bluuebunny/crossref_metadata_2025 huggingface dataset:
Avoidable stillbirths and neonatal deaths in rural Tanzania
Authors: Hinderaker Sven G. , Olsen Bjørg E. , Bergsjø Per B. , Gasheka Peter , Lie Rolv T. , Havnen Jakob , Kvåle Gunnar
Published: December 2003

Objective
To determine the causes of stillbirths and neonatal deaths in the community in rural Tanzania and to evaluate whether the deaths were avoidable under the prevailing circumstances.

Design
Review of stillbirths and neonatal deaths.

Setting
Rural northern Tanzania, Mbulu and Hanang districts.

Sample
One hundred and nineteen stillbirth and neonatal deaths identified in a prospective cohort of antenatal attendees and 21 stillbirths and neonatal deaths identified retrospectively in a household survey in seven rural communities.

Methods
Verbal autopsy was done to reach a diagnosis, in many cases supplemented with information from antenatal records and hospital records. The avoidability of deaths under the prevailing circumstances was assessed for each case. An account of risk factors detectable at antenatal clinic was done and compared with the woman's recall of the risk assessment and recall of being referred.

Main outcome measures
Avoidability of stillbirths and neonatal deaths.

Results
There were 60 stillbirths, 49 early neonatal deaths and 27 late neonatal deaths. Infection‐related deaths were most common (n= 53), followed by asphyxia‐related deaths (n= 32) and immaturity‐related deaths (n= 20). Malaria was the most common infectious agent observed (21 children and 20 mothers). Twenty‐one deaths (15%) were probably avoidable and 13 (10%) were possibly avoidable. A patient‐oriented avoidable factor was identified in 17 (51%) and a provider‐oriented avoidable factor was identified in 22 cases (65%). Twenty‐six of the 34 avoidable deaths had risk factors, but only two of the women were aware of it and only one recalled being referred to a hospital for the risk factor. There were eight deaths among the 133 mothers who experienced a perinatal death.

Conclusions
Our data indicate that prevention and adequate treatment of infections and asphyxia in the newborn should have high priority in low‐income settings. The relatively low proportion of avoidable stillbirths and neonatal deaths may be partly due to accessible emergency obstetric care in the area. Future efforts should emphasise improving the communication between midwife and women at the antenatal clinics, preparing the women—and their families—for the delivery and to be ready for complications.
Pharmacokinetics of anti‐D IgG in pregnant RhD‐negative women
Authors: Bichler Johann , Schöndorfer Georg , Pabst Günther , Andresen Irmgard
Published: December 2003

Objective
To assess the pharmacokinetics of anti‐D IgG in pregnant Rhesus D‐negative women after intramuscular and intravenous administration of 300 μg of Rhophylac.

Design
An open, randomised, multicentre study.

Setting
Seven gynaecological practices in Germany.

Sample
Fourteen RhD‐negative pregnant women at risk of becoming Rhesus D immunised received study drug at 28th week of pregnancy either by intramuscular or intravenous route.

Main outcome measures
Anti‐D IgG concentrations of serum samples obtained up to 11 weeks following antenatal Rhesus D prophylaxis were quantified by flow cytometry.

Results
Mean anti‐D IgG concentrations after intravenous and intramuscular administration differed up to seven days post‐injection, from two weeks onwards they were comparable to each other. Irrespective of the administration route, anti‐D IgG in serum was detectable in all women up to at least nine weeks post‐administration.

Conclusions
The serum concentrations of anti‐D IgG measured after administration of Rhophylac were very similar to those obtained with 300 μg of a different anti‐D immunoglobulin product.
Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy
Authors: Jacobsen Anne Flem , Qvigstad Erik , Sandset Per Morten
Published: December 2003

Objective
To evaluate the effect and dose of dalteparin given to pregnant women with acute venous thromboembolism.

Design
An observational study of pregnant women in Norway.

Setting
Delivery and haematological departments in Norway.

Population
Twenty women, aged 22–41 years, with acute venous thromboembolism verified by objective means.

Methods
Patients were treated with dalteparin from diagnosis until delivery. Treatment was monitored with anti‐activated factor Xa (anti‐Xa) activity, and the dose was adjusted to achieve target 0.5–1.0 U/mL 2–3 hours post‐injection.

Main outcome measure
Anti‐Xa activity and side effects.

Result
None of the patients suffered recurrent venous thromboembolism or major bleeding complications. In 9 of 13 women starting with conventional dose of dalteparin (100 iu/kg bd), dose escalation was necessary to reach target anti‐Xa activity. None of the six women who started with 105–118 iu/kg bd required dose escalation. One woman who started with 133 iu/kg bd required dose reduction. Bioaccumulation of dalteparin was not observed.

Conclusion
Our study suggests that dalteparin may be used for the treatment of acute venous thromboembolism in pregnancy. Approximately 10–20% higher doses of dalteparin may be needed as compared with non‐pregnant individuals.
Radioimmunoscintigraphy with Tc‐99m‐labelled SM3 in differentiating malignant from benign adnexal masses
Authors: Ali N. , Jan H. , van Trappen P. , Nasreen F. , Canizales A. , Carroll M.J. , Granowska M. , Jacobs I. , Britton K.E.
Published: December 2003

Objective
Ultrasound scanning, serum CA125 and menopausal status have previously been combined in a risk of malignancy index for the differential diagnosis of adnexal masses. Although this approach has greater accuracy than either individual tests or clinical assessment, it has a significant false positive and false negative rate. Efforts have been directed at refining differential diagnosis and this study assessed the role of radioimmunoscintigraphy using the stripped mucin 3 (SM3) antibody that has a 17‐fold greater uptake in malignant than benign ovarian tumours in vitro.

