bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal diagnosis of omphalocele associated with umbilical cord cyst
Authors: Chen Chih‐Ping , Jan Sheau‐Wen , Liu Fen‐Fen , Chiang Sheng , Huang Shih‐Hung , Sheu Jin‐Cherng , Wang Kuogon , Lan Chung‐Chi
Published: November 2007

Background. To study the cytogenetics, ultrasound findings, biochemical screening, perinatal outcome, and associated abnormalities in cases of omphaloceles associated with umbilical cord cysts.

Methods. From 1988 to 1994, three cases of omphaloceles with umbilical cord cysts were identified at Mackay Memorial Hospital. We compared the clinical data of our three cases with six other cases in the published literature.

Results. Two cases of omphaloceles with umbilical cord cysts were affected with trisomy 18. One had bilateral choroid plexus cyst, intrauterine growth retardation, low levels of maternal serum alpha‐fetoprotein and free beta‐human chorionic gonadotropin, and the other had cleft lip and palate, single umbilical artery and intrauterine growth retardation. An elevated level of maternal serum alpha‐fetoprotein was found in the case with normal karyotype. Elevated levels of amniotic fluid alpha‐fetoprotein were found in two cases. Rupture of the umbilical cord cyst and disruption of the umbilical cord occurred in one case at delivery. Based on the gross and microscopic examinations, the cord cysts we observed are likely to be pseudocysts.

Conclusion. The umbilical cord cysts most commonly associated with omphaloceles are pseudocysts and allantoic cysts. Among our three cases and the six other cases published in the literature, four out of these nine cases were trisomy 18. Prenatal diagnosis of omphaloceles or umbilical cord cysts by ultrasound warrants cytogenetic analysis and detailed sonogram to rule out the possible combination of both abnormalities and trisomy 18. If an omphalocele is associated with a large umbilical cord cyst and a normal karyotype, cesarean section is recommended to prevent the dilemma of intrauterine vascular compromise of umbilical blood flow during labor.
Serum ionized magnesium levels during intravenous MGSO4 therapy of preeclamptic women
Authors: Handwerker Sara M. , Altura Bella T. , Chi Dennis S. , Altura Burton M.
Published: November 2007

Using a novel ion‐selective electrode, we have shown that there is over a 100% increase in venous serum levels of ionized Mg during intravenous MgSO4 therapy of preeclamptic patients. By 6 hours of therapy, the range is 0.92‐1.65 mmol/1 (95% C.I.). There are strong correlations between levels of ionized and total Mg throughout therapy (r=0.92‐0.95.p<0.01).
The effect of nimesulide and naproxen on the uterine and ovarian arterial blood flow velocity. A Doppler study
Authors: Pirhonen Jouko , Pulkkinen Martti
Published: November 2007

Background. To measure the effect of oral naproxen and nimesulide treatments on the uterine and ovarian arterial blood flow velocity in both eumenorrheic and dysmenorrheic women.

Methods. The double‐blind, placebo‐controlled, study comprised six eumenorrheic women receiving either placebo or nimesulide (100 mg, single oral dose) during two consecutive cycles. Six women with moderate to severe dysmenorrhea were treated with placebo, nimesulide or naproxen (500 mg, single oral dose) during three consecutive cycles. Uterine impedance (pulsatile index, PI) was measured during the cycle day 1 at four different levels of the uterus and in the ovarian branch of the uterine artery at 0, 30, 60, and 120‐140 min, with a color Doppler ultrasonograph for orientation and with pulsatile Doppler for recording waveforms.

Results. In the eumenorrheic women no significant changes were found with any treatment. In dysmenorrheic patients, nimesulide relieved symptoms and caused a decrease in uterine artery PI earlier than naproxen. Both treatments reduced the elevated uterine impedance in dysmenorrhea close to the normal level. When analyzing the PIs of the uterine artery at 4 different levels, the most prominent changes were observed in the fundus. The ovarian branch remained unaffected.

Conclusions. Color Doppler ultrasonography and pulsatile Doppler are good methods for investigating disease‐ or drug‐induced changes in uterine and ovarian blood flow velocities. Nimesulide induced a slightly faster and more complete decrease of the elevated uterine vascular resistance in dysmenorrhea, towards normal eumenorrheic levels, than naproxen. The fundal part of the uterus appears to be an important site of the pathogenesis in primary dysmenorrhea.
Trial of routine gonadotropin releasing hormone agonist treatment before abdominal hysterectomy for leiomyoma
Authors: Balasch Juan , Manau Dolors , Mimó Jaime , Duran Magda , Puerto Bienvenido , Vanrell Juan A.
Published: November 2007

Objective. To investigate the usefulness of a routine short term treatment with gonadotropin releasing hormone agonist (D‐Trp‐6‐LHRH depot) before abdominal hysterectomy for leiomyoma.

Study Design. Prospective, comparative, randomized study.

Setting. A teaching hospital of Barcelona University.

Patients. Fifty premenopausal women requiring hysterectomy as treatment for symptomatic leiomyomas. Twenty‐three patients were randomized to receive gonadotropin releasing hormone agonist treatment before hysterectomy (cases), and 27 patients were randomized to immediate hysterectomy (controls).

Main outcome measures. Type of abdominal incision, operating time, operative hemoglobin and hematocrit decrease, postoperative morbidity, and days in hospital.

