Obstetric Antecedents Research Articles

Pathophysiologic Origins of Brachial Plexus Injury.

To analyze the origins and consequences of cases of brachial plexus injuries and their relationship to shoulder dystocia. We conducted a retrospective cohort study and identified all neonates with brachial plexus injury delivered at our institution between March 2012 and July 2019. A review was performed of the maternal and neonatal records of each neonate to identify obstetric antecedents, including the occurrence of shoulder dystocia and persistence of the injury. Experience of the delivering clinician was also examined. Statistical analysis was performed with the Fisher exact test, χ test for trends, and two-tailed t tests. Thirty-three cases of brachial plexus injury were identified in 41,525 deliveries (0.08%). Fourteen (42%) of these cases were not associated with shoulder dystocia; three (9%) followed cesarean delivery. Brachial plexus injury without shoulder dystocia was related to the absence of maternal diabetes, lower birth weights, and a longer second stage of labor. Persistent brachial plexus injury at the time of discharge was seen with equal frequency among neonates with (17/19, 89%, 95% CI 0.52-100%) and without shoulder dystocia (10/14, 71%, 95% CI 34-100%), P=.36). Whether brachial plexus injury was transient or persistent after shoulder dystocia was unrelated to the years of experience of the delivering clinician. Despite ongoing training and simulation, the already low incidence of brachial plexus injury did not decrease over time at our institution. Brachial plexus injury and shoulder dystocia represent two complications of uterine forces driving a fetus through the maternal pelvis in the presence of disproportion between the passage and the shoulder girdle of the passenger. Either or both of these complications may occur, but often are not causally related.

Urological lesions in patients undergoing obstetric hysterectomy secondary due to abnormal placental insertion in a high specialty hospital.

To describe frequency and identify risk factors for urological lesions in patients undergoing obstetric hysterectomy secondary to abnormal placental insertion in a high specialty hospital. Transversal, retrospective study of patients underwent hysterectomy due to abnormal placental insertion, from 2017 to 2019; age, obstetric antecedents, comorbidities, type of abnormal placental insertion type of hysterectomy, site of urinary lesion, anesthesia, surgery time and bleeding were studied. Analyses were made with ji square and Kruskal Wallis tests with SPSS V20.0 program considering significative p values p < 0.05. Clinical records of 96 patients with age 32.6 ± 6.1 years were analyzed. Accretism was present in 38.5%, incretism in 19.8% and percretism in 18.8%. Total hysterectomy was accomplished in 78 (81.2%) cases. Urinary lesion was present in 27 (28.1%); vesical in 19 (19.8%), ureteral in 6 (6.5%) and both in 2 (2.0%). Urinary lesion was significantly more frequent in those patients with more pregnancies (median 4 [interquartile range (IQR): 3-4] vs. 3 [2-4]; p= 0.004), more caesarean sections (4 [3-4] vs. 2 [1-3]; p < 0.001), hemorrhage (3000 mL [2000-4800] vs. 2000 mL [1200-3000]; p = 0.001), and more surgery time (3.75 h [3.5-4.0] vs. 3.0 [2.0-3.5]; p < 0.001). Urinary lesions in patients undergoing obstetric hysterectomy secondary to abnormal placental insertion are more frequent with higher number of pregnancies, caesarean sections, hemorrhage and surgery time.

