Maternal Record Research Articles

The Scrapbook in American life

An Introduction to the History of Scrapbooks - Katherine Ott, Susan Tucker, and Patricia P. Buckler Part I. Manuscripts of Learning and Knowledge 1. Between Person and Profession: The Scrapbooks of Nineteenth-Century Medical Practitioners - Katherine Ott 2. Daily Life on a South Carolina Plantation, 1855-1983: A Scrapbook Memory from Three Generations of Women - Anne Sinkler Whaley LeClercq 3. Letters, Scrapbooks, and History Books: A Personalized Version of the Mexican War, 1846-48 - Patricia P. Buckler 4. History in the Making: A Columbian Exposition Scrapbook - Jennifer A. Jolly 5. Scrapbook, Wishbook, Prayerbook: Trade Card Scrapbooks and the Missionary Work of Advertising - Ellen Gruber Garvey 6. Scrapbook Houses for Paper Dolls: Creative Expression, Aesthetic Elaboration, and Bonding in the Female World - Beverly Gordon 7. Souvenirs of Amerika: Hannah Hoch's Weimar-Era Mass-Media Scrapbook - Melissa A. Johnson Part II. Books of the Self 8. The Secret Scrapbook of a Soiled Dove - Carol Bowers 9. Inviting Narratives: Willa Cather's Childhood Scrapbook and My Antonia - Jennifer L. Bradley 10. In the Hands of Children: A Photographic Essay of Images from Children's Scrapbooks - Meredith Eliassen 11. Picturing Love and Friendship: Photograph Albums and Networks of Affection in the 1860s - Sarah McNair Vosmeier 12. Telling Particular Stories: Two African-American Memory Books - Susan Tucker 13. Maternal Records and Male Modernist Identities: The Family Albums of Ernest Hemingway and Christopher Isherwood - James Kelley 14. Miss Domestic and Miss Enterprise: Or, How to Keep a Photograph Album - Elizabeth F. Siegel 15. Horizons: The Scrapbooks of a Small-Town, Depression-Era Preteen - L. Rebecca Johnson Melvin

The role of independent component analysis in the signal processing of ECG recordings

Independent component analysis (ICA) is an emerging technique for multidimensional signal processing. In recent years, these techniques have been proposed for solving a large number of biomedical applications. This work reviews current knowledge on ICA in electrocardiographic (ECG) analysis. The benefits that ICA can bring to clinical practice are illustrated with four relevant clinical applications: foetal ECG extraction from maternal ECG recordings, analysis of atrial fibrillation, ECG denoising and removal of pacemaker artefacts.

Coding For Pregnancy

Codes for chapter 11 of the International Classification for Disease (ICD-9-CM), Complications from Pregnancy, Childbirth, and the Puerperium, have sequencing priority over most other codes. Additional codes may be used in conjunction with these to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then the code V22.2, Pregnant state, incidental, should be used as a secondary code. Chapter 11 codes are only for the maternal record and never go on the record of the newborn.

A Comparison of Maternal Interview and Medical Record Ascertainment of Violence among Women who had Poor Pregnancy Outcomes

This study investigated the agreement between self-reported and medical record assessment of exposure to violence and the impact of misclassification on the estimation of the association between exposure to violence and infant death and very low birthweight. The study population consisted of women who participated in two case-control studies on infant death and very low birthweight. There were 254 pairs of interviews and medical record reviews available for comparison. A total of 153 women (60.2%) reported ever being exposed to violence--92 (60.1%) based on the interview only, 18 (11.8%) based on the medical record only, and 43 (28.1%) in both sources. The sensitivity of the violence variables was low, ranging from 16.9% to 31.9% and kappa statistics showed poor agreement. Lower rates of all types of violence were found through the medical record than through the interview. Prevalence of violence based on medical record alone had a high degree of misclassification and some odds ratios were biased toward the null. Studies in which violence is an exposure, outcome, or confounder must use participant interviews in order to gather accurate information. A combination of sources may be the most accurate.

How good is probabilistic record linkage to reconstruct reproductive histories? Results from the Aberdeen Children of the 1950s study.

