bluuebunny/crossref_metadata_2025 huggingface dataset:
Vulvodynia ‐ a complex syndrome of vulvar pain
Authors: Paavonen Jorma
Published: November 2007

Vulvodynia is a syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. The incidence or prevalence of this condition is not known. Several subtypes of vulvodynia have been recognized. Recognition of the distinct subsets of vulvodynia is a prerequisite for successful management. Vulvar vestibulitis syndrome, cyclic vulvovaginitis, and dysesthetic vulvodynia are the most common subtypes. Other frequently misdiagnosed vulvar or vaginal conditions which can also cause culvodynia are vulvar papillomatosis, cytolytic vaginosis, lactobacillosis, and desquamative inflammatory vaginitis. In addition, many vulvar dermatoses can cause acute or chronic vulvar itching or pain, and are a frequent cause of differential diagnostic problems. In conclusion, vulvodynia is a complex multifactorial underdiagnosed clinical syndrome. Systematic epidemiologic, etiologic, and therapeutic studies of vulvodynia should be undertaken.
Background factors and scoring systems in relation to pregnancy outcome after fertility surgery
Authors: Strandell Annika , Bryman Inger , Janson Per Olof , Thorburn Jane
Published: November 2007

Background. A study was initiated to identify background factors, clinical features and pre‐operative scoring systems of importance for future selection of patients suitable for fertility surgery.

Methods. Surgical procedures, background factors and scoring systems for tubal lesions and adnexal adhesions and risk factors for ectopic pregnancy were analyzed with respect to possible correlation to subsequent fertility in a retrospective study of 246 patients undergoing fertility surgery (adhesiolysis, salpingostomy, tubal anastomoses, implantation and myomectomy) between 1986 and 1990. Follow‐up periods varied between one to six years.

Results. In 94% of cases a second look laparoscopy was performed. Adhesiolysis was done in 62%. The conception rate was 41.1%, the ectopic pregnancy rate was 14.6% and the delivery rate was 22.0%. Myomectomy procedures were most successful, with a delivery rate of 44.0% and no ectopic pregnancy. Previous ectopic pregnancy indicated a higher risk for recurrence, as did a high risk score for ectopic pregnancy. The extent of tubal damage was most relevant to subsequent fertility. Salpingostomies in women with mild or moderate tubal damage resulted in a delivery rate of 25.4% compared with those with severe damage (5.6%). No deliveries were seen after lysis of extensive adnexal adhesions.

Conclusion. Adhesion formation is not negligible and a second look laparoscopy is recommended. Women with fibroids should always be considered for fertility surgery, not only because of high success rates, but also as an adjuvant to subsequent in vitro fertilization. Patients with previous ectopic pregnancy, extensive adhesions and unfavorable tubal scores should not be considered for surgery but referred for in vitro fertilization.
The association between hormone levels and vascular resistance in uterine and ovarian arteries in spontaneous menstrual cycles – a Doppler ultrasound study
Authors: Tinkanen Helena , Kujansuu Erkki , Laippala Pekka
Published: November 2007

Ninety‐four infertility patients were studied by Doppler ultrasound during spontaneous ovulatory menstrual cycles. The pulsatility index (PI) in uterine and ovarian arteries was measured in the follicular and midluteal phase of the cycle. Associations between high PI values and hormones (estradiol, progesterone, prolactine. testosterone, follicle stimulating hormone) measured during the investigated cycle and age were evaluated. A high PI in uterine arteries in the follicular phase was associated with low estradiol (E2) and progesterone (P) levels in the studied cycle. In the luteal phase PI values of uterine arteries have no obvious association with E and P levels, and other vasoactive compounds influence the perfusion of uterus during this period. The other hormones analysed and age did not correlate with vascular resistance in spontaneous ovulatory cycles.
Varicella pneumonia complicating pregnancy
Authors: Zambrano Miguel A.R. , Martinez Angel , Minguez Jose A. , Vázquez Fernando , Palencia Rafael
Published: November 2007

Varicella pneumonia can endanger the life of pregnant women. We have a case of varicella pneumonia complicating pregnancy in the third trimester. The patient required intubation, early treatment with acyclovir (700 mg/IV every eight hours), as well as the extraction of the fetus by cesarean section before the time gestation was completed. Early treatment with acyclovir has improved hope for these patients.
Prenatal diagnosis of osteogenesis imperfecta
Authors: Berge Lillian N. , Marton Valeria , Tranebjærg Lisbeth , Kearney Michael S. , Kiserud Torvid , Øian Pal
Published: November 2007

The lethal perinatal types (II A‐C) of osteogenesis imperfecta are reported to occur in approximately 1:55000 births. We here present three cases in three unrelated families, diagnosed by antenatal ultrasound within one year. A reliable diagnosis of the lethal perinatal type of osteogenesis imperfecta can be made by ultrasound examination during the second trimester, by identification of fractures of the long bones. The compression of the fetal head by the ultrasound probe and the low echogeneity of the cranium, should raise the suspicion of skeletal dysplasia, but is not diagnostic for osteogenesis imperfecta. The diagnosis is confirmed by postmortem examination including radiography and biochemical studies of cultivated fibroblasts from the fetus. Although rare, this lethal condition should be recognized when an ultrasound examination is performed, to prevent unnecessary obstetric intervention. In families with a previously affected fetus, prenatal diagnosis by first trimester transvaginal ultrasound investigation or chorionic villus sampling should be discussed.
Treatment of vaginal recurrence in endometrial cancer
Authors: Møller Lars Alling , Engelholm Svend Aage
Published: November 2007

Background. We have reviewed the literature concerning vaginal recurrence in endometrial cancer with emphasis on prognostics and therapeutic results. Compared to the overall outcome of recurrences (11‐17 per cent survive more than 3‐19 years) the survival rate of strictly vaginal recurrence appears significantly higher (up to 60‐70 per cent survive more than 5 years). However, the prognosis deteriorates significantly in cases where recurrences prove to be more widespread. Other factors towards predicting a poor outcome are high age, high stage, high grade, detection of papillary carcinoma, rapid recurrence, location to the lower part of vagina, large tumorsize, and previous radiation.

