bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of 33 women who demanded a cesarean section for personal reasons
Authors: Ryding Elsa Lena
Published: November 2007

The purpose of this study was to obtain a better understanding of women who demand a cesarean section when obstetricians do not think it is necessary. Thirty‐three pregnant women were interviewed about their reasons for the demand. The 28 parous women referred to previous childbirth experiences and feared mainly for intractable labor pain and for the life and health of the child. The most prevalent fear of the five nulliparae was for vaginal rupture. According to their wishes and prerequisites the women received counselling or short‐term psychotherapy by a psychotherapeutically trained obstetrician. At term 14 women chose vaginal delivery and 19 had elective cesareans, three on obstetric indications and 16 at their own choice.
Surgical results and urodynamic studies 10 years after retropubic colpourethrocystopexy
Authors: Herbertsson G. , Iosif C. S.
Published: November 2007

Retropubic colpourethrocystopexy has been shown to be associated with good immediate cure rate in treating female urinary stress incontinence. Urodynamic data is often lacking in follow‐up studies. This study presents long‐term results 8–12 years after operation. Between 1979 1982, 72 women suffering from genuine stress incontinence underwent a colpourethrocystopexy. Follow‐up was done 1989–1990. Each patient had a complete urodynamic evaluation preoperatively and at the follow‐up. Mean age at operation was 46.2 years and follow‐up was done on average 9.4 years later (8–12 years). 71% were postmenopausal at the time of follow‐up. Surgical cure rate was 90.3%, 9.7% (seven patients) were considered failures. Five of the seven patients had experienced much improvement. A number of patients showed a decrease in one or more urodynamic parameter without a recurrence of stress incontinence. The bladder neck was incompetent in 38 (52.8%) of the patients, 31 of the 38 patients were still continent. Retropubic colpourethrocystopexy should be considered the primary operation for the treatment of female stress incontinence. Cure rate and postoperative evaluation cannot be judged by urodynamic parameters only, as some of the continent women showed a decrease in one or more urodynamic parameters that are considered important for continence. Bladder neck competence is not necessary for postoperative continence.
Uterine leiomyoma with a focus of fatty and cartilaginous differentiation
Authors: Yamadori Ichiro , Kobayashi Shoji , Ogino Tetsuro , Ohmori Masaki , Tanaka Hirokazu , Jimbo Toshiharu
Published: November 2007

A uterine leiomyoma with a focus of fatty and cartilaginous differentiation in a 58‐year‐old female is reported. The leiomyoma was located in the posterior uterine wall and had a maximum diameter of about 15 cm. A yellow hard nodule, about 5 cm in diameter, was found in the periphery of the leiomyoma and histologically was composed of cartilaginous tissue in islands with lipofibromyomatous tissue surrounding them. Generally so‐called lip‐omatous lesions of the uterus include circumscribed or diffuse lipomatosis of a leiomyoma and pure lipoma. Although appearance of cartilaginous tissue in lipomatous lesions of the uterus has never been reported, this case should be a very special form of circumscribed lipomatosis of a uterine leiomyoma.
Blue rubber bleb nevus syndrome with manifestations in the vulva
Authors: Busund Bjørn , Stray‐Pedersen Sverre , Iversen Olav Hllmar , Austad Joar
Published: November 2007

The blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder, manifesting with hemangiomas which are usually located in the gastrointestinal tract and/or in the skin. These lesions can cause local, sometimes severe bleedings or cosmetic problems. This report describes a young woman with BRBNS manifestations on the buttocks and in the vulva, the latter giving rise to symptoms specific to this location. The blood‐filled blebs were successfully treated by argon laser. As far as we know, manifestations of this disease in the female genital tract have not previously been described.

Address for correspondence: Professor emeritus Olav Hilmar Iversen, M.D., Ph.D. Institute of Pathology University of Oslo The National Hospital (Rikshospitalet) 0027 Oslo Norway
Fetal sex and maternal alpha‐fetoprotein concentration at late normal singleton pregnancies
Authors: Chen Ruey‐Jien , And Yu‐Hung Lin , Huang Su‐Cheng
Published: November 2007

The aim of this study is to investigate maternal and fetal clinical parameters on maternal serum alpha‐fetoprotein (MAFP) levels at late pregnancies. The studied subjects were 36 to 40 weeks pregnant. The pregnancies were singletons without any medical or gynecologic disease. Delivery followed within three days after blood sampling. A total of 192 subjects were included. The MAFP levels were measured by radioimmunoassay. The results showed the average MAFP was 108.2 ng/ml (SE 4.8 ng/ml). Male‐fetus‐bearers had higher MAFP (mean 121.4, SE 8.2 ng/ml, n = 84) than female‐fetus‐bearers (mean 97.9, SE 5.43 ng/ml, n= 108) (p = 0.014). MAFP did not have significant correlation with fetal weight (p>0.05) regardless of whether the fetus was a male (p>0.05) or female (p>0.05). By stepwise multiple regression, fetal sex was revealed to be the only factor that can affect MAFP (p = 0.0071). MAFP did not correlate with maternal age, gravidity, parity, maternal weight, total weight gain during pregnancy, gestational weeks, or fetal weight (all p > 0.05). Since fetal sex is the only factor that influences MAFP levels at uncomplicated late pregnancies, MAFP values should be interpreted with caution.
Iron status markers and serum erythropoietin in 120 mothers and newborn infants: Effect of iron supplementation in normal pregnancy
Authors: Milman Nils , Agger Anders Ole , Nielsen Ove Juul
Published: November 2007