Design
Prospective study of patients with a pelvic mass using radioimmunoscintigraphy.

Setting
Department of Nuclear Medicine of St Bartholomew's Hospital in collaboration with Cancer Network.

Population
A total of 93 patients with pelvic masses were recruited for this study of which 32 had ovarian cancer and 61 had benign lesions.

Methods
Radioimmunoscintigraphy was performed with Tc‐99m‐labelled SM3 (600 MBq), anterior and posterior pelvis imaged at 10 minutes and at 4 and 24 hours and evaluated with change detection analysis and probability mapping.

Main outcome measures
Sensitivity and specificity of radioimmunoscintigraphy for ovarian cancer.

Results
Radioimmunoscintigraphy had a sensitivity for ovarian cancer of 84% (27 true positive and 5 false negatives) and a specificity of 87% (53 true negatives and 8 false positives) giving a negative predictive value of 91%.

Conclusion
These results suggest that radioimmunoscintigraphy could be used to reduce the number of false positive findings in a strategy to refine differential diagnosis of the pelvic mass.
Distribution of fetal erythroblasts in maternal blood after chorionic villous sampling
Authors: Al‐Mufti Raghad , Hambley Henry , Farzaneh Farzin , Nicolaides Kypros H.
Published: December 2003

Objective
To investigate whether chorionic villus sampling (CVS) is associated with an increase in fetomaternal cell trafficking.

Design
Prospective study.

Setting
King's College London School of Medicine, King's College Hospital.

Sample
Eighteen singleton pregnancies undergoing CVS for fetal karyotyping at 11–14 weeks of gestation and subsequently found to have chromosomal defects.

Method
Maternal blood samples were obtained immediately before and at 3–14 (median 5) days after CVS. Fetal erythroblasts were isolated using triple density gradient separation and anti‐CD71 magnetic cell sorting techniques. The enriched erythroblasts were stained with Kleihauer–Giemsa and with fluorescent antibodies for the epsilon (ɛ) and gamma (γ) globin chains. The percentage of fetal cells positive for each stain was calculated. Fluorescence in situ hybridisation (FISH) for X‐ and Y‐chromosomes was also performed. Comparison was made in the proportion of enriched fetal cells between the pre‐CVS and post‐CVS samples.

Main outcome measures
The proportion of fetal erythroblasts in maternal blood.

Results
The percentage of erythroblasts enriched from maternal blood that stained positive for ɛ and γ globin chains and with Kleihauer–Giemsa was significantly higher in the post‐CVS samples compared with the pre‐CVS samples. FISH analysis for the Y‐chromosome confirmed the increase in fetal cell proportion in the post‐CVS samples. The percentage difference in fetal cells decreased significantly with time interval from CVS.

Conclusion
CVS results in an increase in fetomaternal cell trafficking, which continues to be present for several days after the procedure.
Acceptability of a urinary continence promotion programme to women in postpartum
Authors: Chiarelli Pauline , Murphy Barbara , Cockburn Jill
Published: December 2003

Objective
To assess the acceptability to postpartum women of a physiotherapist‐delivered urinary continence promotion programme.

Design
A survey of women participating in a randomised controlled trial where women received the intervention (which involved training in pelvic floor exercises and incorporated adherence‐enhancing strategies) or usual postpartum care.

Setting
Postpartum wards of three tertiary teaching hospitals in the Hunter Region, NSW, Australia.

Sample
Women were eligible to participate in the trial if they had a forceps/ventouse assisted delivery and/or delivered a higher birthweight baby (≥4000 g). This study is based primarily on data obtained for 348 women in the intervention group.

Methods
Baseline hospital‐based interview; eight‐week follow up appointment with physiotherapist; three‐month follow up telephone interview.

Main outcome measures
Comparative dropout rates for intervention and control groups; reasons for non‐participation; attendance at hospital follow up; self‐reported acceptability of and embarrassment about per vaginum examination; utilisation and perceived usefulness of intervention components; self‐reported adherence with recommended pelvic floor exercise regime.

Results
There was no significant difference in dropouts between intervention (5.9%) and control groups (6.3%). Only 14% of women gave not wanting the per vaginum assessments as their main reason for not participating in the study. Eighty‐eight percent of women participated in the eight‐week postpartum follow up visit with the physiotherapist, with two‐thirds of these women attending the hospital for this; 72.2% of women reported no embarrassment, and 22.5% just a little embarrassment about per vaginum assessment. The information components of the intervention were well received. At the eight‐week follow up visit, 83.9% reported performing pelvic floor exercises at adequate frequency.

Conclusions
The postpartum period provides an ideal opportunity for pelvic floor muscle testing and the delivery of continence promotion advice.
Screening for trisomy 21 in twins using first trimester ultrasound and maternal serum biochemistry in a one‐stop clinic: a review of three years experience
Authors: Spencer Kevin , Nicolaides Kypros H.
Published: December 2003

Objective
To evaluate the performance of screening for fetal trisomy 21 in the first trimester of twin pregnancies by a combination of maternal serum biochemistry and ultrasonography.

Design
Three year retrospective review of screening performance.

Setting
District General Hospital maternity unit.

