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Previous studies on adverse fetal outcomes in women of low maternal age (10-14 years) have rarely examined the occurrence of stillbirth in this age group a complication that could lead to subsequent poor obstetric outcomes and perturb future reproductive functions. We therefore carried out this study to estimate the risk across stillbirth phenotypes among singleton deliveries to women of very low maternal age. We used data assembled by the National Center for Health Statistics (NCHS) covering the period 1989-2000. We selected singleton live births and fetal deaths from 20 through 44 gestational weeks. We defined very low maternal age as gravidas aged 10-14 years inclusive and this represents the study group. We constructed two comparison groups consisting of women aged 15-19 years (also designated as adolescent mothers) and 20-24 years (also designated as mature mothers). (excerpt)

placental abruption: a retrospective cohort study Hamisu Salihu, Elise Diamond, Ronee Wilson, Euna August, Alfred Mbah, Valerie Whiteman University of South Florida, Epidemiology and Biostatistics, Tampa, FL, University of South Florida, Obstetrics and Gynecology, Tampa, FL, University of South Florida, Community and Family Health, Tampa, FL, University of South Florida, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tampa, FL OBJECTIVE: Weight gain during pregnancy has recently been identified as a risk factor for placental abruption but the association remains relatively understudied. The purpose of this study was to assess the relationship between gestational weight gain and the incidence of placental abruption utilizing a highly reliable and tested populationbased, maternally-linked, longitudinal dataset. STUDY DESIGN: This retrospective cohort was restricted to Missouri women who had a singleton, live birth between the years 1989 to 2005 (N 1,146,935). Weight gain during pregnancy was categorized as below optimal, optimal, and above optimal according to the most recent guidelines established by the Institute of Medicine (IOM). Multivariate logistic regression was used to generate independent measures of association between pregnancy weight gain and placental abruption. Sub-group analyses were conducted utilizing pre-pregnancy body mass index (BMI) categories: underweight, normal, overweight, and obese. Regression models were adjusted for level of prenatal care, maternal race, age, smoking habits, and the occurrence of other pregnancy complications. RESULTS: Overall, women who gained more than the optimal weight recommended during pregnancy had a 30% reduced odds of placental abruption [adjusted odds ratio (AOR) 0.695, 95% confidence interval (CI): 0.660-0.731], as compared to those with optimal weight gain. By contrast, women who gained less than the optimal weight during pregnancy had a 67% increased likelihood of experiencing placental abruption (AOR 1.673, 95% CI: 1.588-1.762). The results remained statistically significant even after controlling for the confounding effects of maternal BMI status. CONCLUSION: Pregnant women that gain weight below the recommended IOM guidelines are at elevated risk for placental abruption regardless of their BMI status. These findings underscore the importance of weight gain management during pregnancy to improve maternal/fetal outcomes.

Studies on prenatal smoking and its association with infant respiratory distress syndrome are sparse. In a study by Curet et al. w1x the investigators found that the incidence of respiratory distress syndrome (RDS) among infants of nonsmoking gravidas was higher than among neonates of smoking mothers. Similar results were documented by other authors w2x. However, all these studies were conducted on singletons, and to our knowledge, there are as yet no data on multiples. This study explores the relationship between maternal smoking during pregnancy and the incidence of respiratory distress syndrome (RDS) among triplets in the United States during a period (1995–1997) when the use of steroids and surfactant therapy has become an established practice among preterm births. The current epidemic of multiple births, most remarkable among triplet gestations, coupled with the fact that 90% of triplets are born preterm w3x motivated us to undertake this study. The data for this analysis were from the ‘matched multiple birth file’ assembled by the National Center for Health Statistics (NCHS) cov

(2000). Prune belly syndrome co-existing with the VACTERL-complex in a background of antenatal ingestion of traditional concoction. Journal of Obstetrics and Gynaecology: Vol. 20, No. 1, pp. 95-96.

