bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol use before and during pregnancy: a population‐based study
Authors: ALVIK ASTRID , HEYERDAHL SONJA , HALDORSEN TOR , LINDEMANN ROLF
Published: December 2009

Background. Few population‐based studies have estimated alcohol consumption and binge drinking before and during pregnancy. Methods. The study is a longitudinal questionnaire study. In Norway, virtually 100% attend an ultrasound screening at 17–18 weeks of pregnancy. In Oslo, a representative sample attending this between June 2000 and May 2001 were invited to join the study, accepted by 92%. Non‐Norwegian‐speaking and/or immigrants from non‐Western countries were not invited; 1,749 (93%) completed the first questionnaire. Measures: T‐ACE (screening for pregnancy risk drinking), frequency of alcohol use, Standard Units (SU) per occasion, SU/week, and binge drinking (≥5 SU per occasion). Binary logistic regression analyses, Student's t‐test and Pearson's chi square were used. Results. Alcohol use was reported by 89% pre‐pregnancy and by 23% after pregnancy week 12. Binge drinking was reported by 59% pre‐pregnancy and by 25% during weeks 0–6. Change of drinking pattern occurred at pregnancy recognition for 85%, although 78% had planned the pregnancy, fetal welfare being the main reason. Participants reporting alcohol use during pregnancy were older, smokers, with more SU/week pre‐pregnancy, had some elevated anxiety score, higher income, and a partner with higher education. However, mental health, high income, or education were not predictive of usually drinking 1 SU per occasion or more, and not of binge drinking. The latter was predicted mainly by smoking during pregnancy and being T‐ACE positive. Conclusions. The study shows a drinking pattern before pregnancy recognition that, according to other studies, in 25% or more may cause suboptimal fetal development.
Maternal cerebral Doppler velocimetry before, during, and after a normal pregnancy: a longitudinal study
Authors: LINDQVIST PELLE G. , MARŠÁL KAREL , PIRHONEN JOUKO P.
Published: December 2009

Objective. Our purpose was to determine normative data for maternal cerebral blood flow indices. Study design. A prospective longitudinal study. Methods. The maternal middle cerebral artery was examined by transcranial Doppler ultrasound in 14 healthy women before (0–10 months prior to conception) and during pregnancy (at 8, 15, 22, 29, and 36 weeks of gestation), and twice after delivery (at 8 and 24 weeks). Middle cerebral artery blood flow velocities were recorded, and pulsatility index and cerebral perfusion pressure were calculated. Results and conclusion. Pulsatility index of middle cerebral artery peaked in mid‐pregnancy and was constantly increased between 8 and 29 weeks of gestation. The diastolic middle cerebral artery velocity remained fairly constant at about 40 cm/s during the study period, while the systolic velocity peaked at 15 weeks (mean 102 cm/s). Cerebral perfusion pressure dropped to its lowest levels in mid‐pregnancy and after delivery.
Practices and perceptions on intrauterine contraception among Latvian obstetrician–gynecologists
Authors: Viberga Ilze , Odlind Viveca , Zodzika Jana
Published: December 2009

Background. To investigate the professional activity and perceptions of intrauterine contraception among Latvian obstetrician–gynecologists. Methods. A questionnaire was completed by 122 Latvian obstetrician–gynecologists attending an annual meeting. Statistical analysis was done with the Epi‐Info 2002 statistical package. Results. Every day contraceptive consultancy was done by 91.8% of physicians and 98.4% reported ever having inserted intrauterine contraception. The majority of doctors reported careful selection of intrauterine contraception candidates, including screening for sexually transmitted infections before insertion. Intrauterine contraception insertion was definitely excluded in women without a stable monogamous relationship only by 9.8%. A causal relationship between intrauterine contraception and pelvic inflammatory disease was believed by 52.5%. Many doctors sometimes prescribed prophylactic antibiotics before or immediately after intrauterine contraception insertion. However, antibiotics were never prescribed before intrauterine contraception insertion by 50.8%. Younger doctors had significantly more often themselves used combined oral contraceptives than had older doctors, whereas older doctors more often had been intrauterine contraception users. Of current and former intrauterine contraception users, 93.4% were satisfied with this contraceptive method. Conclusions. Latvian obstetrician–gynecologists have wide experience in contraception counseling of intrauterine contraception, but some gaps in the theoretical knowledge of doctors about intrauterine contraception were identified. We could not find any significant differences in attitudes to and personal experience with contraceptive methods between older and younger generations, nor were there any differences between genders of obstetrician–gynecologists.
Audit of severe maternal morbidity in Uganda – implications for quality of obstetric care
Authors: Okong Pius , Byamugisha Josaphat , Mirembe Florence , Byaruhanga Romano , Bergstrom Staffan
Published: December 2009

Background. For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. Methods. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Results. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. Conclusions. A systemic analysis found substandard care and records, and patient‐related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non‐threatening stimulus for improving the quality of obstetric care.
A narrow pelvic outlet increases the risk for emergency cesarean section
Authors: Stålberg Karin , Bodestedt Åke , Lyrenås Sven , Axelsson Ove
Published: December 2009

Background. The rate of cesarean section (CS) is increasing in Sweden as well as in most of the industrialized world. One of the most common indications for emergency CS is protracted labor. To what extent fetal pelvic disproportion is a cause of protracted labor is unclear. The value of pelvimetry has been questioned. The purpose of this study was to investigate whether women delivered with emergency CS because of protracted labor had a narrower pelvis than women delivered vaginally did.