Population
All women booked to receive routine antenatal care at Harold Wood Hospital between 1 June 1998 and 30th September 2001. The population included 13,940 women of all ages presenting with pregnancies between 10 weeks 3 days and 13 weeks 6 days gestation. Of these, 230 had a twin pregnancy.

Methods
Women booked into the clinic were offered screening using a combination of maternal serum free β‐hCG and pregnancy‐associated plasma protein‐A (PAPP‐A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 13/18 (≥1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out. For women who on examination were at 14 weeks of gestation or greater, or for women presenting as late bookers beyond 14 weeks, screening was performed in the same time frame using only maternal serum free β‐hCG and α‐fetoprotein.

Main outcome measures
The first trimester detection rate for trisomy 21 and all aneuploides, false positive rate, uptake of screening, uptake of invasive testing in women identified at increased risk and fetal loss rates after invasive testing.

Results
Overall, 97.4% of the women with twins (224/230) accepted first trimester screening. The rate of detection of trisomy 21 was 75% (3/4). Fetal death at presentation was found in 3.4% of fetuses (16/460). Of women who accepted screening, 4.3% (10/230) presented too late for fetal nuchal translucency measurement and 10.0% of women (23/230) presented too early. A risk for trisomy 21 was calculated for each fetus based on the individual fetal nuchal translucency thickness and the maternal biochemistry. The false positive rate among those eligible for first trimester screening was 9.0% (19/206) of pregnancies and 6.9% of fetuses (28/412). Uptake of invasive testing was 59% (10/17) with chorionic villus sampling in eight cases and amniocentesis in two. No fetal loss occurred within 28 days of chorionic villus sampling and no loss occurred after amniocentesis. One case of trisomy 21 was identified for every three invasive procedures.

Conclusion
First trimester screening for trisomy 21 in twin pregnancies is both theoretically possible and practically achievable using a combination of nuchal translucency thickness and maternal serum biochemistry. However, dilemmas for the mother and health professionals when both nuchal translucency thickness measurements are normal might suggest that greater reliance be placed on the nuchal translucency thickness risk alone when counselling women about invasive testing.
Maternal and neonatal hair mercury concentrations: the effect of dental amalgam
Authors: Lindow S.W. , Knight R. , Batty J. , Haswell S.J.
Published: December 2003

Objective
To evaluate maternal and fetal hair mercury levels in relation to the placement of dental amalgam tooth restorations.

Design
Cross sectional study involving women who never had dental amalgam restorations placed, women who had amalgam restorations placed before pregnancy and women who had restorations placed during the index pregnancy.

Setting
North of England Maternity Hospital.

Sample
Fifty‐three healthy women who delivered healthy babies at term.

Methods
Maternal and fetal hair was collected in a standardised manner in the first few days following delivery.

Main outcome measures
Maternal and neonatal hair mercury concentrations.

Results
When compared with women without restorations, there was a significant increase in the maternal hair mercury concentration in women who had dental amalgam placed outside of the index pregnancy and also in women who had dental amalgam placed during the index pregnancy. The fetal hair mercury concentration was significantly higher in babies when mothers had been exposed to dental amalgam either before pregnancy or during pregnancy compared with unexposed babies. There was no difference in the maternal or fetal hair mercury levels in the groups of patients who had dental amalgam placed before or during pregnancy.

Conclusion
Maternal and fetal hair mercury levels were significantly higher in women who previously had dental amalgam restorations placed. There was no evidence that placement of dental amalgam restorations in pregnant women who had already similar restorations increased the maternal or fetal hair mercury level.
Experience with three cases of laparoscopic transabdominal cervico‐isthmic cerclage and two subsequent pregnancies
Authors: Gallot Denis , Savary Denis , Laurichesse Hélène , Bournazeau Jean Alain , Amblard Joël , Lémery Didier
Published: December 2003

Three women with a history of recurrent miscarriages and failed vaginal cerclage had laparoscopic transabdominal cerclage. A 5 mm non‐absorbable polyether suture was placed laparoscopically at the level of the internal os as an interval procedure. All procedures were successful. All women were discharged on day 2 and none required transfusion. Two of them were pregnant within four months and were delivered by caesarean section at 38 weeks of gestation. The main interest of this technique is to avoid a laparotomy; thus, reducing the abdominal wall aggression and the recovery time.
Anatomical and functional changes in the lower urinary tract following spontaneous vaginal delivery
Authors: Wijma Jacobus , Potters Annemarie E. Weis , de Wolf Ben T.H.M. , Tinga Dick J. , Aarnoudse Jan G.
Published: December 2003

Objective
To assess the incidence of urinary incontinence in pregnancy and after spontaneous vaginal delivery and its relation with changes in the static and dynamic function of the pelvic floor.

Design
The second part of a prospective longitudinal study.

Setting
University Hospital Groningen and Martini Hospital Groningen, the Netherlands.

Population
A cohort of 62 women before and after spontaneous vaginal delivery at term and 27 nulliparous non‐pregnant controls.

Methods
Urinary incontinence was measured by a questionnaire and by a 24 hour pad test. The position and mobility of the urethrovesical junction were measured by perineal ultrasound and related to simultaneously measured abdominal pressure changes. Serial investigations were done at 38 weeks of gestation and at 6 weeks and 6 months after delivery.

Main outcome measures
Urinary incontinence and its relation with the position of the urethrovesical junction at rest and with the mobility of the urethrovesical junction during Valsalva and during coughing, indicated by the displacement/pressure coefficient and with obstetric variables.

