Removal Of Women Research Articles

Validation of uterine artery embolization before surgical laparoscopic myomenucleation compared to single surgical laparoscopic myomenucleation for the treatment of large fibroids and uterus myomatosus.

To determine the efficacy of preoperative uterine artery embolization (uterine artery embolization; UAE) prior to elective laparoscopic fibroid removal compared to single laparoscopic fibroid removal in women with large uterine fibroids and women with uterus myomatosus. A total of 202 women with symptomatic uterine fibroids who were scheduled for elective fibroid enucleation were included in this retrospective, monocentric, non-randomized study. Two procedures were compared: women who received percutaneous UAE 24 h prior to elective laparoscopic fibroid eviction for large uterine fibroids (>6 cm) and uterus myomatosus. And women who received laparoscopic fibroid enucleation alone for large uterine fibroids and uterus myomatosus. Outcome parameters for effectiveness were the hospital stay, the operating time and the intraoperative blood loss. Women who underwent preoperative percutaneous embolization of the uterine arteries, both for large fibroids and uterus myomatosus, had significantly less blood loss, shorter hospital stays, and shorter operating times. Especially women with large uterine fibroids and women with uterus myomatosus after having children can benefit from the combination therapy of preoperative percutaneous uterine embolization with subsequent laparoscopic myoma enucleation.

Predictive factors for the success of trial catheter removal for women with urinary retention.

To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention. Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases. Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p=.392), median ECOG (Eastern Cooperative Oncology Group) performance status (p=.374), diabetes mellitus (p=.842), dementia (p=.801), previous history of cerebrovascular events (p=.592), or intrapelvic surgery (p=.800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p=.598). Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p=.039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p=.038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p=.030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p=.066, OR 4.8, 95% CI of OR 0.9-25.0). This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.

Long-term colorectal cancer incidence and mortality after adenoma removal in women and men.

Women and men with colorectal adenomas are at increased risk of colorectal cancer and colonoscopic surveillance is recommended. However, the long-term cancer risk remains unknown. To investigate colorectal cancer incidence and mortality after adenoma removal in women and men METHODS: We identified all individuals who had adenomas removed in Norway from 1993 to 2007, with follow-up through 2018. We calculated standardized incidence ratios (SIR) and incidence-based mortality ratios (SMR) with 95% confidence intervals (CI) for colorectal cancer in women and men using the female and male population for comparison. We defined high-risk adenomas as ≥2 adenomas, villous component, or high-grade dysplasia. The cohort comprised 40293 individuals. During median follow-up of 13.0years, 1079 women (5.5%) and 866 men (4.2%) developed colorectal cancer; 328 women (1.7%) and 275 men (1.3%) died of colorectal cancer. Colorectal cancer incidence was more increased in women (SIR 1.64, 95% CI 1.54-1.74) than in men (SIR 1.12, 95% CI 1.05-1.19). Colorectal cancer mortality was increased in women (SMR 1.13, 95% CI 1.02-1.26) and reduced in men (SMR 0.79, 95% CI 0.71-0.89). Women with high-risk adenomas had an increased risk of colorectal cancer death (SMR 1.37, 95% CI 1.19-1.57); women with low-risk adenomas (SMR 0.90, 95% CI 0.76-1.07) and men with high-risk adenomas had a similar risk (SMR 0.89, 95% CI 0.76-1.04), while men with low-risk adenomas had reduced risk (SMR 0.70, 95% CI 0.59-0.84). After adenoma removal, women had an increased risk of colorectal cancer death, while men had reduced risk, compared to the general female and male populations. Sex-specific surveillance recommendations after adenoma removal should be considered.

Pain after midurethral sling; the underestimated role of mesh removal.