Background: This study analyzes the social, economic and behavioral factors most frequently associated with adherence to Highly Active Antiretroviral Treatment (HAART) in urban India. Materials and Methods: Data was collected in a metropolitan teaching hospital in Mumbai using a cross-sectional survey design. Face-to-face interviews were conducted with 152 patients. The semistructured survey included both open and closed ended questions on socio-demographic, economic and behavioral factors. Factors affecting treatment adherence were analyzed. Results: The median age of patients was 40.5 years, 73% were males and all were heterosexual. Patients had been given ART from six months to five years (median is equal to 3.5). Ninety per cent lived at home and commuted to the clinic by bus or train. Behaviorally, 37% were sexually active, but only 55% used condoms. In assessing adherence, income, education, knowledge of their drugs, transportation, side effects, cost of treatment, distance from clinic and personal clinic satisfaction were analyzed. We found that 75% of patients reported cost of HAART to be the single greatest obstacle to adherence (p less than 0.01). Additionally, those claiming knowledge of their drugs were 2.3 times more likely to be adherent (p less than 0.03), while those who abused drugs or alcohol were 53% less likely to be adherent (p less than 0.03). There was no correlation with other factors. Conclusions: Our study population was representative of the lower middle class of India. It found that an educated, employed group considered the cost of treatment to be a significant obstacle for successful therapy. Additionally, it showed a significant increase in adherence when patients had knowledge of their HAART medications. Therefore, reducing the cost of medication as well as teaching about antiretroviral medications are both likely to improve adherence.

Objective The objective of the study was to analyze the histopathologic content of the vascular portion of the cardinal ligament in patients undergoing radical hysterectomy for cervical cancer. Study Design The vascular portion of the cardinal ligament was completely removed during radical hysterectomy. The maximum cervical diameter and length of the vascular ligament were measured on the fresh specimen. After inking, the pathologist separated and embedded the entire vascular segment from each side. Microscopic examination followed. Results Eighty-four patients were available for analysis. The mean cervical diameter was 3.9 cm (2-8), whereas the mean vascular segment length on the right and left sides were 4 cm (1-10) and 3.8 cm (1-7), respectively. Mean number of vascular segment lymph nodes were as follows: medial right = 0.7 (0-4), medial left = 0.6 (0-5), lateral right = 0.4 (0-3), and lateral left = 0.6 (0-6). Mean diameter of medial and lateral lymph nodes were 2 mm (0.25-8) and 3.3 mm (0.25-16), respectively. The length of the vascular segment correlated inversely with maximum cervical diameter. Thirty-one percent (26 of 84) had positive pelvic side wall lymph nodes. Fourteen patients had positive vascular segment lymph nodes (1 positive = 7, more than 1 positive = 7). Three of 7 patients had bilateral positive vascular segment lymph nodes; all 7 had microscopic disease in the paravaginal soft tissue, and all 7 had positive pelvic side wall lymph nodes (6 of 7 bilateral). Including the 14 patients, a total of 19 had nodal or nonnodal microscopic disease in the vascular segment. Of these, 7 had disease in the lateral half of the vascular ligament. Histologic sectioning revealed nerve twigs and/or scattered ganglia in the vascular segment but no large nerve trunks. Conclusion Among a population of women with high-risk, early-stage cervical cancer, the lateral vascular segment of the cardinal ligament contained metastatic disease in a substantial number of patients. This segment contains no major nerve trunks. When radical hysterectomy is chosen as primary treatment for such patients, the vascular segment of the cardinal ligament should be completely excised.