Results. In the agonist treated group mean uterine volume decreased and mean hemoglobin and hematocrit significantly rose after 8 weeks of treatment. Operative time was similar in both groups of patients but the number of women having Pfannenstiel incision was significantly higher in the cases. Mean operative hemoglobin and hematocrit decrease and postoperative morbidity were lower in the cases. There was a trend for shorter postoperative hospital stays in the agonist treated group.

Conclusions. Our results favor the routine use of a short term gonadotropin releasing hormone agonist treatment before abdominal hysterectomy for leiomyoma in order to decrease operative blood loss and postoperative morbidity.
Malignant germ cell tumors of the ovary: Hacettepe hospital experience
Authors: Ayhan Ali , Tuncer Z. Selçuk , Yanik Filiz , Bükülmez Orhan , Yanik Ali , Küçükali TÜRkan
Published: November 2007

Background. To determine the most important prognostic factors in patients with malignant germ cell tumors of the ovary.

Methods. Age, histologic type, tumor size, stage, treatment mode, type of surgery of 67 patients with malignant germ cell tumors managed consecutively were evaluated retrospectively using multivariate analysis.

Results. The overall survival rate was 60.6%. This figure was 78.5% for dysgerminoma, 53.3% for immature teratoma, 12.0% for endodermal sinus tumor, 33.3% for mixed germ cell tumor and 100.0% for others. The patients with endodermal sinus tumor had significantly poorer survival than other groups. Among the factors analyzed for survival histologic type was found to be the most significant predictor for survival.

Conclusions. Finding of histologic type as the strongest independent risk factor may be evaluated in correlation with the literature that these tumors have historically been investigated as dysgerminomatous and nondysgerminomatous tumors. Furthermore, endodermal sinus tumors had long been known for poor survival. Based on this data, despite advent of staging and effective chemotherapy, prognosis still is basically related to histologic type and histology of tumor should be taken into account while comparing results.
Detection of fetal Y‐specific DNA from the cervix
Authors: Mei Fung Hedy Yun , Wong Yick Fu , Haines Christopher John
Published: November 2007

Detection of fetal Y‐specific DNA by polymerase chain reaction was performed on cervical samplings obtained from 24 patients who underwent first trimester suction termination of pregnancy. The results were compared with the fetal gender determined by Y‐sequence polymerase chain reaction on the fetal parts. Fourteen male pregnancies were identified. Correct predictions were made in two (14.3%) from the cervical swabs and three (21.4%) from the trans‐cervical samplings. The failure of isolation of fetal cells from the cervix was not related to the gestation of sampling.
Variations in serum relaxin (hRLX‐2) concentrations during human pregnancy
Authors: Petersen Lone Kjeld , Vogel Ida , Agger Anders Ole , Westergård Jes , Nils Milman , Uldbjerg Niels
Published: November 2007

Study objective. To study variations in serum relaxin concentrations during normal and abnormal human pregnancy and parturition and in umbilical cord blood.

Design and patients. Diurnal variations were determined in samples collected every 2 hours for 24 hours (n=4). Variations during pregnancy were studied in samples taken every 4th week from normal pregnant women (n=26). Additionally samples were collected once a week from the 37th week of pregnancy and until spontaneous delivery (n= 5). Changes in relaxin during early pregnancy (gestational age: 30 to 97 days) were studied in serum from 12 normal pregnant women, 13 with spontaneous abortion and 38 with an ectopic pregnancy. Fetal serum was obtained at delivery from the umbilical vein (n=20). All samples were analysed for relaxin by an ELISA based on human relaxin antibodies.

Main results. No diurnal variation in relaxin concentrations were found. In normal pregnant women relaxin concentrations increased during the first 14 weeks of pregnancy. From week 14 to 24 a gradual decrease was found and the concentrations remained constant during the last part of pregnancy. No changes in concentrations were found immediately before or during spontaneous delivery. Women with abnormal pregnancies had lower serum relaxin values than normal early pregnant women. The relaxin concentration was significantly correlated to the serum HCG concentration in early pregnancy but not to the serum HPL levels after week 28. In the umbilical vein relaxin concentrations were low.

Conclusion. The variation in circulating levels of relaxin during human pregnancy differs markedly from those found in other species. This suggests a different role for relaxin in human pregnancy.
Maternal serum alpha‐fetoprotein screening for neural tube defects
Authors: Candenas M. , Villa R. , Collar R. Fernandez , Moina M. J. , Pintado S. , Saez F. Garcia , Alvarez F. V.
Published: November 2007

Maternal serum alphafetoprotein (MSAFP) screening has been set up in Asturias, in the north of Spain, in 1987 in order to make possible the prenatal diagnosis of neural tube defects (NTD) to overall pregnancy population.

This large study shows the high sensitivity and specificity of MSAFP screening when it is done with absolute control of all variables such as gestational age, pregnant woman's weight, diabetes, etc. On the other hand, this study also shows a poor sensitivity second level ultrasound for the early diagnosis of NTD in the presence of spina bifidas with no bulge. We have also observed that the incidence of NTD in Asturias remained constant in the last six years, around 1.5‐1.6 per 1000 pregnancies. However, due to MSAFP screening, there has been a decline in the prevalence of children born with these defects. We conclude that MSAFP screening is the best tool to identify and reduce NTD in our Region (Spain).
An oocyte donation program with goserelin down‐regulation of voluntary donors
Authors: Söderstrom‐Anttila Viveca , Hovatta Outi
Published: November 2007

Background. In ovum donation programs oocytes can be requested from infertile women going through an in vitro fertilization cycle. Currently, when embryos can be cryopreserved, these donors have virtually disappeared. Instead, most donors have been healthy fertile volunteers willing to go through an IVF attempt solely for the purpose of donating all oocytes.

