Fetal loss and contraceptive acceptance among the Bhopal gas victims

Abstract

The rates of fetal loss and family planning acceptance among Bhopal gas victims from 1984 to 1989 were compared to those of a control group. In all, 136 eligible women in the affected area and 139 women in the control area were interviewed. Care was taken to ensure that these women had conceived at least once during the previous five years. The fetal loss rate among the gas‐affected women was abnormally high (26.3 per cent) compared to that of women in the control area (7.8 per cent). Family planning acceptance in both areas was similar, with most women using permanent methods. In the case of temporary methods, the percentage of use was higher in the gas‐affected area.     

AN EVALUATION OF CESAREAN SECTION

The risks of cesarean section have been reduced in step with the increase in safety of all major surgical procedures.In a series of 13,153 deliveries, 1,265 (9.6 per cent) were by cesarean section. There were three obstetrical maternal deaths in 11,888 cases in which delivery was by the vaginal route—0.025 per cent. In the series of 1,265 deliveries by cesarean section there was one death attributable to the operation—0.08 per cent.The total uncorrected fetal loss following cesarean section was 3.8 per cent. This compares favorably with fetal loss of 3.2 per cent in the vaginal delivery group in this series, and with fetal loss rates reported from large obstetrical centers.Anesthesia by spinal injection is the method of choice in cesarean section. There were no maternal deaths or accidents attributable to spinal anesthetic, and in no case was it felt that fetal death was attributable to it.The incidence of maternal morbidity in the cesarean section group following spinal anesthesia was 15.8 per cent—less than half the incidence of morbidity following inhalation anesthesia.     

Preface: Genetics and the human encounter with alcohol

Abstract

In this paper, we calculate a base line of statistical data on the frequency of sexual activity at various ages of Taiwanese women. A cross‐sectional study using questionnaires administered during personal interviews was conducted on more than seventeen thousand women who attended family planning clinics in the Taipei metropolitan area in 1991 and 1992. Of the women surveyed, 2.8 per cent were sexually inactive in the previous month, 83.67 per cent had intercourse one to nine times in the previous month, and 13.56 per cent had intercourse ten times or more. The mean frequency of sexual activity was 6.8 times a month. Age‐specific mean coital frequencies for the age groups of less than 25 years, of 25–34 years, and of 35–44 years were 10.3, 7.3, and 6.6 times per month, respectively. Increased sexual frequency was associated with the following factors: young age, unmarried, lower educational level, fewer years of marriage and being on the pill. When logistic regression was used to control for confounding variables, we found that a woman's age is the most significant factor in predicting her sexual frequency.     

APPENDICITIS AND PREGNANCY

In 74,000 obstetrical patients at Los Angeles County Hospital the incidence of acute appendicitis in pregnancy was 0.05 per cent. In a study of 36 cases of clinically diagnosed appendicitis in pregnancy between 1956 and 1960, it was shown that the fetal and maternal morbidity and mortality were decreased when a definite operative procedure was done early. The difficulty in diagnosis is increased by the necessary consideration of pyelonephritis and twisted ovarian cyst. Rupture of the appendix increased hazards to maternal and fetal survival. It was noted also that threatened premature labor may indicate a ruptured appendix. Emergency operation with the use of antibiotics in such cases was effective therapy. The incidence of premature delivery was proportionate to the delay in operating. If operation was performed in less than eight hours after admission to the hospital, there was no maternal or fetal loss. A delay greater than eight hours resulted in a 17 per cent fetal loss in premature delivery and 4 per cent fetal loss of infants at term.     

Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994.

