First-trimester placental vascular development in multiparous women differs from that in nulliparous women

Background Little is known about the association between bisphenol A (BPA) or triclosan (TCS) exposure and hypertension in pregnancy. Objective To investigate potential associations between maternal urinary concentrations of BPA or TCS and gestational hypertension (GH) and preeclampsia. Study Design Among 1,909 pregnant women participating in the maternal-infant research on environmental chemicals (MIREC) study, urinary concentrations of BPA and TCS were measured in the first trimester by liquid chromatography-tandem mass spectrometry using isotope dilution. Blood pressure was measured during each trimester. Multinomial regression was performed to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the associations between these phenols and GH and preeclampsia. Results BPA and TCS were not associated with GH or preeclampsia. However, in multiparous women, BPA (0.50–1.30 µg/L) was associated with decreased risk of GH (aOR =0.45; 95%CI: 0.21–0.98) while among nulliparous women, TCS was associated with an increased risk of GH (3.60–32.60 µg/L; aOR = 2.58; 95% CI: 1.09–6.13 and > 32.60 µg/L: aOR = 2.74; 95% CI: 1.15–6.51). Conclusion BPA and TCS urinary concentrations were not associated with GH or preeclampsia; however, our results suggest an association between TCS and GH in nulliparous women. Additional studies are required to confirm our results.

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Cytokine Patterns in Maternal Serum From First Trimester to Term and Beyond

Frontiers in Immunology ◽

10.3389/fimmu.2021.752660 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anders Hagen Jarmund ◽

Guro Fanneløb Giskeødegård ◽

Mariell Ryssdal ◽

Bjørg Steinkjer ◽

Live Marie Tobiesen Stokkeland ◽

...

Keyword(s):

Maternal Obesity ◽

Serum Levels ◽

First Trimester ◽

Maternal Serum ◽

Serum Samples ◽

Female Fetus ◽

Reactive Protein ◽

Nulliparous Women ◽

Cytokine Levels ◽

Multiparous Women

Pregnancy implies delicate immunological balance between two individuals, with constant changes and adaptions in response to maternal capacity and fetal demands. We performed cytokine profiling of 1149 longitudinal serum samples from 707 pregnant women to map immunological changes from first trimester to term and beyond. The serum levels of 22 cytokines and C-reactive protein (CRP) followed diverse but characteristic trajectories throughout pregnancy, consistent with staged immunological adaptions. Eotaxin showed a particularly robust decrease throughout pregnancy. A strong surge in cytokine levels developed when pregnancies progressed beyond term and the increase was amplified as labor approached. Maternal obesity, smoking and pregnancies with large fetuses showed sustained increase in distinct cytokines throughout pregnancy. Multiparous women had increased cytokine levels in the first trimester compared to nulliparous women with higher cytokine levels in the third trimester. Fetal sex affected first trimester cytokine levels with increased levels in pregnancies with a female fetus. These findings unravel important immunological dynamics of pregnancy, demonstrate how both maternal and fetal factors influence maternal systemic cytokines, and serve as a comprehensive reference for cytokine profiles in normal pregnancies.

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Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 811-818

Author(s):

Nicole B. Kurata ◽

Keith K. Ogasawara ◽

Kathryn L. Pedula ◽

William A. Goh

Keyword(s):

Perinatal Outcomes ◽

Kaiser Permanente ◽

Second Stage Of Labor ◽

Second Stage ◽

Labor Duration ◽

Nulliparous Women ◽

Multiparous Women ◽

Comparison Groups ◽

Maternal And Neonatal Outcomes ◽

Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

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The level of unpleasantness of pain influences the choice of home treatment during medical abortion

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.09.007 ◽

2011 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Satu Suhonen ◽

Marja Tikka ◽

Seppo Kivinen ◽

Timo Kauppila

Keyword(s):

Medical Abortion ◽

Nulliparous Women ◽

Home Based ◽

Vaginal Deliveries ◽

Multiparous Women ◽

Induced Abortions ◽

Pain Drawings ◽

Nonopioid Analgesics ◽

Post Abortion ◽

At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

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Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183290 ◽

2018 ◽

Vol 7 (8) ◽

pp. 2998

Author(s):

Hale Göksever Çelik ◽

Engin Çelik ◽

Gökhan Yıldırım

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Prospective Observational Study ◽

Transperineal Ultrasound ◽

Direct Visualization ◽

Fetal Head ◽

Nulliparous Women ◽

Multiparous Women ◽

High Possibility ◽

Angle Of Progression

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was greater in the multiparous women giving birth by vaginal route.Conclusions: Transperineal ultrasound can be applied at the beginning of labor to predict whether vaginal delivery will occur or not. As shown in our study, the pregnant women with shorter HPD and wider AOP might have a high possibility to achieve vaginal delivery.

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Interinstitutional Variation of Caesarean Delivery Rates According to Indications in Selected Obstetric Populations: A Prospective Multicenter Study

BioMed Research International ◽

10.1155/2013/786563 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Gianpaolo Maso ◽

Monica Piccoli ◽

Marcella Montico ◽

Lorenzo Monasta ◽

Luca Ronfani ◽

...

Keyword(s):

Caesarean Delivery ◽

Relative Size ◽

Group Classification ◽

Prospective Multicenter Study ◽

Nulliparous Women ◽

Spontaneous Labour ◽

Multiparous Women ◽

Regional Centers ◽

Spearman’S Correlation ◽

Failure To Progress

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman’s correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P=0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P<0.001). As for the indications, “cardiotocographic anomalies” and “failure to progress” in the group of nulliparous women in spontaneous labour and “one previous CD” in multiparous women previous CD correlated significantly with institutional CD rates (P=0.021,P=0.005, andP<0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.