Methods. Different methods of initial treatment and cross‐relations between most prognostic factors renders any ranking of prognostic factors almost impossible.

Results. Standard treatment of vaginal recurrence including combined external and intra vaginal radiation used for decades have been unable to improve survival rate.

Conclusion. We suggest a more individualized treatment based on exact delineation of the disease.
Conservative versus radical surgery for tubal pregnancy
Authors: Clausen Ingo
Published: November 2007

Objective. The aim of this work was to analyse the fertility prognosis after conservative or radical surgery for tubal pregnancy.

Data sources. Index Medicus was searched for all attainable literature on the subject. Methods of study selection. A total of 40 scientific publications through the latest 40 years were selected. For fulfilling the selection criterias the study design should appear clearly. Furthermore the rate of women obtaining intrauterine pregnancy and the rate of repeat ectopic pregnancy following radical or conservative tubal surgery was to be compared using 95% confidence limits. The results from each report were compared in four groups according to study design i.e. retrospective non‐comparing materials, retrospective comparing studies, prospective selected treatment series or prospective randomized comparing investigations. Data extraction and synthesis. Pooling the results from the retrospective noncomparing materials revealed that there was no significant difference in intrauterine pregnancy rates, i.e. 46% following conservative tubal surgery and 44% after radical surgery. The repeat ectopic pregnancy rate was 10% following conservative surgery and 15% after radical surgery. In the group of restrospective comparing studies only one of 15 materials could document a significant better intrauterine pregnancy rate after conservative tubal surgery than following radical treatment for tubal pregnancy. There were no differences either in this group in repeat ectopic pregnancy rates. Prospective investigations were almost exclusively represented by selected conservative treatment series. In these series the average intrauterine pregnancy rate was 57% and the repeat ectopic pregnancy rate was 13%.

Conclusions. In studies on fertility after radical or conservative surgical treatment for tubal pregnancy no significant difference in intrauterine pregnancy rates or repeat ectopic pregnancy rates were found. Prospective selected treatment series demonstrated higher intrauterine pregnancy rates than retrospective studies. The repeat ectopic pregnancy rate was not raised in prospective series. No prospective randomised trial was found.
Effects of estradiol and interaction with progesterone or oxytocin on term human myometrial contractile activity
Authors: Fu Xin , Moberg Christian , Bäckström TorbjÖRn , Ulmsten Ulf
Published: November 2007

Background. To investigate the effects of estradiol (E2) alone and in combination with progesterone or oxytocin on contractile activity of term human myometrium in vitro.

Methods. Myometrial specimens were obtained from 24 term pregnant women not in labor who underwent elective cesarean. Biopsies were kept in ice‐cold and oxygenated Hepes buffer and buffer containing different hormonal solutions. The biopsies were dissected and mounted in tissue baths at 37d`C and isometric tension was recorded.

Results. (1) Estradiol at 0.1 and 1 μg/mL increased the contractile frequency (p<0.01 for each), decreased the tonus (p<0.05 and p<0.01) and suppressed the activity area of contractions (p<0.05 and p<0.01) as compared to control. (2) No significant differences in frequency and activity area of contractions between strips superfused with E2 plus progesterone and progesterone alone were recorded. Myometrial tonus was decreased by 0.1 μg/mL or 1 μg/mL E2 plus progesterone as compared to progesterone alone (p<0.05 and p<0.01). (3) There were no significant differences in frequency between strips superfused with E2 plus oxytocin and oxytocin alone. Myometrial tonus was decreased by 0.1 μg/mL or 1 μg/mL E2 plus oxytocin as compared with oxytocin alone (p<0.05 and p<0.01). Estradiol at 0.1 μg/mL or 1 μg/mL plus oxytocin reduced the activity area of contractions compared to oxytocin (p<0.05 and p<0.01).

Conclusions. These data suggest that E2 had both stimulatory and inhibitory effects on term human myometrial contractility and that E2 altered the myometrial response to progesterone and oxytocin mainly by decreasing tonus.
The relationship between psychological distress during pregnancy and birth weight for gestational age
Authors: Hedegaard Morten , Henriksen Tine Brink , Sabroe Svend , Secher Niels Jørgen
Published: November 2007

Background. Fetal growth may be determined by genetic as well as environmental factors. Whether psychological distress during pregnancy influences fetal growth is a matter of debate.

Material and methods. A prospective population‐based study with repeated measures of psychological distress (General Health Questionnaire) during pregnancy, based on the use of questionnaires. Danish speaking women with singleton pregnancies attending antenatal care between August 1, 1989 and September 30, 1991 were eligible to the study (n = 8719). Of these women 5868 women (67%) completed all questionnaires. The main outcome measure was fetal growth (assessed as birth weight for gestational age (continuous)) and birth weight below the 10th percentile of birth weight for gestational age (light for gestational age (LGA) (dichotonmus). Gestational age was calculated primarily from an early ultrasound scan. Confounders were controlled using multivariate statistical methods.