BackgroundProbabilistic record linkage is widely used in epidemiology, but studies of its validity are rare. Our aim was to validate its use to identify births to a cohort of women, being drawn from a large cohort of people born in Scotland in the early 1950s.MethodsThe Children of the 1950s cohort includes 5868 females born in Aberdeen 1950–56 who were in primary schools in the city in 1962. In 2001 a postal questionnaire was sent to the cohort members resident in the UK requesting information on offspring. Probabilistic record linkage (based on surname, maiden name, initials, date of birth and postcode) was used to link the females in the cohort to birth records held by the Scottish Maternity Record System (SMR 2).ResultsWe attempted to mail a total of 5540 women; 3752 (68%) returned a completed questionnaire. Of these 86% reported having had at least one birth. Linkage to SMR 2 was attempted for 5634 women, one or more maternity records were found for 3743. There were 2604 women who reported at least one birth in the questionnaire and who were linked to one or more SMR 2 records. When judged against the questionnaire information, the linkage correctly identified 4930 births and missed 601 others. These mostly occurred outside of Scotland (147) or prior to full coverage by SMR 2 (454). There were 134 births incorrectly linked to SMR 2.ConclusionProbabilistic record linkage to routine maternity records applied to population-based cohort, using name, date of birth and place of residence, can have high specificity, and as such may be reliably used in epidemiological research.

Risk scoring system for prediction of obstetric anal sphincter injury

The objective was to begin the process of developing an antenatal risk scoring system, as a first step towards examining whether elective Caesarean section for women at high risk of injury could be an effective and acceptable intervention. Retrospective study. Tertiary maternity unit in the UK. One hundred and twenty-three women who sustained an obstetric anal sphincter injury (OASI) and 123 controls without OASI. Case notes of women with a third or fourth degree tear between 1997 and 1999 were examined for risk factors. Controls matched for age and week of delivery were identified from the maternity record database and case records reviewed for the presence of risk factors. Unweighted and weighted risk scores were produced using odds ratios, and compared between cases and controls. Receiver operating characteristics (ROC) curve analysis of the risk scores was performed to discriminate between cases and controls and to calculate the sensitivity and specificity of each scoring system. Odds ratio (OR) and 95% confidence interval (CI) for each risk factor. Sensitivity and specificity from ROC curves for weighted and unweighted risk score. Among the cases there were more nulliparous women (OR 1.77; CI 1.05-2.99) and a trend towards more women with an episiotomy (OR 1.57; CI 0.99-2.47). Among women with sphincter injury, trends towards more epidurals (OR 1.64; CI 0.97-2.75), and more babies weighing more than 4000 g among (OR 1.45; CI 0.85-2.49) were noted. The median unweighted risk score was 2 for cases and 2 for controls (P= 0.05), while the weighted risk score was 2.1 and 1.37 (P= 0.03), respectively. The ROC curves approximated to a straight line demonstrating very poor discrimination between cases and controls. The predictive test performed poorly, suggesting that the risk factors identified do not exert a large enough effect in a cohort of this size.

Weight gain in childhood and bone mass in female college students

The attainment of maximal peak bone mass early on in life is one of the most important strategies for the prevention of osteoporosis in women. The aim of this study was to clarify the correlation between gains in body size in all growth phases in childhood and adult bone mass in women. The subjects were 86 female first-year university students, aged 18-21 years. We measured the subjects' bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine and the left hip, including the femoral neck, with dual energy X-ray absorptiometry. Each subject was measured for current height and weight. Height and weight at birth, and at 1.5, and 3 years were obtained from each maternity record book, and those between 6 and 18 years were obtained from their school health records. Other information, including physical activity and calcium intake, was obtained through an interview. Bivariate analysis showed that weight gains during the periods from birth to 1.5 years and from 9 to 12 years significantly correlated with both BMC and BMD values at any site. The stepwise method of multiple regression analysis showed that a weight gain during the period from birth to 1.5 years was significantly associated with BMC at the lumbar spine (P = 0.0001) and at the femoral neck (P = 0.0290) and with BMD at the lumbar spine (P = 0.0387). Birth weight was significantly associated with BMC at the lumbar spine (P = 0.0474) and the total hip (P = 0.0352), and weight gain during the period from 9 to 12 years was significantly associated with BMC at the femoral neck (P = 0.0376). In conclusion, birth weight and weight gain in infancy are important determinants of bone mass in young women. Additionally, a girl's prepubertal growth spurt is likely to be a key phase for the acquisition of bone mass in relation to body weight. Our findings suggest that osteoporosis prevention programs may need to start very early in the life cycle.

Analysis of the influence of diurnal variation in maternal movements on fetal heart rate acceleration.

