bluuebunny/crossref_metadata_2025 huggingface dataset:
Alteration of sonographic texture of the endometrium in post‐menopausal bleeding
Authors: SHEIKH MEHRAJ , SAWHNEY SUKHPAL , KHURANA ASHOK , AL‐YATAMA MAJDA
Published: March 2003

Background. The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling.

Methods. Two hundred and seven consecutive cases of postmenopausal bleeding were evaluated by transvaginal ultrasound. Endometrial thickness was measured as the maximum anteroposterior thickness of the endometrium including both the anterior and posterior layers, in the sagittal long axis view. The morphology of the endometrium was studied and categorized as homogeneous, focally increased echogenecity, diffusely increased echogenecity or diffusely inhomogeneous. Patients were followed up for clinical course and endometrial histopathology.

Results. Textural inhomogeneity was observed in all the three cases of endometrial cancers with endometrial thickness of less than 6 mm, and, in ten out of 11 cases of a more than 6 mm thick endometrium. On the other hand the endometrial texture was homogeneous in all cases of endometrial atrophy/tissue inadequate for diagnosis, with thickness of less than 6 mm.

Conclusion. This study adds the dimension of abnormal echogenecity of the endometrium to the currently followed criterion of endometrial thickness with a view to enhance accuracy, both for a better prediction of atrophy and a higher prediction for endometrial cancer. Expectant management can be offered to patients with a homogeneous endometrium which is 6 mm thick or less. Aggressive evaluation for a malignancy must be made if there is a focal increased echogenecity or a diffuse increased echogenecity even in a thin endometrium.
Hormonal predisposition to menstrual dysfunction in collegiate dance students
Authors: TO WILLIAM W. K. , WONG MARGARET W. N. , LAM IVY Y. L.
Published: March 2003

Objective. To evaluate the effect of dance training on menstrual function in teenage dance students and to identify risk factors associated with menstrual dysfunction.

Methods. Dance students from a collegiate school of performing arts were recruited when they were first admitted to the school. Basic epidemiological data and menstrual history were gathered using a structured questionnaire. The subjects' self image appraisal was scored utilizing the Offer Self Image Questionnaire. Anthropometric measurements, body fat percentages and hormonal profiles were measured. The subjects were followed up after 12 months of intensive dance training, and the menstrual pattern, self image scoring and fat composition assays were repeated.

Results. A total of 50 students completed the study. The mean age was 18.9 years (s.d. 1.86). While all were eumenorrheic at first assessment, eight were amenorrheic and eight were oligomenorrheic at the second assessment, giving an incidence of menstrual dysfunction of 32%. A general reduction in weight and body fat composition was observed after training. Those with menstrual dysfunction did not differ from those that remained eumenorrheic in their basic anthropometric parameters, nor was the serial change in these parameters in the second assessment different between the two groups. Psychological assessment scores also showed an identical trend. All hormonal values were within the normal range, but the group with menstrual dysfunction showed a significantly higher LH/FSH ratio (p=0.012) and DHEAS levels (p=0.036) at the pre‐training assessment while other hormonal parameters did not differ.

Conclusion. The incidence of menstrual dysfunction in adolescent dance students undergoing intensive training was high. Those with pre‐existing hormonal predisposition prior to entering training appeared particularly at risk.
Embryo quality and developmental potential is compromised by age
Authors: Ziebe Søren , Loft Anne , Petersen Jørgen Holm , Andersen Anne‐Grethe , Lindenberg Svend , Petersen Karsten , Andersen Anders Nyboe
Published: March 2003

Aims. The aim of this retrospective study was to assess whether and how the age of the woman affects the quality and developmental potential of the oocytes and embryos in an ART program.

Method and material. A total of 878 IVF cycles was included as a consecutive series of single transfers (n=292), dual transfers (n=366) and triple transfers (n=220), where all the transferred embryos in each cycle were of identical quality score and identical cleavage stage.

