bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome for fetuses with abdominal wall defects detected by routine second trimester ultrasound
Authors: Eurenius Karin , Axelsson Ove
Published: November 2007

The outcome for 70 fetuses with abdominal wall defects detected by routine second trimester ultrasound during the years 1983‐90 was investigated. In 65 of the 70 cases the prenatal diagnoses were correct. Thirty‐two women had their pregnancies terminated by legal abortions. Thirty‐eight pregnancies continued. Six of these ended with spontaneous abortion or intrauterine fetal death. Thirty‐two infants were born alive. Nearly all cases with associated malformations and all cases with chromosomal defects were in the omphalocele group. The neonatal survival for infants with gastroschisis and infants with omphalocele without associated malformations or chromosomal defects was high (96%).
Objectively measured tobacco exposure among pregnant women in Finland in 1986 and 1990
Authors: Bardy Ali Henri , Seppala Timo , Lillsunde Pirjo , Koskela Pentti , Gref Carl‐Gustav
Published: November 2007

Objective. First, to study tobacco exposure among pregnant Finnish women in 1986 and 1990. Second, to study the objectively measured exposure in different socioeconomic classes and in different geographical regions. Third, to assess the value of serum thiocyanate concentrations in estimating fetal tobacco exposure.

Design. Tobacco exposure was measured from maternal and umbilical serum samples by measuring the concentration of nicotine metabolite, cotinine. In addition, the concentrations of thiocyanate were measured from umbilical serum samples. The occupations of the mothers were obtained from the Finnish Birth Registry, and the area of residence from laboratory records.

Setting. Finland.

Subjects. 1323 infants born in late February‐early March in 1991, 1263 mothers of these infants during antenatal visits in Autumn 1990, and 976 pregnant mothers during antenatal visits in Autumn 1986. The mothers and infants studied represented all newborn infants and their mothers during one week in one country.

Measurements and main results. In 1986, 21.3% of Finnish mothers and in 1990 21.2% were exposed to tobacco. In 1986, exposed mothers were on average 1.4 (95% confidence interval 0.9‐1.8) years younger than nonexposed mothers, and in 1990, exposed mothers were on average 1.6 years (95% confidence interval 1.1‐2.3) younger than nonexposed mothers. 28.5% of mothers classified as unskilled workers were exposed, but only 9.1% of those classified as upper white‐collar. There were no significant geographical differences in exposure. Although umbilical serum thiocyanate levels were always elevated in exposed infants, high serum thiocyanate concentrations were detected in infants not exposed to tobacco.

Conclusions. More than 20% of pregnant Finnish mothers and their fetuses were exposed to tobacco in 1986 and 1990. Young women and women in low socioeconomic classes were the most seriously exposed. Measurement of serum thiocyanate concentrations did not yield reliable estimates of exposure.
Cervical incompetence and cerclage in Denmark 198O‐1990 A register based epidemiological survey
Authors: Lidegaard Øjvind
Published: November 2007

Objective. To assess the incidence rate of cervical incompetence diagnoses in Denmark 1980‐1990 according to maternal age, to analyse regional variations, to investigate how often cerclage is applied, and finally to estimate abortion rates among women with cervical incompetence with and without cerclage.

Design. A register‐based retrospective cross section study.

Setting. All Danish gynecological departments.

Material and methods. Since 1977, all hospitalized patients in Denmark have been centrally recorded by diagnosis according to the ICD classification and by operation codes in The National Patient Register. From this database, all women with cervical incompetence (CI) and cerclage in the period 1980‐1990 were identified. From the same database all cases of spontaneous abortions were registered.

Results. A total of 2756 cases of cervical incompetence were registered in the period 1980‐1990, corresponding to an incidence rate of 4.6/1000 births. The risk of cervical incompetence increased from 2/1000 births among women 15‐19 years old to 7.5/1000 births among women 35‐39 years old. The incidence rate of the Cl‐diagnosis fell 44% from 1980 to 1990. The incidence rates in different counties ranged from 1.7/1000 births to 10.0/1000 births. The average length of stay in hospital among patients with cervical incompetence was three weeks. Among patients with cervical incompetence, 61% were treated with cerclage. This per cent increased from 29% among women 15‐19 years old to 68% among women 35‐39 years old. 13.5% of women with CI experienced spontaneous abortion. This percentage increased from 12% for women 15‐19 years old to 17% among women 40‐44 years old (p < 0.01). Among women with CI and cerclage, the abortion rate was 17.6%.

Conclusion. In the period 1980‐1990 the incidence rate of cervical incompetence in Denmark was on the average 4.6/1000 births. The incidence rate of the Cl‐diagnoses has fallen significantly during the last decade, and it increases four‐fold with increasing age. Six out of ten patients with cervical incompetence were treated with cerclage.
Bilateral virilizing hilus (Leydig) cell tumors of the ovary
Authors: Duun Susanne
Published: November 2007

A 72‐year‐old postmenopausal woman with high plasma testosterone levels and virilization, as demonstrated by hirsutism and balding, is presented. Urinary 17‐ketosteroids and 17‐hydroxycorticosteroids, as well as computed axial tomography scan of the adrenal glands were normal. Although no pelvic mass was detected by ultrasonography or pelvis examination, the patient was found to have small bilateral hilus cell tumors of the ovary. Following bilateral salpingo‐oophorectomy the plasma testosterone dropped to normal level. This is the third case of bilateral hilus cell tumors of the ovary to be reported.
Outcome of pregnancy and childbirth following laryngectomy
Authors: Albrechtsen Susanne , Julseth Eli , Olofsson Jan , Dalaker Knut
Published: November 2007

Objects. Pregnancy and delivery in two laryngectomized women.

