Multiparous Women Research Articles

Gender Disparities in Allograft Access Due to HLA-Sensitization in Multiparous Women: Implications for Evaluation of Female Patients for Alternative Donor Transplantation

Introduction: The relationship between allograft patient (pt) demographics & HLA-antibody (HLA-Ab) burden, & the degree to which HLA-Ab burden impacts donor type received in the current era of “donors for all”, is not established. Methods: We examined associations between pt sex/ parity, ancestry, & HLA-Ab burden in consecutive adult allograft recipients (excluding HLA-identical siblings) with acute leukemia, MDS, or MPN, transplanted 1/2018-12/2022. We also assessed the impact of HLA-Ab burden on donor type received. We classified HLA-Ab burden by the number & intensity of class I (HLA-A, B, -C) & II (HLA-DR, -DQ, -DP) HLA-Abs. A mean fluorescence intensity (MFI) > 1,000 defined a positive HLA-Ab. Pts were classified as broadly sensitized (more than the median number of class I/ II HLA-Abs among Ab positive pts) &/or highly sensitized (MFI > 10,000 for ≥ 1 HLA-Ab). For pts with > 1 screen, the one closest to transplant was used. We hypothesized that multiparous females have the greatest HLA-Ab burden, limiting provision of haploidentical (haplo) grafts in these pts due to the rejection risk. Results: Of 672 pts [median age 60 yrs (range 29-79), 419/672 (62%) with acute leukemia, 472/672 (70%) with European ancestry], 278/672 (41%) were female of whom 54/278 (19%) were nulliparous, 52/278 (19%) uniparous & 172/278 (62%) multiparous. Overall, 367/672 (55%) received 8/8 unrelated donor (URD) & 305/672 (45%) HLA-disparate grafts [137 cord blood (CB), 88 haplo, & 80 5-7/8 URD (mmURD)]. As expected, non-European pts received 2x the proportion of HLA-disparate grafts [165/472 (35%) vs 141/200 (70%), p < .001]. Pt ancestry was not associated with HLA-Ab burden. Pt sex/ parity & HLA-Ab burden associations are shown in Table 1A & Fig. 1. Over one third [254/672 (38%)] of pts had a positive screen for class I/ II HLA-abs (median of 8 HLA-Abs of positive pts, range 1-113). In the 254 positive pts, 3,563 Abs were detected with the MFI distribution being 1,001-4,000 in 1,340/3,563 (38%), 4,001-10,000 in 874/3,563 (25%) & > 10,000 in 1,349/3,563 (38%). Of the total pt cohort, 140/672 (21%) pts were broadly &/or highly sensitized with 90/672 (13%) being both broadly & highly sensitized. Compared with males & nulliparous females, uni- & multi-parous female pts had over 2x the proportion of positive screens [117/448 (26%) vs 137/224 (61%), p < .001]. They also had more than 8x the proportion broadly & highly sensitized [17/448 (4%) vs 73/224 (33%), p < .001]. HLA-Ab burden by donor type is shown in Table 1B. Among HLA-disparate graft recipients, compared with recipients of CB & mmURDs, fewer haplo recipients had positive screens [96/217 (44%)CB/ mmURD vs 27/88 (31%) haplo, p = .029]. Less than half the proportion were broadly & highly sensitized [37/217 (17%) CB/ mmURD vs 7/88 (8%) haplo, p = .041]. Also, haplo recipients included the fewest multiparous females [16/88 (18%)] compared with making up over one quarter of 8/8 URD [98/367 (27%)], CB [36/137 (26%)], or mmURD [22/80 (28%)] transplants. Conclusion: Over 10% of transplanted pts were broadly & highly sensitized to HLA. The HLA-Ab burden was predominantly in parous females (33% of our pt cohort), most of whom had HLA-Abs with one-third of this group being both broadly & highly sensitized. Moreover, pts with a high HLA-Ab burden were the least likely to receive haplos, & thus these transplants were less common in multiparous females. These data have immediate implications for alternative donor transplant evaluations of female patients: given that HLA-Abs should be expected among parous females, in the absence of a matched adult donor, mmURD or CB may need to be considered over haplo grafts. This could compound allograft access for multiparous female pts of non-European heritage, given many will lack a fully matched adult donor & non-European pts have greatly decreased URD availability (Fingrut et al., ASH 2023). These challenges are under-appreciated in the transplant field. At initial allograft evaluation, transplant centers should obtain ancestry & parity histories & screen for HLA-Abs. In the absence of a suitable HLA-identical sibling donor, this information, together with the URD search prognosis (ie Davis et al., TCT 2023), should then guide triage to alternative donor allografts. Finally, prospective analysis of the impact of donor-specific HLA-Abs on donor selection & transplant outcomes as well as development of effective HLA de-sensitization strategies are urgently needed.

