bluuebunny/crossref_metadata_2025 huggingface dataset:
Multifamily psychoeducation groups (MFPG) for families of children with bipolar disorder
Authors: Fristad Mary A , Goldberg‐Arnold Jill S , Gavazzi Stephen M
Published: March 2003

Objectives:
 Multi‐family psychoeducation groups (MFPG) have been developed and tested for adults, but not for children with bipolar disorder (BPD). We present data from a pilot study of our manual‐driven MFPG treatment for families of children with mood disorders and address two questions: Do families of children with BPD and families of children with major depressive disorder/dysthymic disorder (MDD/DD): 1) differ at treatment entry?; 2) benefit equally from intervention?

Method:
 A total of 35 children (n=16, BPD; n=19, MDD/DD) aged 8–11 years and their parents were randomized into immediate MFPG plus treatment as usual (TAU) or wait‐list + TAU and assessed periodically.

Results:
 At baseline, there was a trend toward parents in BPD families being more knowledgeable about mood symptoms than parents in MDD/DD families (p < 0.04). Additionally at baseline, children with BPD evidenced greater mood severity historically and a trend toward more hospitalizations, day treatment, outpatient treatment, medication trials, and placement in special education classrooms than children with MDD/DD. Immediately following and 4 months post‐treatment, both BPD and MDD/DD families described having gained knowledge, skills, support, and positive attitudes during treatment. MDD/DD families increased their knowledge of symptoms to the same level as BPD families.

Conclusions:
 While BPD families enter treatment with more impaired children and more extensive treatment histories, both BPD and MDD/DD families benefit from intervention. The clinical issues concerning combining families of children with bipolar and depressive spectrum illnesses in groups are discussed. Clinical impressions suggest that such combinations are clinically feasible and potentially beneficial.
Valproate, bipolar disorder and polycystic ovarian syndrome
Authors: McIntyre Roger S , Mancini Deborah A , McCann Sonia , Srinivasan Janaki , Kennedy Sidney H
Published: March 2003

Background:  Persons with bipolar disorder are often overweight and cluster risk factors for cardiovascular disease. Some antibipolar agents adversely impact upon weight and the lipid milieu. Recent data suggest that valproic acid, a commonly prescribed mood stabilizer, may be associated with polycystic ovarian syndrome (PCOS). This adverse event has not been systematically studied in bipolar disorder.

Method:  Thirty‐eight female subjects, aged 18–50 years, meeting DSM‐IV criteria for bipolar I or II disorder, in any phase of illness were evaluated. Eighteen females received valproate (sodium valproate and valproic acid) and 20 females received lithium. Patients completed questions regarding their menstrual, reproductive and medical histories. During the follicular phase they were assessed for weight, body mass index (BMI kg/m2), and changes in the reproductive endocrine milieu that included morning estradiol, progesterone, follicle‐stimulating hormone (FSH), luteinizing hormone (LH), sex‐hormone binding globulin (SHBG), androstenedione, dehydroepiandrosterone‐sulfate (DHEAS), testosterone, free testosterone, prolactin and thyroid‐stimulating hormone (TSH). The blood was also analyzed for fasting metabolic parameters which included total cholesterol (TC), high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), insulin, glycosylated hemoglobin (HbA1C), insulin‐like growth factor 1 (IGF‐1), insulin‐like growth factor binding‐protein 1 (IGFBP‐1), fasting blood glucose and morning leptin.

Results:  Nine (50%) of the valproate‐treated females had menstrual abnormalities versus three (15%) of the lithium‐treated females (p < 0.05). Valproate‐treated females had significantly higher levels of follicular phase androgen concentrations than lithium‐treated females (p < 0.05). Nine (50%) of females who were overweight (BMI ≥ 25 kg/m2) and with a history of menstrual irregularities also exhibited laboratory evidence of hyperandrogenism (p < 0.05). Persons receiving valproate exhibited significant increases in fasting biochemical parameters suggestive of an adverse metabolic syndrome (p < 0.05). Leptin levels were significantly elevated in the valproate‐treated females (p < 0.05).

Conclusions:  In this pilot, open‐label cross‐sectional study, valproate‐treated females exhibited higher rates of menstrual abnormalities and biochemical evidence of both hyperandrogenism and adverse metabolic parameters when compared with lithium‐treated females. These preliminary data suggest that valproate may, in some predisposed females, adversely impact upon the reproductive endocrine milieu and result in aspects of the metabolic syndrome (1).
Suicide risk in bipolar patients: the role of co‐morbid substance use disorders
Authors: Dalton E Jane , Cate‐Carter Tasha D , Mundo Emanuela , Parikh Sagar V , Kennedy James L
Published: March 2003

Objective:  Bipolar disorder is associated with a high frequency of both completed suicides and suicide attempts. The primary aim of this study was to identify clinical predictors of suicide attempts in subjects with bipolar disorder.

Methods:  We studied 336 subjects with a diagnosis of bipolar I, bipolar II, or schizoaffective disorder (bipolar type). The Structured Clinical Interview for DSM‐IV (SCID‐I) was administered and subsequently two expert psychiatrists established a diagnosis. Predictors of suicide attempts were examined in attempters and non‐attempters.

Results:  The lifetime rate of suicide attempts for the entire sample was 25.6%. A lifetime co‐morbid substance use disorder was a significant predictor of suicide attempts: bipolar subjects with co‐morbid substance use disorders (SUD) had a 39.5% lifetime rate of attempted suicide, while those without had a 23.8% rate (odds ratio=2.09, 95% CI=1.03–4.21, χ2=4.33, df=1, p=0.037).

