Subjects: The study population consisted of 100 apparently healthy multiparous women recruited from the staff of the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. They all had given birth to all least two children and had no children in the one year prior to the study. The age range was from 26–59 years (mean 40.6±8.4 years). Their parity ranged from 2–11 with a mean of 4.0±1.9. Their parity status was grouped into two, those having less than or equal to four children constituted the highest percentage (72.0%) while those having more than or equal to five children constituted 28.0%. These subjects were selected randomly from February to June, 2009.
In the two groups of mothers who did not stay together with their babies at the delivery ward, but who were exposed to a two hour separation period, one group was allowed rooming-in at the maternity ward (Reunion group, Group IV) while infants in the other group remained in a nursery (Nursery group, Group III) during the remaining time spent at the maternity home. For these two groups, the explanatory variables "rooming-in", "swaddling", "marked engorgement on day 3" and "feel- ing 'low/blue' on day 3" were used in the regression anal- yses, performed in primi- and multiparous women, respectively. Again different results were obtained in primi- and multiparous mothers. The variable "marked engorgement" was associated with a significant mean increase of 157 ml of milk on day 4 while "feeling low/ blue" gave a significant mean decrease of 159 ml in the primiparous mothers. In the multiparous mothers, how- ever, the only significant explanatory variable was "room- ing-in" which was associated with a mean increase of 149 ml milk.
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With only a minority (11.8%) of the participants frequently inserting IUDs in nulliparous women, we found that the main barriers to IUD insertion in this part of the population were concern over painful insertion, difficulty of insertion, higher risk of perforation, PID, changes in bleeding patterns, high cost, and extrauterine pregnancy. Similarly, a study con- ducted in Australia found that, while most general physicians were confident about IUD insertion in multiparous women, only 46% of them felt confident about IUD insertion in nul- liparous patients. 8 Another study conducted in the United
Background : The purpose of the present study is to analyze the autonomic nervous activity in multiparas while resting, nursing, and rooming-in/room- ing-out during days 1 to 3 of early postpartum period. Methods : Subjects were asked to record the actions they performed while wearing a heart rate moni- tor. Changes in autonomic nervous activity from 9 am to 12 pm and relaxa- tion based on the relaxation (RE) scale were surveyed in multiparous women experiencing a normal postpartum period, on postpartum days 1 to 3. Results : Thirteen subjects were enrolled but heart rate data for all 3 days were available for only 5 of them. In these patients, the autonomic nervous activity (heat rate, high frequency [HF], or low frequency [LF]/HF) showed no significant differences between the days during any of the time periods. However, of the 3 days, day 2 demonstrated a lower HF and higher LF/HF. Subjective sense of relaxation was higher on postpartum day 3 compared to days 1 and 2, but there was no significant difference observed in the 3-day total score. Though no significant differences in HF and LF/HF at rest and during nursing were observed for any of the 3 days, there was a tendency for HF to be lower and LF/HF to be higher during nursing than at rest. Conclusions : Autonomic nervous activity demonstrated no significant major changes between the 3 days of postpartum (day 1 to 3). However, the lower HF and higher LF/HF during nursing and rooming-in suggest that even multiparas, who are suppo- sedly accustomed to nursing and child-rearing, can be tense. Results suggest that multiparas require monitoring, personal care, and attention so that they can be relaxed and less tense while nursing and caring for their children.
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Our main finding is that, in addition to cervical dilation, both birthweight and spontaneous rupture of the mem- branes markedly affect conditional time to completion of the first stage of labor in multiparous women. The associ- ation of fetal macrosomia (>4 kg) with longer labor and more frequent use of oxytocin has been well documented in previous research [25, 26]. In studies of labor 6 decades ago, Friedman found an large increase in the length of active nulliparous labor with increasing birthweight , but this association was much weaker among multipara . This association was also found in the work of Nesheim  and in a large study which included women who delivered singleton, cephalic babies with gestational age >34 weeks at 19 hospitals in the United States . This recent study analyzed birthweight in 0.5-kg increments and found that birthweight of more than 3 kg apparently became a factor in prolonging labor in multiparous women. However, a high proportion of the sample received epidurals and/or
Few studies have investigated risk factors for pre- eclampsia development among multiparous women. Re- ported risk factors of preeclampsia for multiparous women include interbirth interval (IBI) [15,17-19], part- ner change [11,20,21], previous low birth weight delivery and preterm deliveries , and history of previous pre- eclampsia [8-11,15]. The literature suggests that longer IBI increases the risk of preeclampsia, indicating that the protective effect of past pregnancies may decline over time or that other time dependent factors contribute to increased risk . Although different studies have used different time intervals, most report a significant associ- ation between long IBI and increased risk of preeclamp- sia. Although the exact length of the interval where the risk of preeclampsia begins to increase is not clear, IBIs of five years or more are associated with increased risk of preeclampsia .