Results. One woman had a pregnancy complicated by hypothyroidism and stenosis of the tracheostoma, she was delivered by cesarean section. The other had an uneventful pregnancy and a spontaneous vaginal delivery.

Conclusions. Individualized handling of the delivery. By modifying the technique of bearing down spontaneous vaginal delivery is possible.
Cesarean section in twin pregnancies in two Danish counties with different cesarean section rates
Authors: Henriksen Tine B. , Sperling Lene , Hedegaard Morten , Ulrichsen Helle , Øvlisen Bjarni , Secher Niels Jørgen
Published: November 2007

Objective. Based on a comparison of the clinical indications for cesarean section (CS) in two Danish counties and a review of the literature regarding this issue the aim of this study was to discuss possible explanations for variations in CS rates in twin pregnancies. The comparison of indications for CS in twin pregnancies was made between two Danish counties, one with a high and one with a low overall CS rate in twin deliveries, taking into account the distribution of parity, mother's age, gestational age at birth, and birth weight.

Design. A population based, historic follow‐up study based on antecedent data.

Setting. Two Danish counties, with a CS rate in twin pregnancies of 57% and 28%, respectively.

Subjects. All women with twin pregnancies who delivered in 1989 in the two counties.

Main outcome measures. Comparison of the CS rates in the two counties according to indications and fetal presentation.

Secondary measures. Perinatal and maternal outcome.

Results. The difference in CS rates between the two counties could not be explained by different distributions of background characteristics. Different attitudes were found towards CS in cases with previous CS, with twin A in breech presentation and in cases with vertex‐breech deliveries. These differences could explain less than two thirds of the overall 29% (CI: 12‐46%) difference in risk of CS between the two counties, indicating more subtle reasons for the discrepancy. No difference between the two counties in perinatal morbidity and mortality was seen.

Conclusion. In order to understand and discuss regional variations in the use of CSs in twin deliveries the subjects must be addressed in different ways: the unequivocal indications related to fetal presentations and previous CS can be subjected to randomised controlled trials or large scaled follow‐up studies regarding maternal and perinatal morbidity and mortality. Other more subtle determinants of the physicians’ and the pregnant women's attitude towards CS, however, seem quantitatively important, and these can only be evaluated in observational studies and through discussions.
Oral contraceptive tablets containing 20 and 30 μg of ethinyl estradiol with 150 μg desogestrel: Their influence on lipids, lipoproteins, sex hormone binding globulin and testosterone
Authors: Åkerlund Mats , Almström Elisabeth , Högstedt Stellan , Nabrink Margareta
Published: November 2007

The effect of two oral contraceptive (OC) pills, both containing 150 μg of desogestrel, but with 20 (Mercilon®) or 30 μg (Marvelon®/Desolett®) of ethinyl estradiol on plasma levels of lipids, lipoproteins and sex hormone binding globulin (SHBG), total and free testosterone were compared in a double‐blind, randomized, two‐center study in a total of 60 women over one year. A significant rise with Marvelon® but not with Mercilon® was seen in total cholesterol, HDL cholesterol, HDL‐3 and apolipoprotein B, whereas LDL cholesterol decreased with Mercilon® only. These effects resulted in significant differences between the two groups in the magnitude of responses in all these parameters except HDL‐3. HDL‐2, apolipoprotein A‐1 and total phospholipids were elevated with both pills after treatment and with no difference in the degree of response between groups. The HDL/LDL cholesterol ratio tended to increase in both groups and that of apolipoproteins A‐1/B in the women on Mercilon®. Total triglycerides increased in both groups, but more in the women on Marvelon®. Total testosterone decreased, particularly in the Marvelon® group, whereas the two pills caused a similar increase in SHBG and decrease in free testosterone. It is concluded that the direction of changes in plasma lipids and lipoproteins with both these pills may as a whole be interpreted as beneficial, and that the differences in effect on LDL cholesterol and apolipoprotein B may suggest a slightly advantageous effect of Mercilon® in this aspect. However, the clinical significance of these changes is uncertain. The results indicate a lack of androgenicity of both pills.
Massive theca‐lutein cysts, virilization, and hypothyroidism associated with normal pregnancy
Authors: Bakri Younes N. , Bakhashwain M. , Hugosson Claes
Published: November 2007

A 28‐year old primigravida with massive bilateral theca‐lutein cysts associated with a non‐molar pregnancy is reported. The pregnancy resulted in a spontaneous premature vaginal birth of a 27‐week gestation female infant, with no placental pathology or congenital anomalies. During the same pregnancy and post partum period the patient manifested an associated synchronous endocrinopathy of severe hypothyroidism and virilization. The cysts, except for one 2.5 cm in size still present, completely resolved with non‐surgical approach during the 10 months period following delivery.
Successful pregnancy outcome in uterus didelphys with leiomyoma uteri
Authors: Johnsrud Marja‐Liisa
Published: November 2007