Results
After delivery, reported urinary incontinence was reduced from 26% at 38 weeks of gestation to 16% and 15% at 6 weeks and 6 months after delivery, respectively. Even lower rates were measured by the 24 hour pad test, which revealed a decrease from 14% at 38 weeks to 10% and 5% at 6 weeks and 6 months postpartum, respectively. Six weeks and six months after delivery, the angle of the urethrovesical junction at rest was significantly increased compared with the non‐pregnant control women. Compared with the antenatal measurements, the displacement/pressure coefficients during coughing and during the Valsalva manoeuvre were significantly increased six weeks after delivery. Six months after delivery, only the coefficient for coughing was still significantly greater than the antenatal value and the value in the non‐pregnant control group. No relations were found between urethrovesical junction measurements and obstetric variables and subjective or objective urinary incontinence parameters.

Conclusion
Although pregnancy and spontaneous vaginal delivery significantly increased the degree of bladder neck descent during coughing, urinary incontinence, quite common during pregnancy, occurs less frequently postpartum.
Increased susceptibility to low density lipoprotein oxidation in women with a history of pre‐eclampsia
Authors: Gratacós Eduard , Casals Elena , Gómez Olga , Llurba Elisa , Mercader Imma , Cararach Vicenç , Cabero Lluıacute;s
Published: December 2003

Objectives
To evaluate the susceptibility to oxidation of low density lipoprotein (LDL) in women with a history of pre‐eclampsia.

Design
A case–control study.

Setting
The departments of obstetrics and gynaecology at two university teaching hospitals.

Population
Women delivering one to three years before enrolment, 35 who were diagnosed with severe pre‐eclampsia and 35 controls matched for age, body mass index (BMI), smoking and parity.

Methods
Plasma samples were analysed for total cholesterol, high density lipoprotein (HDL) cholesterol, LDL cholesterol, triglycerides and lipoprotein A. The in vitro susceptibility to oxidation of LDL was measured and expressed in minutes (lag time). Results are expressed as mean and standard deviation.

Main outcome measures
Serum lipid profile and in vitro susceptibility to oxidation of LDL.

Results
Mean LDL cholesterol (116 [37] vs 98 [20] mg/dL, P < 0.05) and trygliceride (112 [56] vs 78 [38] mg/dL, P < 0.05) levels were significantly higher in the groups of women who had pre‐eclampsia compared with controls. The rest of the measured lipid parameters were similar between the two study groups. The susceptibility to oxidation of LDL was also significantly higher in the pre‐eclampsia group (lag time: 37.9 [8.4] vs 44.8 [9.1] minutes, P < 0.01).

Conclusion
Women with a history of pre‐eclampsia have significant differences in lipid parameters and an increased susceptibility to lipoprotein oxidation when compared with women who had a normal pregnancy one to three years after delivery.
Does perineal suturing make a difference? The SUNS trial
Authors: Fleming Valerie E.M. , Hagen Suzanne , Niven Catherine
Published: December 2003

Objective
To examine differences in outcome between primiparous women who do and who do not have suturing to first or second degree perineal lacerations sustained during spontaneous vaginal births after 37 weeks of gestation.

Design
Parallel group randomised controlled trial.

Setting
Bellshill Maternity Hospital, Lanarkshire, and St John's Hospital, Livingston.

Population
Primigravidae with perineal lacerations following spontaneous birth.

Methods
One thousand and three hundred fourteen women were recruited to the trial antenatally from whom 74 were randomised either to be sutured or not sutured immediately after giving birth. Randomisation was stratified by degree of tear.

Main outcome measures
Using standardised measures, perineal pain and healing were measured at 1 and 10 days and 6 weeks postpartum. In addition, postnatal depression was assessed at 10 days and 6 weeks postpartum.

Results
Findings indicated that there were no significant differences between the groups with regard to pain or depression but there were differences with regard to healing. At six weeks, there remained a significant difference in wound closure between the groups, with women who had not been sutured having poorer wound approximation.

Conclusions
While acknowledging the small sample size, the results are nonetheless important, showing persistent evidence of poorer wound approximation in those women who had not been sutured. Practitioners need to review the present practices of not suturing perineal lacerations until research examining the longer term implications is undertaken.
Influence on fetal blood pH when adding amniotic fluid: an in vitro model
Authors: Lösch Alexander , Kainz Christian , Kohlberger Petra , Heinze Georg , Hefler Lukas , Lahodny Johann , Tempfer Clemens
Published: December 2003

Objective
To assess the effect of contamination with amniotic fluid in different quantities on fetal capillary blood pH.

Design
In vitro model.

Setting
Department of Obstetrics, St Pölten Hospital.

Sample
Venous umbilical blood and amniotic fluid from 35 women who underwent amniotomy during labour.

Methods
Venous umbilical blood was mixed in vitro with amniotic fluid in diluted series (venous umbilical blood/amniotic fluid, 10:1 to 1:1). In every case two parallel runs of the dilution series in an inverted fashion were performed to rule out a possible time‐dependent bias of the pH measurements.

Main outcome measures
pH change in dilutions of umbilical venous blood with amniotic fluid: 10:1, +0.07 (0.02); 8:1, +0.08 (0.02); 6:1, +0.08 (0.03); 4:1, +0.07 (0.02); 2:1, +0.09 (0.03); 1:1, +0.12 (0.05); all P < 0.001.

