Evaluation of the relationship between adenosine deaminase, myeloperoxidase, cholinesterase, preeclampsia severity, and neonatal outcomes.

We aimed to evaluate whole blood adenosine deaminase (ADA), myeloperoxidase (MPO), butyrylcholinesterase (BChE), and acetylcholinesterase (AChE) activities and to investigate whether there was a correlation between these enzymes and severity of preeclampsia and neonatal outcomes. Sixty-one pregnant women with mild (n = 31) or severe (n = 30) preeclampsia and 50 healthy controls were included in this study. Whole blood adenosine deaminase, myeloperoxidase, butyrylcholinesterase, and acetylcholinesterase activities were measured. Adenosine deaminase and myeloperoxidase activities were significantly higher in both mild and severe preeclamptic women than they were in the controls. There was also a significant difference between the severe and the mild preeclamptic groups with respect to these enzyme activities. Although BChE activity was lower in the severe preeclamptic women than it was in the healthy controls (P < .05), AChE activity was similar in all groups (P > .05). We noted an inverse correlation between ADA activity and birth weight (r = -0.337) (P < .05) and between MPO activity and Apgar scores at 1 and 5 minutes (r = -0.438 and r = -0.475, respectively, P < .01). We concluded that elevated ADA and MPO but not AChE activities may correlate with disease severity and neonatal outcomes in preeclamptic women. Further studies are needed to elucidate the exact roles of ADA and MPO in the pathophysiology of preeclampsia.

Expression of laminin receptor 1 in human placentas from normal and preeclamptic pregnancies and its relationship with the severity of preeclampsia.

OBJECTIVES: To investigate the expression of laminin receptor 1 (LR1), a non-integrin-type laminin receptor, in preeclamptic and normal third-trimester placentas, as well as to investigate whether its expression differs with disease severity. STUDY DESIGN: Third trimester placental samples obtained from deliveries of preeclamptic (n=34) and normotensive healthy pregnant women (n=35) were immunohistochemically studied for the expression of LR1. The placentas from both mild (n=14) and severe (n=20) preeclamptic pregnancies were further assessed for strength of LR1 expression according to disease severity. RESULTS: When compared with normal placentas, the staining with LR1 protein in cytotrophoblasts and syncytiotrophoblasts was lower in preeclamptic placentas (P<0.05 and P<0.01, respectively). The intensity of staining with LR1 in decidual cells, cytotrophoblasts, syncytiotrophoblasts, and extracellular matrix cells of preeclamptic placentas did not vary with disease severity (P>0.05). CONCLUSIONS: Decreased LR1 expression in cytotrophoblasts and syncytiotrophoblasts of preeclamptic placentas, which may be independent of disease severity, might have a role in shallow trophoblastic invasion in preeclampsia.

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels.

PURPOSE: To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction. METHODS: A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion and the second group consisted of 50 healthy babies of women who had received 25 µg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period. RESULTS: The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 ± 0.27 mg/dl versus 3.55 ± 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but was not significantly so [7.47 ± 0.63 mg/dl versus 6.86 ± 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 ± 1.23 and 58.04 ± 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 ± 1.27 and 58.96 ± 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance. CONCLUSIONS: Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.

Does residual amniotic fluid after preterm premature rupture of membranes have an effect on perinatal outcomes? 12 years experience of a tertiary care center.