Methods. Sixty‐four patients had 93 started cycles of oocyte donation from 59 donors. Twenty recipients had primary ovarian failure, 24 had secondary ovarian failure, 15 had had repeated failures in earlier IVF attempts and five were carriers of genetic diseases. The donors were 51 healthy volunteers recruited through the press. Eight patients from an IVF program donated excess oocytes. Donors were not paid and their mean age was 30 years. To minimize discomfort of the treatment, a long‐acting GnRH‐agonist, goserelin, was used for down‐regulation.

Results. The pregnancy rate per transfer with fresh embryos was 28.4% (23/81) and with frozen‐thawed embryos, 17% (3/18). Twenty‐one healthy infants have been born including one set of triplets and three sets of twins. Nine pregnancies ended in abortion and one in intrauterine fetal death. The most common complications of pregnancy were pre‐eclampsia and pregnancy‐induced hypertension (41.2%, 7/17). Ten of 17 patients delivered by cesarean section (58.8%).

Conclusion. It was possible, through the press, to obtain highly motivated oocyte donors, who go through IVF treatment solely for altruistic reasons. Oocyte recipients appear to have many complications in their pregnancies. Until more data are available, these patients need a high standard of obstetric care.
Small bowel herniation after laparoscopically assisted vaginal hysterectomy
Authors: Puls Larry E. , Henderson Robert C.
Published: November 2007

Laparoscopically assisted vaginal hysterectomies have been done with increasing frequency in the United States. To date, minimal complications have been noted with this procedure. The authors review a series of 90 individuals and note a three percent small bowel obstruction rate. This complication is more common in this group of patients than in patients having a standard abdominal hysterectomy. Since this operation has been commonly performed, it is often possible to convert an abdominal hysterectomy to a vaginal approach, this increase in complications is exceedingly high. The authors recommend closure of lateral abdominal wall port sites under direct laparoscopic visualization to prevent this serious complication.
Births by younger and older mothers in a population with late and regulated childbearing: Finland 1991
Authors: Hemminki Elina , Gissler Mika
Published: November 2007

Purposes. The aims of this study were: first, to ascertain the characteristics of younger and older mothers in the Finnish population; second, to assess the health conditions pertaining to births and newborns according to maternal age groups.

Methods. The data, 26 373 primiparous and 38 895 multiparous women, came from the 1991 nationwide Finnish birth register, and was completed using death and education registers. The younger (<18 and 18‐19 year olds) and older (35‐39 and 40 and over) mothers were compared to 20‐34 year olds. Infant outcomes were studied by adjusting for mothers' social and obstetric background characteristics by using stepwise logistic regression.

Results. Births were rare among women younger than 18 years or 40 years or older. Younger primiparous mothers (less than 20 years) were less often married, more often had a lower social class background, and tended to live in Northern Finland and used antenatal care somewhat less. Their pregnancies, giving birth and infant outcomes were similar to those of 20‐34 years old mothers. Most older mothers were women having their families late, rather than having big families. Older primiparas (35 years or older) were less likely to be married, were more often highly educated and lived in urban areas and in the most southern county. Older mothers had more problems during pregnancy and labor, and their infant outcomes were worse.

Conclusions. Our study supports the notion that for young mothers giving birth is a social rather than a medical problem, whereas the reverse is true for older mothers. However, perinatal results for most older mothers are good.
Premature rupture of the membranes (PROM) at term in nulliparous women with a ripe cervix
Authors: Hjertberg Ragnhild , Hammarström Margareta , Moberger Birgitta , Nordlander Elisabeth , Granström Lena
Published: November 2007

Objective. To compare maternal and neonatal outcomes after 12 or 24 hours of expectant management in healthy nulliparous women with a ripe cervix and PROM at term.

Design. A prospective, randomized study.

Location. Karolinska Hospital, Stockholm. Sweden.

Subjects. Two hundred and five healthy nulliparous women with singleton pregnancies, cephalic presentation, gestational duration 36 to 42 weeks, randomized to 12 or 24 hours of expectant management after evaluation of the cervical score (>5). If spontaneous labor did not occur, induction was performed with oxytocin after 12 or 24 hours, respectively. Main parameters. Maternal early morbidity and neonatal infections, obstetric intervention rate (cesarean section or instrumental delivery).

Results. The cesarean section rate was 4% in each group. The vacuum extraction rate was 21% in each group. Induction of labor was performed in 47% of the women allocated to 12 hours of expectant management vs 17% of the women allocated to 24 hours of expectant management (p<0.05). The maternal morbidity rate was almost negligible. Only a few fetal infections occurred and no difference was noted between the groups.

Conclusions. In healthy nulliparous women at term with a ripe cervix, expectant management over 24 hours vs 12 hours resulted in fewer inductions of labor and no increase in instrumental deliveries, without any increase in neonatal or maternal morbidity.
Intrauterine growth retardation at term: association between anthropometric and endocrine parameters
Authors: Nieto‐Diaz Anibal , Villar Jose , Matorras‐Weinig Roberto , Valenzuela‐Ruiz Pedro
Published: November 2007

Objective. To investigate the endocrine profile of the intrauterine growth retardation newborns and its association with anthropometric parameters at birth.