Methods. Thirty women delivered with CS because of protracted labor comprised the study group. Thirty women vaginally delivered served as controls. The two groups were matched for gestational age, birth weight, and parity. The study group and the control group underwent an X‐ray pelvimetry within 1 month of delivery.

Results. The study group and the control group did not differ in maternal age or body mass index. The mean birth weight was 3914 g in the study group and 3884 g in the control group. The mean pelvic outlet was 328 mm in the study group and 346 mm in the control group (P=0.0024). The mean pelvic inlet was 245 mm in the study group and 255 mm in the control group (P=0.0038).

Conclusion. A narrow pelvic outlet is associated with an increased risk of emergency CS because of protracted labor. A postpartum pelvimetry is recommended and should be used when to decide on route of delivery in forthcoming pregnancies.
Are there second thoughts about the results of the WHI study?
Authors: HAIMOV‐KOCHMAN RONIT , HOCHNER‐CELNIKIER DRORITH
Published: December 2009

The publication of the Women's Health Initiative (WHI) study had significant impact on the attitude of physicians and patients towards the use of hormones in the menopause. It has been estimated that 40–83% of patients using hormones ceased treatment on their own initiative following publication of the WHI results. While in the pre‐WHI period, use of hormones in the menopause was termed ‘hormone‐replacement therapy’ (HRT) with an emphasis on replacement; ‘HRT’ has now been replaced with the term ‘hormone therapy’ (HT), focusing on the therapy's status as a treatment with defined risks and benefits. Following the publication of the WHI study, many caregivers concluded that HT had absolutely no role in clinical practice. However, the decision to begin HT for the symptomatic, healthy, newly postmenopausal woman should be based on whether the WHI study addresses all the issues that must be taken into consideration before initiation of HT, whether there are effective alternatives available to relieve climacteric symptoms, and also whether HT is better able to prevent cardiovascular disease (CVD) and Alzheimer's disease (AD) than to halt atherosclerotic lesions. Every postmenopausal woman should have an individual risk‐benefit evaluation to determine whether HT suits her needs. Until the effectiveness of HT for primary prevention of CVD and AD is established or disproved, there is no justification for HT use in the asymptomatic postmenopausal woman. However, symptomatic newly menopausal women might experience relief of their climacteric symptoms following HT use without exposing themselves to unreasonable risks.
A prospective, randomized trial comparing immediate versus delayed catheter removal following hysterectomy
Authors: Alessandri Franco , Mistrangelo Emanuela , Lijoi Davide , Ferrero Simone , Ragni Nicola
Published: December 2009

Background. A prospective, randomized study was used to assess whether the immediate removal of an in‐dwelling catheter after hysterectomy affects the rate of recatheterization, symptomatic urinary tract infections, time of ambulation, and hospital stay.

Methods. We randomly assigned 96 women who underwent hysterectomy [44 vaginal hysterectomy (VH), 37 abdominal hysterectomy, and 15 laparoscopic assisted VH) to three groups. The in‐dwelling catheter was removed immediately (group A), at 6 hr (group B), or at 12 hr (group C) after the operation. The association between clinical variables and the length of catheterization was assessed by Chi‐square analysis.

Results. Recatheterization occurred in six patients (18.8%) of group A, all after VH under spinal anesthesia. All patients in the groups B and C could spontaneously void the bladder after catheter removal. Symptomatic urinary tract infection occurred in one patient in group A, compared with four patients in group B, and five in group C. The mean time to ambulation was 4.3 hr in group A, 6.5 hr in group B, and 9.4 hr in group C. Patients with immediate removal of urinary catheter had a shorter hospital stay.

Conclusions. There could be an association between necessity of recatheterization and the type of surgery (VH) or the type of anesthesia (spinal). Despite recatheterization rate, early removal of in‐dwelling catheters immediately after uncomplicated hysterectomy seems to decrease first ambulation time and hospital stay.
Perforated appendicitis during near‐term pregnancy causing necrotizing fasciitis of the lower extremity: a rare complication of a common disease
Authors: Penninga Luit , Wettergren André
Published: December 2009

A 33‐year‐old woman presented with pain in the right side of the abdomen at 35 weeks of gestation. She was treated for cystitis. A few days later, her abdominal pain had disappeared; however, she had developed pain in the right thigh and fever. She delivered a healthy child, but postpartum her leg symptoms deteriorated. She was found to have a necrotizing fasciitis, which necessitated disarticulation of the hip. The source of the infection was a perforated appendix.
Colpoperineoplasty in women with a sensation of a wide vagina
Authors: Pardo Jack S. , Solà Vicente D. , Ricci Paolo A. , Guiloff Enrique F. , Freundlich Odette K.
Published: December 2009

