bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of hormone replacement therapy among Danish nurses in 1993
Authors: ANDERSEN HUNDRUP YRSA , OBEL ERIK BERNHARD , RASMUSSEN NIELS KRISTIAN , PHILIP JOHN
Published: March 2003

Background. To describe the prevalence of women using systemic hormone replacement therapy in various age groups. To identify their reasons for choosing or not choosing the therapy, reasons for discontinuing the treatment, the prevalence of side effects among current users, and to estimate the duration of treatment.

Methods. The study is based on postal questionnaires sent to 23,000 female Danish nurses above the age of 44 years. Out of these 19,953 (86%) responded. The questionnaire gave information on age, use of hormone replacement therapy, use of oral contraceptives, family predisposition and diseases. Duration of hormone replacement therapy was calculated by Cox regression analysis. Chi square tests were used to evaluate differences and 5% was used as the level of significance.

Results. Overall, 6673 (33%) had ever used hormone replacement therapy. The prevalence was highest in the age group 55–59, where 29.3% were currently using hormones. The most cited reasons for choosing hormone replacement therapy were vasomotor symptoms (62%) and prevention of osteoporosis (44%). Among never users 43% had not experienced climacteric symptoms, 24% found the therapy unnatural, and 22% were afraid of side effects. It was estimated that 70% still were using hormones five years after the start of therapy, 57% after ten years, and 48% after fifteen years. Women with a family history of osteoporosis used hormones longer than women without this predisposition.

Conclusions. One third of all the women had ever used hormone replacement therapy and more than half of ever users used the therapy for more than ten years.
Determinants of urinary incontinence in a population of young and middle‐aged women
Authors: SAMUELSSON EVA , VICTOR ARNE , SVÄRDSUDD KURT
Published: March 2003

Background. Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population‐based sample of young and middle‐aged women.

Methods. Of 641 eligible women aged 20–59 years in a primary health care district, 487 (76%) responded to a questionnaire and accepted an invitation to a gynecological examination. The examination included digital assessment of the pelvic floor muscle strength (PFMS). Genital prolapse presence (cystocele, rectocele, uterine prolapse or absence of the urethrovesical crease) was graded in relation to the vaginal introitus.

Results. The prevalence of urinary incontinence was 28%, 3.5% having daily leakage. Stress urinary incontinence was the dominant type. The odds ratio (OR) of having incontinence increased from 1 to 3.5 with increasing age and from 1 to 2.7 with increasing parity. The OR also increased with decreasing PFMS; from 1 in the group with the best PFMS to 3.4 in the group unable to contract their pelvic musculature. In addition, women with cystocele and/or absence of the urethrovesical crease had a 2.5‐fold increased OR of incontinence (95% CI 1.5‐4.2), smoking increased the OR 1.9 times (95% CI 1.1‐3.2) and estrogen replacement therapy (ERT) increased the OR 2.9 times (95% CI 1.4‐5.9). There were no significant correlations with the presence of chronic disease, episiotomy or the birth weights of children but small non‐significant correlations with performed hysterectomy and the woman's weight.

Conclusions. Urinary incontinence is a frequent symptom in the female general population and related to age, pelvic floor muscle strength, genital prolapse, smoking, parity and estrogen replacement therapy.
Prognostic significance of serous and clear cell adenocarcinoma in surgically staged endometrial carcinoma
Authors: SAKURAGI NORIAKI , HAREYAMA HITOSHI , TODO YUKIHARU , YAMADA HIDETO , YAMAMOTO RITSU , FUJINO TAKAFUMI , SAGAWA TADASHI , FUJIMOTO SEIICHIRO
Published: March 2003

Background. The serous adenocarcinoma (SA) and clear cell adenocarcinoma (CCA) of endometrium have been shown to be associated with high relapse rate and poor survival. It is not clear whether prognostic significance of these specific cell types of tumor is independent of retroperitoneal lymph node metastasis and other histopathologic prognostic factors in endometrial carcinoma.

Methods. We examined 240 consecutive patients with clinical stage I to stage III endometrial carcinoma who were treated prospectively with radical surgery and/or platinum‐based chemotherapy. Surgery included extended hysterectomy, bilateral salpingo‐oophorectomy, and systematic pelvic and paraaortic lymph node dissection. Prognostic significance of various histopathologic factors was determined by Cox regression analysis.

Results. SA/CCA were more frequently associated with deep myometrial invasion, high nuclear grade (G3), lymph‐vascular space invasion (LVSI), and pelvic lymph node metastasis when compared to endometrioid adenocarcinoma (EMA). Of 216 clinically staged stage I or II disease, seven of 12 cases of SA/CCA had extrauterine disease. This incidence was much higher than that for EMA (46/204) (p<0.01). A multivariate Cox regression analysis revealed that cell type, grade, LVSI, and paraaortic node metastasis (PANM) were independent prognosticators.

Conclusions. Prognosis of patients with endometrial carcinoma depends on cell type, grade, LVSI, and PANM. Poor prognosis for patients with SA/CCA is independent of lymph node metastasis and other histopathologic prognostic factors. The SA/CCA should be strictly discriminated from EMA.
Predictive value of serum interleukin‐6 and ‐8 levels in preterm labor or rupture of the membranes
Authors: VON MINCKWITZ GUNTER , GRISCHKE EVA‐MARIA , SCHWAB STEFANIE , HETTINGER SUSANNE , LOIBL SIBYLLE , AULMANN MICHAEL , KAUFMANN MANFRED
Published: March 2003

Background. The aim of this prospective study was to examine if serum concentrations of cytokines are of value in the identification of patients at risk for preterm delivery.

