bluuebunny/crossref_metadata_2025 huggingface dataset:
Does exposure to magnesium sulfate in utero decrease the risk of necrotizing enterocolitis in premature infants?
Authors: Ghidini Alessandro , Espada Roberto A. , Spong Catherine Y.
Published: March 2003

Background. The objective of this study is to assess whether antenatal exposure to magnesium sulfate may decrease the risk of necrotizing enterocolitis in preterm infants.

Methods. We have compared the rate of magnesium sulfate exposure before birth among 23 consecutive infants diagnosed with necrotizing enterocolitis with that of 46 controls matched by gestational age at delivery and gender. Relevant obstetric and neonatal variables were compared between the two groups using chi‐square and Fisher’s exact test for categorical data, and one‐way analysis of variance for continuous variables, with a two‐tailed p‐value <0.05 considered significant.

Results. No significant differences were present between the two groups in mode of delivery (p=0.9), rate of Apgar score at five minutes below seven (p=0.4), prenatal exposure to indocin (p=0.5) or steroids (p=0.6), or neonatal administration of surfactant (p=0.1). Similar proportions of babies with necrotizing enterocolitis and controls were diagnosed with respiratory distress syndrome (p=0.5), intraventricular hemorrhage grades three or four (p=0.9), and sepsis (p=0.6). Babies with necrotizing enterocolitis had a significantly longer hospital stay (74.6±64.0 vs. 41.9±37.0 days, p=0.01) and intubation period (31.4±24.1 vs. 16.8±15.6 days, p=0.01) than controls. The rates of prenatal exposure to magnesium sulfate were similar in the necrotizing enterocolitis and control groups (30% vs. 39% respectively, p=0.4). Power analysis demonstrated that 385 babies would be required in each group to reach statistical significance (α=0.05, β=80%).

Conclusion. In this retrospective case‐control study, maternal administration of magnesium sulfate prior to delivery does not appear to confer a significant protective effect for the neonatal occurrence of necrotizing enterocolitis.
Huge acoustic neurinomas presenting in the late stage of pregnancy
Authors: Beni‐Adani Liana , Pomeranz Shlomo , Flores Ivan , Shoshan Ygal , Ginosar Yehuda , Ben‐Shachar Inbar
Published: March 2003

Background. Even though vestibular schwannomas rarely present during pregnancy, symptoms may appear or worsen particularly in this period. The clinical picture may include tinnitus, hearing abnormalities, and in large tumors, brain‐stem and cerebellar compression with involvement of additional cranial nerves. Large vestibular schwannomas (also known as Acoustic Neurinomas) present a great challenge in peripartum management of both the mother and the fetus.

Material and method. We present a case of a 24‐year old woman, with headache, papilledema, ataxia, and multiple cranial nerve weakness, diagnosed in the 35th week of pregnancy. MRI demonstrated a huge vestibular schwannoma compressing the brainstem and causing obstructive hydrocephalus.

Result. In the presence of high intra‐cranial pressure a ventriculo‐peritoneal shunt was first inserted, enabling delay of tumor surgery until after delivery. A successful elective cesarean section followed at 37 weeks, and radical tumor surgery was performed a week later. Maternal and fetal outcome were excellent.

Discussion. The options, sequence and timing of the neurosurgical and obstetrical interventions are discussed. Other reports of large vestibular schwannomas that presented during pregnancy are reviewed. Advances in neurosurgery, neuroradiology, neuroanesthesiology and obstetrics are highlighted, and their impact on outcome is discussed in comparison to the poor results reported in the past. Emphasis is made on the importance of early diagnosis, that necessitates high‐index of suspicion by the obstetrician, in any pregnant woman presenting abnormal neurological signs.

Conclusion. We conclude that with a cooperative team approach, maternal and fetal prognosis can today be excellent, even in cases of large vestibular schwannomas diagnosed in the late stage of pregnancy.
Prospective, randomized study to evaluate the success rates using hCG, vaginal progesterone or a combination of both for luteal phase support
Authors: Ludwig Michael , Finas Astrid , Katalinic Alexander , Strik Dominika , Kowalcek Ingrid , Schwartz Petra , Felberbaum Ricardo , Küpker Wolfgang , Schöpper Beate , Al‐Hasani Safaa , Diedrich Klaus
Published: March 2003

Background. A prospective study was done to compare the efficacy of luteal phase support (LPS) using either three times hCG (group I, n=77), hCG on the day of embryo transfer (ET) in combination with daily vaginal progesterone (group II, n=62) or vaginal progesterone only (group III, n=70).

Method. All patients were treated using the long luteal protocol for controlled ovarian stimulation in an IVF (in vitro fertilization) cycle. Patients were randomized to one of these groups when estradiol was <2500 pg/ml and less than 12 oocytes were retrieved (low risk groups). If estradiol was ≥ 2500 pg/ml and/or at least 12 oocytes were retrieved (high risk groups), patients were randomized to receive either hCG in combination with daily vaginal progesterone (group IV, n=83) or progesterone only (group V, n=121). For vaginal progesterone Utrogest® was used (three times daily two capsules containing 100 mg progesterone, 600 mg/d).