Results. Birth weight for gestational age and risk of delivering a LGA baby were not associated with psychological distress, neither distress in 16th week nor in 30th week of pregnancy.

Conclusion. To the extent that fetal growth can be explored at birth, the results indicate that psychological distress does not influence fetal growth.
Endocervical cell retrieval following excisional treatment of CIN
Authors: Urbaniak Krzysztof J. , Widjaja Andreas
Published: November 2007

Background. The purpose of our study was to compare laser cone excision with large loop excision of the transformation zone with particular respect to the retrieval of endocervical cells on follow‐up cervical cytology.

Methods. Retrospective analysis of case records of 368 women who had large loop excision of the transformation zone and 188 women who had laser cone excision for suspected CIN changes at Middlemore Hospital, Auckland.

Results. The retrieval of endocervical cells on cervical cytology following large loop excision was 94.7% and 85.2% following laser cone excision. Laser cone excision was associated with a higher chance of normal follow‐up cervical cytology.

Conclusions. The retrieval of endocervical cells was satisfactory following both large loop excision and laser cone excision. Laser cone excision is recommended with large or more severe lesions.
The prevalence of spontaneous endometriosis in the baboon (Papio anubis, Papio cynocephalus) increases with the duration of captivity
Authors: D'hooghe Thomas M. , Bambra Charanjit S. , De Jonge Inge , Lauweryns Johan M. , Koninckx Philippe R.
Published: November 2007

Background. It is not known whether stress affects the prevalence of endometriosis in women. Baboons with spontaneous endometriosis may be interesting models to study the human disease. For baboons, living in captivity is a period of chronic stress without continuous exposure to pregnancy. This study was done to compare the prevalence of endometriosis between baboons recently captured in the wild and those living in captivity for several years. Methods. A diagnostic laparoscopy was performed for screening endometriosis and obtaining biopsies in 104 female baboons including animals that had been captured in the wild less than 1 year ago (n=52. Group I), primates that had been living in captivity for one to two years (n=30. Group II) and animals that had been captured for more than two years (n=22, Group III).

Results. The prevalence of clinical and biopsy‐proven endometriosis in all baboons was 17% and 12%, respectively. Clinical endometriosis was found more frequently in group III (32%) than in group II(17%) or group I (11%). The prevalence of biopsy‐proven endometriosis was also significantly higher in group III (27%) than in groups I and II combined (8%, p=0.03). Conclusions. The results indicate that the prevalence of endometriosis increases with the time spent in captivity. This trend may be explained by more menstrual cycles uninterrupted by pregnancy in captive than in wild baboons, and possibly also by age‐related factors or by captivity‐associated stress.
Accuracy of the umbilical arteries Doppler flow velocity waveforms in detecting adverse perinatal outcomes in a high‐risk population
Authors: Todros Tullia , Ronco Guglielmo , Fianchino Ornella , Rosso Stefano , Gabrielli Sandro , Valsecchi Luca , Spagnolo Daniele , Acanfora Luisa , Biolcati Marilisa , Segnan Nereo , Pilu Gianluigi
Published: November 2007

Objective. To define the accuracy of the umbilical artery Doppler flow velocity waveforms, according to different cut‐off values, in predicting adverse perinatal outcomes among fetuses at high risk of hypoxic complications.

Subjects. Two hundred and sixty‐five pregnant women with diagnosis of small for gestational age fetus and/or pregnancy induced hypertension studied in four Italian ultrasound units. Methods. Prospective study. Serial Doppler ultrasound measurements of the umbilical artery were performed. Results were not available for clinical management. Cut‐off curves, corresponding to different age‐specific centiles of the pulsatility index distribution among pregnancies resulting in healthy newborns, regardless of birthweight, were computed by regression methods. Sensitivity, specificity, positive predictive value and negative predictive value of such cut‐off curves, and of absent/reverse end‐diastolic flow, in predicting different adverse outcomes were estimated. The adverse outcomes were: perinatal or neonatal death (OUTCOME 1). Death or Apgar<7 at 5′ or need for admission to intensive care unit or other hypoxic related abnormalities (OUTCOME 2). Either OUTCOME 2 or birthweight<10th centile (OUTCOME 3). Both OUTCOME 2 and birthweight<10th centile (OUTCOME 4). Results. The best accuracy was in predicting OUTCOMES 1 and 4. Positive predictive value increased strongly with higher cut‐off curves while negative predictive value only decreased slightly. For absent/reverse end‐diastolic flow, negative predictive value and positive predictive value were respectively 94% and 39% for death, and 81% and 72% respectively for OUTCOME 2. For the 95th centile curve the corresponding figures were 96%, 33% and 84%, 67%. The 60th centile curve had a 85% and 74% sensitivity value for death and OUTCOME 2 respectively, but the corresponding positive predictive values were 18% and 40% only.

Conclusions. The findings of an absent end diastolic flow or of pulsatility index values above the 95th centile curve strongly suggest it is time to deliver the fetus. The 60th centile curve is the most suitable to recognize fetuses at risk for abnormal outcome, but early delivery should be avoided because of its low positive predictive value.
Different responses of insulin, C‐peptide, and testosterone to an oral glucose tolerance test in two groups of women with polycystic ovarian syndrome
Authors: Ke Wu Xiao , Shan Gu Qiu , Hua Su Yan
Published: November 2007

Background. To further investigate the relationship between inappropriate gonadotropin. hyperinsulinemia and androgen excess.