In a randomized, double‐blind, placebo controlled study of the effect of iron supplementation during pregnancy, iron status (hemoglobin (Hb), serum (S‐)transferrin saturation, S‐ferritin) and S‐erythropoietin (EPO) were assessed in 120 healthy pregnant women at 14–16 weeks of gestation, and just before delivery; 63 women were treated with 66 mg iron daily, and 57 with placebo. There were no differences in baseline values in the two groups. At term, the iron treated group had significantly higher Hb, transferrin saturation, S‐ferritin (median 22 μg/1 vs. 14 μg/1, (p<0.0001) and lower S‐EPO compared to the placebo treated group. In the iron group, 30.2% had exhausted iron stores (i.e. S‐ferritin <20 μg/1), 6.3% latent iron deficiency (S‐ferritin <20 μg/1 and transferrin saturation < 15%), and no patients had iron deficiency anemia (S‐ferritin <20 μg/1 and transferrin saturation < 15% and Hb < 110 g/1). In the placebo group, 93.0% had exhausted iron stores, 54.4% latent iron deficiency, and 17.5% iron deficiency anemia; S‐EPO was inversely correlated to iron status markers: Hb, rs = −0.51,p<0.001; transferrin saturation, rs= −0.65,p<0.0001; S‐ferritin, rs= − 0.31, R<0.01, suggesting that the elevation in S‐EPO was secondary to iron deficient erythropoiesis. Newborns to iron treated mothers had higher cord S‐ferritin, median 155 μg/1, than newborns to placebo treated mothers, median 118 ug/1 (p<0.02); there were no differences in birth weight, transferrin saturation, or S‐EPO. Supplemental iron in a dose of 65 mg/day from the second trimester is sufficient to prevent iron deficiency in pregnant Danish women.
Twin pregnancies with single fetal death
Authors: Prömpeler Heinrich J. , Madjar Helmut , Klosa Wolfgang , du Bois Andreas , Zahradnik Hans P. , And Helmut Schillinger , Breckwoldt Meinert
Published: November 2007

Objective. Analysis of the fetal outcome of the surviving twin and the cause of fetal death. Patients. Between January 1979 and December 1992, 43 twin pregnancies with single fetal death were observed: in 11 cases (group I) before 16 weeks of gestation, in 11 cases (group II) between 17 and 24 weeks, and in 21 cases (group III) after 24 weeks of gestation.

Results. The pregnancies in group I continued without complication. In groups II and III the incidence of preterm delivery was 50%, of cesarean section 59%, of growth retardation of the surviving twin 22% and perinatal mortality was 13%. Twenty‐five (78%) of the surviving twins had a normal postnatal development and one (3%) was handicapped.

Conclusion. Loss of one of the twins in the first trimester does not impair the development of the surviving fetus. In the second trimester however this event is associated with increased risk for the survivor as reflected by a high incidence of growth retardation, premature labor and perinatal mortality.
Lactate in fetal scalp blood and umbilical artery blood measured during normal labor with a test strip method
Authors: Nordstrom Lennart , Ingemarsson Ingemar , Persson Bengt , Shimojo Nobuo , Westgren Magnus
Published: November 2007

A new test strip method was used to determine the lactate concentration in fetal scalp blood during normal labor. Sixty‐six fetal scalp blood samples were collected at cervical dilatations between 4 cm and 10 cm. The mean lactate value was 1.7 + 0.8 mmol/1 simultaneously (1S.D.) and the mean pH sampled simultaneously was 7.36 ±0.04 (1S.D.). The corresponding values for base deficit was 2.1 (±1.9) and for pC02 5.8 (±0.8). No difference was seen in lactate concentrations or pH values in early compared to late first stage of labor. The mean lactate concentration in the umbilical artery immediately after delivery was 3.7 mmol/l±1.2(lS.D.). The method was easy to handle and gave the result within 60 seconds.
Equality in health and health care during pregnancy
Authors: Hakansson Anders
Published: November 2007

Objective: To study health and health care during pregnancy for manual workers compared with non‐manual employees.

Design: A prospective population‐based study of all women who were registered for antenatal care during 1986 in the catchment areas of three health centers.

Subject: Three district antenatal clinics in southern Sweden.

Setting: 409 pregnant women; of whom 403 with singleton pregnancies; of whom 185 were manual workers and 175 were non‐manual employees.

Main outcome measures.: Problems encountered (registered according to the international classification of diseases) and measures taken.

Results: The study population resembled all women who gave birth in Sweden during the same year. Both manual workers and non‐manual employees registered for antenatal care in early pregnancy (96% and 97%, respectively, before 15 completed weeks). The women in both groups made the same number of visits to the antenatal clinics (median 17 and 13 respectively). There were no differences between the two groups of women as regards the percentage figures for obstetric problems encountered during pregnancy. The manual workers had a higher frequency of diseases of the musculoskeletal system (mainly low‐back pain) compared with the non‐manual employees (RR = 1.89; 95% CI = 1.20‐2.98), and they were sicklisted more often (RR = 1.21; 95% CI = 1.01‐1.46). On the other hand, their frequency of amniocentesis was lower (RR = 0.39; 95% CI = 0.19‐0.80); the reason for this was that the manual workers were younger than the non‐manual employees. Otherwise, there were no differences between the two groups of women as regards the percentage figures, either for non‐obstetric problems encountered, or measures taken, or regarding the outcome of pregnancy.

