Pregnancy and delivery in women aged 35 years and over.

At the Medical Centre Department of Gynaecology and Obstetrics in Sibenik there were 26 116 deliveries over the 1970-1991 period, of which 1502 (5.75%) occurred in women aged 35 years and older. Among them 254 (0.97%) were primiparas, 1074 (4.11%) multiparas (two to four deliveries) and 174 (0.6%) grand multiparas (five deliveries and more). The control group consisted of 7920 primiparas, 7920 multiparas (two to four deliveries) and 80 grand multiparas (five deliveries and more) aged 20 to 34 years. There was no difference for occupation between the two groups (P > 0.05), whereas rural women (59.5%), unmarried women (4.2%), women with spontaneous (21.0%) or induced abortions (23.3%) were more common in the study group (P < 0.001). No antenatal visit received 5.9% and 1.8% (P < 0.001) in the study and control groups, respectively; the mean number of antenatal visits was 6.05 +/- 3.20 and 6.26 +/- 3.12, respectively (t = 2.41, P < 0.05). Threatened abortion (16.8%), EPH gestosis (9.5%), cervical cerclage (5.8%), weight gain above 14 kg (9.8%), preterm labour (8.4%), delivery at > or = 42 weeks (3.1%), premature rupture of the membranes (16.4%), meconium-stained amniotic fluid (14.4%), and up to 6-hour duration of labour (73.2%, elective caesarean section (6.8%), emergency caesarean section (5.7%), vacuum extraction (3.8%) and placental lysis or uterine exploration (3.8%) were more common in women > or = 35 years of age (P < 0.05). Higher rates for 7-to-12-hour duration of labour (33.6%) and episiotomy (64.2%) were found in the control group (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal macrosomia--pregnancy and delivery.

The authors have studied pregnancy, delivery and early neonatal status of macrosomic infants (> or = 4000 g) delivered between January 1, 1984, and December 31, 1992. The control group comprised age--and parity--matched pregnant women and their newborns weighing 3000 to 3999 g. From 9980 singleton pregnancies, 2021 (20.3%) macrosomics were delivered. The incidence of macrosomia was 16.7% in the primiparous group, 23.1% in the parity 2-4 group, and 28.2% in the multiparous group (parity > or = 5) (P < 0.001). The rates of macrosomic infants for pregnant adolescents (aged < or = 19 years), pregnant women aged 20-34 years and old pregnant women (> or = 35 years) were 12.0%, 20.6% and 21.5%, respectively (P < 0.001). Macrosomia was not influenced by occupation and antenatal visits (P > 0.05). The rates of > or = 16 kg weight gain in the macrosomic and control groups were 36.2% (mean 14.30 +/- 4.66 kg) and 16.7% (mean 12.18 +/- 4.82 kg), respectively (t = 12.05; P < 0.001). Of 546 pregnant women with fetal macrosomia subjected to oral GT testing, glucose intolerance was found in 20.0% and gestational diabetes in 4.8%. The rates of glucose intolerance and gestational diabetes in 259 control subjects were 13.9% and 2.3%, respectively (P < 0.05). Light (index 1-4) and moderate (index 5-7) forms of EPH gestosis were more common in the macrosomic group, whereas no difference was observed for severe forms (index > or = 8) between the groups (P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The grand multipara--an obstetric problem?

At the Medical Central Department of Obstetrics and Gynecology in Sibenik over 1970-1991 period there were 26,116 deliveries (multiple births excluded), of which 254 (0.97%) occurred in grand multiparas (five and more deliveries). The authors have found that the number of grand multiparas decreased by 38.3% (P < 0.001) over the past eleven years. Control subjects were 7920 multiparas (two to four deliveries, 20-34 years of age, from the same period). In 84.3% of the cases grand multiparas were delivered of their fifth or sixth infant, and 68.5% were > or = 35 years of age. Spontaneous abortion occurred in 16.9%, and 14.2% had no antenatal visit. EPH gestosis (8.3%), glucose intolerance (9.9%), preterm delivery (8.3%) and meconium-stained amniotic fluid (15.0%) were more common in the grand multiparas, whereas cervical cerclage (5.4%) and 7-to-12-hour duration of labour (12.8%) were more common in the control group. No significant differences were found in weight gain, prolonged pregnancy, caesarean delivery, assisted breech and vacuum extraction between two groups. There was also no difference in the incidence of neonatal morbidity and congenital abnormalities between the grand multiparas and controls. Late fetal and early neonatal deaths in the grand multiparous and control group occurred in 1.18% and 1.57, respectively, resulting in a 2.75% overall perinatal death rate for both groups (P > 0.05). No case of maternal death or uterine rupture occurred in either group. The authors conclude that pregnancy and delivery in grand multiparas are at higher risk due to poorer antenatal care and advancing maternal age.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

[Pregnancy and labor in women over 40 years of age]. / Trudnoca i porodaj u rodilja s 40 i vise godina.

