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Obstetric complications and schizophrenia - Two case-control studies based on structured obstetric records

BRITISH JOURNAL OF PSYCHIATRY 2000年第6期176卷 516-522页

作者： Kendell, RE McInneny, K Juszczak, E Bain, M Univ Edinburgh Dept Psychiat Royal Edinburgh Hosp Edinburgh Midlothian Scotland Natl Hlth Serv Scotland Informat & Stat Div Edinburgh Midlothian Scotland

Background Most previous case-control studies of obstetric complications in schizophrenia have been small scale and many have relied on retrospective information. Aims To determine which obstetric complications are more common in probands with schizophrenia than matched controls. Method Two hundred and ninety-six probands with an in-patient diagnosis of schizophrenia who had been born in Scotland in 1971-74, and a further 156 born in 1975-78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly afterbirth. Results Not a single complication of pregnancy or delivery was significantly more common in the probands with schizophrenia than the controls in the 1971-74 birth cohort and only emergency Caesarean section and labour lasting over 12 hours were significantly more common in the schizophrenia probands in the 1975-78 cohort. Conclusion The evidence that schizophrenia is associated with a raised incidence of obstetric complications is weaker than has recently been assumed. Declaration of interest Funded by the Scottish Office Department of Health.

关键词：病例对照研究队列研究分娩并发症/流行病学妊娠并发症/流行病学妊娠并发症/心理学产褥期疾病/流行病学产褥期疾病/心理学精神分裂症/流行病学精神分裂症/病因学苏格兰/流行病学青少年成年人女(雌)性人类男(雄)性妊娠

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Maternal smoking during pregnancy and evidence based intervention to promote cessation

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PRIMARY CARE 1999年第3期26卷 577-+页

作者： Mullen, PD Univ Texas Ctr Hlth Promot Res & Dev Sch Publ Hlth Hlth Sci Ctr Houston TX 77225 USA

Maternal smoking during pregnancy is hazardous to the developing fetus and mother. Smokers should be identified and offered personalized advice and assistance, including self-help materials tailored for pregnancy. Results of a meta-analysis of 16 randomized trials with validated outcomes indicate that such intervention increases cessation by 70% in diverse populations of pregnant women. At this time, intensive counseling on multiple occasions does not appear to increase cessation.

关键词：循证医学妊娠并发症/流行病学妊娠并发症/预防和控制产前保健患病率吸烟/流行病学吸烟/预防和控制戒烟/方法美国/流行病学女(雌)性人类妊娠

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Effect of medicaid managed care on pregnancy complications

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OBSTETRICS AND GYNECOLOGY 2000年第1期95卷 6-13页

作者： Oleske, DM Linn, ES Nachman, KL Marder, RJ Sangl, JA Smith, T Rush Univ Dept Hlth Syst Management Chicago IL 60612 USA Advocate Lutheran Hosp Pk Ridge IL USA Agcy Hlth Care Policy & Res Rockville MD USA Calif Dept Hlth Serv Maternal & Child Hlth Branch Sacramento CA USA

Objective: This study examined the impact of managed care on hospital obstetric outcomes in Medicaid-sponsored women. Methods: The study sample consisted of a total of 525,517 maternal deliveries for singleton births from three payer groups, Medicaid managed care, Medicaid fee-for-service, and private managed care in 439 short-term-stay nonfederal hospitals in California and Florida. Quality of care comparisons were made using six indicators. Data were derived from linked computer files of birth certificates, hospital discharge abstracts, Medicaid eligibility records, Medicaid health care claims, and surveys of hospital characteristics. Results: The overall multivariate likelihood of an adverse maternal outcome during hospitalization for a delivery was not significantly different between Medicaid managed care and Medicaid fee-for-service groups in California and Florida. However, mothers in the Medicaid managed care group compared with mothers in the private managed care group experienced a higher likelihood of eclampsia (California) (adjusted odds ratio = 1.26;95% confidence interval 1.05, 1.57;P=.04). Conclusion: Overall, managed care has not adversely affected pregnancy outcomes in Medicaid-sponsored women. Yet, payer system changes may be insufficient to achieve complete parity of outcomes relative to private managed care patients. (Obstet Gynecol 2000;95:6-13. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：加利福尼亚/流行病学按诊疗收费计划佛罗里达/流行病学 Logistic模型管理医疗规划/统计学和数值数据 Medicaid/组织和管理妊娠并发症/经济学妊娠并发症/流行病学妊娠结局/经济学妊娠结局/流行病学质量保证卫生保健美国女(雌)性人类妊娠