Methods. Interleukin‐1β,2,4,6,8 and tumor necrosis factor α were determined between 25 and 37 weeks of gestation in the serum of 72 consecutive patients with preterm labor, 38 patients with preterm rupture of the membranes, and 24 healthy pregnant women as a control group. Material was collected within 18 hours after hospitalization and was immediately centrifuged and shock frozen.

Results. Significantly increased serum levels were found for interleukin‐6 and ‐8 in patients with preterm labor or preterm rupture of the membranes when compared to the control group (p<0.001 and p<0.005, respectively). In patients with preterm rupture of the membranes and interleukin‐6 levels above the median of 4.0 pg/ml the delivery occurred significantly earlier than in patients with lower levels (1 versus 5.5 days; p=0.005). Patients of both pathology groups with detectable (>18 pg/ml). Interleukin‐8 levels had a shorter pregnancy duration when compared to other patients (p=0.05 for preterm labor and p=0.04 for preterm rupture of the membranes). Interleukin‐1β,2,4, and tumor necrosis factor α were not correlated with clinical outcome.

Conclusions. Increased serum interleukin‐6 and ‐8 levels are associated with a shorter interval between onset of preterm rupture of the membranes and delivery and should therefore be further evaluated for their use in clinical practice.
Menstrual cycle symptom variation in a community sample of women using and not using oral contraceptives
Authors: SVEINSDÓTTIR HERDÍS , BÄCKSTRÖM TORBJÖRN
Published: March 2003

Background. The prevalence of significant symptom change (symptom cyclicity) prospectively rated over multiple menstrual cycles has not been established in a non‐clinical population.

Methods. Seventy‐three women charted 57 symptoms over 2–6 menstrual cycles each. Symptoms, and summarized symptom scores within seven symptom groups, were tested for changes between the follicular phase and the luteal phase of each cycle. Recurrent symptom cyclicity over multiple cycles within individuals was ascertained and the stability between cycles of mean symptom scores for both the follicular phase and the luteal phase.

Results. Forty‐five percent of the participants experienced cyclicity over multiple cycles in at least one symptom and 23% in at least one symptom group. Eighteen percent of the participants consistently reported a higher symptom score during the luteal phase compared to the follicular phase (a PMS‐like pattern) in all symptoms in which they experienced a change. The remaining 27% experienced a varying direction of change in the same symptom between cycles, or consistently experienced a lower symptom score during the luteal phase (a reverse PMS‐like pattern) of the cycles they charted. Recurrent cyclicity was experienced by 16% of the participants in one symptom; in two symptoms by 15%; in 3–8 symptoms by 14%; in one symptom group by 19% and in two symptom groups by only 4% of participants. Average symptom severity did not vary significantly between cycles.

Conclusion. Due to the varied direction of symptom severity change over multiple cycles, prospective daily ratings are necessary to achieve a true picture of menstrual related symptom cyclicity in the general population.
Changes in flow velocity, resistance indices, and cerebral perfusion pressure in the maternal middle cerebral artery distribution during normal pregnancy
Authors: Belfort Michael A. , Tooke‐Miller Cathy , Allen John C. , Saade George R. , Dildy Gary A. , Grunewald Charlotta , Nisell Henry , Herd J. Alan
Published: March 2003

Background. There are few longitudinal data currently available detailing the normal changes in maternal cerebral hemodynamics during human pregnancy. This lack of information limits the study of pregnancy‐associated cerebrovascular adjustments and, in particular, preeclampsia, where the brain appears to be especially susceptible to ischemic and encephalopathic injury. Our objective was to define the hemodynamic changes, specifically velocity, resistance indices, and cerebral perfusion pressure, in the middle cerebral artery (MCA) distribution of the brain during normal pregnancy.

Methods and materials. Transcranial Doppler ultrasound was used to determine the systolic, diastolic and mean blood velocities in the middle cerebral arteries in non‐laboring women studied longitudinally during normal gestation. The resistance index (RI), pulsatility index (PI), and cerebral perfusion pressure (CPP) were calculated using the velocity and blood pressure data. Data were analyzed using a longitudinal statistical model incorporating random patient effects and a homoscedastic (compound symmetric) variance‐covariance structure over time (gestational age). The predicted mean value (Least Squares Mean), and the 5th and 95th percentiles, were defined for normal pregnancy.

Results. MCA systolic velocity decreased (24%) as did the mean velocity (17%). The diastolic velocity did not change significantly. The MCA RI decreased by 19% and the PI decreased by 25%. The MCA CPP increased by 52% between 12 and 40 weeks of gestation.

Conclusions. The normative ranges for MCA velocity, RI, and CPP have been defined in normal human pregnancy using longitudinally collected data. By having a defined normal range, identification of abnormalities in cerebral hemodynamics during pregnancy is now possible, and this may help researchers and clinicians to elucidate etiologies and treatments for pregnancy‐related pathophysiologic states such as preeclampsia
Maternal risk factors for cause‐specific stillbirth and neonatal death
Authors: Winbo Ingrid , Serenius Fredrik , Dahlquist Gisela , Källén Bengt
Published: March 2003

Background. To study specific effects of four maternal risk factors: age, parity, educational level, smoking, for specific causes of stillbirth and neonatal death according to a previously described hierarchic classification.

