pregnancy related to forced or pressured sex was similar to mean age at sexual debut in all countries. Preventing sexual violence against girls and young women will prevent a significant proportion of adverse effects on health, including unintended pregnancy. Implementation of strategies to prevent and respond to sexual violence against adolescent girls and young women is urgently needed.

Background Monochorionic twinning involves numerous maternal and fetal complications, triplets complicated by a monochorionic pair are at further increased risk. Here, we report a case of repeated triplets complicated by monochorionic diamniotic twins with successful pregnancy outcomes in a woman using autologous oocytes. Case presentation A 30-year-old female undergoing embryo transfer with fresh and frozen embryo cycles with autologous oocytes. The two cycles were confirmed by transvaginal ultrasound to result in successful clinical pregnancies of triplets complicated by a monochorionic twinning. The first pregnancy resulted in a singleton delivery after a selective reduction of the monochorionic pair. The subsequent pregnancy resulted in a dichorionic diamniotic twin pregnancy after the heartbeat of one of the monochorionic twin fetuses stopped at 43 days after embryo transfer. Both of the pregnancies ended with successful live births. Conclusions Our case report of repeated triplets with monochorionic twins suggests the potential causes and risk factors of monochorionic twinning in assisted reproduction and raises concern regarding the timing of multifetal pregnancy reduction.

The association of gestational hypertension (GH) with future hypertension in Japanese women is unclear. Hence, this study aimed to examine the association between GH and the risk of future hypertension in middle-aged-to-older Japanese women. A case-control study was performed, including 62 hypertensive women (case) and 75 nonhypertensive women (control). GH during the first pregnancy was diagnosed on the basis of the Maternal and Child Health Handbook record. Hypertensive women were recruited from outpatients in the hospital and residents who completed an annual health check-up in a community. Hypertension was defined as blood pressure with systolic blood pressure &ge, 140 mmHg and/or diastolic blood pressure &ge, 90 mmHg, or taking antihypertensive medications. The average age (SD) of the cases and controls at the time of recruitment was 63.1 (8.4) and 57.7 (9.4), respectively. The multivariable-adjusted odds ratio of GH for hypertension in middle-aged-to-older women was 4.2 (95% confidence interval, 1.0&ndash, 17.5) after adjustment for potential confounding factors such as age and body-mass index (BMI) upon recruitment, prepregnancy BMI, and age at first delivery. In conclusion, GH can be an independent risk factor for future hypertension among Japanese women.

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.

Obstetric complications are more common in women with diabetes than in the general population. This study aimed to learn about the first pregnancy of women with type 1 diabetes from the perspective of women from T1D Exchange-Glu and the T1D Exchange Clinic Registry. Participants were ≥18, diagnosed with type 1 diabetes before conception, and either currently pregnant or had given birth in the preceding 10 years. The final sample size was 533 women. Women who planned pregnancy had significantly lower HbA1c (A1c) at conception. Women who had higher A1cs at conception were at a higher risk for cesarean birth, increased weight gain, hypoglycemia during pregnancy, and earlier onset of preeclampsia. Overall 29% of women developed preeclampsia in this population, over seven times the rate in the general population. This study helps to expand our knowledge of women with type 1 diabetes during the perinatal period. Planning pregnancy, expanding education and support, and preventing preeclampsia may help to improve pregnancy outcomes.

We analyze household-level changes in alcohol consumption in response to pregnancy. Using scanner data, we identify households with a pregnant household member. Within an event study and a dynamic difference-in-differences estimation, we find that during a first pregnancy, households reduce their alcohol purchases by 36%. After pregnancy, purchases of alcohol are 34% lower than before pregnancy. We do not find any effect during the second pregnancy. One possible explanation for our result is that lower consumption during pregnancy changes habits and reduces consumption in the long term. We discuss other explanations and comment on policy implications.

The relationship between pregnancy and breast cancer risk is not fully understood. Most of the literature has described this interaction in terms of the age at first pregnancy and the number of full-term pregnancies. During the prospective accrual of the "Joven & Fuerte: Program for young women with breast cancer in Mexico" cohort, a series of cases with pregnancy-associated breast cancer and a history of a short inter-pregnancy interval was identified. To date, there is a very limited number of descriptions about the interaction between a short inter-pregnancy interval and breast cancer, but none specifically regarding the association of a short inter-pregnancy interval and pregnancy-associated breast cancer. Based on findings from a prospective cohort of young Mexican breast cancer patients, we hypothesize that a short inter-pregnancy interval may increase the incidence of pregnancy-associated breast cancer, possibly by amplifying the effects of the pregnancy-associated factors involved in the development of breast cancer.