Study design. This is a case‐control study of 76 full term gestations, of which 31 were diagnosed as intrauterine growth retardation (IUGR) confirmed at birth, and 45 as normal births. Insulin, insulin‐like growth factor I (IGF‐I), growth hormone (GH), thyroid stimulating hormone (TSH), hydrocortisone, prolactin and 15 metabolic parameters were measured in maternal blood antepartum, amniotic fluid and umbilical cord blood at birth.

Results. Blood taken from the umbilical cord in the IUGR group had statistically significant lower levels of IGF‐I, insulin and TSH, but higher levels of GH. In amniotic fluid and maternal blood, IUGR babies had lower levels of cortisol. The changes in GH and glucose levels in cord blood of IUGR babies were independently associated to birth weight variability (Adjusted regression coefficient‐squared=0.09 and 0.17 respectively). Ponderal index (weight/length3) among IUGR babies was independently associated with metabological changes in amniotic fluid (Adjusted regression coefficient‐squared=0.35).

Conclusions. The endocrine profile of IUGR fetus would be: hypoinsulinemic, hypothyrotropinemic, hypoglycemic, hypoalbuminemic, hypocholesterolemic and hypermagnesemic with lower IGF‐I levels, yet higher than normal group GH levels at birth. Tryglicerides in amniotic fluid; GH, Glucose and Mg changes in cord blood of IUGR babies were independently associated with birth weight variability.
Assessment of fetal fibronectin in cervical secretion in cases of equivocal rupture of the membranes at term
Authors: Nisell Henry , Hagskog Katrin , Westgren Magnus
Published: November 2007

Background. To evaluate if the presence of fibronectin in cervical secretion might provide information on the natural course of equivocal prelabor rupture of membranes (ROM) at term.

Methods. One hundred and sixteen women with a history of prelabor ROM at term but without visible amniotic fluid leakage were included in the study. The presence of fetal fibronectin in cervical secretion was determined by a commercially available kit (ROM check® limit of detection 100 ng/ml). Women with (n=49) and without (n=67) a positive fibronectin test were compared with regard to time interval between presumed membrane rupture and delivery, mode of delivery and fetal distress rates.

Results. There was no significant difference in the time interval between presumed ROM and delivery between those with a negative fibronectin test (median: 80 hours) and those with a positive test (median: 64 hours: p=0.28, Mann‐Whitney U‐test). Neither were there any differences in complicated delivery or fetal distress rates.

Conclusion. Determination of fetal fibronectin in cervical secretion with the present method is of limited value in the clinical management of patients with equivocal rupture of the membranes.
Fetal pulse oximetry
Authors: Maesel Alf , Mårtensson Laila , Gudmundsson Saemundur , Maršål Karel
Published: November 2007

Background. During recent years fetal pulse oximetry has been under development for use in monitoring fetal oxygenation during labor. In a methodological study we have tested the practical applicability of one type of sensor (FS‐10 Oxisensor, Nellcor®). Both obstetricians and midwives took active part in sensor placement. The readings of fetal arterial oxygen saturation (SpO2) were not taken into account when managing the patients.

Methods. Oxygenation was monitored during labor in 96 singleton pregnancies. Mean SpO2 levels were calculated when cervical dilatation was 4‐7 cm and 8‐10 cm, and in the second stage of labor. Student's t‐test was used for paired comparisons. A p‐value<0.05 was considered significant.

Results. Of the 96 oxisensors. 91 (95%) were successfully placed. One mother felt pain which disappeared when the sensor was removed. Two of the newborns manifested an impression mark caused by the sensor, which disappeared completely within a day. No infection or increased bleeding was noted. The mean recording time was 134 minutes. SpO2‐values were obtainable during 69% of the recording time. A significant fall of mean SpO2 occurred between the first and second stages of labor.

Conclusions. The method seems to be harmless for mother and child, and allows SpO2‐values to be obtained during two thirds of the recording period. Further research is needed to evaluate the possible clinical value of the method.
Does hyperandrogenism explain lower in vitro fertilization (IVF) success rates in smokers?
Authors: Gustafson Owe , Nylund Lars , Carlström Kjell
Published: November 2007

Background. Our aims were to elucidate whether a decreased fertility in smoking women treated by in vitro fertilization (IVF) could be related to a divergent hormonal response to the controlled stimulation prior to IVF, to study the effect of smoking on the ovarian endocrine milieu and to possibly identify factors that might be detrimental to oocyte fertilization.

Methods. Serum and follicular fluid concentrations of estradiol‐17β (E2), progesterone (P), testosterone (T), 4‐androstene‐3,17‐dione (A‐4), dehydroepiandrosterone (DHA), DHA sulfate (DHAS), sex hormone‐binding globulin (SHBG) and serum Cortisol were studied in 50 non‐smoking and 50 smoking women in an IVF program. Follicular fluid concentrations were also compared in follicles which gave rise to cleaved oocytes (TYPE I) and follicles which failed to yield fertilized oocytes (TYPE II) in the same woman.

Results. The fertilization rate did not differ significantly between the two groups, but the live birth rate was 30% in non‐smokers and 4% in smokers. During treatment, serum A‐4, DHAS and the T/SHBG‐ratio were significantly higher in smokers than in non‐smokers. In the TYPE I follicles, smokers had higher follicular fluid concentrations of A‐4 and DHA and a higher E2/P ratio. The TYPE II follicles in smokers had higher A‐4 and T and lower E2 levels.