OBJECTIVE: To review our experience with preterm premature rupture of membranes at a tertiary-care hospital in Turkey to determine whether the amount of residual amniotic fluid after rupture has prognostic value for adverse maternal and fetal outcomes. METHODS: We reviewed the medical records of 191 pregnant women with gestational ages between 24 and 34 weeks at the time of rupture of the amniotic membrane and of their babies delivered in our hospital between January 1996 and September 2008. On the basis of amniotic fluid index (AFI) values recorded at the time of admission, patients were categorized into two groups: those with an AFI < 50 mm (n = 119) and those with an AFI > 50 mm (n = 72). RESULTS: The patients with high gravidity (4-8) were more prevalent in the group with an AFI < 50 mm (37 vs. 23.6%), while nulliparous women were more common in the group with an AFI > 50 mm (44.4 vs. 30.2%) (P < 0.05). Seventy-two percent of the cesarean sections performed due to nonreassuring fetal status were in the group with an AFI < 50 mm (P < 0.01). In 71.4% of the cases with a 5 min Apgar score < or = 7, AFI was less than 50 mm (P < 0.01). AFI < 50 mm was present in 65, 70.8, 76.7, and 73.1% of the pregnancies complicated by chorioamnionitis, respiratory distress syndrome, composite neonatal morbidity, and neonatal death, respectively (P < 0.05). CONCLUSIONS: A residual AFI < 50 mm after preterm PROM between 24 and 34 weeks of gestation, which is mostly seen in grand multiparous women in Eastern Turkey, may be a valuable prognostic variable for anticipating adverse maternal and neonatal outcomes.

Short-term results of posterior intravaginal slingplasty in grade 4 uterine prolapse.

PURPOSE: The purpose of this study was to evaluate the short-term efficacy and complication rates of posterior intravaginal slingplasty (IVS) procedures. METHODS: Thirty-four patients who had advanced (grade 4) uterine prolapse were recruited. All patients underwent vaginal hysterectomy and the cuff was suspended with a posterior IVS operation. The mean follow-up duration was 12 months (range 3-20 months). RESULTS: Thirty-three patients (97.1%) had satisfactory level I support defined objectively as stage 0 or I for point C as described in the pelvic organ prolapse quantification system. There were no rectal, vesical, ureteric, or vascular injuries in this series. During the postoperative period no complications, including tape erosion, were seen. CONCLUSIONS: Posterior IVS is a minimally invasive procedure for grade 4 genital prolapse with a high success rate.

Brucellosis in pregnancy: a 6-year clinical analysis.

AIM: To review our experience with brucellosis in pregnancy and to characterize the risk factors, clinical presentations, the rates of possible perinatal complications, and the effect of hospitalization on pregnancy outcomes. METHODS: We reviewed the medical records of 21 pregnant women at a tertiary care hospital and 12 at a maternity hospital, who presented with acute, subacute, chronic, or relapsing brucellosis. Their risk factors and clinical presentations were defined. The reproductive outcomes of 29 cases were compared within themselves according to the hospitals they were managed and with the outcomes for all women followed in the maternity hospital for the period from January 2008 through December 2008. RESULTS: Consumption of unpasteurized dairy products had occurred in 92.3% of the cases. Spontaneous abortion, intrauterine fetal death, and preterm delivery rates were 24.14, 3.45, and 6.9%, respectively. Only spontaneous abortion rate substantially exceeded that among the general population of pregnant women in our maternity hospital (P<0.05). Hospitalization did not affect pregnancy outcomes significantly (P>0.05). CONCLUSIONS: Brucellosis in pregnancy is associated with increased incidence of spontaneous abortion without an association with the magnitude of serum agglutination titer, the clinical type of brucellosis and hospitalization. In endemic areas with inhabitants of low socioeconomic class and low educational level, educating women of childbearing age about brucellosis may help to prevent the disease and its complications in pregnancy.

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels.

PURPOSE: To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction. METHODS: A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion, and the second group consisted of 50 healthy babies of women who had received 25 microg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period. RESULTS: The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 +/- 0.27 vs. 3.55 +/- 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but not significantly so [7.47 +/- 0.63 vs. 6.86 +/- 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 +/- 1.23 and 58.04 +/- 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 +/- 1.27 and 58.96 +/- 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance. CONCLUSIONS: Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.

Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome.