Obstetric Antecedents of Perinatal Clavicular Fracture [27O

INTRODUCTION: Perinatal clavicular fractures generally heal without sequelae, however their discovery may carry an inference of improper obstetric care. We sought to examine risk factors associated with the largest contemporary U.S. series of perinatal clavicular fractures. METHODS: A retrospective cohort study including all newborns with clavicular fracture, identified by coding data, born at our teaching institution between March 2012 and July 2019. The records of newborns with clavicular fracture were linked to their respective maternal charts. Clinical factors of interest were extracted and analyzed. Chi-square analysis was utilized. RESULTS: During the study time period, 132 neonatal clavicular fractures occurred in 25,760 infants born vaginally (0.51%). There was no difference in the rate of clavicular fracture when analyzed by parity, maternal diabetes, gestational age, prior cesarean delivery or length of second stage labor. A statistically significant increase in fracture was seen in macrosomic (&gt;4,000 g) vs. non-macrosomic infants (2.13% vs. 0.41%, P&lt;.001), attempted or successful operative vs. spontaneous vaginal delivery (0.99% vs. 0.48%, P=.014) and shoulder dystocia (3.99% vs. 0.44%, P&lt;.001). CONCLUSION: Important risk factors for clavicular fracture were identified. However, the overwhelming majority of perinatal clavicular fractures occur in non-macrosomic infants with uncomplicated spontaneous deliveries following a normal second stage of labor. This highlights important biologic variability in the tolerance of infants to contraction-driven passage through the maternal pelvis without sustaining injury.

The epidemiologic characteristics and associated risk factors of preterm birth from 2004 to 2013 in Taiwan

BackgroundThe rate of preterm birth has been increasing worldwide. Most preterm babies are at an increased risk of central nervous system impairments as well as respiratory and gastrointestinal complications. The aim of this study was to investigate the epidemiologic characteristics of and associated factors contributing to preterm birth in Taiwan.MethodsInformation on obstetric antecedents and risk factors for preterm birth in pregnant women was obtained from the National Health Insurance Research (NHIR) database provided by the Taiwan National Health Research Institute. All live births from 2004 to 2013 in Taiwan were included in this study.ResultsA total of 130,362 live births from 2004 to 2013 were included in this study. Overall, the average annual rate of preterm births increased by 5.3% (from 3.33% in 2004 to 5.11% in 2013). Multiple logistic regression analyses showed that nulliparous women, multifetal pregnancies, advanced mother age, history of preterm birth, history of maternal drug abuse/dependence, and maternal medical complications were positively associated with an increased risk of preterm birth (all p-values< 0.05).ConclusionThe overall proportion of preterm births increased from 2004 to 2013 in Taiwan. Babies born preterm had a higher risk of developing morbidities and mortalities. The development of a comprehensive program to identify the high-risk group is needed for effective interventions to prevent premature birth.

Fatores sociodemográficos e condições de risco em gestantes de um ambulatório especializado do sul do Brasil

Objetivo: Analisar a presença de condições de riscos e sua relação com as características sociodemográficas de gestantes atendidas em um ambulatório especializado do sul do Brasil. Métodos: Estudo exploratório, descritivo, de abordagem quantitativa, realizado a partir de prontuários de 920 gestantes acompanhadas no pré-natal de alto risco. As variáveis desfechos foram: condições pré-existentes, antecedentes obstétricos e intercorrências clínicas e as variáveis independentes foram características sociodemográficas da mulher. Resultados: Mulheres com 36 anos ou mais apresentaram associação significativa para hipertensão (28,8%), endocrinopatias (20,6%), mioma uterino (6,9%) e mais de três cesáreas (6,9%). A baixa escolaridade esteve associada com hipertensão (25,0%), epilepsia (6,4%), mais de três cesáreas (10,8%) e gemelaridade (10,8%). Conclusão: Identificaram-se associações entre o perfil sociodemográfico com condições clínicas pré-existentes, antecedentes obstétricos e intercorrências clínicas na gestação de alto risco, atribuindo aos ambulatórios especializados a necessidade de realizar ações para minimizar os desfechos desfavoráveis e melhorar a qualidade dos serviços.