Conclusion: In Sweden, both manual and non‐manual working women appear to enjoy equal antenatal health and receive equal antenatal care. This conclusion is based on a small study population, meticulously monitored prospectively throughout pregnancy.
Bleeding time in preeclampsia
Authors: Ivankovic Milenko , Pereira Jaime , Bianchi Marcelo , Germain Alfredo , Mezzano Diego
Published: November 2007

The association of preeclampsia with thrombocytopenia and prolonged bleeding time is reported The analysis of bleeding time (Simplate II) and the platelet count (Automatic Coulter Counter) in 41 patients with different grades of preeclampsia is presented. Our results suggest that the decrease in the bleeding time observed in moderate preeclampsia and the increase observed in severe preeclampsia are not mainly dependent on the platelet count.
Vaginal operative deliveries in Italy
Authors: Parauini Fabio , Cortinovls Ivan , Restelli Slmona , Bortolus Renata , Tozzl Luca
Published: November 2007

Objective. To analyze the trends in vaginal operative deliveries in Italy.

Design. Analysis of information on all deliveries after the 28th week of gestation. Routinely collected by the Italian Central Institute of Statistics using a standard form.

Setting. National data on all Italian deliveries in the period 1981‐85.

Subjects. All deliveries occurred in Italy in the period.

Results. Forceps and vacuum delivery were reported in 1981 respectively in 0.9 and 2.1/100 deliveries. Similar percentages were observed during the whole considered quinquennium for viicuum extraction, but the forceps delivery rate decreased to 0.6/100 in 1985. Nulliparous women more frequently had an operative vaginal delivery: the rates of forceps and vacuum deliveries were respectively 1.1 and 3.7/100 in nulliparae and 0.3 and 1.0 in women reporting one or more previous births. There was a direct relationship between vacuum delivery rate and birth weight: vacuum deliveries were reported for respectively 0.9 and 2.3/100 infants weighing less than 2500 g and 22500 g. Likewise. vaginal operative deliveries were more frequent in term or post‐term births, and vacuum deliveries among singleton births than multiple ones (2.3 vs 1.71100 deliveries).

Conclusions. Operative vaginal delivery rates in Italy in the mid 1980′s were lower than in most developed countries. The reasons for forceps and vacuum extraction were similar to other developed countries with regard to obstetric determinants, but some differences emerged for socio‐demographic factors.
Psychosocial aspects of donor insemination
Authors: Pedersen Bjørn , Nielsen Anders Faurskov , Lauritsen Jørgen Glenn
Published: November 2007

Study objectives. To examine sperm donors' motivations and emotional reactions to the role of donors and to measure their willingness to provide information about themselves to recipients and offspring.

Design. A prospective trial in which the 26 subjects who were actively functioning as sperm donors in our fertility clinic at the time of investigation were asked to fill in a questionnaire and return it anonymously and voluntarily.

Main results. 8% of the donors stated purely altruistic motivation. 32% purely financial and 60% a combination of both. The acceptance rate for providing non‐identifying, phenotypic. descriptive information to recipients is 76%, for providing medical information it is 60% and the provisioii of psychosocial infornmation is accepted by 28% to 40%, depending on the item. 20% of donors are willing to continue donation if the present rules of anonymity are revoked.

Conclusions. Most donors do not seem to feel any close relationship to donor offspring and at least 60% found anonymity to be essential for their further functioning as donors.
Salpingitis caused by Chlamydia trachomatis and its significance for infertility
Authors: Czerwenka Klaus , Heuss Friedrich , Hosmann Josef , Manavi Mahmood , Jelincic Darko , Kubista Ernst
Published: November 2007

Between July and November 1991. 32 women (mean age 24.8 years) were examined laparoscopically in our department for suspected tubal sterility. All women had smears taken from cervix, vagina, and urethra, and all were negative regarding an infection with Chlamydia trachomatis. All women had open fallopian tubes, however, with inflammatory changes that varied in degree. Fifteen women reported pains and were classified as PID (pelvis inflammatory disease)‐positive, as compared to the PID‐negative group of 17 women without pain. In the group of the 15 PID‐positive women, we could detect Chlamy dia trachomatis in the form of salpingitis in II cases in the direct demonstration of the infectious agent. IgA antibodies were delected in the serum of all of these women. in 12 of them IgA +IgG antibodies. In the group of the 17 PID‐negative women, three were positive in the direct detection of the infectious agent. and IgA and/or IgG antibodies were detected in five cases. 38% of the women in the PID‐positive group and 68% in the PID‐negative group conceived within a period of one year after having completed a treatment with antibiotics.
Bacterial vaginosis and pregnancy
Authors: Platz‐Christensen Jens Jorgen
Published: November 2007

Bacterial vaginosis (BV) represents a disturbance in the vaginal microflora with a massive overgrowth of predominantly anaerobic bacteria resulting in a disagreeable vaginal discharge. The syndrome of BV has been described in the medical literature since the turn of the century. BV has been considered as an unpleasant but essentially harmleis disturbance of the vaginal micro‐flora. However, during the last decade a number of clinical reports have appeared indicating that women with BV run an increased relative risk of postabortal pelvic inflammatory disease, preterm labor, premature rupture of the membranes and post par‐tum and post‐Cesarean endometritis. The present study was carried out
A study of the effect of rotational forceps delivery on fetal acid‐base balance
Authors: Baker Philip N. , Johnson Ian R.
Published: November 2007

Objective. To determine whether Kiellands forceps rotational delivery causes a significant reduction in fetal pH or base excess, as compared to a control group delivered using non‐rotational forceps.

