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Rebecca M Reynolds - One of the best experts on this subject based on the ideXlab platform.
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altered maternal hypothalamic pituitary adrenal axis activity in obese Pregnancy is associated with macrosomia and Prolonged Pregnancy
Pregnancy Hypertension, 2014Co-Authors: Laura I Stirrat, J R Oreilly, Simon C Riley, A F Howie, G J Beckett, R Smith, Brian R Walker, Jane E Norman, Rebecca M ReynoldsAbstract:Background The hypothalamic-pituitary-adrenal (HPA) axis is important for fetal growth and timing of parturition. Maternal obesity is associated with macrosomia (birthweight ⩾4000 g) and Prolonged Pregnancy (⩾41 weeks). We aimed to characterise HPA axis hormones in obese Pregnancy and to test associations with these Pregnancy outcomes. Method Fasting cortisol was measured by radioimmunoassay in venous blood at 16, 28 and 36 weeks of gestation in 286 obese (BMI 44.05 ± 3.98 kg/m 2 ) and 137 lean (BMI 22.71 ± 1.66 kg/m 2 ) pregnant women. In subsets ( n = 20 obese, 20 lean) we measured corticosteroid binding globulin (CBG) and CRH by radioimmunoassay; progesterone, estradiol (E2), estriol (E3) and sex-hormone-binding-globulin (SHBG) by ELISA; and albumin by bromocresol green binding. Free cortisol levels were calculated using Coolen’s equation. Results Cortisol, CBG, calculated free cortisol, CRH, E2, E3, progesterone and SHBG levels rose similarly during Pregnancy in obese and lean, but were significantly lower in obese ( p r = −0.46, p p r = −0.557, p Conclusion Our findings suggest that decreased HPA axis activity in obese Pregnancy may be a mechanism underlying macrosomia and Prolonged Pregnancy.
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ppo 21 altered maternal hypothalamic pituitary adrenal axis activity in obese Pregnancy a potential mechanism underlying macrosomia and Prolonged Pregnancy
Archives of Disease in Childhood-fetal and Neonatal Edition, 2014Co-Authors: Laura I Stirrat, J R Oreilly, Simon C Riley, A F Howie, R Smith, Brian R Walker, Jane E Norman, Rebecca M ReynoldsAbstract:Background Increased hypothalamic-pituitary-adrenal (HPA) axis activity has been associated with low birthweight and preterm labour. Maternal obesity is associated with macrosomia (birthweight ≥4000 g) and Prolonged Pregnancy (≥41 weeks). We hypothesised altered HPA axis activity may underlie these Pregnancy outcomes and aimed to characterise HPA axis hormones in obese Pregnancy. Method Fasting serum cortisol was measured by radioimmunoassay at 16, 28 and 36 weeks in 286 obese (BMI 44.05 ± 3.98 kg/m 2 ) and 137 lean (BMI 22.71 ± 1.66 kg/m 2 ) pregnant women. In subsets (n = 20 obese, 20 lean) we measured corticosteroid-binding-globulin (CBG) and corticotrophin-releasing-hormone (CRH) by radioimmunoassay. Free cortisol was calculated using Coolen’s equation. Results Cortisol was significantly lower throughout Pregnancy in obese (Table 1), and lower free cortisol at 16 weeks was associated with higher birthweight (r = -0.46, p Conclusion Decreased HPA axis activity in obese Pregnancy may underlie macrosomia and Prolonged Pregnancy.
K H Nicolaides - One of the best experts on this subject based on the ideXlab platform.
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preinduction sonographic measurement of cervical length in Prolonged Pregnancy the effect of parity in the prediction of induction to delivery interval
Obstetrical & Gynecological Survey, 2004Co-Authors: S M Rane, G K Pandis, R R Guirgis, B Higgins, K H NicolaidesAbstract:In Prolonged pregnancies, inducing labor reduces perinatal mortality compared with expectant management, but approximately 1 in 5 women who are induced require cesarean delivery. The preinduction Bishop score does not accurately predict whether induced labor will result in successful vaginal delivery. Measuring the length of the cervix by transvaginal sonography (TVS) offers an objective means of estimating the chance of vaginal delivery taking place within 24 hours. The influence of parity on the relationship between preinduction cervical length and the interval from induction to delivery was examined in 382 singleton pregnancies in which labor was induced at 41 + 3 to 42 + 1 weeks gestation. TVS was carried out before inducing labor with dinoprostone in either pessary or gel form. The study included 192 nulliparous and 190 multiparous women with median cervical lengths of 18 and 16 mm, respectively. Cesarean section was done for fetal distress in 71 cases and for failure to progress in 34 others. It was performed within 24 hours.