Background. In women complaining of a wide vagina and decreased sexual satisfaction we performed colporrhaphy – including perineoplasty in most cases. Methods. Between November 2003 and October 2004, a total of 53 patients were selected for operation at the Urogynecology and Vaginal Surgery Unit, Las Condes Clinic, Chile. The patients were requested to assess the results of surgery in terms of experienced vaginal tightening and regained or enhanced sexual satisfaction. Results. Six months after surgery, 94% experienced a tighter vagina and said they were able to achieve orgasm. Expectations were fulfilled in 74%, partially fulfilled in 21%, and not met in 5%. Only two patients (4%) regretted surgery, and two patients had minor surgical complications. Conclusion. In a selected group of women with acquired sensation of a wide vagina, colporrhaphy seems to improve symptoms and enhance sexual gratification in a majority of the women. A controlled trial with a longer follow‐up is needed for a proper evaluation.
Women's preference on mode of delivery in Southern Italy
Authors: Mancuso Alfredo , De Vivo Antonio , Fanara Giusi , Settineri Salvatore , Triolo Onofrio , Giacobbe Annamaria
Published: December 2009

Background. Rates of cesarean section are rising worldwide and maternal requests for this kind of delivery contribute to the increase in this trend. The purpose of this study was to analyze the factors influencing maternal demand in our region and the profile of women preferring this mode of delivery. Methods. Six obstetricians (3 male and 3 female) were asked to give out a questionnaire to their patients with an uncomplicated pregnancy. Demographic data, obstetrical history, lifestyle, and physician–patient relationship were analyzed. Patients who would have preferred abdominal delivery were asked to report the motivations for their choice. A psychiatric evaluation, using the Hamilton Anxiety Scale and the Montgomery–Åsberg Depression Rating Scale, was conducted. Results. 16.9% of 390 patients enrolled preferred cesarean section. This wish was correlated with patients’ age ≥ 35 years (OR 2.43; p=0.0065), high level of education (OR 4.28, p=0.019), previous infertility (OR 3.91, p=0.0045), smoking (OR 4.25, p=0.0008), quality of information (OR 29.08, p=0.0013), and desire for more comprehension (OR 8.25, p=0.00001). The most frequent motivation for this choice was a safer childbirth (90.9%). No difference was found for the Hamilton scale's score, while the Montgomery‐Asberg Scale showed a lower mean score for the cesarean section group (7.2±3.3 versus 9.4±7.3, p=0.0002). Conclusions. A high rate of women wish to give birth by cesarean section. This is probably an expression of the changes in society's attitudes. However, more careful attention to the psychological aspects and more personalized information about pregnancy and delivery could reduce this maternal demand.
Severe anemia in pregnancy in rural Ghana: a case–control study of causes and management
Authors: GEELHOED DIEDERIKE , AGADZI FLORENCE , VISSER LUCIA , ABLORDEPPEY EMELIA , ASARE KOFI , O'Rourke Peter , VAN LEEUWEN JULES SCHAGEN , VAN ROOSMALEN JOS
Published: December 2009

Background. Various factors contribute to severe anemia in pregnancy in low‐income countries. This study assesses which of these are of importance in rural Ghana, and evaluates management.

Methods. Prospective case–control study in two (sub)district hospitals in rural Ghana among 175 severely anemic pregnant women (Hb < 8.0 g/dl), receiving a comprehensive treatment package; and 152 non‐anemic pregnant women (Hb ≥ 10.9 g/dl), giving birth at the study hospitals, matched for age and parity. Evaluated characteristics were need for treatment for urinary tract infection and schistosomiasis; sickle cell and HIV status; antenatal care characteristics; and Hb increase after treatment. Statistical analysis included Chi square test and general linear modeling.

Results. Associated with severe anemia were multiple pregnancy (OR 8.9; 95%CI 1.1–71.0), urinary tract infection (OR 6.2; 95%CI 3.5–11.0), residence outside study (sub)district (OR 2.7; 95%CI 1.7–4.3), body mass index < 20.0 (OR 2.0; 95%CI 1.2–3.4), and less than 4 antenatal clinic visits (OR 1.9; 95%CI 1.2–3.0). No association was found with sickle cell or HIV status, schistosomiasis treatment, blood loss in pregnancy, or gestational age at antenatal care registration. After treatment, mean Hb in the severe anemia group increased by 3.2 g/dl, significantly more than in the control group (0.2 g/dl; p<0.001). Modeling showed that the number of antenatal visits and the lowest Hb together explained approximately 25% of the variability in Hb prior to childbirth among women with severe anemia.

Conclusions. Treatable causes contribute considerably to severe anemia in pregnancy in low‐income countries. Even with limited resources, a substantial increase of Hb can be achieved.
Geographical variation in relationships between parental body size and offspring phenotype at birth
Authors: Leary Sam , Fall Caroline , Osmond Clive , Lovel Hermione , Campbell Doris , Eriksson Johan , Forrester Terrence , Godfrey Keith , Hill Jacqui , Jie Mi , Law Catherine , Newby Rachel , Robinson Sian , Yajnik Chittaranjan
Published: December 2009