Design. A prospective observational study. Setting. A teaching hospital labor ward in the UK.

Methods. Fetal blood sampling was performed prior to delivery by Kiellands forceps (n=26) or by non‐rotational forceps (n=24). Following delivery, the umbilical vein was sampled. Outcome measures. The changes in fetal pH and base excess.

Results. No significant changes in pH were noted in fetuses delivered using Kiellands forceps or in those delivered using Neville Barnes forceps. However, whilst no changes in base‐excess were found in the fetuses delivered using Neville Barnes forceps, there were significant changes in base‐excess in those fetuses delivered using Kiellands forceps.

Conclusion. This small study suggests that delivery by Kiellands forceps may result in a significant deterioration in fetal acid‐base balance.
Vaginal discharge ‐ comparison of clinical, laboratory and microbiological findings
Authors: Wathne Bjarne , Holst Elisabeth , Hovelius Birgitta , Mårdh Per‐Anders
Published: November 2007

Of 101 fertile women (15–50 years of age) consulting in general practice due to vaginal discharge and/or genital malodor, bacterial vaginosis was diagnosed in 34% and vaginal candidi‐asis in 23%. The presence of Chlamydia trachomatis, Trichomonas vaginalis, genital herpes virus and Neisseria gonorrhoeae was demonstrated in 15%, 9%, 7% and 1% of cases, respectively. No specific genital tract pathogens were found in 25 patients, where the clinical diagnosis was psychological factors (n=5), intra‐uterine device‐associated discharge (n=5), cyto‐lytic vaginosis (n=5), urinary tract infection (n=3), or other/unknown causes (n=7). In most cases diagnosis of bacterial vaginosis, vaginal candidiasis or trichomoniasis was established by clinical examination and simple office tests (pH indicator paper, amine test, microscopy of wet smear, yeast culture kit). C. trachomatis and N. gonorrhoeae were diagnosed by means of culture, cervicitis being diagnosed clinically in five of 15 cases with culture‐confirmed chlamydial infection, while gonorrhoea was suspected from findings in a stained cervical smear. Sexually transmitted micro‐organisms were detected in 16% of women with bacterial vaginosis or candidiasis. Of 29 women with sexually transmitted agents, 14% harbored more than one such organism.
A new symphysis‐fundus height growth chart based on a well defined female population with ultrasound‐dated singleton pregnancies
Authors: Håkansson Anders , Áberg Anders , Nyberg Per , Scherstén Bengt
Published: November 2007

Background. The aim was to construct a new symphysis‐fundus (SF) height growth chart, based on ultrasound‐dated singleton pregnancies.

Methods. We made a population‐based study of all women, from the catchment areas of three district antenatal clinics, who registered for antenatal care during 1986. The growth of the SF height was measured on 403 women with singleton pregnancies.

Results. During pregnancy each woman made on average 14.0 (s.d. 2.8) visits to the antenatal clinic, where the SF height was measured on average 10.4 (s.d. 2.6) times. All but two women had an ultrasound examination. Using proper longitudinal methods a new SF height growth chart was constructed.

Conclusion. The mean values of the present curve, based on longitudinal data, were almost identical with the mean values of a recently presented curve based on stratified cross‐sectional data. Both these Swedish studies were population‐based and the pregnancies were ultrasound‐dated.
Recalled menarche in relation to infertility and adult weight and height
Authors: Helm Peter , Münster Kirstine , Schmidt Lone
Published: November 2007

Background. Possible relationships between menarche and fertility and fecundity later in life have not been fully clarified.

Methods. A cross‐sectional study was made in a random sample of 3743 women, aged 15–44 years, in the county of Copenhagen; 78% responded. Telephone interviews were made with a sample of the non‐respondents.

Results. Associations were observed between early menarche and increased risk of pelvic inflammatory disease (odds ratio 2.4 (1.4–4.1)) and spontaneous abortion (OR 3.1 (1.6–5.7)) later in life. On the other hand, no association was found with irregular bleedings or amenor‐rhoea; nor was a significant relationship established with fertility or fecundity. Late menarche was associated with underweight (OR 3.1 (1.4–6.9)), and early menarche with excess weight (OR 5.0 (2.4–10.6)). A significant positive correlation (R=0.17) was found between menarcheal age and final body height.

Conclusions. Menarche was not associated with fatuity or fecundity. Early menarche was associated with pelvic inflammatory disease and spontaneous abortion. Menarche showed relationships with weight and height.
Adjuvant chemotherapy in stage IB neuroendocrine small cell carcinoma of the cervix
Authors: Abulafia Ovadia , Sherer David M.
Published: November 2007

Background. Neuroendocrine small cell carcinoma of the cervix is a very rare and aggressive tumor which tends to metastasize early. This tumor is similar histologically to small cell carcinoma of the lung. Conventional treatment with surgery and/or radiation therapy has not been successful and has prompted the use of adjuvant chemotherapy regimens similar to those used for small cell carcinoma of the lung.

Methods. Three patients with Stage IB neuroendocrine small cell carcinoma of the cervix treated with postoperative adjuvant chemotherapy consisting of cisplatinum and VP‐16, were identified. Analysis of the outcome of these three patients and a review of the current literature were performed.