Conclusions:  Lifetime co‐morbid SUD were associated with a higher rate of suicide attempts in patients with bipolar disorder. This relationship may have a genetic origin and/or be explained by severity of illness and trait impulsivity.
Long‐term therapy with lithium in a private practice clinic: a naturalistic study
Authors: Luby Elliot D , Singareddy Ravi Kumar
Published: March 2003

Objective:  To document the effectiveness and vicissitudes of treating 14 bipolar patients with lithium carbonate over a combined 300 years, and an average of 21 years/patient.

Methods:  Chart review of the narrative and laboratory studies of these 14 patients ranging in duration from 12 to 29 years.

Results:  Lithium stabilized these bipolar patients over these periods. Only three patients required hospitalization, one because lithium was slowly tapered at her request after 6 years of mood stability, another because of non‐compliance, and a third because of co‐morbid alcohol abuse. One patient attempted suicide after lithium was tapered off. However, in some patients, there were serious side‐effects necessitating lithium discontinuation.

Conclusions:  Controlled studies in psychopharmacology are obviously preferred to open‐label or naturalistic case studies. However, controlled studies are rarely conducted over long periods, and practice‐related naturalistic research can be of value, albeit anecdotal and without the use of structured rating scales. In this paper, we are reporting on 14 patients seen consistently by one psychiatrist. These patients were functional and productive at work and in family life. The patients suffered brief hypomanic or depressive episodes. Although several patients experienced serious side‐effects, lithium was continued with stable mood, while the side‐effects were managed in collaboration with other specialists.
Longitudinal distance standards of fetal growth
Authors: DI BATTISTA ELIANA , BERTINO ENRICO , BENSO LODOVICO , FABRIS CLAUDIO , AICARDI GIORGIO , PAGLIANO MARCO , BOSSI ANNA , DE BIASIO PIERANGELA , MILANI SILVANO ,   (Intrauterine and Infant Longitudinal Growth Study: IILGS)
Published: March 2003

Background. Most ultrasonographic fetal growth norms are derived from cross‐sectional data or from longitudinal data treated as coming from cross‐sectional studies, although only longitudinal models may detect particular aspects of fetal growth shape, such as peak of growth velocity.

Materials and methods. The sample included 238 singleton normal pregnancies. All the fetal traits under study (biparietal diameter, occipito‐frontal diameter, head circumference, femur diaphysis length and abdomen circumference) were measured according to the classical ultrasound techniques by highly trained operators. Individual growth profiles (made up of 5 to 9 measures) were taken at regular intervals between the 12th and the 40th week. Growth norms were traced by means of a two‐stage linear model: (I) a 3‐constant fetal growth function was fitted to each individual growth profile, (II) growth centiles were based upon the weighted mean and covariance matrix of the individual growth constants.

Results. Fetal growth curves show a sigmoid shape with a maximum slope (i.e. a peak growth velocity) which occurs earlier for head diameters (about 18 weeks), later for femur diaphysis length (20 weeks) and abdomen circumference (22 weeks). During intrauterine growth, all traits show a progressive increase in interindividual variability, which is more prominent for abdomen circumference.

Conclusion. The mathematical model applied to a large sample of growth profiles provided a satisfactory description of the individual fetal development and its biological variability, and allowed the construction of longitudinal distance standards useful for clinical purposes.
Note
Magnetic resonance imaging compared to ultrasonography in fetal weight and volume estimation in diabetic and normal pregnancy
Authors: UOTILA JUKKA , DASTIDAR PRASUN , HEINONEN TOMI , RYYMIN PERTTI , PUNNONEN REIJO , LAASONEN ERKKI
Published: March 2003

Objective. To estimate fetal volume and weight in diabetic and normal pregnancy using high‐resolution magnetic resonance imaging.

Methods. T1‐weighted magnetic resonance imaging was combined with semiautomatic segmentation technique. The accuracy of fetal volume estimations thus obtained was compared with conventional ultrasound‐based weight estimations in ten pregnant women with insulin‐dependent diabetes mellitus and ten women with normal pregnancy. Examinations were made within 48 hours before delivery.

Results. Ultrasound‐based estimations of fetal weight showed a correlation rate of r=0.77 with the actual birth weights in the whole material, while volume determinations based on magnetic resonance imaging showed a significantly better correlation rate of r=0.95. Diabetic women did not differ from the normal pregnancy group with regard to birth weight or the accuracy of weight estimations.

Conclusions. High‐resolution magnetic resonance imaging combined with semiautomatic segmentation software was found to be accurate in determining fetal volume and, consequently, better than conventional ultrasound‐based techniques in estimating fetal weight. The use of magnetic resonance imaging in fetal weight estimation may be recommended for clinical situations where an accurate weight estimate is considered essential.
Emergency cerclage in the presence of protruding membranes: is pregnancy outcome predictable?
Authors: CARUSO ALESSANDRO , TRIVELLINI CARMEN , DE CAROLIS SARA , PARADISI GIANCARLO , MANCUSO SALVATORE , FERRAZZANI SERGIO
Published: March 2003

Background. The aim of this retrospective study is to verify whether some maternal features are related to pregnancy outcome in cases of emergency mid‐trimester cerclage when membranes are protruding through the dilated cervix.

Methods. Between 1988 and 1996 twenty‐three pregnant patients with dilated cervix and protruding membranes were treated with emergency cerclage. At the time of cerclage, gestational age ranged from 17 to 27 weeks (median 22).