Background. Size and body proportions at birth are partly determined by maternal body composition, but most studies of mother–baby relationships have only considered the effects of maternal height and weight on offspring birth weight, and few have examined the size of effects. Paternal size and body composition also play a role, primarily through the fetal genome, although few studies have investigated relationships with neonatal phenotype. Methods. Data from the UK, Finland, India, Sri Lanka, China, DR Congo, Nigeria and Jamaica were used to investigate the effects of maternal measures (derived at 30 weeks’ gestation, n=16,418), and also paternal size (n=3,733) on neonatal phenotype, for singleton, live‐born, term births. Results. After accounting for variation in maternal size and shape across populations, differences in neonatal phenotype were markedly reduced. Mother–baby relationships were similar across populations, although some were stronger in developing countries. Maternal height was generally the strongest predictor of neonatal length, maternal head circumference of neonatal head and maternal skinfold thickness of neonatal skinfolds. Relationships with maternal arm muscle area were generally weak. Effects of paternal height and body mass index were weaker than the equivalent maternal measurements in most studies. Conclusions. Differences in maternal body composition account for a large part of the geographical variation in neonatal phenotype. The size of the effects of all maternal measures on neonatal phenotype suggests that nutrition at every stage of the mother's life cycle may influence fetal growth. Further research is needed into father–baby relationships and the genetic mechanisms that influence fetal growth.
Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil
Authors: Vieira Cunha Rudge Marilza , Nagib Atallah Álvaro , Carlos Peraçoli José , da Rocha Tristão Andréa , Mendonça Neto Moisés
Published: December 2009

Background. There is a need to assess the effects of different antibiotic administration models on infectious complications among women from low‐income populations who undergo cesarean delivery, and the cost benefit. Design. Randomized, blinded controlled clinical trial study of a single preoperative dose of cephalothin, versus a postcesarean scheme for infection prophylaxis, versus no antibiotics. Methods. The setting was a tertiary Brazilian center with 1,500 deliveries annually. Pregnant women (n=600) with an indication for emergency or elective cesarean section were randomly allocated consecutively to one of three groups and treated as follows: Group 1 (n=200), no antibiotics; Group 2 (n=200), the standard antibiotics scheme followed at this center; Group 3 (n=200), a single dose of intravenous cephalothin 2 g, intraoperatively. Main outcome measurements. Prevalences of wound infection, puerperal and postcesarean infections, and costs of antibiotics used. Results. Antibiotics reduced the incidence of puerperal infection, but did not change the percentages of wound and postcesarean infections and no use of antibiotics increased the puerperal infection risk sixfold. Cephalothin reduced the relative risk of puerperal infection by 89% (95% confidence interval: 7–87%). Penicillin reduced it by 78%, but this was not statistically significant. No deaths occurred. The costs of the two schemes were similar (almost US$1.00). Conclusions. Prophylactic cephalothin use was associated with decreased postcesarean puerperal infection and presented a cost benefit.
Apoptotic and morphological features of the umbilical artery endothelium in mild and severe pre‐eclampsia
Authors: Yuluğ Esin , Yenilmez Engin , Unsal Mesut A. , Aydin Sevim , Tekelioglu Yavuz , Arvas Haluk
Published: December 2009

Background. The pathology of the umbilical arterial endothelium in normal pregnancy and in pregnancy complicated with pre‐eclampsia remains unclear. In this study the changes that occur in the umbilical artery endothelial cells were examined and endothelial cell morphology and apoptosis were compared among control, mild, and severe pre‐eclamptic subjects. Methods. Umbilical cords with a gestational age of between 35 and 40 weeks were collected from women with normal pregnancies (n=17), mild pre‐eclampsia (n=10), and severe pre‐eclampsia (n=12). We studied the umbilical artery endothelial cells using flow cytometry, and light and electron microscopy. Apoptosis was measured using flow cytometry and the terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling technique. The Kruskall–Wallis variance analysis and Mann–Whitney U‐tests as post hoc were applied. Results. In mild pre‐eclamptics, the endothelial cells appeared ultrastructurally separated. A dilated endoplasmic reticulum, swollen mitochondria, and vanished mitochondrial cristae were observed. In severe pre‐eclamptics, the cells were disorganized, highly contracted and vacuolated, separated from each other, and protruding prominently into the lumen. The percentages of endothelial cells that underwent apoptosis in mild (p<0.017) and severe pre‐eclamptics (p<0.017) were higher than those in the controls. These apoptosis values were highest in severe pre‐eclamptics (p<0.0001). Conclusion. Apoptosis and structural disruptions in the arterial endothelium of severe pre‐eclamptics were prominent in all subjects. Increased endothelial apoptosis and structural disruptions are clinically related to intensity of pre‐eclampsia, and may be associated with adaptation of the endothelial cells to pre‐eclampsia.
Birth outcomes in adolescent pregnancy in an area with intense malaria transmission in Tanzania
Authors: Uddenfeldt Wort Ulrika , Warsame Marian , Brabin Bernard J.
Published: December 2009