Broad Band Ligament Hernia Revisited (85 Cases of Allen-Master’s Syndrome; History and Perspectives)

The purpose of this review is to update readers on the characteristics and pathogenesis of internal hernia secondary to a defect of broad ligament of the uterus. The etiopathogenesis of the disease is controversial. There are two main hypotheses to explain the generation of the defect in the ligament. The first of them would explain this entity as a result of obstetric trauma, an inflammatory pelvic disease, or gynecological surgery. However, in the absence of them, the second hypothesis would speak of congenital defects due to rupture of cysts of the ligament itself. In either case, a defect in the ligament would occur, and that would typically allow the herniation of the bowel, causing an intestinal obstruction. In addition, despite the classic tendency of conventional open surgery access as part of the treatment, laparoscopic access is today, in trained hands, a perfectly valid option. Internal hernias account for less than 1% of the total bowel obstruction cases. Those originated by a defect of the broad ligament are exceptional. A non-systematic review of the cases reported in PubMed was carried out. Eighty-seven cases were found. In them, we analyzed variables such as age, surgical or obstetric background, laterality, incarcerated content, clinical, imaging tests, need for intestinal resection, hernia type, and surgical access. Patient’s age was 1–94 years (mean 44.6 ± 15 years). The results obtained were compared with those contributed to literature by each author. Early diagnosis of this pathology is difficult and should be suspected in women with obstetric or gynecological antecedents who present with intestinal obstruction. Its treatment is mainly surgical: access to the abdominal cavity, release the incarcerated part, repair the defect (by suturing it), and, if necessary, treat the incarcerated bowel with economic resection and anastomosis. Nowadays, laparoscopic access is considered an adequate option in surgeons with proper training.

Multiple Events Model for the Infant Mortality at Kigali University Teaching Hospital

Introduction: The present study applies multiple events survival analysis to infant mortality at the Kigali University Teaching Hospital (KUTH) in Rwanda. Materials and Methods: The primary dataset consists of newborns from KUTH recorded in the year 2016 and in the current paper, a complete case analysis was used. Two events per subject were modeled namely death and the occurrence of at least one of the following conditions that may also cause long-term death to infants such as severe oliguria, severe prematurity, very low birth weight, macrosomia, severe respiratory distress, gastroparesis, hemolytic, trisomy, asphyxia and laparoschisis. Covariates of interest include demographic covariates namely the age and the place of residence for parents; clinical covariates for parents include obstetric antecedents, type of childbirth and previous abortion. Clinical covariates for babies include APGAR, gender, number of births at a time, weight, circumference of the head, and height. Results/Conclusion: The results revealed that Wei, Lin and Weissfeld Model (WLWM) fit the data well. The covariates age, abortion, gender, number, APGAR, weight and head were found to have a significant effect.

Investigating the relationships between chronic ill health and educational outcomes in children

ABSTRACT&#x0D; ObjectivesThis population wide record linkage study linked Scottish education data to a number of administrative health datasets to explore the impact of childhood chronic ill health on subsequent educational and health outcomes. Chronic conditions investigated in this study were diabetes, asthma, epilepsy, ADHD and depression. Specific educational outcomes of interest were academic attainment, school leaver destination, absence levels, exclusions and record of special educational need (SEN). Children were also followed up for hospital admissions and all-cause mortality.&#x0D; ApproachPupil census data and associated education records for all children attending primary and secondary schools in Scotland between 2009 and 2013 were linked to national prescribing data, hospital admissions (acute, psychiatric and cancer), death records and their mother’s maternity records to enable a range of different chronic conditions to be studied whilst controlling for various confounders. Specific drugs are prescribed for some particular chronic conditions therefore children identified from prescribing data as receiving these drugs at the time of the school census were assumed to have these conditions. Hospital admissions and death records provided information on subsequent admissions and mortality. Linking all children to their mother’s maternity records provided ability to control for a range of obstetric factors, birth outcomes and maternal antecedents.&#x0D; ResultsDiabetes, asthma, epilepsy, ADHD and depression were significantly associated with increased numbers of absences at school and increased risk of SEN. All of the conditions with the exception of diabetes were significantly associated with poorer subsequent educational grade attainment. ADHD and depression were significantly associated with increased numbers of exclusions at school whilst asthma was significantly associated with less exclusion. Epilepsy, ADHD and depression were significantly associated with poorer leaver destination 6 months after leaving school.&#x0D; ConclusionCompared to peers, children who had ADHD or depression were most adversely affected experiencing poorer educational outcomes in all five of the educational domains investigated. Children with epilepsy experienced poorer outcomes across four domains. Children with diabetes and asthma experienced more absence and increased SEN and asthmatic children experienced poorer attainment. Children who have these chronic illnesses at school appear to be at an educational disadvantage therefore further understanding of the intricate relationships between health and education is an on-going important area of public health.