Results. We found a highly significant decrease in oocyte recovery with increasing age with about one oocyte per 2.3 years (95% CI 1.8 years to 3.1 years, p<0.0001). Further, we found that the number of oocytes that cleaved declined significantly with increasing age with one per 3.7 years (95% CI 2.7 years to 5.5 years, p<0.0001). This decline was mainly due to the decline in number of oocytes retrieved as the ratio of aspirated oocytes that cleaved with increasing age (approx. −0.04/10 year 95% CI: −0.10; +0.009) was not significantly different (p=0.10). The percentage of transfers using fragmented embryos did not increase significantly with increasing age (p=0.08). The odds of fragmentation increased by 3% per year. The average number of embryos transferred decreased significantly (p=0.03) with age from approximately 2.1 at the age of 25 to approximately 1.8 at the age of 40. In a selected subgroup of embryos all consisting of good quality embryos, a significant decrease was found in implantation rate with increasing age (approx. −0.08/10 years, 95% CI: −1.6; +0.00, p=0.05). Of the 357 pregnancies achieved in this study we found a significantly decreased ongoing pregnancy rate and a significantly increased abortion rate with increasing age (p=0.03). The decrease in the rate of ongoing pregnancies was almost linear, decreasing by approximately 1.5% per year.

Conclusions. We conclude that age has an impact throughout a woman’s reproductive life and that it is important to realize that the age‐related decline in fertility may start already in the late twenties and not in the mid‐thirties as is generally assumed.
Third and fourth degree perineal tears
Authors: Jandér Charlotte , Lyrenäs Sven
Published: March 2003

Background. Tears of the anal sphincter are a feared complication of vaginal delivery, as many as 50% of these patients experience incontinence as an after‐effect. Identifying significant predictor factors leading to third or fourth degree perineal tears during vaginal delivery was the objective of this study.

Methods. During a two‐year period (1995–1996), a third or fourth degree perineal rupture occurred in 214 women (3.7%) after vaginal delivery. Data from these deliveries were collected and compared to data from deliveries without anal sphincter tears in order to identify risk factors. A stepwise logistic regression model was used for the analysis.

Results. Independent risk factors of significance were vaginal nulliparity, a squatting position on a delivery chair, maternal age exceeding 35 years, baby’s birth weight over 4000 g, vacuum extraction (both outlet and mid release), median episiotomy, oxytocin augmentation and birthing between 3 a.m. and 6 a.m.

Conclusions. This study identified several factors associated with anal sphincter tears. Median episiotomy should be avoided. Delivery, while squatting on a low chair, should be used with caution. A woman with one or more risk factors requires caution by birth attendants during delivery. Gynecologists should consider the option of cesarean section instead of vacuum extraction, especially when mid release is needed in the presence of macrosomia. A continuous audit regarding instrumental delivery technique is necessary.
Conduct of labor and rupture of the sphincter ani
Authors: Parnell Christine , Langhoff‐Roos Jens , Møller Henrik
Published: March 2003

Objective. To determine whether the conduct of the second stage of labor and delivery technique influences the incidence of rupture of the anal sphincter.

Material and method. A total of 1072 primipara delivered vaginally at term at Rigshospitalet in 1998. A questionnaire on prenatal risk factors, conduct of the second stage of labor, and delivery technique was completed by the attending midwife immediately after delivery in 90 cases with rupture of the sphincter and in two subsequent controls (n=164), matched by use of vacuum extractor and episiotomy.

Results. Partial or total sphincter rupture was found in 8.4% of primipara who delivered vaginally, in 20.9% of those delivered by vacuum extraction, and in 6.4% of those with episiotomy only. The prenatal risk factors – maternal age, birth weight, shoulder dystocia, and edema of the perineum were found to have a statistically significant effect on the incidence of rupture of the sphincter ani. In non‐instrumental vaginal deliveries easing of the perineum over the caput as it advanced helped prevent a rupture of the anal sphincter. Vacuum extraction performed with the woman in a semi‐recumbant position was associated with an increased risk of rupture of the anal sphincter, whereas attention to the perineum during extraction decreased the risk.