Methods. We divided women with polycystic ovarian syndrome (PCOS) into two groups on the basis of LH/FSH (LH/FSH ≥3, Group 1. n=30: LH/FSH<3, Group 2, n=25) and measured the responses of insulin. C‐peptide (C‐P). C‐P/insulin (C‐1) and testosterone concentrations to an oral glucose tolerance test (OGTT) in these patients and 15 control subjects. Results. Significant positive correlations were found between basal LH and T (r‐0.58. p<0.05) in Group 1, and between fasting serum insulin and T (r=0.48. p<0.05) in Group 2. Although these patients had higher, delayed insulin and C‐P responses to OGTT than the control group, much greater insulin and C‐P levels and lower C/I values were found in Group 2. T concentrations decreased mildly during OGTT in Group 1 and the control, while they increased slightly in Group 2.

Conclusion. Our data suggest that hyperinsulinemia in PCOS is due to a enhanced β‐cell secretion and an impaired hepatic clearance of this hormone, hyperandrogenism may be LH‐dependent in Group 1 and insulin‐dependent in Group 2.
New disposable vaginal device (continence guard) in the treatment of female stress incontinence
Authors: Thyssen Hans , Lose Gunnar
Published: November 2007

Background. To develop a new disposable vaginal device for use during the daytime, and test its efficacy and short‐term safely in the treatment of stress incontinence.

Methods. The intravaginal support device was designed from polyurethane. a foam product with documented high tissue compatibility. It was tested in 26 women with the symptom of stress incontinence. Before and after one month's use of the device, a 24‐hour home pad weighing test, uroflowmetry, postvoid residual urine and a 3‐days voiding diary were made. A questionnaire about the subjective effect and adverse events was filled in. In vitro and in vivo microbiology testing were performed.

Results. Four women discontinued the treatment because of discomfort or difficulties in using the device. Out of 22 women who completed the study nine (41%) were subjectively cured of incontinence, ten (45%) improved while three (14%) claimed unchanged incontinence. With the device in place all had decreased leakage at the 24‐hour pad weighing test and unchanged urodynamic tests. The subjective complaints were few, and no vaginal or urinary infections were found. All women whose condition both subjectively and objectively improved, (19/22) wanted to continue treatment with the device.

Conclusions. The new disposable vaginal device is effective in alleviating the symptoms of stress incontinence. It is well accepted and safe.
Toxic Hepatitis: a Rare Complication Associated with the use of Ritodrine During Pregnancy
Authors: de Arcos Francisco , Gratacós Eduard , Palacio Montserrat , Cararach Vicenç
Published: November 2007

Objectives. To evaluate the incidence of toxic hepatitis associated with the use of ritodrine in pregnancy.

Design. A prospective study.

Setting. A large teaching hospital in Barcelona. Spain.

Patients: One hundred and twenty‐three consecutive pregnant women, 101 singleton and 22 multiple pregnancies, receiving intravenous ritodrine with normal transaminase levels prior to the initiation of therapy.

Measurements. Serum glutamic pyruvic transaminase (SGPT) and glutamic oxaloacetic transaminase (SGOT). gamma‐glutamyl transpeptidase (GGT). alkaline phosphatase (PA), direct and total bilirubin.

Results. In two (1.9%) of 101 singleton and two (9.1%) of 22 multiple pregnancies, elevation of SGOT and SGPT levels was detected. PA, GGT, and bilirubin were normal in all women studied. Other causes of hepatitis were ruled out, and no other signs of liver impairment were found in these women. Transaminase levels recovered rapidly in all cases after discontinuation of therapv

Conclusion. Elevation of liver enzymes is a rare complication of ritodrine. Discontinuation of therapy does not appear to be indicated as long as other signs of liver dysfunction are not present and tocolytic treatment is required.
Effect of Dehydroepiandrosterone Sulfate on Fetal Middle Cerebral Artery Flow Velocity Waveforms in term Pregnancy
Authors: Hata Toshiyuki , Senoh Daisaku , Hata Kohkichi , Kitao Manabu , Masumura Sumio
Published: November 2007

Objective. To investigate whether bolus injection of dehydroepiandrosterone sulfate (DHAS) is associated with changes in fetal middle cerebral artery flow velocity waveforms in term pregnancy.

Methods. Ten normal full‐term pregnant women received the administration of a 200‐mg intravenous dose of DHAS in 20 ml of 5% dextrose. Ten normal full‐term pregnant women received 20 ml 5% dextrose as controls. Color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were made on fetuses in each group before and 10 min, 30 min, 60 min, 90 min, and 120 min after DHAS or dextrose administration. The pulsatility index (PI) values for the middle cerebral artery, and umbilical artery, and fetal heart rate were recorded.

Results. In the DHAS group, middle cerebral artery PI decreased from baseline by 24% (p<.05) after 10 min, and the mean reduction was 22% (p<.05) after 30 min. The PI returned to the baseline value 60 min later. In the control group, there was no change in middle cerebral artery PI. No change was found in umbilical artery PI or fetal heart rate in the control or DHAS group.