137: Periventricular leukomalacia with PPROM: obstetric antecedents and infants’ outcomes

137: Periventricular leukomalacia with PPROM: obstetric antecedents and infants’ outcomes

Preterm birth trend in Taiwan from 2001 to 2009.

The aim of this study was to analyze the trends and risk factors of preterm birth from all the women who delivered during 2001-2009 in Taiwan. We analyzed the preterm birth rates, the proportions of obstetric antecedents and risk factors in the population of pregnant women and neonatal Apgar scores according to the National Medical Birth Register database from 2001 to 2009. Adjusted odds ratios (OR) with 95% confidence intervals for risk factors of preterm birth were assessed using multivariable logistic regression models. The obstetric antecedents of preterm birth for singletons were stratified by spontaneous preterm labor and indicated preterm delivery (labor induction or elective cesarean delivery). The preterm birth rate was 8.56% with the majority (89.76%) delivered between 32 and 37 weeks of gestation. A 0.07% annual increase (P < 0.001) in preterm delivery was observed. The greatest risk factors were multiple pregnancies (OR > 20), followed by medical complications (OR > 2.8), congenital malformations (OR > 2), teen pregnancies (OR > 1), and advanced maternal age (OR > 1). Specifically, singleton preterm births comprised 57.3% spontaneous labor and 42.7% indicated delivery. There was a 0.5% annual increase (P < 0.001) in indicated delivery. Incidence of neonates with poor Apgar scores (<7) was significantly different between those with and without medical complications (P < 0.001). The preterm birth rate increased significantly from 2001 to 2009 and multiple pregnancies were the most important contributing factor. Most of the singleton preterm births resulted from spontaneous labor, but the proportion of indicated deliveries increased.

What Is New in Obstetric Antecedents of Chronic Disease?

This month, we focus on current research in obstetric antecedents of chronic disease. Dr Malone discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page along with direct links to the abstracts.

Obstetric antecedents to body-cooling treatment of the newborn infant

Obstetric antecedents were analyzed in births in which the infant received whole-body cooling for neonatal encephalopathy. This retrospective cohort study included all live-born singleton infants delivered at or beyond 36 weeks' gestation from October 2005 through December 2011. Infants who had received whole-body cooling identified by review of a prospective neonatal registry were compared with a control group comprising the remaining obstetric population delivered at greater than 36 weeks but not cooled. Univariable analysis was followed up by a staged, stepwise selection of variables with the intent to rank significant risk factors for cooling. A total of 86,371 women delivered during the study period and 98 infants received whole-body cooling (1.1 per 1000 live births). Of these 98 infants, 80 newborns (88%) had moderate encephalopathy and 10 (12%) had severe encephalopathy prior to cooling. Maternal age of 15 years or younger, low parity, maternal body habitus (body mass index of ≥40 kg/m(2)), diabetes, preeclampsia, induction, epidural analgesia, chorioamnionitis, length of labor, and mode of delivery were associated with significantly increased risk of infant cooling during a univariable analysis. Catastrophic events to include umbilical cord prolapse (odds ratio [OR], 14; 95% confidence interval [CI], 3-72), placental abruption (OR, 17; 95% CI, 7-44), uterine rupture (OR, 130; 95% CI, 11-1477) were the strongest factors associated with infant cooling after staged-stepwise logistic analysis. A variety of intrapartum characteristics were associated with infant cooling for neonatal encephalopathy, with the most powerful antecedents being umbilical cord prolapse, placental abruption, and uterine rupture.

