Non-pregnant Nulliparous Women Research Articles

Affective cognition in response to infant stimuli in pregnant compared with non-pregnant women

ABSTRACT Physiological, neurocognitive, and psychological changes facilitates adaptation to motherhood. This cross-sectional study aimed to examine differences between pregnant and non-pregnant women in affective cognitive and psychophysiological responses to infant stimuli. We hypothesized that pregnant women would display (I) reduced negative emotional reactivity and perception of distressed infant stimuli, (II) increased attention toward infants compared to adults, and (III) greater psychophysiological response to infant distress. The sample comprised 22 pregnant women (22–38 weeks gestation) and 18 non-pregnant nulliparous women. Four computerized tasks were administered to measure affective cognitive processing of infant stimuli, while recording facial expressions, electrodermal activity, and eye gazes. Results indicated that pregnant women exhibited fewer negative facial expressions, reported less frustration when exposed to distressed infant cries, and showed greater attention to emotional infant faces compared to non-pregnant women, but the differences did not remain statistically significant after correction for multiple comparisons. No differences were observed in psychophysiological responses. The findings indicate a possible pregnancy-mediated effect regarding the cognitive processing of infant stimuli, potentially as preparation for motherhood. Future research with larger samples and longitudinal design is needed to understand the predictors, timing, and plasticity of cognitive changes during pregnancy.

Pregnancy Activity Levels and Impediments in the Era of COVID-19 Based on the Health Belief Model: A Cross-Sectional Study.

Physical activity (PA) and exercise benefit both the mother and the fetus. Many pregnant women avoid or severely limit PA, leading to complications before and after delivery. This study elucidated the precise effect of each moderator variable on prenatal physical activity (PPA) by examining demographic factors, the PPA-related health belief level (HBL), and the current PPA level. The health belief model (HBM) in conjunction with the international prenatal physical activity questionnaire was used. The HBL in pregnant parous women (PPW) (3.42) was significantly higher than that in nonpregnant nulliparous women (NNW) (3.06). The PPA level in pregnant nulliparous women (PNW) (5.67 metabolic equivalent-hours per week (MET-h/week)) was lower than in the PPW (6.01 MET-h/week). All HBM dimensions (except for perceived barriers) were positively correlated with exercise expenditure in both PNW and PPW. According to the regression tree, participants in PNW aged ≤ 23 years with annual household incomes > CNY 100,001–150,000 had the highest energy expenditure (10.75 MET-h/week), whereas participants in PPW with a perceived benefit score of >4 had the highest energy expenditure (10 MET-h/week). The results demonstrated that the HBL in all groups was acceptable, whereas the PPA level was lower than the recommended PA level. In both PPW and PNW, the HBL was most strongly correlated with exercise expenditure. There is an urgent need to organize public-interest courses to alleviate household expenditure, raise the HBL about PPA in pregnant and NNW, and ensure personal health in the context of COVID-19.

Fecal incontinence in nonpregnant nulliparous women aged 25 to 64 years-a randomly selected national cohort prevalence study