Effect of grand multiparity on maternal, obstetric, fetal and neonatal results.

The aim of the study was to compare the incidence of antenatal and intrapartum complications and perinatal outcomes between grand multiparous women of the same age and socioeconomic status and nulliparous and multiparous women. A prospective case-control study was conducted at the Tertiary Center Gynecology and Obstetrics Clinic of the Eastern Anatolia Region between January 1, 2021, and January 1, 2023. It was compared with 149 grand multiparous, 724 multipara, and 258 nulliparous singleton pregnancies. The data were entered separately by two people and then compared. The delivery period, gestation period, maternal obstetric, and fetal and neonatal outcomes of the groups were compared. The frequency of postpartum hemorrhage, antepartum and postpartum anemia was significantly higher in grand multiparity patients than in other groups. Gestational hypertension, Gestational DM and Abortus imminent, and the frequency of preterm birth increases with parity. The frequency of hyperemesis gravidarum and preeclampsia was significantly higher in nulliparous pregnant women than in others. There was no difference between the groups in terms of premature rupture of membranes and post-term pregnancy. Among the neonatal outcomes, only the frequency of low birth weight was significantly higher in grand multiparous patients. The frequency of postpartum anemia, postpartum bleeding, gestational hypertension, gestational diabetes, and preterm pregnancy is higher in grand multiparity patients than in multiparous and nulliparous patients. Due to the increased risks with grand multiparity, pregnancy follow-up, and follow-up should be done within the risk factors of these patients in regions where grand multiparity is intense, and family planning practices should be increased.

Effect of hypopressive exercises versus pelvic floor muscle exercises on stress urinary incontinence among multiparous women

Effect of hypopressive exercises versus pelvic floor muscle exercises on stress urinary incontinence among multiparous women

Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland.

Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.

Comparing Obstetric and Perinatal Outcomes Following Elective and Emergency Cervical Cerclage in Singleton and Multiple Pregnanciesin a Tertiary Care Perinatal Centre.

To compare the success, failure rates and perinatal outcomes following emergency and elective cervical cerclage in singleton and twin pregnancies at a tertiary care perinatal centre over half a decade. All pregnant women, both with singleton and twin pregnancies, who had cervical cerclage between June 2014 and May 2019were included in the retrospective study. Success rates, failure rates, maternalcomplications and perinatal outcomes were compared in both groups. There were 129 women enrolled in the study, 48 in the emergency and 81 in the elective group. A significantly greater number of multiparous women werein the elective group (97.5% versus 68.7%; p-value < 0.001). Twins were nearly four times more in the emergency group as compared tothe elective group. The mean cervical length at time ofcerclage was 2.05cm and 1.5cm; (p-value < 0.001) respectively in the elective and emergency groups. Almost half of the women in the emergency group hadbulging membranes. (52.2%). Following cerclage, mean gestational age at delivery was similar in both groups. However, more women in the elective group delivered at or beyond 34weeksin comparison to the emergency groups (71% versus 53.3%. P-value 0.05). Preterm labour leading to preterm births wasalmost twice in the emergency groupthan elective group (49% versus 22%, P-value 0.002). Rates of maternal chorioamnionitis were similar in both groups. Theoverall live birth rates were comparable (81.3% versus 84.4% P-value 0.85) in boththe groups. These results were also seen on doing subgroup analysis of elective versus emergency cerclage in singleton pregnancies only. Failure rates were also similar in both groups (18.7% versus 15.6%, P-value 0.85) Composite neonatal morbidity was more in the emergency group than in the elective group (35.5 versus 14%, P-value 0.01). Live birth rates and failure rates were comparable following elective and emergency cerclageboth overall and in singleton pregnancies. Maternal chorioamnionitis and neonatal sepsisrates were similar in both the groups. However, composite neonatal morbidity was higher in the emergency cerclage group.