OBJECTIVE: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome in near to being achieved. DESIGN: Prospective collection of population based information on pregnancies in women with diabetes from all participating hospitals. SETTING: District general and teaching hospitals of the former Northern region. SUBJECTS: 111 diabetic women booking with pregnancy during 1 January to 31 December 1994. MAIN OUTCOME MEASURES: Diabetic control, perinatal mortality rate, fetal abnormality rate. RESULTS: The perinatal mortality rate was 48/1000 for diabetic pregnancies compared with 8.9/1000 for the background population (odds ratio 5.38; 95% confidence interval 2.27 to 12.70) and the neonatal mortality rate was 59/1000 compared with 3.9/1000 (15.0; 6.77 to 33.10). Two late neonatal deaths were due to congenital heart defects. Six per cent of all fetal losses (6/109 cases) were due to major malformations. The congenital malformation rate was 83/1000 compared with 21.3/1000 (3.76; 2.00 to 7.06) in the background population. CONCLUSIONS: Diabetic pregnancy remains a high risk state with perinatal mortality and fetal malformation rates much higher than in the background population.     

Pattern of menstrual cycle length in south Indian women: a prospective study.

Data on 8,308 menstrual cycles from 1,740 South Indian women prospectively recorded were analyzed to identify the effect of age on menstrual cycle length. The distribution was skewed to the right with the mean (SD) cycle length of 31.8 (6.7) days. The range of 25-40 days constituted 10-82 per cent of menstrual cycle lengths. In no age group did 28-day cycles occur in more than 9 per cent of women. Variability as measured by the standard deviation was high among those below 19 years of age, stabilized during 25-39 years, and then increased in women aged 40 years or more. The findings are discussed in the light of other studies and possible implications in fertility control programs.     

Pattern of menstrual cycle length in South Indian women: A prospective study

Abstract

Data on 8,308 menstrual cycles from 1,740 South Indian women prospectively recorded were analyzed to identify the effect of age on menstrual cycle length. The distribution was skewed to the right with the mean (SD) cycle length of 31.8 (6.7) days. The range of 25–40 days constituted 10–82 per cent of menstrual cycle lengths. In no age group did 28‐day cycles occur in more than 9 per cent of women. Variability as measured by the standard deviation was high among those below 19 years of age, stabilized during 25–39 years, and then increased in women aged 40 years or more. The findings are discussed in the light of other studies and possible implications in fertility control programs.     

Contraceptive use and efficacy in a genetically counseled population

Abstract

This paper reports contraceptive use and efficacy rates among 648 married women aged 15 to 44 who had received genetic counseling six months previously. Over half (53.5 per cent) of the counseled population were using non‐surgical contraception; 20 per cent were pregnant or postpartum; 10 per cent were seeking to become pregnant; 11 per cent were sterilized. Only 4.5 per cent were neither using contraceptives nor seeking to become pregnant. Women who were certain about their reproductive intentions after counseling utilized contraceptives effectively, with only two pregnancies at six months among those seeking to delay wanted pregnancies and only one pregnancy among those seeking to prevent pregnancy. This represents six‐month contraceptive failure rates of 4.3 and 2.1 per cent respectively for the two groups, rates similar to those with comparable intentions in the U. S. population at large. A distinguishing characteristic of the genetically counseled group was that 32 per cent of contraceptive users reported that their reproductive intentions were uncertain after counseling. The six‐month pregnancy rate in this uncertain group was 10 per cent.     

Can women remember how many children they have borne? Data from the east Caribbean.

The number of births reported by 786 women of native ancestry on the 1954 census of St. Barthélémy, French West Indies, was compared to the number of births registered to these same women in the records of vital events. The magnitude of the difference between the two numbers was related to a woman's parity and marital status, but not to her age or literacy. In general, the agreement between the two numbers was very high, with the mean of reported parities within 5 per cent of the mean of registered births for all age groups except one, where the difference was 5.6 per cent. The women of St. Barthélémy were well able to remember the number of children they had borne. It appears likely that the discrepancies between reported parities and registered statistics in previous studies are the result of cultural misunderstandings in questionnaires, or perhaps sample decay, rather than of women's memory loss.     

