Objective: The purpose of this study was to examine whetherw omen with one elevated value of the 3- hour glucose tolerance test are at increased risk for adverse perinatal outcomes.Study design: This was a retrospecti...Objective: The purpose of this study was to examine whetherw omen with one elevated value of the 3- hour glucose tolerance test are at increased risk for adverse perinatal outcomes.Study design: This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the use of the glucose loading test and with a glucose tolerance test for follow up, if screened values were positive. Perinatal outcomes in women with one elevated glucose tolerance test value were compared with the outcomes in women who screened negative by glucose loading test. The chi-square test was used to compare categorical outcomes, and multivariate logistic regression analysis was used to control for potential confounding factors; a P value of < .05 indicated statistical significance. Results:Of 14,036 women who met the study criteria, women with one elevated glucose tolerance test value exhibited higher rates of cesarean delivery (in nulliparous women only)- , preeclampsia, chorioamnionitis, birth weight > 4000 g and > 4500 g, and neonatal admission to the intensive care nursery as compared with women who screened negative (P < .05 for all). Conclusion: Although women with one elevated glucose tolerance test value are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse perinatal outcomes.展开更多
The purpose of this study was to exami ne maternal and neonatal outcomes in relation to len gthening intervals of the second stage of labor.This is a retro spective cohort study of15,759nulliparous,term,cephalic,singl...The purpose of this study was to exami ne maternal and neonatal outcomes in relation to len gthening intervals of the second stage of labor.This is a retro spective cohort study of15,759nulliparous,term,cephalic,singleton births at the University of California,San Francisco,between 1976and2001.The second stage of labor was di vided into 1-hour intervals.Maternal and neonatal ou tcomes were compared with the use of chi -squared and Student t tests,and a probability value of≤.05was used to indicate statistical significance.Potential confounders were controlled for withmultivariate logistic regression.Increasing rates of cesarean delivery,operative vaginal delive ry,and perineal trauma were associated with the second stag e beyond the first hour.In multivariate analysis,the>4-hour interval group had higher rates of cesarean delivery(odds ratio,5.65;P <.001),operative vaginal deliveries(odds ratio,2.83;P <.001),3rd -or 4th -degree perineal lacera-tions(odds ratio,1.33;P =.009),and chorioam-nionitis(odds ratio,1.79;P <.001).There were no differences in neonatal acid -base s tatus associated with length of second stage.However,there were fewer neonates with a 5-minute Apgar score of<7(odds ratio,0.45;P =.01).Although the length of the second stage of labor is not associated with poor n eonatal outcome,a prolonged second stage is associate d with increased mater-nal morbidity and operative delivery rates.展开更多
Objective: To determine if variation exists between ethnicities for risk of perineal, vaginal, and cervical laceration at vaginal delivery. Study design: Retrospective cohort study of nulliparous women who underwent v...Objective: To determine if variation exists between ethnicities for risk of perineal, vaginal, and cervical laceration at vaginal delivery. Study design: Retrospective cohort study of nulliparous women who underwent vaginal delivery of a vertex presentation. Predictor variable was ethnicity with outcome variables cervical, vaginal, and second- , third- , or fourth-degree perineal laceration. Logistic regression analysis was conducted to control for confounders. Results: Of the 17,216 who met criteria, Filipino (OR = 1.92, 95% CI 1.64- 2.25) and Chinese (OR = 1.60, 95% CI 1.33- 1.92) women were at greatest risk for third-and fourth-degree laceration. Only Filipino (OR = 1.32, 95% CI 1.10- 1.57) and other Asian (OR = 1.23, 95% CI 1.08- 1.41) women were at slightly increased risk of vaginal laceration. No differences were seen for cervical laceration. Conclusion: Different ethnicities are at widely varying risk of perineal laceration, but little difference exists for vaginal or cervical lacerations. Research into the mechanisms behind this should investigate differences in perineal anatomy.展开更多