Results. Median survival was 28 months. Two patients received pelvic radiation therapy, one due to positive surgical margins and the other due to recurrent disease. Currently two patients are alive and free of disease at 17 and 61 months. The third patient developed hepatic and pelvic recurrence and died 30 months after her presentation and 18 months after recurrence.

Conclusion. The outcome of our three patients and eight similar cases in the literature suggest an improved survival rate with adjuvant chemotherapy compared to conventional treatment with surgery and or radiation therapy.
Book Review
Authors: Markestad Trond
Published: November 2007

Clements R. V (editor). Safe practice in Obstetrics and Gynaecology. A medico‐legal handbook. 492 pages. Edinburgh‐London‐Madrid‐Melbourne‐New York: Churchill Livingstone 1994.

Monif GRG: TORCH syndrome. 172 pages, 25 tables. Omaha: IDI Publications. Parthenon Publishing Group Ltd, 1993. Price GBP 27.00.
Chronological changes in subjective symptoms during pregnancy in nulliparous and multiparous women
Authors: Oga Masayuki , Shono Hideaki , Kohara Mayumi , Ito Yuji , Tanaka Tomomitsu , Sugimori Hajime
Published: November 2007

Background. To investigate chronological changes of subjective symptoms during a normal pregnancy in nulliparous and multiparous women.

Methods. Prospective data were collected using a 20‐item questionnaire (general fatigue, headache, palpitation, nausea/vomiting, fever, insomnia, edema, abnormal abdominal size, urinary frequency, lumbago, fetal descent, genital bleeding, watery discharge, high frequency of uterine contraction, increase in frequency of uterine contraction, strong intensity of uterine contraction, increase in intensity of uterine contraction, no change of uterine contraction at rest, high frequency of fetal movements, strong intensity of fetal movements) at Tsushima Izuhara Hospital in Nagasaki Prefecture, Japan. Seven hundred and twenty‐nine nulliparous and 588 multiparous normal pregnant women were questioned from 1988 to 1992. A simple (chi‐square test) analysis of appearance percentages in each item for every term of pregnancy was made.

Results. Each symptom showed different chronological patterns. In the simple analysis, there were significant differences (p < 0.05) in 10 symptoms (headache, palpitation, fever, insomnia, lumbago, fetal descent, watery discharge, increase in frequency of uterine contraction, strong intensity of uterine contraction, strong intensity of fetal movements) between nulliparous and multiparous subjects. In the multiparous group, there was a higher severity in eight of the ten symptoms, except for fever and watery discharge.

Conclusions. The multiparous group had more complaints than did the nulliparous subjects. These normal patterns are of practical clinical use concerning subjective symptoms of pregnancy.
Is misoprostol the drug of choice for induced cervical ripening in early pregnancy termination?
Authors: Platz‐Christensen Jens Jörgen , Nlelsen Sven , Hamberger Lars
Published: November 2007

Background. To study the effectiveness of three different cervical ripening agents in terms of dilatation ability and patient discomfort in connection with legal first trimester abortion.

Methods. Three randomized trials among unselected nulliparous women were performed 1: hygroscopic tent versus gemeprost, 2: misoprostol versus gemeprost and 3: misoprostol administered orally 17 versus 10 hours before vacuum curettage was performed.

Main outcomes. Dilatation ability, frequent gastrointestinal side effects, severe pain (patients' perception).

Results. In Trial 1, there was a tendency of a greater dilatation ability using the hygroscopic tent, while the experience of pain was a greater problem with gemeprost. In Trials 2 and 3, there were no significant differences in the dilatation abilities or gastrointestinal patient discomfort. There was a tendency towards a higher demand for narcotic analgesics in patients treated with gemeprost compared with all other groups.

Conclusions. Gemeprost and misoprostol showed almost identical ability to dilate and caused patient‐experienced discomfort to the same degree. The use of misoprostol may be preferred as it has the advantage of being both less expensive and easier to administer.
Reasons for pregnancy termination: Negligence or failure of contraception?
Authors: Savonius Hannele , Pakarinen Päivi , Sjöberg Lena , Kajanoja Pauli
Published: November 2007

Background. The aim of the study was to analyze the reasons for the failure of contraception and the reasons for not using any contraception among women seeking a legal abortion on social grounds. The women were also asked about their knowledge of contraception methods, including postcoital contraception.

Methods. We interviewed 200 women applying for a legal abortion within the first trimester of pregnancy about contraception, the contraceptive methods used, and the possible reasons for failure of contraception.

Results. Of all the women interviewed, 93% claimed to have adequate knowlegde of contraception. At the time of conception 11.5% used safe methods (OCs 8%, IUDs 3.5%), 63% used less safe methods, and 26% were without contraception. Only 25% of the pill users had no explanation for the failure. 76.7% of the condom users reported that the condom was broken, had slipped off or its use had been irregular. The concern about side effects was the most common reason for not using safe contraceptives (25%).

Conclusions. The women claimed to have enough information about contraceptives, and post‐coital contraception was also familiar, but the knowledge on how to use them in practice was inadequate. Irregular use and breaks in contraception were common. Despite the data based on Pearl indices, pills failed twice as often as IUDs. Counseling about the proper use of contraceptives is important, although the concern about the side effects appeared to be a big, unsolved problem.
Carbon dioxide laser miniconization for treatment of human papillomavirus infection associated with cervical intraepithelial neoplasia
Authors: Békássy Zoltán , Ahlgren Mats , Eriksson Margareta , Lindh Elisabet
Published: November 2007

Background. The effect of the carbon dioxide laser miniconization for treatment of cervical intraepithelial neoplasia with concomitant human papillomavirus infection was evaluated.