Is parenthood associated with self-rated health among women in Brazil?

Previous studies conducted in Europe and North America addressing the relationship between self-rated health and parenthood offer inconsistent results, with effects ranging from nonsignificant to significant and in opposite directions. The aim of the present study was to explore the relationship between parenthood and self-rated health (SRH) among women in Brazil (a country with strong inequalities) considering the time interval from the last delivery in the analyses, as proposed in previous studies set in Sweden. The study used data from cross-sectional National Health Surveys in Brazil conducted from 2013 to 2014 and 2019 to 2020 with selected groups of 20,046 and 25,100 women for whom complete data were available on the variables of interest. The primary outcome was self-rated health measured on a five-point scale. Partial proportional odds models were employed. Compared to women that were not a parent, primiparous women whose delivery was within less than one year had a lower likelihood of worse SRH (OR (95% CI): 0.58-0.84 in 2013, and 0.64-0.94 in 2019), whereas multiparous women whose last delivery was more than one year earlier had greater likelihood of worse SRH (OR (95% CI): 1.08-1.27 in 2013, and 1.21-1.39 in 2019). An association was found between parenthood and SRH among Brazilian women. Considering the epidemiological relevance of SRH, different aspects of parenthood concerning parity and time since the last delivery should be considered in further analyses.

Comparison of efficacy and safety of the Dinoprostone Vaginal tape and Dinoprostone vaginal tablet for the induction of labor in para three and more women: A retrospective cohort Study

Background: Prostaglandins have a central role in the cervical ripening and parturition, and have been widely used for induction of labor (IOL). This study aimed to compare the effectiveness and safety of Dinoprostone vaginal tape (Propess) over Dinoprostone vaginal tablets (Prostin) for IOL and find which has better outcome to be applied in clinical practice. Participants and Methods: A retrospective cohort study was conducted via reviewing of medical records of multipara women admitted to King Fahad Medical City, Riyadh between January-2021 and December-2022 for IOL by Propess or Prostin. Results: A total of 87 multipara women were included in the study; 39 (44.8%) were treated by Propess and 48 (55.2%) were treated by Prostin for IOL. Full dilatation of the cervix after induction of labour was reported among majority of women (94.2%): being 92.1% among women treated with Propess and 95.8% among those treated with Prostin, however, this difference was not statistically significant, p&gt;0.05. Regarding mode of delivery, normal spontaneous vaginal delivery was reported among 84.9% of women; 86.8% among women treated with Propess and 83.3% among those treated with Prostin while emergency cesarean section delivery was reported among 10.5% of women; 7.9% among women treated with Propess and 12.5% among those treated with Prostin. However, these differences were not statistically significant, p&gt;0.05. Conclusion: The success rate of IOL among multipara women was high; however, no difference was reported between Propess and Prostin as regards the effectiveness (maximum cervical dilatation) and safety (rate of emergency cesarean section).

Socioecological correlates of parental lifestyle patterns during the prenatal period

Abstract Background There is growing evidence that family lifestyle patterns in early life are associated with the risk of child obesity. However, beyond the influence of socio-economic position, scarce are studies on the social determinants of such lifestyle patterns. The aim was therefore to investigate the socio-ecological correlates of parental lifestyle patterns in pregnancy. Methods We selected 1,110 families from the EDEN birth cohort, recruited in two maternity hospitals in France between 2003 and 2006. In a previous work, we identified two parental lifestyle patterns characterized by 1) “high parental smoking, low maternal diet quality, and low leisure physical activity 2) “low parental body mass index and high gestational weight gain”. Within the framework of both socio-ecological and hierarchical approaches, we conducted multivariable linear regression analyses, with socio-ecological factors added progressively from the most distal to the most proximal, i.e. urban environment variables (block 1); socio-economics, geographic origin, parents’ age, parity (block 2); and psychological factors or access to health care (block 3). Results Parents with a higher socio-economic position (education level, household income), first-time or older mothers and those having attended antenatal sessions had lower scores on the first pattern. Multiparous women, with an intermediate level of education, and older fathers had lower scores on the second pattern. No major associations were reported with urban environment or psychological factors. Conclusions Beyond the expected socio-economic gradient of family lifestyle patterns, we report novel insights into potential levers specific to the prenatal period, such as the opportunity of parenting preparation to engage in healthy behaviours. Analyses will be replicated in three other European cohorts, if confirmed, these findings will be valuable to increase the effectiveness of future childhood obesity prevention strategies in early life. Key messages • Higher socio-economic conditions and attendance of parenting preparation classes are associated with healthier family lifestyle in pregnancy. • The identification of potential facilitators and barriers for family lifestyle in early life will help for further translation to effective childhood obesity prevention and implementation strategies.