Results. Demographic data were comparable within the high risk and low risk groups. However, for unknown reasons the fertilization rate was significantly higher in group V (48%) compared to group IV (40%) (p<0.05), leading to a significantly higher cumulative embryo score. There were no statistically significant differences with regard to the main outcome parameter, the clinical ongoing pregnancy rate in the low risk groups (14.3%, 14.5%, 11.4%) and the high risk groups (21.0%, 21.5%), respectively. Using a standardized discomfort scale, there were more complaints towards the end of the luteal phase in the groups receiving hCG only or an additional injection of hCG, when compared to the progesterone only groups.

Conclusion. Progesterone only for luteal phase support leads to the same clinical ongoing pregnancy rate as hCG, but has no impact on the comfort of the patient.
Oxidative stress in pre‐eclampsia
Authors: Bowen Robin S. , Moodley Jack , Dutton Michael F. , Theron Annette J.
Published: March 2003

Background. The objective of this study was to test the hypothesis that maternal plasma, cord plasma and placental tissue lipid peroxidation products are increased and antioxidants are decreased in women with pre‐eclampsia.

Methods. Placenta, maternal and cord plasma were collected at delivery from 29 normal, 21 pre‐eclamptic and six eclamptic women. Plasma was collected from 21 non‐pregnant matched controls. The analyses were measured by HPLC and colorimetric assay.

Results. Plasma maternal concentrations of uric acid, LPO, MDA, ascorbic acid, vitamin E and cholesterol were not significantly different in pre‐eclampsia as compared with normal pregnancy. Plasma concentrations of ascorbic acid and vitamin E were not significantly different in normal pregnancy as compared with the non‐pregnant controls. Cord plasma concentrations of MDA were significantly higher in eclampsia (1.16±0.26 μmol/l) as compared with normal pregnancy (0.79±0.05 μmol/l, p<0.02) and pre‐eclampsia (0.83±0.05 μmol/l, p<0.05). Cord plasma concentrations of vitamin E were significantly higher in eclampsia (21.3±7.5 μmol/l) as compared with normal pregnancy (10.2±1.1 μmol/l, p<0.01) and pre‐eclampsia (10.4±1.8 μmol/l, p<0.04). Placental concentrations of LPO, MDA and ascorbic acid were not significantly different in pre‐eclampsia as compared with normal pregnancy. Plasma cord concentrations of LPO and placental concentrations of vitamin E were undetected for normal pregnant, pre‐eclamptic and eclamptic women respectively. Uric acid concentrations were significantly increased in eclampsia as compared with the non‐pregnant controls (p<0.0001), normal pregnant controls (p<0.0001) and pre‐eclampsia (p<0.008).

Conclusions. The findings in this study do not show any evidence of deficiency in the maternal protective antioxidant systems or increased production of lipid peroxidation products, LPO and MDA in African women with pre‐eclampsia as compared with normal pregnancy. However, there was evidence of increased cord plasma concentrations of MDA and vitamin E in eclampsia as compared with normal pregnancy and pre‐eclampsia. The placenta may be effective in removing MDA. The antioxidant uric acid serves as a protective role whilst the antioxidant and oxidant capacity in the different study groups remained unchanged.
Labor admission test: an assessment of the test’s value as screening for fetal distress in labor
Authors: Blix Ellen , Øian Pål
Published: March 2003

Background. To determine if the labor admission test (LAT) can predict fetal distress in a population of laboring women, and in subgroups of low‐ or high‐risk women, who delivered within six hours or between six and 24 hours after LAT.

Methods. The data charts of all women who delivered at Hammerfest Hospital in 1996, 1997 and 1998 were retrospectively read. If the woman was admitted to the hospital because of onset of labor, was in the first stage of labor and delivered within 24 hours after admission, she was included. In the study period, 1639 gave birth and 932 were included in the study. A descriptive analysis of the population and assessment of LAT’s sensitivity, positive predictive value, specificity and negative predictive value at different cut‐off values was done.

Results. In the study population 5.8% had fetal distress, and 5.3% had an operative delivery because of fetal distress. LAT’s sensitivity in the whole population was 0.15 and positive predictive value was 0.16. Specificity was 0.95 and positive predictive value was 0.95. In the subgroups of low‐ and high‐risk women, who delivered within six hours or between six and 24 hours after LAT, sensitivity varied between 0 and 0.36, and positive predictive value varied between 0 and 0.27. Specificity varied between 0.92 and 0.96, and negative predictive value varied between 0.89 and 0.97.

Conclusions. According to these results, LAT cannot be recommended as a screening test for fetal distress in labor in low‐risk women. Sensitivity is too low, and there are too many false‐positive tests. It is unclear if LAT has benefits among high‐risk women.
Fertility preservation in gynecologic cancer
Authors: Makar Amin PH. , Tropé Claes
Published: March 2003

Subject. Management of patients with gynecologic cancer can now often be tailored to the extent of the disease and preservation of child‐bearing ability and/or sexual function may be possible for certain women with early invasive disease.

Method. A better understanding of the tumor‐biology, and the consideration of different clinicopathologic factors, that bear prognostic significance in therapeutic modalities, will allow more and more individualization of treatment.

Discussion. Management of young women with early gynecologic cancer should therefore be individualized with the risk of conservative therapy balanced against the dangers and advantages of more radical therapy. Experts in gynecologic oncology and infertility together with an informed patient and her family should make treatment decisions.