Results. Pregnancy was prolonged from 0 to 20 weeks (median 4). Eleven living infants were born (46%); median gestational age at delivery was 25 weeks (range 21–39) and median birth weight 700 g (range 350–3980 g). Obstetric histories, white blood cell count, and vaginal‐cervical and urine cultures obtained on admission were analyzed in the two following groups: data from patients with good pregnancy outcome (live births) versus those from patients with poor outcome (stillbirths and neonatal deaths). No significant difference was found between the groups for the above mentioned maternal features.

Conclusions. The possibility of 46% live births is considered a good result for mid‐trimester emergency cerclage when the membranes are protruding. Success of the procedure remains unpredictable on the basis of the maternal features investigated.
Maternal thrombocytopenia at term: a population‐based study
Authors: SAINIO SUSANNA , KEKOMÄKI RIITTA , RIIKONEN SEIJA , TERAMO KARI
Published: March 2003

Background. Thrombocytopenia is a common problem during pregnancy and often inappropriately managed. This study aimed to assess the prevalence and causes of maternal thrombocytopenia at term with special attention to immune mechanisms of thrombocytopenia and the need for assessing fetal risks.

Methods. We conducted a 1‐year population‐based surveillance study involving 4382 fullterm (at least 37 weeks' gestation) women (83.8% of the study population) and their infants from the city of Helsinki. Maternal and cord platelet counts were performed at delivery. Immune studies were performed if maternal platelet counts were less than 100×109/l; 95% confidence intervals (CIs) were calculated from the binomial distribution.

Results. A total of 317 women (7.3%; 95% CI 6.5, 8.1) had platelet counts of less than 150×109/l. Most cases (81%) of maternal thrombocytopenia at term were due to gestational thrombocytopenia, which had no impact on either the mother or the fetus unless associated with some other medical or obstetric disorder. Other causes of thrombocytopenia were preeclampsia (16%) and idiopathic thrombocytopenic purpura (ITP) (3%). There was no association between maternal and fetal platelet counts: of the infants born to thrombocytopenic mothers, 2.1% had thrombocytopenia in the cord blood, which did not differ significantly from the 2.0% of thrombocytopenic infants born to non‐thrombocytopenic mothers.

Conclusion. Women with gestational thrombocytopenia do not require alteration of their treatment. Fetal blood sampling is not considered necessary when thrombocytopenia is discovered unexpectedly at term.
Immunohistochemical analysis of CA125, CA19‐9, and Ki‐67 in stage III or IV endometriosis:
Authors: TOKI TOSHIHIKO , KUBOTA JUNKO , LU XIN , NAKAYAMA KUNIAKI
Published: March 2003

Background. Serum levels of CA125 and CA19‐9 are often elevated in patients with endometriosis, but the clinical or biological significance of this is not well established. The aim of the present study was to compare serum and tissue levels of CA125 and CA19–9, and to examine the correlation between these levels and cell proliferation using immunohistochemical analysis in stage III or IV endometriosis.

Methods. Forty‐five cases diagnosed histologically as endometriosis were analyzed (26 cases were stage III and 19 were stage IV using the revised American Fertility Society classification). The preoperative serum levels of CA125 and CA19‐9 were measured by immunoradiometric assay. Immunohistochemical analysis was performed using antibodies against CA125, CA19‐9, and Ki‐67 (a representative marker of cell proliferation).

Results. The serum levels of CA125 and CA19‐9 were elevated (over the cutoff values) in 25 cases and 21 cases, respectively. There was no significant correlation between serum CA125 and serum CA19‐9 levels (correlation coefficient [ρ]=0.19). The serum CA19‐9 level correlated well with the degree of immunostaining for CA19‐9 (ρ=0.57), but not with the Ki‐67 labeling index. The serum CA125 level did not show a strong correlation with CA125 staining (ρ=0.41), but it correlated well with the Ki‐67 labeling index (ρ=0.53).

Conclusions. The present study indicates that the serum CA125 level may correlate with the proliferative activity of epithelial cells in endometriotic lesions.
Factors affecting the volume of umbilical cord blood collections
Authors: YAMADA TAKASHI , OKAMOTO YUKIKO , KASAMATSU HAJIME , HORIE YOSHINORI , YAMASHITA NAOKO , MATSUMOTO KAYOKO
Published: March 2003

Objective. Our purpose was to find factors that may help increase the number of the
HSC (
CD34+) collected from umbilical cord blood for transplantation.

Study design. We assessed the effect of cesarean sections and vaginal deliveries on the volume of the umbilical cord blood collected from 155 healthy term neonates retrospectively.

Results. The volume of umbilical cord blood obtained in 29 cesarean deliveries was 103.9±33.6 ml compared with 84.2±25.3 ml collected in 126 vaginal deliveries. Although the percentage of
CD34+ cells was comparable in both groups, the absolute number of
CD34+ cells was significantly higher in the cesarean section group because of the larger volume collected.

Conclusions. Cesarean sections may allow collection of significantly increased volumes of umbilical cord blood and numbers of
CD34+ cells compared to vaginal deliveries.
Aims, options and outcomes in measuring maternal mortality in developing societies
Authors: BERHANE YEMANE , ANDERSSON TOBIAS , WALL STIG , BYASS PETER , HÖGBERG ULF
Published: March 2003

Background. Effective methods for measuring maternal mortality in developing countries are important, particularly in assessing interventions aiming for safer motherhood. Here the performance of different approaches is compared in the same setting.