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pre induction sonographic measurement of cervical length in Prolonged Pregnancy the effect of parity in the prediction of induction to delivery interval
Ultrasound in Obstetrics & Gynecology, 2003Co-Authors: S M Rane, G K Pandis, R R Guirgis, B Higgins, K H NicolaidesAbstract:Objective To examine the effect of parity on the relationship between pre-induction cervical length and the induction-to-delivery interval and rate of vaginal delivery within 24 h in women undergoing induction of labor for Prolonged Pregnancy. Methods In 382 singleton pregnancies, induction of labor was carried out at 41 + 3 to 42 + 1 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. Univariate analyses were performed by constructing Kaplan–Meier survival curves for the induction-to-delivery interval for various subgroups, and comparing these using log rank tests. Multivariate analyses were performed using the Cox proportional hazards model and multiple linear regression. Results Successful vaginal delivery within 24 h of induction occurred in 67% of the women and the pre-induction cervical length was significantly associated with the induction-to-delivery interval and the rate of vaginal delivery within 24 h. Sonographically measured cervical length was better than the Bishop score or cervical length by vaginal examination in predicting the outcome of induction. Parity provided a significant independent contribution, in addition to pre-induction cervical length, in the prediction of the outcome of labor. Thus, in multiparae the incidence of successful vaginal delivery within 24 h of induction was about 30% higher than in nulliparae. For the same cervical length, the induction-to-delivery interval in multiparae was 37% lower than in nulliparae. Conclusion In women undergoing induction of labor for Prolonged Pregnancy, cervical length and parity provide independent prediction of induction-to-delivery interval and the likelihood of vaginal delivery within 24 h of induction. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
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pre induction sonographic measurement of cervical length in Prolonged Pregnancy the effect of parity in the prediction of the need for cesarean section
Ultrasound in Obstetrics & Gynecology, 2003Co-Authors: S M Rane, R R Guirgis, B Higgins, K H NicolaidesAbstract:Objective To examine the effect of parity on the relationship between pre-induction cervical length and the risk of Cesarean section in women undergoing induction of labor for Prolonged Pregnancy. Methods In 382 singleton pregnancies, induction of labor was carried out at 41 + 3 to 42 + 1 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. In 71 of these cases a Cesarean section was required for either fetal distress or failure to progress and 311 women delivered vaginally. The effect of parity and pre-induction cervical length on the risk of Cesarean section was examined. Results In nulliparous women the incidence of Cesarean section was significantly higher than in multiparous women (28.1% vs. 8.9%). In both nulliparae and multiparae there was a significant association between pre-induction cervical length and the rate of Cesarean section. Logistic regression analysis demonstrated that cervical length and parity provided significant independent prediction of all Cesarean sections and Cesarean sections for failure to progress. The odds of Cesarean section increased by about 10% with each increase of 1 mm in cervical length, over the mean cervical length of 20 mm for nulliparae and 18 mm for multiparae, and the odds was about 75% lower in multiparae, compared to nulliparae with the same cervical length. Receiver–operating characteristics curves (ROC) demonstrated that cervical length was better than the Bishop score in the prediction of all Cesarean sections (area under ROC = 0.72 vs. 0.68) and Cesarean sections for failure to progress (area under ROC = 0.76 vs. 0.69). Conclusion In women undergoing induction of labor for Prolonged Pregnancy, cervical length and parity provide significant independent prediction of the likelihood of Cesarean section. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Lil Valentin - One of the best experts on this subject based on the ideXlab platform.