Material and methods. One hundred and eighteen women with cytologically proven cervical intraepithelial neoplasia stage 1 and/or 2 were investigated with repeat vaginal smear, colposcopy and human papillomavirus DNA sampling. Seventy‐five out of 118 women were subjected to laser miniconization or punch biopsy and cervical curettage.

Results. Out of 118 patients 37 proved to have positive human papillomavirus DNA with one or more oncogenic types (31.4%). Of these, 32 women were miniconized and five subjected to punch biopsy or cervical curettage. On the first follow‐up after miniconization all 32 patients were HPV negative. With follow‐up up to five years no recurrences of HPV or dysplasia were seen.

Conclusion. A miniconization procedure with carbon dioxide laser for treatment of cervical intraepithelial neoplasia proved useful also for simultaneous therapy of concomitant human papillomavirus infection of the uterine cervix.
Magnetic resonance imaging (MRI) in endometrial carcinoma; preoperative estimation of depth of myometrial invasion
Authors: Minderhoud‐Bassie Willy , Treurniet Frank E. E. , Koops Wim , Chadha‐Ajwani Sawi , Hage Jacobus C. , Huikeshoven Frans J. M.
Published: November 2007

Background The incidence of pelvic and aortic lymph node involvement in endometrial carcinoma depends on both tumor differentiation grade and myometrial invasion depth. It was evaluated whether magnetic resonance imaging (MRI) provides a preoperative technique to assess the depth of myometrial invasion.

Methods. The study includes 34 patients with an endometrial carcinoma. MRI (T5 Gyroscan. Philips) was made a few days before operation. Myometrial invasion was divided in four categories. Cervical invasion was classified as absent, superficial or deep. For comparison an in vitro MRI of the uterus was made directly after the operation. Histo‐pathological examination of the uterus was used as a golden standard of the depth of myometrial invasion.

Results. The estimation by MRI of the myometrial invasion depth was correct in 25 out of 31 patients. In three patients estimation was not possible, because of bad image quality. In four patients the MRI underestimated the cervical invasion.

Conclusions. Preoperative MRI in patients with an endometrial carcinoma can be used to estimate myometrial and cervical invasion. Therefore, in combination with the histological grading of the tumor, a preoperative MRI can be used to select patients at high risk of nodal involvement.
Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms
Authors: Almstrom Harald , Axelssön Ove , Ekman Gunvor , Ingemarsson Ingemar , Maesel Alf , Årström Kjell , Maršál Karel
Published: November 2007

Background. In a previous prospective randomised trial on pregnancies complicated by small‐for‐gestational‐age fetuses fewer operative deliveries for fetal distress were found after antenatal surveillance with umbilical artery Doppler velocimetry (Doppler group) than after surveillance with cardiotocography (CTG group). Despite that, the neonatal outcome was similar in both groups. This raised the question whether the knowledge of the antenatal Doppler results had influenced the obstetric management of labor.

Methods. In this retrospective study 242 intrapartum cardiotocogram tracings, obtained from the above mentioned prospective trial, were re‐interpreted by an expert without knowledge of the results in the original study. The re‐interpretation was then compared to the original interpretation.

Results. The expert interpreted 18 intrapartum tracings in the Doppler group and 18 in the CTG group as abnormal, whereas the clinicians interpreted only 8 tracings as abnormal in the Doppler group and 18 tracings in the CTG group.

Conclusions. The results of this retrospective study lend support to our hypothesis that the obstetricians in clinical practice are influenced by the knowledge of a normal umbilical Doppler velocimetry when interpreting an intrapartum CTG. This finding may partly explain why there were fewer emergency cesarean sections for fetal distress in the Doppler group than in the CTG group in the original prospective study.
Complications after radiotherapy and radical hysterectomy in early‐stage cervical carcinoma
Authors: Gerdin Eva , Cnattingius Sven , Johnson Per
Published: November 2007

Objective. To evaluate the overall complications, major as well as minor, in patients treated for early‐stage cervical carcinoma as related to treatment parameters.

Methods. In this retrospective study, 167 consecutive patients with early‐stage cervical carcinoma treated with preoperative radiotherapy and radical hysterectomy were investigated. Clinical data were collected from the medical files.

Results. Transient or permanent complications appeared in up to half of all patients. Seven percent exhibited intraoperative complications and 35% suffered from early postoperative urinary tract problems; most frequently urinary tract infection. After one year, the urinary tract complications dominated; voidance difficulties and incontinence being most common. Gastrointestinal complications occurred in 15% of patients. Lymphedema appeared during the first year in 21% of the patients but several of the mild or moderate cases improved after the first year. The relative risk of lymphedema was increased with shorter duration of surgery, extensive preoperative irradiation to the bladder and after external postoperative irradiation. Some form of late sequelae remained in every fifth patient, and every fourth patient, aged 24‐44 years, periodically suffered from vasomotor symptoms despite estrogen replacement therapy.

