There were 28,600 deliveries of 500 g or more to women at the Rotunda Hospital between January 1st 1985 and December 1st 1989. Of these, 595 were to women aged 40 years and over. Thirty-five variables of clinical significance were analyzed, comparing those of 40 years of age and more with those under 40. The older group had significant increases in gestational diabetes, ante-partum hemorrhage, fetal distress, prematurity, low birth weight and perinatal mortality. Chromosome congenital abnormalities were significantly higher, particularly Down syndrome. There were significantly increased rates of induction and cesarean section in the older women. Some evidence of interaction of age with other factors was found, however these were difficult to separate out in the clinical setting. We therefore recommend it wiser to manage all elderly gravidas in a high risk manner dealing with cases individually within this framework. Intervention should, however, need to be justified in the older as in the younger woman.

OBJECTIVE.A prospective study was designed to evaluate the effects of hormone replacement therapy on mammographic density in postmenopausal women. The possible association of breast pain with increased mammographic density was evaluated. SUBJECTS AND METHODS. Thirty-three postmenopausal women undergoing hormone replacement therapy for a mean of 11 months had mammography before and after commencing treatment. As a control, 31 postmenopausal women who never had hormone therapy also had baseline and follow-up mammograms after a mean of 13 months. Subjects were asked whether breast pain, which they graded as mild, moderate, or severe, had developed since their entry into the study. Baseline and follow-up mammograms were assessed objectively and subjectively for interval changes in density. The presence of breast pain was correlated with changes in density on the mammograms.RESULTS. A subjective increase in mammographic density was seen in nine (27%) of the women taking hormones and in none of the control subjects (p = .002). Changes were focal in four, multifocal in four, and diffuse in one. An increase in density was seen with all types of treatment used, and was noted as early as 4 months after the start of treatment.Seven (78%) of nine patients with mammographic changes had breast pain, which they classed as moderate or severe, that had developed since the start of treatment. In five patients with mild or moderate breast pain, an increase in density was not shown on mammograms.Of the 21 women taking hormones who did not have breast pain, increased density on follow-up mammograms was shown in only two (p = .004). None of the patients in the control group had breast pain.CONCLUSION. Focal, multifocal, or diffuse mammographic increases in density occur in a significant percentage of women undergoing hormone replacement therapy. A large proportion of these women have breast pain. Increased mammographic density appears to be associated with breast pain in women receiving hormones. This has implications for mammography in women receiving hormone replacement therapy.

Some changes accompanying tibolone may be favorable and may counter its adverse effect on HDL cholesterol. Lowering of lipoprotein (a) was the only significant change found with estrogen-progestin.

Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.