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three dimensional ultrasound assessment of the cervix for predicting time to spontaneous onset of labor and time to delivery in Prolonged Pregnancy
Ultrasound in Obstetrics & Gynecology, 2006Co-Authors: Linas Rovas, P Sladkevicius, E Strobel, F De Smet, B De Moor, Lil ValentinAbstract:Objectives To determine whether three-dimensional (3D) ultrasound including power Doppler examination of the cervix is useful for predicting time to spontaneous onset of labor or time to delivery in Prolonged Pregnancy. Methods A prospective study was conducted in 60 women who went into spontaneous labor. All underwent transvaginal 3D power Doppler ultrasound examination of the cervix immediately before a Prolonged-Pregnancy cbeck-up at >= 41 + 5 gestational weeks. Univariate and multivariate logistic regression analysis was used to determine which of the following variables predicted spontaneous onset of labor > 24 h and > 48 h and vaginal delivery > 48 h and > 60 h: length, anteroposterior (AP) diameter and width of the cervix and of any cervical funneling; cervical volume (cm(3)); vascularization index (VI); flow index (FI); vascularization flow index (VEI); parity; and Bishop score. Multivariate logistic regression analysis was carried out both with and without Bishop score as a predictive variable. Receiver-operating characteristics (ROC) curves were used to describe the diagnostic performance of the tests. Results The areas under the ROC curves for Bishop score, cervical length, and logistic regression models did not differ significantly (areas ranging from 0.72 to 0.82). If Bishop score was not included in the logistic regression model, cervical length, VI and FI independently predicted delivery > 48 h, the likelihood increasing with increasing cervical length, decreasing VI and increasing FI. Conclusions In Prolonged Pregnancy cervical vascularization as estimated by 3D power Doppler ultrasound is related to time to delivery > 48 h, but the likelihood of delivery > 48 h can be predicted equally well using Bishop score alone or sonograpbic cervical length alone Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd. (Less)
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bishop score and ultrasound assessment of the cervix for prediction of time to onset of labor and time to delivery in Prolonged Pregnancy
Ultrasound in Obstetrics & Gynecology, 2006Co-Authors: Linas Rovas, P Sladkevicius, E Strobel, F De Smet, Dejin E Karlsson, Lil ValentinAbstract:Objectives To determine the ability of Bishop score and sonographic cervical length to predict time to spontaneous onset of labor and time to delivery in Prolonged Pregnancy. Methods Ninety-seven women underwent transvaginal ultrasound examination and palpation of the cervix at 291-296 days' gestation according to ultrasound fetometry at 12-20 weeks' gestation. Sonographic cervical length and Bishop score were recorded. Multivariate logistic regression analysis was used to determine which variables were independent predictors of the onset of labor/delivery 24 h, 48 h, and 96 h. Receiver-operating characteristics (ROC) curves were drawn to assess diagnostic performance. Results In nulliparous women (n = 45), both Bishop score and sonographic cervical length predicted the onset of labor/delivery 24 h and 48 h (area under ROC curve for the onset of labor 24 h 0.79 vs. 0.80, P = 0.94; for delivery 24 h 0.81 vs. 0.85, P = 0.64; for the onset of labor 48 h 0.73 vs. 0.74, P = 0.90; for delivery 48 h 0.77 vs. 0.71, P = 0.50). Only Bishop score discriminated between nulliparous women who went into labor/delivered 96 h or > 96 h. A logistic regression model including Bishop score and cervical length was superior to Bishop score alone in predicting delivery 24 h (area under ROC curve 0.93 vs. 0.81, P = 0.03) and superior to Bishop score alone and cervical length alone in predicting the onset of labor 24 h (area under ROC curve 0.90 vs. 0.79, P = 0.06; and 0.90 vs. 0.80, P = 0.06). In parous women (n = 52), Bishop score and sonographic cervical length predicted the onset of labor/delivery 24 h (area under ROC curve for the onset of labor 0.75 vs. 0.69, P = 0.49; for delivery 0.74 vs. 0.70, P = 0.62), but only Bishop score discriminated between women who went into labor/delivered 48 h and > 48 h. Three parous women had not gone into labor and six had not given birth at 96 h. In parous women logistic regression models including both Bishop score and cervical length did not substantially improve prediction of the time to onset of labor/delivery. Conclusions In Prolonged Pregnancy Bishop score and sonographic cervical length have a similar ability to predict the time to the onset of labor and delivery. In nulliparous women the use of logistic regression models including Bishop score and cervical length is likely to offer better prediction of the onset of labor/delivery 24 h than the use of the Bishop score alone.