Methods. The study is based on 9,785 stillbirths or neonatal deaths among infants born in Sweden, 1983–1995 (n=1,412,754) and identified with various Swedish health registers. Statistical analysis is performed using Mantel‐Haenszel analysis.

Results. Some risk factors, known from the literature, were confirmed and could be quantified. In addition, high parity was shown to increase the risk for death associated with multiple births (OR=2.49, 95% CI 2.07–3.01) and low educational level seems to be protective for such death (OR=0.75, 95% CI 0.60–0.93). If the infant is SGA, the risk for death is higher at high than at low parity (1.70, 95% CI 1.19–2.43, and 1.0, 95% CI 1.06–1.15, respectively). Maternal smoking seems to aggravate the placental abruption because the death risk in the presence of abruption increases when the mother smoked (OR=1.74, 95% CI 45–2.08).

Conclusions. The study shows that the groups of the classification system used (NICE) differ in their association with known risk factors for stillbirth and neonatal deaths and an analysis based on specific causes of death can therefore unravel risk factors hidden when total mortality is used. The computerized method of classification and the cause‐of‐death classification developed by us is clearly useful for such analyses which requires large materials.
Prevalence of depressive symptoms in late pregnancy and postpartum
Authors: Josefsson Ann , Berg Göran , Nordin Conny , Sydsjö Gunilla
Published: March 2003

Background.Postnatal depression refers to a non‐psychotic depressive episode that begins in or extends into the postpartum period. The aims of this study were to examine the prevalence of depressive symptoms in a pregnant and later postnatal population, to determine the natural course of these symptoms and whether there is an association between antenatal and postnatal depressive symptomatology.

Methods.A longitudinal study with a total population of 1,558 consecutively registered pregnant women in the southeast region of Sweden. Presence of depressive symptoms was measured with the Edinburgh Postnatal Depression Scale on four occasions namely in gestational week 35–36, in the maternity ward, 6–8 weeks and 6 months postpartum.

Results.The prevalence of depressive symptoms during late pregnancy was 17%; in the maternity ward 18%; 6–8 weeks postnatally 13%; and 6 months postnatally, 13%. A correlation between antenatal and postnatal depressive symptoms was found (r=0.50,p<0.0001).

Conclusion.Detection of women at risk for developing postnatal depressive symptoms can be done during late pregnancy. Antenatal care clinics constitute a natural and useful environment for recognition of women with depressive symptoms.
An introduction to gene therapy and its potential prenatal use
Authors: Staff Anne Cathrine
Published: March 2003

This review article is an introduction to the general field of gene therapy with examples from the specialized field of prenatal gene therapy.
Feto‐maternal morbidity and mortality after cardiac valve replacement
Authors: Ayhan Ali , Yucel Aykan , Bildirici Ibrahim , Dogan Riza
Published: March 2003

Background. The aim of this study is to evaluate the fetomaternal morbidity and mortality of the pregnancies of women who conceived after cardiac valve replacement.

Methods. A consecutive series of one hundred and thirty‐six pregnancies of one hundred and one patients who conceived after cardiac valve replacement were retrospectively analyzed. Regarding the anticoagulation therapy, 101 patients were classified into three groups: A: patients on oral anticoagulants (n=68), B: patients on heparin (n=16) and C: patients who received no anticoagulation (n=17).

Results. Three groups (patients on oral anticoagulants (A), on heparin (B), patients who received no anticoagulation (C)) were compared in terms of spontaneous abortion (19%, 11%, 5.6%), preterm delivery (14%, 22.3%, 16.6%), maternal mortality (3%, 11.1%, 0%), thromboembolic events (4%, 11.1%, 0%), cardiac failure (6%, 11.1%, 11.1%), atrial fibrillation (9%, 11.1%, 5.6%), antenatal bleeding (9%, 11.1%, 5.6%), delivery route and fetal malformation (5%, 0%, 0%) and no statistically significant differences were detected. In group B, hematoma formation rate (22.2%) (p=0.011) and transfusion rate (27.8%) (p=0.005) were significantly higher. Five cases of congenital anomalies were detected, all belonging to group A, but this tendency was not found to be statistically significant.

Conclusions. Management of pregnancies with prosthetic heart valves require closely monitored anticoagulation, and an obstetrician should be familiar with the potential fetal and maternal adverse effects of any anticoagulant therapy during the course of pregnancy.
Influence of maternal magnesium sulphate and ritodrine treatment on cerebral blood flow velocity of the preterm newborn
Authors: Pezzati Marco , Giani Teresa , Gambi Beatrice , Dani Carlo , Bertini Giovanna , Biagiotti Roberto , Rubaltelli Firmino F.
Published: March 2003

Background. To evaluate the effect of antenatal tocolytic administration of magnesium sulphate and ritodrine on the cerebral blood flow velocity and on the cerebral vascular resistance of preterm newborns in the first hours of life.

Methods. Cerebral blood flow velocity, resistance index and relative vascular resistance were studied in 27 preterm infants (<34 weeks gestation) with antenatal exposure to maternal magnesium sulphate treatment and in 27 preterm infants (<34 weeks gestation) with antenatal exposure to maternal ritodrine treatment. Both antenatal magnesium sulphate or ritodrine were used for tocolysis. Cerebral blood flow was measured, using Doppler ultrasonography, in the anterior cerebral artery, in the left middle cerebral artery and in the right middle cerebral artery.