Conclusion. DHAS induces a significant decrease in the fetal middle cerebral artery PI, which suggests a possible decrease in fetal cerebral vascular impedance in term pregnancy.
Validity of Self‐Reported Smoking Habits in Pregnancy: a Saliva Cotinine Analysis
Authors: Parazzini Fabio , Davoli Enrico , Rabaiotti Manuela , Restelli Simona , Stramare Luca , Dindelli Moreno , La Vecchia Carlo , Fanelli Roberto
Published: November 2007

Background. We examined the validity of self‐reported cigarette smoking during the third trimester of pregnancy using saliva cotinine as a marker

Methods. Eligible for the study were 109 pregnant women attending the outpatient Prenatal Service of the Luigi Mangiagalli Clinic (the largest maternity clinic in Milan) for routine prenatal visits during the third trimester of pregnancy on twenty days in 1994. Women self‐reporting current smoking or quitting smoking in pregnancy were asked to provide a saliva sample. Cotinine concentration was analyzed and classified as follows: cotinine not detectable, not probable nicotine use or passive exposure; cotinine <10 ng/ml, not probable nicotine use/probable passive exposure; cotinine, $10 ng/m. probable occasional or regular nicotine use. Results. A total of 57 (52.3%) women were non‐smokers at conception and were excluded from any subsequent analysis. Of the remaining 52 women, 25 self‐reported quitting smoking in pregnancy and 27 were current smokers. Saliva cotinine levels were below 10 in 20 of the 25 subjects reporting quitting smoking in pregnancy. The five cases with cotinine $10 reported a husband smoking more than 10 cigarettes per day. Among the 26 current smokers, seven had a cotinine level $10 ng/ml (four reported smoking fewer then five cigarettes per day and two reported smoking five or more per day); in 20 cases the cotinine value was $10 ng/ml. Conclusions. These findings provide evidence of a satisfactory validity of self‐reported smoking habits in pregnancy.
The effects of estradiol valerate plus medroxyprogesterone acetate and conjugated estrogens plus medrogestone on climacteric symptoms and metabolic variables in perimenopausal women*
Authors: Egarter Christian , Geurts Paul , Boschitsch Ewald , Speiser Paul , Huber Johannes
Published: November 2007

Background. Two sequential hormone replacement regimens, containing either estradiol valerate plus medroxyprogesterone acetate (E2V/MPA) or conjugated estrogens plus medrogestone (CE/MED). were compared with respect to effects on climacteric symptoms, lipid metabolism, and hemostasis.

Methods. In an open, multicenter study. 51 perimenopausal women were randomized to E2V/ MPA and 50 to CE/MED. Assessment of climacteric complaints was performed at baseline and at months 1, 3. and 6. The effects on lipid and hemostatic variables were measured at baseline and at month 6. Quantitative data were analyzed using analysis of variance, the paired t‐test, or the χ2 Mantel‐Hänszel test, where appropriate.

Results. Efficacy regarding treatment of climacteric symptoms was with E2V/MPA as good as with CE/MED. with a statistically significant reduction of most symptoms in both groups. After 6 months, total cholesterol and triglycerides had remained unchanged in both groups. High‐density lipoprotein cholesterol showed no significant change with E2V/MPA. whereas an increase was noted in the CE/MED group (p<0.05). Low‐density lipoprotein cholesterol was decreased with E2:V/MPA (p<0.05) and was unchanged in the CE/MED group. Hemostatic parameters showed no significant changes after 6 months, with the exception of a decreased prothrombin time with E2V/MPA (p<0.05). Acceptability was excellent, expressed by the low incidence of treatment‐related drop‐outs in both groups.

Conclusions. E2V/MPA is a one tablet per day sequential HRT regimen, which is as effective and acceptable as hormone replacement therapy with CE/MED regarding treatment of climacteric symptoms. Neither preparation had negative effects on lipid metabolism and hemostatic variables.
Previous ectopic pregnancy should be considered a contraindication for microsurgery
Authors: Strandell Annika , Thorburn Jane
Published: November 2007

Background. To estimate the risk of subsequent ectopic pregnancy (EP) after tubal surgery, given that the woman becomes pregnant, by means of a logistic model, a retrospective study was initiated.

Methods. During the period 1986‐1990. 221 women with tubal infertility underwent microsurgery. Subsequent fertility was evaluated in 1991. Ninety women conceived, of whom 84 were included in the study (30 with EP and 54 with intra‐uterine pregnancy as the only outcome). Clinical background factors of importance, surgical procedures used, scoring systems for tubal lesions, adnexal adhesions and risk of EP were analysed for possible correlation to subsequent EP. These factors were further used in a logistic model to estimate the risk of subsequent EP as only outcome.

Results. The risk of EP after microsurgery is minimum 15% without any risk factors. Previous EP and endometriosis could be identified as factors with prognostic power in the logistic model. One previous EP implies a 60% risk, whereas two previous EPs and endometriosis increases the risk to 95%.

Conclusion. Patients with previous EP should generally not be considered for microsurgery owing to the high risk of recurrence and to the reduced chance of intra‐uterine pregnancy.
Abdominal hysterectomy should not be considered as a primary method for uterine removal: A prospective randomised study of 100 patients referred to hysterectomy
Authors: Langebrekke Anton , Eraker Runar , Nesheim Britt‐Ingjerd , Urnes Arne , Busund Bjørn , Sponland Geir
Published: November 2007

Objective. The present study is a prospective randomized comparison of laparoscopically assisted vaginal hysterectomy (LH) with total abdominal hysterectomy (TAH).