The extent to which fecal incontinence is associated with obstetrical history or pelvic floor injuries is still a controversial andunresolved issue. One crucial first step toward answering this question is the need to study fecal incontinence in nonpregnant, nulliparous women. The aim of this study was to present detailed, descriptive measures of the accidental leakage of liquid or solid stool and gas in a randomly selected, large national cohort of nonpregnant, nulliparous women aged 25 to 64 years. The Swedish Total Population Register identified the source population. Four independent, age-stratified, simple random samples in a total of 20,000 nulliparous women aged 25 to 64 years were drawn from 625,810 eligible women. Information was collected in 2014 using postal and web-based questionnaires. The 40-item questionnaire included questions about the presence and frequency of the leakage of solid and liquid stool and gas, which provided the basis for the generic terms fecal and anal incontinence. Statistical analyses of the differences between the groups were performed using the Fisher's exact test for dichotomous variables and the Mann-Whitney U-test for continuous variables. The trend between >2 ordered categories of dichotomous variables was analyzed with Mantel-Haenszel statistics. When analyzing the trend between multiple ordered vs nonordered categorical variables, the Kruskal-Wallis test was used. The age-related probability and risk increase per 10 years for incontinence parameters was calculated from logistic regression models adjusted for body mass index. The study population was 9197 women, and the response rate was 52.2%, ranging from 44.7% in women aged 25 to 34 years to 62.4% among those from 55 to 64 years. All the types of incontinence, except severe isolated gas incontinence, increased with age up to 64 years. The estimated probability of fecal incontinence was 8.8% at age 25 years and 17.6% at age 64. The leakage of liquid stool was dominant, occurring in 93.1% (95% confidence interval, 91.4-94.5) of the women with fecal incontinence, whereas leakage of solid stool occurred in 33.9% (95% confidence interval, 31.1-36.7), of which approximately 80% also had concomitant leakage of liquid stool. The leakage of liquid stool increased markedly up to age 65, whereas the increase in the isolated leakage of solid stool was negligible across all ages (overall <0.4%). Liquid and solid stool, separate or in combination, co-occurred with gas in approximately 80%. The distribution pattern of the different types of leakage, single or combined, was similar in all the age groups. Both age and body mass index (kg/m2) were risk factors for fecal incontinence (P<.0001), with an interaction effect of P=.16. Abnormal stool consistency has been identified as the strongest risk factor for accidental bowel leakage. The same pattern characterized by a dominance of liquid stool and gas leakage, prevalent concomitant leakage of solid and liquid stool, and a negligible rate of isolated leakage of solid feces was observed across all ages. The low rates of isolated leakage of solid stool support the impression that dysfunction of the continence mechanism of the pelvic floor had a negligible role for bowel incontinence, which is essential information for comparison with women with birth-related injuries.

Transperineal ultrasound shear-wave elastography is a reliable tool for assessment of the elastic properties of the levator ani muscle in women

Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction. Assessments were done with a transperineal approach, using an AIXPLORER device with a linear SL 18–5 (5-18 MHz) probe. For each condition, 3 consecutive measures were performed at each visit. The mean of the three measures, then the first one, were considered for the reproducibility by calculating intraclass correlation coefficient (ICC), and coefficient of variation (CV). Twenty women were included. Reproducibility was excellent when considering the mean of the 3 measures at rest (ICC = 0.90; CV = 15.7%) and Valsalva maneuver (ICC = 0.94; CV = 10.6%), or the first of the three measures at rest (ICC = 0.87; CV = 18.6%) and Valsalva maneuver (ICC = 0.84; CV = 19.9%). Reproducibility was fair for measurement during contraction. Transperineal ultrasound SWE is a reliable tool to investigate LAM elastic properties at rest and during Valsalva maneuver.

Is there a role for HLA-G in the induction of regulatory T cells during the maintenance of a healthy pregnancy?

Pregnancy remains an immune challenge for the uterus that has to adapt to a semi-allogeneic fetus using various regulatory mechanisms. Both HLA-G and regulatory Tcells(CD4+ CD25+ FOXP3+ Tregs ) are upregulated in successful pregnancy, but not in abortion. It is unclear if HLA-G plays a role in the upregulation of regulatory cells. We measured the level of both sHLA-G and Treg cells in the blood of healthy pregnant multigravida, unexplained recurrent spontaneous abortions (URSA) and healthy non-pregnant and nulliparous females. We cultured peripheral blood lymphocytes of healthy non-pregnant multigravida females who never had an abortion with lymphocytes of their partners at ratio of 1:1, with and withoutsHLA-Gto detect changes in number ofTreg cells, or relevant cytokines. Soluble HLA-G concentrations and Treg cells percentage were significantly lower in women with URSA as compared to healthy pregnant multigravida women and were comparable to healthy non-pregnant nulliparous women. Percentage of Tregs increased between zero time and mixed lymphocyte cultures (MLC) in both cultures with and without recombinant sHLA-G but no significant difference between the two cultures. When stimulated with sHLA-G the mean extracellular IL-10 concentration was unchanged, while the mean INF-γ concentration was slightly higher with no significant difference. Intracellular TGF-β was higher in CD4+ cells after incubation with sHLA-G. The results of this study are consistent with previous studies on the role of sHLA-G and Treg cells in inducing immune-tolerance in pregnancy. The results also suggest a possible role for HLA-G in the enrichment of Treg cells.