Results
Amniotic fluid pH increases, whereas umbilical blood pH decreases slightly over time since collection. Dilutions of umbilical venous blood with amniotic fluid resulted in a significant pH rise. There was no significant difference between the two inversely performed dilution series.

Conclusion
Amniotic fluid influences in vitro fetal venous blood pH immediately after contact. This observation indicates the possible masking of a fetus in distress by fetal scalp blood pH determination when amniotic fluid contaminates the sample.
Ovarian stromal hyperplasia and ovarian vein steroid levels in relation to endometrioid endometrial cancer
Authors: Jongen V.H.W.M. , Hollema H. , van der Zee A.G.J. , Santema J.G. , Heineman M.J.
Published: December 2003

Objective
To study the relationship between the presence of endometrioid endometrial cancer, the degree of ovarian stromal hyperplasia and ovarian steroid production in postmenopausal women.

Design
Retrospective and prospective study, respectively.

Setting
Medical Centre Leeuwarden and the University Hospital Groningen, The Netherlands.

Population
Postmenopausal women with or without endometrial cancer, undergoing a hysterectomy with bilateral salpingo‐oophorectomy.

Methods
In 112 women with endometrioid endometrial cancer, 47 women with a benign gynaecological condition and 10 women with non‐endometrioid endometrial cancer, the degree of ovarian stromal hyperplasia was scored retrospectively on a semi‐quantitative scale (atrophy, slight, marked). All women were postmenopausal and had undergone a hysterectomy with bilateral salpingo‐oophorectomy. Prospectively, blood sampling from the ovarian veins was performed in a further 60 women. Steroid levels (oestrone, oestradiol, androstenedione, testosterone) were determined and related to the degree of ovarian stromal hyperplasia and the presence (n= 52) or absence (n= 8) of endometrioid endometrial cancer.

Main outcome measures
Degree of ovarian stromal hyperplasia and steroid levels in the utero‐ovarian circulation.

Results
In the retrospective study, the degree of ovarian stromal hyperplasia was higher in the presence of endometrioid endometrial cancer (P= 0.0001). The prospective study showed that an increasing degree of ovarian stromal hyperplasia was related to higher ovarian levels of both testosterone and androstenedione (P < 0.05 and P < 0.005, respectively), but not to oestrone or oestradiol. A non‐significant increase in mean ovarian vein levels of both testosterone and androstenedione was seen in patients with endometrial cancer as compared with patients with benign conditions.

Conclusion
In endometrioid endometrial cancer, higher degrees of ovarian stromal hyperplasia were found and with increasing degrees of ovarian stromal hyperplasia, levels of ovarian vein androgens were higher. A causal relationship in the origin of hormone‐dependent endometrial pathology may exist between ovarian stromal hyperplasia, ovarian vein androgen levels and endometrioid endometrial carcinoma.
Pregnancy after EMA/CO for gestational trophoblastic disease: a report from The Netherlands
Authors: Lok C.A.R. , van der Houwen C. , ten Kate‐Booij M.J. , van Eijkeren M.A. , Ansink A.C.
Published: December 2003

Objective
To investigate whether a desire for pregnancy changed after etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA/CO) treatment for gestational trophoblastic disease and whether the incidence of infertility and adverse pregnancy outcome differed from the general population.

Design
A cohort study was performed. Data were collected from hospital records and questionnaires.

Setting
The study was carried out in referral hospitals in The Netherlands.

Population
All women registered by the Dutch Working Party on Trophoblastic Disease and treated with EMA/CO were included.

Methods
A questionnaire was sent to all surviving patients treated with EMA/CO from 1986 until 1997. Women who underwent a hysterectomy were excluded from the study.

Main outcome measures
Pregnancy outcome and pregnancy wish after chemotherapy.

Results
Fifty patients were treated with EMA/CO. In 86%, a complete remission was achieved. A questionnaire was sent to 33 patients. Response rate was 82% (27/33). After EMA/CO, 18 of the patients experienced a regular menstrual cycle. Three patients had an amenorrhoea. Fourteen patients had a pregnancy wish. Twelve patients conceived; 21 pregnancies occurred. Sixteen pregnancies were term deliveries. Two pregnancies ended in a miscarriage and two congenitally abnormal children were delivered prematurely.

Conclusion
After EMA/CO, 86% of women with a pregnancy wish achieved pregnancy. However, women can be so anxious about a new pregnancy that they refrain from it. A causative relation between the two congenitally abnormal children and EMA/CO cannot be determined because of the small sample. The rate of miscarriages is not higher than in the general population. We can reassure patients that pregnancy after EMA/CO has a high probability of success and a favourable outcome. To diminish the fear of getting pregnant in some patients, psychosocial care should be considered in addition to medical care.
Interleukin‐18 in cervical mucus and amniotic fluid: relationship to microbial invasion of the amniotic fluid, intra‐amniotic inflammation and preterm delivery
Authors: Jacobsson Bo , Holst Rose‐Marie , Mattsby‐Baltzer Inger , Nikolaitchouk Natalia , Wennerholm Ulla‐Britt , Hagberg Henrik
Published: December 2003

Objective
To evaluate the relationship between interleukin (IL)‐18 in cervical mucus and amniotic fluid and microbial invasion of amniotic fluid, preterm delivery and intra‐amniotic inflammation in women in preterm labour, with preterm prelabour rupture of membranes and at term.

Design
A prospective follow up study.