Müllerian anomalies are in different degrees complicated by poor fetal outcome. Our young patient had in addition to uterus didelphys a leiomyoma of the nonpregnant part of the double uterus. Though her pregnancy was complicated, it was conserved to 37 weeks, when the baby was delivered by cesarean section. The right uterine body with a leiomyoma weighing 1500 grams was removed at the same time.
Diagnosis of premature rupture of the membranes by the identification of alpha‐feto‐protein in vaginal secretions
Authors: Gaucherand P. , Guibaud S. , Rudigoz R. C. , Wong A.
Published: November 2007

Premature rupture of membranes (PROM) is sometimes difficult to diagnose. This report proposes the use of alpha‐feto‐protein (AFP) values in vaginal secretions for diagnostic tests. Our investigation took place in two separate phases. The first phase validated the AFP test using an immuno‐enzymatic assay method and determined a threshold value from a sample of 167 female patients (Group 1: 133 patients with an extremely low probability of PROM, and Croup 2: 54 patients with confirmed PROM). In the second phase the test was applied to a sample of 145 female patients (Group 3) with suspected, but unconfirmed, PROM. Results from alpha‐feto‐protein (AFP) evaluation were compared with data obtained from clinical. echographic and other tests. The positive/negative threshold adopted was an AFP concentration of 30 μg/l. For the two first groups, 1 and 2, sensitivity and specificity was in the 98%) to 99% confidence level. For Group 3, sensitivity and specificity results at the 30 μg/1 threshold value were 94.5′% and 95.4%) respectively. Quantitative measurement of AFP determined by imniuno‐enzymatic assay of vaginal secretions with a threshold of 30μgil is a reliable, simple and rapid diagnostic test. Results obtained are significantly better than the measurement of pH. the determination of prolactin, and more practical than diamino‐oxidase (DAO) assoys.
‘To bathe or not to bathe’ during the first stage of labor
Authors: Cammu Hendrik , Clasen Koen , Van Wettere Lut , Derde Marie‐Paule
Published: November 2007

Objective. Does a warm tub bath relieve labor pain? How is it experienced by the parturient?

Methods. Design: prospective randomised trial.

Setting: Labor ward of a teaching hospital with a uniform active labor management.

Participants: one hundred and ten nulliparous low risk women, at term, in true spontaneous labor. Fifty‐four women had a bath. 56 women served as controls. Mean outcome measures: labor pain (assessed by means of a visual analogue scale) and post partum patients' bathing experience (by means of a self‐made questionnaire).

Results. The study group and the control group were comparable with respect to maternal age. weight, length, duration of gestation. cervical status and labor pain sensation before randomisation. Absolute values of labor pain were not statistically different between the two groups. yet this latter progressed differently: in the bathing group the initial pain sensation (V.A.S.) was 6.8. and this remained stable during the first 25 minutes (V.A.S. = 6.7) and then rose to 8.2 after a mean of 53 minutes. In the control group, labor pain rose progressively from 6.3 to 7.3 after 25 min and to 8.7 after a mean of 52 min (p <0.O1, Student t‐test). There was no difference in the use of epidural analgesia. There were no differences in labor duration nor in the frequencies of either operative deliveries or neonatal complications. Eighty percent of the bathers experienced soothing of the pain and all but one reported body relaxation. Ninety percent wanted to bathe again during a next labor.

Conclusion. Bathing provided no objective pain relief. It had, however, a temporal pain stabilizing effect possibly mediated through the improved ability to relax in between contractions. No side effects were found. It gives great satisfaction to users. Bathing, in conjunction with other forms of analgesia, is recommended.
Evaluation of vaginal and perineal area during the use of external sanitary protection throughout the menstrual cycle
Authors: Hanke‐Baier Petra , Johannigmann Josef , Levin Roy J. , Wagner Gorm
Published: November 2007

A clinical study evaluated potential external genital effects associated with the use of sanitary protection. The subjects used either a pad with traditional cellulose absorbent core or one containing cellulose and absorbent gelling material. Assessments included objective (transepidermal water loss, vaginal pH) and semi‐quantitative subjective methods (skin irritation grading, gynaecological inspection). No statistical or clinical significant differences for any of the parameters evaluated between the groups using the two pads, or compared to the non‐pad control period, were found. The parameters used to study the effects on the genital area of an external sanitary product appear appropriate. No significant changes were observed for either of the two pads during daily use for two menstrual cycles.
Microcurettage sampling of the endometrium for histopathological examination—simpler but not safe?: Comparison of endometrial histopathology in samples obtained by a disposable mechanical curette and by traditional curettage
Authors: Schei Berit , Bang Torill Floa , Halgunset Jostein , Haugen Olav A. , Haarstad Ivar , Onsrud Mathias
Published: November 2007

The routine use of dilatation and curettage (D&C) is questioned as a standard procedure for endometrial sampling. Instruments have been developed in order to simplify the procedure. The aim of the present study was to estimate the sensitivity to detect malignancy/premalignancy by histological exmination of endometrial samples obtained by microcurettage using a disposable plastic curette. Gynoscannk. The histological examination of the combined microcurettage and D&C material was defined as the true diagnosis.