Methods. Estimates of maternal mortality in a rural Ethiopian community are reported, made by direct observation, a case‐control approach, and the sisterhood method.

Results. Adjusted estimates of MMR using these methods ranged between 440 and 665 per 100,000 live births.

Conclusions. The advantages and disadvantages of the different approaches are compared, both for operational feasibility and outcome.
Combined oral contraceptives do not increase the risk of back and pelvic pain during pregnancy or after delivery
Authors: BJÖRKLUND KENNETH , NORDSTRÖM MARIE‐LOUISE , ODLIND VIVECA
Published: March 2003

Objectives. To elucidate whether the duration of previous use of combined oral contraceptives (COC) is associated with disabling back or pelvic pain during pregnancy and pain persisting eight months after delivery.

Methods. Questionnaires were distributed to a group of women at 36 weeks of pregnancy and eight months after their delivery. There were no exclusion criteria. Disabling pain was defined as moderate or severe pain restricting physical activity. Multiple logistic regression analysis of disabling pain during pregnancy and persistent pain after delivery comprised the duration of COC use adjusted for age, pain in a previous pregnancy and a history of back pain when not pregnant.

Results. The study comprised 161 women. Pain during pregnancy was classified as disabling in 57 of the women (35%), pain in a previous pregnancy being a risk factor; odds ratio (OR) 5.0 (95% CI 2.1; 12.1), whereas no association was found with the duration of COC use. Persistent pain eight months after delivery was reported by 41 women (26%), risk factors being a history of back pain when not pregnant; OR 7.5 (2.8; 19.5), disabling pain in the recent pregnancy; OR 5.0 (1.9; 13.4), and short use of COC; 0–<1 year; OR 4.2 (1.3; 12.9), 1–<5 years; OR 4.6 (1.5; 14.4) (reference=>10 years).

Conclusion. The results indicate that non‐ or short term users of COC have an increased risk of persistent pain after delivery compared to long term users. No association was found between the duration of COC use and back or pelvic pain during pregnancy.
A case‐referent study on fetal bacteremia and late fetal death of unknown etiology in Lithuania
Authors: MALECKIENE LAIMA , NADISAUSKIENE RUTA , STANKEVICIENE IRENA , CIZAUSKAS ARVYDAS , BERGSTRÖM STAFFAN
Published: March 2003

Background. The objectives were to test the hypothesis that certain strains of microorganisms are present in fetal blood in a significant proportion of parturient women suffering unexplained third trimester fetal death, and to examine the correlation between fetal bacteremia and histologic chorioamnionitis and vasculitis.

Methods. A case‐referent study was carried out on 58 pregnant women with fetal death of unknown etiology (cases) and 116 pregnant women at term (referents) with live fetuses. Cultures from maternal endocervix, amniotic fluid, placental homogenate, external ear and blood of newborns were performed in both groups. Histological examination of placentas and fetal membranes was carried out in order to identify chorioamnionitis and chorionic vasculitis.

Results. Intrauterine fetal bacteremia was observed in 36% of cases and in 0% of referents (p=0.001). Escherichia coli was the most common strain, isolated in 21% of fetal blood samples in cases. Extensive histologic chorioamnionitis was observed in 50% of cases with the presence of Escherichia coli in blood of stillborns. Chorionic vasculitis was found in 67% of such cases. Positive significant correlations between isolation of the Escherichia coli from maternal endocervix, amniotic fluid, placenta, fetal ear and blood in stillborns and histological chorioamnionitis and chorionic vasculitis were observed.

Conclusions. Escherichia coli bacteremia was detected in a significant proportion of stillborns suffering a third trimester prelabor death. Fetal bacteremia significantly correlated with histologic signs of inflammation in placenta and membranes. Ascending subclinical intrauterine infection may play an important role in the etiology of otherwise unexplained late prelabor fetal death.
VEGF mRNA is unaltered in decidual and placental tissues in preeclampsia at delivery
Authors: Ranheim Trine , Staff Anne Cathrine , Henriksen Tore
Published: March 2003

Background. VEGF (vascular endothelial growth factor) is a growth factor which is central in blood vessel formation. We wanted to determine whether the mRNA levels of VEGF are altered in preeclampsia in decidual and placental tissues compared to control pregnancies.

Methods. Decidua basalis was obtained by vacuum aspiration during cesarean section in 25 preeclamptic and 19 uneventful pregnancies. Placental biopsies were taken immediately after delivery. Relative mRNA levels of VEGF were quantified and compared to those of the housekeeping gene β‐actin.

Results. No statistically significant differences in VEGF mRNA levels were found between the preeclampsia and the control group for either the decidual or placental tissues. Furthermore, there were no significant differences between VEGF mRNA levels in the preeclamptic and control group with respect to gestational age of the women.

Conclusions. This study provides no evidence of abnormal VEGF expression at delivery in decidua basalis or placenta in pregnancies complicated by preeclampsia.
Prenatal diagnosis of six major cardiac malformations in Europe – A population based study
Authors: Garne Ester ,   THE EUROCAT WORKING GROUP
Published: March 2003

Aim. To present data on prenatal diagnosis of six major cardiac malformations in low‐risk European populations.

Methods. Data from 12 Eurocat registries on congenital malformations. All registries have multiple sources of information and use the same methods of data collection and coding. The six cardiac malformations included were hypoplastic left heart, tricuspid atresia, single ventricle, Tetralogy of Fallot, transposition of great arteries and common A‐V‐canal.