Methods. 100 patients referred for uterine removal were included in the study, 46 undergoing LH and 54 TAH. at two teaching hospitals in Norway.

Results. In the LH group, the duration of surgery was longer while duration of hospitalization and time from operation to return to normal activity were shorter as compared to the TAH group. Postoperative pain, assessed by the need for analgesics, was less in the LH group. All these differences were statistically significant. There were two ureteral lesions in the LH group, and one center withdrew early from the study for this reason.

Conclusions. In expert hands. LH as a primary method for uterine removal is superior to TAH.
A study of monoamine oxidase activity in fetal membranes
Authors: Sekizawa Akihiko , Ishikawa Hiromi , Morimoto Taro , Hirose Kazuhiro , Suzuki Akira , Saito Hiroshi , Yanaihara Takumi , Arai Yuichiro , Oguchi Katsuji
Published: November 2007

Objective. To study the role of decidual monoamine oxidase (MAO) ‐A and ‐B activities before delivery, the relationship between MAO activity in fetal membranes and catecholamine (CA) concentration in amniotic fluid (AF) was determined.

Methods. Fetal membranes and AF were obtained at the time of elective Cesarean section (CS group, n=11) and Cesarean section due to fetal distress without labor pains (FD group, n=5). MAO‐A and ‐B activities were radiometrically measured using 14C‐5‐hydroxytriptamine for MAO‐A substrate and 14C‐benzylamine for MAO‐B substrate. CA concentrations in AF were measured by high performance liquid chromatograph with an electro‐chemical detector.

Results. Both MAO‐A and ‐B activities in decidua obtained from CS were significantly lower than those obtained from FD. Both norepinephrine (NE) and epinephrine (EP) concentrations were significantly lower in the CS group than the FD group. A significant positive correlation between decidual MAO‐A activity and NE concentration in AF was observed. No significant correlation was observed between MAO‐B activity and the concentration of NE in AF. There was no correlation between EP concentrations and MAO activities.

Conclusion. These results suggest that CA concentration in AF may be related to the activity of MAO in fetal membranes, determined by certain physiological processes during pregnancy. It has been suggested that metabolism of monoamines in fetal membranes also plays an important role in reducing monoamine influx into maternal myometrium from the AF.
Pregnancy related changes in some cardiovascular risk factors
Authors: Berge Lillian Nordbø , Arnesen Egil , Forsdahl Anders
Published: November 2007

Background. Certain risk factors for development of ischemic heart disease are influenced by pregnancy related changes of female sex hormone levels.

Postpartum values were similar to prepregnancy levels, except serum triglycerides which remained 35% higher (p<0.001) and blood glucose (p<0.05).

Conclusions. The major serum lipid fractions, and blood glucose, were significantly different during pregnancy and postpartum, which may influence the risk of cardiovascular disease development in women.

Methods. As a part of the cardiovascular risk factor studies in Finnmark county, Norway, 1974‐75 and 1977‐78, cross‐sectional clinical and non‐fasting laboratory data were obtained prior to conception (n=463), during pregnancy (n=335), and following delivery (n=451).

Results. Compared with prepregnancy values, total cholesterol was on average 7% lower in the first trimester (p<0.001), and 30% higher at the end of gestation (p<0.001). High density lipoprotein cholesterol was 38% higher at mid‐pregnancy (jxO.001), but only 14% higher in the last trimester (p<0.01). Serum triglycerides were 18% lower in the first (p<0.001) and 123% higher in the third trimester (p<0.001). Blood glucose was 5% lower than baseline in mid‐pregnancy (p<0.001). Except for the second trimester, when only 27% of women smoked, more than 40% of the women examined were smokers.
Sexual risk behavior and history of sexually transmitted diseases in relation to casual travel sex during different types of journeys
Authors: Arvidson Maria , Hellberg Dan , Mårdh Per‐Anders
Published: November 2007

Objectives. The study investigated if women with experience of casual travel sex, with a previously unknown man abroad, on different types of journeys (charter, vagabond, business and education trips), differ with regard to sexual risk behavior and history of sexually transmitted diseases (STDs).

Study design. The study population consisted of 996 women. Of these, 27.7% admitted that they had had casual sex during journeys. The remaining women were used as a comparison group. History of STDs and sexual risk behaviors were investigated.

Results. The frequency of women who had more than ten lifetime sexual partners were greatly increased in all groups, as compared to the controls. A history of gonorrhea was most frequent among the charter travellers. A history of genital chlamydial infection was most common among the vagabond travellers. The lowest frequencies of a history of STDs was observed in women engaging in casual sex on “business’ journeys and they had significantly less often a history of STDs as compared to the charter travellers. A high frequency of STDs were seen in women who had experience of casual sex on different types of journeys.

Conclusion. Women on business trips, although they had a similar sexual risk behaviour as the other groups of travellers, had less often a history of STDs.
Biochemical changes in the cervical mucus after application of laminaria tent
Authors: Maradny Emad El , Kanayama Naohiro , Halim Abdul , Maehara Kayoko , Kobayashi Takao , Terao Toshihiko
Published: November 2007

Background This research was aimed to study the biochemical changes in cervical mucus after application of laminaria tent.

Material and methods Cervical mucus was collected before and after insertion of laminaria tent from 20 normal pregnant women in the first and second trimesters. Interleukin‐1β, IL‐8, collagenase activity, elastase activity, PGE2 and PGF2α were measured in the collected samples.

