Los indicadores de mortalidad perinatal constituyen hoy en día eficaces evaluadores de las condiciones de desarrollo de un país y del seguimiento obstétrico, por lo que realizamos un estudio ...prospectivo descriptivo del año 1998 en el Hospital Docente Ginecoobstétrico de Matanzas "Julio Alfonso Medina", de los productos y neonatos fallecidos. De un total de 3 707 nacimientos ocurrieron en 16 pacientes, 17 defunciones neonatales (1 gemelar) para tasa de 2,7 x 1 000 NV y 63 pacientes aportaron 65 muertes fetales (2 gemelares) para una tasa de 14 x 1 000 NV (la muestra está formada por 79 pacientes con 82 fetos). Una base de datos permitió la recogida de los datos primarios que después de una forma descriptiva mediante su procesamiento en una computadora IBM de la Universidad de Matanzas y por las bondades del sistema MICROSTAT, se aplicó el porcentaje, la prueba de x2 (µ£ 0,01). Se elaboraron tablas estadísticas para su discusión y se comparó con la bibliografía actualizada. Se encontró que las mujeres con mejores condiciones de fecundidad, nulíparas, con enfermedad obstétrica y partos transpelvianos fueron las que predominaron en la muestra. Las muertes neonatales ocurrieron en su mayoría en niños producto de edades gestacionales extremas y con peso debajo de 2 500 g.
Se ha observado que el embarazo después de 35 años es bastante común en nuestra sociedad y por la asistencia obstétrica especializada se ha logrado el feliz término de los mismos, a pesar de los ...factores de riesgo asociados. Se realizó un estudio en el Hospital ginecoobstétrico de Matanzas, durante el año 1999, de todas las parturientas con esta condición (171) que representaron el 5,2 % de 3 292 nacimientos. Se recogieron los datos en un libro registro y en forma de variables, se procesaron en una computadora IBM de la Universidad de Matanzas, mediante el sistema MICROSTAT para el hallazgo de porcentaje y la media como medida de tendencia de dispersión con sus desviaciones mínimas y máximas y la prueba del X2 donde a £ 0,05. Se demostró que la edad madura (de 35 en adelante) no influyó en los indicadores de mortalidad perinatal, sin embargo, la única muerte materna recayó en ese grupo.
An extensive study as to whether maternal age itself is a risk factor for blood loss during parturition.
A total of 10,053 consecutive women who delivered a singleton infant were studied. The excess ...blood loss was defined separately for women with vaginal and cesarean deliveries as > or = 90th centile value for each delivery mode. The effects of 13 potential risk factors on blood loss were analyzed using multivariate analysis.
The 90th centile value of blood loss was 615 ml and 1,531 ml for women with vaginal and cesarean deliveries, respectively. A low lying placenta (odds ratio OR, 4.4), previous cesarean (3.1), operative delivery (2.6), leiomyoma (1.9), primiparity (1.6), and maternal age > or = 35 years (1.5) were significant independent risk factors for excess blood loss in women with vaginal delivery. Placenta previa (6.3), leiomyoma (3.6), low lying placenta (3.3), and maternal age > or = 35 years (1.8) were significant independent risk factors for excess blood loss in women with cesarean sections.
A maternal age of > or = 35 years was an independent risk factor for excess blood loss irrespective of the mode of delivery, even after adjusting for age-related complications such as leiomyoma, placenta previa, and low lying placenta.
Since the introduction, in 1984, of maternal serum screening for fetal aneuploidy, obstetrical practitioners and their patients have learned to cope with the challenges and limitations of risk ...estimation. In the instance where the "odds" are not entirely reassuring, the hazards of invasive, yet definitive, testing are weighed against the costs of uncertainty. Non-invasive prenatal screening has improved dramatically over the past 20 years, with early administration, high sensitivity, and low false positive rates as the benchmarks. With a wide array of tests at her disposal, the woman who chooses to undergo prenatal screening for aneuploidy presumably does so in the context of counselling and consent, and with the assurance that the tests offered, having evolved through the rigours of large-scale clinical trials, are as good as they can possibly be. Or does she? The following is a highly personal account of one woman's experience with prenatal screening, in particular, with the "Pandora's box" of ultrasonic soft markers for aneuploidy. The author challenges the experts in the field to ensure that all "advancements" meet the standards described above.