Setting
Sahlgrenska University Hospital, Göteborg, Sweden.

Sample
Women with singleton pregnancies (<34 weeks) presenting with preterm labour (n= 87) or preterm prelabour rupture of membranes (n= 47) and women, not in labour, at term (n= 28).

Methods
Amniotic fluid was retrieved transabdominally. Cervical mucus was taken from the uterine cervix of women in preterm labour and at term. IL‐18 was analysed with enzyme‐linked immunosorbent assay.

Main outcome measures
IL‐18 in relation to microbial invasion of the amniotic fluid, delivery within seven days or <34 weeks of gestation and intra‐amniotic inflammation.

Results
The levels of IL‐18 in cervical mucus and amniotic fluid were higher in women with preterm labour than in those not in labour at term. In the preterm labour group, significant associations were found between elevated IL‐18 in amniotic fluid and microbial invasion of the amniotic fluid, as well as between delivery within seven days or <34 weeks of gestation and intra‐amniotic inflammation. Delivery was delayed longer in the preterm prelabour rupture of membranes subgroup with IL‐18 ≥1.0 ng/mL than in that with IL‐18 <1.0 ng/mL.

Conclusions
In the preterm labour group, high IL‐18 in amniotic fluid (but not in the cervix) was associated with microbial invasion of the amniotic fluid, intra‐amniotic inflammation and prompt delivery. On the other hand, elevated IL‐18 in preterm prelabour rupture of the membranes group correlated with a longer interval to delivery.
A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy
Authors: Zanetta Gerardo , Mariani Eloisa , Lissoni Andrea , Ceruti Patrizia , Trio Diego , Strobelt Nicola , Mariani Silvana
Published: December 2003

Objective
To assess the clinical relevance of adnexal masses in pregnancy and the usefulness of ultrasound in their management.

Design
A prospective study on pregnancy complicated by adnexal masses.

Setting
Department of Obstetrics and Gynaecology in Italy.

Population
6636 women with pregnancy in utero followed in our clinic from January 1996 to December 1999.

Methods
From 1996 to 1999, all ovarian cysts with a diameter exceeding 3 cm were prospectively recorded and followed. The management was expectant except in case of symptoms or suspected malignant features. Cysts suggestive of borderline tumours were treated expectantly.

Main outcome measures
Clinical relevance of adnexal masses in pregnancy, the outcome of these pregnancies and the usefulness of ultrasound examination in their management.

Results
We detected 82 cysts in 79 of 6636 women (1.2 in 100 term pregnancies). Sixty‐eight women were asymptomatic at the time of diagnosis, whereas 11 (13.9%) were diagnosed because of pain. Diagnosis occurred in the first trimester for 57 cases and in the second or third trimester in 22 (27.8%). One‐half of the cysts were simple and anechoic at ultrasound. Fifty‐seven had a diameter not exceeding 5 cm. Forty‐two cyst resolved in pregnancy without treatment. Three cysts required surgery within few days (torsion). One woman required laparotomy at the 37th week of gestation, due to torsion. When one case of termination was excluded, 78 women delivered at term (66 vaginally, 12 by caesarean section). Nineteen women underwent surgery after pregnancy. We recorded three Stage Ia borderline tumours, accounting for 3/82 cysts (3.6%) and 3/30 persisting masses (10%).

Conclusions
Ultrasound allows definition of ovarian cysts in pregnancy and this positively impacts on management. The incidence of cancer among persistent masses is lower than previously reported. Acute complications in stable cysts are extremely uncommon after the first trimester. An expectant management is successful in the majority of cases and should be considered more often. Routine removal of persistent cysts is not justified.
Randomised comparison of uterine artery Doppler and aspirin (100 mg) with placebo in nulliparous women: the Essai Régional Aspirine Mère–Enfant study (Part 2)
Authors: Subtil Damien , Goeusse Patrice , Houfflin‐Debarge Véronique , Puech Francis , Lequien Pierre , Breart Gérard , Uzan Serge , Quandalle Florence , Delcourt Yves Marie , Malek Yves Marie ,   Essai Régional Aspirine Mère–Enfant (ERASME) Collaborative Group,   Collaborators and participating centres are listed in Part 1 at the end of the report.
Published: December 2003

Objective
To assess the effectiveness of a pre‐eclampsia prevention strategy based on routine uterine artery Doppler flow velocity waveform examination during the second trimester of pregnancy, followed by a prescription for 100 mg aspirin in the case of abnormal Doppler findings.

Design
Multicentre randomised controlled trial.

Setting
Eleven centres in the north of France and one in Belgium.

Population
One thousand and eight hundred and fifty‐three nulliparous women recruited between 14 and 20 weeks of gestation.

Methods
Randomisation either to undergo a uterine Doppler examination between 22 and 24 week of gestation or to take a placebo. Women with abnormal Doppler waveforms received 100 mg of aspirin daily from Doppler examination through 36 weeks.

Main outcome measures
Pre‐eclampsia was defined as hypertension (≥ 140 and/or 90 mmHg) associated with proteinuria (≥ 0.5 g/L).

