Изучение контроля (управления) случая факторов риска для эклампсии. Недооцениваемые риски повторнородящего пожилого

TI: Case-control study of the risk factors for eclampsia.

TI: изучение Контроля (управления) случая факторов риска для эклампсии.

AU: Abi-Said-D; Annegers-JF; Combs-Cantrell-D; Frankowski-RF; Willmore-LJ

AD: Epidemiology Discipline, School of Public Health, University of Texas, Houston Health Science Center, USA.

SO: Am-J-Epidemiol. 1995 Aug 15; 142(4): 437-41

AB: A case-control study was conducted to investigate risk factors for eclampsia. A total of 66 cases of eclampsia were ascertained from deliveries between 1977 and 1992 at two hospitals in Houston, Texas, based on the criteria defined by the American College of Obstetrics and Gynecology. Cases were matched to nonpreeclamptic controls on a 4:1 ratio on the basis of hospital and month of delivery. The ratio of eclampsia cases to number of deliveries over the study period was 0.63 per 1,000. In a logistic regression model, risk factors for eclampsia included 1) two or fewer prenatal care visits (odds ratio (OR) = 6.10, 95% confidence interval (CI) 2.26-16.41), 2) urinary tract infection (OR = 4.23, 95% CI 1.27-14.06), 3) primigravidity (OR = 2.87, 95% CI 0.97-8.44), 4) obesity (OR = 2.49, 95% CI 0.78-7.96), 5) black ethnicity (OR = 2.25, 95% CI 0.88-5.78), 6) history of diabetes (OR = 2.07, 95% CI 0.45-9.62), and 7) age < or = 20 years (OR = 1.55, 95% CI 0.47-5.10). Nulliparity was not shown to be a risk factor for eclampsia when controlled for primigravidity, and neither were previous history of abortion or previous history of pregnancy-induced hypertension. Thus, prior pregnancy itself, independent of outcome and preeclamptic/eclamptic complications, appears to be the protective factor against eclampsia in a subsequent pregnancy.

Изучение контроля (управления) случая проводилось, чтобы исследовать факторы риска для эклампсии. Общее количество 66 случаев эклампсии было установлено от поставок между 1977 и 1992 в двух больницах в Хьюстоне, Штате Техас, основанном на критериях, определенных американским Колледжем Акушерства и Гинекологии. Случаи были согласованы к контрольным группам nonpreeclamptic на 4:1 отношение на основе больницы и месяца родоразрешения. Отношение случаев эклампсии к количеству(номеру) поставок в течение периода изучения было 0.63 в 1,000. В логистической модели регресса, факторы риска для эклампсии включили 1) два или меньшее количество пренатальных посещений заботы(осторожности) (отношение разницы(разногласий) (ИЛИ) = 6.10, интервал секретности(доверия) на 95 % (CI) 2.26-16.41), 2) мочевую инфекцию тракта (ИЛИ = 4.23, 95 % CI 1.27-14.06), 3) primigravidity (ИЛИ = 2.87, 95 % CI 0.97-8.44), 4) ожирение (ИЛИ = 2.49, 95 % CI 0.78-7.96), 5) черная этническая принадлежность (ИЛИ = 2.25, 95 % CI 0.88-5.78), 6) история диабета (ИЛИ = 2.07, 95 % CI 0.45-9.62), и 7) возраст < или = 20 лет (ИЛИ = 1.55, 95 % CI 0.47-5.10). Неспособность к деторождению не показывалась, чтобы быть фактором риска для эклампсии когда управляется для primigravidity, и ни один были предыдущая история аборта или предыдущей истории вынужденной беременностью артериальной гипертензии. Таким образом, предшествующая беременность, непосредственно, независимая от результата и preeclamptic/eclamptic осложнений, кажется, защитный фактор против эклампсии в последующей беременности.

TI: Underappreciated risks of the elderly multipara.

TI: Недооцениваемые риски повторнородящего пожилого.

AU: Bobrowski-RA; Bottoms-SF

AD: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI 48201, USA.

SO: Am-J-Obstet-Gynecol. 1995 Jun; 172(6): 1764-7; discussion 1767-70

AB: OBJECTIVE: Our purpose was to identify the age-related increased risks of the elderly gravida by clarifying the effects of age and parity, their combination, and their interaction. STUDY DESIGN: We studied 9556 singleton pregnancies in women aged 20 to 29 years or > or = 35 years delivered over an 8-year period. Data were analyzed by stepwise multiway contingency table analysis, with p < 0.002 considered significant. RESULTS: Many of the previously reported risks of the elderly gravida are expected on the basis of age and parity. Significant associations (primarily related to advanced age) included higher frequencies of obesity, chronic hypertension, gestational diabetes, and large-for-gestational-age and macrosomic infants. These elderly gravidas, on the other hand, had fewer postdates pregnancies. Although often overlooked, the greatest age-related increases in risk for induction (1.8 times), preeclampsia (2.7 times), gestational diabetes (4.5 times), clinical diabetes (3.2 times), oxytocin use (1.7 times), and macrosomia (1.6 times) occur in multiparas, not nulliparas. The risk for preeclampsia in the elderly multipara is significantly higher than expected on the basis of age and parity. CONCLUSION: The increased risks of the elderly multipara may have been overshadowed by the previous focus on the elderly nullipara. It is important to recognize the increases in age-related risks of the elderly multipara to appropriately counsel and manage this group of patients.

: Наша цель состояла в том, чтобы идентифицировать возрастные