Preferred ways of giving birth in non-pregnant and pregnant nulliparous women: the role of control beliefs

Purpose To explore the association between delivery-specific, health-related control beliefs and preferred ways of delivery in nulliparous Hungarian women. Moreover, since data about the delivery-specific control beliefs and delivery-related preferences of non-pregnant nulliparous women are lacking, the present study also seeks to provide descriptive information in this regard. Methods A total of 984 Hungarian nulliparous women (26.45 ± 5.42 years; 660/77.2% non-pregnant and 224/22.8% pregnant) were included in the present study. The online assessment included measures of delivery-specific (internal-, healthcare professional-, and chance-related) health control beliefs, fears of childbirth, self-esteem, as well as preferences regarding delivery setting (i.e. spontaneous vaginal birth in hospital, planned cesarean birth and home birth). Results Healthcare professional-related control beliefs were associated with a stronger preference for spontaneous vaginal birth in hospital (OR = 1.87, 95% CI: 1.56–2.23) and planned cesarean birth (OR = 1.96, 95% CI: 1.60–2.40), alongside a weaker preference for home birth (OR = 0.31, 95% CI: 0.25–0.39). In contrast, internal delivery-specific control beliefs predicted a weaker preference for planned cesarean (OR = 0.66, 95% CI: 0.55–0.78) and a stronger preference for home birth (OR = 1.63, 95% CI: 1.33–2.00). A general preference index for medicalized ways of delivery was negatively associated with internal – and positively with healthcare professional – and chance-related control beliefs (βs = −.173, .074 and .445, respectively). Conclusions Delivery-related control beliefs are important psychological characteristics in the prediction of preferences for ways of delivery. Understanding delivery-specific control beliefs may be an important component of supporting women to give birth in a mentally and physically healthy way.

Morphometry of the nulliparous pelvic floor.

To describe morphometry of the pelvic floor in a large population of nulliparous women, comparing those with and those without pelvic pain. We also aimed to assess its association with characteristics such as age and body mass index (BMI). This was a prospective study performed between January 2013 and November 2015 in non-pregnant nulliparous women attending a general gynecology clinic. Following collection of demographic data, women were examined using translabial four-dimensional (4D) ultrasound. Dynamic volumes of pelvic floor muscle were obtained at rest, on maximal contraction and on Valsalva maneuver, and analyzed at a later date by an assessor blinded to demographic details. Standard measurements for each volume included levator hiatal area and anteroposterior and transverse diameters, and pubovisceral muscle length and width. Subanalysis was performed comparing women with and those without pelvic pain. Linear regression analysis was performed to assess the association between characteristics, including age and BMI, and levator hiatal area at rest. Three hundred and sixty eight nulliparous women were examined using translabial 4D ultrasound. Median levator hiatal area was 10.62 cm2 at rest, 11.95 cm2 on Valsalva maneuver and 8.18 cm2 on maximal contraction. There was no difference between women with and those without pelvic pain when comparing biometric measurements of the pelvic floor musculature, except for in pubovisceral muscle width during the contraction phase. Regression analysis demonstrated that higher age and BMI were associated with increased levator hiatal area measurement. Pelvic floor morphometry in nulliparous women is unchanged by pelvic pain, but levator hiatal area is increased in women with higher BMI and age. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Prevalence and predictors of overactive bladder in nonpregnant nulliparous women below 65years of age.