Objective: To evaluate the effect of parietal peritoneal closure at cesarean delivery on adhesion formation. Methods: A prospective cohort study of women undergoing first repeat cesarean delivery was designed. All sur...Objective: To evaluate the effect of parietal peritoneal closure at cesarean delivery on adhesion formation. Methods: A prospective cohort study of women undergoing first repeat cesarean delivery was designed. All surgeons were asked immediately after surgery to score the severity and location of adhesions. Patient records were then abstracted to assess prior surgical technique, including parietal peritoneal closure, other attributes of first surgery, and patient characteristics. Exclusion criteria included adhesions, other surgery, or use of permanent suture at the first cesarean, unavailable first postoperative note and course, wound infection or breakdown following first surgery, intervening pelvic surgery, insulin-dependent diabetes mellitus, and steroid-dependent disease. The χ 2 test and multivariable logistic regression were used for statistical comparison and analysis. A total of 128 patients was required to have 80% power to detect a 50% reduction in adhesions when the parietal peritoneum was left open. Results: One hundred seventy-three patients were enrolled. Prior parietal peritoneal closure was associated with significantly fewer dense and filmy adhesions (52% versus 73% , P =.006) and significantly fewer dense adhesions (30% versus 45% , P = .043). When controlling for potential confounding variables, including prior infection, visceral peritoneal closure, rectus muscle closure, payor status, ethnicity, maternal age, gestational diabetes, and labor, parietal peritoneal closure at primary cesarean delivery was 5-fold protective against all adhesions (odds ratio 0.20, 95% confidence interval 0.08-0.49), and 3-fold protective against dense adhesions (odds ratio 0.32, 95% confidence interval 0.13-0.79). Omental-fascial adhesions were decreased most consistently. Conclusion: Parietal peritoneal closure at primary cesarean delivery was associated with significantly fewer dense and filmy adhesions. The practice of nonclosure of the parietal peritoneum at cesarean delivery should be questioned.展开更多
Objective: The purpose of this study was to investigate the outcomes that are associated with pregnancy and treated hypothyroidism. Study design: This was a retrospective cohort study of all women who received prenata...Objective: The purpose of this study was to investigate the outcomes that are associated with pregnancy and treated hypothyroidism. Study design: This was a retrospective cohort study of all women who received prenatal care and were delivered at the University of California, San Francisco, between 1989 and 2001. All patients with hypothyroidism diagnosed before pregnancy or early in pregnancy were identified. Maternal, fetal, and obstetric outcomes were then collected and analyzed for women with hypothyroidism and compared with women without hypothyroidism. Results: Among 20,499 deliveries, there were 419 women (2.1% ) who were treated for hypothyroidism during the study period. Hypothyroidism was more common among women ≥ 35 years old, white women, and women without Medicaid insurance. Treated hypothyroidism was not associated with any increase in maternal, fetal, or neonatal complications. In addition, hypothyroidismdid not affect mode of delivery. Conclusion: Compared with patients without hypothyroidism, patients with treated hypothyroidism are not at any increased risk for perinatal morbidity.展开更多
Objective: To examine the association of maternal and paternal ethnicity as well as parental ethnic discordance with preeclampsia. Methods: Retrospective cohort study of all low-risk women delivered from 1995 to 1999 ...Objective: To examine the association of maternal and paternal ethnicity as well as parental ethnic discordance with preeclampsia. Methods: Retrospective cohort study of all low-risk women delivered from 1995 to 1999 within a mature managed care organization. Rates of preeclampsia were calculated for maternal, paternal, and combined ethnicity using both univariate and multivariate analyses. Results: Among the 127,544 low-risk women, when examining maternal ethnicity in a multivariate model controlling for maternal age, parity, education, and gestational age, we found that the rates of preeclampsia were higher among African American (5.2% ; odds ratio OR 1.41, 95% confidence interval CI 1.25-1.62) women and lower among Latina (4.0% ; OR 0.90, 95% CI 0.84-0.97) and Asian women (3.5% ; OR 0.79, 95% CI 0.72-0.88), with all results being statistically significant as compared with white women. When paternal ethnicity was controlled for separately, however, the difference in the rate of preeclampsia among Asian women