Outcome. This article will review the conservative surgical management of early invasive cancers of the ovary, cervix and endometrium, in order to help preserve child‐bearing capacity. In addition, management of gynecologic cancers diagnosed during pregnancy will also be discussed.
Effect of ceramide analogs on interleukin‐1α‐induced production of prostaglandin E2 by amnion‐derived (WISH) cells
Authors: Nakamura Satomi , Kawano Yasushi , Kamihigashi Shoko , Sugano Terumasa , Narahara Hisashi , Miyakawa Isao
Published: March 2003

Background. Prostaglandin E2 (PGE2) is reportedly synthesized in the amnion, and its levels are increased during labor. Our objective was to measure the level of PGE2 induced by interleukin (IL)‐1α following treatment with ceramide analogs in amnion‐derived cells.

Methods. Amnion‐derived (WISH) cells were cultured and stimulated by IL‐1α, IL‐1 receptor antagonist (ra), C2‐ceramide and C6‐ceramide. The levels of PGE2 in the media were measured by ELISA. The induction of prostaglandin H synthase (PGHS)‐2mRNA was detected by reverse transcription and polymerase chain reaction (RT‐PCR).

Results. Following stimulation with IL‐1α, the production of PGE2 could not be detected until incubation had continued for 2 h, but this production appeared to continue after 4 h of incubation. The production of PGE2 was significantly increased by IL‐1α, and was suppressed by IL‐1 ra, in a dose‐dependent manner. PGE2 production was significantly increased by IL‐1α and C2‐ceramide as compared with IL‐1α alone. However, PGE2 production was not significantly increased by IL‐1α and C6‐ceramide as compared with IL‐1α alone. PGHS‐2 mRNA were induced by treatment with IL‐1α, and were strongly induced by treatment with IL‐1α and C2‐ceramide by RT‐PCR.

Conclusions. Results suggest that IL‐1α induce the PGHS‐2 mRNA and stimulate the production of PGE2 by a mechanism that involves the sphingomyelin‐ceramide system. Ceramide may be important in increasing the production of PGE2 during parturition.
Changes in quality of life after hormonal treatment of endometriosis
Authors: Bergqvist Agneta , Theorell Töres
Published: March 2003

Background. To assess whether hormonal treatment of endometriosis improves quality of life for women with endometriosis.

Methods. In a prospective, randomized, double‐blind, double‐dummy study on 48 women with verified endometriosis, the pain pattern and quality of life were registered before, during and after treatment with nafarelin or medroxyprogesterone acetate. The distribution of the studied parameters were tested by means of a Skewness test. ANOVA analysis was used for normally distributed variables and Friedman's analysis and Mann‐Whitney U‐test for non normally distributed variables.

Results. There was a difference between the 30 women who participated all through the study and the 18 who dropped out. It was noticeable that anxiety‐depression and sleep disturbances were significantly more common among the drop outs. There was a significant reduction in symptom score during the study, without any significant difference between the treatment groups. The sleep disturbances and anxiety‐depression score improved significantly from before treatment to the end of the follow‐up, but the anxiety‐depression score increased during the nafarelin treatment period. There was a statistically significant improvement of paid working life in the nafarelin treated group. All the other psycho‐social parameters as well as emotional balance improved during the study period without difference between groups.

Conclusion. When hormonal treatment is planned it is very important to take into consideration previous psychosocial experiences of the patient. Factors of importance for quality of life such as sleep disturbances and anxiety‐depression improved significantly after treatment with nafarelin or medroxyprogesterone acetate.
Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair
Authors: Ottesen Marianne , Møller Charlotte , Kehlet Henrik , Ottesen Bent
Published: March 2003

Background. Postoperative care and convalescence recommendations following vaginal surgery are generally not evidence based. The aim of this study was to describe pre and postoperative treatment, and advice and restrictions for the convalescence period, given by Danish hospital‐employed gynecologists, and gynecologists in private practice, to patients undergoing vaginal repair.

Method. In 1999 all Danish gynecologists (n=433) received a tested questionnaire about postoperative treatment and convalescence recommendations following vaginal repair. Non‐responders received one reminder.

Outcome measures. Pre and postoperative treatment, and expected hospital stay. Furthermore, lifting restrictions, sick leave, and convalescence before resumption of defined activities.

Results. The overall response rate was 82%. The expected postoperative hospital stay was median 3 days (range, 1–7) following anterior repair, and 2 days (range, 1–7) following posterior repair. The recommended sick leave was median 6 weeks (range, 2–12) for patients with work with heavy lifts. There were substantial differences in recommendations. Recommended lifting restrictions were median 3 kg (range, 0–20) for median 4 weeks (range, 1–12), and the recommended time till recommencement of sexual intercourse was median 4 weeks (range, 0–12). The recommended convalescence was median 4–5 weeks for strenuous activities, and median 1–2 weeks for non‐strenuous activities, with ranges from 0–24 weeks. The overall, great variance could not be explained by demographic differences between gynecologists.

Conclusion. Postoperative treatment, and convalescence recommendations given by Danish gynecologists following vaginal repair, show substantial variability and are based on individual viewpoints. Evidence based guidelines and consensus are desirable.
Perinatal deaths and insufficient antenatal care in Latvia
Authors: Jansone Maira , Lindmark Gunilla , Langhoff‐Roos Jens
Published: March 2003

Objective. A national audit on perinatal deaths was performed to assess the quality of antenatal care, and to suggest measures for improved antenatal care.