The present observational investigation confirms our previous data that L-T4, administered to keep maternal fT4 serum levels in the upper third of the refer- ence ranges, which is high normal during pregnancy, may effectively and safely reduce preterm birth rate in multiparous women, and this applies in particular to women who were already taking L-T4 prior to conception. Regarding our published data in 2011, the presented results suggest that the preterm birth lo- wering effects of high normal fT4 seem to be independent of the use of trimester specific reference ranges . Our data did not confirm an association between high normal maternal fT4 serum levels and an increased risk for SGA newborns. This is in accordance with a newly published meta-analysis .
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Grand-multiparity is a serious risk factor in pregnancy and common in de- veloping countries. The objective was to compare the obstetric outcome of grand-multiparous women with that of low parity in our center. The study comprised of 150 grand-multiparous women (cases) and 150 multiparous women (para 2 - 4) in this index pregnancy as controls matched for age and admitted for delivery. The mean age of the grand-multiparous women at deli- very was 37.0 ± 2.8 years. Grand-multiparity was significantly higher among women with only primary education (48.0% versus 44.7%), polygamous mar- riages (9.3% versus 3.3%) and Muslims (17.3% versus 6.7%). Pregnancy in- duced hypertension and primary postpartum hemorrhage were significantly more often seen among grand-multiparous women than among the controls. The mean packed cell volume before delivery in the grand-multiparous women was significantly lower (33.6% ± 2.7%) than in the multiparous group (35.2% ± 2.7%) (P-value = 0.000). Grand-multiparity with its associated com- plications still occurs frequently in our environment. However, with adequate antenatal surveillance, optimal care during labour and contraceptive use, these problems will be reduced.
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is the leading cause of ill health that exists throughout the entire nation especially in rural regions. While studying the situation globally, World Health Organization estimates that the en in women globally. The main aim of the present study was to assess the Effectiveness of Structured teaching programme on Prevention of Uterine prolapse among Multiparous women residing in selected villages at Kirumambakkam rry. The study samples were 100 multiparous women selected from two different villages for experimental and control group. Comparing the pre-test & post-test scores of knowledge, attitude and practice between experimental and control group, the structured teaching programme on prevention of uterine prolapse provided by the investigator proved to be highly effective in the improvement of knowledge, attitude and practice among multiparous women in gested that the programme should be continued in order to uplift the overall health and practices of mothers. Hence, it will help to reduce the incidence of Uterine prolapse and enhance the quality of life in future.
Conclusion: This study has observed a high prevalence of anti-HPA-5b in our sample population. The prevalence of alloantibodies to HPA antigens was found to associate strongly with parity. These results indicate that there is a need to initiate platelet serology in our ter- tiary health institutions, as well as educate our women on the risk associated with frequent pregnancies, and ensure that adequate caution is taken when recruiting multiparous women as blood donors.