Results. There were significant differences in the proportion of cases diagnosed prenatally, with the highest detection rate in France (91% for single ventricle in Paris) and the lowest detection rate in countries without prenatal ultrasound screening (no cases diagnosed prenatally in the Danish registry area). Prenatal detection rate was significantly higher for the three malformations affecting the size of the ventricles (hypoplastic left heart, tricuspid atresia, single ventricle) compared to the other three malformations (46% versus 24%, p<0.001). Time of diagnosis was late, with only one third diagnosed before 24 weeks of gestation. The risk of fetal death seems to be low.

Conclusion. There are significant regional differences in prenatal detection rate of major cardiac malformations in Europe.
Correlation between serum testosterone levels and peripartal mood states
Authors: Hohlagschwandtner Maria , Husslein Peter , Klier Claudia , Ulm Barbara
Published: March 2003

Background. We conducted a prospective study at the Department of Obstetrics and Gynecology, University Hospital of Vienna to investigate associations between serum testosterone levels and maternal peripartal mood states.

Methods. Two hundred and fifty‐two pregnant women at term (38 to 40 weeks’ gestation) took part in the study. Blood samples for plasma testosterone levels and other biochemicals were obtained prepartum, and on the 1st and 3rd day postpartum. Mood was assessed with the McNair Profile of Mood States (POMS) at term pregnancy and daily from the first day after delivery until discharge from the hospital.

Results. The final study population consisted of 193 women. Serum testosterone levels correlated significantly with maternal depression scores, both pre‐ and post partum (at term r=0.148, p=0.04; 1st day postpartum r=0.156, p=0.03; and 2nd day postpartum r=0.186, p=0.02, respectively). Testosterone concentrations also correlated with anger prepartum (r=0.164, p=0.02) and on the third day after delivery (r=0.188, p=0.02). No significant correlation between testosterone concentration and fatigue and vigor both pre‐ and post partum, respectively were found.

Conclusion. Serum testosterone levels correlate with depression and anger in the first postpartum days.
Preimplantation genetic diagnosis (PGD): The Gothenburg experience
Authors: Hanson Charles , Jakobsson Ann‐Helene , Sjögren Anita , Lundin Kersti , Nilsson Lars , Wahlström Jan , Hardarson Thorir , Stevic Justina , Darnfors Catarina , Janson Per Olof , Wikland Matts , Hamberger Lars
Published: March 2003

Background. A program for preimplantation genetic diagnosis of pre‐embryos from patients with hereditary disorders was set up in our unit at Sahlgrenska University Hospital in 1994. The majority of the patients were carriers of X‐chromosome linked disorders; a few patients were translocation carriers. In this paper we describe our experiences of our first 36 cycles, 30 gender determinations and six analyses of embryos with possible translocations.

Methods. Conventional hormone replacement treatment with intracytoplasmic sperm injection to fertilize the eggs followed by blastomere biopsy and fluorescent in situ hybridization at the eight cell stage was used for sexing as well as detection of translocations.

Results. Out of the 30 cycles in 13 patients for gender determination, blastomere biopsies could be carried out in 25 cycles. Transfer of normal female embryos (XX) was performed in 18 cycles, resulting in five pregnancies (pregnancy rate 27.8%) and an implantation rate of 20% per transfer. Three girls have been born. Hence the take home baby rate was 16.7% per transfer and 10% per started cycle. Six cycles (three patients) for detection of translocations in embryos were performed. Diagnosis was possible in four cycles. Transfer of normal embryos was carried out in one cycle. No pregnancy was achieved.

Conclusion. Successful PGD in its clinical application demands close collaboration between a large group of specialists. Even so, the success rate is considerably lower than after conventional IVF or ICSI procedures. Taking into account the stress caused to the parents facing late interruption of pregnancy following conventional prenatal diagnosis we are convinced that this technique is well worthwhile continuing and refining.
Choice and chance: Determinants of short interpregnancy intervals in Denmark
Authors: Kaharuza Frank M. , Sabroe Svend , Basso Olga
Published: March 2003

Background. It is still unclear whether short interpregnancy intervals are a marker for women at risk of poor pregnancy outcome or a direct risk factor for poor perinatal outcomes. The study objective was to identify risk factors associated with short interpregnancy intervals in Denmark.

Methods. From a cohort of pregnant women in a geographically defined area in Denmark (n=11,288) and using register linkage, we identified 5756 multiparous mothers who completed a detailed interview on social behavior during pregnancy. We restricted our analysis to 2904 mothers who had an interpregnancy interval of less than 37 months. Multiple logistic regression was used to estimate the Odds Ratio (OR) of having a short interval as a function of a number of determinants.

Results. About 4.8% of the mothers had an interpregnancy interval less than 9 months. Short interpregnancy intervals were more likely to occur in an unplanned pregnancy (OR=2.9, 95% CI: 2.2–3.9), to follow irregular menstruation (OR=1.7, 95% CI: 1.1, 2.5) and to occur in older (OR=1.7, 95% CI: 1.1, 2.5) and high parity mothers (OR=1.9, 95% CI: 1.1, 3.1). Poor housing, smoking and low social status were also associated with short interpregnancy interval

Conclusion. Short interpregnancy intervals may be a marker for women at risk and these risk factors differ among populations. They also appear to be a result of choice (e.g. in older women). Biological factors also play a significant role in determining short interpregnancy intervals.
Preoperative treatment of anemic women with epoetin beta
Authors: Larson Barbro , Bremme Katarina , Clyne Naomi , Nordström Lars
Published: March 2003

Aim. To compare the effects of preoperative treatment with recombinant human erythropoietin (EPO) and iron with iron only on hemoglobin levels (Hb) in anemic women prior to hysterectomy.