Results. We did not find any significant difference in the blood flow velocity, resistance index or relative vascular resistance in the three cerebral arteries between the two treatment groups.

Conclusions. Our study shows that maternal antenatal administration of magnesium sulphate to delay preterm delivery, compared to antenatal administration of ritodrine, does not induce any significant differences either in cerebral blood flow velocity or in cerebral vascular resistance of preterm infants in the first hours of life.
Do very sick neonates born at term have antenatal risks?
Authors: Sutton Lee , Sayer Geoffrey P. , Bajuk Barbara , Richardson Valerie , Berry Geoffrey , Henderson‐Smart David J.
Published: March 2003

Aims. 1. Ascertain antenatal and intrapartum risk factors for term neonates ventilated primarily for ‘perinatal asphyxia’. 2. Describe the neonatal morbidity and mortality.

Methods. Population‐based case control cohort study.

Setting. Sydney and four large rural/urban health areas in New South Wales.

Subjects. Singleton term infants, no major congenital anomaly: subset of 83 infants ventilated primarily for ‘asphyxia’ from 182 cases admitted to a tertiary neonatal intensive care unit (NICU) for mechanical ventilation, 550 randomly selected controls.

Outcome. Risk factors for case status by maternal, antenatal, labor, delivery, and combined epochs, adjusted odds ratios (OR), 95 per cent confidence intervals (CI), p<0.05.

Results. Predictors of case status by multivariate epochs: Primigravida (1.8 [1.1, 2.8]), thyroid disease (7.8 [1.1, 57.0]), any antenatal complication (5.1 [3.0, 8.6]), growth restriction (4.2 [1.7, 10.4]), male gender (2.1 [1.3, 3.5]), gestational age >40 weeks (1.9 (1.1, 3.3)), prolonged rupture of membranes (9.7 [1.3, 72.5]), complicated labor (6.6 [3.7, 11.9]), induced labor (2.2 [1.3, 3.9]), prostaglandins 2.46 [1.23, 4.91]), maternal pyrexia (10.8 [2.8, 42.7]), placental hemorrhage in labor (OR 4.24 [1.45, 12.42]), forceps delivery (4.1 [1.9, 8.5]), emergency cesarean section (4.7 [2.6, 8.7]). Twenty case infants (24%) and no control infants died.

Conclusions. This study has shown maternal and antepartum risk factors for severe neonatal morbidity in term infants. More centers need to become interested in the term baby, so that a larger multicenter study can further elucidate the heterogeneous causal pathways to term neonatal morbidity.
Do very sick neonates born at term have antenatal risks?
Authors: Sutton Lee , Sayer Geoffrey P. , Bajuk Barbara , Richardson Valerie , Berry Geoffrey , Henderson‐Smart David J.
Published: March 2003

Aims. 1. Ascertain antenatal and intrapartum risk factors for term neonates ventilated primarily for respiratory problems. 2. Describe the neonatal morbidity and mortality.

Methods. Population‐based case control cohort study.

Setting. Sydney and four large rural/urban Health Areas in New South Wales, 1996.

Subjects. Singleton term infants, no major congenital anomaly: subset of 99 infants ventilated primarily for respiratory problems from 182 cases admitted to a tertiary neonatal intensive care unit (NICU) for mechanical ventilation, and 550 randomly selected controls.

Outcome. Risk factors for case status by maternal, antenatal, labor, delivery, and combined epochs, adjusted Odds Ratios (OR), 95 per cent Confidence Intervals (CI), p<0.05.

Results. Predictors of case status by multivariate epochs: mother’s age ≥35 years (1.9 (1.1, 3.2) p=0.03), primigravida (1.8 (1.1, 2.8) p=0.01), any antenatal complication (3.8 (2.4, 5.9) p=0.0001), birth weight <3rd percentile (3.7 (1.5, 9.1) p=0.006), gestational diabetes (2.9 (1.3, 6.9) p=0.01), maternal pyrexia (6.5 (1.6, 27.2) p=0.01), birth weight >90th percentile (1.8 (1.01, 3.2) p=0.047), gestation 37–38 weeks (2.3 (1.5, 3.6) p=0.0004), forceps (4.4 (2.1, 9.1) p=0.0001), elective cesarean section (3.7 (2.0, 6.5) p=0.0001), emergency cesarean section (4.5 (2.4, 8.4) p=0.0001). Case mortality rate was 5 per cent.

Conclusion. The pathways to neonatal respiratory morbidity in term infants are multifactorial. Several areas which warrant more in‐depth study are: elective cesarean section at 37–38 weeks gestation, fetal growth restriction, macrosomia and the pattern of in‐utero growth, maternal weight gain during pregnancy, gestational diabetes, pyrexia in labor and the role of chorioamnionitis.
Do fertile women remember the onset of stress incontinence?
Authors: Viktrup Lars , Lose Gunnar
Published: March 2003

Background. To evaluate fertile women’s ability to recall the onset of stress incontinence.

Methods. In a prospective cohort study 305 primiparae were interviewed after 1st delivery and again 5 years later using a tested questionnaire. In 83 women with stress incontinence 5 years after 1st delivery history of onset was compared with data from the initial questionnaire by grouping women with onset before 1st pregnancy, during 1st pregnancy, during 1st puerperium or after 1st puerperium.