In many birthing units, it is common practice to restrict oral fluid intake during labor and delivery (25). According to several studies, the practice of eating and drinking during labor does not impose a threat and, in fact, they may benefit laboring women. Benefits of oral intake during labor include maternal satisfaction, maintenance of serum glucose, preservation of muscle glycolgen and a possible reduction in maternal fatigue (26, 27). McErleen (28) reviewed the historic import- ance and function of the taken food and fluids during labor. He noted that if intravenous therapy was initiated to treat dehydration, other interven- tions were more likely to follow. He concluded that positive practices such as providing nutrition would prevent dehydration and ketosis, minimize analgesic requirements and improve the laboring women's moral. In this study, multiparous women reported that restriction of fluid intake increased their stress and pain. This finding is consistent with the findings by Fowles (29). He found that restricting oral intake during labor added to labor stress. However, the study carried out by Klassen (26) does not confirm this finding. He noted that there were no differences in feeling pain with or without restricting drinking. Furthermore, Parsons et al. (30) found that mothers who ate food in the labor room tended to experience a longer labor. In general, as the duration of delivery increases the mother gets more tired and this leads to a decrease in the individual's capacity to tolerate environ- mental conditions and an increase in the mother's anxiety about herself and her baby, which in itself retards the progression of the labor process. Fear from not eating and drinking during labor is a predictor for increased perception of pain in labor. In multiparas, the lowest levels of stressors were related to lack of privacy. Lothian (20) noted that lack of privacy would induce catecholamine surge that would terminate early labor, make contrac- tions ineffective and cause severe pain. In our study, privacy was less important for many women. This disparity between the results of the present study and other studies might be attributed to the influence of different environmental contexts of birth and culture.
The partner was described as an immense support by more than half (58%) of the women. Based on experi- ences, MP women described different kinds of support. A recurrent theme was the partner’s readiness to take night shifts with the infant, his active participation in child care and domestic chores—“You know last pregnancy, I went all crazy, I got depressed and I panicked. I think he was shocked about how bad it really can get. But he handles it so well. He supports me 100%. He arranges everything, there’s really no end to what he does, because I need to rest a lot, even when I am not pregnant. He does a lot of the housekeeping, and doesn’t really complain, even if I say that it’s bad that it has to be like that. He says, “But, that’s how we function. Then our daily life works.”” (P5, MP).
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was no evidence of a difference for either freestanding or alongside midwifery units compared with obstetric units. In the subgroup analysis by parity, the odds of the primary outcome for nulliparous women was higher for planned home births than for planned obstetric unit births (adjusted odds ratio 1.75, 1.07 to 2.86; table 3⇓). The strength of this association was increased when the sample was restricted to women with no complicating conditions at the start of care in labour (adjusted odds ratio 2.80, 1.59 to 4.92). There were no significant differences in the odds of the primary outcome for nulliparous women in the freestanding midwifery unit or alongside midwifery unit groups compared with the obstetric unit group. For multiparous women there was no evidence of a difference in the primary outcome by planned place of birth. The overall test for interaction (heterogeneity) was of borderline statistical significance for all women (P=0.06), and was significant for women with no complicating conditions at the start of care in labour (P=0.03). The pairwise tests for each non-obstetric unit birth setting versus the obstetric unit group showed that this interaction was only statistically significant for the home birth group (all women P=0.01, no complicating conditions P=0.006), indicating that the differences seen are unlikely to be due to chance variation.
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confident”. Each item begins with the phrase “I can always”. The scores range from 33 to 165, with higher scores indicating a higher level of breastfeeding self-efficacy. The instrument was deemed reliable for internal consistency, scoring a Cronbach’s alpha coefficient of 0.96, whereby the coefficient alpha did not increase by more than 0.10 if any items were deleted (Dennis & Faux, 1999). The scale was also determined to have construct validity through factor analysis as well as through comparisons with constructs theoretically related to self-efficacy theory. Bandura’s performance appraisal suggests that women with prior breastfeeding experience will have higher levels of breastfeeding self-efficacy. Dennis and Faux (1999) found that multiparous women with previous breastfeeding experience had significantly higher BSES scores than primiparous women with no prior experience (p=<0.001), thereby demonstrating construct validity. Predictive validity was also shown whereby women with higher BSES scores were more likely to be exclusively breastfeeding at 6 weeks post-partum compared to women with low BSES scores (Dennis & Faux, 1999).
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In this well-defined cohort of HIV-infected women in Lusaka, Zambia, the reuse of SDNVP for PMTCT at a sub- sequent pregnancy did not reduce the efficacy of the inter- vention. Women who reported use of SDNVP in a previous pregnancy had transmission rates that were sim- ilar to multiparous women who were drug naïve. Moreo- ver, women who used SDNVP for two pregnancies during the study did not experience increased transmission rates in the second pregnancy, despite having demonstrable progression in their HIV disease as indicated by a decline in CD4 cell counts of nearly 100 cells/uL. In conjunction with the previous published studies from South Africa/ Cote d'Ivoire  and Uganda , these data indicate that reuse of SDNVP may not be associated with a loss of effi- cacy.