Laminaria tent was also inserted in one vaginal cervix of five non‐pregnant rabbits and the clinical and histological changes were compared with five non‐treated rabbits. Collagen contents were assessed histologically and Leukocyte number was counted. Results IL‐1β and IL‐8 and elastase activity were significantly increased after insertion of laminaria (p < 0.0001, 0.001 and 0.001 respectively). Collagenase activity was not significantly changed. Whereas concentration of PGE2 and PGF2α in the mucus were markedly increased (p < 0.0001 and 0.001 respectively).

Collagen contents were significantly decreased in laminaria and opposite side cervices (p < 0.0001). No significant changes in leukocyte count could be observed in treated and non treated cervices.

Conclusions Insertion of laminaria leads to increase concentration of IL‐1β, IL‐8, PGE2, PGF2α and elastase activity. Mechanical stretching of the cervix and biochemical changes in cervical mucus may explain the mechanism of cervical ripening induced by laminaria.
Second trimester routine ultrasound and abnormal findings
Authors: Eurenius Karin , Axelsson Ove , Eriksson Lars
Published: November 2007

Objective To estimate the detection rate of abnormal findings, especially fetal anomalies, at second trimester ultrasound screening performed in a way representative of Swedish antenatal clinics.

Design A prospective study carried out over two years in Uppsala county, Sweden, including 8,228 unselected pregnant women (8,345 fetuses). The ultrasound scans were performed by specially trained mid wives.

Main outcome measures The number of abnormalities suspected by the midwives and the number of abnormalities confirmed by the obstetricians were registered, as was pregnancy outcome for these cases.

Results Midwives reported suspected abnormalities at the screening procedure in 59 cases (0.7%), abnormalities were confirmed by obstetricians in 42 cases (0.5%, of which 0.36% were fetal malformations). Seventeen of these 42 pregnancies were terminated and 11 ended with miscarriages or intrauterine fetal deaths. Fourteen of the 42 pregnancies ended with a live born infant, of which two died postnatally.

Conclusions The described ultrasound screening procedure led to suspected abnormalities in 0.7% of the scanned cases and to confirmed abnormalities in 0.5% of the cases. The outcome for the confirmed abnormalities was poor, as 71% were either terminated or ended with miscarriage or perinatal death.
Uterine evacuation by vaginal misoprostol after second trimester pregnancy interruption
Authors: Bugalho Antonio , Bique Cassimo , Pereira1 Caetano , Granja Ana Carla , Bergstrom Staffan
Published: November 2007

Background The purpose was to study the capacity of vaginal misoprostol in combination with methylergometrine to achieve complete evacuation of the uterus without ensuing surgical evacuation of the uterine cavity.

Methods We performed this trial on 228 women seeking pregnancy interruption. Vaginal misoprostol was given in a dosage of 800 μg in early second trimester. All women received concomitant treatment with peroral methylergometrine from the moment of misoprostol application every 8 hours until uterine evacuation. Follow‐up was continued until the first menstruation after interruption.

Results Complete uterine evacuation was achieved in 173/228 cases (76%) [group 1]. The remaining 55 women [group 2] underwent manual evacuation of placental remnants trapped in the cervix. In seven of these women a conventional curettage was carried out due either to ultrasound evidence of placental remnants or due to uterine bleeding. The interval between misoprostol application and fetal expulsion averaged 14.9 hours (s.d. 9.6) in group 1 and 21.0 hours (s.d. 14.5) in group 2 (p = 0.006).

Conclusions Misoprostol, in combination with methylergometrine, is a remarkably efficient drug in achieving uterine evacuation also in the absence of surgical evacuation of the uterine cavity. The present study provides justification for a more expectant attitude after vaginal misoprostol treatment for pregnancy interruption. The avoidance of close to 80% of otherwise conventional curettages would seem to represent a major advantage, particularly in settings where manpower and material resources are scarce.
Effect of the non‐peptide, vasopressin V1a receptor antagonist, SR 49059 and its enantiomer, SR 49770, on isolated human myometrium
Authors: Bossmar Thomas , Rasmussen Thomas , Åkerlund Mats
Published: November 2007

Background. Vasopressin seems to be an important etiological factor for the myometrial hyperactivity and reduced blood flow in primary dysmenorrea. Substances which block the action of vasopressin on the uterus are therefore of interest.

Methods. The effect of an orally active, non‐peptide vasopressin V1a receptor antagonist, SR 49059, as well as its enantiomer, SR 49770, which is 50 to 100 fold less potent in binding studies, were tested in vitro on myometrium from 14 subjects. Two doses of the compounds, 2 nmol/L and 10 nmol/L, were used for counteracting the contractile effect of arginine vasopressin in a concentration of 0.7 nmol/L.

Results. SR 49059, in the lower concentration, significally decreased the response to arginine vasopressin, measured as area under the recording curve, to 48 per cent of that to the agonist alone, and in the higher dose to 28 per cent. SR 49770 was much less potent in reducing the response to vasopressin.