Gebelerin ikinci trimester ayrıntılı ultrasonografi muayenesi öncesi bilgi düzeyleri, beklenti ve tutumları

Objective: Our objective is to investigate the pregnant women’s background knowledge, expectations, emotional status and attitudes about detailed ultrasonography performed between 18-24 weeks of gestation.&#x0D; Methods: A cross-sectional survey study with a consecutive sampling method was conducted with the pregnant women between 18- 24 weeks of gestation admitted to the perinatology unit at a tertiary referral center. Questionnaire was designed for the study and it was mainly composed of closed questions investigating pregnant women’s sociodemographic data, obstetric history, background information about ultrasound, purpose&amp;expectations, opinion about invasive diagnostic testing and termination of pregnancy in fetal anomalies and emotional status. Data was analysed using descriptive statistics. &#x0D; Results: Two hundred fifty seven pregnant women were enrolled to the study. Confirmation of health of the baby was the main motive for having an ultrasound scan at second trimester. One hundred twentyfive (48,6%) and 77 (30%) women believed that all congenital anomalies and all genetic diseases are detectable by second trimester ultrasound respectively. Ultrasonography was regarded as a safe imaging method for the fetus by 162 (63%) women. Multiparous women did not have a better background knowledge about ultrasound scan than nulliparous. In the case of a severe fetal anomaly, 193 (75%) women said they would continue pregnancy. Overall number of women that felt anxious prior to the ultrasound scan decreased and their feelings changed in a positive way following ultrasound examination (p

Predicting female pelvic tilt and lumbar angle using machine learning in case of urinary incontinence and sexual dysfunction

Urinary incontinence (UI) is defined as any uncontrolled urine leakage. Pelvic floor muscles (PFM) appear to be a crucial aspect of trunk and lumbo-pelvic stability, and UI is one indication of pelvic floor dysfunction. The evaluation of pelvic tilt and lumbar angle is critical in assessing the alignment and posture of the spine in the lower back region and pelvis, and both of these variables are directly related to female dysfunction in the pelvic floor. UI affects a significant number of women worldwide and can have a major impact on their quality of life. However, traditional methods of assessing these parameters involve manual measurements, which are time-consuming and prone to variability. The rehabilitation programs for pelvic floor dysfunction (FSD) in physical therapy often focus on pelvic floor muscles (PFMs), while other core muscles are overlooked. Therefore, this study aimed to predict the activity of various core muscles in multiparous women with FSD using multiple scales instead of relying on Ultrasound imaging. Decision tree, SVM, random forest, and AdaBoost models were applied to predict pelvic tilt and lumbar angle using the train set. Performance was evaluated on the test set using MSE, RMSE, MAE, and R2. Pelvic tilt prediction achieved R2 values > 0.9, with AdaBoost (R2 = 0.944) performing best. Lumbar angle prediction performed slightly lower with decision tree achieving the highest R2 of 0.976. Developing a machine learning model to predict pelvic tilt and lumbar angle has the potential to revolutionize the assessment and management of this condition, providing faster, more accurate, and more objective assessments than traditional methods.

First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors

BackgroundEarly detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa.MethodsObservational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger’s test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis.ResultsA total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3–41.0; I2 = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5–3.1; I2 = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2–1.9; I2 = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4–2.2; I2 = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2–2.4: I2 = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5–2.7; I2 = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7–2.1; I2 = 94.4%).ConclusionBecause so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women.Trial registrationPROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).