Methods. The study was an open‐labelled randomized parallel study. Fifteen women scheduled for hysterectomy due to uterine myoma were given oral iron and EPO (NeoRecormon®) 4 weeks prior to surgery (group I) and 16 women were given oral iron only (group II).

Results. Group I showed a significantly greater increase in mean Hb during the pre‐surgery study period compared with group II (p=0.007). Two weeks postoperatively, however, there was no significant difference in mean Hb between the two groups.

Conclusion. We found that a significantly greater increase in Hb was achieved with iron in combination with EPO, although in most cases iron only seemed to be as efficacious as iron+EPO in correcting anemia in myoma patients pre‐operatively.
Perinatal complications in women with gestational diabetes mellitus
Authors: Svare Jens A. , Hansen Bent B. , Mølsted‐Pedersen Lars
Published: March 2003

Background. The aim of the study was to examine the outcome of the pregnancy and neonatal period in 1) women with gestational diabetes mellitus and non‐diabetic pregnant women, and 2) in women with early and late diagnosis of gestational diabetes mellitus.

Methods. Included were 327 women with gestational diabetes mellitus and 295 non‐diabetic women, who were screened with a 75 g oral glucose tolerance test because of risk factors for gestational diabetes. Women with gestational diabetes mellitus were treated with low‐caloric diet and insulin when appropriate, while women in the control group received routine antenatal care.

Results. Gestational age at delivery was significantly lower in the group with gestational diabetes mellitus, both when considering all deliveries (39.1±1.7 weeks versus 39.8±2.0 weeks, p<0.05) and only those with spontaneous onset of labor (38.8±2.0 weeks versus 40.0±1.6 weeks, p<0.05). The frequency of macrosomia was increased, although not statistically significant (8% vs. 2%, p=0.07), and the rate of admission to the neonatal ward was significantly increased (18% vs. 9%, p<0.05) in the group with gestational diabetes. Women with early diagnosis of gestational diabetes mellitus had a significantly increased need for insulin treatment during pregnancy (36% vs. 9% p<0.05) and a significantly higher occurrence of diabetes mellitus at follow‐up from two months until three years postpartum.

Conclusions. This study of women with gestational diabetes mellitus and non‐diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.
Pregnancy planning and acceptance among Danish pregnant women
Authors: Rasch Vibeke , Knudsen Lisbeth B. , Wielandt Hanne
Published: March 2003

Objective. To study how living conditions influence pregnancy planning and acceptance among Danish women.

Method. A cross‐sectional questionnaire study performed among 3516 pregnant women attending Odense University Hospital, Denmark. The study population consisted of women with spontaneous abortion, women with ectopic pregnancies, women attending antenatal care and women with induced abortion. They were divided into four groups: women with planned and accepted pregnancies (accepting planners, n=2137), women who accepted an initially unplanned pregnancy (accepting non‐planners, n=1006), women who rejected an initially planned pregnancy (rejecting planners, n=31), and women with unplanned and rejected pregnancies (rejecting non‐planners, n=342). The association between socio‐economic characteristics and pregnancy planning and acceptance was evaluated by comparing accepting non‐planners with accepting planners and by comparing rejecting planners with rejecting non‐planners. The variables studied comprise age, number of children, partner relationship, education, occupation, economic situation and contraceptives.

Results. The characteristics of accepting non‐planners and accepting planners were in accordance and in contrast to those of rejecting planners and in particular of rejecting non‐planners. The contraceptive prevalence rate among accepting non‐planners was 15%. Among rejecting non‐planners the same figure was 51%.

Conclusion. Accepting non‐planners seemed to be in a situation which could be considered appropriate for childbirth. The contraceptive prevalence rate among accepting non‐planners was low and might reflect that these women were not entirely against the thought of having a child, although they did not actively plan to have one.
Urinary heparan sulfate proteoglycan excretion in black African women with pre‐eclampsia
Authors: Khedun Shaun M. , Naicker Thajasvarie , Moodley Jagdisea , Gathiram Prem
Published: March 2003

Background.  The heparan sulfate proteoglycan of the glomerular basement membrane is considered to be mainly responsible for the charge selectivity of the glomerular basement membrane. Decreased heparan sulfate proteoglycan results in a decreased anionic charge of the glomerular basement membrane with increased heparan sulfate proteoglycan in the urine, and is believed to be responsible for the proteinuria in pre‐eclampsia.

Aim.  To determine the urinary heparan and chondroitin sulfate proteoglycan levels in women with pre‐eclampsia.

Materials and methods.  Eighty‐four patients were studied: 28 were normotensive pregnant, 28 were nonproteinuric hypertensive, and 28 were pre‐eclamptic. Urine samples were obtained and urinary glycosaminoglycan concentrations were determined using the dimethyl‐methylene blue assay. Plotting absorbance against the concentrations of heparan and chondroitin sulfate proteoglycans drew a standard curve. The concentration of heparan and chondroitin sulfate proteoglycans was read‐off from the linear portion of the standard curve. The standard solutions contained 25, 50, 100 and 200 mg/l heparan or chondroitin sulfate. The Mann–Whitney U‐test was used to detect differences between the three groups, and the Pearson's correlation coefficient was calculated for clinical data correlation of the pre‐eclamptic group.