All patients undergoing diagnostic D&C at the two participating hospitals were included in the study. The endometrial samples were evaluated at the Department of Pathology as part of their routine work. The microcurettage samples were re‐examined independently by two pathologists (observer 1 and observer 2) who did not have access to the rest of the tissue material nor the diagnosis given previously. A total of 902 patients were enrolled in the study. Endometrial cancer was found in four women below SO years of age. None of these were detected by histological examination of the Gynoscannk obtained sample. Among women aged 50 and above, samples from 16 women turned out to have endometrial cancer. The microcurettage samples were correctly classified as malignant/premalignant by observer 1 in 13 casts bind by observer 2 in 14 cases. We conclude that diagnostic D&C among women 50 years aid below cannot be replaced by histological examination of Gynoscannk samples without the risk of overlooking significant pathology.
Is differentiation of benign and malignant cystic adnexal masses possible by evaluation of cysts fluids with respect to color, cytology, steroid hormones, and tumor markers?
Authors: Gaetje R. , Popp L. W.
Published: November 2007

Objective. Differentiation of benign and malignant cystic adnexal masses by analysis of cyst fluid was investigated.

Study design. Eighty‐one cystic adnexal lesions of 80 patients were punctured intraoperatively or after surgical removal. Color of the cyst fluid, cytology, concentrations of steroid hormones (estradiol. progesterone, testosterone), and tumor markers (CEA, CA 125, CA 15‐3) were correlated to histology.

Results. Color or cyst fluid was not reliable in the differential diagnosis of cystic adnexal masses. Cytology missed four out of seven malignant tumors. One mucinous cystadenoma was cytologically suspicious for malignancy. The combination of negative cytology, low tumor marker levels. and estradiol levels higher than 1000 pg/ml may support the diagnosis of a ‘functional’ cyst. Elevated CEA levels may be suspicious for all mucinous and malignant lesions.

Conclusions: Analysis of cyst fluid could not accurately discriminate between benign or malignant tumors.
The U‐elevator: A new manipulator for gynecologic laparoscopy
Authors: Gregersen Erik
Published: November 2007

A new uterine elevator/manipulator for gynecologic laparoscopy is described. The instrument is a u‐formed tube with a cone for insertion into the uterus via the vagina. In the other end is a handle with a canal for instillation of fluid (dye). After insertion the handle is placed at the pubic area and the operation can be performed with the patient placed at a normal position on her back. The elevator can be handled by the surgeon without moving his hands outside the sterile area. No assistant is necessary. The u‐form of the instrument allows the uterus to be moved in all directions facilitating the laparoscopic view and operation. At a study of 97 laparoscopies no difficulties concerning the insertion and use were found. The instrument was easy to handle and pertubation was possible in most cases. The U‐elevator is found to be a good alternative to the existing elevators.
Ultrasound in abruptio placentae praecox of the second twin: ‘Boomerang Phenomenon’
Authors: Biskup Igor , Malinowski Witold
Published: November 2007

The diagnosis of abruptio placentae praecox of the second twin is usually difficult. The clinical symptoms may not be evident. The appearance of the new (third) hypoechogenic space, on ultrasound scan. was in our case the only diagnostic clue. It proved to be blood from the abrupted edge of twin B's placenta penetrating the dividing septum. Its characteristic ultrasound image brought forward the idea and namegiving ‘boomerang phenomenon’ and indeed, it could return like a boomerang as the intrauterine fetal demise, if ignored. This picture could mislead to the conclusion of being the leakage of amniotic hid or the amniotic sack of the' vanishing fetus' in primarily triplet pregnancy. The potentially ominous prognosis of abruptio placentae praecox warrants strict supervision of pregnancies with this phenomenon.
Serum testosterone, androstenedione and luteinizing hormone levels after short‐term medroxyprogesterone acetate treatment in women with polycystic ovarian disease
Authors: Anttila Leena , Koskinen Pertti , Erkkola Risto , Irjala Kerttu , Ruutiainen Kristiina
Published: November 2007

Background. Medroxyprogesterone acetate (MPA) ‐treatment suppresses serum gonadotropin and androgen concentrations in women with polycystic ovarian disease (PCOD). This study ws designed to determine serum testosterone (T), androstenedione (A) and luteinizing hormone (LH) patterns in a group of oligomenorrheic PCOD patients after MPA‐treatment.

Methods. The study group consisted of 11 women with ultrasonographically diagnosed PCOD. Blood samples were drawn in the morning in fasting conditions first during oligomenorrhea and then within one week after MPA‐induced bleeding. After that the sampling was repealed four times at one week intervals. Student's paired t‐test was used for statistical calculations.

Results. The levels of T, A and LH decreased significantly after MPA‐treatment. During the follow‐up the T and A concentrations increased significantly till the third sampling week, after which no further increases were found.

Conclusions. Our results show that T and A secretion return to levels characteristic of PCOD after discontinuation of MPA‐treatment within a few weeks in women with PCOD.
Color Doppler ultrasound in the preoperative assessment of adnexal masses
Authors: Zanetta Gerardo , Vergani Patrizia , Lissoni Andrea
Published: November 2007

Objective. To differentiate benign from malignant ovarian tumors preoperatively by means of transhaginal color Doppler ultrasound and to compare the sensitivity and specificity of this technique with that of conventional transvaginal ultrasound and CA 125 serum levels.