To determine the influence of diurnal variation in maternal movements (MM) on fetal heart rate (FHR) accelerations, 24-hour maternal heart rates (MHR), MM and FHR recordings were made simultaneously on nine healthy pregnant women at 36-39 weeks of gestation. Correlations between the diurnal variations in maternal factors and FHR parameters; that is, baseline FHR, amplitude, duration and hourly percentage of time spent in accelerations, were examined. Only a few cases showed a significant correlation between acceleration parameters and the diurnal variation of MHR or MM, while most cases indicated a high correlation between the diurnal variation in baseline FHR and that of maternal factors. In conclusion, the occurrence and form of accelerations might be independent of maternal activity.

The Relationship between Birth Weight and Serum Insulin in Obese Children.

To reveal the relationship between birth weight and type II diabetes mellitus (DM) in obese children. Obese children (128 boys and 52 girls) with a mean age of 10.3 years were examined. The mean percent relative weight was 48.3% in boys, and 53.7% in girls. The fasting serum level of insulin and fasting plasma glucose were measured, and the homeostasis model assessment (HOMA) was calculated. Maternity record books were used to determine the weeks of gestation and the standard deviation score (SDS) for birth weight was calculated. The relation between insulin and HOMA, and birth weight and birth weight SDS were analyzed by simple regression. In boys, no relationship was found between serum insulin and birth weight. HOMA showed a negative correlation with birth weight SDS (r=-0.175, p<0.05). In girls, serum insulin showed a negative correlation with birth weight and birth weight SDS (r=-0.287, p<0.05, r=-0.316, p<0.05). HOMA showed a negative correlation with birth weight and birth weight SDS (r=-0.289, p<0.05, r=-0.315, p<0.05). Also, percent relative weight showed a negative correlation with birth weight and birth weight SDS (r=-0.301, p<0.05, r=-0.307, p<0.05). This study suggested a relationship between low birth weight and hyperinsulinemia. Fetal malnutrition in utero may lead to insulin resistance. We consider that low birth weight is one of the risk factors for type II DM in obese children.

Editor's Choice

Editor's Choice

Analysis of 104 twin pregnancies conceived with assisted reproductive technologies and 193 spontaneously conceived twin pregnancies

Objective: To evaluate pregnancy outcome of assisted reproductive technology (ART)-conceived twin pregnancies. Design: Retrospective study. Setting: A tertiary obstetric care center. Patient(s): All twin pregnancies delivered ≥24 weeks of gestation from January 1, 1996, to December 31, 1997. Intervention(s): Maternal and neonatal record review. Main Outcome Measure(s): Pregnancy and perinatal outcome. Result(s): The study group comprised 104 ART-conceived twin pregnancies, and 193 non-ART-conceived pregnancies served as controls. Mean maternal age, the proportion of nulliparae, and the percentage of women who delivered before 34 weeks’ gestation was higher among the study women, whereas mean gestational age was younger. The incidences of pregnancy-induced hypertension, uterine bleeding, premature contractions, intrauterine growth retardation, fetal death, discordance, and cesarean section were significantly higher in the study group. Correspondingly, in the study group, the mean birth weight of both twins was lower; more neonates weighed <1,500 g, more had Apgar scores of <7 at 5 minutes, more were admitted to the intensive care unit, and more second twin neonates died. The outcome of twin pregnancies conceived spontaneously was comparable with those conceived by ovulation induction. Conclusion(s): Assisted reproductive technology-conceived twin pregnancies are at greater risk than non-ART-conceived ones for pregnancy complications and adverse perinatal outcome.

The reliability and validity of self-reported reproductive history and obstetric morbidity amongst Birth to Ten mothers in Soweto.

To assess whether self-reports of reproductive history and obstetric morbidity provide an accurate basis for clinical decision-making. SETTING, PARTICIPANTS AND METHODS: Self-reports of maternal age and reproductive history, together with clinical measurements of five medical disorders, were abstracted from the obstetric notes of 517 mothers whose children were enrolled in the Birth to Ten study. These data were compared to self-reported information collected by interview during the Birth to Ten study. The reliability of self-reported age and gravidity was high (R = 0.810-0.993), yet self-reports of previous miscarriages, terminations, premature- and stillbirths were only fairly reliable (Kappa = 0.48-0.50). Self-reported diabetes and high blood pressure had specificities of more than 95% for glycosuria, hypertension and pre-eclampsia. However, the specificity of self-reported oedema for hypertensive disorders and the specificity of self-reported urinary tract infection for STD seropositivity were only around 65%. The modest reliability and limited validity of self-reported obstetric morbidity undermines the clinical utility of this information. These results strengthen the case for providing mothers with "Home-based Maternal Records" to facilitate access to accurate obstetric information during subsequent clinical consultations.