Conclusions. Smoking women have a relative hyperandrogenism of ovarian origin, which may contribute to the lower pregnancy rate at IVF in this group.
The Influence of Glucose Tolerance tests on Subsequent Carbohydrate Metabolism in Pregnancy
Authors: Mei Fung Hedy Yun , Wong Shu Pong , Rogers Michael
Published: November 2007

5 September 1995

Background. This present study was designed to prospectively confirm a previous observational finding that a 75g glucose load exerts an influence on the results of a subsequent 50g glucose tolerance test performed after an interval of one week.

Methods. Pregnant Chinese patients were given both 50g 3‐hour and 75g 2‐hour oral glucose tolerance test (OGTT) in random order, 7 days apart, between 28 and 32 weeks of gestation. Patients were divided according to whether they received 50g test first (group 1) or 75g test first (group 2). Student's t‐test for independent samples and for paired samples were used for between group comparisons and within patient comparisons respectively using SPSS for Windows software.

Results. Significant decrease in fasting glucose levels (p<0.0001) between paired 50g and 75g OGTT was found when 75g test was performed first. The mean difference in 2‐hour values was also 35% lower. Similar results were also found when individual timed glucose levels were compared between groups.

Conclusions. Differences in the blood glucose levels between OGTTs were confirmed to be related to which glucose load was given first. The 75g test exerts a significant effect on the fasting glucose and the response to a 50g glucose load up to one week later. These effects are consistent with improvement in glucose utilization. The differences observed will not significantly alter current clinical practice but may necessitate modification in the diagnostic criteria of mild abnormal glucose tolerance in pregnancy. We postulate that in some cases of mild glucose intolerance, the response to diet may not be due to caloric reduction but rather stimulation of a previously inadequate insulin response since a proportion of our local pregnant women consistently have caloric intakes significantly below the 1800 kcal per day.
Smoking habits among pregnant women in a Norwegian county 1987‐1994
Authors: Eriksson Kjerstin M. , Salvesen Kjell Å. , Haug Kjell , Eik‐Nes Sturla H.
Published: November 2007

Background. The aim of the study was to investigate changes in smoking habits among pregnant women in the city of Trondheim and its surroundings. We also wanted to register the effect of a national campaign against smoking in pregnancy introduced in December 1989.

Material and methods. From 1987‐1994 midwives interviewed 21 348 women in a non‐selected population during a routine ultrasound examination at 18 weeks of pregnancy. Smoking habits and cigarette consumption were recorded.

Results. The point prevalence smoking rate among pregnant women decreased from 34% in 1987 to 22% in 1994 (p<0.001). A stratified analysis indicated that the reduction was not confounded by changes in age and parity over time. The mean number of cigarettes per pregnant smoker decreased from 8.6 cigarettes per day to 7.0 cigarettes per day during the study period (p<0.001). In 1987, 49% of the pregnant smokers consumed >10 cigarettes per day compared with 35% in 1994 (p<0.001). The national campaign may have reinforced the on‐going decline in smoking rate, but no significant effect was observed.

Conclusions. The study demonstrated a statistically significant reduction in smoking prevalence among pregnant women in the study area. A similar decrease was not observed among women in the general population. No significant effect of the national campaign against smoking during pregnancy was observed.
Maternal risk factors for preterm birth and low birthweight in Cape Verde
Authors: Wessel Hans , Cnattingius Sven , Bergstrom Staffan , Dupret Alice , Reitmaier Pitt
Published: November 2007

Background. Fifteen years after the implementation of an antenatal risk screening program in Cape Verde, the first assessment of an association between maternal obstetric characteristics and preterm birth or low birthweight (LBW) infants was undertaken.

Methods. A cohort of 353 systematically selected antenatal clinic attenders in the county of Praia. Cape Verde, was studied prospectively during the period October 1991 through December 1992, The cohort was followed past the perinatal period and information was obtained according to a pretested structured questionnaire. In the analysis of preterm birth and LBW, multiple logistic regression was listed to estimate the relative risks of 11 background variables.

Results. The prevalence of preterm birth (<37 gestational weeks) was 12%, and the prevalence of LBW infants was 8%. Low birthweight (<2500 grams) was significantly associated with low maternal age (<19 years. RR=3.7); nulliparity (RR=5.2) and obstetric history of previous LBW infant (RR=6.5). The risk for preterm birth was significantly increased if the woman had an obstetric history of hypertension or convulsions (RR=2.6).

Conclusions. In the setting studied, teenage women and women with previous pregnancy hypertension should be given selective attention in antenatal care to achieve improved pregnancy outcome. Primary prevention is needed to lower the prevalence of teenage pregnancies.
Possible influence of expatriation on perinatal outcome
Authors: Kuvacic Ivan , Skrablin Snjezana , Hodzic Damir , Milkovic Gorana
Published: November 2007

Background. In order to test the hypothesis of possible influence of environmental stress on the length of gestation the data on deliveries in the Maternity Unit, Zagreb University School of Medicine in three six months periods: May‐October 1991 (active war in Croatia), May‐October 1990 (pre‐war period), and the same period in 1992 are analysed.

Methods. Deliveries of 7845 women from free areas of Croatia (non‐displaced population) and deliveries from 712 women from occupied areas of Croatia, as well of 593 Croatian refugees from Bosnia and Herzegovina and Serbia (expatriated population) were compared. The duration of pregnancy, fetal weight, immediate neonatal condition, mode of delivery and perinatal outcome in non‐displaced and expatriated population were compared using chi‐square test in statistical analysis.