Background. Although the effects of malaria for the mother and young baby are well described in developing countries, there is very little data on the consequences for adolescent pregnancies. This paper analyses birth outcome in adolescent pregnancy in an area of Tanzania with intense malaria transmission. Methods. A cross‐sectional descriptive analysis of 528 adolescents and 1,156 adults, malaria prevalence, and birth weight outcomes for women delivering in Kilosa Hospital between June 2001 and October 2002. Results. This area has high malaria transmissions with some seasonality. Adolescent primigravidae had higher parasite prevalence than adolescent secundigravidae (41.3% versus 28.1%, p>0.05), and than adult primigravidae (41.3% versus 31.5%, p=0.007). Low birth weight prevalence was highest among adolescents delivering during the malaria season (odds ratio 1.7, 95% CI 1.1–2.6, p=0.02), and was double that of adult primigravidae (31.5% versus 15.9%, p=0.021). The prevalence of parasitemia (p=0.003) and low birth weight (p=0.033) declined with increasing age amongst adolescent primigravidae. Adjusted logistic regression showed a 1.4‐fold increased risk of low birth weight amongst adolescents (95% CI, 0.98–1.96). Conclusions. Failure to prioritize adolescent malaria will seriously limit the success of malaria control programs in pregnancy.
Adverse maternal and neonatal outcome of prolonged course of magnesium sulfate tocolysis
Authors: Nassar Anwar H. , Sakhel Khaled , Maarouf Hoda , Naassan Georges R. , Usta Ihab M.
Published: December 2009

Background. Magnesium sulfate continues to be widely used as a tocolytic agent despite a paucity of evidence supporting its use. Many practitioners use prolonged courses of magnesium sulfate, sometimes for months. This study was conducted to determine maternal and neonatal outcome of patients exposed to prolonged tocolytic magnesium sulfate. Methods. A retrospective review of maternal and neonatal charts (1995–2003) of pregnancies that received tocolytic magnesium sulfate. Cases who received magnesium sulfate >48 h (n=78) were compared to controls who received it ≤48 h (n=77) for maternal side effects and neonatal outcome. Results. Cases were more likely to be nulliparous (55.1% versus 37.7%, p=0.044), multiple gestations (33.3% versus 10.4%, p=0.001), and of lower gestational age (29.0±3.9 versus 30.5±3.8 weeks, p=0.017) compared to controls. The median magnesium sulfate infused was 154 (78–5,500) versus 54 (8–86) g (p<0.001) and the highest maternal magnesium level was 6.5±1.7 versus 5.6±1.9 mg/dl (p=0.002) in cases and controls, respectively. Cases were more likely to have ≥1 adverse side effect (30.8% versus 15.6%, p=0.045). The median neonatal magnesium level was significantly higher in cases (3.3 (1.4–7.2) versus 2.6 (1.1–5.2) mg/dl, p=0.016); however, neonatal mortality and other neonatal morbidity rates were similar in both groups. Abnormal bone mineralization was encountered in 3 neonates (cases). Conclusions. Maternal morbidity rate is higher with prolonged intake of tocolytic magnesium sulfate compared to ≤48‐h regimen. Despite similar neonatal morbidity and mortality rates, bone demineralization in the neonates may be encountered.
Therapeutic group psychoeducation and relaxation in treating fear of childbirth
Authors: SAISTO TERHI , TOIVANEN RIIKKA , SALMELA‐ARO KATARIINA , HALMESMÄKI ERJA
Published: December 2009

Background. The increase in the numbers of women fearing childbirth and requesting cesarean sections call for new forms of antenatal treatment. Methods. Finnish nulliparous women experiencing severe fear of childbirth (experimental group, n = 102) attended 5 group sessions with a psychologist, once together with a midwife, during the third trimester. One session was held 3 months after the delivery. Each session consisted of a discussion of fear and feelings towards the impending birth and parenthood in a psychotherapeutic atmosphere and of relaxation exercises focused on an imaginary childbirth. The results were compared with those of 85 women treated for fear of childbirth by 2 appointments with an obstetrician (conventional treatment). Results. Before the sessions, among the women in the experimental group, scored fear of childbirth, on a scale of one to ten, was 6.9±2.0 (SD), which is similar to the score of those receiving conventional treatment (6.0±1.6). After the sessions, 84 women in the experimental group (82.4%) and 57 in the conventional treatment group (67.1%) chose to have a vaginal delivery (p = 0.02). The women in the experimental treatment group rated the helpfulness of the sessions 8.5±1.6 on a scale where 10 was maximum help and 1 no help at all, and mentioned “sharing their feelings” twice as often as “receiving information” as the most helpful factor in relieving fear. Conclusions. Group psychoeducation and relaxation exercises were well received and rated as very helpful. More cesarean section requests were withdrawn than in the comparison group and in previous studies.
Polycystic ovary syndrome and metformin in pregnancy
Authors: Lilja Anna E. , Mathiesen Elisabeth R.
Published: December 2009