Newborn discharge timing and readmissions: California, 1992-1995.

Hospital stays for newborns and their mothers after uncomplicated vaginal delivery have decreased from an average of 4 days in 1970 to 1.1 days in 1995. Despite the lack of population-based research on the quality-of-care implications of this trend, federal legislation passed in 1996 mandated coverage for 48-hour hospital stays after uncomplicated vaginal delivery. To assess the impact of very early discharge (defined as discharge on the day of birth) on the risk of infant readmission during the neonatal period in a California healthy newborn population. Retrospective cohort study, based on a linked dataset consisting of the birth certificate, newborn, and maternal hospitalization record, and linked infant readmission records for all healthy, vaginally delivered, and routinely discharged California newborns from 1992 to 1995. Very early discharge and infant readmission during the first 28 days of life. The percentage of infants discharged very early or early (after a 1-night stay) increased from 71% in 1992 to 85% in 1995. The percentage of infants discharged very early increased from 5.0% in 1992 to 5.7% in 1993 and 7.0% in 1994, then decreased to 6.7% in 1995. Characteristics that have been previously associated with suboptimal pregnancy outcomes were found to decrease the likelihood of very early discharge, eg, maternal complications, primiparity, and Hispanic, African American, South East Asian, or other Asian race/ethnicity. The rate of readmission in the neonatal period initially decreased from 27.6 infants per 1000 in 1992 to 25.67 infants per 1000 in 1994, then increased to 30.2 infants per 1000 in 1995. For infants discharged early, no statistically significant increase in the risk of readmission was observed, compared with infants discharged after a 2+-night stay. The adjusted odds ratio (OR) for readmission was statistically significantly higher for infants who were discharged very early, compared with infants discharged early (OR: 1.27), first order births (OR: 1.21), infants born to mothers who experienced complications (OR: 1.11), infants with Medicaid insurance (OR: 1.23), and infants born to mothers who received adequate plus prenatal care (OR: 1.15). The risk was statistically significantly lower for female infants (OR: 0.75). The proportion of infants rehospitalized for dehydration and low-risk infections over the 4 study years combined was statistically significantly higher in infants discharged very early (4.37 per thousand and 10.30 per thousand, respectively), compared with infants discharged early (3.59 per thousand and 8.16 per thousand, respectively) or after a 2+-night stay (2.91 per thousand and 7.95 per thousand, respectively). The proportion of infants rehospitalized for dehydration increased statistically significantly from 2.89 per thousand in 1992 to 4.52 per thousand in 1995. One-night stays with adequate antenatal and postnatal care outside the hospital do not increase the risk of readmission for healthy, vaginally delivered infants born in California. However, the decision to discharge infants on the day of birth should be applied conservatively because of the increased risk of infant readmission associated with very early discharge.

Home-based mother's record: operational feasibility, understanding and usage in a rural community in Zimbabwe.

Utilization of health services is variable but may contribute to the well being of women during pregnancy. If people understand when there is a risk of illness or death, they are likely to cooperate in reducing those risks and participate in their own care. In rural communities people need to be provided with simple but scientifically-sound technology adapted to their understanding and needs. One such technology is the home-based maternal record (HBMR). We assess the feasibility, understanding and usage of a locally adapted HBMR of the World Health Organization prototype in a rural community in Binga district, Zimbabwe.

New epidemiological insights into pre-eclampsia, caesarean section and growth restriction