Results.  Urinary excretion of heparan sulfate proteoglycan (123.1 ± 22.1 mg/l) was significantly increased in the pre‐eclamptic group compared with the normotensive pregnant group (60.5 ± 5.1 mg/l; p < 0.0001) and the hypertensive nonproteinuric group (63. 2 ± 3.7 mg/l; p < 0.0001). Urinary chondroitin sulfate proteoglycan excretion followed a similar pattern, being significantly increased in the pre‐eclamptic group (88.86 ± 9.79 mg/l) compared with the normotensive pregnant group (49.1 ± 8.49 mg/l; p < 0.0001) and the hypertensive nonproteinuric group (43. 9 ± 5.7 mg/l; p < 0.0001). A significant Pearson's correlation between 24‐h urine output vs. 24‐h protein excretion (r = 0.51; p < 0.001), and between loss of HSPG versus 24‐h urinary protein excretion (r = 0.72; p < 0.0001) was obtained in the pre‐eclamptic group.

Conclusion.  This study demonstrates a reduction of glomerular charge in pre‐eclampsia. The strong correlation between the severity of proteinuria and the loss of charge supports the hypothesis that the loss of glomerular charge induces structural changes of the filtration barrier, and may be the mechanism responsible for the proteinuria in pre‐eclampsia. Furthermore, the elevated levels of urinary proteoglycan (heparan and chondroitin sulfate proteoglycans) in this disorder show a loss into the urine rather than a neutralization of these macromolecules.
Maternal and fetal morbidity in pregnancies of Norwegian and Swedish women with cystic fibrosis
Authors: ØDegaard Inger , Stray‐Pedersen Babill , Hallberg Karin , Haanaes Ole Christen , Storrøsten Olav Trond , Johannesson Marie
Published: March 2003

Background.  The survival of patients with cystic fibrosis has increased. More women with cystic fibrosis reach reproductive age and wish to become pregnant. The aim of this work was to study the outcome of completed pregnancies in women with cystic fibrosis in Norway and Sweden.

Methods.  A retrospective audit from medical records was performed for 33 successful pregnancies in 23 women from the cystic fibrosis center in Norway and two cystic fibrosis centers in Sweden. Lung function, body weight and use of antibiotics together with other medical data were related to the complications and outcomes of the pregnancies.

Results.  The most frequent complication of the pregnancies was preterm delivery, which occurred in 24% of cases. The lung function of the women was significantly lower in the preterm group than in those delivering at term. Those who went on to deliver preterm were more likely to have other cystic fibrosis complications including diabetes, asthma or liver disease. The weight gain of the women with cystic fibrosis delivering preterm was less than in the term group (corrected for gestation), but the frequency of pulmonary infections did not differ. As for the total group, lung function did not deteriorate during pregnancy, even though the need for intravenous antibiotics was doubled compared with the year before and after pregnancy. Weight gain in pregnancy was on average 10.3 kg, and almost half of the women needed supplementary nutrition. Gestational diabetes developed in four of the 23 patients. Caesarean sections were performed in eight of the 33 deliveries (24%), and 26 of the babies (79%) were breast‐fed. None of the 33 children suffered from cystic fibrosis.

Conclusion.  Women with cystic fibrosis with mild to moderate disease may safely go through pregnancy. In those with severe disease, preterm delivery is common. A team approach is necessary to provide the best medical care for pregnant women with cystic fibrosis.
New rapid bed‐side test to predict preterm delivery: phosphorylated insulin‐like growth factor binding protein‐1 in cervical secretions
Authors: Lembet Arda , Eroglu Derya , Ergin Tolga , Kuscu Esra , Zeyneloglu Hulusi , Batioglu Sertaç , Haberal Ali
Published: March 2003

Background.  Phosphorylated insulin‐like growth factor binding protein‐1 (phIGFBP‐1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP‐1 in cervical secretions by a rapid bed‐side test could be used to predict preterm delivery in patients with regular uterine contractions.

Study design.  In our prospective study, 36 women between 20 and 36 weeks of gestation with regular, persistent contractions (> 10/h) and 18 women between 20 and 36 weeks gestation without symptoms of preterm labor were assessed for the presence of cervical phIGFBP‐1. Dacron swabs were applied to the cervix and assayed in 5 min by using immunochromotography, a new rapid bed‐side test (actim partus test, Medix Biochemica, Kauniainen, Finland). Data analysis included one‐way variance analysis (ANOVA), Student's t‐test, chi‐square and Fisher's exact test.

Results.  Of the 36 patients with regular uterine contractions, 18 had a positive actim partus test and 18 had a negative test. Among the 18 patients with a positive test, only one delivered term and the other 17 patients delivered preterm (< 37 weeks). Among the 18 women with a negative test, only two delivered preterm (p < 0.05). Mean gestational age at delivery for patients with a positive and a negative test was 34.4 ± 3.0 and 37.9 ± 2.3 weeks, respectively (p < 0.05). Sensitivity, specificity, positive and negative predictive values of the rapid phIGFBP‐1 test for preterm delivery was 89.5, 94.1, 94.4 and 88.9%, respectively. For delivery < 37 weeks, positive likelihood ratio was 15.2 (± 95% CI; range 2.6–102.5). When cervical phIGBP‐1 assay was used to predict delivery within 7 days, sensitivity, specificity, positive and negative predictive values were 93.8, 85%, 83.3 and 94.1%, respectively. Positive likelihood ratio with ± 95% CI was 6.25 (range 2.2–17.8). When patients were categorized according to cervical dilatation, the positive likelihood ratio of the test when the cervix was closed at ≤ 1, ≤ 2 and > 2 cm were 8.3 (1.3–55.3), 13.6 (2–91.4), 15.8 (2.3–106.3) and 1.5 (0.2–11.5), respectively,

Conclusion.  The presence of cervical phIGFBP‐1 is predictive of preterm delivery < 37 weeks of gestation. Our study shows that cervical detection of phIGFBP‐1 by immunochromotography is a rapid and easily applicable test that highly anticipates preterm delivery in patients at risk.
Major postpartum hemorrhage: survey of maternity units in the United Kingdom
Authors: Mousa Hatem A. , Alfirevic Zarko
Published: March 2003

Background.  To determine current clinical practice among different maternity units in the United Kingdom for the management of major postpartum hemorrhage.