Post‐cervical conization outcomes in patients with high‐grade intraepithelial lesions

To investigate the rates of residual, recurrent and invasive disease after cervical conization in patients diagnosed with cervical intraepithelial neoplasia (CIN) grades 2/3. A retrospective study was conducted with 274 patients undergoing cervical conization due to diagnosis of CIN 2/3. Cervical conization was done through the Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Conization. Data related to personal, familial, gynecological, and obstetric antecedents, as well as surgical specimens margins were collected from medical records. The outcome after conization was evaluated, including the time of follow-up and disease recurrence. The outcome after conization was not associated with age of menarche (p = 0.920), age of the first sexual intercourse (p = 0.533), number of parturition (p = 0.063), number of sexual partners (p = 0.328), immunosuppression (p = 0.225), smoking habit (p = 0.193), and conization type (p = 0.198). However, the outcome presented a significant association with age (p < 0.001), pregnancy numbers (p = 0.009), use of hormonal contraception methods (p = 0.016), menopause (p = 0.007), type of margins (p = 0.011), and cone histological results (p = 0.030). The routine control of all patients who had undergone cervical conization is obligate, independently of surgical margins, due to the risk of disease recurrence; the older patients and those with CIN 3 should have a more rigorous follow-up.

Epicure 2: obstetric antecedents of extremely premature delivery in England

<h3>Objectives</h3> To examine the effects of antenatal steroids, tocolysis, and delivery mode on extremely preterm delivery; to identify other potential antecedents through a hypothesis-generating analysis. <h3>Design</h3> National cohort study. <h3>Setting</h3> England. <h3>Participants</h3> Singleton pregnancies delivering before 27 weeks gestation during 2006. <h3>Main outcome measures</h3> Survival at birth (heart rate &gt; 100 at 5 minutes) and at hospital discharge. <h3>Results</h3> 1723 births were identified for inclusion. Antenatal steroids were associated with improvements in live birth (adjusted odds ratio (aOR) for any steroids: 1.65, 95% CI: 1.20–2.27) and survival to discharge (partial course of steroids: aOR 1.80, (1.25–2.59); complete course: aOR 2.38, (1.69–3.34)). Tocolysis was positively associated with both: aORs 1.38 (1.04-1.83) and 1.32 (1.04-1.68) for survival at birth and discharge, respectively. Caesarean delivery did not affect either outcome after adjustment. In the hypothesis-generating analysis, gestational age had the strongest influence (aORs per week: 2.08 (1.86–2.34) for live birth; aOR 2.89 (2.56–3.28) for survival to discharge). Male sex reduced survival to discharge (aOR 0.64 (0.50–0.82)), as did non-cephalic presentation (aOR 0.59 (0.46–0.75)), in contrast with an aOR of 1.99 (1.17–3.43) for cervical cerclage and of 1.76 (1.27–2.45) for a spontaneous onset of labour. <h3>Discussion</h3> Our results confirm the efficacy of antenatal steroids and tocolysis for promoting survival of extremely premature babies. Fetal sex, presentation, presence of a cervical suture, and a spontaneous onset of labour potentially provide extra information concerning the odds of survival over and above gestational age; these factors warrant further investigation and may influence management decisions and counselling.

