Background The increased potential for negative pregnancy outcomes in both extremes of reproductive age is a well-debated argument. The aim of this study was to analyze the prevalence and the outcome of pregnancies conceived at extreme maternal ages. Methods This retrospective study considered all single consecutive pregnancies delivered in a tertiary referral center between 2001 and 2014. Patients were categorized into 4 groups according to maternal age at delivery (< 17 years; 18–28 years; 29–39 years; > 40 years). The following outcomes were considered (amongst others): pregnancy-related hypertensive disorders (PRHDs), neonatal resuscitation (NR), neonatal intensive care unit (NICU) admission, periventricular leucomalacia (PVL), and grade 3 and 4 intraventicular hemorrhage (IVH). Results During the considered period 22,933 single pregnancies gave birth in our unit. We observed 71 women aged < 17 years, and 1552 aged > 40 years. In each year throughout the study period, there was a significant increment in maternal age of 0.041 years (95% CI 0.024–0.058) every new year. Multivariate analysis concluded out that maternal age over 40 years was an independent risk factor for preterm delivery (OR 1.36 95% CI 1.16–1.61, p < 0.05, PRHDs (OR 2.36 95% CI 1.86–3.00, p < 0.05), GDM (OR 1.71 95% CI 1.37–2.12, p < 0.05) cesarean section (OR 1.99 95% CI 1.78–2.23, p < 0.05), abnormal fetal presentation (OR 1.29 95% CI 1.03–1.61, p < 0.05), and fetal PVL (OR 3.32 95% CI 1.17–9.44, p < 0.05). We also observed that maternal age under 17 years or over 40 years was an independent risk factor for grade 3 or 4 neonatal IVH (OR 2.97 95% CI 1.24–7.14, p < 0.05). Conclusions These findings confirm a negative impact of extreme maternal ages on pregnancy. These results should be carefully taken into account by maternal care providers in order to inform women adequately, supporting them in understanding potential risks associated with their procreation choices, and to improve clinical surveillance. Electronic supplementary material The online version of this article (10.1186/s12884-019-2400-x) contains supplementary material, which is available to authorized users.
Peritoneal metastasis from breast cancer is a serious and deadly condition only limited considered in the literature. Our aim was to study prevalence, risk factors, and prognosis of breast cancer peritoneal metastasis. We retrospectively analyzed 3096 women with a diagnosis of invasive breast cancer. We took into consideration presence and localization of breast cancer distant metastasis as well as the possible risk factors and survival from the diagnosis of the breast cancer metastasis. The prevalence of breast cancer peritoneal metastases was 0.7 % (22/3096), representing the 7.6 % (22/289) of women affected by distant metastases. Moreover, independent risk factors for breast cancer peritoneal metastases resulted high grading, lobular invasive histology, and advanced T and N stage at diagnosis. Overall survival after metastasis diagnosis was shorter in women affected by peritoneal metastases or brain metastases in comparison to other metastatic women. Breast cancer peritoneal metastases were uncommon but not rare events with a poor prognosis after standard treatments.
Purpose: To evaluate the role of quantitative elastography of the cervix in the prediction of successful labor induction compared to the Bishop score (BS) and ultrasound cervical length (CL). Materials and Methods: A prospective pilot study was conducted between July 2010 and June 2011 in patients without preterm membrane rupture undergoing labor induction with vaginal prostaglandins. Before starting induction, the BS, functional CL and cervical tissue strain (TS) were assessed. TS assessment was performed twice using the Tissue Doppler Imaging (TDI) software. Diagnostic accuracy was evaluated for the prediction of the following endpoints: active labor achievement (success vs. failure, time interval 24?h and 48?h), vaginal delivery (success vs. failure, time interval 36?h and 72?h) and total amount of prostaglandins used for labor induction (6?mg and 12?mg). Results: We analyzed 77 patients with a mean gestational age of 39.7???1.5 weeks of gestation and a mean strain of 0.75???0.17. The TS significantly predicted a failure of labor induction, which occurred in 4 cases, both in mono- and multivariate analysis, independently of the functional cervical length (TS 0.6???0.1). No correlation was found between the TS and other outcomes. The Bishop score and functional cervical length were found to predict only an early response to labor induction (time to active labor 24?h, time to vaginal delivery 36?h and PG usage 6?mg). The diagnostic accuracy was slightly but not significantly improved if both TS and CL were considered. Conclusion: Preliminary data show the possible usefulness of quantitative cervical elastography in the prediction of labor induction failure.
Quantitative cervical elastography performed in at-term pregnancies, under standardized conditions, has a high reliability.
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