The aetiology of the overactive bladder (OAB) symptom complex is still poorly understood. In order to obtain further insight, the prevalence and predictors of the symptoms included in OAB, that is urgency, urgency incontinence (UUI), frequency and nocturia, were investigated in a sample of nonpregnant nulliparous women. A national, postal and web-based survey of OAB symptoms was conducted in women aged 25-64years (n=9,197). Crude prevalence and prevalence adjusted according to body mass index (BMI) were calculated from a logistic regression model to evaluate the prevalence of OAB. The response rate was 52%. The prevalence of urgency, bothersome urgency, UUI, and nocturia, but not daytime frequency, increased consistently with advancing age and increasing BMI. Urgency was associated with BMI, age ≥45years, nocturia, and daytime frequency of eight or more micturitions. Daytime urinary micturition frequency was not affected by age either in women with OAB or in women without OAB. Bothersome OAB affected almost half of the woman in the oldest age group and was strongly associated with nocturia of two or more micturitions and OAB with UUI. There were contrasting changes in the prevalence of the different symptoms included in OAB. With increasing age and BMI, the prevalence of nocturia, urgency and UUI increased, while daytime frequency remained stable. These findings are of importance as the primary endpoint for the evaluation of drug therapies for OAB has often been daytime urinary frequency.

Evaluation of pelvic floor muscle strength and its correlation with sexual function in primigravid and non-pregnant women: A cross-sectional study.

We aimed to compare pelvic floor muscle (PFM) strength and sexual function in primigravid and non-pregnant women and compare PFM strength between those who exhibited and did not exhibit sexual dysfunction. A cross-sectional observational study was conducted. The sample consisted of 154 women, including 76 primigravid and 78 non-pregnant women. The inclusion criteria were as follows: non-pregnant nulliparous women or primigravid women who were pregnant with a single foetus at least 14 weeks of gestational age and reported having sexual intercourse at least once during the last 4 weeks. The exclusion criteria were as follows: inability to contract the PFMs and prior urogynaecologic surgery. PFM strength was assessed via vaginal palpation (using the Modified Oxford Scale) and vaginal squeeze pressure (using the Peritron™ manometer). Sexual function was assessedusing the Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was identified based on low FSFI scores.The data were analyzed using the Mann-Whiney and Spearman correlation tests. To discussion, primigravid women had lower FSFI scores and lower PFM strength than non-pregnant women. Women with sexual dysfunction had lower PFM strength than women without sexual dysfunction, as indicated by vaginal palpation (scores of 2 out of 5 and 4 out of 5, respectively; P < 0.001) and vaginal squeeze pressure (17.5 and 36.8 cm H2 O, P < 0.001, respectively)regardless of whether they were non-pregnant nulliparous women and primigravid. Primigravid women exhibited worse sexual function and lower PFM strength than non-pregnant women. Women who had higher FSFI scores demonstrated greater PFM strength.

Differences in cardiovascular function comparing prior preeclamptics with nulliparous controls.

The objective of the current study was to evaluate cardiovascular function; including blood pressure, cardiac output, pulse wave velocity and vascular compliance in nonpregnant nulliparous women compared to women with a history of preterm preeclampsia. This was a case control study. Blood pressure was measured using the Finapres Pro. Baseline cardiac output was determined by echocardiography. Pulse wave velocity was estimated using simultaneous electrocardiographic tracings and ultrasound determined arterial flow waveforms and calculated as estimated distance divided by the time interval between EKG r-wave peak and ultrasound derived peak popliteal artery flow. During volume challenge, 500mL of lactated Ringers solution was infused through an indwelling antecubital catheter over 10min. Cardiac output and blood pressure during and 15min after the infusion were estimated using the Finapres Pro. Indices of arterial stiffness and vascular compliance. Previous preeclamptics exhibited a significant increase in pulse pressure and cardiac output in response to volume challenge when compared with nulliparous controls. Prior preeclamptics had a strong positive correlation between blood pressure indices (r=0.50-0.68, p⩽0.01) and pulse pressure (r=0.58, P=0.008) with pulse wave velocity that was not evident in control women. In women with prior preterm preeclampsia a relationship between blood pressure, intravascular volume and arterial stiffness, is evident in the nonpregnant state and in the absence of hypertension or overt cardiovascular disease. This supports an overarching hypothesis that nonpregnant physiology is an important contributor to pregnancy adaptations.

A mixed-methods study on factors influencing prenatal weight gain in ethnic-minority women.