Conclusions. The significant effect of prenatal risk factors did not explain a correlation between delivery technique and rupture of the sphincter ani. The present study indicates that a reduction in the incidence of sphincter rupture may be accomplished by improved obstetric care: fewer vacuum extractions and improved delivery technique.
Expression of basic fibroblast growth factor (bFGF), FGF receptor 1 and FGF receptor 2 in uterine leiomyomas and myometrium during the menstrual cycle, after menopause and GnRHa treatment*
Authors: Wu Xuxia , Blanck Agneta , Olovsson Matts , Möller Björn , Lindblom Bo
Published: March 2003

Background. To investigate whether basic fibroblast growth factor (bFGF) is involved in the growth regulation of human uterine leiomyomas the expression of bFGF and its receptors was measured in leiomyomas and myometrium obtained under different endocrine conditions.

Methods. The expression of bFGF, fibroblast growth factor receptor 1 (FGFR1) and fibroblast growth factor receptor 2 (FGFR2) was analyzed by immunohistochemistry and Western blot.

Results. Twenty‐seven women with leiomyomas included eight in the proliferative phase, seven in the secretory phase, six after menopause and six after GnRHa treatment. In the proliferative phase, bFGF staining in leiomyomas was significantly stronger than in any other leiomyoma group. After GnRHa treatment, the expression of bFGF in both leiomyomas and myometrium was weaker than in the proliferative phase. The staining of FGFR1 was less intense in proliferative phase myometrium than in myometrium from any other group, significantly weaker than in the secretory phase. The leiomyomas demonstrated homogeneous cytoplasmic FGFR1 staining that was similar in all groups, except in the GnRHa treated patients where a more intense staining was observed, significantly stronger than in proliferative phase leiomyomas. No tissue differences were observed for staining of FGFR2 and no significant differences were observed between the different groups. Slightly less staining of FGFR2 was found in leiomyomas in the secretory phase but it did not reach statistical significance. The specificity of immunostaining was confirmed by Western blot.

Conclusions. We suggest that the regulation of bFGF, and to some extent also its receptors in leiomyomas and in myometrium, is influenced by sex steroid hormones. However, the lack of differences in expression between leiomyomas and myometrium favors the view that bFGF does not necessarily contribute to the differences in growth regulation in these tissues.
Insulin‐like growth factor‐binding protein‐1 in cervical secretion as a predictor of preterm delivery
Authors: Kekki Minnamaija , Kurki Tapio , Kärkkäinen Tytti , Hiilesmaa Vilho , Paavonen Jorma , Rutanen Eeva‐Marja
Published: March 2003

Background. The aim of the study was to evaluate whether the phosphorylated isoforms of insulin‐like growth factor‐binding protein‐1 (IGFBP‐1), a protein produced by the decidua, can be detected in cervical secretions of pregnant women with preterm uterine contractions, and whether their presence predicts an increased risk of preterm delivery.

Methods. A prospective analysis of sixty‐three women who presented with preterm labor but intact fetal membranes at weeks 22–36+6 days of gestation at the Antenatal clinic at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital. Phosphorylated IGFBP‐1 (phIGFBP‐1) was measured in cervical swab samples obtained at presentation, using an immunoenzymometric assay. The values ≥10μg/L were considered as positive. In addition, 58 asymptomatic women at the same gestational stage were studied as controls. Multiple logistic regression was applied to control for confounding variables and to obtain adjusted odds ratios.

Results. The concentration of phIGFBP‐1 in cervical samples ranged from undetectable to 95 μg/L. In 17 of the 63 (27%) women with preterm labor it was ≥10 μg/L. Seven of these 17 (41%) women with a positive phIGFBP‐1 result delivered preterm, all before 35 weeks of gestation. Among the women with preterm labor and a negative phIGFBP‐1 result, three of the 46 (7%) delivered before 37 weeks of gestation (adjusted OR 24, 95% CI 1.2–487), but all after 35 weeks of gestation. In the asymptomatic control population three out of 58 (5%) women had a positive cervical phIGFBP‐1 test result but none delivered preterm. Among the controls with a negative cervical phIGFBP‐1 test result (55 of 58, 95%), one woman delivered preterm (1 of 55, 2%).