IntroductionThe primary aim of this study was to evaluate the results of midurethral sling (MUS) removal in women who have pain as their single complication of MUS.Material and methodsWe performed a retrospective chart study supplemented with a cross sectional questionnaire. Women who underwent MUS removal for pain as the solitary reason for removal between 2004 and 2018 were included. Primary outcome was change in pain levels assessed by the visual analogue scale (VAS) pain score (range 0–10). Secondary outcome was the recurrence of stress urinary incontinence (SUI).ResultsTwenty-six of 31 patients returned the questionnaire. Median medical file follow-up was 12 months (range 2–66) and 25 months (range 5–104) regarding questionnaires. VAS pain score dropped from 7.8 (SD 1.9) at baseline to 4.5 (SD 3.2) at follow-up (p <.00). Seven (23%) patients were pain-free. Patients undergoing partial vaginal resection (n = 6) had a VAS pain score decrease of 4.7 (p = .02) versus 2.7 (p = .02) for complete vaginal removal (n = 14). Twenty-three (89%) patients experienced SUI at follow-up, whereof 10 (45%) reported (almost) no incidents of SUI.ConclusionsMUS removal is a viable and safe option with a significant drop in VAS pain score in patients with chronic pain after MUS placement. A post-operative increase of SUI and a possible renewed wish for SUI treatment have to be considered. This should not be a reason to refrain from information and/or referral for surgical removal.

Gendered isolation, idealised communities and the role of collective power in West Bengal self-help groups

Empowerment and power have long been fervently contested in feminist theory and geography. Much debate focuses on whether empowerment is mainly monetary or more holistic and emancipatory. In both cases, most of the literature centres on individual empowerment and internal ‘power within’. Much less attention, however, has been given to the idea of ‘power with’ and how friendship, solidarity and emotional connections are fundamental to empowerment and yet are highly vulnerable to outside influence. Drawing on field research from Self-Help Groups in West Bengal, this article highlights how the formation of ‘power with’ is particularly important in contexts of gendered isolation, where patriarchy is enacted through the spatial control of women and removal of women from the public sphere, illustrating that communities in the Global South are not necessarily sites of collective unity and cohesion. These findings contest both idealised notions of community and mainstream theories of power and empowerment and in turn, provide crucial insights for feminist geography and power theory.

322: A comparison of intrauterine balloon deflation techniques in postpartum hemorrhage

Intrauterine balloon tamponade is a commonly used treatment for refractory postpartum hemorrhage (PPH). However, balloon deflation techniques at the time of tamponade removal have not been studied. The objective of this study was to compare gradual intrauterine balloon deflation versus all-at-once removal in women with PPH. Retrospective cohort study of women with PPH requiring intrauterine balloon tamponade from 2015-2018. Patients who had gradual balloon deflation (≥30 minutes from start of deflation to removal) were compared to those who had the balloon deflated and removed all-at-once. Clinical outcomes were assessed including estimated blood loss (EBL), decrease in hemoglobin, blood transfusion, need for additional invasive surgical procedures (i.e. uterine artery embolization, B-Lynch, hysterectomy), ICU admission and postpartum fever. The primary study outcome was a composite maternal morbidity of transfusion ≥4 units PRBC, disseminated intravascular coagulopathy (DIC), need for additional invasive surgical procedures or ICU admission. Chi-square, Mann Whitney U and multivariate logistic regression models were used for statistical analysis. Of 51 women with PPH and intrauterine balloon placement, 40 (78.4%) underwent gradual balloon deflation and 11 (21.6%) underwent all-at-once removal. The median duration of intrauterine balloon tamponade was 1100 minutes (150-2025 minutes), and did not differ between the two groups (1090 vs 1230 minutes, p=0.95). Within the gradual group, the median time from start of deflation to complete balloon removal was 150 minutes (30-510 minutes). Clinical outcomes are shown in the Table. Composite maternal morbidity was not statistically different between the gradual and all-at-once groups (25% vs 27.3%, p=0.88). Maternal age, parity, gestational age, BMI, mode of delivery, and neonatal weights did not differ between the two groups. The groups had similar rates of inductions, cesarean deliveries, multifetal pregnancies, episiotomies and postpartum fevers. There were no peripartum hysterectomies or maternal deaths. In women with refractory PPH requiring intrauterine balloon tamponade, gradual balloon deflation compared to all- at-once removal have similar clinical outcomes.