Results. Five years after 1st delivery only 26% recalled the onset of stress incontinence precisely. The statistical agreement for each of the four groups of women with different recall of onset varied with a Kappa from 0.02 to 0.38.

Conclusion. Five years after 1st delivery stress incontinent women seem to recall the onset of the symptom imprecisely.
Pain experience during transvaginal aspiration of immature oocytes
Authors: Hildebrandt Nan B. , Høst Erik , Mikkelsen Anne Lis
Published: March 2003

Background. We wanted to determine the pain conception prior to, during, and after transvaginal recovery of immature oocytes for in vitro maturation (IVM).

Material and methods. Fifty women received 1 g Paracetamol and 0.125 mg Halcion as preanalgesics. During the oocyte pick‐up para‐cervical blockage (PCB) with 5 ml Citanest ×2 was given, in addition to 1.5–2 ml Raphiphene intravenously. The pain was measured by using a visual analog scale (VAS). The expected pain was recorded just before the oocyte pick‐up. Right after the oocyte pick‐up the actual pain was measured and again 1/2 hour, and 1–11/2 hour later. Furthermore, the pain was recorded every second hour after discharge and every third hour the next day.

Results. Forty‐three women experienced less pain than expected (p=0.003). The pain conception was correlated to the number of punctures through the vagina (p=0.012). Fifteen patients received analgesics postoperatively, and all patients were discharged less than 2 hours after the procedure without complaints. None noted any discomfort or pain after 30 hours following the oocyte pick‐up.

Conclusion. Although the IVM oocyte pick‐up procedure involved puncture of very small follicles that required numerous punctures through the vagina, the experienced pain was significantly less than the expected pain, and the procedure was well accepted.
The impact of frozen embryos on emotional reactions during in vitro fertilization
Authors: Svanberg Agneta Skoog , Boivin Jacky , Hjelmstedt Anna , Bergh Lena Andersson , Collins Aila , Bergh Torbjörn
Published: March 2003

Background. Emotional reactions of couples were investigated during in vitro fertilization (IVF) at a private clinic in Sweden. The purpose was to compare such reactions between couples who obtained supernumerary embryos that could be cryopreserved and couples without such embryos.

Methods. Forty women and men undergoing IVF treatment monitored individually their emotional reactions daily for one complete treatment cycle from the first day of down‐regulation until the outcome of treatment was known. Ratings were extracted and analyzed from two separate days; the very first day of treatment and the day of embryo transfer.

Results. The group of women (n=16; 40%) with supernumerary embryos suitable for cryopreservation reported a greater increase in optimism than the group (n=24; 60%) without such embryos (p=0.024). Correspondingly, women with supernumerary embryos reported less pessimism than women without such embryos (p=0.014). Among men there was no difference in optimism or pessimism between the groups. The women and men with supernumerary embryos did not differ in distress reactions compared to those women and men without such embryos. There was no correlation between optimism and distress on the day of embryo transfer in women; r=−0.167 and men; r=−0.135 respectively.

Conclusion. The presence of frozen embryos increased optimistic and reduced pessimistic feelings about pregnancy among women undergoing IVF treatment. However, the couples’ increased optimism on the day of embryo transfer did not seem to reduce their experience of distress.
Expression of cadherins and CD44 isoforms in human endometrium and peritoneal endometriosis
Authors: Poncelet Christophe , Leblanc Marc , Walker‐Combrouze Francine , Soriano David , Feldmann Gérard , Madelenat Patrick , Scoazec Jean‐Yves , Daraï Emile
Published: March 2003

Background.  To evaluate (a) cadherins and CD44 expression in normal endometrium and in peritoneal endometriosis, and (b) to correlate, their expressions with clinicopathological parameters.

Methods.  E‐ and N‐cadherin, CD44 isoforms, CD44v3 and CD44v6 expressions were evaluated: (a) by immunoblotting in endometrium (n = 6) and in peritoneal endometriotic samples (n = 7) and, (b) by immunohistochemistry in endometrium (n = 15) and in peritoneal endometriotic samples (n = 23).

Results.  By immunoblotting, endometrium expressed E‐ and N‐cadherin, CD44 isoforms, CD44v3 and CD44v6. Similar results were observed in peritoneal endometriosis. By immunohistochemistry, in endometrium, E‐cadherin was restricted to epithelial cells. Its expression remained constant throughout the menstrual cycle. N‐cadherin was detected in both epithelial and stromal cells in the proliferative phase but was restricted to epithelial cells in the secretory phase. CD44 immunostaining was detected in the secretory but not in the proliferative phase. Decreased expression of E‐cadherin (p < 0.01) and CD44 (p < 0.01) in epithelial cells was found in peritoneal endometriosis as compared with normal endometrium. In endometriotic stromal cells, decreased CD44 expression was found. In peritoneal endometriosis, we observed a decreased expression of E‐cadherin in advanced stages of the disease (p < 0.01).

Conclusion.  Our results suggest that E‐cadherin and CD44 proteins could be involved in the development of endometriotic lesions. Investigation of the mechanisms of altered adhesion molecule expression may contribute to the understanding of the behavior of endometriotic cells.
Management and outcome of pregnancy in women with thrombophylic disorders and past cerebrovascular events
Authors: Soriano David , Carp Howard , Seidman Daniel S. , Schiff Eyal , Langevitz Pnina , Mashiach Shlomo , Dulitzky Motti
Published: March 2003

Objective. To evaluate the maternal and fetal outcome in a cohort of women undergoing a subsequent pregnancy after a previous cerebrovascular event in the presence of thrombophilia.