Material and methods. Medical records of all the perinatal deaths in Latvia in the years 1995–1996 have been studied. Non‐attenders and attenders of antenatal care were characterized by socio‐economic and medical variables: maternal age, parity, history of perinatal outcome, health status and behavioral hazards during the index pregnancy, length of gestation and birth weight. The Nordic‐Baltic perinatal death classification was used.

Results. In 85 of 442 cases (19%) of perinatal deaths women had not taken advantage of antenatal care provided for them. Non‐attenders were more likely to be smokers (p<0.001) and alcohol abusers (p<0.005), above 35 years of age (p<0.005), and had higher parity (p<0.001). Non‐attenders more often had systemic diseases and pregnancy complications. Neonatal complications, such as congenital syphilis (p<0.05) and other infections (p<0.05), were more common among non‐attenders. There was no difference in rates of preterm birth and low birth weight between attenders and non‐attenders.

Conclusions. One fifth of mothers with perinatal death did not attend ANC, and in some women who attended ANC, lack of intervention was related to the perinatal death.
Embryo transfer after 2 or 5 days of IVF culture: a retrospective comparison
Authors: Lundqvist Monalill , Rova Karin , Simberg Niklas , Lundkvist ÖRjan
Published: March 2003

Background. To determine whether prolongation of embryo culture in vitro from day 2 to day 5 after ovum pick‐up (OPU) and fertilization can improve the results of in vitro fertilization (IVF), and the morphology of the spare embryos on day 2 can predict the developmental capacity during prolonged culture. We also wanted to consider this as a strategy to avoid twin pregnancies if it could be possible to transfer only one blastocyst at a time in the future.

Methods. A retrospective analysis with embryo transfer timed according to the weekday of OPU. Embryo transfer was performed on day 2 in 103 cases and on day 5 in 120 cases. Only one cycle per couple was included.

Results. The pregnancy rates per embryo transfer on day 2 (27/103, 26%) and day 5 (36/120, 30%) were similar. There were significantly more miscarriages in the day 5 (50%) than in the day 2 group (22%, p = 0.02), but there was no significant difference in the baby take home rate (20% in day 2 group, 15% in day 5 group). The morphological appearance of the embryos on day 2 was poorly correlated to the developmental potential during prolonged culture in vitro. On day 5, transfer of one or two blastocysts resulted in a pregnancy rate that tended to be higher than that after transfer of morulae only.

Conclusion. Prolongation of embryo culture from day 2 to day 5 did not improve the clinical outcome of the IVF treatment when measured as baby take home rate. Therefore, for the time being, this strategy does not increase our chances to move towards single embryo transfer.
Induction of labor in toxemia with misoprostol
Authors: SAHIN H. GULER , SAHIN HUSEYIN AVNI , KOCER MUSTAFA
Published: March 2003

Background.  To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in toxemia of pregnancy with a modified Bishop score of ≤4.

Methods.  A hundred preeclamptic women with a modified Bishop score of ≤4 were randomized into two groups of 50 patients one group receiving 50 μg intravaginal misoprostol 4 times at 4 hour intervals, the second group receiving oxytocin infusion for induction of labor starting from 1 mIU/per minute, increasing it every 30 minutes with 2 mIU/per minute increments up to maximum of 30 mIU/per minute. Modified Bishop scores 12 hours after induction, the time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann Whitney‐U, Chi‐Square and hypothesis tests about differences for two proportions (t test) to determine differences between the two groups. p≤0.05 was considered significant.

Results.  Misoprostol was significantly superior for induction of labor in toxemia of pregnancy with modified Bishop score of ≤4. After 12 hours median modified Bishop scores of misoprostol administered group and oxytocin administered group were 7 and 4 respectively. Misoprostol administered group 1 was significantly better than oxytocin administered group 2 (p=0.027). The rate of patients who were in labor after 12 hours were 94% and 80% in group 1 and 2 respectively and the difference showed significant difference (p<0.05). The median time from induction to delivery was 14 hours and 16 hours in the misoprostol and oxytocin administered group respectively with significant difference between the groups (p=0.003). The rate of vaginal delivery was significantly higher in the misoprostol administered group 1 (82%) when compared with the oxytocin administered group 2 (66%) (p<0.05). The 1 and 5 minutes median Apgar scores were 5–7 and 6–7.5 in group 1 and 2, respectively with no significant differences between the groups (p=0.96, p=0.64). The rate of admission to neonatal intensive care unit was similar in both groups. The complication rates were similar in all groups and no significant detrimental effects were noted.

Conclusions.  Intravaginal misoprostol is an efficacious, cheap and safe method of induction of labor in toxemia of pregnancy with modified Bishop score of ≤4.
Effects of hormones on uPA, PAI‐1 and suPAR from cultured endometrial and ovarian endometriotic stromal cells
Authors: Guan Yong‐Mei , Carlberg Magdalena , Bruse Christine , Carlström Kjell , Bergqvist Agneta
Published: March 2003

Problem.  To investigate whether endometriotic stromal cells release the urokinase plasminogen activator, soluble urokinase plasminogen activator receptor and plasminogen activator inhibitor‐1. If so, to establish if there are any differences between endometrial stromal cells from women with and without endometriosis, and whether the release is hormonally regulated.

Method.  Biopsies were obtained from endometriotic tissue and from endometrium from women with and without endometriosis. Stromal cells were isolated, incubated and treated with estradiol‐17β, progesterone or raloxifen. Incubation media collected at 0, 24, 48 and 72 h were analyzed by enzyme‐linked immunosorbent assay.