PURPOSE: To investigate the correlation between serum 25-hydroxyvitamin D (25-OH-VD) concentrations and metabolic parameters in obese and non-obese women with polycystic ovary syndrome (PCOS). METHODS: One hundred women with PCOS were divided into two groups, obese and non-obese, according to their body mass index (BMI). Waist-to-hip ratio (WHR), Ferriman-Gallwey score, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol, triglycerides, calcium, 25-OH-VD, LH/FSH, total testosterone, and DHEAS were measured. RESULTS: The serum 25-OH-VD mean levels were 56.31% lower in the obese PCOS patients. There was an association of increased HOMA-IR, BMI, WHR, triglycerides, total testosterone, and DHEAS with decreased 25-OH-VD concentrations in the obese PCOS patients. CONCLUSION: Low serum 25-OH-VD concentrations result from the presence of obesity and insulin resistance. However, the dependency between PCOS and hypovitaminosis D is questionable. Hypovitaminosis D should be kept in mind while managing obese women with PCOS.

A prospective randomized study comparing misoprostol and oxytocin for premature rupture of membranes at term.

OBJECTIVE: The aim of this randomized trial was to compare the efficacy and safety of vaginal misoprostol and oxytocin for cervical ripening and labor induction in patients with premature rupture of membrane (PROM) at term. METHODS: Ninety-seven women with PROM at term were assigned randomly to receive intravaginal misoprostol or oxytocin. The primary outcome measure was the induction-delivery interval. Secondary outcomes included the number of women who delivered vaginally within 12 hours of the start of the induction in the two groups, the cesarean, hyperstimulation, and failed induction rates, the mode of delivery, and the neonatal outcome. RESULTS: Forty-eight women were assigned to intravaginal misoprostol and 49 to oxytocin administration. The mean interval from induction to delivery was 10.61 +/- 2.45 hours in the misoprostol group and 11.57 +/- 1.91 hours in the oxytocin group (p = 0.063). The rates of vaginal delivery were 83.3% and 87.7% and cesarean delivery were 16.7% and 8.2% in the misoprostol and oxytocin groups, respectively. Neonatal outcomes were not significantly different. Of the cases, 8.3% in the misoprostol group and 8.2% in the oxytocin group revealed uterine contraction abnormalities. CONCLUSION: Our study demonstrates that, intravaginally, misoprostol results in a similar interval from induction of labor to delivery when compared to oxytocin.

Association of fibrinogen and C-reactive protein with severity of preeclampsia.

OBJECTIVE: The aim of this study was to determine the levels of plasma fibrinogen and C-reactive protein (CRP) in preeclampsia and their association with the severity of the disease. STUDY DESIGN: CRP and plasma levels of fibrinogen were investigated in 26 cases of normal pregnant women, 26 cases with mild preeclampsia and 26 cases with severe preeclampsia in the third trimester of pregnancy. Mean arterial pressure (MAP) was used as an indicator of the severity of the disease. Analysis of variance with the Kruskal-Wallis test was used when three groups were compared. For correlations, Spearman's rank correlation tests were used. A receiver operating characteristic curve was constructed to evaluate the sensitivity and specificity of CRP. RESULTS: Plasma CRP and fibrinogen levels in mild and severe preeclampsia patients were markedly higher than that of normal third trimester pregnant women. There were significant correlations between MAP and CRP (r = 0.515, p = 0.0001) and MAP and fibrinogen parameters (r = 0.383, p = 0.005) in pregnancies complicated with preeclampsia. CONCLUSION: We found higher levels of fibrinogen and CRP and presence of good correlation between CRP and MAP in preeclampsia.

Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey.