Pattern of Pica Practices and Prevalence of Gestational Hypertension among Antenatal Attendees in Tertiary Hospitals in Rivers State

More than 500,000 women die each year from pregnancy and childbirth-related causes. Gestational hypertension complicates the pregnancy of 6-17% of healthy primigravida women and 2-4% of multiparous women. Maternal nutrition is a major factor for avoiding many complications in pregnancy and bring about good pregnancy outcomes. The aim of the study was to assess the Pattern of Pica Practice and Prevalence of Gestational Hypertension among Antenatal Attendees in Tertiary Hospitals in Rivers State. This study was a descriptive cross sectional study conducted on 250 antenatal attendees between the ages of 18 and 45 years in tertiary hospitals in Rivers State. It was a non-invasive self-administered questionnaire based study. Data obtained from the study was analysed using Statistical Package for Social Sciences (SPSS) version 25 and values of 0.05 and below were considered significant. The result obtained from the study revealed a 14.0% prevalence of gestational hypertension among antenatal attendees. It also revealed a 31.6% pattern of pica among the attendees. The most common forms of pica in the study were Geophagia (75.9%), Pagophagia (64.6%), Amylophagia (20.3%), and lastly Lithophagia (16.5%). The frequency of pica was 55.7% daily, 8.9% thrice a week and 36.4% weekly. Those with mild pica were about 31.6%, moderate pica was 55.7% and severe was about 12.7%. At the end of the study, it was ascertained that there was a 14% prevalence of gestational hypertension among antenatal attendees at tertiary hospitals in Port Harcourt. The pattern of pica among the women was 31.6% and consisted of Geophagia, Pagophagia, amylophagia and lithophagia. There was a significant association between sociodemographic characteristics such as age, marital status, occupation and ethnicity with pica practice. Clinical and obstetric characteristics like gravidity, parity, blood pressure and f

Postpartum resolution of hypertension, proteinuria and acute kidney injury among women with preeclampsia and severe features at Mulago National Referral Hospital, Uganda: a cohort study.

The resolution of hypertension, proteinuria and AKI postpartum among women with preeclampsia is not well documented in Uganda. To determine the time to resolution of hypertension, proteinuria and AKI postpartum until 6 weeks among women with preeclampsia in Mulago Hospital, Uganda. Between August 2017 and April 2018, we measured blood pressure, urine protein and serum creatinine on days 1,7,21 and 42 postpartum among 86 women with preeclampsia. The primary outcomes were time to the resolution of hypertension, proteinuria and AKI. We fitted accelerated failure models using Stata 17's stintreg. command with a log normal distribution and obtained time ratios of selected exposures on time to resolution of hypertension, proteinuria and AKI intervals. The median time to resolution of hypertension, proteinuria and AKI was seven (7) days (Inter quartile range, IQR 1-21). The time to resolution of hypertension among primiparous women was 3.5 times that of multiparous women [TR 3.5, 95%CI 1.1, 11.3]. No differences were observed in resolution of hypertension, proteinuria and acute kidney injury. The time to resolution of hypertension, proteinuria and AKI was seven days. We recommend larger studies with longer follow-up beyond six-weeks postpartum to inform revision of our guidelines.

Beyond Fear: Unveiling the Relationship Between Fear of Childbirth and Pharmacological Pain Relief

BackgroundPharmacological analgesia is the dominant method for pain relief in labor. Fear of childbirth (FOC) may significantly affect women's preferences for and usage of pharmacological analgesia. AimThis study aimed to investigate the relationship between FOC in late pregnancy and preferences for, as well as actual use of, pharmacological analgesia among nulliparous and multiparous women, accounting for confounding factors. MethodsA total of 1,300 women participated in the study, completing questionnaires assessing preferences for pharmacological analgesia, FOC, perception of labor pain, social support, coping styles, and demographic variables. The actual use of pharmacological analgesia was followed up. The data were analyzed using univariate and multivariate regression analyses. ResultsUnivariate analysis revealed that women with moderate to severe FOC had a stronger preference for pharmacological analgesia compared to those with none to mild FOC. However, multivariate analysis showed no direct association between FOC and actual usage of pharmacological analgesia. Instead, a stronger preference for pharmacological analgesia increased the likelihood of its actual usage during labor. ConclusionsOur study underscores the effect of FOC on preferences for pharmacological analgesia and its potential influence on actual usage during labor. Healthcare providers should consider women's FOC and preferences when evaluating pain management options. Targeted interventions focusing on promoting non-pharmacological techniques should be implemented to optimize labor pain management for women, particularly nulliparous women.

Association of Parity With Insulin Resistance Early in Pregnant Women: ECLIPSES Study.