Mate selection and its impact on female marriage age, pregnancy wastages, and first child survival in Tamil Nadu, India

Marriage in Indian society is a religious duty. Consanguineous marriage is common, where individuals prefer to marry within their clan (a unilateral kin group based on either matrilineal or patrilineal descent). Keeping in mind that this form of marriage has certain disadvantages for social and biological as well as demographic aspects of individuals and families, the present study examines the influence of mate selection (i.e., close relatives, distant relatives, not related) on female age at marriage, pregnancy wastages, and survival status of the first child. The study was designed based on the information collected on a sample size of 3,948 married women aged 13-49 in Tamil Nadu, India, by the National Family Health Survey (NFHS), 1992. Results suggest that 48 per cent of women in Tamil Nadu marry their relatives. This practice of marrying relatives is high in rural areas, among Hindus, Scheduled Castes/tribes, and illiterate women as compared to urban areas, among non-Hindus, non-SC/ST, and educated women, respectively. The bivariate analysis reveals that women marrying their close relatives had low age at marriage and experienced a higher per cent of pregnancy wastage and child loss (first child) as compared to those women marrying their distant relatives or nonrelatives. The result is found to be consistent even after controlling for selected background variables through multivariate techniques (applied separately for age at marriage, pregnancy wastages, and the survival status of first child). Hence, this study suggests that steps should be taken to inform people about the problems of marrying close relatives through appropriate IEC programs in Tamil Nadu.     

First presidential addressbehavior genetics association April 6, 1973

Abstract

The number of births reported by 786 women of native ancestry on the 1954 census of St. Barthélémy, French West Indies, was compared to the number of births registered to these same women in the records of vital events. The magnitude of the difference between the two numbers was related to a woman's parity and marital status, but not to her age or literacy. In general, the agreement between the two numbers was very high, with the mean of reported parities within 5 per cent of the mean of registered births for all age groups except one, where the difference was 5.6 per cent. The women of St. Barthélémy were well able to remember the number of children they had borne. It appears likely that the discrepancies between reported parities and registered statistics in previous studies are the result of cultural misunderstandings in questionnaires, or perhaps sample decay, rather than of women's memory loss.     

Demographic and contraceptive patterns among women in Northern Mindanao, the Philippines

Desired family size and contraceptive behavior of 986 ever-married women aged 15-54 from Northern Mindanao, the Philippines, are described. Using the Dow and Werner typology of demographic and contraceptive patterns, it was found that a majority of the women were traditional in their demographic attitude and contraceptive behavior. A substantial proportion of the women desired medium to large families. In consistency in attitude and behavior was also manifested by women who desired small families but have never used efficient family planning methods. Sociodemographic characteristics of these women are described. A majority of the women who have never used efficient contraception also never practiced family planning. Rhythm was the primary method of birth control among demographic innovators and traditionals who have ever used inefficient methods; the pill was popular among contraceptive innovators and moderns. A considerable proportion of the demographic innovators and the traditionals were not currently using any family planning method; a lesser proportion of contraceptive innovators and moderns were also not using birth control methods. Relevance of the findings to family planning programs is pointed out. Recommendations are given. Motivation for a small family is a prerequisite for a successful family planning program. Without motivation, what family planning programs do is reduce the number of unwanted births. Family planning programs should reach out to those who are sufficiently motivated to have small families but have never used efficient family planning methods. A major finding of this research is that a majority of the women who never used efficient contraception also never used inefficient or traditional methods. Efforts should be made to change this. Additionally, efforts should be made to bring those modern and contraceptive innovators who had stopped using any family planning method to practice contraception again.     

Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study

Objective: To examine differences in late fetal death rates in association with determinants of small for gestational age fetuses. Design: Population based cohort study. Subjects: 1 026 249 pregnancies without congenital malformations. Setting: Sweden 1983-92. Main outcome measure: Late fetal death rate. Results: Depending on underlying determinants late fetal death rates were greatly increased in extremely small for gestational age fetuses (range 16 to 45 per 1000) compared with non-small for gestational age fetuses (1.4 to 4.6). In extremely small for gestational age fetuses late fetal death rates were increased from 31 per 1000 in mothers aged less than 35 years to 45 per 1000 in older mothers, and from 22 per 1000 in women <155 cm in height to 33 per 1000 in women ⩾175 cm tall. Late fetal death rates were also higher in extremely small for gestational age fetuses in singleton compared with twin pregnancies and in non-hypertensive pregnancies compared with pregnancies complicated by severe pre-eclampsia or other hypertensive disorders. Slightly higher late fetal death rates were observed in nulliparous compared with parous women and in non-smokers compared with smokers.Conclusions: Although the risk of late fetal death is greatly increased in fetuses that are extremely small for gestational age the risk is strongly modified by underlying determinants—for example, there is a lower risk of late fetal death in a small for gestational age fetus if the mother is of short stature, has a twin pregnancy, or has hypertension.

Key messages

• Small for gestational age fetuses are at increased risk of late fetal death regardless of the underlying determinants
• The effect of birthweight ratio on risk of late fetal death is modified by underlying determinants, except maternal age
• Regardless of birthweight ratio the rates of late fetal death are higher among women aged 35 years or older compared with younger women
• In pregnancies of extremely small for gestational age fetuses lower rates of late fetal death are associated with a maternal age of less than 35 years, short maternal stature, multiple births, and hypertensive disorders
• In pregnancies with non-malformed fetuses late fetal death rates are increased in smokers, in multiple births, and in women with severe pre-eclampsia.

     

Book notes

Abstract

Marriage in Indian society is a religious duty. Consanguineous marriage is common, where individuals prefer to marry within their clan (a unilateral kin group based on either matrilineal or patrilineal descent). Keeping in mind that this form of marriage has certain disadvantages for social and biological as well as demographic aspects of individuals and families, the present study examines the influence of mate selection (i.e., close relatives, distant relatives, not related) on female age at marriage, pregnancy wastages, and survival status of the first child. The study was designed based on the information collected on a sample size of 3,948 married women aged 13–49 in Tamil Nadu, India, by the National Family Health Survey (NFHS), 1992. Results suggest that 48 per cent of women in Tamil Nadu marry their relatives. This practice of marrying relatives is high in rural areas, among Hindus, Scheduled Castes/tribes, and illiterate women as compared to urban areas, among non‐Hindus, non‐SC/ST, and educated women, respectively. The bivariate analysis reveals that women marrying their close relatives had low age at marriage and experienced a higher per cent of pregnancy wastage and child loss (first child) as compared to those women marrying their distant relatives or nonrelatives. The result is found to be consistent even after controlling for selected background variables through multivariate techniques (applied separately for age at marriage, pregnancy wastages, and the survival status of first child). Hence, this study suggests that steps should be taken to inform people about the problems of marrying close relatives through appropriate IEC programs in Tamil Nadu.     

Demographic and contraceptive patterns among women in northern Mindanao,the Philippines

Abstract

Desired family size and contraceptive behavior of 986 ever‐married women aged 15–54 from Northern Mindanao, the Philippines, are described. Using the Dow and Werner typology of demographic and contraceptive patterns, it was found that a majority of the women were traditional in their demographic attitude and contraceptive behavior. A substantial proportion of the women desired medium to large families. Inconsistency in attitude and behavior was also manifested by women who desired small families but have never used efficient family planning methods. Sociodemographic characteristics of these women are described. A majority of the women who have never used efficient contraception also never practiced family planning. Rhythm was the primary method of birth control among demographic innovators and traditionals who have ever used inefficient methods; the pill was popular among contraceptive innovators and the moderns. A considerable proportion of the demographic innovators and the traditionals were not currently using any family planning method; a lesser proportion of contraceptive innovators and moderns were also not using birth control methods. Relevance of the findings to family planning programs is pointed out. Recommendations are given.     