Methods.  A postal questionnaire was sent to 258 maternity units in the UK. It was developed to identify the definition of major postpartum hemorrhage, and to identify the medical and surgical interventions used for postpartum hemorrhage, as considered by each unit, and the type and use of thromboprophylaxis following surgery for major hemorrhage after delivery.

Results.  A total of 212 (82%) returned the questionnaire, but 13 units indicated that the questionnaire was not applicable to them, leaving 199 (82%) for analysis. There was a lack of agreement between the different units regarding the definition and interventions for major postpartum hemorrhage. The majority of the units use oxytocin, ergometrine and carboprost as a ‘first‐line’ for the treatment of postpartum hemorrhage. Hysterectomy was the most common surgical procedure (89% of units had performed at least one hysterectomy for major hemorrhage in the last 5 years). There was a lack of agreement regarding the use and choice of thromboprophylaxis following surgery for major hemorrhage.

Conclusions.  Current management of major postpartum hemorrhage varies considerably. There is an urgent need to identify protocols that will reduce the need for hysterectomy in women with major hemorrhage who are unresponsive to conventional medical therapy.
Relationship between umbilical cord morphology and nuchal cord entanglement
Authors: Rogers Michael S. , Ip Yim W. , Qin Yun , Rogers Sean M. , Sahota Daljit
Published: March 2003

Acta Obstet Gynecol Scand 2002; 82: 32–37. © Acta Obstet Gynecol Scand 2003

Objective.  To determine whether tightening of nuchal cord entanglement is more likely to occur where normal cord coiling is absent and there is deficient Wharton's jelly. The study was carried out in the delivery suite of a university teaching hospital, using a prospective matched controlled‐pairs survey.

Methods.  Midwives identified index cases with nuchal cord entanglement at the time of delivery. The next delivery of equivalent gestation (± 1 week) without cord entanglement was taken as the control. Only singleton pregnancies with cephalic presentation undergoing spontaneous labor were studied. Placental insertion, nuchal entanglement (tight or loose), length, presence of knots, umbilical coiling index (UCI), and the amount of Wharton's jelly were recorded.

Results.  Longer cords were more frequent amongst male infants and were predisposed towards entanglement. There were no significant differences in the amount of Wharton's jelly, or in the UCI between tight and loose nuchal cord groups. The only measurement that differed significantly was the total cord length, with shorter cords predisposed towards tightening.

Conclusion.  Whilst nuchal cord entanglement amongst male babies is frequently associated with long and straight umbilical cords, tightening is more likely to occur if the cord is of short or normal length. Neither low UCI nor low percentage of Wharton's jelly are predisposed towards tightening of cord entanglement.
Comparative evaluation of early vs. deferred vitrectomy in Eales' Disease
Authors: Kumar Atul , Tiwari Hem Kumar , Singh R. P. , Verma Lalit , Prasad Nagendra
Published: March 2003

Methods: 40 cases of vitreous haemorrhage secondary to Eales' disease were taken up for vitrectomy. Depending upon duration of vitreous haemorrhage patients were divided into two groups: Group I (20 eyes); early vitrectomy group with duration between 3–6 months; Group II (20 eyes); deferred vitrectomy group with duration of more than 6 months. All patients were followed up for a minimum period of 3 months following vitrectomy.

Results: Eyes in Group I showing a preoperative ultrasonic picture of complete posterior vitreous detachment, less mobility of organised vitreous haemorrhage and mid vitreous organisation on kinetic echography achieved a final visual acuity of 6/9 or better in 13 (65%) eyes as compared to 4 (20%) eyes in Group II (p<0.01). Poor visual outcome in the deferred group was secondary to cystoid macular oedema, macular scar, macular pucker formation and macular degeneration.

Conclusion: Improved visual outcome in the early vitrectomy group was probably because the haemorrhagic blood and its toxic products had less time to damage the macula, a lesser incidence of macular traction and cystoid macular oedema.
Acremonium keratitis in a patient with herpetic neurotrophic corneal disease
Authors: Rodriguez‐Ares Teresa , De Rojas Silva Victoria , Ferreiros Manuel Pereiro , Becerra Eugenio Perez , Tome Carmela Capeans , Sanchez‐Salorio Manuel
Published: March 2003

ABSTRACT. Fungi belonging to the genus Acremonium Link ex Fries 1821 are ubiquitous environmental contaminants and soil saprophytes, but are infrequent pathogens in humans. These filamentous fungi (previously known as Cephalosporium) are an uncommon cause of mycotic keratitis. As in the case of other filamentous fungi, corneal trauma with contaminated matter is the most frequent risk factor for the infection.

We report in this paper a case of keratomycosis caused by Acremonium potronii, in a patient with a history of herpetic keratitis. Medical treatment with amphotericin B was unsuccessful and the infection eventually resolved with penetrating keratoplasty.