Results.  All these types of stromal cells released the urokinase plasminogen activator, soluble urokinase plasminogen activator receptor and urokinase plasminogen inhibitor‐1. There was a significantly higher release of urokinase plasminogen inhibitor‐1 and lower release of urokinase plasminogen activator and soluble urokinase plasminogen activator receptor in endometriotic cells. The release of urokinase plasminogen activator from endometrial stromal cells decreased during the study period both in control cultures and in cultures treated with progesterone or estradiol‐17β, but not in cultures treated with raloxifen nor in endometriotic cultures. The given hormones did not influence the release of the soluble urokinase plasminogen activator receptor. Progesterone significantly increased the urokinase plasminogen inhibitor‐1 release in endometrial cells from both patient categories, and raloxifen significantly reduced the urokinase plasminogen inhibitor‐1 release from stromal cells from both tissue categories from endometriotic patients. Estradiol‐17β had no effect.

Conclusions  This study shows that stromal cells from endometrium and endometriotic tissues release the urokinase plasminogen activator, soluble urokinase plasminogen activator receptor and urokinase plasminogen inhibitor‐1. The release is partly hormonally regulated, but differently in endometriotic than in endometrial cells.
Doppler ultrasonography in singleton pregnancies at risk of intrauterine growth retardation – a national estimate
Authors: Westergaard Hanne Brix , Langhoff‐Roos Jens
Published: March 2003

Background.  In order to assess the organizational and economical implications of Doppler ultrasonography used in high risk pregnancies, a national estimate of the use in singleton pregnancies with risk of small for gestational age (>2 SD below mean birthweight) (SGA) or intrauterine growth retardation (IUGR) was needed.

Methods. Through retrospective analyzes of both national registry data, and local clinical and ultrasonic records from Copenhagen University Hospital annual populations of singleton pregnant women with suspected IUGR and/or infants born SGA were described. The antenatal care program for assessing pregnancies with suspected IUGR was described.

Results.  In 1996 2.8% of all singleton infants were born SGA. The population had increased risk of perinatal mortality and morbidity, and about 40% had labor induced or were delivered by caesarean section, compared to 15% of the infants with normal birthweight. In the local population 79 (3.3%) of singleton infants were born SGA and 2/3 of these were considered SGA or IUGR before delivery. Of all singleton pregnancies, a total of 88 (3.7%) were assessed by ultrasonic fetometry because of a risk or clinical suspicion of SGA, and 49 (55.7%) of these pregnancies resulted in a SGA infants. Combining national and local data it is estimated that in Denmark, about 2000 women (3.1%) will be referred for ultrasonic fetometry each year because of a risk or clinical suspicion of SGA and have a mean of 2.5 fetometries. About 75% (1500) will be further assessed by Doppler ultrasonography and have a mean of 3.4 Doppler examinations.

Conclusion.  The annual number of Doppler ultrasonography examinations in singleton pregnancies with increased risk of or signs of IUGR is estimated to be about 5000.
Gestational diabetes mellitus and fetal death in Mozambique: an incident case‐referent study
Authors: Challis Kenneth , Melo Armandio , Bugalho Antonio , Jeppsson Jan O. , Bergström Staffan
Published: March 2003

Background. Third trimester fetal death is a common problem in Mozambique, occurring in approximately 5% of parturient women.

Objective. To elucidate the magnitude of the gestational diabetes mellitus problem, and to estimate its prevalence in a group of women with unexplained late fetal deaths and in women with live fetuses (referents).

Methods. An incident case‐referent study of 109 pregnant Mozambican women with fetal deaths and 110 women delivering liveborns, regarding fasting B‐glucose, oral glucose tolerance test and glycosylated hemoglobin.

Result. The difference in gestational diabetes mellitus prevalence in the two groups is not significant. The prevalence of gestational diabetes mellitus was high in both groups: 11% and 7%, respectively.
Reference range for cervical length in twin pregnancies
Authors: Fujita Mariza M. , Brizot Maria L. , Liao Adolfo W. , Bernáth Tatiana , Cury Luciana , Neto Jorge D. Banduki , Zugaib Marcelo
Published: March 2003

Background.  Twin pregnancies are at increased risk of preterm delivery, and cervical length measurement by transvaginal ultrasound examination has been shown to be an effective method of screening for this complication. The aim of the present study is to establish a reference range for cervical length measurement throughout gestation in twin pregnancies.

Methods.  Prospective study involving 144 nonselected twin pregnancies that delivered after 34 weeks and underwent ultrasound examination every 4 weeks for transvaginal measurement of cervical length. Mean cervical length measurements, 95% confidence intervals for the estimate and 95% prediction intervals were established throughout gestation by linear regression analysis.

Results.  There was a significant correlation between cervical length measurements and gestational age [cervical length (mm) = − 0.758 * gestation age (weeks) + 56.69, r=− 0.43, p < 0.0001], and mean cervical length shortened by approximately 0.8 mm per week, from 47 mm at 13 weeks to 32 mm at 32 weeks. The corresponding lower limits for the 95% prediction intervals were 29 and 15 mm, respectively.