Methods. Different indicators of blood flow resistance (pulsatility index and resistance index) within intratunioral vessels were evaluated preoperatively in 80 adnexal masses by means of color Doppler ultrasound. Results were compared to CA 125 levels, conventional ultrasound and histopathologic findings.

Results. Forty‐seven benign, 29 malignant and four borderline masses were studied. Mean PI and RI were significantly higher in benign than in malignant masses but an overlap was observed Sensitivity, specificity and accuracy of color Doppler in predicting malignancy were 85%, 91% and 89% by using a cut‐off value of 0.56 for resistance index and 97%, 87%, 91% by using a cut‐off value of 1.0 for pulsatility index. The accuracy of both indexes in differentiating benign from malignant tumors was superior to that obtained by using conventional ultruaound and CA 125. In eight of nine masses where disagreement existed between color Doppler ultrasound and conventional ultrasound, pathologic examination confirmed the nature suggested by color Doppler ultrasound.

Conclusions. Compared to conventional ultrasound and CA 125, color Doppler ultrasound was more accurate in discriminating malignancies from benign tumors. The best use for this techniquc seems in giving further preoperative information about masses with uncertain sonographic characteristics. allowing better timing and tailoring of surgery.
Prognostic factors and long‐term results of the Burch colposuspension
Authors: Kjølhede Preben , Rydén Gunnar
Published: November 2007

The purpose of this retrospective study was to evaluate the importance of different preoperative estimates and postoperative complications on the outcome of the Burch colposuspension with respect to urinary continence.

During the period 1980‐1988 243 women were operated upon with the Burch colposuspension for stress incontinence or mixed incontinence. The patient records have been analysed with respect to preoperative assessments and postoperative complications. 236 patients were alive at the follow‐up, median 6 years after operation, and 232 (98%) answered a postal questionnaire about their present urinary symptoms.

According to the postal questionnaire the overall cure‐rate was 63 per cent, another 27 per cent were improved. Prognostic factors for an unsuccessful outcome of the operation were previous urinary incontinence surgery, postoperative febrile morbidity, and immediate voiding difficulties (stranguria and difficulties emptying the urinary bladder). At the follow‐up the voiding difficulties were still significantly more often seen in patients not cured from incontinence than among women cured by the colposuspension. Among the patients with recurrent incontinence we also found a significantly higher rate of lower urinary tract infections (> 3 UTI per year). The continence rate was found to be almost constant between the second and tenth year postoperatively. No significant differences in preoperatively measured maximal urcthral closure pressure and functional urethral length were found between cured and not cured patients. Although not significant, the cure‐rate showed a tendency to decrease with age iit the operation. both in the short‐term result as well as the long‐term result.
Ureteral injury secondary to laparoscopic CO2 laser
Authors: Bakri Younes N. , Sundin Torsten , Mansi Mostafa
Published: November 2007

A case of a 32‐year‐old nulligravida who underwent a carbon dioxide laser‐laparoscopy for endometriosis is reported. Ureteral injury was complicated by a postoperative ‘urinoma’. Injury occurred despite utilizing the hydrodissection technique destined to create a bed of water beneath the peritoneum to prevent laser beam penetration to adjacent normal tissue. This case illustrates that the hydrodissection technique may be less effective in the presence of severe endometriotic adhesions and fibrosis.
The role of vascularisation of the corpus luteum in the short luteal phase studied by Doppler ultrasound
Authors: Tinkanen Helena
Published: November 2007

One hundred infertility patients were investigated by Doppler ultrasound and 17 were found to have a short luteal phase (<10 days) (SLP), which is regarded a subgroup of luteal insufficency (LPD). The vascularisation within the corpus luteum (CL) was investigated using vaginal Doppler ultrasound. The values were compared with those of a control material. In both groups the resistance to blood flow was lowest on the fifth postovulatory day and grew from the ninth postovulatory day towards the end of the luteal phase. The results in these groups did not differ significantly. In both groups serum progesterone values had a slight negative correlation with pulsatility index (PI) and resistance index (RI) measured within the CL. The defect in vascularisation of the CL is not a reason for SLP, and Doppler ultrasound measurements from the CL do not help in the diagnosis of SLP.
Transvaginal sonography of myometrial invasion depth in endometrial cancer
Authors: Prömpeler Heinrich J. , Madjar Helmut , du Bois Andreas , Lattermann Ulrich , Wilhelm Christian , Kommoss Friedrich , Pfleiderer Albrecht
Published: November 2007

The myometrial invasion depth of endometrial cancer is an important prognostic factor. The preoperative assessment is decisive for the appropriate surgical treatment. In 96 patients with endometrial cancer, the myometrial invasion depth (greater than 50% or less than 50%) was measured preoperatively using transvaginal sonography (TVS). The sonographic results were compared to the histopathological findings. A sensitivity of 93% was obtained for invasion depths greater than 50%. The predictive value of an invasion depth less than 50% was 93% as well. In 16% of the cases the invasion depth was overestimated while, in only 3% it was underestimated. The diagnostic accuracy was 81%. Forty‐five patients were examined preceding a diagnostic dilatation and curettage and fifty‐one were examined following a diagnostic dilatation and curettage. The diagnostic accuracy in both groups was equivalent. Using transvaginal sonography, the spread of cancer to the cervix was observed in five of the seven cases in which it was postoperatively confirmed.