The diagnostic criteria of polycystic ovary syndrome incorporate hyperandrogenism, polycystic ovaries, anovulation and irregular menstrual bleeding and the syndrome is a recognized reason behind infertility. The biguanide metformin has encouraging effects on several metabolic aspects of the syndrome, including insulin sensitivity, plasma glucose concentration and lipid profile. Moreover, metformin improves the ovarian function in women diagnosed with polycystic ovary syndrome. Hence, metformin is considered an agent for ovulation induction among these patients. However, even higher ovulation frequencies have been observed when metformin has been adjuvant to clomifene therapy. Metformin‐induced ovulation presumably brings about resumption of regular menstrual cycles and improved conception rates. Polycystic ovary syndrome patients are presumably more likely than healthy women to suffer from pregnancy‐related problems like early pregnancy loss, gestational diabetes mellitus and hypertensive states in pregnancy. Recent data suggest sparing effects of continued metformin therapy throughout pregnancy on early pregnancy loss and gestational diabetes mellitus, but its impact on hypertensive complications to pregnancy appears less evident. Instead, metformin might even induce pre‐eclampsia or exert no effect on blood pressure. Conclusion. So far, evidence for safety of continued therapy throughout gestation is insufficient, and existing papers are limited in design and might mask for fetal toxic outcomes due to metformin therapy. Prior to a recommendation of sustained metformin therapy throughout pregnancy, randomized placebo‐controlled double‐blinded clinical trials are awaited with interest, so that present assumptions on efficiency can be clarified, in order to assure efficient and safe management of pregnant polycystic ovary syndrome patients.
Latzko operation for vault vesicovaginal fistula
Authors: ANSQUER YAN , MELLIER GEORGE , SANTULLI PIETRO , BENNIS MALIKA , MANDELBROT LAURENT , MADELENAT PATRICK , CARBONNE BRUNO , MATHEVET PATRICE
Published: December 2009

Background. Various surgical procedures are currently performed for the treatment of posthysterectomy vesicovaginal fistula. Most of them are carried out via an abdominal incision. Objective. Report of our experience with Latzko's operation, a simple purely transvaginal procedure. Methods. Retrospective study of vesicovaginal fistulas treated by a Latzko procedure between June 1991 and June 2005. Results. Eleven patients were operated on. Two (18%) had a prior failed attempt of vesicovaginal fistula repair. Mean size of the fistulas was 12±11 mm (range: 2–40 mm). Mean operative duration was 62±33 min (range: 20–110 min). All fistulas healed. No intraoperative complications were observed. There was only one postoperative complication, a lower urinary tract infection in one patient. Mean hospital stay was 6±4 days (range: 2–12 days). Conclusions. The Latzko procedure is an efficient, safe, and simple technique for the management of vault vesicovaginal fistulas, and can therefore be proposed as the first‐line surgical treatment.
Personality and mode of delivery
Authors: WIKLUND INGELA , EDMAN GUNNAR , LARSSON CHRISTINA , ANDOLF ELLIKA
Published: December 2009

Background. Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning.

Method. Three hundred and twenty‐eight pregnant women from two different groups, “cesarean section on maternal request” (n = 84), and “vaginal delivery group” (n = 242) completed the self‐report inventory Karolinska Scales of Personality at 37–39 gestational weeks in pregnancy.

Results. A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p<0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p<0.003) and Socialization (p<0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale.

Conclusion. Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not.
Food for thought in women's health. The gynecologist: the new European gatekeeper in Chlamydia trachomatis infection
Authors: POLYZOS NIKOLAOS P. , VITTORAKI ANGELIKI , TSAPPI MARIA , MAURI DAVIDE , SPILIOPOULOU ANASTASIA , TZIORAS SPYROS , KAMPOSIORAS KONSTANTINOS , IOAKEIMIDOU ALIKI
Published: December 2009

Genital Chlamydia trachomatis infection is the principal cause of bacterial sexually transmitted disease in industrialized countries. A wide spectrum of pathologic conditions has been associated with the disease ranging from urethritis, cervicitis, to pelvic inflammatory disease, ectopic pregnancy, tubal infertility and cervical neoplasia.

Screening for genital Chlamydia infection may prevent its serious complications. The need of a comprehensive European screening policy has been recently underlined by PACMeR's scientific committee. Anyhow invitational screening programs are only at the beginning. Chlamydia trachomatis control “orphan” and women's health at risk.

Until organized programs are developed, implementation of opportunistic screening is mandatory. Since the infection is more commonly observed among juvenile females proper testing of the young women is recommended. As asymptomatic young women in reproductive age are more eager to visit gynaecologists for periodical gynaecological examination and councelling (cervical cytology, breast examination, contraception and family planning), gynaecologist represents the only specialist able to provide early diagnosis of Chlamydia trachomatis.

Gynaecologists are called to play a new role in public healthcare, being “gatekeepers” for the early detection of the disease, emphasizing their crucial part in young women's health.
Evaluation of stress urinary incontinence by computer‐aided vector‐based perineal ultrasound
Authors: CHEN HUEY‐YI , HUANG YU‐LEN , HUNG YAO‐CHING , CHEN WEN‐CHI
Published: December 2009

Background. In this study, we compared the differences in dynamic changes of the bladder neck between women with and without urodynamic stress incontinence by computer‐aided vector‐based perineal ultrasound.

Methods. The function and morphology of the lower urinary tract were assessed in 48 women with or without urodynamic stress incontinence by urodynamic study and computer‐aided vector‐based perineal ultrasound.

Results. Patients in the urodynamic stress incontinence group had a significantly higher parity and higher prevalence of funneling of the bladder neck than participants in the control group (p<0.05). After adjusting for parity, women with a corrected bladder neck movement ≥10 mm were 9.0 times more at risk of having urodynamic stress incontinence than women with a corrected bladder neck movement <10 mm (p < 0.05). If we used corrected bladder neck movement ≥10 mm as the cut‐off point for diagnosis of urodynamic stress incontinence, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 77.8%, 66.7%, 87.5%, 50%, and 75%, respectively.