Conclusion.  Cervical length shortens gradually throughout gestation in twin pregnancies.
Power spectral analysis of heart rate variability during acute hypoxia in fetal lambs
Authors: Min Seong‐Won , Ko Hong , Kim Chong‐Soo
Published: March 2003

Backgrounds.  The aim of the current study was to investigate the changes in the power spectral pattern of the heart rate variability of fetal lambs during acute hypoxia and the possible value of power spectral analysis as a quantitative fetal monitoring method.

Methods.  Acutely instrumented eight fetal lambs in the third trimester of gestation were subjected to reproducible hypoxia by reducing the maternal placental blood flow with complete obstruction of the maternal abdominal aorta for 60 s. Fetal electrocardiographic data 5 min prior to occlusion, 1 min during occlusion and 1, 5, and 10 min after the removal of occlusion were analyzed using power spectral analysis. Differences among the procedural steps were determined by the Friedman test with multiple comparisons using Duncan's multiple‐range test. Wilcoxon's rank sum test was used for the comparison between low‐and high‐frequency power values at each step. p< 0.05 was considered significant.

Results.  Low‐, high‐, total‐frequency power and low‐to‐high frequency ratio all significantly increased with hypoxia compared with the baseline state (p < 0.05). High‐frequency power remained higher than low‐frequency power during the resting state (baseline state, 5 and 10 min after hypoxia).

Conclusions.  Increased low‐frequency power and low‐to‐high frequency ratio during hypoxia reflects increased sympathetic activity compared with the baseline state. Higher high‐frequency power during the resting state compared with low‐frequency power reflects active respiratory movement of the fetal lambs near term and increased parasympathetic activity. It appeared possible that power spectral analysis could serve as a useful quantitative tool to monitor the autonomic changes in fetal lambs during hypoxia.
Persistent ectopic pregnancy after linear salpingotomy: a non‐predictable complication to conservative surgery for tubal gestation
Authors: Lund Claus Otto , Nilas Lisbeth , Bangsgaard Nannie , Ottesen Bent
Published: March 2003

Background.  The drawback of conservative surgery for ectopic pregnancy (EP) is the risk of persistent trophoblast. The purpose was to characterize patients who develop persistent ectopic pregnancy (PEP) after salpingotomy for EP and to assess prognostic factors.

Methods.  The medical records of 417 patients treated by salpingotomy for EP were reviewed. Forty‐eight (11.5%) patients were diagnosed with persistent EP. The data were analyzed using the Mann–Whitney U‐test, Fischer's exact test or the χ2‐test.

Results.  Of 417 women, 48 (11,5%) were treated for PEP by either repeat surgery (n= 25) or methotrexate (n= 23). Oral methotrexate failed in 4/19 cases while intramuscular (i.m.) methotrexate was successful in 4/4 cases. Women treated for PEP had a higher preoperative and a slower postoperative decline of serum human chorionic gonadotropin (hCG). Both the preoperative and the early postoperative hCG levels had a low diagnostic sensitivity (0.38–0.66) and specificity (0.74–0.77) for predicting PEP. In multivariate logistic analysis, none of the following clinical variables were predictive of PEP: duration of surgery, laparoscopic approach, history of previous EP, history of previous lower abdominal surgery, ruptured EP, pelvic adhesions, absence of products of conception at microscopy and hemoperitoneum.

Conclusions.  Persistent ectopic pregnancy can neither be predicted from clinical variables nor from single measurements of hCG with an accuracy sufficient for clinical use.
Management of missed abortion: comparison of medical treatment with either mifepristone + misoprostol or misoprostol alone with surgical evacuation. A multi‐center trial in Copenhagen county, Denmark
Authors: Grønlund Annelise , Grønlund Lars , Clevin Lotte , Andersen Bodil , Palmgren Nina , Lidegaard ØJvind
Published: March 2003

Objective.  To compare the efficacy of two different medical treatment regimens: mifepristone 600 mg orally + misoprostol 0.4 mg vaginally (Mf + Ms) or misoprostol 0.4 mg vaginally (Ms) with conventional surgical evacuation (SE) in women with missed abortion.

Materials and methods.  Prospective crossover study with alternating regimens every 4 months. The three university clinics of Obstetrics and Gynecology in Gentofte, Herlev and Glostrup of Copenhagen County. During the period October 1999 to October 2000, 176 women with missed abortion accepted to participate in the study.

Results.  The proportion of women who needed surgical evacuation after medical treatment, number of women who needed re‐evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, need of analgesics, and the subjective experiences from the participating women. Fifty‐four, 73 and 49 patients were randomized to Mf + Ms, Ms and SE, respectively. Within 1 week, complete expulsion occurred in 40 (74%), 52 (71%), 47 (96%) of the three arms, respectively. Duration of bleeding was 6.9, 7.1 and 2.5 days in the three arms, respectively (p < 0.01). Women with an initial plasma chorionic gonadotrophine (p‐hCG) between 2000 and 20 000 IU/l and a gestational age less than 75 days had a significantly better response to the medical treatment than those not fulfilling these two criteria. Initial p‐progesterone did not correlate with success of medical treatment.

Main outcome measures  Proportion of women who needed surgical evacuation after medical treatment, and the number of women who needed re‐evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, the need of analgesics, and subjective experiences from participating women.