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three dimensional power doppler ultrasound assessment of the cervix for the prediction of successful induction of labor with prostaglandin in Prolonged Pregnancy
Journal of Ultrasound in Medicine, 2005Co-Authors: Linas Rovas, P Sladkevicius, E Strobel, Lil ValentinAbstract:Objective The purpose of this study was to determine whether 3-dimensional (3D) power Doppler ultrasound examination of the cervix can predict the success of labor induction with prostaglandin in Prolonged Pregnancy. Methods A prospective study was conducted with 36 women undergoing labor induction with prostaglandin at 41 gestational weeks 5 days and later. All 36 women underwent a transvaginal 2-dimensional gray scale ultrasound examination and a 3D power Doppler ultrasound examination of the cervix immediately before a planned post-term checkup. The analyzed variables were length, anterior-posterior diameter, and width of the cervix and any cervical funneling, cervical volume (in cubic centimeters), vascularization index, flow index, vascularization flow index, parity, and Bishop score. Results were compared among women with start of labor at 12 hours or less and more than 12 hours after application of the first prostaglandin suppository and among women who had delivery at 24 hours or less and more than 24 hours after the start of induction. Results Sonographically measured cervical length was shorter (mean, 1.8 versus 2.4 cm; P = .04), the Bishop score was higher (median, 5 versus 3; P = .02), and more women were parous (70% versus 37%; P = .05) among women who were in labor within 12 hours than in those who were not. The Bishop score was higher (median, 4 versus 2; P = .03) and more women were parous (69% versus 23%; P = .01) among women who had delivery at 24 hours or less than among those who did not. Cervical volume and the results of the 3D power Doppler ultrasound examination did not differ among women with different outcomes of labor induction. Conclusions In women undergoing induction of labor with prostaglandin at 41 gestational weeks 5 days or later, sonographic cervical length, Bishop score, and parity are related to the success of labor induction, whereas cervical volume and the results of the 3D power Doppler examination are not.
S M Rane - One of the best experts on this subject based on the ideXlab platform.
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preinduction sonographic measurement of cervical length in Prolonged Pregnancy the effect of parity in the prediction of induction to delivery interval
Obstetrical & Gynecological Survey, 2004Co-Authors: S M Rane, G K Pandis, R R Guirgis, B Higgins, K H NicolaidesAbstract:In Prolonged pregnancies, inducing labor reduces perinatal mortality compared with expectant management, but approximately 1 in 5 women who are induced require cesarean delivery. The preinduction Bishop score does not accurately predict whether induced labor will result in successful vaginal delivery. Measuring the length of the cervix by transvaginal sonography (TVS) offers an objective means of estimating the chance of vaginal delivery taking place within 24 hours. The influence of parity on the relationship between preinduction cervical length and the interval from induction to delivery was examined in 382 singleton pregnancies in which labor was induced at 41 + 3 to 42 + 1 weeks gestation. TVS was carried out before inducing labor with dinoprostone in either pessary or gel form. The study included 192 nulliparous and 190 multiparous women with median cervical lengths of 18 and 16 mm, respectively. Cesarean section was done for fetal distress in 71 cases and for failure to progress in 34 others. It was performed within 24 hours.
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pre induction sonographic measurement of cervical length in Prolonged Pregnancy the effect of parity in the prediction of induction to delivery interval
Ultrasound in Obstetrics & Gynecology, 2003Co-Authors: S M Rane, G K Pandis, R R Guirgis, B Higgins, K H NicolaidesAbstract:Objective To examine the effect of parity on the relationship between pre-induction cervical length and the induction-to-delivery interval and rate of vaginal delivery within 24 h in women undergoing induction of labor for Prolonged Pregnancy. Methods In 382 singleton pregnancies, induction of labor was carried out at 41 + 3 to 42 + 1 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. Univariate analyses were performed by constructing Kaplan–Meier survival curves for the induction-to-delivery interval for various subgroups, and comparing these using log rank tests. Multivariate analyses were performed using the Cox proportional hazards model and multiple linear regression. Results Successful vaginal delivery within 24 h of induction occurred in 67% of the women and the pre-induction cervical length was significantly associated with the induction-to-delivery interval and the rate of vaginal delivery within 24 h. Sonographically measured cervical length was better than the Bishop score or cervical length by vaginal examination in predicting the outcome of induction. Parity provided a significant independent contribution, in addition to pre-induction cervical length, in the prediction of the outcome of labor. Thus, in multiparae the incidence of successful vaginal delivery within 24 h of induction was about 30% higher than in nulliparae. For the same cervical length, the induction-to-delivery interval in multiparae was 37% lower than in nulliparae. Conclusion In women undergoing induction of labor for Prolonged Pregnancy, cervical length and parity provide independent prediction of induction-to-delivery interval and the likelihood of vaginal delivery within 24 h of induction. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