Objective To determine if patients with a history of low pregnancy-associated plasma protein A (PAPP-A) in an initial pregnancy are at higher risk for adverse obstetric outcomes in a subsequent pregnancy. Study Design This was a retrospective cohort study in patients who underwent first trimester screening for PAPP-A in two consecutive pregnancies. Two groups were examined: patients who had low PAPP-A in the first pregnancy followed by normal PAPP-A in the second pregnancy and patients who had recurrent low PAPP-A. Maternal and neonatal outcomes were compared between the groups, with the primary outcome being intrauterine growth restriction (IUGR) or preeclampsia. Results A total of 124 patients were included, representing 248 pregnancies. Ninety-two (74.2%) patients had normal PAPP-A in the second pregnancy, and 32 (12.9%) patients had recurrent low PAPP-A. Patients with recurrent low PAPP-A had a higher rate of IUGR or preeclampsia compared with patients with normal PAPP-A in the second pregnancy but this was not significantly different (12.5 vs. 10.9%, p = 0.51). There were no significant differences for all other outcomes. Conclusion Among patients with a history of low PAPP-A, patients with normal PAPP-A in the subsequent pregnancy have a similar risk of adverse neonatal outcomes compared with patients with recurrent low PAPP-A.

Background To improve maternity services in any country, there is need to monitor the quality of obstetric care. There is usually disparity of obstetric care and outcomes in most countries among women giving birth in different obstetric units. However, comparing the quality of obstetric care is difficult because of heterogeneous population characteristics and the difference in prevalence of complications. The concept of the standard primipara was introduced as a tool to control for these various confounding factors. This concept was used to compare the quality of obstetric care among districts in different geographical locations in Zimbabwe. Methods This was a substudy of the Zimbabwe Maternal and Perinatal Mortality Study. In the main study, cluster sampling was done with the provinces as clusters and 11 districts were randomly selected with one from each of the nine provinces and two from the largest province. This database was used to identify the standard primipara defined as; a woman in her first pregnancy without any known complications who has spontaneous onset of labour at term. Obstetric process and outcome indicators of the standard primipara were then used to compare the quality of care between rural and urban, across rural and across urban districts of Zimbabwe. Results A total of 45,240 births were recruited in the main study and 10,947 women met the definition of standard primipara. The maternal mortality ratio (MMR) and the perinatal mortality rate (PNMR) for the standard primiparae were 92/100000 live births and 15.4/1000 total births respectively. Compared to urban districts, the PNMR was higher in the rural districts (11/1000 total births vs 19/ 1000 total births, p

Introduction In Kenya, abortion is illegal under most circumstances, yet about 48 abortions per 1,000 women occurred in 2012. Given the stigma around abortion, little is known about the availability of safe abortion. Thus, we explored the feasibility and acceptability of using SMS mobile surveys to collect information about women's pregnancy and abortion histories in Kenya. Methods We sent a one-time mobile survey to 500 18–24 year old women who had opted-in to a 16,000-person mobile survey panel. Women elected to answer questions about pregnancy only (number of pregnancies, number of births, age at first pregnancy) or pregnancy and abortion (ever tried to obtain an abortion and whether medical treatment was sought for any complications). The final question for all survey versions was an open-ended question asking respondents how they felt answering these questions. Results 356 (71%) responded to the initial survey question and 333 (94%) consented to answer questions about pregnancy. Of these, 233 (70%) agreed to answer questions about just pregnancy and 76 (23%) agreed to answer questions about pregnancy and abortion. Three-quarters of respondents indicated that they had positive or neutral feelings about answering these questions over SMS. Lastly, all data was retrieved within 24 h of survey distribution allowing for immediate analysis and dissemination. Conclusion Women's willingness to share their pregnancy history suggests mobile surveys are a cost-effective and accessible method for gathering information on abortion in Kenya.