Gaining too much weight in pregnancy is associated with perinatal complications and increases the risks of future obesity for both women and their infants. Unfortunately, women enrolled in intervention trials have seen little improvement in adherence to prenatal weight gain recommendations compared to women receiving standard prenatal care. Therefore, the purpose of this descriptive mixed-methods study was to explore factors related to excessive weight gain in pregnancy. Nonpregnant nulliparous women, currently pregnant women, and postpartum women (N = 43) were recruited from a health center serving an inner-city minority community. Women completed questionnaires on knowledge, self-efficacy, and behaviors related to nutrition, exercise, and prenatal weight gain. Fifteen of these women participated in focus groups. Focus group data were analyzed using ATLAS.ti (Scientific Software Development GmbH, Berlin, Germany). Codes were created, themes were identified, and consensus was reached through multiple iterations of the analysis by study personnel. Excessive weight gain was common. Nutritional knowledge was poor and significantly lower among nonpregnant nulliparous women. Women felt sure that they could engage in healthy behaviors, but few did so. Participants in focus groups identified multiple barriers to healthy behaviors in pregnancy and made suggestions on how to help women more readily make improvements in these behaviors. Strategies identified in this study such as providing focused education directed at nonpregnant nulliparous women, stressing portion control, helping women better manage their cravings, and providing more pragmatic support and resources need to be explored in future research.

Trunk motion and gait characteristics of pregnant women when walking: report of a longitudinal study with a control group

BackgroundA longitudinal repeated measures design over pregnancy and post-birth, with a control group would provide insight into the mechanical adaptations of the body under conditions of changing load during a common female human lifespan condition, while minimizing the influences of inter human differences. The objective was to investigate systematic changes in the range of motion for the pelvic and thoracic segments of the spine, the motion between these segments (thoracolumbar spine) and temporospatial characteristics of step width, stride length and velocity during walking as pregnancy progresses and post-birth.MethodsNine pregnant women were investigated when walking along a walkway at a self-selected velocity using an 8 camera motion analysis system on four occasions throughout pregnancy and once post birth. A control group of twelve non-pregnant nulliparous women were tested on three occasions over the same time period. The existence of linear trends for change was investigated.ResultsAs pregnancy progresses there was a significant linear trend for increase in step width (p = 0.05) and a significant linear trend for decrease in stride length (p = 0.05). Concurrently there was a significant linear trend for decrease in the range of motion of the pelvic segment (p = 0.03) and thoracolumbar spine (p = 0.01) about a vertical axis (side to side rotation), and the pelvic segment (p = 0.04) range of motion around an anterio-posterior axis (side tilt). Post-birth, step width readapted whereas pelvic (p = 0.02) and thoracic (p < 0.001) segment flexion-extension range of motion decreased and increased respectively. The magnitude of all changes was greater than that accounted for with natural variability with re testing.ConclusionsAs pregnancy progressed and post-birth there were significant linear trends seen in biomechanical changes when walking at a self-determined natural speed that were greater than that accounted for by natural variability with repeated testing. Not all adaptations were resolved by eight weeks post birth.

Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women

We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG). Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM. In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 μv) than in the pregnant group (30 μv), with p < 0.001. The same results were observed after vaginal palpation, measured by the Oxford scale, which presented an average of 2.1 in the pregnant group and 4.5 in the nonpregnant group (p = 0.005). In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.

Intraobserver and interobserver reliability of the three-dimensional ultrasound imaging of female urethral sphincter using a translabial technique

The aim of the study was to assess the interobserver and intraobserver reliability of translabial 3D ultrasound imaging of the urethral sphincter in non-pregnant nulliparous asymptomatic women. A study using a 3D translabial ultrasound on thirty-seven women was performed. Urethral sphincter parameters were measured by the same experienced clinician 2weeks apart. Multiple axial cross-sectional areas at 1-mm distances were used to calculate urethral sphincter volumes. The same measurements were carried out by a second experienced clinician to assess the interobserver reliability. We found an excellent intraobserver reliability (interclass correlation coefficient, ICC >0.8) and good interobserver reliability (ICC >0.6). The described technique using multiple axial cross-sectional areas at set distances and a translabial approach is a reliable and accurate tool in the evaluation of the urethral sphincter. This should be used instead of mathematical formulas as the urethral sphincter is not a uniform geometrical sphere. The technique and values reported may help clinicians in the assessment of women with lower urinary tract disorders.