OBJECTIVES: The aim of this study was to find the incidence and clinical implications of peripartum hysterectomy in our hospital at the Eastern region of Anatolia. STUDY DESIGN: We analyzed retrospectively all cases of peripartum hysterectomy performed at YYU Medical Faculty Hospital between January 1995 and April 2003. Emergency peripartum hysterectomy was performed for hemorrhage which cannot be controlled with other conventional treatments within 24h of a delivery. There were 24 cases of emergency peripartum hysterectomy performed. RESULTS: The incidence of emergency peripartum hysterectomy was 5.09 per 1000 deliveries. Half of the hysterectomies followed cesarean section. Eleven patients were referred to our clinics from other hospitals. Uterine atony (45.8%) was the most common indication and placenta accreta (25.0%) was the second most common. Eighteen patients (75%) had subtotal hysterectomy. Bladder injury was seen in three cases. Re-exploration was performed in three cases (12.5%). Seventeen patients stayed in hospital over 7 days. There were four (16.7%) maternal deaths all of whom were referred from other hospitals. CONCLUSION: The mortality and morbidity of performing a peripartum hysterectomy is elevated, especially if performed in critical patients referred from other hospitals.

Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse.

AIM: To investigate the anatomical relationships of the structures and the topographic anatomy of the sacrospinous ligament and validate current anatomic knowledge of this area. MATERIALS: Nine embalmed half female cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament. RESULTS: The average length of the sacrospinous ligament was measured to be 43.04 +/- 6.58 mm. The inferior gluteal complex emerges from the infrapiriform foramen at a distance of 17.02 +/- 3.08 mm from the ischial spine and courses to inferior-laterally with a slight curve. During this course, it passes close to the upper-lateral half of the sacrospinous ligament. The pudendal complex passes above the spine in six of the nine cases (66.6%) and lies maximum of 5.5 mm medial to the spine. On average the sciatic nerve is measured to be 25.14 +/- 3.94 mm lateral to the ischial spine. CONCLUSION: Placing the suture inferomedially and close to sacrum, the risk of complication will be minimal.

Body hair scores and total hair diameters in healthy women in the Kirikkale Region of Turkey.

It was aimed to determine the normal hair scores of women of Kirikkale region according to the Ferriman- Gallwey scale and to investigate the relationship between the hair shaft diameter and hair scores. Hair scores were calculated in 204 healthy women, and hair shaft diameters were measured from the hair samples collected from 60 patients. Body mass index, waist to hip ratio, insulin resistance and blood androgen levels were determined. Neutral, hormonal and total hair scores were 2.1 1.4, 3.1 2.7 and 5.2 3.6, respectively. The average total hair diameter and hormonal hair diameter were 191.93 90.49 m and 121.8 75.9 m respectively. The correlation between total hair diameter and total hair score was statistically significant (r=0.704 p 0.001). Also, the correlation between hormonal hair diameter and hormonal hair score was statistically significant (r=0.724 p 0.001). While hair scores and diameters show meaningful positive correlation with androgen levels, they show negative correlation with age. In our population, 95% value of total hair score was 11, and for the hormonal score, it was 9. Hair diameters increase with hair score, regardless of total or hormonal of hair scores. Hair scores and hair diameters may be affected by blood androgens in healthy women.

Metastin levels in pregnancies complicated by pre-eclampsia and their relation with disease severity.

AIMS: To evaluate the role of metastin levels in the pathophysiology of pre-eclampsia and to determine whether there is a relationship between the severity of the disease and Doppler velocimetry measurements. METHODS: This cross-sectional study included 89 pregnant women (50 healthy normotensive pregnant women, 15 patients with mild pre-eclampsia, and 24 patients with severe pre-eclampsia) at the third trimester of pregnancy. The maternal levels of plasma metastin were determined by enzyme-linked immunosorbent assay. The umbilical artery and uterine artery blood flow velocities were measured by transabdominal color and pulsed Doppler ultrasound. RESULTS: Plasma metastin levels were lower in patients with pre-eclampsia than those in the normotensive pregnant women. Four patients with mild pre-eclampsia and seven patients with severe pre-eclampsia had abnormal Doppler velocimetry findings. Metastin levels of pre-eclamptic patients with abnormal Doppler velocimetry findings were significantly lower than those in patients with normal Doppler velocimetry findings. Plasma metastin levels negatively correlated with proteinuria in 24 hours and with mean arterial pressure in the cases of pre-eclampsia. CONCLUSIONS: The findings suggest that decreased maternal concentrations of plasma metastin may be involved in the pathogenesis of pre-eclampsia. Plasma metastin levels may be useful in the assessment of the severity of pre-eclampsia. However, further trials are needed to clarify the role of metastin in pre-eclampsia.