Patients. Fifteen pregnancies were followed up in 12 women with past cerebrovascular events and thrombophilic disorders. The cerebrovascular events occurred during a previous pregnancy in five patients. Six patients had a bad obstetric history including intrauterine fetal death in four cases, early onset of severe preeclampsia in two cases and one infant that was small for gestational age.

The thrombophilic disorders included: anti–phospholipid syndrome, protein C, S or antithrombin III deficiencies, mutations of the methyltetrahydrofolate reductase (MTHFR). All patients received prophylactic treatment with low molecular weight heparin and low dose aspirin.

Results. Thromboembolic complications occurred in four pregnancies. Postpartum complications occurred in one patient; deep vein thrombosis and pulmonary emboli after stopping anticoagulation treatment. No patient had long‐term neurologic damage. All pregnancies except one resulted in live births. (mean gestational age at delivery 36 ± 3. 7 weeks, mean birth weight 2656 ± 811 g). The one remaining pregnancy was electively terminated. There was one neonatal death due to the complications of severe prematurity in a woman with severe HELLP syndrome.

Conclusion. This preliminary data suggests that women with a history of cerebrovascular events and thrombophilic disorders receiving prophylactic treatment, have a relatively favorable pregnancy outcome, however, they remain at significant risk during pregnancy further studies are necessary to determine the optimal prophylactic treatment.
Ovarian carcinoma associated with pregnancy. A review of 9 cases
Authors: Sayedur Rahman Mohammad , Al‐Sibai Mohammad Hisham , Rahman Jessica , Al‐Suleiman Suleiman Awdah , El‐Yahia Abdul Rahman , Al‐Mulhim Abdul Aziz , Al‐Jama Fathia
Published: March 2003

Background. The purpose of this study was to review patients with ovarian cancer in pregnancy, the effectiveness of the available methods of treatment and their prognosis.

Methods. A retrospective review of all women diagnosed to have cancer of the ovary associated with pregnancy who delivered at the authors' hospitals between January 1976 and December 2000. The demography, clinical presentation, time and mode of diagnosis, treatment, pregnancy outcome and maternal survival were noted.

Results. The incidence of ovarian carcinoma in pregnancy in the series was 0.08/1000 deliveries. Of the 9 patients, 7 had epithelial cancers; 4 serous cystadenocarcinoma, 2 mucinous cystadenocarcinomas and one undifferentiated cancer. One patient each had dysgerminoma and granulosa cell tumor. Six patients were in FIGO stage Ia, one Ic, one IIa. One patient was in stage III. Five patients were treated by unilateral salpingo‐oophorectomy during pregnancy. Three patients had total abdominal hysterectomy, bilateral salpingo‐oophorectomy and omentectomy followed by chemotherapy. Debulking of the tumor was done in a patient in stage III with subsequent chemotherapy. This patient died 13 months from the time of diagnosis of the tumor. The overall 5‐year survival rate in the series was 78% and 100% for stage Ia.

Conclusions. Association of ovarian cancer with pregnancy is a rare occurrence. Early diagnosis and appropriate treatment offers the best prognosis for the patient. The higher survival rates in the series was attributed to a larger number of patients in stage I of the disease and 2 patients with a germ cell tumor and dysgerminoma which have the best prognosis. Aggressive postoperative chemotherapy also contributed to the better outcome.
Pregnancy and the Ehlers–Danlos syndrome: a retrospective study in a Dutch population
Authors: Lind Jan , Wallenburg Henk C. S.
Published: March 2003

Background.  The study was carried out to assess the course and outcome of pregnancies in women with the Ehlers–Danlos syndrome, with the aim of developing guidelines for assessment of risk and counseling, and for providing optimum medical and obstetric care.

Methods.  A retrospective study based on data collected from members of the Dutch Association of Ehlers–Danlos patients. Pregnancies and neonatal outcomes of the affected mothers were compared with those of the nonaffected mothers who delivered an infant with Ehlers–Danlos syndrome.

Results.  In a group of 46 women with Ehlers–Danlos syndrome, 128 pregnancies beyond 24 weeks gestation were evaluated and compared with 43 pregnancies of 33 nonaffected women. The main maternal complications consisted of pelvic pain and instability (26% vs. 7%). One bowel rupture was reported in a woman with Ehlers–Danlos syndrome type IV. Preterm delivery occurred in 21% of the affected mothers compared with 40% of the nonaffected women with an affected infant; the women with Ehlers–Danlos syndrome experienced postpartum hemorrhage (19% vs. 7%) and complicated perineal wounds (8% vs. 0%) more often than the unaffected women. The floppy infant syndrome was diagnosed in 13% of the affected infants and did not occur in the nonaffected neonates.

Conclusion.  Pregnancy is generally well‐tolerated in women with Ehlers–Danlos syndrome, with favorable maternal and neonatal outcomes. In Ehlers–Danlos syndrome type IV it may be associated with severe maternal complications. Preconceptional counseling concerning specific possible complications and a multidisciplinary approach are recommended.
Short‐term complications after surgically induced abortions: a register‐based study of 56 117 abortions
Authors: Zhou Weijin , Nielsen Gunnar Lauge , Møller Margrethe , Olsen Jørn
Published: March 2003

Background.  Performing an induced abortion is a rather simple medical procedure which is frequently done and side‐effects will have public health implications unless they are very rare. We estimated the incidence of side‐effects detected during the stay at the hospital and 2 weeks after the discharge. We only include side‐effects reported by clinics or hospitals.