disappeared, the effect of African-American maternal ethnicity increased slightly (OR 1.49, 95% CI 1.33-1.72), and Asian paternity was found to be associated with the lowest rate of preeclampsia (3.2% ; OR 0.76, 95% CI 0.68-0.85). Further, parental ethnic discordance was associated with an increase in the rate of preeclampsia (OR 1.13, 95% CI 1.02-1.26). Conclusion: We found that rates of preeclampsia were lower with Asian paternal ethnicity. We also found that having a differing paternal and maternal ethnicity was associated with increased rates of preeclampsia. For every 1,000 pregnancies, there would be approximately 10 fewer cases of preeclampsia in the setting of Asian paternity and 5 more cases of preeclampsia in the setting of parental ethnic discordance. These differences may be useful in further investigation of the cause of preeclampsia.展开更多
文摘Objective: The purpose of this study was to examine whetherw omen with one elevated value of the 3- hour glucose tolerance test are at increased risk for adverse perinatal outcomes.Study design: This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the use of the glucose loading test and with a glucose tolerance test for follow up, if screened values were positive. Perinatal outcomes in women with one elevated glucose tolerance test value were compared with the outcomes in women who screened negative by glucose loading test. The chi-square test was used to compare categorical outcomes, and multivariate logistic regression analysis was used to control for potential confounding factors; a P value of < .05 indicated statistical significance. Results:Of 14,036 women who met the study criteria, women with one elevated glucose tolerance test value exhibited higher rates of cesarean delivery (in nulliparous women only)- , preeclampsia, chorioamnionitis, birth weight > 4000 g and > 4500 g, and neonatal admission to the intensive care nursery as compared with women who screened negative (P < .05 for all). Conclusion: Although women with one elevated glucose tolerance test value are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse perinatal outcomes.
文摘The purpose of this study was to exami ne maternal and neonatal outcomes in relation to len gthening intervals of the second stage of labor.This is a retro spective cohort study of15,759nulliparous,term,cephalic,singleton births at the University of California,San Francisco,between 1976and2001.The second stage of labor was di vided into 1-hour intervals.Maternal and neonatal ou tcomes were compared with the use of chi -squared and Student t tests,and a probability value of≤.05was used to indicate statistical significance.Potential confounders were controlled for withmultivariate logistic regression.Increasing rates of cesarean delivery,operative vaginal delive ry,and perineal trauma were associated with the second stag e beyond the first hour.In multivariate analysis,the>4-hour interval group had higher rates of cesarean delivery(odds ratio,5.65;P <.001),operative vaginal deliveries(odds ratio,2.83;P <.001),3rd -or 4th -degree perineal lacera-tions(odds ratio,1.33;P =.009),and chorioam-nionitis(odds ratio,1.79;P <.001).There were no differences in neonatal acid -base s tatus associated with length of second stage.However,there were fewer neonates with a 5-minute Apgar score of<7(odds ratio,0.45;P =.01).Although the length of the second stage of labor is not associated with poor n eonatal outcome,a prolonged second stage is associate d with increased mater-nal morbidity and operative delivery rates.
文摘Objective: To determine if variation exists between ethnicities for risk of perineal, vaginal, and cervical laceration at vaginal delivery. Study design: Retrospective cohort study of nulliparous women who underwent vaginal delivery of a vertex presentation. Predictor variable was ethnicity with outcome variables cervical, vaginal, and second- , third- , or fourth-degree perineal laceration. Logistic regression analysis was conducted to control for confounders. Results: Of the 17,216 who met criteria, Filipino (OR = 1.92, 95% CI 1.64- 2.25) and Chinese (OR = 1.60, 95% CI 1.33- 1.92) women were at greatest risk for third-and fourth-degree laceration. Only Filipino (OR = 1.32, 95% CI 1.10- 1.57) and other Asian (OR = 1.23, 95% CI 1.08- 1.41) women were at slightly increased risk of vaginal laceration. No differences were seen for cervical laceration. Conclusion: Different ethnicities are at widely varying risk of perineal laceration, but little difference exists for vaginal or cervical lacerations. Research into the mechanisms behind this should investigate differences in perineal anatomy.