Conclusions. Pregnant women who are in preterm labor with intact fetal membranes and who have a positive phIGFBP‐1 test result in cervical secretion have an increased risk of preterm delivery.
Manual vacuum aspiration, a safe and effective alternative in early pregnancy termination
Authors: Hemlin Johan , Möller Bo
Published: March 2003

Background and objective. Vacuum aspiration has become standard surgical procedure for safe early pregnancy termination. Most of these operations are performed in the operating theater using suction curettage and an electric vacuum pump. MVA (manual vacuum aspiration) is an alternative that is well suited for use as a clinical procedure, which could have advantages both for the patient and the health care system. In order to compare conventional VA and MVA in a Swedish setting, a randomized study was undertaken.

Methods. Two hundred women requesting abortion in early pregnancy, gestational age less than 56 days, and choosing surgical termination, were randomized to VA or MVA. Main study outcome was frequency of complete abortion but also other variables were recorded.

Results. There were no significant differences between the two groups regarding background characteristics. Altogether 91 MVA and 88 VA operations were performed. There was no significant difference in frequency of complete abortion; two patients in each group subsequently needed re‐curettage because of incomplete evacuation. No case of ongoing pregnancy occurred. Two patients in each group received treatment for endometritis. No other complications were recorded.

Conclusion. This study indicates that MVA is effective in emptying the uterine cavity, on par with the standard vacuum aspiration. The rate of complications with MVA was on the same low level as with conventional VA.
Iron supplementation in pregnancy – evidence and controversies
Authors: Haram Kjell , Nilsen Stein Tore , Ulvik Rune J.
Published: March 2003

Approximately 20% of women in industrialized countries have iron deficiency in pregnancy. This article focuses on the diagnostic problem of anemia and iron deficiency and discusses different strategies for iron supplementation in pregnancy. S‐ferritin is commonly used to diagnose empty iron stores and is considered useful early in pregnancy as a diagnostic tool. Mean cellular volume (MCV), s‐Fe and erythrocyte distribution width is too unspecific. Serum transferrin receptor (sTfR) is a relatively novel promising indicator of iron deficiency. Iron demands of the pregnant women are discussed as well as the dietary content of iron. Both beneficial and adverse effects of iron supplementation are outlined. It is not documented that supplementation has any substantial effect on birth weight or various complications in pregnancy. However, supplementation corrects the iron store and biochemical parameters of iron deficiency including hemoglobin concentration (Hb) and maintains the maternal iron stores in the puerperium. Recent literature also suggests that iron supply to the pregnant women may have beneficial effects on the iron content of neonates the first year of life.
Blood pressure during pregnancy in a Swedish population; impact of parity
Authors: Strevens Helena , Wide‐Swensson Dag , Ingemarsson Ingemar
Published: March 2003

Subject. Hypertension represents the most commonly encountered complication of pregnancy. Normal levels of blood pressure (BP) need to be established in each pregnant population in order to recognize pathology. A lack of studies from our own country and certain methodological objections to early studies motivated this study.

Patients and methods. Six hundred pregnant women were included in a historical cohort. The maternal BP had been measured with a mercury sphygmomanometer and standardized routines at each antenatal visit. Data regarding age, baseline BMI, weight gain and smoking habits as well as parity had been recorded.

Results. BP values were overall somewhat higher than in international studies, the SBP increasing slightly towards term. The diastolic blood pressure (DBP) decreased slightly until 25–28 weeks of gestation. A steady increase thereafter led to values at term 7.3% above initial values. In nulliparae the increase was significantly greater, 9.9% versus 5.4% in multiparae. Primigravidae showed mean DBP levels significantly higher than all multigravidae towards term. The DBP was correlated with the baseline BMI, but not with age or weight gain. In smoking pregnant women the DBP showed a significantly greater initial decrease and failed to follow the subsequent rise to the same degree as in non‐smokers.