TVS is a valuable, non‐invasive diagnostic method for patients with endometrial cancer. When the TVS data are combined with results from other preoperative tests, the prognostic information obtained provides a useful basis in choosing the appropriate therapy.
Rupture of pregnant rudimentary uterine horn with fetal salvage
Authors: Zaidi Jamal , Carr John
Published: November 2007

Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity or mortality. A case is presented of such a pregnancy associated with a high maternal serum alpha feto‐protein presenting as an acute emergency at 29 weeks' gestation resulting in fetal salvage.
Lack of association between Doppler velocimetry and synthesis of prostacyclin and thromboxane in umbilical cord vessels from growth retarded fetuses
Authors: Saldeen Pia , Olofsson Per , Marsál Karel
Published: November 2007

Background. The aim of this study was to investigate the possible association between Doppler velocimetry and synthesis of prostacyclin (PGI2) and thromboxane A2 (TxA2) in umbilical cord vessels. The hypothesis was that an altered balance between PGI2 and TxA2 production is associated with a change of artery flow resistance.

Methods. 17 cases with a suspicion of intrauterine growth retardation and 21 normal pregnancies were studied. The umbilical artery pulsatility index (PI) and venous mean velocity were recorded in vivo by Doppler velocimetry. Cord vessel prostanoid synthesis was determined in vitro. The Mann‐Whitney U test and simple linear regression were used for statistical analyses. Results. The umbilical vessel synthesis of both PGI2 and TxA2 was in general lower in small‐for‐gestational age (SGA) cases (n=10) compared to appropriate‐for‐gestational age (AGA) (n=28). In the vein, the PGI2/TxA2 ratio was significantly lower in SGA cases. No certain correlations were found between umbilical artery PI and venous velocity, respectively, and PGI2 or TxA2, or their ratio.

Conclusion. The prostanoid synthesis was in general lower in SGA cases, resulting in a significantly lower PGI2/TxA2 ratio in the umbilical vein. This indicates that fetal growth retardation might be associated with a disturbed endothelial function in this vessel. The synthesis of PGI2 and TxA2 in the juxtaplacental umbilical cord vessels was not correlated to the umbilical artery PI or venous flow velocity. It is possible that an altered release of prostanoids in the placental vasculature and tissue accounts for the rise of umbilical artery flow resistance instead.
Comparative study of three amniotic fluid markers in premature rupture of membranes
Authors: Gaucherand Pascal , Guibaud Suzanne , Awada Azzam , Rudigoz René C.
Published: November 2007

Background. To study the comparative diagnostic value in premature rupture of membranes (PRM) of three amniotic components: fetal fibronectin (EN), alphafetoprotein (AFP), diamino‐oxydase (DAO).

Methods. 131 pregnant women took part in our prospective study. Three samples were obtained successively for each patient in a random order. Two clinical situations were studied: group A of 68 women with clinical certain PRM and group B of 63 women with a highly unlikely PRM.

Results. fFN is the best marker for diagnosis of PRM (sensitivity of 94% and specificity of 97%). AFP and DAO are complementary: the NPV is greater for AFP (87% against 84%) whereas the PPV is greater for DAO (95% against 86%).

Conclusion. Apart from its value in predicting premature labor, vaginal fFN represents a diagnostic test of PRM with good specificity and sensitivity.
Paracervical Block‐A Viable Alternative for Labor Pain Relief?
Authors: Ranta P. , Jouppila P. , Spalding M. , Kangas‐Saarela T. , Jouppila R.
Published: November 2007

Background. Two hundred and forty‐eight consecutive deliveries with a 0.25% bupivacaine paracervical block (PCB) using a superficial injection technique were studied prospectively during the progress of labor in the three month study period. Parturients with signs of fetal distress were excluded. Pain level and the maternal, fetal and neonatal effects related to PCB were evaluated.

Methods. Pain intensity level was assessed on a visual scoring scale (0–10). The intrapartum fetal heart rate patterns were recorded and reviewed to correlate the incidence of paracervical fetal bradycardia.

Results. Parturients with PCB were provided a significant reduction (p<0.001) in pain levels and the change in pain scores could be maintained until the beginning of the second stage. After the block, bradycardia patterns were noted in five (2.0 %) fetuses, a fetal heart rate ranged from 60 to 105 beats per minute with an onset time of 2–20 minutes after the block and a duration of 4–12 minutes. All newborns in the bradycardia group were delivered va‐ginally without signs of asphyxia.

Conclusions. PCB in selected parturients with a low‐dose superficial technique has been shown to be an effective analgesic modality with minimal fetal and neonatal side‐effects, but post‐blockade fetal bradycardia cannot be wholly eliminated.
Father's heart beat responds to the birth of his child
Authors: Kurki Tapio , Toivonen Lauri , Ylikorkala Olavi
Published: November 2007

We monitored the electrocardiogram of 20 fathers while their child was born. Paternal heart rate rose on average by 53% during delivery from the starting point frequency (72 beats/min.) to the maximum (115 beats/min.) just before the birth of the child. Judging from the heart rate variation, paternal sympathetic activity increased by 25% and vagal tone decreased by 22% during delivery. No derangements in cardiac function were encountered, not even in the man who fainted.
Quality of life during pelvic radiotherapy
Authors: Bye Asta , Ose Turid , Kaasa Stein
Published: November 2007

Background. A randomized clinical trial was carried out to evaluate the effect of a diet low in fat and lactose to prevent acute radiation‐induced diarrhea. The effect of the diet treatment on the patients' health related quality of life was studied.