Use of fiberoductoscopy for the management of patients with pathological nipple discharge: experience of a single center in Poland

BackgroundPathological nipple discharge (PND) is associated with serious clinical and diagnostic issues. Fiberoductoscopy (FDS) is a new diagnostic option in PND patients. This study summarizes our initial experience of FDS for the management of PND patients in a single center in Poland and assesses its safety.MethodsA total of 256 women with PND were included in this prospective, case-controlled, single-center study between 2006 and 2014. Of the 250 patients who underwent FDS, 154 had mammary duct lesions and 96 had no visible lesions. Subsequently, 129 patients with lesions identified by FDS underwent microductectomy and the lesions were pathologically evaluated.ResultsThe mean duration of FDS examination was 17 min. The most frequent intraductal lesion was amputation of a duct (35.1%), followed by circular narrowing or hyperplasia (22.7%). Final histological findings were unremarkable in 11.6% of cases, whereas mammary duct papilloma, duct ectasia, and ductal carcinoma in situ were detected in 71.3, 10.9, and 6.2% of cases, respectively.ConclusionsFDS is an innovative method for visualizing intraductal mammary lesions and allows accurate selection of mammary ducts with suspicious lesions that require surgical removal in women with PND.

Effect of Body Hair Removal on Female Sexual Function

Body hair is a sign of sexual maturity for both women and men, but in women femininity is actually associated with a lack of body hair. women in ancient Egypt and classical Greece may have removed some or all of their body hair and grooming pubic hair may have been considered a feature of women‟s sexual attractiveness. woman with body hair was seen as less sexually attractive, sociable and intelligent, and more masculine, than the same woman without body hair.Evaluate the impact of removal of body hair on various aspects of female sexuality. a self-report questionnaire designed by the authors guided by the female sexual function index (Rosen et al, 2000). The aim of the study and the details of the questionnaire were explained to the women before taking their informed consent. Participants were 222 women recruited from those attending the Dermatology and Andrology outpatient clinics at El-menshawy General Hospital, Tanta. Increase all sexual function after body hair removal.The present study findings indicate that sexual functions as desire, lubrication, orgasm improve after body hair removal in women .Several factors affect female sexual function after hair removal as circumcision, education, occupational status and site of hair removal.

Management of Urinary Incontinence Following Suburethral Sling Removal

We evaluated urinary incontinence outcomes following synthetic suburethral sling removal in women. We reviewed a prospectively maintained database of 360 consecutive women who underwent transvaginal suburethral sling removal from 2005 to 2015. We excluded patients with neurogenic bladder, nonsynthetic or multiple slings, prior mesh for prolapse, concomitant surgery during sling excision, urethral erosion or fistula, postoperative retention or less than 6-month followup. Demographics, sling type, indications for removal, time to removal and patient reported outcomes were recorded. Outcomes were stratified by incontinence type, including stress predominant, urge predominant and mixed urinary incontinence. Subsequent management was evaluated, including observation, minimally invasive outpatient interventions (bulking agents, neuromodulation or onabotulinumtoxinA) or more invasive surgery (autologous fascial sling or bladder suspension). No patients elected to receive a subsequent synthetic sling. Success was defined by responses to UDI-6 (Urogenital Distress Inventory) questions 2 and 3, self-reported satisfaction with continence at the last visit and no further intervention. Of the 99 patients who met inclusion criteria 27 denied any subjective leakage after suburethral sling removal alone while 72 experienced some degree of incontinence after removal. Stress predominant urinary incontinence occurred in 26 patients, which was persistent in 7 and de novo in 19, urge predominant incontinence was noted in 14, which was persistent in 6 and de novo in 8, and mixed urinary incontinence occurred in 32, which was persistent in 13 and de novo in 19. Mean followup was 23 months (range 6 to 114). The success rate following a single minimally invasive intervention after suburethral sling removal was 81%, 86% and 75% in patients with stress predominant, urge predominant and mixed urinary incontinence, respectively. Patients who undergo suburethral sling removal may show urinary control, or de novo or persistent incontinence with a higher predilection for stress predominant or mixed urinary incontinence. However, after a single minimally invasive intervention following suburethral sling removal the success rate reached 75% to 86%.