The Effect of Pregnancy and Parity on Headache Prevalence: The Head‐HUNT Study

In previous studies, pregnancy has been associated with less headache, but the influence of parity on this association is largely unknown. To examine the prevalence of headache and migraine among pregnant women, and explore the relation of headache to parity in a large, population-based study. In the Nord-Trøndelag Health Study in Norway 1995-1997 (HUNT 2), a total of 27,700 (60%) out of 46,506 invited women responded to headache questions (Head-HUNT). In total, 9281 women were 40 years or younger and responded to questions on pregnancy and birth, and 550 of these reported to be pregnant when filling in the questionnaire. A total of 20,287 women who were 70 years or younger and reported not to be pregnant responded to questions on headache and reported number of child births. Adjusting for age and educational level, the headache prevalence was lower among pregnant than among nonpregnant women. The association between headache and pregnancy was significant for nulliparous (one who has never given birth) (OR = 0.5, 95% CI = 0.4-0.7), but not for primiparous (1 child only) and multiparous (several children) women (OR = 0.8, 95% CI = 0.7-1.0). This was evident for both migraine and nonmigrainous headache. Among nonpregnant women, there was an increased headache prevalence among primi- and multiparous women compared with nulliparous (OR = 1.3, 95% CI = 1.2-1.4). Headache, both migraine and nonmigrainous, was less prevalent in nulliparous pregnant women compared with all nonpregnant women, and to nulliparous nonpregnant women. Headache was less prevalent in the third trimester of pregnancy, but not in the first and second trimesters, compared with nonpregnant women. Also in nonpregnant women, headache was less prevalent in nulliparous than in primi- and multiparous women.

Interpretation of blocking activity in maternal serum depends on the equation used for calculation of mixed lymphocyte culture results

Immunosuppressive blocking factors in maternal serum are usually determined by inhibition of mixed lymphocyte cultures (MLC), but reports on the importance of these factors for successful pregnancy are conflicting. Here we measured serum blocking activity in men, non-pregnant nulliparous women, non-pregnant multiparous women, women with normal pregnancies, and in women who had had recurrent spontaneous abortions and were treated with leucocyte immunizations. Three different equations were used for calculation of blocking activity: blocking effect index (BEI); stimulation index (SI); and blocking index (BI). By all three methods of calculation, significantly lower levels of blocking activity were noted for men and women compared with pregnant women and multiparae. In the patients with a history of recurrent spontaneous abortions blocking activity as determined by BEI and BI increased into the positive range after treatment with infusions of third-party donor leucocytes in a statistically significant number of women (P less than 0.05). However, blocking activity as determined by BEI had a higher predictive value for successful pregnancy than did that determined by BI or SI. Our data suggest that the equation used for calculating BEI is superior to other methods for the determination of blocking activity when monitoring the response to leucocyte immunization in women with recurrent spontaneous abortion. However, these results also cast doubt on the importance of blocking antibodies in histories of recurrent abortion, since pregnancies occurred in the absence and spontaneous abortions occurred in the presence of blocking activity.

Melatonin Level and Pattern in Postpartum Versus Nonpregnant Nulliparous Women

To compare 24-hour melatonin level and timing in postpartum and nonpregnant nulliparous women. Melatonin release provides information regarding circadian rhythm timing, which influences health. 2-group comparison of data derived from intensive within-subject data collection. Participants' typical daily environment. 38 postpartum and 20 nonpregnant nulliparous women. Mothers' infants were 4 to 10 weeks of postnatal age. Urinary 6-sulfatoxymelatonin assayed from each voiding and corrected for volume using creatinine. Postpartum women had significantly higher baseline, lower maximum, lower percent rise, and differing pattern of 6-sulfatoxymelatonin than nonpregnant nulliparous women. Differences in melatonin suggest possible circadian rhythm disruption in the postnatal period.