Relationship between erythrocyte catalase and serum adenosine deaminase activities in eclampsia.

OBJECTIVE: To examine the relationship between antioxidant status and T-cell activation in the pathogenesis of eclampsia by measuring the activities of erythrocyte catalase, an enzyme of antioxidant mechanism, and serum adenosine deaminase (ADA), regarded as a marker of T-cell activation. METHODS: A total of 60 patients [20 eclamptic (E) pregnant women, 20 healthy pregnant (HP) women and 20 non-pregnant (NP) women] were included in the study. Maternal venous blood samples were obtained from each patient during weeks 28-37 of gestation, and biochemical analyses of catalase activity in erythrocytes and ADA activity in serum were carried out. RESULTS: Erythrocyte catalase activity was significantly lower and serum ADA activity was significantly higher in the E pregnant women when compared with the HP women and NP women (P <0.001). No significant correlation was observed between erythrocyte catalase activity and serum ADA activity. CONCLUSIONS: Erythrocyte catalase and serum ADA activities may at least in part contribute to the pathogenesis of eclampsia. However, more studies are needed to verify and clarify the relationship between antioxidant status and T-cell activation in eclampsia.

Increased visfatin and leptin in pregnancies complicated by pre-eclampsia.

OBJECTIVE: To evaluate the role of the adipokines, visfatin and leptin in the pathophysiology of pre-eclampsia and how their concentrations correlate with the severity of the disease and abnormal Doppler velocimetry. METHODS: A cross-sectional study was carried out in 72 pregnant women (30 patients with mild pre-eclampsia, 20 patients with severe pre-eclampsia and 22 healthy normotensive pregnant women) during the third trimester of pregnancy. The maternal levels of plasma visfatin and serum leptin were determined in all cases by enzyme immunoassay and enzyme-linked immunosorbent assay, respectively. The uterine artery and umbilical artery RI were determined by Doppler analysis in all cases. RESULTS: Plasma visfatin levels and serum leptin levels were higher in patients with pre-eclampsia than in the normotensive pregnant women. Six patients with mild pre-eclampsia and five patients with severe pre-eclampsia had abnormal Doppler velocimetry. Visfatin and leptin levels of pre-eclamptic patients with abnormal Doppler velocimetry were significantly higher than they were in those with normal Doppler velocimetry. Serum leptin levels were positively correlated with plasma visfatin level in cases of pre-eclampsia. CONCLUSIONS: These findings suggest that increased maternal levels of leptin and visfatin may be involved in the pathogenesis of pre-eclampsia, and measurement of these adipokines may be useful in assessment of the severity of disease.

Uterine rupture: a twelve-year clinical analysis.

OBJECTIVE: To review the experience of uterine rupture at a tertiary obstetric unit in Eastern Turkey and to propose preventive measures. METHODS: All uterine rupture cases managed from November 1995 to March 2007 at the Department of Obstetrics and Gynecology of the Medical School of Yuzuncu Yil University, Van, Turkey, were analyzed retrospectively. RESULTS: There were 33 cases of uterine rupture with an incidence of 1/287 deliveries. Of these, 72.72% had complete and 27.27% had incomplete uterine rupture. Of the patients, 39.39% had a scarred uterus, 90.90% received no antenatal care, 60.60% were referred after various interventions had been attempted, and 42.42% required subtotal or total hysterectomy. The maternal mortality rate was 15.15% and the perinatal mortality rate was 42.42%. CONCLUSIONS: Improvements in antenatal care, reduction in cesarean rates, the place where the birth occurs, and skilled attendants are important factors in reducing uterine rupture.