Results
One thousand two hundred and fifty‐three women (67%) were randomised into the systematic Doppler group and 617 (33%) into the placebo group. Of the 1175 patients in the Doppler group who underwent this examination, 239 (20.3%) had abnormal uterine artery Doppler and received a prescription for aspirin. Despite the aspirin prescription, the frequency of pre‐eclampsia did not differ between the systematic Doppler group and the placebo group (28 of 1237 [2.3%] vs 9 of 616 [1.5%]; RR = 1.55, 95% CI 0.7–3.3). Furthermore, the groups did not differ in the frequency of children who were very small for their gestational age (≤3rd centile) or for perinatal deaths. Compared with patients with normal Doppler findings, those with abnormal Doppler were at high risk of pre‐eclampsia (RR = 5.5, 95% CI 2.5–12.2) and of giving birth to a small‐for‐gestational‐age child (RR = 3.6, 95% CI 1.6–8.1).

Conclusion
Despite its sensitivity in screening for pre‐eclampsia, routine uterine Doppler in the second trimester cannot be recommended for nulliparous patients.
Is eye size related to orbit size in human subjects?
Authors: Chau Anson , Fung Karl , Pak Karen , Yap Maurice
Published: December 2003

The purpose of this study is to determine if there is an association between eye size and the volume of the orbit in adult subjects. Thirty‐three subjects with varying degrees of ametropia (+1.00 to −12.75 D) underwent magnetic resonance scan of the orbit. Results show that the larger myopic eye was not associated with a larger orbit.
Searching for a connection between matroid theory and string theory
Authors: Nieto J. A.
Published: December 2003

We make a number of observations about matter-ghost string phase, which may eventually lead to a formal connection between matroid theory and string theory. In particular, in order to take advantage of the already established connection between matroid theory and Chern–Simons theory, we propose a generalization of string theory in terms of some kind of Kahler metric. We show that this generalization is closely related to the Kahler–Chern–Simons action due to Nair and Schiff. In addition, we discuss matroid/string connection via matroid bundles and a Schild type action, and we add new information about the relationship between matroid theory, D=11 supergravity and Chern–Simons formalism.
Ab initio centroid path integral molecular dynamics: Application to vibrational dynamics of diatomic molecular systems
Authors: Ohta Yasuhito , Ohta Koji , Kinugawa Kenichi
Published: December 2003

An ab initio centroid molecular dynamics (CMD) method is developed by combining the CMD method with the ab initio molecular orbital method. The ab initio CMD method is applied to vibrational dynamics of diatomic molecules, H2 and HF. For the H2 molecule, the temperature dependence of the peak frequency of the vibrational spectral density is investigated. The results are compared with those obtained by the ab initio classical molecular dynamics method and exact quantum mechanical treatment. It is shown that the vibrational frequency obtained from the ab initio CMD approaches the exact first excitation frequency as the temperature lowers. For the HF molecule, the position autocorrelation function is also analyzed in detail. The present CMD method is shown to well reproduce the exact quantum result for the information on the vibrational properties of the system.
Quantum stochastic equation for a test particle interacting with a dilute Bose gas
Authors: Pechen A. N.
Published: December 2003

We use the stochastic limit method to study long time quantum dynamics of a test particle interacting with a dilute Bose gas. The case of arbitrary form factors and an arbitrary, not necessarily equilibrium, quasifree low density state of the Bose gas is considered. Starting from microscopic dynamics we derive in the low density limit a quantum white noise equation for the evolution operator. This equation is equivalent to a quantum stochastic equation driven by a quantum Poisson process with intensity S−1, where S is a one-particle S matrix. The novelty of our approach is that the equations are derived directly in terms of correlators, without use of a Fock–anti-Fock (or Gel’fand–Naimark–Segal) representation. Advantages of our approach are the simplicity of derivation of the limiting equation and that the algebra of the master fields and the Ito table do not depend on the initial state of the Bose gas. The notion of a causal state is introduced. We construct master fields (white noise and number operators) describing the dynamics in the low density limit and prove the convergence of chronological (causal) correlators of the field operators to correlators of the master fields in the causal state.
Lattice approximations and continuum limits of φ24-quantum fields
Authors: Albeverio Sergio , Bernabei Maria Simonetta , Zhou Xian Yin
Published: December 2003

Lattice φ24-quantum field models with different lattice cutoffs in the free and interacting parts are constructed and their continuum limits are studied. A comparision with previously constructed continuum limits is given, in the spirit of a discussion on how limit models depend on chosen regularizations.
Laser-plasma diamagnetism in the presence of an ambient magnetized plasma
Authors: VanZeeland M. , Gekelman W.
Published: December 2003

This work is an experimental study of the diamagnetic cavity created by a dense laser-produced plasma (initially, nlpp/n0≫1) expanding into an ambient magnetized background plasma (n0=2×1012 cm−3) capable of supporting Alfvén waves. The experiments are carried out on the upgraded Large Plasma Device [W. Gekelman, H. Pfister, Z. Lucky, J. Bamber, D. Leneman, and J. Maggs, Rev. Sci. Instrum. 62, 2875 (1991)] at UCLA. Two-dimensional data of both the diamagnetic cavity as well as visible light emission are presented and found to be rich in structure with spatially similar characteristics. Laser-plasma diamagnetism has been observed to be relatively unaffected by the presence of a background plasma for nlpp/n0≈10 at time of peak diamagnetism.
Dissipative Schrödinger–Poisson systems
Authors: Baro M. , Kaiser H.-Chr. , Neidhardt H. , Rehberg J.
Published: December 2003