Conclusion. The myometrial action of arginine vasopressin is exerted via V1a receptors. The potent stereospecific inhibitory effect of SR 49059 on arginine vasopressin‐induced myometrial activity indicates that the compound acts specifically through V1a receptors and may have a therapeutic potential in primary dysmenorrea.
Endometrial and fetoplacental markers in pregnancies with fetal congenital nephrosis
Authors: Heinonen Seppo , Ryynänen Markku , Kirkinen Pertti , Saarikoski Seppo
Published: November 2007

Objective. Congenital nephrotic syndrome of the Finnish type [CNF] is an autosomal recessive disorder leading to death in early childhood, if treated conservatively without early renal transplantation. Prenatal screening at midtrimester is feasible by measuring maternal serum alpha‐fetoprotein [MSAFP], elevated amniotic fluid [AF] AFP being the only diagnostic test in population screening. We studied whether concentrations of other pregnancy‐related markers offer any ancillary procedure for screening.

Methods. In a prospective case‐control study, the concentrations of maternal serum human chorionic gonadotropin [hCG], unconjugated estriol [uE3], human placental lactogen [hPL] and placental protein 14 [pp14] were measured in samples from six singleton pregnancies associated with fetal CNF and from 18 matched controls at 15 weeks of gestation.

Results. In the CNF group, mean hCG and pp 14 concentrations were slightly elevated, whereas uE3 and hPL concentrations were within the lower normal range. None of these differences were statistically significant and the distribution of these values was too wide to use them for screening.

Conclusions. Low unconjugated E3 and elevated hCG concentrations were expected, since newborns with CNF are growth‐retarded and have large placentas. The extent of these alterations was not sufficient to identify high risk pregnancies. Substantial differences in the maternal serum concentrations of hPL and pp 14 were not observed. Hence, MSAFP screening at midtrimester is the strategy of choice for prenatal detection of CNF.
Preliminary experience in pelviscopic uterine suspension using Webster‐Baldy and Franke's method
Authors: Koh Lim‐Woh , Tang Francisco C. , Huang Ming‐Huo
Published: November 2007

Objective. To find which method gives the best relief from dyspareunia and pelvic pain caused by a retroverted uterus using the two methods mentioned as compared to other methods reported in the medical literature.

Subjects. Twenty‐five patients, with ages ranging from 25‐55 years old, complaining of mild to severe pelvic pain and dyspareunia seeking treatment in our OPD were evaluated and treated in a span of 3 years' time.

Methods. Pelviscopic retrouterine ligament fixation using Webster‐Baldy and Franke's method were done after each patient was evaluated as to the uterine position, degree of misalignment of the uterus and severity of adhesion. Pelvic pain and dyspareunia were reproduced by palpation of the retroverted uterus. Ultrasonographies were performed to confirm initial findings and to rule out any ovarian or uterine abnormalities. Orthopedic and psychological consultations were done to rule out any orthopedic disorders or non‐organic causes of their problem.

Results. Of the twenty‐five patients treated, 20 patients were treated using Webster‐Baldy method and five patients were treated using Franke's method, all the patients (100%) experienced great improvement 6 weeks after the operation. After 6 months, 16 patients (80%) with the Webster‐Baldy method and four patients (80%) with the Franke's method had complete relief from pelvic pain and dyspareunia. The remaining four patients (20%) with the former method and one patient (20%) with the latter method complained of mild abdominal discomfort. After 6 months to 2 years of follow‐up, 17 patients with Webster‐Baldy method and five patients with Franke's method (88%) had improved sexual life and the remaining three patients were lost to follow‐up.

Conclusion. When dyspareunia and pelvic pain are caused by a retroverted method, we believe uterine suspension using different procedures will certainly relieve this problem. We have presented and have chosen these two procedures mainly due to their simplicity and the almost nil possibility of bowel intussusception into the anterior cul‐de‐sac as compared to other methods.
Uterine artery color Doppler assisted veloeimetry and perinatal outcome
Authors: Hofstaetter Cornelia , Dubiel Mariusz , Gudmundsson Sæmundur , Marsal Karel
Published: November 2007

Background. Previously, we have found uterine artery blood veloeimetry performed with Doppler ultrasound without vessel visualization to be a poor predictor of perinatal outcome. The aim of this study was to ascertain whether the combination of color Doppler imaging with the method would improve its predictive value.

Methods. In a cross‐sectional study of 110 uncomplicated pregnancies, uterine artery blood velocity was recorded bilaterally from 18 to 42 weeks of gestation to obtain reference values for pulsatility index (PI). Using color Doppler imaging, the main uterine artery was located as it crosses the iliac vessels and blood velocity was then recorded with pulsed Doppler ultrasound. The uterine and umbilical blood velocity waveforms were also obtained in 421 complicated pregnancies, and the results related to placental site and perinatal outcome.

Results. In uncomplicated pregnancies, the uterine artery PI was unrelated to gestational age using 1.20 as the upper cut‐off limit for the mean PI of both vessels (mean+2 s.d.). Corresponding values for unilateral placental localization were 1.00 at the placental side and 1.40 at the non‐placental side. Blood velocities obtained using the color Doppler combination were similar to previously presented results. In the complicated pregnancies, significant correlation was found between abnormal perinatal outcome and abnormality of the uterine artery blood velocity waveform, either increased PI (n=44) or a notch in early diastole (n=92). The predictive value of an early diastolic notch was superior to an increased PI in predicting abnormal outcome. The mean PI for both uterine arteries was a better predictor of outcome than blood velocity on the placental side. The blood velocity waveforms on the non‐placental side were the poorest predictors of outcome.

Conclusion. The addition of color Doppler imaging to pulsed wave Doppler ultrasound recording of uterine artery blood velocity improves the predictive value of blood velocity waveforms with regard to the perinatal outcome.