[Pregnancy, labor and the neonate in multiparas under 34 years of age]. / Trudnoca, porodjaj i novoredjence multipara do 34. godine zivota.

The authors describe the pregnancy, labour and baby in 63 multiparae (five or more births), aged up to 34 years. The control group was composed of 6,480 pregnant patients (2-4 births), aged up to 34 years. The pregnancy in 17.5% of multiparae developed without medical examination and 19.0% of patients had one or two medical control examinations. This finding exceeded the findings in the control group (p less than 0.001). Rural house-wives predominated (p less than 0.001). During labour meconic foetal fluid was found in multiparae. Also exploration of the uterus or desquamation of the placenta were more frequent in them (p less than 0.05). However, the other course of pregnancy was the same as that in the control group (p greater than 0.05). There was no difference in babies born by a multipara or by a mother in the control group (p greater than 0.05). No death was recorded in the two groups. The authors conclude that there was no difference in pregnancy, labour and baby in a multipara with five or more labours and in a pluripara (2-4 births) aged up to 34 years.

[Perinatal outcome in older primiparas]. / Perinatalni ishod u starih prvorotkinja.

Pregnancy, delivery and the newborn infant of 212 old primiparas (aged greater than or equal to 35 years) and of 1968 age-matched old multiparas as controls were studied for the 1970-1989 period. The frequency of old primiparas and old multiparas was 0.9% and 4.1%, respectively, with no change for the 1970-1979 (1.0%) and 1980-1989 (0.8%) periods. The mean age in the old primiparous and old multiparous groups was 38.08 + 4.2 and 38.2 + 4.8 years, respectively (P greater than 0.05). The old primiparas had an average of 7.37 +/- 2.8 antenatal visits, whereas the old multiparas had 6.08 +/- 3.3 visits (P less than 0.05). The old primiparous group included more employees and fewer unskilled workers and housewives (P less than 0.05), more urban and unmarried pregnant women (P less than 0.001), whereas the old multiparas had more spontaneous and induced abortions (P less than 0.05). Threatened abortion (23.7%), EPH gestosis (20.3%), meconium-stained amniotic fluid (21.7%), caesarean section (35.8%), placental lysis or uterine exploration (6.6%) and episiotomy (100.0%) are more frequent in old primiparas than in old multiparas (P less than 0.05). The duration of labour in old primiparas tends to be longer: there was a significantly smaller number of pregnant women with an up 6-hour duration of labour (42.5%; P less than 0.05). The average duration of labour in the old primiparous and old multiparous groups was 8.18 +/- 5.40 and 5.89 +/- 3.80 hours, respectively (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pregnancy, labor and the neonate in pluriparas and multiparas]. / Trudnoca, porodaj i novorodence pluripare i multipare.

From 1971 to 1988, out of 22001 deliveries (multiple pregnancies excluded) 212 (0.96%) occurred in multiparas with five or more deliveries. The control group included 7340 pluriparas (two to four deliveries) from the same period. In 82.1% cases the multiparas were para 5 and 6, and 63 (29.7%) were less than 34 years of age. 15.9% had no antenatal visit; for the most part they were housewives and rural pregnant women. Transverse presentation, preterm delivery, meconium-stained amniotic fluid, and placental lysis or uterine exploration were more frequent in the multiparous group (P less than 0.001), whereas cervical cerclage and episiotomy were more frequent in the control group (P less than 0.05). Newborn infants in the multiparous group were severely asphyxiated at birth more frequently than those in the control group (P less than 0.05). There were no differences as regards late fetal and early neonatal deaths between the two study groups. The overall perinatal death rate in the multiparas and pluriparas was 2.83% and 1.81%, respectively (P less than 0.05). There was no case of uterine rupture or maternal death in the multiparous and pluriparous group.

[Prevention of hemolytic disease in newborn infants using anti-D immunoglobulin G]. / Prävention hämolytischer Krankheit bei Neugeborenen durch Anwendung von Immunglobulin-G-Anti-D.