Cigarette smoking has undoubted harmful effects on health, but may protect against venous thromboembolism, inflammatory disease of the bowel and even pre-eclampsia. This last possibility is examined by Christine Martin and her colleagues (pages 745–749), who investigated the association of smoking and pre-eclampsia in 1575 twin pregnancies, using the information held by the Aberdeen Maternity and Neonatal Databank. The authors analysed the results of their study by tests of significance, but from the information in the paper it is possible to estimate the magnitude of the effect of smoking on pre-eclampsia. In multiparae the relative risk (95% confidence interval) of pre-eclampsia in smokers was 0.64 (0.42,0.98), a relationship which was not found in primiparae. Furthermore there was a linear trend in the number of cigarettes smoked and the risk of pre-eclampsia in multiparae. Does this dose-response effect in multiparae imply that smoking protects against pre-eclampsia? Not necessarily, say Christine Martin and colleagues, for the study also shows that women who smoked were more likely to sustain a miscarriage (relative risk 1.54; 95% confidence interval 1.11, 2.15), and to deliver prematurely (relative risk 1.12; 95% confidence interval 0.99, 1.26). Since pre-eclampsia is a disorder mainly of the latter part of the third trimester it is possible that miscarriage or preterm delivery associated with smoking may result in fewer women being at risk of pre-eclampsia later in pregnancy. The results of this investigation should be confirmed elsewhere in the world, if possible controlling for the confounding factors of parity, miscarriage and preterm delivery. Secular trends of increasing birthweight are often blamed, at least in part, for the progressive increase in the rate of caesarean section, but Gordon Smith (pages 740–744) suggests that the relationship is not straightforward. The author carried out a retrospective study of over one hundred thousand singleton pregnancies at term where labour was spontaneous, the information being obtained from the Scottish Maternity Record. There were positive trends in the rates of emergency caesarean section, birthweight and the proportion of infants with birthweights greater than 4000 grams, and a negative trend in the proportion of infants with birthweights less than 2500 grams. The risk of caesarean section with increasing birthweight showed a U shape, such that the risk was almost the same below 2500 grams as it was above 4000 grams. The trend towards increasing birthweight therefore will decrease the proportion of caesarean sections due to low birth weight but will increase the proportion of caesarean sections due to macrosomia. From Table 1, however, there were six times as many infants born with macrosomia as low birth weight, and so part of the increase in the number of caesarean sections must be due to macrosomia, on account of true cephalo-pelvic disproportion. However, the secular trend in the risk of caesarean section, adjusted for birth-weight, showed a steady increase, suggesting that other factors are also responsible for the increase in the rate of caesarean section, and not birthweight alone. Birthweight is also the theme of the study of J. Zeitlin and colleagues (pages 750–758), who tested the hypothesis that preterm infants are more likely to have growth restriction (or more correctly, be small for gestational age) than term infants. The authors used information from the European Program of Occupational Risks and Pregnancy Outcome, a case control study to identify the determinants of preterm birth. Standards of birthweight were derived from estimations of fetal weight by ultrasound, adjusted for maternal parity, weight, height, smoking and sex of the infant. After adjusting for confounding variables the risk of small for gestational age was six times as great where preterm delivery was induced, and was nearly twice as great where preterm delivery occurred spontaneously, compared with control infants delivered at term. This latter finding is especially interesting, for it suggests hypotheses which may explain idiopathic preterm delivery—subtle congenital defects, infection or intrauterine growth restriction.

Patient-controlled epidural analgesia in labor: The addition of clonidine to bupivacaine-fentanyl

Epidural clonidine has not been evaluated as a component of patient-controlled epidural analgesia (PCEA) solutions during labor. A randomized, double-blind trial was conducted to investigate the efficacy and side effects of PCEA using bupivacaine and fentanyl, with or without clonidine. Seventy-five healthy parturients in active labor were assigned to a PCEA solution of 0.0625% bupivacaine and fentanyl 2 microg/mL (4 mL demand bolus, 15 min lockout), with or without clonidine 4.5 microg/mL. The primary outcome measure was parturient rating of analgesia; others assessments included pain scores, drug utilization, supplementation and side effects. Thirty-one parturients received clonidine (group BFC) and 38 received control solution (group BF). Eight (6 group BF, 2 group BFC, P = .28) failed to achieve satisfactory epidural analgesia. There was a trend for parturient ratings of pain relief to be higher in group BFC, with significantly more reporting excellent first-stage analgesia (81% v. 57%, P<.05). Pain scores were similar. Clonidine (median dose, 28 microg/h) reduced total bupivacaine and fentanyl use (P<.01), and reduced supplementation (P<.01). Maternal blood pressure (BP) and recordings of systolic BP below 100 mm Hg did not differ. Group BFC had higher sedation scores (P<.01), but no one appeared oversedated. Shivering was reduced in group BFC (P<.01). The addition of clonidine to epidural bupivacaine and fentanyl for PCEA in labor improved analgesia, reduced the supplementation rate, and reduced shivering. Increased sedation and lower BP were not clinically important.