Cigarette smoking during pregnancy is an important, avoidable factor associated with low birth weight. Maternal age is also associated with variations in birth weight. Using birth certificate data ...from all 347,650 singleton births for which maternal age and birth weight were recorded during 1984-1988 in Washington State, this study investigated birth weight and smoking during pregnancy (yes/no) for mothers of different ages. In multiple linear regressions adjusted for race, marital status, parity, adequacy of prenatal care, and urban/rural residence, the decrement in mean birth weight associated with smoking grew steadily from 117 g for the youngest mothers (age less than 16 years) to 376 g for the oldest (age 40 years or more). Similarly, the adjusted relative risk of having a low weight birth (less than 2,500 g) for smokers compared with nonsmokers was lowest for mothers aged 16-17 years, at 1.43 (95% confidence interval 1.22-1.68), and increased steadily to 2.63 (95% confidence interval 1.77-3.90) for mothers aged 40 or more. This result suggests that the effect of exposure to cigarette smoking during pregnancy is modified by advancing maternal age. Further research using data that more precisely measure the exposure (cigarettes per day, years smoked) could help further clarify this issue and better address the public health question of whether smoking cessation programs ought to focus limited resources more selectively toward pregnant smokers in particular age groups.
The use of a 1.48 um diode laser for assisted hatching was investigated in animal experimentation. Laser assisted hatching was offered to patients with advanced maternal age to evaluate a possible ...benefit.
Using the Fertilase(r) system we investigated the impact of openings with different size in the zona of mouse embryos on the hatching process, as well as that of two openings. Laser-drilling was performed at the blastocyst stage to look for differences in timing and efficacy of hatching. The possible benefit of assisted hatching was studied in 24 couples with advanced maternal age (38.8+2.1 years) and compared to a control group (37.8+2.5 years) treated in the same time period but without assisted hatching.
A certain diameter of a laser drilled opening in the zona pellucida is necessary for efficient hatching. When two openings are present in the zona, the embryo will use both openings for hatching and subsequently become trapped. Laser-drilling at th e expanded blastocyst stage causes an immediate collapse of treated blastocysts and the onset of hatching is retarded. Assisted hatching in 24 patients with advanced maternal age resulted in a significant increase (p<0.01) in the implantation rate when compared to 24 untreated patients.
The use of a 1.48 microm diode laser to drill an opening into the zona pellucida provides a good alternate to conventionally applied techniques. The procedure is efficient and safe as long as it is applied properly. In a human in vitro fertilization program, selected patients will have a benefit form assisted hatching.
Summary
The objective of this study is to determine whether a normal fetal morphology ultrasound scan in women older than 35 years reduces the risk of aneuploidy. We reviewed the results of ...amniocentesis and second trimester sonogram in all women older than 35 years from 1991 to 1995. None had prior screening. We excluded fetuses with structural anomalies. We determined the sensitivity and specificity of minor markers in detecting Down syndrome and also determined the reduction in risk of a normal sonogram. Among the 2060 women older than 35 years giving birth during the study period, 16 (0.78%) delivered an infant with Down syndrome. Of the 16 fetuses, two had no prenatal testing or ultrasound, two had invasive testing but no second trimester sonogram, five had a normal sonogram and seven had one or more sonographic markers of Down syndrome. At least 17% of women older than 35 years did not participate in prenatal testing or ultrasound. Ultrasound detected Down syndrome with a sensitivity of 59% (95% confidence interval: 45–72%), a false‐positive rate of 10.6% (9.4–11.8%) and a positive predictor value of 1 in 9. The likelihood of having normal karyotype if the sonogram was normal was 0.46 (0.31–0.61). In women older than 35 years, a normal second trimester sonogram reduces the risk of Down syndrome by more than 50%. At least 17% of women older than 35 years do not participate in prenatal testing or ultrasound.
The expected utility theory suggests eliminating an age-specific criterion for recommending prenatal diagnosis to patients. We isolate the factors which patients and physicians need to consider ...intelligently in prenatal diagnosis, and show that the sole use of a threshold age as a screening device is inadequate. Such a threshold fails to consider adequately patients' attitudes regarding many of the possible outcomes of prenatal diagnosis; in particular, the birth of a chromosomally abnormal child and procedural-related miscarriages. It also precludes testing younger women and encourages testing in patients who do not necessarily require or desire it. All pregnant women should be informed about their prenatal diagnosis options, screening techniques, and diagnostic procedures, including their respective limitations, risks, and benefits.
This hospital-based retrospective cohort study examined the effect of maternal age on preterm birth and perinatal mortality in nulliparous women. Prospectively collected information for 9,835 births ...was used to investigate whether women 35 years and older and women less than 20 years of age had an increased risk of preterm birth or perinatal mortality compared with women aged 20-34 years. Other primary risk factors selected from univariate analyses were controlled in logistic regression analyses of the study outcomes. The effect of intervening biological variables on odds ratios and confidence intervals was evaluated in a sequential analysis. An initial significant association between young maternal age and preterm birth was due to confounding by marital status. Older maternal age at first birth was significantly associated with perinatal mortality, after controlling for other covariates and intervening biological variables. After controlling for preterm birth, the increased risk did not quite achieve statistical significance, but should still be considered clinically significant.
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