Flying in the rain: hovering performance of Anna's hummingbirds under varied precipitation

Flight in rain represents a greater challenge for smaller animals because the relative effects of water loading and drop impact are greater at reduced scales given the increased ratios of surface area to mass. Nevertheless, it is well known that small volant taxa such as hummingbirds can continue foraging even in extreme precipitation. Here, we evaluated the effect of four rain intensities (i.e. zero, light, moderate and heavy) on the hovering performance of Anna's hummingbirds (Calypte anna) under laboratory conditions. Light-to-moderate rain had only a marginal effect on flight kinematics; wingbeat frequency of individuals in moderate rain was reduced by 7 per cent relative to control conditions. By contrast, birds hovering in heavy rain adopted more horizontal body and tail positions, and also increased wingbeat frequency substantially, while reducing stroke amplitude when compared with control conditions. The ratio between peak forces produced by single drops on a wing and on a solid surface suggests that feathers can absorb associated impact forces by up to approximately 50 per cent. Remarkably, hummingbirds hovered well even under heavy precipitation (i.e. 270 mm h(-1)) with no apparent loss of control, although mechanical power output assuming perfect and zero storage of elastic energy was estimated to be about 9 and 57 per cent higher, respectively, compared with normal hovering.     

A retrospective study of 932 second trimester terminations using gemeprost (16,16 dimethyl-trans delta 2 PGE1 methyl ester).

A retrospective study of 932 second trimester terminations between 12-27 weeks gestation was carried out to determine the efficacy of gemeprost for second trimester termination. A single course of 5 x 1 mg gemeprost pessaries was administered every three hours. If abortion had not occurred after the first course of pessaries, a further course of 5 x 1 mg pessaries was administered. Intravenous oxytocin was administered after 36 hours if abortion had not occurred. Eighty per cent and ninety five per cent of patients aborted within 24 and 48 hours respectively. Of the remaining 5 per cent of women, 3 per cent aborted with escalating doses of oxytocin. In the remaining 18 (2 per cent) women, the pregnancies were electively terminated with an alternative method. The median induction-abortion interval was 18.0 hours and 15.0 hours in nulliparous and parous women respectively (P less than 0.0001). The number of pessaries required to induce abortion was not influenced by parity. Significantly more parous women bled more than 500 ml. The incidence of pelvic sepsis (0.1 per cent) and cervical tear (0.1 per cent) was low. Twenty six per cent of women had diarrhoea and 23 per cent vomited following administration of prostaglandin. This study confirmed the efficacy of gemeprost for second trimester termination of pregnancy. This method of termination is safe, non-invasive, simple and has a low complication rate.     

Epidemiology of fetal alcohol syndrome among American Indians of the southwest

Abstract

The epidemiological features of Fetal Alcohol Syndrome (FAS) were examined among American Indians in the southwestern United States. All FAS suspects were screened in specific populations of Navajo, Pueblo, and Plains culture tribes. A total of 115 alcohol‐affected children were identified. The incidence of FAS was found to be highly variable from one cultural group to the next, ranging from 1.3 per 1,000 births (1/749) for the Navajo to 10.3 (1/97) for the Plains. The pattern of age‐specific prevalence indicates an increase over the past fifteen years. The overall rate of mothers who have produced fetal alcohol children was 6.1 per 1,000 women of childbearing age with a range of 4 to 33 per 1,000. These maternal prevalence rates were important for the accurate prediction of public health risk because 25 per cent of all mothers who had produced one affected child had also produced others. The average per mother was 1.3 alcohol‐affected children. Other findings indicate that the mothers of these children led highly disruptive and chaotic lives and were frequently isolated from mainstream social activities. In general, the gross social and cultural patterns of the tribes studied can readily explain the variation in incidence of FAS.     