Little is known about whether parity is associated with elevated early-pregnancy insulin resistance (IR), or whether overweight/obesity contributes to increasing the possible effect. We determined the associations between parity and glucose metabolism parameters in the first trimester of pregnancy in a Mediterranean pregnant population, and whether these associations are affected by overweight/obesity. A cross-sectional study was conducted of 264 healthy pregnant women from the ECLIPSES study who were recruited at 12 weeks of gestation. At baseline, details on socioeconomic status, obstetric history (including parity, ie, number of births), lifestyle factors, anthropometry, and blood samples were collected. Fasting serum glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index were assessed in the first trimester. Elevated IR was defined as the upper HOMA-IR tertile (≥1.58). Multivariable linear regression and Cox regression model with constant time were performed. Parity ranged from 0 to 4. After multivariable adjustment, the insulin levels (β [% change]: 20.92; 95% CI, 4.08-37.71) and HOMA-IR index (β [% change]: 19.72; 95% CI, 2.43-40.49) were positively associated with parity. Additionally, multiparous women, as compared to nulliparous, were more likely to have higher HOMA-IR levels (primiparous [1 birth], β [% change[: 16.88; 95% CI, -1.00 to 37.99; multiparous [≥2 births), β [% change]: 32.18; 95% CI, 3.56-68.71), and an increased relative risk (RR) of an elevated IR (primiparous [1 birth], RR: 1.55; 95% CI, 1.03-2.36; multiparous (≥2 births), RR: 1.72; 95% CI, 1.05-2.83). The combination of multiparity and overweight/obesity conferred a 3.04-fold increase in the RR of elevated IR, which increased proportionally to the number of parities. This study demonstrates that parity may have a negative effect on early-pregnancy IR and that maternal overweight/obesity appears to further aggravate this relationship.

EP25.28: The effect of double‐balloon cervical ripening catheter on cervical shortening rates in nulliparous and multiparous women

EP25.28: The effect of double‐balloon cervical ripening catheter on cervical shortening rates in nulliparous and multiparous women

Subcutaneous onlay laparoscopic approach versus laparoscopic intraperitoneal onlay mesh repair of ventral hernia and correction of rectus diastasis: randomized controlled study

Background The association between ventral hernia and rectus abdominis diastasis is a common condition especially in multiparous women. Hernia correction alone without midline reinforcement increases the risk of hernia recurrence. Subcutaneous onlay laparoscopic approach (SCOLA) is a new minimally invasive procedure that allows the surgeons to do simultaneous correction of rectus diastasis and hernia mesh repair with low cost without the need for large transverse abdominal incision. Patients and methods 50 patients with non-complicated ventral hernia associated with rectus diastasis without significant redundancy in the skin of the abdominal wall were allocated randomly in 2 groups. 25 patients underwent SCOLA, and 25 patients underwent intraperitoneal on-lay mesh (IPOM) repair. Both techniques were compared as regard operative time, hospital stay, intra and postoperative complications, and recurrence rate. Results IPOM group experienced shorter operative time than SCOLA (115.27±10.54 vs 77.48±12.72) with no significant difference as regard intraoperative complications between both techniques. Although early postoperative pain was significantly less in SCOLA patients (P=0.021), IPOM group had earlier restoration of normal daily activities (P&lt; 0.001). No significant recurrence rate was considered in both groups apart from one case (4%) after IPOM repair. Conclusion SCOLA could be a good choice in the concurrent repair of ventral hernia and rectus diastasis without significant postoperative complications. In addition, the use of regular proline mesh instead of composite mesh significantly decreases the economic burden.

Factors Associated With the Timing of First Antenatal Care by Pregnant Women Attending Specialist Hospital, Sokoto