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Inflammatory pseudotumor of the liver and pregnancy

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第2期94卷 529-530页

作者： Maze, GL Lee, M Schenker, S Univ Texas Hlth Sci Ctr Dept Med San Antonio TX 78284 USA

Inflammatory pseudotumor of the liver (IPL) is a rare, nonneoplastic entity of unknown etiology, Our patient represents the first reported case of IPL that was managed conservatively during an intrauterine pregnancy. ... 详细信息

关键词：活组织检查肉芽肿浆细胞/流行病学肉芽肿浆细胞/病理学肉芽肿浆细胞/治疗肝/病理学肝疾病/流行病学肝疾病/病理学肝疾病/治疗妊娠并发症/流行病学妊娠并发症/病理学妊娠并发症/治疗妊娠结局成年人女(雌)性人类妊娠

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RELATIONSHIPS BETWEEN PRENATAL MEDICAL AND NUTRITIONAL MEASURES, PREGNANCY OUTCOME, AND EARLY INFANT DEVELOPMENT IN AN URBAN POVERTY SETTING .1. ROLE OF NUTRITIONAL INTAKE

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1975年第7期123卷 682-690页

作者： OSOFSKY, HJ TEMPLE UNIV HOSP HLTH SCI CTR DEPT OBSTET & GYNECOL PHILADELPHIA PA 19122 USA

Repeated nutritional assessments were made on 118 low-income women who registered at an urban hospital clinic prior to the 28th wk of pregnancy and then on 122 comparable women who were provided with protein-mineral supplementation. Demographic and background information were obtained. Medical assessments were carried out throughout pregnancy, labor, delivery and the postpartum period. The infants were assessed both medically and with Brazelton Neonatal Behavioral Assessment Scales. Despite their low-income status, the subjects did not appear nutritionally deprived. Few significant relationships were obtained between maternal nutritional intake and measures of maternal or infant medical status or infant psychological status. A limited number of consistent relationships were obtained when the supplemented and nonsupplemented groups were compared. Although consistent infant medical and psychological benefits were not noted, mothers in the supplemented group developed fewer parameters of pre-eclampsia and had fewer complications during labor and delivery.

关键词：方差分析儿童发育膳食收入婴儿新生母亲福利营养生理学现象营养需要宾夕法尼亚贫困妊娠妊娠并发症/流行病学产前保健市区人口青少年成年人女(雌)性人类

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Working conditions and adverse pregnancy outcome: A meta-analysis

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OBSTETRICS AND GYNECOLOGY 2000年第4期95卷 623-635页

作者： Mozurkewich, EL Luke, B Avni, M Wolf, FM CS Mott Childrens Hosp Dept Obstet & Gynecol Ann Arbor MI 48109 USA Univ Michigan Sch Med Div Maternal Fetal Med Ann Arbor MI 48109 USA Univ Michigan Sch Med Dept Obstet & Gynecol Ann Arbor MI 48109 USA Univ Washington Sch Med Div Maternal Fetal Med Seattle WA USA Univ Washington Sch Med Dept Med Educ Seattle WA USA Univ Washington Sch Med Dept Hlth Serv Seattle WA USA

