(精选)CALCIUM The most plentiful mineral in the body教学课件.pptVIP

* * Hyperfertility: the Paradox of Plenty Louis Keith, MD, PhD Professor Emeritus, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL Adjunct Professor, Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham Basic Premise The effects of hyperfertility on mothers are well known: witness Shah Jehan’s wife The effects of hyperfertility on fetal outcomes are not well known or studied Agreed Definitions of Parity Nullipara-gravidas with no prior pregnancy 20 weeks gestation Primapara-gravidas with 1 prior pregnancy 20 weeks gestation Variable Definitions of Parity (With no risk threshold for outcomes) Multipara Grand Multipara* Great Grand Multipara** Grand Grand Multipara** Extreme Grand Multipara** * Generally at least 8 prior deliveries ** Variably used for greater than 10 prior deliveries Reclassification of Parity:the UAB Model Previous live births Fertility Class Definition 2-4 I Moderately fertile 5-9 II Very fertile 10-14 III Extremely fertile ? 15 IV HYPERFERTILE Value of UAB Parity Classification Permits comparisons across discrete clinically relevant groups for assessment of maternal and fetal outcome parameters Literature Prior to the UAB Hyperfertility Studies Frequency of “High” (5) Parity(10 studies, 9 nations, 1954-2001) 30% United Arab Emirates 11% Nigeria 5.0% Trinidad 0.6% Croatia Hong Kong The Great Grand Multipara (10 prior live births)(only 11 studies, 6 nations, 1992-2002) 7 of these from Middle East Definitions vary Variable study sizes (139-2709) (ascertainment bias) Non-adjustment for confounders (methodological bias) The UAB Hyperfertility Studies Thanks to Muktar Aliyu, DPh, University of Alabama at Birmingham Basic Hypotheses on Hyperfertility #1: Babies born to mothers with parity ? 15 are more likely to have adverse fetal outcomes compared to women of lower parity #2: Stillbirth rates are greater among mothers with parity ? 15 compared to mothers who a