Maternal Morbidity in Women with Placenta Previa Managed with Prediction of Morbidly Adherent Placenta by Ultrasonography.

Objective. To determine maternal morbidity in women with placenta previa managed with prediction of morbidly adherent placenta (MAP) by ultrasonography. Methods. A retrospective cohort study was undertaken comprising forty-one women who had placenta previa with or without risk factors for MAP. Women who had all three findings (bladder line interruption, placental lacunae, and absence of the retroplacental clear zone) were regarded as high suspicion for MAP and underwent cesarean section followed by hysterectomy. We attempted placental removal for women having two findings or less. Results. Among 28 women with risk, nine with high suspicion underwent hysterectomy and were diagnosed with MAP. Three of 19 women with two findings or less eventually underwent hysterectomy and were diagnosed with MAP. The sensitivity and positive predictive value for the detection of MAP were 64% and 100%. The pathological severity of MAP was significantly correlated with the cumulative number of findings. There were no cases of MAP among 13 women without risk. There was no difference of blood loss between women with high suspicion and those without risk (2186 ± 1438 ml versus 1656 ± 848 ml, resp.; p = 0.34). Conclusion. Management with prediction of MAP by ultrasonography is useful for obtaining permissible morbidity.

Ultrasound-Guided Ureteral Stent Removal in Women.

The purpose of this study was to develop a fast, comfortable, and safe method of ureteral stent removal in women. From February 2014 to July 2015, a retrospective multicenter controlled study including 82 female outpatients was conducted. The control group was composed of 46 patients who underwent stent removal using a 22F cystoscope. The experimental group was composed of 36 patients who underwent stent removal under ultrasound guidance with a 15F spiral-ending device. Exclusion criteria were pelvic organ prolapse quantification stage II or higher and complicated stents (with migration or encrustation). All studied patients had successful ureteral stent removal. No complications were seen in both groups. Differences between mean visual analog pain scale scores and stent removal durations were statistically significant in favor of the experimental group (P = .0077 and .0075, respectively). The proposed method for ureteral stent removal in women under ultrasound guidance was shown to be faster and to have lower visual analog pain scale scores, in comparison with removal by a cystoscope, which makes it an attractive option for outpatient urologic praxis in uncomplicated cases, and because it is free of the risk of ionizing radiation and more comfortable, it can be used in pregnant patients.

3 Mid-term outcomes following sub-urethral synthetic sling removal in women

INTRODUCTION AND OBJECTIVES: Midurethral slings are most commonly performed procedure for treatment of Stress Urinary incontinence (SUI). With the limitations attributed to synthetic materials, there continues to be an unmet for improved biomaterials that exhibits the attributes of synthetic material and potentially avoids the negative aspects. Our aim is to examine the biocompatibility of our woven collagen mesh with different crosslinking: Genipin and 1-ethyl-3-dimethylaminopropyl carbodiimide & N-hydroxy succinimide (EDC); against commonly used biomaterials (Prolene and xenograft). METHODS: Collagen solution derived from bovine corium was electrochemically aligned into threads and crosslinked with either Genipin or EDC, then woven into a macroporous mesh. A total of 15 Sprague Dawely rats were randomly grouped into 3 time points: 2 weeks, 8 weeks and 20 weeks. Four different scaffolds were implanted subcutaneously in the abdomen per animal, one each of 1 x 1 cm mesh of Xenmatrix, Prolene, Genipin collagen and EDC collagen. At respective time points, scaffolds were harvested and fixed for a week then sent for histology. Scoring was done by senior pathologist in accordance with ISO 10399. Slides were also scanned for image analysis using ImageJ. Statistical analysis was done using IBM SPSS software. RESULTS: There is no significant acute or chronic inflammation in all materials. Collagen mesh presented favorable biocompatibility scores comparable to Prolene at all time points. Xenmatrix meshes were totally encapsulated and lacked tissue integration with no evidence of cellular infiltration, neovascularization or collagen deposition inside the material at all time points. (see Table 1 for complete results). Although significant microscopic degradation of collagen threads over time, the rate of collagen remodeling recovered collagen density at 5 months (figure 1). CONCLUSIONS: Macroporous Collagen mesh allowed tissue integration & new collagen deposition comparable to Prolene mesh. Thus, our novel mesh has a promising potential in incontinence and pelvic floor reconstruction. Source of Funding: none