Methods. 143 women with gynecological malignancies were included. The daily number and consistency of stools, use of antidiarrheal agents and quality of life measured by using the EORTC Core Quality of life Questionnaire 36 item version, were recorded before therapy, in the last week of treatment, six weeks after end of radiotherapy and every eight weeks during one year's follow up.

Results. Fourteen patients (23%) in the intervention group reported diarrhea during radiotherapy, compared to 32 (48%) in the control group (p<0.01). This difference was not seen with the EORTC questionnaire. The diet intervention did not interfere with emotional and social well‐being. Within the control group diarrhea was associated with higher scores on the physical functioning scale (p<0.01), and fatigue and malaise scale (p<0.01) indicating more pronounced dysfunction of symptoms.

Conclusion. When measuring specific phenomena such as diarrhea in a clinical trial, the EORTC questionnaire does not seem to be as sensitive as specific trial‐related instruments. Diet intervention during radiotherapy might influence the patients' ability to cope with diarrhea by giving them more control over their own situation.
The laparoscopic Burch procedure
Authors: Langebrekke Anton , Dahlstrøm Berlt , Eraker Runar , Urnes Arne
Published: November 2007

Laparoscopic retropubic colposuspension (Burch procedure) is now being performed in our department as the treatment for genuine stress urinary incontinence. This study presents the first eight cases. Our experience with the laparoscopic approach seems promising. The operative technique has been developed, and the method provides better visualization of the space of Retzius, the patients experienced minimal blood loss and a shorter hospital stay than with the laparotomy approach. Although short follow‐up, all the patients except one were continent after three months. This preliminary report demonstrates that laparoscopic Burch procedure may be a valuable addition to the new procedures in ‘minimal invasive surgery’.
Prediction of fetal weights in twins
Authors: Jensen Odd H. Rognerud , Jenssen Helge
Published: November 2007

Objective. To determine the accuracy of sonographic weight estimation of twin fetuses. Methods In 73 twin‐pregnancies, fetal weight estimation by ultrasound was performed within 7 days prior to delivery. Fetal head biparietal diameter and abdominal circumference were measured. The coefficient of correlation (r), and the ratio between estimated weight and actual weight were calculated.

Results. The coefficient of correlation was r=0.954 between estimated weight and actual birth weight. The ratio between the two parameters was 1.025, the standard deviation 0.089. In our study, 41% of the antenatal estimated weights deviated less than 5% from the actual birth weight. For 72% of all estimated weights, the deviation was less than 10%. Ultrasonographic prediction of actual weight below the 10th percentile level showed a sensitivity of 85%, predictive value of 80% and specificity of 87%. In detecting inter‐twin discordance 2200, the respective values were 64%, 64% and 91%.

Conclusions. Antenatal estimation of birth weight by ultrasound correlates well with the actual weights of twin fetuses. Prediction of individual fetal weight seems to be more accurate than prediction of inter‐twin discordance.
Expectant management in severe preeclampsia: does magnesium sulfate prevent the development of eclampsia?
Authors: Chen Fang‐Ping , Chang Shuenn‐Dyh , Chu Kiu‐Kwong
Published: November 2007

Although magnesium sulfate has been a traditional or standard treatment for severe preeclampsia and eclampsia to prevent convulsions, its efficiency has always been in doubt and its induced side‐effects also make it controversial for use. In this study, 64 patients, diagnosed with severe preeclampsia, were randomized into group I (34 patients) managed with MgS04, and group II (30 patients) managed without MgS04. There were no occurrences of eclampsia in either group. Although there was no statistical significance in the final delivery method, group I had a higher rate in cesarean section, in which most were significantly due to fetal distress (p<0.05). Furthermore, group I had significantly more babies with poor apgar score than group II (p = 0.019). During the reatment period for those with a gestational age of less than 34 weeks, there were two patients with abruptio placentae in group 1 and the treatment periods were noted to be longer in group II than in group I. From the results of monitoring serum magnesium level in group I, when therapeutic level was achieved, magnesium sulfate induced great discomfort which might have led to the deterioration of the patients' condition. According to this study, magnesium sulfate's minimal efficiency. and its adverse side‐effects, also make magnesium sulfate a poor choice in the management of preeclampsia. Therefore, because of our poor understanding of the etiology of preeclampsia, suitable management should be undertaken without magnesium sulfate. Improvement of the patient's pathophysiological condition or termination of pregnancy as early as possible, is recommended.
Vaginal misoprostol as an alternative to oxytocin for induction of labor in women with late fetal death
Authors: Bugalho Antonio , Bique Cassimo , Machungo Fernanda , Bergström Staffan
Published: November 2007

Background. Induction of labor in women with late fetal death is often difficult in settings with scarce resources. The purpose of this study was to assess the value of vaginal misoprostol for induction of labor in women with such fetal death.