Conclusion. The complications after radiotherapy and radical hysterectomy in early stage cervical carcinoma suggest that attempts should be made to evaluate effective treatments designed to minimize risk to the patients.
Expression of mRNA for keratinocyte growth factor and its receptor in human endometrium
Authors: Siegfried Sari , Pekonen Fredrika , Nyman Tuulikki , Ämmälä Martti
Published: November 2007

Background. The aim of the present study was to evaluate the expression of mRNA for the keratinocyte growth factor and the keratinocyte growth factor receptor in human endometrium at different stages of the menstrual cycle. The role of estrogen and progesterone in regulating the expression of the mRNAs encoding keratinocyte growth factor and its receptor was further examined by studying the effect of continuous progestin (endometrium exposed to levonorgestrel releasing intrauterine contraceptive device), and continuous estrogen (endometrium hyperplasia) on the endometrium.

Methods. The expression of mRNA in endometrial samples was evaluated using reverse transcriptase polymerase chain reaction.

Results. The expression of KGF mRNA was found to vary during the menstrual cycle, with the highest levels in the progesterone‐dominated late‐secretory stage endometrium. Keratinocyte growth factor mRNA expression was low in both the endometrium that had been under the influence of continuous progestin (atrophic endometrium) and continuous estrogen (hyperplastic endometrium). The highest level of keratinocyte growth factor receptor mRNA expression was seen in late‐proliferative stage of the menstrual cycle and in hyperplasia when the estrogen exposure to endometrium is high. A low receptor mRNA level was found in endometrium exposed to continuous progestin.

Conclusion. The results suggest that keratinocyte growth factor mRNA expression is progesterone dependent, whereas keratinocyte growth factor receptor mRNA expression seems to be more estrogen than progesterone dependent.
Relationship between acute fetal distress and maternal‐placental‐fetal circulations in severe preeclampsia
Authors: Yang Jenn‐Ming , Wang Kuo‐Gon
Published: November 2007

Background. Hypoxic complications are thought to be the result of vascular lesions in the maternal‐placental or fetal‐placental circulation, with a resultant decrease in blood flow. This study was designed 1) to explore what kind of pathophysiological changes occur in the maternal‐placental‐fetal circulations associated with acute fetal distress, and 2) to determine whether umbilical velocimetry can be used as a predictor of acute hypoxia in severe preeclampsia.

Methods. Eighty‐nine cases of severe preeclampsia, who had Doppler ultrasonography, maternal blood chemistry and hematogram examinations all performed within two days of delivery or fetal death, were studied.

Results. According to the absence or presence of acute fetal distress as determined by the fetal heart rate pattern, patients were divided into two groups: distress group and non‐distress group. There was no significant difference between the two groups in maternal general status. However, patients in the distress group had a significantly shorter gestation age on admission and at delivery (p<0.00001). In the distress group, the perinatal outcome was poor. Newborns in the distress group had, significantly, a lower birthweight, and a higher incidence of SGA, 1‐min Apgar scores of less than 7, and fetal acidosis (pH<7.2) (p<0.001). Doppler ultrasonography also showed a significantly higher incidence of abnormal umbilical artery Doppler waveforms in the distress group (p<0.05). However, there was no difference between the two groups in the uterine arter Doppler velocimetry. Maternal blood chemistry and hematogram examinations revealed significantly higher blood levels of hemoglobin, hematocrit, blood urea nitrogen, and creatinine but lower levels of total protein and albumin in the distress group. An abnormal umbilical artery SD ratio (>95th centile) as a predictor of acute fetal compromise, judged by the incidence of abnormal fetal heart tracing mandating emergency delivery, 1‐minute Apgar scores of less than 7, 5‐minute Apgar scores of less than 7, and a pH value for the umbilical arterial blood of less than 7.2, had a sensitivity of 40.5‐75%, specificity of 71.8‐80%, positive predictive value of 12.5‐75%, and negative predictive value of 64.5‐98.4%.

Conclusion. In severe preeclampsia, early onset of disease superimposed with maternal hemoconcentration might initiate an acute insult and predispose the fetus to acute hypoxia.
The success rate in a Swedish in‐vitro fertilization unit: a cohort study
Authors: Bergh Christina , Josefsson Birgitta , Nilsson Lars , Hamberger Lars
Published: November 2007

Objective. To evaluate the cumulative childbirth rate after completion of in vitro fertilization (IVF) treatment including three or, in a few cases, four stimulated cycles. Design. A cohort of 398 couples starting their first IVF treatment between January 1990 and December 1992 were followed until completion of their treatment.

Results. Of 826 started cycles, embryo transfer was performed in 793 cycles, giving a mean of 2.0 completed cycles per couple. In addition, cryopreserved embryos were transferred in 228 cycles (0.57 cycles per couple). 204 couples completed their treatment with delivery or with an ongoing pregnancy, 95 couples underwent three stimulated cycles without achieving an ongoing pregnancy and 66 couples cancelled their treatment after one or two cycles because of varying reasons. In seven women no transfer took place. Twenty‐six women have not yet completed their planned cycles. Of 398 couples, where the vast majority had completed their IVF treatment, 51% (204) delivered as a result of the treatment.

Conclusion. IVF treatment combined with freezing of surplus embryos, is a highly effective procedure giving a ‘take home baby rate’ on a cumulative basis of more than 50% within 1 to 3 cycles.
Are Israeli women in a low risk group for developing squamous cell carcinoma of the uterine cervix?
Authors: Bar‐Am Amiram , Niv Jacob , Yavetz Haim , Jaffa Ariel J. , Peyser Reuven M.
Published: November 2007

Objective. Invasive cervical squamous cell carcinoma is not a common disease among Jewish women. In the present study an attempt was made to find what is the distribution of the known risk factors in this population.

