Our objective was to explore whether the radiation fallout in Finland after the accident at the Chernobyl nuclear power plant in April 1986 led to an increased incidence of trisomy 21. In this geographic and temporal cohort study, the country was divided into three zones according to the amounts of radioactive fallout and internal radiation caused by two cesium isotopes. The 518 cytologically verified cases of trisomy 21 were divided into a control group (conceived before the accident), and a study group of children whose expected dates of birth were in the post-accident years 1987-1988, i.e., pregnancies commenced after May 1986. The cases were also divided into three subgroups according to the zones of radiation. There were no significant differences in prevalence of trisomy 21 between the control and study groups nor between the three zones in spite of the significant differences in the levels of radiation and in the body burden that prevailed throughout the study period. Power estimates showed that in the two zones of lower radiation, an increase of 0.5% in the prevalence would have been detected with a power of 0.85, and in the somewhat smaller zone of the highest radiation, with a power of 0.70. The study lends no further support to the view that the low radiation fallout in western Europe would have been causally associated with trisomy 21.
OBJECTIVE: The aim of this study was to investigate the influence of maternal age on perinatal and obstetric outcome in women aged 40-44 years and those 45 years or older and to estimate whether adverse outcome was related to intercurrent illness and pregnancy complications. METHODS: National prospective, population-based, cohort study in women aged 40-44 years and those 45 years or older and in a control group of women aged 20-29 years who delivered during the period 1987-2001. Adjusted odds ratios (OR) were calculated after adjustments for significant malformations, maternal pre-existing diseases, and smoking. Main outcome measures were perinatal mortality, intrauterine fetal death, neonatal death, preterm birth, and preeclampsia. RESULTS: During the 15-year period, there were 1,566,313 deliveries (876,361 women were 20-29 years of age, 31,662 were 40-44 years, and 1,205 were > or = 45 years). Perinatal mortality was 1.4%, 1.0%, and 0.5% in women 45 years or older, 40-44, and 20-29 years, respectively. Adjusted OR for perinatal mortality was 2.4 (95% confidence interval [CI] 1.5-4.0) in women aged 45 years or older, compared with 1.7 (95% CI 1.5-1.9) in women 40-44 years. Adjusted OR for intrauterine fetal death was 3.8 (95% CI 2.2-6.4) in women aged 45 years or older, compared with 2.1 (95% CI 1.8-2.4) in women 40-44 years. Preterm birth, gestational diabetes, and preeclampsia were more common among women 40-44 years of age and those 45 years or older. Perinatal mortality was increased in women with intercurrent illness or pregnancy complications compared with women without these conditions, but there was no evidence that these factors became more important with increasing age. CONCLUSION: Perinatal mortality, intrauterine fetal death, and neonatal death increased with age. There was also an increase in intercurrent illnesses and pregnancy complications with increasing age, but this did not entirely explain the observed increase in perinatal mortality with age. LEVEL OF EVIDENCE: II-3
Age at first full-term pregnancy (FTP) has long been thought to be the major reproductive risk factor in breast cancer but a Norwegian study suggested that age at last FTP might be more important. In Norway "high parity" means 4 or more deliveries. Does this finding hold in an area with a much broader distribution of parity? Data from a case-control study done in 1980-82 in Fortaleza and Recife, two cities in Brazil's impoverished north-east, have been used to explore further the influence of age at last FTP. The cases were 509 women with histologically diagnosed breast cancer who were matched with hospital controls for age and area of residence. The analysis was based on case-control pairs interviewed by the same person. High breast cancer risk was associated with low parity; after adjustment for parity, breast cancer risk was related both to late age at first FTP (odds ratio [OR] 1.21 for each 5 year increase, p = 0.008) and to late age at last FTP (OR 1.24, p = 0.0007). However, multivariate analysis revealed that the effect of age at last FTP dominated that of age at first FTP: once age at last FTP was taken into account the effect of age at first FTP was no longer significant (OR 1.08, p = 0.38) while the association with parity became more striking. These results challenge the view that age at first FTP is the principal reproductive variable related to breast cancer risk. Moreover, they suggest that high parity is protective independent of ages at first and last FTP. Given recent worldwide reductions in fertility rates, breast cancer incidence may be expected to increase. Balancing that may be the willingness of some women to complete their families by, say, age 35 if they were to be told that this might reduce their risk of breast cancer.
Comment In: Lancet. 1993 Feb 20;341(8843):502-38094531
Comment In: Lancet. 1993 Jan 2;341(8836):24-58093271
PURPOSE: The aim of the study was to evaluate the prenatal diagnosis at a secondary referral hospital. METHOD: A retrospective study was carried out on 1752 women examined by amniocentesis (AC) (n = 1037) or chorion villus sampling (CVS) (n = 715) at Randers Centralsygehus from 1 April 1987 to 31 December 1996. RESULTS: A cytogenetic diagnosis was made in 99.8% of the AC group and 99.4% of the CVS group. Complications, recorded as either spontaneous abortion, bleeding/threatening abortion, pain/contractions or amniotic fluid leakage, were seen in 1.9%, 3.3%, 2.9%, and 2.3% after AC and 1.8%, 7.3%, 3.4%, and 0% after CVS. There were significantly more re-examinations after CVS when the procedure was carried out by less experienced operators (p
BACKGROUND: The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases. METHODS: An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996-2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin. RESULTS: Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well-being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases. CONCLUSION: In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.
BACKGROUND: To investigate a possible effect of age on maternal androgen levels in uncomplicated pregnancies. METHODS: A study of 134 parous women with uncomplicated pregnancies was carried out at three university hospitals in Norway and Sweden. Maternal levels of androstenedione, dehydroepiandrosterone sulphate, testosterone and the free testosterone index were measured during weeks 17 and 33 of pregnancy. RESULTS: Maternal levels of androstenedione and testosterone had a negative association with maternal age in weeks 17 and 33 of pregnancy, while dehydroepiandrosterone sulphate and the free testosterone index were associated negatively in week 33 only. Adjustment for maternal parity, pre-pregnancy body mass index, smoking and fetal gender did not affect the results. CONCLUSIONS: Maternal androgen levels decrease with increasing maternal age. The cause and possible implication of this finding remain unknown.
Standardized risk assessment plays an important role in providing medical care of uniform quality to pregnant women, even though it is not a substitute for clinical judgement. This study was designed to determine whether the antepartum risk score currently used across Alberta is associated with neonatal morbidity and adverse pregnancy outcomes for singleton live births and to examine whether the current classification of "lower risk" pregnancies (score