Methods. In Maputo 156 women with late fetal death were allotted in a non‐randomised way to either vaginal misoprostol or intravenous infusion of oxytocin. Treatment outcomes were compared as to cost‐effectiveness and safety. In the misoprostol group none received more than 800 µg. Oxytocin infusion followed an established routine. Statistical analyses were performed by EPI Info software.

Results. In cases with Bishop's score <6 the induction‐to‐delivery interval averaged 14.8 hours in the misoprostol group and 31.0 hours in the oxytocin group (p=0.001). The corresponding values for women with Bishop's score <6 were 6.6 and 8.7 hours, respectively (p=0.4). Women with intact membranes had an induction‐to‐delivery interval of 13.8 hours in the misoprostol group and 26.9 hours in the oxytocin group (p=0.002). The corresponding values in women with ruptured membranes were 7.8 and 10.5 hours, respectively (p=0.6). Successful induction was achieved in 81% of misoprostol‐treated women at a dose of 100 pg or less.

Conclusions. Vaginal misoprostol is a safe, low‐cost drug particularly suitable in women of high average parity having late, fetal death.
Declining an alpha‐fetoprotein test in pregnancy, why and who?
Authors: Jørgensen Finn Stener
Published: November 2007

Objective. The aim of the study was to elucidate the questions: 1) Why are some women declining an alpha‐fetoprotein (AFP)‐test? and 2) Do women who decline an AFP‐test differ in background and in attitudes towards abortion issues from women who accept the test? Furthermore the study was aimed at clarifying some aspects of the decision process.

Design. Questionnaire study over a one‐year period from October 1, 1988 to September 30, 1989.

Setting. Hvidovre University Hospital, Copenhagen, and the county hospitals of Sønderjyl‐land. Denmark.

Subjects. 336 women who declined the AFP‐test and 3331 women who had the test performed.

Main outcome measures. Main questions concerned reasons for declining AFP‐testing, attitudes to abortion issues and how the decision was made.

Results. The main reasons for declining were found to be ethicalireligious reasons or the view that the test was not reliable enough. The frequencies of women with a high school degree (46.4% versus 30.8%) and of women who had had a previous spontaneous abortion (24.1% versus 14.8%) were both significantly higher in the declining group. Regarding abortion issues, women who declined the test were significantly more restrictive in their acceptance of abortion than women who had taken the AFP‐test. 5.7% of the women who declined reported that they had perceived pressure to accept the offer to have the test.

Conclusion. The study has clarified the questions as to who declines the AFP‐test and why. It is discussed whether the AFP‐programme and its consequences are, in fact, too difficult for some women to grasp and understand in detail. From the Health Service's point of view, it is noteworthy that a considerable number of women who declined the test offer might make a different choice if the AFP‐programme were improved.
Use of antenatal care services in a controlled ultrasound screening trial
Authors: Saari‐Kemppainen Aulikki
Published: November 2007

Background. The purpose of the present study was to evaluate whether systematically organized ultrasound screening would have an effect on the uptake of antenatal care services. Methods. A total of 9310 women were randomised to an ultrasound screening (4691) or to a control (4619) group. The screening group had an ultrasound examination between the 16th and 20th week of gestation, but otherwise both groups had identical antenatal care. Results. Antenatal outpatient clinic visits were significantly fewer (2.3 compared to 2.6, p<0.0001) in the screening group. On the other hand women in the screening group had more visits to maternal health centers than those in the control group (12.9 compared to 12.6, p<0.0001). No difference was noted between the groups with respect to days in hospital, rest at home on sick leave and visits for medical check‐ups.

Conclusion. Ultrasound screening reduced the need for specialist services and increased the use of basic maternal health care services.
Evaluation of breast stimulation for induction of labor in women with a prior cesarean section and in grandmultiparas
Authors: Segal Shmuel , Gemer Ofer , Zohav Efraim , Siani Moshe , Sassoon Essi
Published: November 2007

Background. Information on the efficacy of breast stimulation for inducing labor in grandmultiparas and in women with a previous cesarean section with or without premature rupture of membranes is limited.

Methods. Retrospective study of labor data from 135 women of grand multiparity or those with a previous section with or without premature rupture of the membranes in whom labor was induced by breast stimulation.

Results. The success rate in achieving vaginal delivery was 84%. The duration of breast stimulation, length of labor, vaginal delivery rate, and Apgar score did not differ significantly among the four groups studied.

Conclusion. Breast stimulation in grandmultiparas and in women with a previous cesarean section is efficacious and safe.
Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity
Authors: Bilenka Boris , Ben‐Shlomo Izhar , Cozacov Carlos , Gold Clive H. , Zohar Shlfra
Published: November 2007

Vertical banded gastroplasty (VBG) is today the most widely performed bariatric operation. The procedures used previously for the same purpose resulted in metabolic derangements and other pathologies during pregnancy. In a retrospective study we compared the reproductive performance of nine women prior to VBG and after it.

Of eighteen pregnancies prior to the operation, seven ended with miscarriage, while only one of fourteen pregnancies conceived after the operation was aborted. The rate of spontaneous conception was greatly increased after the operation and there were fewer complications in the course of the pregnancies. From the obstetrician and gynecologist's point of view VBG seems to be a good treatment for morbid obesity.