Methods.  Altogether 56 117 induced abortions performed by public hospitals in Denmark from 1980 to 1994 were analyzed in this study. The study combined results from the mandatory reporting of side‐effects to the National Induced Abortion Registry and all diagnoses reported to the Hospital Discharge Registry.

Results.  Side‐effects in the form of bleeding, infections or re‐evacuation were recorded for about 5%. We found more side‐effects in teenage women and for abortions performed late in pregnancy. We found nothing to indicate that the frequency of side‐effects following an abortion changed over time.

Conclusions.  About 5% have side‐effects registered by hospitals following an induced abortion. The long‐term consequences of this are not known.
Is mid‐trimester maternal serum inhibin‐A a marker of preeclampsia or intrauterine growth restriction?
Authors: D'Anna Rosario , Baviera Giovanni , Corrado Francesco , Leonardi Iolanda , Buemi Michele , Jasonni Valerio M.
Published: March 2003

Background. To evaluate maternal serum Multiple of Median inhibin‐A in mid‐trimester blood samples of women who subsequently developed preeclampsia, gestational hypertension and intrauterine growth restriction and controls. Also, to verify whether this marker is related to these pathological conditions.

Methods. Retrospective analysis of serum samples from a bank of stored serum, originally taken for Down's syndrome screening over 15–18 weeks, was performed. The sample consisted of 20 patients with gestational hypertension, 20 patients with preeclampsia, 10 patients with intrauterine growth restriction and 40 controls.

Results. No statistically significant difference of inhibin‐A Multiple of Median values between the control group and the preeclamptic or gestational hypertension groups was found. There was a statistically significant elevation in the intrauterine growth restriction group in comparison with the control group, and the same was true for each subgroup of gestational hypertension and preeclampsia complicated by intrauterine growth restriction.

Conclusion. Elevated maternal inhibin‐A concentrations in the second trimester are strongly associated with intrauterine growth restriction and not with preeclampsia, as previously stated.
Menopause, energy expenditure, and body composition
Authors: Poehlman Eric T.
Published: March 2003

Objectives.The effects of menopause transition on metabolic and cardiovascular disease risk in women are unclear. It is unknown whether estrogen deficiency, aging, or a combination of both factors are independent contributors to a worsening health profile in women. We considered the effects of menopause transition and hormone replacement therapy on body composition, regional body fat, energy expenditure, and insulin sensitivity.

Methods.A brief review of current literature that has considered the role of menopause transition and hormone replacement therapy on body composition, energy expenditure, and insulin sensitivity with an emphasis on longitudinal investigations.

Results.Preliminary evidence suggests that natural menopause is associated with reduced energy expenditure during rest and physical activity, an accelerated loss of fat‐free mass, and increased central adiposity and fasting insulin levels. Hormone replacement therapy has been shown to attenuate these changes. Longitudinal and longer intervention studies are needed to confirm these initial findings.

Conclusions.Menopause transition may represent a risky period in a woman's life, ‘triggering’ adverse metabolic and cardiovascular processes that predispose women to a greater incidence of obesity‐related comorbidities. Dietary, exercise, and hormonal interventions specifically targeted at premenopausal women may help mitigate the worsening cardiovascular and metabolic risk profile associated with menopause.
Prevalence and outcome of pregnancies in Norwegian and Swedish women with cystic fibrosis
Authors: ØDegaard Inger , Stray‐Pedersen Babill , Hallberg Karin , Haanaes Ole Christen , Storrøsten Olav Trond , Johannesson Marie
Published: March 2003

Background:  As patients with cystic fibrosis now live longer, more women with cystic fibrosis wish to become mothers. We looked at the prevalence and outcome of pregnancies in women with cystic fibrosis who were alive in Norway and Sweden in the year 2000.

Methods:  Women with cystic fibrosis aged 18 years and older attending cystic fibrosis centers in Norway and Sweden were included in the study. Information was obtained from medical records, interviews and questionnaires.

Results:  One hundred and thirty‐two women with cystic fibrosis were included. Sixty‐one (46%) had considered or were now considering pregnancy. Forty‐six (75%) of these 61 women had already conceived. Eighty pregnancies were reported, including 12 (15%) conceived by assisted reproductive techniques. There were eight (10%) induced abortions, 11 (14%) miscarriages, and one extrauterine pregnancy. The remaining 60 (75%) pregnancies resulted in live born infants.

Conclusions:  Today women with cystic fibrosis have a better chance of getting pregnant than previously reported. In this study, 75% of those who wanted to get pregnant had succeeded. Fifteen percent of pregnancies were conceived by artificial reproductive techniques. The possibility of motherhood must be considered in these patients. It is important to plan pregnancies with optimal follow up by a cystic fibrosis team.
Deliveries in maternity homes in Norway: results from a 2‐year prospective study
Authors: Schmidt Nina , Abelsen Birgit , ØIan Pål
Published: March 2003

Background.  The study aims to report the short‐term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway.

Methods.  A 2‐year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum.

Results.  The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection.

Conclusion.  Midwives and general practitioners working in the districts can identify a low‐risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.
Initiation of lactation in women after preterm delivery
Authors: Cregan Mark D. , De Mello Thalles R. , Kershaw Daphne , McDougall Kate , Hartmann Peter E.
Published: March 2003

Background.  Lactogenesis II describes the onset of copious milk secretion, and the success of lactogenesis II has been determined in women by measuring the changes in the composition of mammary secretion in the immediate postpartum period.