Objective: To evaluate the association between working conditions and adverse pregnancy outcomes by performing a meta-analysis of published studies. Data Sources: We searched the English-language literature in MEDLINE through August 1999 using the terms standing, posture, work, workload, working conditions, shift, occupational exposure, occupational diseases, lifting, pregnancy complications, pregnancy, small for gestational age (SGA), fetal growth retardation (FGR), preterm, and labor. Methods of Stimy Selection: We included observational studies evaluating the effect of one or more of the following work-related exposures on adverse pregnancy outcome: physically demanding work, prolonged standing, long work hours, shift work, and cumulative work fatigue score. Outcomes of interest were preterm birth, hypertension or preeclampsia, and SGA. We conducted a meta-analysis based on 160,988 women in 29 studies to evaluate the association of physically demanding work, prolonged standing, long working hours, shift work, and cumulative work fatigue score with preterm birth. Also analyzed were the associations of physically demanding work with hypertension or preeclampsia and SGA infants. The data were analyzed using the Peto-modified Mantel-Haenszel method to estimate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). Tabulation, Integration, and Results: Physically demanding work was significantly associated with preterm birth (OR 1.22, 95% CI 1.16, 1.29), SGA (OR 1.37, 95% CI 1.30, 1.44), and hypertension or preeclampsia (OR 1.60, 95% CI 1.30, 1.96). Other occupational exposures significantly associated with preterm birth included prolonged standing (OR 1.26, 95% CI 1.13, 1.40), shift and night work (OR 1.24, 95% CI 1.06, 1.16), and high cumulative work fatigue score (OR 1.63, 95% CI 1.33, 1.98). We found no significant association between long work hours and preterm birth (OR 1.03, 95% CI 0.92, 1.16). Conclusion: Physically demanding work may significantly i

关键词：职业暴露妊娠并发症/流行病学妊娠并发症/病因学妊娠结局女(雌)性人类妊娠

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Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999年第5期106卷 498-500页

作者： Locatelli, A Roncaglia, N Arreghini, A Bellini, P Vergani, P Ghidini, A Ist Sci Biomed San Gerardo Dept Obstet & Gynecol I-20052 Monza Italy

To investigate a possible relationship between hepatitis C virus infection and cholestasis of pregnancy, we identified all cases of cholestasis of pregnancy (145/16,271) and hepatitis C virus infection (63/16,271) between January 1992 and December 1997. Serologic screening was performed universally. The rate of cholestasis of pregnancy was greater in women whose hepatitis C virus antibodies were positive rather than negative [15.9% (10/63) vs 0.8% (135/16,208), P < 0.001]. Among women with cholestasis of pregnancy, mean (standard deviation) gestational age at onset of symptoms and at delivery was significantly lower among women whose hepatitis C virus antibodies were positive compared with negative women: 28.9 (3.2) vs 34.3 (3.5) weeks, P < 0.001 and 36.3 (0.9) vs 37.0 (1.6) weeks, P = 0.03, respectively. These findings suggest that early occurrence of cholestasis of pregnancy may be an indication for serologic testing for hepatitis C virus.

关键词：胆汁淤积/流行病学胆汁淤积/病因学酶联免疫吸附测定孕龄丙型肝炎/并发症丙型肝炎/流行病学发病率意大利/流行病学妊娠并发症/流行病学妊娠并发症/病因学回顾性研究女(雌)性人类妊娠

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Symptomatic nephrolithiasis complicating pregnancy

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OBSTETRICS AND GYNECOLOGY 2000年第5期96卷 753-756页

作者： Butler, EL Cox, SM Eberts, EG Cunningham, FG Univ Texas SW Med Ctr Dept Obstet & Gynecol Dallas TX 75390 USA