A new ultrasound guided method for ureteral stent removal in women after lithotripsy

Objective : to develop a rapid, convenient and safe method for ureteral stent removal in women after lithotripsy. Materials and methods : We conducted a retrospective multicentre study (time frame: February 2014 – March 2016) that included 122 female patients after lithotripsy: 46 of them were in the control group (where the stent was removed in a conventional way using cystoscope 22 Ch), 76 patients were in the experimental group (where the stent was removed using «spiral device» 15 Ch under ultrasound guidance). The exclusion criteria were the following: pelvic organ prolapse (stage 2 or greater according to POP-Q system), presence of stent complications (stent displacement or encrustation). We evaluated the duration of stents removal, pain intensity according to Visual Analog Scale for Pain, and the likelihood of complications. Results. Stents were successfully removed in all patients. No complications were observed in both groups. Stent removal in the experimental group was approximately 4 sec longer than that in the control group (p = 0,0056). The difference was statistically significant, but didn»t have great clinical importance. Difference in pain intensity according to Visual Analog Scale for Pain was the most significant; patients in experimental group were found to have lower levels of pain (p = 4 × 10 –5). Conclusion . Proposed ultrasound guided method for ureteral stent removal by a loop in women after lithotripsy appears to be more comfortable. It is characterized by lower pain intensity according to Visual Analog Scale for Pain comparing to conventional method with cystoscope; it does not imply any additional costs associated with usage of endoscopic equipment, its sterilization and working time of a nurse. Therefore, the method can be considered as a good option for outpatient practice in patients without complications; moreover it can be recommended for stent removal in pregnant women as soon as the technique does not require the use of ionising radiation.

Relationship between serum concentrations of persistent organic pollutants and markers of insulin resistance in a cohort of women with a history of gestational diabetes mellitus

The aim of the present study was to assess the relationship between serum concentrations of several persistent organic pollutants and insulin resistance markers in a cohort of women with a history of gestational diabetes mellitus. ∑POPs was computed as the sum of individual serum POP concentrations. No statistically significant associations were found between levels of any POP and fasting glucose. However, polychlorinated biphenyl (PCB) congeners 138 and 180 were positively associated with 2-h glucose levels and PCB 180 also with fasting immunoreactive insulin (IRI). We also found a positive association of p,p′- dichlorodiphenyldichloroethylene (p,p′- DDE), PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs with 2-h IRI. Serum concentrations of PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs were also positively associated with homeostasis model assessment (HOMA2-IR) levels. Moreover, p,p′- DDE, PCBs (138, 153 and 180), hexachlorobenzene, and ∑POPs were negatively associated with Insulin Sensitivity Index (ISI-gly) levels. No significant association was found between glycated hemoglobin and the concentrations of any POP. The removal of women under blood glucose lowering treatment from the models strengthened most of the associations previously found for the whole population. Our findings suggest that exposure to certain POPs is a modifiable risk factor contributing to insulin resistance.

Women with disabilities: from discrimination and violence towards an ethics of reciprocity

Since 2001 DPI Italia, the Italian section of Disabled People's International, has played an important role in a series of research projects in the European Commission's Daphne Programme on violence against women with disabilities. Several different types of violence have been identified, from sexual abuse to removal of women's control over their environment to invasion of their privacy in healthcare contexts to control of their reproductive capacity, particularly of women with intellectual disabilities. In the light of these projects, and of the CRPD's recognition of the multiple discriminations experienced by many women with disabilities, the article argues for a shift away from an ethics of care and dependency towards one of equal reciprocal relations between disabled women and others and to a bioethics grounded not in exceptional need but in everyday life. Peer counselling among disabled women is particularly important in effecting this shift.