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The expectant brain: Being pregnant causes changes in brain morphology in the early postpartum period

10.1101/2021.06.29.450283 ◽

2021 ◽

Author(s):

Natalia Chechko ◽

Juergen Dukart ◽

Svetlana Tchaikovski ◽

Christian Enzensberger ◽

Irene Neuner ◽

...

Keyword(s):

Longitudinal Research ◽

Morphological Changes ◽

Gray Matter Volume ◽

Superior Temporal Gyrus ◽

Brain Morphology ◽

Cortical Thinning ◽

Nulliparous Women ◽

Maternal Brain ◽

Multiparous Women ◽

The Right

There is growing evidence that pregnancy may have a significant impact on the maternal brain, causing changes in its structure. However, the patterns of these changes have not yet been systematically investigated. Using voxel-based (VBM) and surface-based morphometry (SBM), we compared a group of healthy primiparous women (n = 40) with healthy multiparous mothers (n = 37) as well as nulliparous women (n = 40). Compared to the nulliparous women, the young mothers showed decreases in gray matter volume in the bilateral hippocampus/amygdala, the orbitofrontal cortex/subgenual prefrontal area, the right superior temporal gyrus, the right insula, and the cerebellum. However, these pregnancy-related changes in brain structure did not predict the quality of mother-infant attachment at either 3 or 12 weeks postpartum, nor were they more pronounced among the multiparous women. SBM analyses showed significant cortical thinning especially in the frontal and parietal cortices, with the parietal cortical thinning likely potentiated by multiple pregnancies. We conclude, therefore, that the widespread morphological changes seen in the brain shortly after childbirth reflect substantial neuroplasticity. Also, the experience of pregnancy alone may not be the underlying cause of the adaptations for mothering and caregiving. As regards the exact biological function of the changes in brain morphology as well as the long-term effect of pregnancy on the maternal brain, further longitudinal research with larger cohorts will be needed to draw any definitive conclusions.

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OP17.01: Risk assessment for pre-eclampsia in nulliparous women in the first trimester

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.17850 ◽

2017 ◽

Vol 50 ◽

pp. 102-102

Author(s):

T. Bultez ◽

J. Bernard ◽

J. Stirnemann ◽

L.J. Salomon ◽

Y. Ville

Keyword(s):

Risk Assessment ◽

First Trimester ◽

Nulliparous Women

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Childbirth trauma

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0059 ◽

2020 ◽

pp. 727-742

Author(s):

Stergios Doumouchtsis

Keyword(s):

Pelvic Floor ◽

Anal Sphincter ◽

Well Being ◽

Anal Sphincter Injury ◽

Nulliparous Women ◽

Childbirth Trauma ◽

Multiparous Women ◽

Short And Long Term ◽

Tissue Rupture ◽

Nerve Muscle

Pelvic floor disorders are strongly associated with childbirth and are more prevalent in parous women. Pelvic floor trauma commonly occurs at the time of the first vaginal childbirth. Conventionally, childbirth trauma refers to perineal and vaginal trauma following delivery and the focus has been on the perineal body and the anal sphincter complex. However, childbirth trauma may involve different aspects of the pelvic floor. Pelvic floor trauma during vaginal childbirth may involve tissue rupture, compression, and stretching, resulting in nerve, muscle, and connective tissue damage. Some women may be more susceptible to pelvic floor trauma than others due to collagen weakness. Childbirth trauma affects millions of women worldwide. The incidence of perineal trauma is over 91% in nulliparous women and over 70% in multiparous women. A clinical diagnosis of obstetric anal sphincter injury (OASIS) is made in between 1% and 11% of women following vaginal delivery. Increased training and awareness around OASIS is associated with an increase in the reported incidence. Short- and long-term symptoms of childbirth trauma can have a significant effect on daily activities, psychological well-being, sexual function, and overall quality of life.

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Discrimination by parity is a prerequisite for assessing induction of labour outcome – cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03334-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Branko Denona ◽

Michael Foley ◽

Rhona Mahony ◽

Michael Robson

Keyword(s):

Caesarean Section ◽

Cross Sectional Study ◽

Induction Of Labour ◽

Previous Caesarean Section ◽

Sectional Study ◽

Cross Sectional ◽

Nulliparous Women ◽

Significant Difference ◽

Multiparous Women ◽

Group 3

Abstract Background To demonstrate that studies on induction of labour should be analyzed by parity as there is a significant difference in the labour outcome among induced nulliparous and multiparous women. Methods Obstetric outcome, specifically caesarean section rates, among induced term nulliparous and multiparous women without a previous caesarean section were analyzed in this cross-sectional study using the Robson 10 group classification for the year 2016. Results In the total number of 8851 women delivered in 2016, the caesarean section rates among nulliparous women in spontaneous and induced labour, Robson groups 1 and 2A, were 7.84% (151/1925) and 32.63% (437/1339) respectively and among multiparous (excluding those women with a previous caesarean section), Robson group 3 and 4A were 1%(24/2389) and 4.37% (44/1005), respectively. Pre labour caesarean rates for nulliparous and multiparous women, Robson groups 2B and 4B (Robson M, Fetal Matern Med Rev, 12; 23–39, 2001) were 3.91% (133/3397) and 2.86% (100/3494), of the respective single cephalic cohort at term. Conclusion The data suggests that studies on induction of labour should be analyzed by parity as there is a significant difference between nulliparous and multiparous women.

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