Stress urinary incontinence (SUI) is likelier to develop following a first pregnancy and delivery. Although retrospective epidemiological studies suggest an increased risk from both pregnancy and vaginal delivery, few cohort studies have estimated the long-term risk of SUI. This longitudinal cohort study examined the influence of SUI, beginning in a first pregnancy or puerperal period, on the risk of SUI symptoms 12 years later in 241 primiparous women entered consecutively into the trial in 1989 when seen for their first delivery. The 12-year incidence of SUI was based on 146 women lacking SUI for at least 3 months after delivery. By 12 years after the first delivery, 201 women had had 1-5 further pregnancies, and 187 had had 1-4 additional deliveries.The prevalence of SUI 12 years after the first delivery was 42%, and about 5% of women had SUI on a daily basis. Nearly 9% of women in the study reported hygienic problems or social discomfort resulting from SUI. The 12-year incidence of SUI was 30%. Any degree of SUI at 12 years was significantly more prevalent in women whose SUI began during the first pregnancy or within 3 months after giving birth, compared to women without SUI for at least the first 3 puerperal months. More than half of women whose SUI began during or after the first pregnancy but remitted by 3 months postpartum had SUI when assessed after 12 years. The risk of SUI 12 years after the first delivery was increased in women with higher body mass indices, but decreased in women who breast fed their infants for 6 months or longer and also in those having cesarean section at the first delivery. None of the women had undergone surgery for SUI. Training of the pelvic floor muscles did not lessen its prevalence.These findings show that, when SUI begins during the first pregnancy and especially the first delivery, the risk of symptoms 12 years later is significantly increased. Women who are obese before their first pregnancy and delivery appear to be especially at risk, whereas cesarean delivery may protect again long-lasting SUI in premenopausal women. GYNECOLOGYVolume 62, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY

Stem cells capable of differentiating to multiple lineages may be valuable for therapy. We report the isolation of human and rodent amniotic fluid-derived stem (AFS) cells that express embryonic and adult stem cell markers. Undifferentiated AFS cells expand extensively without feeders, double in 36 h and are not tumorigenic. Lines maintained for over 250 population doublings retained long telomeres and a normal karyotype. AFS cells are broadly multipotent. Clonal human lines verified by retroviral marking were induced to differentiate into cell types representing each embryonic germ layer, including cells of adipogenic, osteogenic, myogenic, endothelial, neuronal and hepatic lineages. Examples of differentiated cells derived from human AFS cells and displaying specialized functions include neuronal lineage cells secreting the neurotransmitter L-glutamate or expressing G-protein-gated inwardly rectifying potassium channels, hepatic lineage cells producing urea, and osteogenic lineage cells forming tissue-engineered bone.

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Biofabrication is an evolving research field that has recently received significant attention. In particular, the adoption of Biofabrication concepts within the field of Tissue Engineering and Regenerative Medicine has grown tremendously, and has been accompanied by a growing inconsistency in terminology. This article aims at clarifying the position of Biofabrication as a research field with a special focus on its relation to and application for Tissue Engineering and Regenerative Medicine. Within this context, we propose a refined working definition of Biofabrication, including Bioprinting and Bioassembly as complementary strategies within Biofabrication.

Recent advances in organ printing technology for applications relating to medical interventions and organ replacement are described. Organ printing refers to the placement of various cell types into a soft scaffold fabricated according to a computer-aided design template using a single device. Computer aided scaffold topology design has recently gained attention as a viable option to achieve function and mass transport requirements within tissue engineering scaffolds. An exciting advance pioneered in our laboratory is that of simultaneous printing of cells and biomaterials, which allows precise placement of cells and proteins within 3-D hydrogel structures. This advance raises the possibility of spatially controlling not only the scaffold structure, but also the type of tissue that can be grown within the scaffold and the thickness of the tissue as capillaries and vessels could be constructed within the scaffolds. Here we summarize recent advances in printing cells and materials using the same device.

Biofabrication holds the potential to generate constructs that more closely recapitulate the complexity and heterogeneity of tissues and organs than do currently available regenerative medicine therapies. Such constructs can be applied for tissue regeneration or as in vitro 3D models. Biofabrication is maturing and growing, and scientists with different backgrounds are joining this field, underscoring the need for unity regarding the use of terminology. We therefore believe that there is a compelling need to clarify the relationship between the different concepts, technologies, and descriptions of biofabrication that are often used interchangeably or inconsistently in the current literature. Our objective is to provide a guide to the terminology for different technologies in the field which may serve as a reference for the biofabrication community.

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