Methods. Three hundred and ninety‐one patients with various cervical cytological abnormalities comprised the study group. They were compared to 350 Israeli women with negative cytology. The risk factors were extracted from an anonymous questionnaire. The results were statistically analyzed and compared to the equivalent figures published in the literature pertaining to non‐Jewish women.

Results. The prevalence of abnormal cytology among the Israeli women was almost the same as that of the non‐Jewish group: 24/1000 and 26/1000, respectively. Significant statistical differences were found between the following risk factors: number of sexual partners, age at first intercourse, age at first pregnancy. Women in the study group were younger when they became sexually active and at first pregnancy, they had a larger number of sexual partners, fewer of them were married and fewer of them were observant of Jewish ritual practices. In addition, they had achieved higher academic levels than the women in the control group.

Conclusions. It was found that the distribution of the known risk factors among the study group was practically the same as those in the non‐Jewish population. Moreover, it was found that there was an increase of 29.2% (from 17/1000 to 24/1000) in the prevalence of cervical premalignant lesions among the Israeli women. We believe that this population can no longer be considered as being at low risk for this disease.
Microalbuminuria following gestational diabetes
Authors: Friedman Shmuel , Rabinerson David , Bar Jacob , Erman Arie , Hod Moshe , Kaplan Boris , Boner Geoffrey , Ovadia Jardena
Published: November 2007

Background. Microalbuminuria (MA) precedes clinical nephropathy in patients with insulin‐dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patients with non‐insulin‐dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' duration. Our study was designed to determine whether MA and its sequelae also appear 5‐8 years after pregnancy complicated by gestational diabetes mellitus (GDM).

Methods. We examined the presence of MA in 72 women who had not conceived since a previous GDM‐pregnancy 5‐8 years ago and compared them to a control group of 35 women who had no GDM history, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann‐Whitney rank‐sum test was used to compare data between the study and the control groups. Student's (test was used to compare data within the study group.

Results. Median value of the urinary albumin excretion rate (AER) in the study group was significantly higher than median value of urinary AER of the control group (p<0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria‐positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fasting blood glucose, serum creatinine, blood urea nitrogen and parity was found.

Conclusions. MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we suggest that it may well be a sign of early renal disease and that long‐term follow‐up of all GDM patients for MA and other markers of renal disease is strongly indicated.
A quality of life perspective on who benefits from estradiol replacement therapy
Authors: Karlberg Johan , Mattsson Lars‐ÅKe , Wiklund Ingela
Published: November 2007

Study objective. To examine who may benefit from estrogen replacement therapy from a quality of life (QoL) perspective, taking both disease‐specific and general aspects at baseline into account.

Design. A double‐blind multi‐center randomized placebo‐controlled prospective study. The subjects were randomized to receive either transdermal estradiol or placebo for 12 weeks. QoL measures were disease‐specific and generic.

Locution. University hospital, teaching hospital and private practice.

Material. Post‐menopausal volunteering Swedish women (n=223) with mild to severe climacteric symptoms, as clinically evaluated by the Kupperman's Index.

Results. All QoL assessments showed highly significant improvement in the estradiol group in comparison with the placebo group. The women receiving placebo treatment also improved. but their improvement reached a peak at six weeks of treatment and then declined. In the estradiol group the improvement continued throughout the 12 weeks. After 12 weeks of treatment the change in the placebo‐treated group was smaller on the disease‐specific scales than on the generic scales and the Kupperman's Index. A high correlation was seen between the baseline score for a certain QoL assessment and the change in this score during treatment. The most striking result was that the mean change in QoL for the two groups was statistically significant for almost any pre‐treatment QoL status.

Conclusions. Women with slightly, moderately or severely diminished QoL status would benefit from estrogen treatment during the climacteric period. A similar tendency was seen in women with mild symptoms at baseline.
Computerized colposcopy and conservative management of cervical intraepithelial neoplasia in pregnancy
Authors: Mikhail Magdy S. , Anyaegbunam Akolisa , Romney Seymour L.
Published: November 2007

Background. Computerized colposcopy is the noninvasive digital processing of colposcopic images acquired using a charge‐coupled device camera. The purpose of this study was to evaluate the clinical applications of computerized colposcopy, and to record the colposcopic changes associated with progression or regression of cervical intraepithelial neoplasia in pregnancy.

Methods. Forty‐one pregnant patients, with abnormal Papanicolaou smears and a fully visualized squamo‐columnar junction, were serially monitored throughout their pregnancies using computerized colposcopy. All patients had baseline computer‐assisted measurements of their cervical lesions and a repeat measurement at monthly intervals and at 3‐months postpartum. Results. During the period of gestation, 17.1% of lesions increased in size, 21.9% remained unchanged, 41.5% decreased in size and 19.5% disappeared completely. In patients with an increase in lesion size, a colposcopically directed punch biopsy was performed which revealed CIN III but no microinvasion. Cervical biopsy during pregnancy was unnecessary in 82.9% of cases.

Conclusion. The ability to sequentially monitor and quantify colposcopically visualized lesions, using computerized colposcopy, provides a noninvasive objective mode to evaluate progression, stability, or regression of CIN lesions during pregnancy.