Conclusions. The increase in corrected bladder neck movement is associated with functional impairment of urethral closure. Computer‐aided vector‐based perineal ultrasound is valuable in assessing anatomic change of the bladder neck, but it is not a sensitive tool for predicting urodynamic stress incontinence.
High risk of cervical pathology among women with postmenopausal bleeding and endometrium ≤4.4 mm: long‐term follow‐up results
Authors: EPSTEIN ELISABETH , JAMEI BABAK , LINDQVIST PELLE G.
Published: December 2009

Background. To determine the risk of endometrial and cervical pathology during long‐term follow‐up in women with postmenopausal bleeding and thin endometrium (≤4.4 mm), and to determine the incidence and significance of re‐bleeding. Methods. Retrospective study including all women (n = 332) with postmenopausal bleeding and thin endometrium examined at the Department of Obstetrics and Gynaecology at Malmö University Hospital from 1992 until 2002. Follow‐up was accomplished by searching the medical records, the local registry of cytology and pathology, and the regional cancer registry up to November 15, 2005. Results. At the first visit, cervical cancer was diagnosed in 1.5% (5/332) and endometrial cancer in 0.9% (3/332) of the women. During follow‐up, cervical cancer was detected in 2/313 (0.6%) of the women; no additional case of endometrial cancer was found. In the region, the expected incidence of cervical and endometrial cancer during follow‐up was 0.23 (standard incidence ratio [SIR], 8.7; 95% CI 1.1–31.4) and 1.34 (SIR, 0.0; 95% CI 0.0–2.7), respectively. Thirteen percent (41/313) of the women sought medical care because of re‐bleeding. Endometrial pathology was found in 16% (4/25) and cervical pathology in 11% (3/28) of these women. Conclusions. Cervical cancer was twice as common as endometrial cancer in women with postmenopausal bleeding and a thin endometrium. During follow‐up, the risk of endometrial cancer was as expected, whereas the risk of cervical cancer was higher than expected. The results support that the diagnostic focus should be directed at excluding cervical pathology and that repeated diagnostic procedures be performed in cases of re‐bleeding.
Self‐reported nicotine exposure and plasma levels of cotinine in early and late pregnancy
Authors: GEORGE LENA , GRANATH FREDRIK , JOHANSSON ANNA L.V. , CNATTINGIUS SVEN
Published: December 2009

Background. The accuracy of maternal self‐reported smoking information, especially exposure to environmental tobacco smoke, has been questioned. This study aimed to validate self‐reported smoking, smoking cessation, and environmental tobacco smoke exposure in early and late pregnancy, using the biomarker cotinine as the gold standard. Methods. Prospective cohort study of 953 pregnant Swedish women between 1996 and 1998. In‐person interviews and cotinine measurements were performed at 6–12 and 31–34 completed weeks of gestation. All women were asked about nicotine exposures throughout pregnancy, including cigarette smoking, oral snuff, nicotine replacement therapy, and environmental tobacco smoke exposure. Results. The validity of self‐reported daily smoking was high in early and late pregnancy. However, among women reporting smoking cessation before the first interview and between the first and second interviews, 13% and 25% misreported active smoking, respectively. According to cotinine measurements, 22% of non‐smoking women were exposed to environmental tobacco smoke in early pregnancy, and 8% were exposed in late pregnancy. Self‐reported information on environmental tobacco smoke exposure in early and late pregnancy misclassified most exposed women as unexposed. Conclusion. The results of this study indicate that self‐reported smoking information among pregnant women can be trusted. However, among women reporting smoking cessation during pregnancy, the misclassification rate increased with recency of quitting. Environmental tobacco smoke exposure was common among non‐smokers, and the low validity of self‐reported environmental tobacco smoke exposure suggests that future studies on environmental tobacco smoke exposure and risks of pregnancy outcomes may have to rely on biomarker assessments.
Impact of menopause on the manifestation and severity of sleep‐disordered breathing
Authors: ANTTALAINEN ULLA , SAARESRANTA TARJA , AITTOKALLIO JENNI , KALLEINEN NEA , VAHLBERG TERO , VIRTANEN IRINA , POLO OLLI
Published: December 2009

Background. Decreased production of female hormones might explain the increased prevalence of sleep‐disordered breathing in postmenopausal women. Objectives. We evaluated, whether menopause has an impact on the manifestation of sleep‐disordered breathing in terms of signs, symptoms, and breathing pattern. Methods. The study was a cross‐sectional study utilizing a patient database, hospital records, sleep studies, and questionnaires. The hospital records and sleep studies were reviewed in 601 consecutive women studied between 1994 and 1998 in a university hospital pulmonary clinic. The records were completed with questionnaires. Results. Nocturnal breathing abnormalities covered a greater proportion of the night in postmenopausal than in premenopausal women (68.1% versus 35.8% of time in bed, p<0.0001), and the prevalence of sleep‐disordered breathing tended to be higher (86.2% versus 79.4% of time in bed, p = 0.057). The body mass indices and the major symptoms of sleep‐disordered breathing were similar in pre‐ and postmenopausal women. Postmenopausal women had less nasal congestion (p<0.001) than premenopausal ones. Body mass index was a significant explanatory factor of daytime sleepiness. Conclusions. Post‐ and premenopausal women present with similar signs and symptoms when referred to sleep studies. However, sleep‐disordered breathing is more severe in postmenopausal than in premenopausal women.
Is sonographic assessment of cervical length better than digital examination in screening for preterm delivery in a low‐risk population?
Authors: MATIJEVIC RATKO , GRGIC OZREN , VASILJ OLIVER
Published: December 2009