Conclusion.  Vaginal misoprostol 0.4–0.6 mg is effective in most patients with missed abortion. Pre‐treatment with the antiprogesterone mifepristone does not increase the success rate. The selection of women with missed abortion for medical treatment based on gestational age and initial p‐hCG level may increase the success of medical treatment significantly.
Management of female genital mutilation in Djibouti: the Peltier General hospital experience
Authors: Collinet P. , Stien L. , Vinatier D. , Leroy J. L.
Published: March 2003

Female genital mutilation (FGM) is still performed on 98% of Djiboutian women. Infibulation (FGM type 3) is the most widely used method of FGM in Djibouti. Even though this operation is mutilating, illegal and sometimes results in death, it is still practiced at approximately the same rate as in the past. Mass immigration of African women to Europe, Canada, Australia and the United States in the past decade has brought the problems of FGM to these countries. Female genital mutilation is a problem unfamiliar to most Western obstetrician‐gynecologists. A tight infibulation can be a high risk for the mother and fetus if not handled by a skilled operator. It can lead to an unnecessary cesarean section as a result of the fear of handling infibulated women. Therefore, Western physicians need to be informed. The aim of this article was to share our experience of FGM. It will focus on FGM in Djibouti, its types, epidemiology and health consequences. It will present the management of obstetric and gynecologic complications and discuss medico‐legal and health service measures to combat these dangerous and unnecessary practices
Optical coherence tomography and localized defects of the retinal nerve fiber layer
Authors: Teesalu Pait , Tuulonen Anja , Airaksinen P. Juhani
Published: March 2003

Purpose: To test the capability of the optical coherence tomography (OCT) to demonstrate and quantitate retinal nerve fiber layer (RNFL) defects.

Methods: The authors examined 6 eyes of 6 chronic open angle glaucoma patients with the OCT. The patients had abnormal Humphrey 30–2 visual fields which corresponded to RNFL defects visible in monochromatic fundus images taken with a digital imaging system. The RNFL images were used for directing the OCT scans to areas where most information was believed to be obtainable. Several linear scans of different lengths across healthy and abnormal RNFL regions were made.

Results: When the OCT images were compared to RNFL photographs, the defective areas showed reduced backscattering with the OCT, being distinctly different from the adjacent normal RNFL. Except for one case the RNFL thickness values were smaller in the areas of abnormal appearance compared to areas of normal appearance.

Conclusion: This preliminary study suggests that the OCT examination results of the RNFL are in good agreement with the RNFL appearance in monochromatic fundus images.
Tapetoretinal degenerations: Experiences, experiments and expectations
Authors: Ehinger Berndt
Published: March 2003

ABSTRACT. Tapetoretinal degenerations are a common cause for vision problems, but have until recently not been amenable to rational treatment. With rapidly increasing insights into basic neurobiology and pathobiology this has now begun to change. From having been a relatively small group of largely unknown yet fairly prevalent disorders, they are rapidly forming a large set of well defined diseases, and it is easy to predict that our knowledge about them will continue to increase for many years to come. Vitamin A (15  000 IU daily) is currently the only rational treatment available. However, in experimental animals, therapy strategies are now actively being developed along several different lines. Apoptotic photoreceptor cell death can be delayed with different drugs, and at least one of them, diltiazem, is approved for human use in cardiovascular diseases. It remains to be seen if it has any clinically significant effect in human tapetoretinal degenerations. Other strategies aim at counteracting the production of harmful protein variants, acting either on DNA or mRNA levels. Transgenes can also be used to induce the production of important but missing metabolic components. Finally, cells or retina sheets can be transplanted, either to replace failing cells or as a source for missing trophic factors. Neither of these strategies has yet been transferred to humans, but trials are under way. With the high increase in the flow of new information on tapetoretinal disorders, much more precise diagnoses and much improved treatments are soon to be expected, augmenting considerably the possibilities for ophthalmologists to help patients with such diseases. It is not likely that there will be a single treatment for all the many varieties. Instead, we are most likely going to see pharmacological treatments for some of them, DNA transfers for some, and transplantations for others.
Microbiopsy in healthy rabbit corneas. A long‐term study
Authors: Kompa Sirpa , Ehlert Eike , Reim Martin , Schrage Norbert F.
Published: March 2003

Purpose: Corneal biopsies are important in diagnosing multiple corneal diseases. They were previously performed by way of keratectomy, a method that causes corneal opacity and topographic changes due to scarring. Microbiopsy is a new way to perform corneal biopsies. Before microbiopsy may be performed on human corneas, the safety of this procedure has to be proved concerning clinical development, histological changes and topographic changes after multiple biopsies.

Methods: The healthy right cornea of 24 rabbits was punctured. 12 microtrephinations in 4 different symmetric patterns were performed. The clinical development of the bioptic sites as well as the topographic changes were observed over 5 months. After enucleation, serial sections of the corneas were analysed histologically.

Results: Out of 294 performed biopsies, 291 samples could be collected. 4 perforations occurred. The initial epithelial defect closed within 3 days. A pale stromal scar remained. The histological analysis of these scars showed a facette underlined by a dense hypocellular fibrous layer and a typical star‐shaped figure consisting of a loose hypercellular stromal tissue. Only dioptric power of corneas with circle‐pattern showed a statistically significant decrease.