Conclusion. Slightly higher blood pressure levels were found in this study compared to other international studies. Multiple regression analysis showed that parity, baseline BMI and smoking all significantly influenced the DBP at term. Multiparae have significantly lower DBP levels in pregnancy compared to nulliparae. The first pregnancy seems to have the greatest impact in lowering the blood pressure in subsequent pregnancies.
The quality of life in women suffering from gynecological disorders is improved by means of hysterectomy
Authors: Rannestad Toril , Eikeland Ole‐Johan , Helland Harald , Qvarnström Ulla
Published: March 2003

Background. Gynecological disorders can have adverse effects on a woman’s quality of life. Most hysterectomies are thus performed to enhance women’s quality of life rather than to save life. This study aims at evaluating the long‐term impact of hysterectomy on this outcome variable.

Methods. The quality of life in 111 women undergoing hysterectomy for benign reasons was tested before, and six and twelve months after, the operation. A control‐group of non‐hysterectomized women from the normal population was tested once. Ferrans & Powers’ Quality of Life Index, consisting of four life domains, was used. This index has a pre‐set highest possible obtainable score. For the subjects with a high pre‐test score, there was little scope for further measurable improvement after hysterectomy, which gives a false stability in the material. A method for calculating the relative differences was introduced.

Results. The health and functioning domain of the quality of life among women awaiting hysterectomy is significantly lower compared to that of the control‐group (p<.01) Both six and twelve months after the hysterectomy, the patients have reached the same level of their health and functioning as the control‐group. Using the relative difference‐form, it is demonstrated that the subjects have obtained significantly higher levels in all the domains of quality of life after hysterectomy.

Conclusions. The results of this study show that hysterectomy is associated with a positive long‐term impact on a woman’s quality of life.
Increased acceptance of HRT and improved level of information: a change in Norwegian women's opinion from 1990 to 1997
Authors: Backe Bjørn , Hunskaar Steinar
Published: March 2003

Aim. To investigate the development in women's attitude to hormone replacement therapy, and the change in views concerning positive and negative effects.

Methods. National cohort study based on telephone interviews in 1990 and 1997, of women randomly sampled from the Norwegian telephone book (n=1019 and 1003). The same questions were asked in both studies.

Results. In 1997, more women stated radio and television, doctors, friends and relatives as sources of information. The general attitude to hormone replacement therapy had become significantly more positive, and the respondents reported a higher level of information than in 1990. However, some misunderstandings about estrogen therapy still remain; the proportion of women who believed that estrogen treatment reduced the risk for breast cancer increased from 4% in 1990 to 15% in 1997. About one third of women aged 60 or more are current or past users. More than 60% of the women in the youngest age group state that they will consider use of estrogen replacement therapy. About four‐fifths of the women in 1997 stated their willingness to use long term estrogen therapy if osteoporosis could be prevented.

Conclusions. Estrogen replacement therapy has become a part of the public debate. A high degree of willingness to use estrogen is demonstrated. The self reported level of information is higher and women are generally more correctly informed about positive and negative effects.
Identification of the major proteoglycans from human myometrium
Authors: Hjelm Ann , Ekman‐Ordeberg Gunvor , Barchan Karin , Malmström Anders
Published: March 2003

Background. During pregnancy and parturition a remodeling within the extracellular matrix of the cervix and the corpus uteri occurs, which is of fundamental importance to a normal labor. The aim of this study is to identify the major proteoglycans in corpus uteri of non‐pregnant subjects.

Methods. From human uterine tissue proteoglycans were extracted and purified using CsCl‐density gradient centrifugation, gel and ion‐exchange chromatography. The proteoglycans were quantified and identified by Alcian Blue before and after ABC‐digestion and by Western blotting.

Results. The results showed that the corpus uteri contains a substantial amount of proteoglycans, 1.825 μg/mg wet weight. Decorin is dominating, constituting 63% of the total amount of proteoglycans. Heparan sulphate proteoglycans accounted for 20% and biglycan for 16%. Less than 1% consisted of the large proteoglycan versican.