Objective: To review our experiences with diagnosis and management of symptomatic nephrolithiasis complicating pregnancy and to ascertain the efficacy of renal sonography for initial diagnosis compared with plain x-rays or single-shot intravenous pyelography. Methods: Perinatal outcomes were evaluated for all pregnant women admitted to Parkland Hospital for nephrolithiasis from 1986 to 1999. Diagnostic studies and management of nephrolithiasis were also evaluated. Results: During the 13-year study period, 57 pregnant women had 73 admissions for symptomatic nephrolithiasis. Symptomatic nephrolithiasis complicated 1 in 3300 (0.03%) deliveries at our institution. Only 12 women (20%) had a history of renal calculi. Mean gestational age at diagnosis was 23 weeks. Imaging techniques included renal ultrasonography, plain abdominal x-ray, and single-shot intravenous pyelography. Calculi were visualized in 21 of 35 (60%) renal ultrasonographic examinations and 4 of 7 (57%) abdominal x-ray studies when these were performed as the initial test. In contrast, urolithiasis was discovered in 13 of 14 (93%) instances in which intravenous pyelography was performed as the initial diagnostic test. When sonography was negative (n = 14), renal calculi were confirmed by single-shot intravenous pyelography (n = 8). Although 43 of 57 (75%) of symptomatic episodes responded to conservative management, 10 women required ureteral stents, 3 needed percutaneous nephrostomy tubes, and 2 underwent ureteral laser lithotripsy for resolution. Conclusion: Although the convenience and safety of ultrasonography to initially diagnose nephrolithiasis are indisputable, 40% of calculi were missed when this method alone was used. Thus, if nephrolithiasis is still suspected clinically despite ultrasonographic findings, single-shot pyelography is recommended. (Obstet Gynecol 2000;96:753-6. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：发病率肾结石/诊断肾结石/流行病学肾结石/治疗病案妊娠并发症/诊断妊娠并发症/流行病学妊娠并发症/治疗妊娠结局产前保健产前诊断得克萨斯/流行病学超声检查产前成年人女(雌)性人类妊娠

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Urinary incontinence: prevalence and risk factors at 16 weeks of gestation

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999年第8期106卷 842-850页

作者： Hojberg, KE Salvig, JD Winslow, NA Lose, G Secher, NJ Aarhus Univ Hosp Dept Obstet & Gynaecol Perinatal Epidemiol Res Unit DK-8200 Aarhus N Denmark Aarhus Univ Hosp Dept Surg L Surg Res Unit DK-8200 Aarhus N Denmark Univ Copenhagen Glostrup Cty Hosp Dept Obstet & Gynaecol DK-1168 Copenhagen Denmark

Objective To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors. Design Cross-sectional study and cohort study. Setting Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark. Population Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department. Results Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%, para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7;95% CI 3.9-8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9;95% CI 1.0-3.6) increased the risk of urinary incontinence;mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3.5;95% CI 1.2-10.2);a number of other intrapartum factors did not increase the risk of urinary incontinence. Conclusions The first vaginal delivery was a major risk factor for developing urinary incontinence;subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk;episiotomy in combination with birthweight > 4000 g also increased the risk.

关键词：剖宫产术/副作用队列研究横断面研究丹麦/流行病学会阴切开术/副作用肥胖症/并发症肥胖症/流行病学分娩并发症/流行病学产次妊娠并发症/流行病学妊娠中期患病率危险因素尿失禁/流行病学青少年成年人女(雌)性人类妊娠

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SICKLE-CELL TRAIT AND PREGNANCY - REVIEW OF A COMMUNITY HOSPITAL EXPERIENCE

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1975年第1期123卷 6-11页

作者： RIMER, BA CHARLOTTE MEM HOSP DEPT OBSTET & GYNECOLPOB 2554CHARLOTTENC 28201

The obstetric experiences of 128 gravidas delivered at Charlotte Memorial Hospital in 1973 who, on hemoglobin electrophoresis, exhibited an SA pattern of hemoglobin are reviewed. In addition to previously reported complications of increased rates of pyelonephritis and refractory anemia, this group of patients exhibited a marked increase in premature rupture of membranes and prematurity. It is suggested that the routine screening procedures be used for discovering sickle-cell trait individuals and that they be categorized as “high-risk” obstetric patients because of the increased complication rates described here and by previous authors.

关键词：贫血镰状细胞性/并发症血红蛋白镰状/分析医院社区北卡罗来纳先兆子痫/流行病学妊娠并发症/流行病学肾盂肾炎/流行病学镰状细胞遗传性状/血液镰状细胞遗传性状/并发症泌尿道感染/流行病学青少年成年人女(雌)性人类妊娠

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