Sheehan Syndrome in Costa Rica: Clinical Experience With 60 Cases

To describe the clinical and hormonal characteristics of patients with Sheehan syndrome. We performed a 20-year cohort study (1969 to 1989) of patients with Sheehan syndrome who were cared for in the endocrinology unit of the México Hospital in San José, Costa Rica. Medical history, physical examination findings, and laboratory test results were documented and reviewed. Sixty patients with a diagnosis of Sheehan syndrome were identified. Mean age at diagnosis was 45.8 ± 10.6 years. The average time between the previous obstetric event and Sheehan syndrome diagnosis was 13 years. Thirteen patients (22%) had a home birth. The median parity was 7. The most frequent obstetric antecedents were history of obstetric hemorrhage in 49 (82%), shock in 28 (47%), blood transfusion in 26 (43%), and peripartum hysterectomy in 4 (7%). The most common symptoms included asthenia and adynamia in 51 (85%), amenorrhea in 44 (73%), loss of axillary or pubic hair in 40 (67%), and agalactia in 40 (67%). The most common findings on physical examination were absence of axillary hair in 56 (93%) and pubic hair in 56 (93%), dry skin in 49 (82%), and pallor in 42 (70%). When a combined pituitary test was performed, 38 of 38 patients (100%) had human growth hormone deficiency, 29 of 30 patients (97%) had adrenal insufficiency, 8 of 10 patients (80%) had hypothyroidism, 8 of 12 patients (67%) had hypogonadism, and 9 of 13 patients (69%) had prolactin deficiency. Despite early onset of symptoms, Sheehan syndrome was diagnosed relatively late in these 60 patients. Hemorrhage during the last delivery, especially if severe and/or associated with shock or transfusion, was the most important obstetric antecedent event. Absence of amenorrhea or presence of postpartum lactation did not exclude the diagnosis. Abnormal responses of human growth hormone to insulin tolerance testing and of prolactin to thyrotropin-releasing hormone confirm the diagnosis. Identification of patients affected with Sheehan syndrome is critical to avoid delays in diagnosis and treatment. Appropriate replacement therapy is capable of yielding complete remission of symptoms.

Compliance with leisure‐time physical activity recommendations in pregnant women

The aim of this study was to identify the prevalence and factors associated with the performance of minimal beneficial leisure-time physical activity in the first half of pregnancy according to the criteria of the American College of Sport and Medicine (ACSM) and the American College of Obstetricians and Gynecologists (ACOG). This was a cross-sectional study carried out at the Maternal and Neonatal University Hospital in Granada, which services the whole population of the hospital reference area. We studied 1,175 healthy pregnant women aged over 18 years. Information about sociodemographics, lifestyles, obstetric antecedents and anthropometric variables were collected. The amount of leisure-time physical activity was quantified by assigning metabolic equivalents to each activity. The ACSM and ACOG criteria were used to define optimal physical activity in the first half of pregnancy. The frequency of compliance for both criteria was estimated. Multiple logistic regression models were fitted to study the factors associated with the recommendations. Only 20.3% (95% confidence interval 15.50-26.10) of the women complied with ACOG criteria. More women complied with ACSM recommendations (70.8%, 95% confidence interval 67.5-73.8), which are less restrictive criteria. Women aged 30 years old or older and those with a university degree tended to devote more time to exercising according to both recommendations. The prevalence of pregnant women who performed minimal beneficial leisure-time physical activity was lower with the dominant and more accepted criteria. It is necessary to encourage physical activity, mainly among those who are younger, and those with lower levels of educational attainment.

Prevalence and risk factors for urinary and fecal incontinence in brazilian women

To evaluate prevalence and risk factors of fecal and urinary incontinence (UI) in Brazilian women. 685 women older than 20 years of age answered a questionnaire about urinary and fecal symptoms, clinical and obstetric antecedents. They were grouped according to presence or absence of UI. Urinary and fecal incontinence was reported in 27% and 2% of cases, respectively. Mean age of incontinent women was significantly higher than continent ones. Incontinent women had a mean number of micturitions significantly higher than the continent ones. On average, incontinent women had higher rate of pregnancies and vaginal delivery when compared to the continent ones. Body mass index (BMI) was significantly higher in incontinent participants and in women with no UI complaints (27.35 vs. 24.95, p < 0.05). Fecal incontinence prevalence was 2% and occurred exclusively in patients with UI. Vaginal delivery and high BMI have been identified as risk factors for UI development while aging and number of pregnancies may be correlated factors.