During the 1970-1989 period, there were 23,915 deliveries of which 278 (1.16%) occurred in women 40 years of age or older. The latter included 62 (22.3%) primiparas, 158 (56.8%) pluriparas and 58 (20.9%) multiparas. The control group consisted of 14,400 women 20-34 years of age (50% primiparas and 50% pluriparas) from the same period. There was no antenatal visit in 9.4% of the women 40 years of age or older. This group included more housewives, more unmarried women and more women with previous spontaneous and induced abortions than the control group (P less than 0.05). Threatened abortion (16.2%), EPH gestosis (22.3%), impaired glucose tolerance (8.3%), gestational diabetes (7.2%), delivery before 37 weeks (11.5%), delivery after 42 weeks (3.6%), premature rupture of the membranes (18.3%), meconium-stained amniotic fluid (19.8%), elective caesarean section (11.5%), caesarean section delivery (16.5%), vacuum extraction (4.7%), placental lysis or uterine exploration (4.3%) were more frequent in the study than in the control group (P less than 0.05). There were more cases with episiotomy (P less than 0.001) in the control group, whereas there were no differences as regards cervical cerclage, weight gain above 14kg, breech presentation, transverse presentation and assisted breech delivery between the two groups (P greater than 0.05). There was no case of uterine rupture or maternal death either in the study or the control group. The authors conclude that a woman 40 years of age and older is in an advanced age for pregnancy and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

[The course and outcome of pregnancy in adolescence in relation to chronologic and gynecologic age]. / Tok i ishod trudnoca maloljetnica prema kronoloskim i ginekoloskim godinama.

A total of 509 single pregnancies in teenagers up to 18 years old were examined. Younger teenagers proved to have low (1-2) gynecological years in 10.7% and older teenagers in 3.9%. There is no difference in the frequency of threatened abortions, EPH gestosis, placenta removal, and uterine exploration between the groups of younger and older, teenagers, but in teenagers with low gynecological years these complications observed significantly more frequently than in those with more gynecological years (p less than 0.001). No significant difference was recorded in the frequency of pre-term deliveries between younger and older teenagers (chronological age), whereas in teenagers with a low gynecological age there were significantly more pre-term deliveries than in those with more gynecological years (p less than 0.05). Vacuum extractor was applied significantly more frequently in teenagers 15-16 years old than in those 17-18 years (p less than 0.01). There is an even more pronounced significance in the frequency of delivery termination by vacuum extractor in teenagers with a low than in those with a higher gynecological age (p less than 0.001). Chronological and gynecological age have an significant effect on low birth mass children, the frequency of early neonatal complications, or perinatal mortality which in the teenagers examined was 15.7.

[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)

[Scoring of risk factors in pregnancy, labor and in the early neonatal period]. / Bodovanje faktora rizika u trudnoci, porodaju i u ranoj neonatalnoj dobi.

The authors established a risk factor scale for pregnancy, delivery, and newborns: the risk factor score up to 9 meaning a low risk, from 10 to 19 a moderate risk, and from 20 onwards a high risk. They found a high pregnancy risk in 10.9% of cases, high delivery risk in 14.02% of cases, and high risk newborns in 16.35% of cases. Low risk pregnant women had a premature delivery in 1.68%, those at moderate risk in 3.99%, and high risk pregnant women in 22.66% (P less than 0.001). There were 0.37% severely asphyxial (Apgar index 3 or below it) newborns in the low risk delivery group, 0.81% in the moderate risk group, and 4.36% in the high risk group (P less than 0.001). In the antepartal low risk group, the birth mass up to 2,499 g was found in 1.07%, in the moderate risk group in 1.71%, and in the high risk group in 19.70% of children (P less than 0.001). The mean birth mass of children from the low antepartal risk group was by 551.48 g higher than that from the high risk group (P less than 0.001). Neonatal morbidity in the low pregnancy risk group amounted to 11.0%, in the moderate risk group to 16.2%, and in the high risk group to 43.3% (P less than 0.001). There were 0.76% stillborns in the low pregnancy risk group and 34.48% in the high risk group (P less than 0.01). In the latter group also neonatal and perinatal mortality rates were higher (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pregnancy, labor and the neonate of the adolescent female]. / Trudnoca, porodaj i novorodence u maloljetnica.

The authors studied pregnancies in adolescents, younger than 18, from 1973 to 1983. The control group, randomly selected, consisted of 1000 child-bearing-women from 1976 (excluding adolescents and multiple pregnancies). The frequency of their labours was 3.24% and for the past five and a half years it decreased from 3.56% to 2.93% (P 0.05). There were 17.86 labours per 1000 adolescents in the age between 15 and 18. Adolescents are considerably more often living in rural areas, are single and unemployed than pregnant women in the control group. (P 0.001). EPH gestosis and threatened miscarriage are more frequent in adolescents than in the control group (P 0.05). Premature labour in adolescents occurs in 11.13% of cases, and postmature labour in 1.81% of cases, which is more frequent than in the control group (P 0.01). Pregnancy in adolescents lasts on the average 39.0 and in the control group 39.4 weeks. Adolescents are mostly primiparas (95.7%) and their labour lasts up to 12 hours (89.37%). Labours are mostly spontaneous (94.34%) and the frequency of cesarean sections is lower than in the control group (P 0.05). Adolescents' newborn infants are lighter than newborn infants in the control group (P 0.05). The newborn infants' birth weight increases with the age of their adolescents mothers. At birth, newborn infants of adolescent mothers have lower values of Apgar index than infants in the control group, have early neonatal complications in 16.06% of cases while infants in the control group in 12.40% of cases (P 0.05).(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.