We assessed the attitudes of UK Obstetrics and Gynaecology (OG) trainees towards a caesarean delivery for maternal request (CDMR); and identified differences in attitude towards patients requesting CDMR and preferences for their own mode of delivery. An internet survey was constructed with questions covering trainees' personal preferences towards and experience of CDMR; attitudes to CDMR; and how they might treat patients making this request. From 02/2013 to 06/2013, the survey was sent electronically via email to all UK Deaneries to be forwarded to OG trainees. Two hundred and forty OG trainees participated; 78% female. 6/101 (6%) respondents had opted for CDMR in their first pregnancy. 28/131 (21%) would choose CDMR in their first pregnancy. Reasons for CDMR included concerns about pelvic floor/perineum, safety of the baby and convenience. 105/226 (46.4%) disagreed or strongly disagreed, and 67 (29.6%) agreed or strongly agreed with CDMR. 75/128 (58.6%) of respondents would grant CDMR to a patient; reasons included maternal choice, psychological concerns of the mother, perineal injury, pelvic floor. Our results are encouraging: positive attitudes of trainees towards vaginal delivery may help to reduce the rising caesarean rate. Impact Statement What is already known on this subject: Over the last 30 years, the rate of caesarean section in the UK has trebled and currently accounts for 25% of all deliveries. The rate of caesarean section in the UK has risen to 25% of all deliveries, incurring a financial burden and an excess clinical risk. With pressure to keep the caesarean rates low, understanding the attitudes and experience of obstetricians in training is important. What the results of this study add: Six percent of obstetric trainees, or their partners who had children had chosen a caesarean delivery for maternal request (CDMR), consistent with the population average. Twenty one percent of those who had not had children would choose CDMR. Both groups cited concerns over the pelvic floor as the predominant reason. Fifty nine percent of respondents would grant patients' request for CDMR. 29.6% of respondents agreed, and 46.4% disagreed with CDMR. Trainees' attitude to CDMR does not appear to be associated with whether or not they have had children, but does appear to be associated with whether they had experienced, or were planning to choose CDMR themselves in the future. What the implications are of these findings for clinical practice and/or further research: Training for obstetric trainees regarding the optimum way to manage patients' requests for, and clearer guidance on CDMR may be of benefit. It is important that obstetricians discuss the reasons behind such requests in order to individualise management.

Objective The effects of pregnancy on autograft dilatation and neoaortic valve function in patients with a Ross procedure have not been studied. We sought to evaluate the effect of pregnancy on autograft dilatation and valve function in these patients with the goal of determining whether pregnancy is safe after the Ross procedure. Design A retrospective chart review of female patients who underwent a Ross procedure was conducted. Patients Medical records for 51 patients were reviewed. Among the 33 patients who met inclusion criteria, 11 became pregnant after surgery and 22 did not. Outcome measures Echocardiographic reports were used to record aortic root diameter and aortic insufficiency before, during, and after pregnancy. Patient's charts were reviewed for reinterventions and complications. Primary endpoints included reinterventions, aortic root dilation of ≥5 cm, aortic insufficiency degree ≥ moderate, and death. Results There were 18 pregnancies carried beyond 20 weeks in 11 patients. There was no significant difference in aortic root diameter between nulliparous patients and parous patients prior to their first pregnancy (3.53 ± 0.44 vs 3.57 ± 0.69 cm, P = .74). There was no significant change in aortic root diameter after first pregnancy (3.7 ± 0.4 cm, P = .056) although there was significant dilatation after the second (4.3 ± 0.7 cm, P = .009) and third (4.5 ± 0.7 cm, P = .009) pregnancies. Freedom from combined endpoints was significantly higher for patients in the pregnancy group than those in the nonpregnancy group (P = .002). Conclusions Pregnancy was not associated with significantly increased adverse events in patients following the Ross procedure. Special care should be taken after the first pregnancy, as multiparity may lead to increased neoaortic dilatation.

Background Adolescent pregnancy and childbearing pose challenges to young women’s educational attainment. Studies show that while adolescent childbearing reduces educational attainment, not becoming pregnant and resorting to induced abortion when pregnant increases women’s educational levels. This study examined relationships between adolescents’ resolution of their first pregnancies and subsequent educational outcomes, for all women ages 20–49 years and across three age cohorts: 20–29, 30–39 and 40–49 year olds. Methods Using the 2007 Ghana Maternal Health Survey (GMHS) dataset, we conducted ANOVA, bivariate and multivariate linear regression analyses on 8186 women ages 20–49 years. Women’s first adolescent pregnancy outcomes were measured as live births, induced abortions, spontaneous abortions or no pregnancy, while educational attainment constituted their years of schooling. Results Findings showed years of schooling was highest for women who had induced abortions, and lowest for those who experienced live births. Women with live births as teenagers experienced significantly fewer years of schooling compared to their counterparts who terminated their pregnancies. Also, women with miscarriages and stillbirths exhibited levels similar to those who gave birth. Although women with no teenage births had higher educational levels than their childbearing counterparts, controlling for age at first pregnancy resulted in similar years of schooling compared to those who gave birth. Finally, the 30 to 39 year olds were the only age group whose results contradicted those of all women. These findings may be due to the socio-economic and political events that affected women’s educational attainment at the time. Conclusions Childbearing during adolescence does impact women’s educational attainment levels. Therefore, in addition to encouraging young mothers to continue schooling, all other interventions to help keep young girls in school must focus on preventing and/or delaying their adolescent pregnancies.