Antioxidant-rich dietary intervention for improving asthma control in pregnancies complicated by asthma: study protocol for a randomized controlled trial

BackgroundAsthma is the most prevalent chronic disease to complicate pregnancies worldwide, affecting around 12% of pregnant women in Australia. Oxidative stress and inflammation manifest during pregnancy; however asthma in pregnancies further intensifies oxidative stress. Consumption of antioxidant-rich foods has been shown to be beneficial for asthma control in non-pregnant asthmatic adults. It has not been investigated whether antioxidant-rich foods can improve the elevated oxidative stress that occurs with asthma in pregnancy, thereby improving asthma control. The primary aim of this study is to determine whether increased consumption of antioxidant-rich foods for 12 weeks will improve maternal asthma control, compared to standard dietary intake during pregnancy.Methods/designA 12 week, parallel randomized controlled trial will be conducted. One hundred and sixty eight pregnant women with mild, moderate, or severe asthma, currently using inhaled corticosteroids, and with poor diet quality, will be recruited at approximately12 weeks gestation. Following a 4 week run-in period, women will be randomized to either a 12 week antioxidant intervention (increased consumption of antioxidant-rich foods (≥5 servings/day vegetables, ≥2 servings/day fruit, ≥8 ½ servings/day grains (mostly wholegrains), 3–4 serving/week lean meat) or standard pregnancy care. The primary outcome is asthma control score (decrease of 0.5, the minimally clinically significant change). Secondary outcomes include plasma antioxidants, markers of oxidative stress, and time to, and number of, exacerbations. With two-tailed t-tests at 80% power, a sample size of 52 completions per group is required. Allowing for a 78% retention including a 20% removal of women from the analysis due to non-compliance, we will recruit 168 women.DiscussionIt is expected that this 12 week study will improve asthma control. This is significant because asthma is the most prevalent condition to complicate pregnancies and contributes to poor maternal, neonatal and infant health outcomes. Our research will provide the first evidence to show that, in pregnancy, consumption of antioxidant-rich foods is a key modifier of clinical asthma status. This research is crucial for contributing to the evidence base to inform future guidelines given existing clinical and research gaps.Trial registrationACTRN12613000301763

Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series

To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta. Case series. Four level-three Japanese obstetric centres. Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out. A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation. Operative fluid loss. The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370 g. No patients required transfer to intensive care, and there were no cases of fetal anaemia. This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta.

Mononuclear Leukocyte Infiltrate in Extraplacental Membranes and Preterm Delivery

Large numbers of polymorphonuclear leukocytes in the amnion and chorion define histological chorioamnionitis (HCA), a condition linked to spontaneous preterm delivery (PTD). Less is known about placental patterns of mononuclear leukocyte (MNL) density and PTD. In this prospective study (1998-2004), women were sampled from 52 clinics in 5 Michigan communities and enrolled at 16-27 weeks' gestation. HCA and MNL distributions in delivered placentas were evaluated microscopically in a subcohort (290 preterm, 823 term). Midpregnancy biomarkers from maternal blood (i.e., C-reactive protein (CRP), corticotropin-releasing hormone, and cytokines) were compared among term and PTD subjects grouped by presence/absence of HCA and high MNL density. A density of more than 10 MNLs per high-power field in the chorion of the membrane roll, referred to as MNL-CMR, was associated with medically indicated PTD (odds ratio = 2.2, 95% confidence interval: 1.3, 3.6) and spontaneous PTD (odds ratio = 2.5, 95% confidence interval: 1.7, 3.7). Associations persisted after removal of women with HCA-positive placentas, abruption, hypertensive disorders, or obesity. HCA-associated PTD showed higher CRP and cytokine levels. MNL-CMR-associated PTD showed higher CRP and corticotropin-releasing hormone levels. These data suggest that an MNL infiltrate in the chorion of the membrane roll marks PTD pathways that are distinct from HCA and not entirely explained by pregnancy complications.