Conclusion: Micropuncture is a safe and efficient bioptic procedure. Even 12 micropunctures do not lead to significant changes of dioptric power in most patterns. Further studies are necessary to evaluate the reproducibility of refractive changes by circle patterns and corrections of astigmatisms.
Hyperfluorescence associated with serous retinal pigment epithelial detachment on indocyanine green angiography
Authors: Parodi Maurizio Battaglia , Saviano Sandro , Bondel Elvio , Panetta Paolo , Iustulin Daniele , Fachin Sandro , Ravalico Giuseppe
Published: March 2003

Purpose: Indocyanine green angiography has been reported to improve detection and delineation of occult choroidal neovascularisation in serous pigment epithelium detachment in age‐related macular degeneration. The study aims to evaluate the visual acuity results of eyes affected by serous pigment epithelium detachment in age‐related macular degeneration, having had indocyanine green‐directed laser photocoagulation, and to correlate them to the pattern of serous pigment epithelium detachment on indocyanine green angiography.

Methods: Thirty‐four eyes of 31 patients affected by serous pigment epithelium detachment in age‐related macular degeneration were prospectively considered. Each patient underwent an ophthalmological examination including fluorescein and indocyanine green angiography one day before, and 6 weeks, 3 months, 6 months, 9 months, 12 months and 24 months after krypton‐laser treatment. The serous pigment epithelium detachment was classified in the late‐phases angiograms as either hypofluorescent, isofluorescent or hyperfluorescent comparing the fluorescence of the serous pigment epithelium detachment with the choroidal background fluorescence.

Results: The indocyanine green‐guided laser treatment was associated with a temporary stabilization and a long‐term progressive reduction of visual acuity: after 24 months visual acuity improved in 2.9%, stabilized in 26.5% and worsened in 70.5% of cases. Serous pigment epithelium detachment presenting a pretreatment hyperfluorescence had a final visual acuity of 0.06, with subfoveal choroidal neovascularisation development in 100% of cases, whereas serous pigment epithelium detachment presenting a pretreatment hypofluorescence and isofluorescence showed a final visual acuity of 0.12, with subfoveal choroidal neovascularisation development in 43.5% of eyes, with statistically significant difference.

Conclusion: Overall visual acuity decreases with time after indocyanine green‐guided laser treatment of choroidal neovascularisation in serous pigment epithelium detachment, and serous pigment epithelium detachment becoming hyperfluorescent in the late‐phases of indocyanine green angiography has the worst functional outcome.
Arterial crimping in branch retinal vein occlusion with macular edema
Authors: Erdρl Hidayet , Akyol Nurettin
Published: March 2003

Purpose: To evaluate the effects of arterial crimping plus grid pattern laser photocoagulation on the macular edema due to branch retinal vein occlusion.

Patients and methods: Seventy two eyes (70 patients) with macular edema due to BRVO were divided into two similar groups according to age, gender, location and extent of the occluded area. Grid pattern laser photocoagulation alone was applied in 34 eyes (group A), whereas arterial crimping plus grid pattern laser was used in 38 eyes (group B). Visual acuity, central 30 degree perimetry, and fundus fluorescein angiography were carried out in all patients at each examination. Patients were followed up for an average of 23 mo (ranging from 11 to 34 mo).

Findings: A rate of 62% and 79% improvement in macular edema was recorded in groups A and B, respectively (p=0.057). The perimetric performance value improved more in group B than in group A (p=0.028). In addition, visual acuity improved more in group B than group A (p=0.041).

Conclusion: In patients with BRVO, grid pattern retinal photocoagulation treatment plus arterial crimping resulted in better visual performance two years after treatment than did grid pattern photocoagulation alone.
Visual field defects in patients taking vigabatrin
Authors: Midelfart Anna , Midelfart Erik , Brodtkorb Eylert
Published: March 2003

Purpose: To investigate visual field loss in patients on long‐term treatment with the antiepileptic drug vigabatrin, recently reported to cause visual disturbances.

Methods: Eighteen patients taking vigabatrin for 0.5–9.5 years were examined with automated perimetry up to 60° from fixation using the Humphrey Field Analyser. Five patients with epilepsy receiving other medications served as controls. Patients found to have a visual field defect underwent ophthalmologic examination.

Results: Among the 18 patients in the vigabatrin group, visual field defects categorised as mild were revealed in 6 right eyes (33%) and 8 left eyes (44.4%), while defects categorised as severe were found in 9 right eyes (50%) and 8 left eyes (44.4%). The majority of the defects (66.7% in the right eye) were peripheral constriction with nasal predominance. The location of the defects was confirmed in 8 patients also tested with Kowa AP340 perimetry.

Conclusion: According to our results, visual field defects among the patients on vigabatrin therapy may occur more frequently than previously recognised.
Retinitis pigmentosa associated with peripheral sea fan neovascularization
Authors: Kadayıfçılar Sibel , Eldem Bora , Kıratlı Hayyam
Published: March 2003

Purpose: To describe a case with retinitis pigmentosa associated with sea fan type retinal neovascularization.

Methods: Complete ocular examination including fluorescein angiography was performed in a 9‐year‐old girl.

Results: Ophthalmoscopically, in addition to arteriolar narrowing and bone corpuscular pigmentation of both retinae, a vascular lesion with surrounding intraretinal exudation was noted in the upper equatorial region of the right eye. On fluorescein angiography, the lesion stained in the form of a sea fan neovascularization.

Conclusion: Sea fan type of neovascularization can be seen in association with retinitis pigmentosa. Fluorescein angiography is important in identifying the exact nature of such a lesion.