We deal with a stationary, dissipative Schrödinger–Poisson system which allows for a current flow through an open, spatially one-dimensional quantum system determined by a dissipative Schrödinger operator. This dissipative Schrödinger operator can be regarded as a pseudo-Hamiltonian of the corresponding open quantum system. The (self-adjoint) dilation of the dissipative operator serves as a quasi-Hamiltonian of the system which is used to define physical quantities such as density and current for the open quantum system. The thus defined charge density in its dependence on the electrostatic potential is the nonlinear term in Poisson’s equation. We prove that the dissipative Schrödinger–Poisson system always admits a solution and all solutions are included in a ball the radius of which depends only on the data of the problem.
Molecular dynamic simulations of atom–cluster collision processes
Authors: Napari Ismo , Vehkamäki Hanna , Laasonen Kari
Published: December 2003

Monomer–cluster collisions of Lennard-Jones argon atoms have been studied using molecular dynamics simulation for target cluster sizes of 2, 3, 4, 5, 10, and 20 atoms. Capture probability of monomers by clusters and the lifetimes of the resulting clusters have been calculated as a function of impact parameter and the total energy of the target cluster. Cluster lifetime is further integrated over all impact parameters to obtain the average lifetime for each cluster size and energy. The average lifetime of the smallest aggregates is shown to be short compared to the collision time between monomers and clusters unless the vapor is highly supersaturated. The formation probability of a new cluster decreases steeply if a minimum lifetime is required for the cluster.
On the relation between the frequency of oscillation of a virtual cathode and injected current in one-dimensional grounded drift space
Authors: Kumar Raghwendra , Puri R. R. , Biswas D.
Published: December 2003

The relationship between the injected current density j0 and the dominant fundamental oscillation frequency f of a virtual cathode in a one-dimensional grounded infinite planar drift space of length L is determined numerically. If the electrons, each of mass me and charge e, are injected with velocity v0, it is found that for |j0|≫mev03/18π|e|L2, f∼|j0| which is in contrast to the relation f∼|j0| reported by earlier workers.
Reverse Monte Carlo simulations, Raman scattering, and thermal studies of an amorphous Ge30Se70 alloy produced by mechanical alloying
Authors: Machado K. D. , de Lima J. C. , Campos C. E. M. , Grandi T. A. , Pizani P. S.
Published: December 2003

The short- and intermediate-range orders of an amorphous Ge30Se70 alloy produced by mechanical alloying were studied by reverse Monte Carlo simulations of its x-ray total structure factor, Raman scattering, and differential scanning calorimetry. The simulations were used to compute the GGe-GeRMC(r), GGe-SeRMC(r), and GSe-SeRMC(r) partial distribution functions and the SGe-GeRMC(K), SGe-SeRMC(K), and SSe-SeRMC(K) partial structure factors. We calculated the coordination numbers and interatomic distances for the first and second neighbors and the bond-angle distribution functions Θijl(cos θ). The data obtained indicate that the structure of the alloy has important differences when compared to alloys prepared by other techniques. There are a high number of Se-Se pairs in the first shell, and some of the tetrahedral units formed seemed to be connected by Se-Se bridges.
Electromagnetic fields around silver nanoparticles and dimers
Authors: Hao Encai , Schatz George C.
Published: December 2003

We use the discrete dipole approximation to investigate the electromagnetic fields induced by optical excitation of localized surface plasmon resonances of silver nanoparticles, including monomers and dimers, with emphasis on what size, shape, and arrangement leads to the largest local electric field (E-field) enhancement near the particle surfaces. The results are used to determine what conditions are most favorable for producing enhancements large enough to observe single molecule surface enhanced Raman spectroscopy. Most of the calculations refer to triangular prisms, which exhibit distinct dipole and quadrupole resonances that can easily be controlled by varying particle size. In addition, for the dimer calculations we study the influence of dimer separation and orientation, especially for dimers that are separated by a few nanometers. We find that the largest |E|2 values for dimers are about a factor of 10 larger than those for all the monomers examined. For all particles and particle orientations, the plasmon resonances which lead to the largest E-fields are those with the longest wavelength dipolar excitation. The spacing of the particles in the dimer plays a crucial role, and we find that the spacing needed to achieve a given |E|2 is proportional to nanoparticle size for particles below 100 nm in size. Particle shape and curvature are of lesser importance, with a head to tail configuration of two triangles giving enhanced fields comparable to head to head, or rounded head to tail. The largest |E|2 values we have calculated for spacings of 2 nm or more is ∼105.
Static light scattering from microgel particles: Model of variable dielectric permittivity
Authors: Fernández-Nieves A. , de las Nieves F. J. , Fernández-Barbero A.
Published: December 2003

We perform static light scattering experiments on a dilute suspension of microgel particles and model the resultant form factors P(q) by assuming an exponentially decaying dielectric permittivity. The result is that P(q) is a Lorentzian function of the scattering wavevector q for length scales greater than the particle size; the width approximately corresponding to twice the particle radius. This simple model reasonably accounts for scattered light from both swollen and shrunken microgel phases.
On the Pauli operator for the Aharonov–Bohm effect with two solenoids
Authors: Geyler V. A. , Št’ovı́ček P.
Published: December 2003

We consider a spin-1/2 charged particle in the plane under the influence of two idealized Aharonov–Bohm fluxes. We show that the Pauli operator as a differential operator is defined by appropriate boundary conditions at the two vortices. Further we explicitly construct a basis in the deficiency subspaces of the symmetric operator obtained by restricting the domain to functions with supports separated from the vortices. This construction makes it possible to apply the Krein’s formula to the Pauli operator.