This study therefore aimed to explore the factors associated with the timing of first antenatal care attendance by pregnant women in specialist hospital, Sokoto, Sokoto state, Nigeria.Three objectives with three corresponding research and questions guided the study. This is a health facility-based cross-sectional study conducted in specialist hospital Sokoto in Sokoto State, North-West Nigeria. Two hundred and seventy nine Pregnant women presenting at the ANC booking clinic were used in this study. Sample size was calculated using Cochran’s formula. A simple random sampling technique was used in selecting respondents using a structured questionnaire. The data analysis was done using SPSS. Pregnant women who initiated ANC early were (42.3%). Majority of the respondents (42.7%) were 25-34 year old. Women with at least secondary level of education were twice likely to commence ANC early compared to those with primary education or no formal education (OR: 2.07, 95% CI: 093-4.58). Nulliparous women were almost twice likely to initiate ANC early compared to primiparous and multiparous women (OR: 1.88, 95% CI: 1.10-1.55). Similarly, Primigravid women were 1.6 times more likely to start ANC early compared to multigravid women (OR: 1.55, 95% CI: 0.93-2.57). Women with planned pregnancy were (6%) more likely to register for ANC early compared to those with unplanned pregnancy (OR: 1.06, 95% CI: 0.59-1.90). Early initiation of ANC was (50%) higher in women from low-income household compared to those from high income household (OR: 1.50, 95% CI: 0.83-2.72). This study shows that less than half of the women commenced ANC early. The WHO ANC model recommendation on early commencement of ANC has not been fully met. Therefore, there is need for Sokoto state government in collaboration with the Federal.

Surgical Anatomy of Transversus Abdominis Muscle for Transversus Abdominis Release: A CT-Based Study in Three Patient Groups.

The anatomy of the transversus abdominis muscle and its aponeurosis is important in transversus abdominis release surgery. We studied the CT anatomy of the transversus abdominis muscle medial to the linea semilunaris at different levels in the abdomen and measured the thickness of this muscle. In this retrospective study, we analysed 150 abdominal computed tomography at L1, L3, and L5 vertebral levels corresponding to subxiphoid, umbilical, and suprapubic regions, respectively. The patients were divided into three groups based on age and sex: women aged 15-20 years (nulliparous), women aged 30-60 years (multiparous), and men aged 15-60 years, with each group having 50 patients. We compared the thickness of the TA muscle at the L1 level between men and women and between nulliparous and multiparous women. Transversus abdominis muscle was consistently present medial to the linea semilunaris at L1 vertebral level in the subxiphoid region (150/150). At the L3 vertebral level in the mid-abdomen, only eight patients had the transversus abdominis muscle there (8/150, 5%). At the L5 vertebral level in the suprapubic region, no patient had the transversus abdominis muscle medial to the linea semilunaris. The mean thickness of the transversus abdominis muscle at the L1 level was 3.4 mm, and at the L3 level, it was 1.6 mm. There was no statistically significant difference in the transversus abdominis muscle thickness between the men and women; however, a significant difference was found between the nulliparous and multiparous women, with thinner TA muscle in later. There is good transversus abdominis muscle bulk medial to the linea semilunaris for doing transversus abdominis muscle division in the upper abdomen. However, as we move towards the mid-abdomen, we have TA aponeurosis or rarely TA muscle of little bulk.

Trends in postpartum hemorrhage and manual removal of the placenta and the association with childbirth interventions: A Dutch nationwide cohort study.

Because the cause of increasing rates of postpartum hemorrhage (PPH) and manual placental removal (MROP) is still unknown, we described trends in PPH, MROP, and childbirth interventions and examined factors associated with changes in rates of PPH and MROP. This nationwide cohort study used national perinatal registry data from 2000 to 2014 (n = 2,332,005). We included births of women who gave birth to a term singleton child in obstetrician-led care or midwife-led care. Multivariable logistic regression analyses were used to examine associations between characteristics and interventions, and PPH ≥ 1000 mL and MROP. PPH rates increased from 4.3% to 6.6% in obstetrician-led care and from 2.5% to 4.8% in midwife-led care. MROP rates increased from 2.4% to 3.4% and from 1.0% to 1.4%, respectively. A rising trend was found for rates of induction and augmentation of labor, pain medication, and cesarean section, while rates of episiotomy and assisted vaginal birth declined. Adjustments for characteristics and childbirth interventions did not result in large changes in the trends of PPH and MROP. After adjustments for childbirth interventions, in obstetrician-led care, the odds ratio (OR) of PPH in 2014 compared with the reference year 2000 changed from 1.66 (95% CI 1.57-1.76) to 1.64 (1.55-1.73) among nulliparous women and from 1.56 (1.47-1.66) to 1.52 (1.44-1.62) among multiparous women. For MROP, the ORs changed from 1.51 (1.38-1.64) to 1.36 (1.25-1.49) and from 1.56 (1.42-1.71) to 1.45 (1.33-1.59), respectively. Rising PPH trends were not associated with changes in population characteristics and rising childbirth intervention rates. The rising MROP was to some extent associated with rising intervention rates.