Late-Preterm Birth by Delivery Circumstance and Its Association With Parent-Reported Attention Problems in Childhood

Late-preterm birth (LPB, 34-36 wk) has been associated with an increased risk of attention problems in childhood relative to full-term birth (FTB, ≥37 wk), but little is known about factors contributing to this risk. The authors investigated the contributions of clinical circumstances surrounding delivery using follow-up data from the Pregnancy Outcomes and Community Health (POUCH) Study. Women who delivered late preterm or full term and completed the sex- and age-referenced Conners' Parent Rating Scales-Short Form: Revised were included in the present analysis (N = 762; children's age, 3-9 y). The Conners' Parent Rating Scales-Short Form: Revised measures dimensions of behavior linked to attention problems, including oppositionality, inattention, hyperactivity, and a global attention problem index. Using general linear models, the authors evaluated whether LPB subtype (medically indicated [MI] or spontaneous) was associated with these dimensions relative to FTB. After adjustment for parity, sociodemographics, child age, and maternal symptoms of depression and serious mental illness during pregnancy and at the child survey, only MI LPB was associated with higher hyperactivity and global index scores (mean difference from FTB = 3.8 [95% confidence interval {CI}: 0.5, 7.0] and 3.1 [95% CI 0.0, 6.2]). These findings were largely driven by children between 6 and 9 years. Removal of women with hypertensive disorders during pregnancy (N = 85) or placental findings related to hypertensive conditions (obstruction, decreased maternal spiral artery conversion; N = 134) reduced the differences below significance thresholds. Among LPBs, only MI LPB was associated with higher levels of parent-reported childhood attention problems, suggesting that complications motivating medical intervention during the late-preterm period mark increased risk for such problems. Hypertensive disorders seem to play a role in these associations.

Abstract P188: Preterm Birth is a Predictor of Future Maternal Intima Medial Thickness: The CARDIA Study

Introduction: Preterm birth (PTB, delivery &lt;37 weeks) may be a marker of a chronic pro- inflammatory response associated with excess risk of coronary artery disease. Hypothesis: We hypothesized that women with PTB would have elevated blood pressure, markers of inflammation (C-reactive protein [CRP], Interleukin-6 [IL-6]) as well as higher intima medial thickness (IMT) in the years following pregnancy. Further, we considered that these differences would persist after removing PTB cases due to self-reported hypertensive disorders of pregnancy (primary reason for indicated PTB). Methods: We studied 916 women (46% Black) who delivered 1,181 live births between enrollment in the Coronary Artery Risk Development in Young Adults (CARDIA) study (age 18-30 years) and 20 years later (age 38-50 years). CRP was measured at years 7, 15 and 20; IL-6 and common carotid IMT (average of the maximum wall thickness of the respective carotid artery segment based on 4 ultrasonic measurements for the common carotid arteries) were measured at year 20. Blood pressure, lipids, and anthropometrics were measured at baseline and 6 follow-up visits. Median concentrations of inflammatory markers and mean IMT were compared in women with and without a history of PTB. Change in blood pressure, lipids, body size and CRP concentrations according to PTB status was also evaluated using generalized estimating equations (GEE). Results: A total of 226 women (24.7%) reported at least one PTB. Women with PTBs had modestly higher pre-pregnancy systolic blood pressure (SBP) compared to women who delivered term births (106.3 vs. 104.9 mmHg, p=0.02); SBP was higher across follow-up (p=0.03 for group differences) and increased more rapidly over 20 years compared to women with term births (p&lt;0.01 for group*time interaction). These differences remained significant after removal of women with hypertension in pregnancy. Women with PTB had modestly higher mean body mass index (BMI) at baseline, and differences were more robust beginning in year 7 of follow up. Compared to women with term births, women with PTB had borderline higher mean IMT at year 20, adjusted for age and BMI (difference=0.016 mm, p=0.06). Adjustment for blood pressure change from baseline to year 20 did not affect the estimate. Adjustment for race attenuated this difference (p=0.33), and after excluding women with self-reported hypertension in pregnancy IMT no longer differed by PTB status. CRP, IL-6 and lipids did not differ according to PTB status. Conclusion: Women with PTBs, regardless of hypertension during pregnancy, had higher blood pressure before pregnancy and in the two decades after pregnancy compared to women with term births. They also higher mean IMTs, explained in part by race. Differences in IMT may be limited to women who reported hypertension in pregnancy, and were not related to inflammatory markers. PTB may mark women at excess risk of atherosclerosis.