Prenatal diagnosis, pregnancy terminations and prevalence of Down syndrome in Atlanta

BACKGROUND: The impact of prenatal diagnosis on the live birth prevalence of Down syndrome (trisomy 21) has been described. This study examines the prevalence of Down syndrome before (1990-1993) and after inclusion of prenatally diagnosed cases (1994-1999) in a population-based registry of birth defects in metropolitan Atlanta. METHODS: We identified infants and spontaneous fetal deaths with Down syndrome (n = 387), and pregnancies electively terminated after a prenatal diagnosis of Down syndrome (n = 139) from 1990 to 1999 among residents of metropolitan Atlanta from a population-based registry of birth defects, the Metropolitan Atlanta Congenital Defects Program (MACDP). Only diagnoses of full trisomy 21 were included. Denominator information on live births was derived from State of Georgia birth certificate data. We compared the prevalence of Down syndrome by calendar period (1990-1993, 1994-1999), maternal age (<35 years, 35+ years), and race/ethnicity (White, Black, other), using chi-square and Fisher's exact tests. RESULTS: During the period when case ascertainment was based only on hospitals (1990-1993), the prevalence of Down syndrome was 8.4 per 10,000 live births when pregnancy terminations were excluded and 8.8 per 10,000 when terminations were included. When case ascertainment also included perinatal offices (1994-1999), the prevalence of Down syndrome was 10.1 per 10,000 when terminations were excluded and 15.3 when terminations were included. During 1990-1993, the prevalence of Down syndrome was 24.7 per 10,000 among offspring to women 35+ years of age compared to 6.8 per 10,000 among offspring to women <35 years of age (rate ratio [RR] = 3.65, 95% confidence interval [CI] = 2.53-5.28). During 1994-1999, the prevalence of Down syndrome was 55.3 per 10,000 among offspring to women 35+ years compared to 8.5 per 10,000 among offspring to women <35 years (RR = 6.55, 95% CI = 5.36-7.99). There was no statistically significant variation in the prevalence of Down syndrome by race/ethnicity within maternal age and period of birth strata. During 1994-1999, the proportion of cases that were electively terminated was greater for women 35+ years compared to women <35 years (RR = 5.10, 95% CI = 3.14-8.28), and lower for Blacks compared to Whites among women 35+ years of age (RR = 0.33, 95% CI = 0.16-0.66). CONCLUSIONS: In recent years, perinatal offices have become an important source of cases of Down syndrome for MACDP, contributing at least 34% of cases among pregnancies in women 35+ years of age. Variation in the prevalence of Down syndrome by race/ethnicity, before or after inclusion of cases ascertained from perinatal offices, was not statistically significant. Among Down syndrome pregnancies in mothers 35+ years we found a lower proportion of elective termination among Black women compared to White women. We suggest that future reports on the prevalence of Down syndrome by race/ethnicity take into account possible variations in the frequency of prenatal diagnosis or elective termination by race/ethnicity.     

Does the treatment of primary hyperaldosteronism influence glucose tolerance?

Primary hyperaldosteronism (PH) is frequently considered to be a secondary form of diabetes mellitus (DM). In our previous study we attempted to evaluate the prevalence of DM among patients with PH compared to control subjects with essential hypertension (EH). We have noted a relatively high prevalence of DM and impaired glucose tolerance in PH, but the differences between the PH and EH groups did not reach statistical significance. We performed this study to assess whether the effective treatment of PH (surgical and conservative) would improve the glucose tolerance. We have studied 24 patients with PH of the following two subtypes: aldosterone-producing adenoma (APA) treated with adrenalectomy and idiopathic hyperaldosteronism (IHA) treated with spironolactone. No significant changes of glucose levels were found in the 60th and 120th min of the oral glucose tolerance test (OGTT) in the APA group. On the other hand, fasting glucose levels were decreased significantly after adrenalectomy. Plasma glucose levels were significantly increased in the 60th min, but no differences were found in fasting values and in the 120th min in the IHA group. There was a significantly higher incidence of impaired glucose tolerance (36 per cent before, 45 per cent after treatment) and DM (9 per cent, 18 per cent) in the IHA group compared to the APA group (8 per cent, 32 per cent; DM 0 per cent, 0 per cent). In conclusion, the treatment of PH does not improve glucose tolerance. Mild worsening of glucose tolerance after treatment could be explained by an increase of the body mass index. These data, in accordance with our previous study, do not support the idea that PH is a secondary form of diabetes mellitus.