Results. During 1992 and 1991, there was a slight increase in total number of deliveries in comparison to 1990. The number of deliveries by displaced women more than doubled. The incidence of major pregnancy complications was almost the same for both groups in all three time periods. The two populations were comparable regarding their age, parity and previous obstetric history. Slight increase in preterm delivery rate (7.7% in 1990, 8.7% in 1991 and 9.4% in 1992), and a subsequent slight decrease in birth weight was found in all women. There was no significant change in the proportion of growth‐retarded newborns. Expatriated women both in 1990 and in 1991 delivered twice as often prematurely in comparison to non‐displaced women (17.5% and 14.3% deliveries), respectively. Birth weight of their infants was significantly more often under 2500 grams. Slight increase in overall perinatal mortality was observed. Perinatal mortality in the experiated population was significantly higher than in the non‐displaced population. Increase in perinatal mortality could be attributed exclusively to increase in prematurity rate.

Conclusions. Our results support the concept of possible influence of stress, fear, exile and inadequate antenatal surveillance on the length of gestation.
A placebo‐controlled trial of oral ergometrine to reduce postpartum hemorrhage
Authors: de Groot Akosua NJA , van Roosmalen Jos , van Dongen Pieter W. , Borm George F.
Published: November 2007

Background. Active management with oral ergometrine 0.4 mg was compared with expectant management for the control of blood loss in the third stage of labor in women at low risk of postpartum hemorrhage (PPH).

Methods. A three‐arms randomized trial in which 0.4 mg ergometrine (2 tablets of 0.2 mg) was set off against placebo, both groups allowing comparison with a standard oxytocin regimen of 5 IU.

Women at low risk for PPH. Of 367 parturients, 146 were randomised to ergometrine 0.4 mg, 143 to placebo and 78 to intramuscular oxytocin in a 2:2:1 design.

Results. Compared with placebo, ergometrine reduced blood loss with 5% (‐5%; Confidence interval: −20% to +13%). Oxytocin reduced blood loss with 9% (−9%; Confidence interval: −26% to +12%) versus placebo.

Conclusion. Oral ergometrine has too little effect on blood loss after childbirth in order to be a good alternative to parenteral prophylactic management.
Surgical management of tubal infertility
Authors: Mosgaard Berit , Hertz Jens , Steenstrup Birgit Ravn , Sorensen Søren Stampe , Lindhard Anette , Andersen Anders Nyboe
Published: November 2007

Objective. To investigate an unselected group of patients in a regional area undergoing tubal surgery for infertility and to identify those women who would benefit from surgery and those who should be referred directly to in vitro fertilization (IVF). Design. A retrospective study based on medical records and questionnaires. Setting. The Departments of Obstetrics and Gynecology, Gentofte, Glostrup and Herlev Hospitals, University of Copenhagen, Denmark.

Subjects. Two hundred and thirty‐six women with primary or secondary infertility undergoing tubal surgery or adhesiolysis during a five year period from 1985 to 1989 with a follow‐up period of minimum of 24 months.

Results. Ninety‐four women (40%) became pregnant at least once and accounted for the total number of 144 pregnancies. One hundred and forty‐two patients (60%) did not become pregnant. The delivery rate was 25%, and 37 women (16%) had at least one ectopic pregnancy. There were no significant differences in the delivery rates of the operations in between, but the risk of ectopic pregnancy was significantly lower after adhesiolysis only than after tubal surgery (p<0.05). The initial laparoscopic findings could not be used to predict the probability of intrauterine pregnancy.

Conclusion. There is still a place for surgical treatment of tubal infertility, but the risk of ectopic pregnancy should be taken into account before a decision concerning line of treatment is made.
Age of sexual debut related to life‐style and reproductive health factors in a group of Swedish teenage girls
Authors: Andersson‐Ellström Agneta , Forssman Lars , Milsom Ian
Published: November 2007

Aim. To compare life‐style and reproductive health care factors in girls with a coitus debut < 15 years of age and girls with a later debut.

Methods: Girls resident in the municipality of Karlstad, Sweden, starting their upper secondary school education were invited to attend the teenage clinic during two years (five visits). Gynecological examinations were performed and questions were asked about possible symptoms, sexual activity, contraception and sexually transmitted diseases.

Results: Ninety‐eight girls accepted the invitation to participate and 88 girls completed all visits (mean age on admission 16 years). Median age for coitarche was 16 years. A sexual debut <15 years was reported by 17 girls (19.3%), 54 (61.4%) had their debut $15 years and 17 girls (19.3%) had not had their sexual debut on completion of this study. Girls with an early sexual debut had a greater number of sexually transmitted diseases (p<0.05) and more cervical atypias (p<0.05), and more often had a menarcheal age <13 years (p<0.05), >two brothers and/or sisters (p<0.01), were more often not living with their parents (p<0.01) and reported a greater number of life‐time partners (p<0.06) than the remainder. Girls with a sexual debut <15 years started drinking alcohol earlier than others (p<0.01). There was a greater proportion of smokers among girls with an early sex debut compared to the remainder (p<0.05).