文摘Objective: To evaluate the effect of parietal peritoneal closure at cesarean delivery on adhesion formation. Methods: A prospective cohort study of women undergoing first repeat cesarean delivery was designed. All surgeons were asked immediately after surgery to score the severity and location of adhesions. Patient records were then abstracted to assess prior surgical technique, including parietal peritoneal closure, other attributes of first surgery, and patient characteristics. Exclusion criteria included adhesions, other surgery, or use of permanent suture at the first cesarean, unavailable first postoperative note and course, wound infection or breakdown following first surgery, intervening pelvic surgery, insulin-dependent diabetes mellitus, and steroid-dependent disease. The χ 2 test and multivariable logistic regression were used for statistical comparison and analysis. A total of 128 patients was required to have 80% power to detect a 50% reduction in adhesions when the parietal peritoneum was left open. Results: One hundred seventy-three patients were enrolled. Prior parietal peritoneal closure was associated with significantly fewer dense and filmy adhesions (52% versus 73% , P =.006) and significantly fewer dense adhesions (30% versus 45% , P = .043). When controlling for potential confounding variables, including prior infection, visceral peritoneal closure, rectus muscle closure, payor status, ethnicity, maternal age, gestational diabetes, and labor, parietal peritoneal closure at primary cesarean delivery was 5-fold protective against all adhesions (odds ratio 0.20, 95% confidence interval 0.08-0.49), and 3-fold protective against dense adhesions (odds ratio 0.32, 95% confidence interval 0.13-0.79). Omental-fascial adhesions were decreased most consistently. Conclusion: Parietal peritoneal closure at primary cesarean delivery was associated with significantly fewer dense and filmy adhesions. The practice of nonclosure of the parietal peritoneum at cesarean delivery should be questioned.
文摘Objective: The purpose of this study was to investigate the outcomes that are associated with pregnancy and treated hypothyroidism. Study design: This was a retrospective cohort study of all women who received prenatal care and were delivered at the University of California, San Francisco, between 1989 and 2001. All patients with hypothyroidism diagnosed before pregnancy or early in pregnancy were identified. Maternal, fetal, and obstetric outcomes were then collected and analyzed for women with hypothyroidism and compared with women without hypothyroidism. Results: Among 20,499 deliveries, there were 419 women (2.1% ) who were treated for hypothyroidism during the study period. Hypothyroidism was more common among women ≥ 35 years old, white women, and women without Medicaid insurance. Treated hypothyroidism was not associated with any increase in maternal, fetal, or neonatal complications. In addition, hypothyroidismdid not affect mode of delivery. Conclusion: Compared with patients without hypothyroidism, patients with treated hypothyroidism are not at any increased risk for perinatal morbidity.
文摘Objective: To examine the association of maternal and paternal ethnicity as well as parental ethnic discordance with preeclampsia. Methods: Retrospective cohort study of all low-risk women delivered from 1995 to 1999 within a mature managed care organization. Rates of preeclampsia were calculated for maternal, paternal, and combined ethnicity using both univariate and multivariate analyses. Results: Among the 127,544 low-risk women, when examining maternal ethnicity in a multivariate model controlling for maternal age, parity, education, and gestational age, we found that the rates of preeclampsia were higher among African American (5.2% ; odds ratio OR 1.41, 95% confidence interval CI 1.25-1.62) women and lower among Latina (4.0% ; OR 0.90, 95% CI 0.84-0.97) and Asian women (3.5% ; OR 0.79, 95% CI 0.72-0.88), with all results being statistically significant as compared with white women. When paternal ethnicity was controlled for separately, however, the difference in the rate of preeclampsia among Asian women disappeared, the effect of African-American maternal ethnicity increased slightly (OR 1.49, 95% CI 1.33-1.72), and Asian paternity was found to be associated with the lowest rate of preeclampsia (3.2% ; OR 0.76, 95% CI 0.68-0.85). Further, parental ethnic discordance was associated with an increase in the rate of preeclampsia (OR 1.13, 95% CI 1.02-1.26). Conclusion: We found that rates of preeclampsia were lower with Asian paternal ethnicity. We also found that having a differing paternal and maternal ethnicity was associated with increased rates of preeclampsia. For every 1,000 pregnancies, there would be approximately 10 fewer cases of preeclampsia in the setting of Asian paternity and 5 more cases of preeclampsia in the setting of parental ethnic discordance. These differences may be useful in further investigation of the cause of preeclampsia.