Hypermobility in reproduction

Peripartum pelvic pain (PPPP) syndrome is thought to be caused by decreased stability of the pelvic girdle, caused by increased relaxin levels during pregnancy. The resulting hypermobility (HM) may result in back pain, symphysiodynia and waddling gait. The hypothesis that pre-existent hypermobility is a major cause of PPPP was investigated. Surveys of HM and HM plus PPPP were conducted in different populations in several countries. The prevalence of HM in non-pregnant nulliparous women ranged between 10% and 39%; cross-sectional studies in pregnant women showed a prevalence between 5% and 19%. Significant correlations between HM and PPPPS were found in the Dutch subjects only. There seems to be a genetic difference between populations with regard to the development of PPPP in HM pregnant women. Pregnancy is the main trigger causing development of benign joint hypermobility syndrome (BJHS) in later life. South African Journal of Obstetrics and Gynaecology Vol. 12(1) 2006: 38-43

Endosonography of the anal sphincter in women of different ages and parity

To obtain reference data representative of normal findings at anal endosonography in pregnant and non-pregnant women. To determine intraobserver and interobserver agreement in the detection of endosonographic anal sphincter defects in asymptomatic women. Twenty-five non-pregnant nulliparous women and 25 non-pregnant parous women (age range, 20-67 years) and 47 pregnant women (age range, 21-39 years) underwent anal manometry and anal endosonography. The endosonographic internal and external sphincter thickness and sphincter length were measured online. Endosonographic sphincter defects were measured and classified offline from videotapes by two independent examiners using an endosonographic defect score ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extension of the defect. Endosonographic sphincter thickness and length did not differ between non-pregnant nulliparous and parous women and did not change substantially with age. The anal sphincter was thicker and the anal resting pressure area and manometric sphincter length were greater in pregnant than in non-pregnant women of the same age (20-39 years). There was good intra- and interobserver agreement with regard to detection of endosonographic anal sphincter defects (kappa > or = 0.70). Eighteen (19%) women had endosonographic sphincter defects but in only four (4%; 4/97) cases were they moderate or large (defect score, 7-10). Ten (20%) of the non-pregnant women reported minor gas incontinence and one reported minor incontinence for both gas and liquid stool. The frequency of incontinence did not differ between women with and without sphincter defects. Reference data representative of normal findings at anal endosonography have been established for non-pregnant women and for nulliparous women in the third trimester of pregnancy. Small endosonographic sphincter defects and minor gas incontinence are common in women without known sphincter trauma. They seem to be unrelated to each other and may be regarded as normal variants.

Magnetic resonance spectroscopy in pre-eclampsia: evidence of cerebral ischaemia

Objective To establish whether there are changes in the maternal brain in pre-eclampsia detectable by magnetic resonance angiography and spectroscopy. Design A prospective, observational study. Setting Obstetric and Radiology Departments, Queen's Medical Centre, Nottingham. Sample Fourteen healthy, nulliparous non-pregnant women, 9 healthy primiparous pregnant women and 10 women with pre-eclampsia. Methods Magnetic resonance angiography and proton magnetic resonance spectroscopy of the brain was performed on each woman. Non-pregnant women were each studied twice. Healthy pregnant women were studied three times during pregnancy and once postnatally. Subjects with pre-eclampsia were studied once antenatally and twice postnatally. Magnetic resonance angiograms were examined for signs of vessel narrowing. On magnetic resonance spectroscopy, the ratios of the dominant peaks of the spectrum: N-acetyl aspartate (NAA), choline, creatine and lactate were compared. Main outcome measures Comparison of spectroscopic indices in non-pregnant, normal pregnant and pre-eclamptic women. Results On magnetic resonance angiography, there was no evidence of vessel narrowing in any of the three groups. NAA/choline ratio was higher at all stages of pregnancy compared with the non-pregnant group ( P < 0.05) associated with lower choline. NAA/choline increased gradually during healthy pregnancy associated with a decrease in choline. NAA/choline was significantly lower in the pre-eclampsia group compared with the healthy pregnant women at similar gestation ( P < 0.01), associated with higher choline. There were no differences between the groups postnatally. Lactate was not detected. These changes are similar to those found in patients with carotid stenosis without cerebral infarction. Conclusions Narrowing of vessels detectable on magnetic resonance angiography does not occur commonly in pre-eclampsia. Magnetic resonance spectroscopy results suggest that there is relative cerebral ischaemia in pre-eclampsia compared with healthy pregnancy.