Objective The objective of our study was to determine whether changes in prepregnancy body mass index (BMI) between the first 2 pregnancies is associated with increased risk for large-for-gestational-age (LGA) birth in the second pregnancy. Study Design A population-based, retrospective cohort analysis was performed using the Missouri 1989-1997 longitudinally linked data. Women with the first 2 consecutive singleton live births (n = 146,227) were analyzed. BMI (kilograms per square meter) was categorized as underweight (less than 18.5), normal (18.5 to 24.9), overweight (25 to 29.9), and obese (30 or greater), and LGA was defined as gestational age-specific birthweight greater than the 90th centile. Multivariate logistic regression analysis was used to estimate the odds ratio (OR) with 95% confidence interval (CI). Population attributable fraction for LGA births was calculated. Results Compared to women with normal BMI in their first and second pregnancies, overweight-overweight (OR 1.7, 95% CI 1.6, 1.8) and obese-obese (OR 2.3, 95% CI 2.2, 2.4) women in their first and second pregnancies were at increased risk of LGA births. Any increase in BMI from normal to obese between pregnancies increased LGA risk (OR 1.6 to 2.0), whereas any decrease in BMI from obese to normal attenuated the risk (OR 1.3 to 1.7). 17.1%, 13.2%, and 7.6% of LGA births are likely preventable had BMI not increased from first pregnancy underweight, normal, and overweight, respectively. Conclusion In comparison with women with normal BMI in both pregnancies, any increase or decrease in prepregnancy BMI between normal and obese is associated with increased risk of LGA birth. A modification in the risk of LGA births by long-term maternal BMI status or maternal genetic factors appears likely.

MORTALITY RATE OF NORMAL CO-TWIN ALAN TITA, HAMISU SALIHU, DWIGHT ROUSE, University of Alabama at Birmingham, Obstetrics and Gynecology, Birmingham, Alabama, UMDNJ-Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, New Jersey OBJECTIVE: We reported adverse birth outcomes, including increased perinatal mortality, among normal siblings due to the presence of anomalous co-fetus(es). We now examine the impact of fetal death of an anomalous twin, and the role of gestational age at delivery, on neonatal and infant mortality of the normal co-twin. STUDY DESIGN: A population-based retrospective cohort study of twins delivered in the US from 1995 through 2000 using validated Matched Multiple Birth Files from the National Center for Health Statistics. Live born nonanomalous twins belonging to a pair with an anomalous co-twin with fetal death, were compared to those from a pair with an anomalous live birth. Cox regression, taking into consideration survival time, and accounting for potential confounders including age, parity and fetal sex, and gestational age at delivery in a further analysis, was utilized. RESULTS: A total of 16068 (2.52 %) of 636716 matched twins, were nonanomalous/anomalous pairs. Of these, 584 twins were excluded because of non-anomalous stillbirths leaving 14,554 (94%) live-born twins and 930 (6%) with stillbirth of an anomalous co-twin. The adjusted incidence rate ratios for neonatal and infant mortality of the non-anomalous twins are presented in the Table.

Introduction The NCEP III -ATP guidelines provide clear clinical directives for lipid management especially statins therapy in appropriate patient groups. Compliance of primary care physicians with these guidelines especially in ambulatory care settings has been shown to be poor. The compliance of cardiologist to these guidelines is less documented.

Objective: To examine the occurence and outcomes of African babies born with features of Eagle-Barret syndrome at a tertiary health centre. Design: Case series. Setting: University Teaching Hospital, Yaounde, Cameroon. Subjects: Patients were identified through a retrospective review of obstetric records of mothers admitted at the centre within the period 1984 to 1996 inclusive. A total of eleven cases were identified over a period of thirteen years. Results: The most prominent associated defects consisted of clubfoot, pulmonary hypoplasia, Potter's facies, imperforate anus and arthrogryposis. None of our patients survived the perinatal period. Conclusion: Our study indicates the need for the establishment of a prenatal and cytogenetic infrastructure in Cameroon to enhance early detection of congenital malformation and chromosomal aberrations. In the meantime, early detection of foetuses with Eagle-Barret syndrome using ultrasound could facilitate timely institutions of antenatal management options and lead to favourable birth outcomes of affected babies.