Conclusions. Early sexual debut is associated with an earlier menarche and a more premature adult life‐style and is an important indicator for continued risk behavior regarding reproductive health.
Genital mutilation of women ‐ is it a concern for gynecologists?
Authors: Sundby Johanne
Published: November 2007

There is no doubt that some of our colleagues at least in some parts of the world take part in the implementation of this harmful practice. They do so with the best intentions, trying to reduce the harm done by traditional practitioners in back streets and with unhygienic tools. And some do it just to earn money, or because people request it. They do, however, provide surgical approaches, anesthetics, aseptic procedures and sutures as opposed to what is known to occur in the back rooms with unsterile razor blades, thorn stitches and a screaming child. In some countries it is illegal to do this in private or public hospitals, in other countries it is permitted. Irrespective of how it was done, there are probably around 85‐115 million mutilated women around the world today, mainly in a belt of 40 countries throughout Africa (1). Although some people associate the tradition with Islam, this is not a Muslim practice. Many Muslims are affected anyway, even if the tradition is older than the Islamic influence in the region. Some women from other religions, including Christianity, are also exposed, whereas most Asian Muslims do not do it (2). Some European and American girls also underwent clitoridectomy a hundred years ago, mainly because their custodians identified them to practice ‘harmful masturbation’. Some of us have also cut the labia minora of modern women, on cosmetic rather than medical demand.
Antibiotic prophylaxis in cesarean section
Authors: Pedersen Trine Kølby , Blaakær Jan
Published: November 2007

Background. To investigate the guidelines for patient selection and drug regimens for application of antibiotic prophylaxis in relation to cesarean section in the maternity clinics in Denmark.

Methods. A questionnaire to all the Danish maternity clinics that perform cesarean section, concerning indications for application of antibiotic prophylaxis and antibiotic regimens to patients undergoing acute and elective cesarean section.

Results. All departments (n=48) returned the questionnaire. Twenty departments (46%) provided written guidelines for antibiotic prophylaxis. Four departments (8%) used antibiotic prophylaxis to elective cesarean sections, 25 departments (52%) applied antibiotics to all emergency sections. In the presence of the rupture of membranes or prolongation of labor (>12hrs) 58% and 63% of the departments applied antibiotic prophylaxis, respectively. The most frequent first choice drug was cefuroxim, employed by 27 departments (56%). Concerning timing, 21 departments (44%) applied antibiotics after cord clamping and 13 departments (27%) before incision.

Conclusion. We propose a nation‐wide prospective investigation on the rate of infections associated with cesarean section to set up rational guidelines for antibiotic prophylaxis.
Endometrial stromal sarcoma of twenty cases
Authors: Huang Kuang‐Ta , Chen Chi‐An , Tseng Guan‐Chin , Chen Tzer‐Ming , Cheng Wen‐Fang , Hsieh Chang‐Yao
Published: November 2007

Background. Endometrial stromal sarcoma is a rare neoplasm. We reviewed twenty cases to study the characteristics of this disease.

Methods. Twenty cases of endometrial stromal sarcoma were treated at our hospital. The clinical stage, treatment and outcome were retrospectively analyzed.

Results. Endometrial stromal sarcoma comprised 4.3% of corpus cancers and 46.4% of uterine sarcomas at our hospital. Seven cases were stage I, one was stage II, ten were stage III, and two were stage IV at the time of diagnosis. Histopathologically, seventeen cases were classified as low‐grade sarcoma and three were high‐grade sarcoma. Seven patients had recurrence and five of them had already died of disease. Among these recurrent patients, one was stage II and six were stage III. All three patients with high‐grade sarcoma and four with low‐grade sarcoma had recurrence.

Conclusions. We think mitotic count is an important prognostic factor in low‐grade endometrial stromal sarcoma and high‐grade endometrial stromal sarcoma has a poor prognosis even with post‐operative adjuvant treatment.
Uterine leiomyosarcoma in patient receiving tamoxifen therapy
Authors: McCluggage Wilson Glenn , Varma Muralidharan , Weir Paul , Bharucha Hoshang
Published: November 2007

Tamoxifen is a non‐steroidal triphenylethyl compound which is widely used as adjuvant therapy in the treatment of breast cancer because of its anti‐estrogen properties. This antiestrogen effect is felt to be mediated by its competitive binding to the estrogen receptor (1). Tamoxifen has been perceived as a safe and effective drug with negligible side effects. However, in addition to its antiestrogen properties, tamoxifen may have a weak estrogenic effect (2) and, in recent years, several studies have described the effects of tamoxifen on the human endometrium (3‐7). A general consensus has emerged that tamoxifen may be implicated in the development of endometrial proliferative lesions including polyps, hyperplasia and carcinoma. The development of uterine sarcoma in association with tamoxifen therapy has been less well documented. In 1994 Silva et al. (8) reviewed 72 patients who developed malignant neoplasms of the uterine corpus after being treated for breast carcinoma with either tamoxifen or other therapeutic regimens. Twelve leiomyosarcomas were included in this group. We report an additional case of uterine leiomyosarcoma arising in a postmenopausal woman on long‐term tamoxifen therapy for breast carcinoma. Immunohistochemistry for estrogen and progesterone receptors was performed in order to ascertain whether the tumor was hormone responsive. The literature on uterine mesenchymal lesions arising in association with tamoxifen therapy is discussed.
Effect of serum from fertile and infertile patients with endometriosis on the development of mouse embryos
Authors: Abu‐musa Antoine , Takahashi Kentaro , Kitao Manabu
Published: November 2007

Objective. To evaluate the effect of serum from infertile and fertile patients with endometriosis on the development of 2‐cell mouse embryos.

Patients. Serum was obtained from 26 infertile patients and 8 fertile patients with endometriosis. Mouse embryo development in serum samples was compared using χ2 analysis.