The authors have analyzed the prevention of Rh-immunization from 1972 to 1983. Results are presented in two six-year periods, i.e. from 1972 to 1977 and from 1978 to 1983. Prevention was applied to all rh-negative women, who have been delivered from a rh-negative baby in their first childbirth (with negative sensibilization tests). Anti D IgG was also applied to all women after their second, third, fourth or subsequent delivery, if they were willing to have more children. Women with Du variant of the Rh factor and having a Rh-positive child were also protected. Preparations containing 250 to 300 micrograms of IgG anti-D were used. During the first period we found rh-negative mothers in 18.41 per cent, in 63.48 per cent of them the newborn was Rh-positive. During the second period 17.89 per cent of our women were rh-negative with 58.45 per cent Rh-positive babies. During the first period, protection was afforded to 60.26 per cent of the rh-negative women with incompatible babies, and in the second period to 79.11 per cent, respectively (P less than 0.05). During the second period, 99.70 per cent of women were protected after their first delivery (except of one case with immunization already during pregnancy), in contrast to the first period, where this percentage amounted only to 84.66 per cent (P less than 0.05). During both periods, a total of 69.51 per cent of the rh-negative women having Rh-positive babies received anti-D-immunization.(ABSTRACT TRUNCATED AT 250 WORDS)

[Advantages of preventing Rh isoimmunization]. / Korist od prevencije Rh imunizacije.

The authors analysed the frequency of Rh immunization from 1972 to 1983. The incidence of Rh-immunized women who after the birth of a Rh (D) positive child were not given anti-D immunoglobulin G and in subsequent pregnancies gave birth to a Rh (D) positive child was found to amount to 11.76%, while in women who were given anti-D immunoglobulin D this incidence was 0.77% (t = 5.98; p less than 0.05). Out of 29 Rh-immunized pregnant women, two developed Rh immunization in the course of the first pregnancy, three after the unsuccessful prevention of Rh immunization, and the rest after delivery or after delivery and abortion. Out of 29 Rh-immunized women, 27 (93.10%) were ABO-compatible and 2 (6.90%) ABO-incompatible with their child (p less than 0.05). In the first pregnancy the incidence of Rh immunization was 1.86 per 1000 deliveries in Rh negative pregnant women and 21.19 per 1000 deliveries in subsequent pregnancies (p less than 0.05). In the period observed there were 2.24 Rh immunizations per 1000 of all deliveries. From 1972 to 1977 there were 3.19 Rh immunizations per 1000 deliveries and from 1978 to 1983 only 1.43 (t = 2.08; p less than 0.05), which is a reduction by 55.17%. The perinatal mortality rate of children affected by Rh-hemolytic disease was 20%. In the last six years it has gone down by 60%, while the number of children with Rh-hemolytic diseases has been reduced by 50%.

[Pregnancy and labor in women with heart diseases]. / Trudnoca i porodaj u zena sa srcanim oboljenjima.

In a ten-year period the frequency of pregnant women with heart disorders amounted to 0.50%. In 83.87% of cases the disorders were acquired and in 16.13% congenital. According to the functional condition of the heart, 95% of the women observed belonged to the first and the second stage. In 82.26% the deliveries were spontaneously vaginal. The frequency of cesarean section proved four times as frequent as that in the control group (P less than 0.05). In not a single case was heart trouble alone the indication for cesarean section. Newborn children of women with heart disorders were slightly asphyxial (Apgar index 7-4) in 9.68% of cases as compared with 5.0% in the control group (P less than 0.05). The average birth mass of these newborns was 3491.9 +/- 2 SD 780.5 g and that in the control group 3,767.5 +/- 2 SD 824.2 g (P less than 0.05). Sixteen (25.8%) newborns in the early neonatal days had one or more neonatal complications, while those in the control group developed such complications in 14.2% of cases (P less than 0.05). Not a single child died perinatally. In the course of pregnancy, delivery, and puerperium only 3 (4.84%) women received cardiotonics and 22 (34.84%) antibiotics. The second day after delivery one puerpera developed paroxysmal tachycardia, while in all the remaining women the course of pregnancy, delivery, and puerperium was normal.