Perinatal Mortality in Breech Presentation Sibships

In Brief Objective To compare perinatal mortality in breech presentation delivered vaginally and by cesarean in individual births and in sibships. Methods A national, population registry-based study, 1967–1994, was conducted, with maternal record linkage of sibships, comprising the first to the third birth of a mother. The main outcome was perinatal mortality. Odds ratios of perinatal mortality were calculated and adjusted by logistic regression analysis. Results The overall relative perinatal mortality was 4.3 (95% confidence interval [CI] 4.1, 4.5) in breech compared with nonbreech presentation and 5.4 (95% CI 4.7, 6.2) in vaginal compared with cesarean delivery. The relative perinatal mortality in breech compared with nonbreech presentation was lowest in birth order one compared with birth orders two and three. In breech vaginal delivery compared with cesarean delivery, the opposite effect of birth order was found. The highest perinatal mortality was found in a current breech presentation of a sibship with no previous breech births. In birth subsequent to breech births, perinatal mortality was more or less independent of current presentation, without respect to delivery method. The increased perinatal mortality in breech presentation is explained partly by its association with other risk factors for perinatal death. Conclusion Women with recurring breech presentation represent a lower risk of adverse perinatal outcome. This might be explained by a biologic mechanism or by increased quality of antenatal care. An increased mortality in subsequent nonbreech siblings after a breech presentation was surprising. Increased perinatal mortality was observed in sibships with a sporadic breech delivery but not in those with recurring breech presentation, without respect to delivery method.

Perinatal mortality in breech presentation sibships

Objective: To compare perinatal mortality in breech presentation delivered vaginally and by cesarean in individual births and in sibships. Methods: A national, population registry–based study, 1967–1994, was conducted, with maternal record linkage of sibships, comprising the first to the third birth of a mother. The main outcome was perinatal mortality. Odds ratios of perinatal mortality were calculated and adjusted by logistic regression analysis. Results: The overall relative perinatal mortality was 4.3 (95% confidence interval [CI] 4.1, 4.5) in breech compared with nonbreech presentation and 5.4 (95% CI 4.7, 6.2) in vaginal compared with cesarean delivery. The relative perinatal mortality in breech compared with nonbreech presentation was lowest in birth order one compared with birth orders two and three. In breech vaginal delivery compared with cesarean delivery, the opposite effect of birth order was found. The highest perinatal mortality was found in a current breech presentation of a sibship with no previous breech births. In birth subsequent to breech births, perinatal mortality was more or less independent of current presentation, without respect to delivery method. The increased perinatal mortality in breech presentation is explained partly by its association with other risk factors for perinatal death. Conclusion: Women with recurring breech presentation represent a lower risk of adverse perinatal outcome. This might be explained by a biologic mechanism or by increased quality of antenatal care. An increased mortality in subsequent nonbreech siblings after a breech presentation was surprising.

Computerized surveillance and maternity records

This article reviews a computer system which incorporates the ability to provide continuous surveillance of cardiotocographs, with a flexible method of creating an electronic maternity record. Quantitative Surveillance (QS) can be purchased to be used as a surveillance unit with a full archiving ability, interfacing with Corometric's fetal monitors, or extended to provide a full maternity record. It will interface with other hospital information modules, including Hospital Information Support Systems (HISS). This article is not proposing to discuss the effect of electronic fetal monitoring on fetal outcome, but to discuss how such a system might enhance midwifery care, and help to assist in risk management issues which result in litigation. The practicalities, advantages and disadvantages from a user's perspective are addressed. The use of such a system should be considered by innovative practitioners.

Reproductive career after breech presentation: subsequent pregnancy rates, interpregnancy interval, and recurrence

Objective: To assess subsequent pregnancy rates and recurrence of breech, as well as interpregnancy interval after a breech presentation. Methods: We conducted a national population registry-based study using data from 1967 to 1994, with maternal record linkage of sibships, comprising the first to the fourth birth of a mother. Results: The subsequent pregnancy rate after a surviving breech birth was lower than after a surviving nonbreech birth. Women with two births, of which one was a perinatal loss, had a higher subsequent pregnancy rate, compared with those who had surviving infants. The subsequent pregnancy rate was lower after a cesarean delivery irrespective of presentation. The interpregnancy interval was shorter if the previous infant died, whereas presentation did not influence the interval. The adjusted odds ratio of recurrence of breech increased from 4.32 (95% confidence interval [CI] 4.08, 4.59) after one previous breech delivery to 28.1 (95% CI 12.2, 64.8) after three. Conclusion: Breech and cesarean delivery lowered the subsequent pregnancy rate, probably because of the women’s decision not to reproduce. Thus, preconceptional counseling with information, support, and reassurance regarding future pregnancies and deliveries might reduce the discouraging effect. A high odds ratio of recurrence of breech suggests effects of recurring specific causal factors of either genetic or more permanent environmental origin.