Results. In the infertile group 23% of the embryos reached blastocyst stage, whereas 22 of the 26 samples were embryo toxic. In the fertile group significantly more embryos (45%) developed to blastocysts and only one serum sample was embryo toxic.

Conclusion. The embryo toxicity of serum samples from patients with endometriosis is related to the infertility associated with the disease and not with the disease per se.
Regional variations in neural tube defects and alfa‐fetoprotein screening in Denmark 1983‐88
Authors: Jacobsen Peter
Published: November 2007

Background. An effect of maternal serum alpha‐fetoprotein screening on prevalence rates for neural tube defects (NTD's) has been demonstrated in some populations. The present study tests the hypothesis that regional rates in the Danish low risk population reflects screening activities.

Methods. Cross‐sectional survey for neural tube defects through the Danish Malformation Register.

Results. The prevalence rate for all neural tube defects was 5.8 pr 104 births which is lower than in most other populations. Standardized risk ratios for NTD in two regions with a program for alfa‐fetoprotein screening were 0.1 (95% c.i. 0.0‐0.7) and 0.4 (95% c.i. 0.2‐0.9). Relative risk at 0.6 (95% c.i: 0.4‐1.1) was found in one county with screening of approximately one third of pregnancies. In most other counties <5% of pregnant women had been examined and point estimates of relative risks varied from 0.9‐1.7.

Conclusion. There was a good agreement between prevalence of neural tube defects at birth and regional alfa‐fetoprotein screening activity. This can be taken as a strong indication of a secondary preventive effect from screening in a population with a priori low risk for NTD's. However, other aspects of screening should also be taken into consideration before general programs are forwarded.
The prospects for vaginal delivery in gestations beyond 43 weeks
Authors: Olofsson Per , Saldeen Pia
Published: November 2007

Objective. To reveal factors influencing the prospect for vaginal delivery in very prolonged pregnancy.

Material and methods. Thirty‐six nulliparae and 14 multiparae delivered beyond 43 weeks followed a routine surveillance protocol. Labor was induced on strict indications (n=11; oligohydramnios, large fetus, hypertension) and on ‘soft’ indications (n=24; favorable cervix, emotional stress).

Statistics. Receiver operating characteristic curves were obtained for maternal stature and birthweight with regard to mode of delivery. Student's unpaired r‐test, Mann‐Whitney U test, and Fisher's exact test were used with a two‐tailed p<0.05 considered statistically significant.

Results. Labor started spontaneously within three days in >50% of cases managed expectantly. All multiparae had nonoperative vaginal deliveries. Of nulliparae, 89% delivered vaginally if spontaneous labor and 56% if induced. Failure to progress was the most common reason for operative delivery. A maternal height of 160 cm, a very unripe cervix, and a birthweight >4250 g were unfavorable factors in induced nulliparae. No case of perinatal mortality, severe birth asphyxia, meconium aspiration, or shoulder dystocia occurred. Fetal meconium release, fetal distress in labor, and birth asphyxia did not significantly differ with regard to parity or mode of labor.

Conclusions. The prospect for vaginal delivery was strongly associated with parity. All multiparae had nonoperative vaginal deliveries, irrespective of spontaneous or induced labor. In nulliparae, a spontaneous onset was favorable but a maternal height of 160 cm, a very unripe cervix, and a birthweight >4250 g were unfavorable factors. In uncomplicated pregnancy with favorable factors spontaneous labor can be awaited for a few days.
The utilization rate and pregnancy outcome of multifetal pregnancy reduction in the nordic countries
Authors: Rådestad A. , Bui T‐H. , Nygren K. G. , Koskimies A. , Petersen K.
Published: November 2007

Objective. To review the utilization rate and pregnancy outcome of multifetal pregnancy reductions (MFR) in the Nordic countries during the period January 1986‐June 1992. Study design. All centers offering assisted conception in Denmark, Finland, Norway and Sweden were retrospectively surveyed by means of a questionnaire with regard to the number and methods used for MFR, pregnancy loss and the outcomes of the pregnancies. The response rate was 100%.

Results. During the period studied, 185 births of triplets or higher multiples occurred in Sweden, 120 in Finland and 102 in Denmark. MFR was performed in 42 women (Sweden 26, Finland 10, Denmark 6) but not in Norway at all. This gives an estimated average utilization rate of 1/7 multiple births of three or more in Sweden, 1/17 in Denmark and 1/12 in Finland. The most frequently used method was intracardiac or intrathoracic injection of a potassium chloride solution in gestational weeks 9‐12. One pregnancy was reduced from seven to four fetuses, two from five to three, 10 from five to two, one from four to three, 17 from four to two, one from four to one, five from three to two, four from three to one and one from two to one. Nine (21%) pregnancies terminated in a spontaneous abortion within one week (n=2) to several weeks (n=7) after the procedure. Of the remaining 33 (79%) pregnancies which continued to delivery, two fetuses died in utero in the second trimester, three infants died perinatally and one child had transverse limb reduction defects. A successful pregnancy defined by the discharge home of at least one infant occurred in 79% of the cases.

Conclusion. This study gives national estimates on the utilization rate of MFR. Although MFR is performed more frequently in Sweden than in Denmark and Finland, the overall figures remain low in the Nordic countries. The incidence of pregnancy loss in this study is somewhat higher than in several larger reported series, probably reflecting the learning curve of the procedure. It seems reasonable that MFR should be performed in only a few centers in the Nordic countries.