Background. This randomized controlled trial compared the diagnostic accuracy of the sonographic assessment of cervical length and clinical digital examination of the cervix in the second trimester regarding the prediction of preterm delivery in a low‐risk population. Methods. In total, 282 unselected, asymptomatic women with singleton pregnancy randomly underwent sonographic cervical length measurement (study group, n = 138) or clinical digital examination (control group, n = 144) in the second trimester. In the study group cervical length ≤5th percentile (≤24 mm) for our population was defined as shortened. In the control group, Bishop score ≥95th percentile (≥4) for our population was defined as high. The primary outcome measure was the diagnostic accuracy of both tests regarding the prediction of preterm delivery (<37 weeks). Results. Shortened cervical length was found in 6/138 (4.3%) women whereas the high Bishop score was found in 17/144 (11.8%) (p = 0.038, Fisher's exact test). The incidence of preterm delivery was 5.7% (16/282). Regarding the prediction of preterm delivery, shortened cervical length and high Bishop score had sensitivity 57.1% versus 33.3% and positive predictive value 66.7% versus 17.6%. Shortened cervical length in comparison with high Bishop score had 12‐fold higher positive likelihood ratio for preterm delivery in a low‐risk population (37.4; 95%CI [8.2–170.7] versus 3.2; 95%CI [1.1–9.2]). Conclusion. Sonographic assessment of cervical length has better diagnostic accuracy in the prediction of preterm delivery compared to digital examination in a low‐risk population.
Follow‐up after incomplete hysteroscopic removal of uterine fibroids
Authors: VAN DONGEN HELEEN , HANS EMANUEL MARK , SMEETS MADDY J. , TRIMBOS BAPTIST , WILLEM JANSEN FRANK
Published: December 2009

Background. In this observational study, we analysed whether a period of wait and see was reasonable following incomplete removal of submucous fibroids, with regard to symptoms of abnormal uterine bleeding, and whether factors predicting subsequent surgery could be identified. Methods. In 3 affiliated hospitals, patients with incomplete removal of submucous fibroids, treated with hysteroscopic myomectomy for abnormal uterine bleeding, between January 1997 and January 2005, were followed over time. Using life‐table analysis (Kaplan‐Meier method), the cumulative proportion of women having surgery‐free survival following incomplete removal of submucous fibroids was calculated. Cox‐proportional hazard analyses were used to analyse relationships of variables with recurrence of symptoms. Results. Forty‐one consecutive patients met the inclusion criteria, and were followed over time. The mean age was 42.5 years (range 27–55). The majority of patients with incomplete removal of submucous fibroids were diagnosed with type 2 fibroids. Termination of the procedure before complete removal was achieved, was principally caused by reaching the maximum fluid deficit (90.2%). The surgery‐free percentages were 70.2% (95%‐CI: 55.3–85.1) at 1 year, 54.8% (95%‐CI: 38.1–70.7) at 2 years, and 44.2% (95%‐CI: 26.9–61.5) at 3 years. Size of fibroid (diameter) pre‐operatively turned out to be of statistically significant influence, with a hazard ratio of 1.762 (95%‐CI: 1.114–2.787) per cm increase in diameter (p = 0.016). Conclusions. The results indicate that incomplete removal does not always seem to necessitate subsequent surgery. Instead of subsequent surgery immediately post‐operatively, a wait and see policy is worth considering after incomplete removal.
Informed consent: providing information about prenatal examinations
Authors: DAHL KATJA , KESMODEL ULRIK , HVIDMAN LONE , OLESEN FREDE
Published: December 2009

Background. Choice in prenatal care has moved on from a paternalistic approach, to increased patient autonomy and informed decision‐making. This review summarises the existing literature on the information of pregnant women about prenatal examinations. The extent to which information about Down syndrome and screening tests empowers informed decision‐making are investigated, as are different ways of expressing a risk estimate. Results. Knowledge scores can be improved and decisional conflict reduced by group counselling, individual sessions, and by use of leaflets. None of the interventions leads to a raise in anxiety scores or influence uptake rates. Satisfaction with information provided was found unrelated to level of knowledge, but associated with having expectations for information met. Information on Down syndrome is missing (13–21%), or restricted (13%), limitations of screenings tests rarely mentioned, and written materials often insufficient. Women experience risk expressed as proportions or relative risk ratio significantly higher than percentage, number needed to treat, or absolute risk reduction. More women correctly understand relative risk reduction compared to absolute risk reduction and number needed to treat (60 versus 42 and 30%). Using medical words rather than lay terms significantly alter risk perception. Conclusions. Information can increase the level of knowledge and reduce decisional conflict, without raising anxiety scores. A clarification of the women's expectations seems paramount to obtain a perception of good information and informed consent. The information provided about Down syndrome and screening tests does not empower an informed consent based on relevant knowledge.