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pre induction sonographic measurement of cervical length in Prolonged Pregnancy the effect of parity in the prediction of the need for cesarean section
Ultrasound in Obstetrics & Gynecology, 2003Co-Authors: S M Rane, R R Guirgis, B Higgins, K H NicolaidesAbstract:Objective To examine the effect of parity on the relationship between pre-induction cervical length and the risk of Cesarean section in women undergoing induction of labor for Prolonged Pregnancy. Methods In 382 singleton pregnancies, induction of labor was carried out at 41 + 3 to 42 + 1 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. In 71 of these cases a Cesarean section was required for either fetal distress or failure to progress and 311 women delivered vaginally. The effect of parity and pre-induction cervical length on the risk of Cesarean section was examined. Results In nulliparous women the incidence of Cesarean section was significantly higher than in multiparous women (28.1% vs. 8.9%). In both nulliparae and multiparae there was a significant association between pre-induction cervical length and the rate of Cesarean section. Logistic regression analysis demonstrated that cervical length and parity provided significant independent prediction of all Cesarean sections and Cesarean sections for failure to progress. The odds of Cesarean section increased by about 10% with each increase of 1 mm in cervical length, over the mean cervical length of 20 mm for nulliparae and 18 mm for multiparae, and the odds was about 75% lower in multiparae, compared to nulliparae with the same cervical length. Receiver–operating characteristics curves (ROC) demonstrated that cervical length was better than the Bishop score in the prediction of all Cesarean sections (area under ROC = 0.72 vs. 0.68) and Cesarean sections for failure to progress (area under ROC = 0.76 vs. 0.69). Conclusion In women undergoing induction of labor for Prolonged Pregnancy, cervical length and parity provide significant independent prediction of the likelihood of Cesarean section. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Erik Wapstra - One of the best experts on this subject based on the ideXlab platform.
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offspring performance and the adaptive benefits of Prolonged Pregnancy experimental tests in a viviparous lizard
Functional Ecology, 2009Co-Authors: Geoffrey M While, Tobias Uller, Erik WapstraAbstract:1. Offspring locomotor performance has been shown to influence fitness related traits in a wide range of taxa. One potential mechanism by which viviparous animals can increase the performance (e.g. sprint speed) of their offspring is by prolonging Pregnancy (beyond that required for complete development). However, to date studies examining this potentially important maternal effect have been largely descriptive. 2. The skink Egernia whitii is an ideal candidate species to examine the consequences of delayed parturition on the performance of offspring as it routinely gives birth asynchronously despite synchronous offspring development. 3. Using correlative data from a natural population and experimental manipulations of birthing asynchrony, we tested the prediction that, within litters, last born offspring have a better locomotor performance than first born offspring. 4. We show that Prolonged Pregnancy does significantly influence average offspring locomotor performance; however, contrary to predictions, the direction of this effect is dependent on gestation length and thus offspring date of birth. Last born offspring had significantly poorer performance than first born offspring in litters early in the season with this pattern reversed late in the season. 5. These results do not support the hypothesis that Prolonged retention of fully formed offspring consistently increases offspring performance; however, they may help us understand the asymmetries in offspring competitive ability generated by birthing asynchrony.
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offspring performance and the adaptive benefits of Prolonged Pregnancy experimental tests in a viviparous lizard
Functional Ecology, 2009Co-Authors: Geoffrey M While, Tobias Uller, Erik WapstraAbstract:1. Offspring locomotor performance has been shown to influence fitness related traits in a wide range of taxa. One potential mechanism by which viviparous animals can increase the performance (e.g. sprint speed) of their offspring is by prolonging Pregnancy (beyond that required for complete development). However, to date studies examining this potentially important maternal effect have been largely descriptive. 2. The skink Egernia whitii is an ideal candidate species to examine the consequences of delayed parturition on the performance of offspring as it routinely gives birth asynchronously despite synchronous offspring development. 3. Using correlative data from a natural population and experimental manipulations of birthing asynchrony, we tested the prediction that, within litters, last born offspring have a better locomotor performance than first born offspring. 4. We show that Prolonged Pregnancy does significantly influence average offspring locomotor performance; however, contrary to predictions, the direction of this effect is dependent on gestation length and thus offspring date of birth. Last born offspring had significantly poorer performance than first born offspring in litters early in the season with this pattern reversed late in the season. 5. These results do not support the hypothesis that Prolonged retention of fully formed offspring consistently increases offspring performance; however, they may help us understand the asymmetries in offspring competitive ability generated by birthing asynchrony.
