Abstract Background The relation between grand multiparity and poor pregnancy outcome, especially post-partum hemorrhage and blood transfusion has not been consistent. Some studies found an association between maternal and neonatal mortality more recent literature is less clear about the risks. Objectives We aimed to determine the association of grand multiparity with the need for post-partum blood transfusion. Study Design: We conducted a retrospective cohort study in a single tertiary university-affiliated medical center between 2011 and 2019. All women were categorized into one of three groups based on the number of previous deliveries: (a) nulliparous (no previous delivery), (b) multiparous (1–4 previous deliveries), (c) grand multiparous (≥ 5 previous deliveries). We compared the demographic, clinical, and pregnancy outcomes of the study groups. The primary outcome was the need for red blood cell transfusion during the index admission. Results Overall, during the study period there were 87,343 deliveries in our center. Among the study population, 36,777 (42.1%) were nulliparous, 49,072 (56.1%) were multipara and 1,494 (1.7%) were grand multiparous. Overall, 1602 women (1.8%) were treated with RBC transfusion. Cesarean delivery, macrosomia, preterm delivery, multiple gestations, antenatal anemia, thrombocytopenia, intrauterine fetal death (IUFD), and prolonged second or third stage of labor, were more prevalent among women who were treated with RBC transfusion. After controlling for potential confounders, including maternal age, preterm delivery, IUFD, mode of delivery, and antenatal thrombocytopenia grand multiparity was found to be an independent protective factor for RBC transfusion [OR = 0.2 (0.007–0.56), p-value = 0.002] Conclusion After controlling for cofounders, grand multiparity alone, after controlling for cofounders, is not associated with postpartum blood transfusion.
Cette recherche est fondee sur l'analyse des testaments des juifs du pape de 1725 a 1825 (sept sont publies en annexe, deux cents ont ete repertories). Temoignent-ils d'une baisse de la religiosite au XVIII e siecle? Les legs pieux presents jusqu'en 1785 montrent certes que ces judeo-comtadins etaient inseres dans la geographie du monde juif, mais ils representent cependant une faible part de l'ensemble des legs. L'investissement sur l'au-dela est bien maigre. Le discours religieux indique une devotion moins prononcee qu'a Bayonne. Ainsi, ces testaments laicises expriment la relative integration dans la societe francaise des habitants des carrieres.
To compare the pregnancy outcome of women who underwent cesarean section in the second stage of labor, with or without a vacuum extraction attempt.A retrospective cohort study of women who underwent a cesarean section during the second stage of labor in a single tertiary university-affiliated medical center (2012-2019). Pregnancy outcome was compared for women who underwent cesarean section following a failed vacuum extraction to women who had cesarean section during the second stage of labor with no vacuum extraction attempt. Neonatal outcomes included umbilical artery pH less than 7.1, Apgar at 5 min < 7, hypoxemic ischemic encephalopathy and NICU admission. Maternal outcomes included duration of hospitalization, need for blood transfusion and need for re-surgery in 45 days.Overall, 88,375 women delivered during the study period. Of them, 120 women had a cesarean section following a failed vacuum (study group). Another 551 women underwent a cesarean section in the second stage of labor without a VE attempt (control group). The groups were similar with regard to obstetrical and demographic characteristics. The rates of umbilical artery pH < 7.1 (17.50% vs 6.53%, p < .001), NICU admission (13.33% vs 2.90%, p < .001), hypoxemic ischemic encephalopathy (5.83% vs 0.18%, p < .001) and epicranial sub-aponeurotic hemorrhage (16.67% vs 2.18%, p < .001) were significantly higher in the study group. No significant differences were found in maternal outcomes. In a sub-analysis including only labor with reassuring fetal heart tracing, failed vacuum attempt was associated with higher rate of NICU admission and epicranial hemorrhage (16.67% vs 3.13%, p = .009, 27.78% vs. 3.41, p = .001, respectively).Failed vacuum attempt is associated with a significant increased neonatal morbidity, but not increased maternal morbidity.