Abstarct Objective To study whether placental weight in the first pregnancy is associated with preeclampsia in the second pregnancy. Study design In this population-based study, we included all women with two consecutive singleton pregnancies reported to the Medical Birth Registry of Norway during 1999–2012 (n = 186 859). Placental weight in the first pregnancy was calculated as z-scores, and the distribution was divided into five groups of equal size (quintiles). We estimated crude and adjusted odds ratios with 95% confidence intervals for preeclampsia in the second pregnancy according to quintiles of placental weight z-scores in the first pregnancy. The 3rd quintile was used as the reference group. Results Among women without preeclampsia in the first pregnancy, 1.4% (2507/177 149) developed preeclampsia in the second pregnancy. In these women, the risk for preeclampsia in the second pregnancy was associated with placental weight in the first pregnancy in both lowest (crude odds ratio (cOR) 1.30, 95% confidence interval (CI); 1.14–1.47) and highest quintile (cOR 1.20, 95% CI; 1.06–1.36). The risk associated with the highest quintile of placental weight was confined to term preeclampsia. Among women with preeclampsia in the first pregnancy, 15.7% (1522/9710) developed recurrent preeclampsia, and the risk for recurrent preeclampsia was associated with placental weight in lowest quintile in the first pregnancy (cOR 1.30, 95% CI; 1.10–1.55). Adjustment for interval between pregnancies, maternal diabetes, age, and smoking in the first pregnancy did not alter these estimates notably. Conclusion Placental weight in the first pregnancy might help to identify women who could be at risk for developing preeclampsia in a second pregnancy.

More than 10% of babies are born too early resulting in over 15 million preterm births and more than one million new-born deaths globally. Although women with a previous spontaneous preterm birth (SPTB) are considered at high risk for recurrence, the majority occur in women without prior history. Prediction of SPTB risk allows for improved care and potential for targeting novel and existing therapeutics to prevent SPTB, which may result in improved outcomes for infant and mother. In this pilot study, a miRNA array was used to analyse plasma from healthy women in their first pregnancy at 20 weeks of gestation who then went on to deliver either at term or experience SPTB at 28–32 weeks. We identified specific miRNA expression profiles that differentiated between those mothers who delivered at term or delivered following SPTB. miR302b, miR1253 and a clustering of miR548 miRNAs were underexpressed in SPTB cases compared to term controls. Conversely, miR223 was elevated in mothers that later experienced a SPTB. The circulating miRNAs identified in the present study may therefore be attractive candidates as non-invasive biomarkers for the early prediction of SPTB. Further larger studies are now warranted to investigate the potential clinical utility of these markers.

We report a case of a 30-year-old woman who was first found to have a persistently low serum potassium level at 26 years of age during her first pregnancy. Genetic test of SLC12A3 confirmed Gitelman syndrome. The patient remained asymptomatic and had two deliveries following spontaneous labor. The first neonate died of heart failure due to cardiac abnormalities. The obstetric and neonatal outcome of the second pregnancy was good.

OBJECTIVES Idiopathic laryngotracheal stenosis (ILTS) is an uncommon problem arising mostly in women. In some, it arises during or is exacerbated by pregnancy. Experience with management of patients with this rare association is limited. This study seeks to evaluate the management of patients with pregnancy-associated ILTS and compare outcomes to cases not associated with pregnancy. METHODS Retrospective review of 15 patients undergoing surgical treatment of pregnancy-associated ILTS from 1971 to 2013. Variables of interest and airway outcomes were compared to patients with non-pregnancy-associated ILTS. RESULTS Pregnancy-associated ILTS was observed in 15/263 (5.7%) patients. Symptoms developed during their first pregnancy. When compared to non-pregnancy patients, these patients were younger (37 vs 47 years; P = 0.0003), had more prior tracheostomies (26.7% vs 10.9%; P = 0.085) and had more preoperative airway dilatations (86.7% vs 57.7%; P = 0.030). All patients completed pregnancy without complications and ultimately underwent laryngotracheal resection. The expression of hormonal receptors in the surgical specimens was similar in both groups (oestrogen receptors: 100% vs 75% and progesterone receptors: 71.4% vs 72.1%, in pregnancy and non-pregnancy patients, respectively). Airway outcomes were good/excellent in 13 (86.7%) patients with pregnancy-associated ILTS and 225 (90.7%) patients without pregnancy association (P = 0.642), and did not change when adjusting for other risk factors. CONCLUSIONS Pregnancy-associated ILTS is rare. The pathophysiology is unclear, but appearance of symptoms during pregnancy may suggest hormonal factors. To minimize foetal risk, dilatation during pregnancy followed by laryngotracheal resection after delivery is the preferred treatment. Pregnancy association does not seem to affect outcomes with expected satisfactory results in most patients.