DOI: 10.4236/ojog.2019.96087 899 Open Journal of Obstetrics and Gynecology The results of our study are consistent with literature data that considers pri- miparity to be one of the most important risk factors . Preeclampsia was more common in primiparous women than in multiparous women, with a rate of 3.6% versus 2.5%. According to Edouard , it is the notion of parity that explains the high risk of preeclampsia and eclampsia in young women and not maternal age. For Goffinet, pre-eclampsia is 3 to 4 times more common in pri- miparous than in multiparous. As in other studies  , our study showed a very significant association between primiparity and hypertension disorders.
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As Japanese guidelines for obstetric practice recom- mend determination of rubella immunity during the 1 st trimester with HI test , a considerable number of multiparous women with seronegative results (HI titer < 8×) may have realized that they were susceptible to rubella in their previous pregnancies. In addition, as the guidelines recommend postnatal vaccination in women with seronegative results and low HI titer (≤ 16×) , a very low frequency of susceptible multipar- ous women was expected in this study. However, the susceptible fraction decreased only by 30% (from 5.4% to 3.8%) in this study (Table 2). These observations indi- cated that some women ignored the recommendation and or some obstetricians forgot to recommend the postpartum vaccination. Furthermore, there were no sig- nificant differences in seronegative rates between prim- iparous and multiparous women in some areas. This suggested that the strength of vaccination campaigns for postpartum women with seronegative results differed be- tween areas. A low postpartum vaccination rate of 11% among eligible women has also been reported in other countries . Thus, it was evident based on this study that some women ignore or underestimate the risk of rubella infection during subsequent pregnancies even after the recognition of susceptibility to rubella.
Assessment of the socio-demographic factors associated with the satisfaction is related to the childbirth experience. Objective: A mother’s satisfaction with the childbirth experience may have instant and lasting effects on her wellbeing, and on the bonding with her infant. The main aim of the study was to assess which socio-demographic factors are associated with this satisfaction. Most factors that authors agree on are: Pain intensity, personal control, self-efficacy, length of la- bor, method of delivery and numerous other demographic factors. Design: A cross-sectional study. Data was collected using a self-reported survey. Settings: The sample consisted of 100 women, se- lected from St Georges Hospital and CHU-NDS, who had to speak Arabic and had given birth in the past three days prior to interview. Methods: The multiple linear regressions and the mean test were used to assess which factors were associated with a positive childbirth experience. The Mackey childbirth satisfaction scale, three items from the Wijma delivery Expectancy/Experience questionnaire, a seven item mastery scale developed by Pearlin and Schooler and a background questionnaire were filled by women. Findings: Factors that were linked to a positive birth expe- rience were: Higher age, multiparous women, higher education, high monthly income, unemploy- ment, childbirth preparation, high personal control and self-efficacy, high childbirth and labor pain, fulfilled expectations, shorter period of labor and instrumented delivery. Conclusion: This study demonstrates that satisfaction with the childbirth experience is multi-dimensional with di- verse factors foreseeing diverse dimensions of satisfaction.
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In conclusion, oral contraceptive pills are a very effective, safe and reliable method of fertility control used by young, well educated multiparous women in Port Harcourt, who want to space their pregnancies. The rapidly declining patronage may likely be sustained due to the introduction and availability of the highly effective long acting reversible contraceptive implants characterised by almost immediate return of fertility at discontinuation.
Adequate animal models are useful tools for the identification of genes involved in complex human diseases. CIA in mice shares both immunological and pathological characteristics with human RA and is one of the most used models for the identification of genes and mechanisms involved in arthritis. The incidence of CIA is sex dependent, like the incidence in RA, although different species and different variants of the dis- ease could lead to both male and female predominance. Male mice are more often affected than females. Gender differ- ences in CIA susceptibility are dependent on many factors, including genetic, hormonal and behavioral influences . However, isolated factors are remarkably consistent between RA and the different animal models [3,9]. Pregnancy in mice, like pregnancy in women, normally causes remission of arthri- tis [5,10], while exacerbation often occurs postpartum [7,10,11]. Pregnancy-induced remission of CIA in mice