Aim and methods.  Therefore, the aim of this study was to determine the success of lactogenesis II at day 5 postpartum in women expressing milk for their preterm infants (n = 22) by measuring the lactogenesis II markers (milk citrate, lactose, sodium and total protein) and comparing them with women breastfeeding full‐term infants (n = 16).

Results.  There were no significant differences between the means (± SD) of the lactogenesis II markers for preterm (4.3 ± 0.7 mM; 147 ± 10 mM; 12 ± 6 mM; 14.0 ± 1.5 g/l, respectively) and term (3.4 ± 1.4 mM; 126 ± 17 mM; 30 ± 13 mM; 15.3 ± 2.5 g/l, respectively) women. However, variation about the mean was greater in preterm women (coefficient of variation for citrate, 40%; lactose, 14%; sodium, 42%; and total protein, 17%) compared with term women (17%, 7%, 33%, and 10%, respectively). All lactogenesis II markers were within 3 SD from the means for the term women and thus these women were considered to have successfully initiated their lactation. Only 18% of preterm women had all four lactogenesis II markers within 3 SD from the mean for term women. The remaining 82% of preterm women had at least one of the markers of lactogenesis II at pre‐initiation concentrations (36% had 1 marker, 32% had 2 markers, and 14% had 3 markers). Furthermore, these women had significantly lower 24‐hr milk production than those preterm women that had all four markers within 3 SD from the mean of the term women.

Conclusions.  It was concluded that 82% of preterm women had a compromised initiation of lactation, and this was not uniform in all women.
Uveitis in children: Population‐based study in Finland
Authors: Päivönsalo‐Hietanen Taina , Tuominen Juhani , Matti Saari K.
Published: March 2003

Purpose: To investigate the incidence and prevalence rates of different types of uveitis in children, and to compare them with the rates in adults.

Subjects and methods: For this population‐based retrospective study the medical records of all residents of the district of Turku University Hospital with a diagnosis of uveitis seen at the Eye Clinic of Turku University Hospital during the years 1980–1982 and 1988 were reviewed.

Results: A total of 1122 uveitis cases were identified, and 55 (4.9%) of them were children under 16 years. The incidence per 100 000 population per year for all uveitis cases in children was 4.3 (95% confidence interval [CI], 2.2 to 6.4), and the prevalence was 27.9 (95% CI, 17.1 to 38.6), which was significantly lower compared with the rates in adults (p=0.001 for incidence and prevalence). The vast majority of children, 50 (90.9%), had anterior uveitis (AU), and the incidence and prevalence rates of AU were significantly lower than in adults (p=0.001 for incidence and prevalence). Three (5.5%) children had posterior uveitis (PU), but there was no significant difference in the incidence and only marginally significant difference in the prevalence rate of PU in children compared with the rates in adults (p=0.33 for incidence, and p=0.07 for prevalence). Only one case (1.8%) was found with intermediate and one with panuveitis, but no new cases. The commonest diagnostic groups in children were AU associated with juvenile rheumatoid arthritis, idiopathic acute anterior uveitis, and idiopathic chronic anterior uveitis. Toxoplasmic retinochoroiditis was found in all of the PU cases with the incidence 0.3, and the prevalence 1.1, which did not differ significantly from the rates in adults (p=1.0 for incidence, and p=0.48 for prevalence).

Conclusion: Uveitis is rarer in children than in adults. However, in contrast to studies from tertiary referral centers, the distribution of different forms of uveitis in children in this population‐based study seems to resemble the distribution in adults.
Foveal haemorrhages in diabetic retinopathy. Clinical characteristics and visual outcome
Authors: Lahrmann Christian , Bek Toke
Published: March 2003

Background: Haemorrhages from retinal vessels is one of the major clinical characteristics of diabetic retinopathy. Vitreous haemorrhages from retinal neovascularizations may extend to the visual axis and disturb central vision, whereas asymptomatic intraretinal haemorrhages may develop from ruptures of smaller retinal vessels. On rare occasions, however, smaller intraretinal haemorrhages may develop in the fovea, and consequently lead to a reduction in central vision. The clinical characteristics and visual outcome of these lesions have not been described in detail.

Methods: Clinical data of 4724 diabetic patients (31.4% with type 1 diabetes and 68.6% with type 2 or other diabetes types) examined in the screening clinic for diabetic retinopathy at the Department of Ophthalmology, Århus University Hospital, 1993–1998 were reviewed. Patients who had had a previous foveal haemorrhage were subjected to a full ophthalmological reexamination.

Results: Six eyes of six patients with type 1 diabetes had previously had a foveal haemorrhage. The lesion had resulted in a visual reduction of on the average 1.4 visual acuity steps (SD=0.5, range:1–2, n=5), and resolution of the lesion was accompanied by an increase in visual acuity of on the average 1.2 visual acuity steps (SD=0.4, range: 1–2, n=6). Four of the patients had progressed to proliferative diabetic retinopathy and had received pan‐retinal photocoagulation.

Conclusions: Foveal haemorrhages in diabetic retinopathy are accompanied by a mild and transient reduction in central vision. The lesions predominate in patients with type 1 diabetes of long duration, and may indicate that retinopathy has developed into a moderate or severe stage.