The Effect of Changing Patterns of Obstetric Care in Scotland (1980–2004) on Rates of Preterm Birth and Its Neonatal Consequences: Perinatal Database Study

Rates of preterm birth are rising worldwide. Studies from the United States and Latin America suggest that much of this rise relates to increased rates of medically indicated preterm birth. In contrast, European and Australian data suggest that increases in spontaneous preterm labour also play a role. We aimed, in a population-based database of 5 million people, to determine the temporal trends and obstetric antecedents of singleton preterm birth and its associated neonatal mortality and morbidity for the period 1980-2004. There were 1.49 million births in Scotland over the study period, of which 5.8% were preterm. We found a percentage increase in crude rates of both spontaneous preterm birth per 1,000 singleton births (10.7%, p<0.01) and medically indicated preterm births (41.2%, p<0.01), which persisted when adjusted for maternal age at delivery. The greater proportion of spontaneous preterm births meant that the absolute increase in rates of preterm birth in each category were similar. Of specific maternal complications, essential and pregnancy-induced hypertension, pre-eclampsia, and placenta praevia played a decreasing role in preterm birth over the study period, with gestational and pre-existing diabetes playing an increasing role. There was a decline in stillbirth, neonatal, and extended perinatal mortality associated with preterm birth at all gestation over the study period but an increase in the rate of prolonged hospital stay for the neonate. Neonatal mortality improved in all subgroups, regardless of obstetric antecedent of preterm birth or gestational age. In the 28 wk and greater gestational groups we found a reduction in stillbirths and extended perinatal mortality for medically induced but not spontaneous preterm births (in the absence of maternal complications) although at the expense of a longer stay in neonatal intensive care. This improvement in stillbirth and neonatal mortality supports the decision making behind the 34% increase in elective/induced preterm birth in these women. Although improvements in neonatal outcomes overall are welcome, preterm birth still accounts for over 66% of singleton stillbirths, 65% of singleton neonatal deaths, and 67% of infants whose stay in the neonatal unit is "prolonged," suggesting this condition remains a significant contributor to perinatal mortality and morbidity. In our population, increases in spontaneous and medically induced preterm births have made equal contributions to the rising rate of preterm birth. Despite improvements in related perinatal mortality, preterm birth remains a major obstetric and neonatal problem, and its frequency is increasing. Please see later in the article for the Editors' Summary.

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature.

The incidence of scar endometrioma ranges from 0.03 to 3.5%. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed. Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. There were 33 patients, of mean age 30.1 +/- 5.0 years (range: 18-41 years). The total incidence was 0.11%: 0.29% in cesarean sections and 0.01% in vaginal deliveries. Twenty-nine tumors (87.9%) were located in cesarean scars, two (6.0%) in episiotomy scars and two (6.0%) in the umbilical region. The main symptom was localized cyclical pain (66.7%), of mean duration 30.5 months (+/- 23). Surgical treatment was successful in all cases. This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01). The surgical treatment of choice is excision of the endometrioma with a safety margin.

Resultados obstétricos tras conización. Hospital de León. Período 1999–2007

Objective To determine the obstetric results after conisation at the Leon Hospital (Spain) between 1999 and 2007. Material and method We performed a retrospective cohort study of 338 conisations. Thirty-six women conceived and a total of 46 pregnancies were obtained during the study period. The following variables were analysed: maternal age, obstetric antecedents, smoking, the diagnoses motivating the conisation, final histopathological diagnosis, height of the extirpated cone, conisation-childbirth interval, type of labor, and gestational age and weight of the newborn. Results Of the 30 pregnancies that exceeded 24 weeks, 20% ended preterm. No differences were found when the groups were compared according to smoking. None of the newborns was underweight for gestational age. Conclusions A significant statistical association was observed between conisation and preterm delivery, independently of cone length or the conisation-labor interval. No statistical association was found between low birthweight and conisation.