Side effects and acceptability of Implanon: a pilot study conducted in eastern Turkey.

OBJECTIVE: To assess side effects during the first 6 months of use of Implanon. DESIGN AND METHODS: The study was conducted in eastern Turkey between June 2004 and May 2005. Forty-one healthy women, aged 18-40 years who chose to use Implanon participated in the study. The implant was inserted between days 1 and 5 of the menstrual cycle. Findings were recorded before and during 6 months following insertion. Statistical analyses were performed using SPSS package programme including paired samples t-test. RESULTS: No pregnancy occurred during the study. Ninety days after initiation of therapy, three of the 41 patients (7.3%) had regular periods, 14 (34.1%) were amenorrhoeic and the remaining 24 (58.5%) had some type of abnormal bleeding. Dysmenorrhoea affected significantly less women (1/41, i.e. 2.4%) than before treatment (17/41, i.e. 41.5%), but mastalgia increased significantly as it was reported by five previously unaffected participants (12.2%). Mood changes appeared in seven patients (17.1%) and acne in 11 of them (26.8%). The circulating levels of protein C, total cholesterol and oestradiol dropped significantly. Endometrial thickness decreased significantly. At completion of the study period, removal of the implant was requested by eight of the 41 patients (19.5%) because of irregular bleeding (six women), depressive symptoms requiring treatment (one woman) or weight gain (one woman). CONCLUSIONS: Mainly because of irregular bleeding, the discontinuation rate of Implanon at 6 months among the women in this region is high (19.5%).

Serum advanced oxidation protein products, myeloperoxidase and ascorbic acid in pre-eclampsia and eclampsia.

BACKGROUND: Activation products from neutrophils and the complement system might cause endothelial dysfunction, which is central to the aetiology of pre-eclampsia. This study aimed to investigate the activity of myeloperoxidase (MPO), and its association with advanced oxidation protein products (AOPP), in women with pre-eclampsia and eclampsia. MATERIALS AND METHOD: Twenty-one pregnant women with pre-eclampsia, 11 pregnant women with eclampsia and 19 healthy pregnant women were studied. Serum levels of malondialdehyde (MDA), AOPP, ascorbic acid (AA) and activities of MPO and catalase (CAT) were measured using a colorimetric method. RESULTS: The MDA level was significantly higher in the pre-eclampsia (3.15+/-0.28 nmol/mL) and eclampsia (4.01+/-0.66 nmol/mL) groups than in controls (1.85+/-0.18 nmol/mL); the difference between MDA levels in the pre-eclampsia and eclampsia groups was not statistically significant. MPO activity was significantly higher in the eclampsia (347.59+/-88.06 U/L) group than in the pre-eclampsia (196.17+/-30.8) and control (93.22+/-9.52) groups, and there was also no significant difference in these levels between the pre-eclampsia and control groups. CAT activity was significantly higher in the pre-eclampsia (166.35+/-31.75 U/L) and eclampsia (166.98+/-40.31 U/L) groups than in controls (81.28+/-7.41 U/L), and AA level was significantly higher in the pre-eclampsia (0.54+/-0.15 mg/dL) group than in controls (0.18+/-0.01 mg/dL); the differences in AA and CAT activity between the pre-eclampsia and eclampsia groups were not statistically significant. AOPP levels did not change significantly among the control, pre-eclampsia and eclampsia groups (106.88+/-5.62, 98.89+/-6.47, 111.89+/-6.8 micromol/L, respectively). CONCLUSIONS: We suggest that increased oxidative stress might contribute to the pathophysiological mechanisms of pre-eclampsia and eclampsia, and that AA and CAT might have a protective role via free radical-scavenging properties. However, further study is needed.

Impaired function of the levator ani muscle in the grand multipara and great grand multipara.

Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 - 5, 6 - 9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 +/- 1.14 (2 - 5), 7.55 +/- 1.23 (6 - 9) and 12.2 +/- 2.16 (10 - 17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.