Conclusions. Further investigations must be performed to provide more information of the biological role of the proteoglycans in the uterus, especially during labor, by the presence of heparan sulphate proteoglycans and the minute presence of versican which indicate that the proteoglycan composition and organization is different to that of the cervix.
Diabetic family history is an isolated risk factor for gestational diabetes after 30 years of age
Authors: Chan Louis Yik‐Si , Wong Shell Fean , Ho Lau Cheung
Published: March 2003

Background. Family history of diabetes is regarded as a risk factor for gestational glucose intolerance. Most selective screening policy includes family history as an indication of oral glucose tolerance test. However, few studies had evaluated the actual incidence of glucose intolerance in this group of women.

Methods. Pregnant women with oral glucose tolerance test performed for family history of diabetes over two consecutive years were identified. Receiver operating curve was used to identify the age cut‐off that give the highest sensitivity and specificity. The incidence of glucose intolerance was compared between women with age above and below this cut‐off.

Results. One hundred and eighty‐seven women were identified. The age cut‐off selected was 30.5 years. In young women (age ≤ 30 years) with family history alone, the incidence of glucose intolerance is similar to that in the low risk pregnant population (12.5% and 6.3% for 8.0 mmol/L and 9.0 mmol/L cut‐off for two hour value of 75 g oral glucose tolerance test, respectively). In women aged above 30 years, the incidence of glucose intolerance raised by three fold (35.2% and 22.0% for 8.0 mmol/L and 9.0 mmol/L cut‐off, respectively).

Conclusions. The risk of glucose intolerance in young women with positive family history is similar to that in the background pregnant population. Standard oral glucose tolerance test may not be necessary in this group of women if selective screening policy is adopted.
A new ultrasonographic method for evaluation of the results of anti‐incontinence operations
Authors: Yalcin Omer T. , Hassa Hikmet , Tanir Mete
Published: March 2003

Background. To evaluate the effectiveness of a new ultrasonographic method for discrimination of successful and failed anti‐incontinence operations.

Methods. Ninety‐six patients who had undergone anti‐incontinence operations for the diagnosis of pure genuine stress incontinence due to bladder neck hypermobility were evaluated by perineal ultrasonography and 1 hr standardized pad test 6, 12 and 24 months after their operations. The distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. Bladder neck mobility (Mu) was obtained by two‐caliper method. After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x‐y coordinate system by using computer programs and the corresponding x and y‐values (X and Y) calculated and the second bladder neck mobility (Mc) were measured on the x‐y coordinate system by computer. Unpaired and paired‐t‐tests were used for statistical analysis.

Results. Ten (10.4%) patients had recurrent urinary incontinence, while 86 (89.6%) were continent 24 months after the operation. The incontinent patients had significantly longer Mu, Mc and distance B during stress and lower X and Y‐values during stress than the continent patients at the last control (P < 0.001). When the previous results were compared, the incontinent patients had significantly lower Y‐values during stress and greater Mc values beginning 6 months after the operation, while they were still continent (P < 0.01). Once present, the significant differences between the incontinent versus continent patients persisted from that point onward.

Conclusions. Measurement of the bladder neck mobility on an x‐y co‐ordinate system could discriminate the failed and successful operations and predict the outcome of the surgery.
The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome
Authors: Janni Wolfgang , Schiessl Barbara , Peschers Ursula , Huber Sandra , Strobl Barbara , Hantschmann Peer , Uhlmann Natalie , Dimpfl Thomas , Rammel Gerhard , Kainer Franz
Published: March 2003

Objective. While obstetrical management has changed significantly over years, the optimal duration of the second stage of labor still remains to be defined. The purpose of this study was to evaluate the effect of the duration of labor on fetal distress and maternal perinatal morbidity.

Methods. There were 1457 consecutive patients delivered of a singleton fetus in cephalic presentation beyond the 34th week of gestation at the I. Frauenklinik, Ludwig‐Maximilians University, Munich between May 1999 and June 2000. The 257 patients (17.6%), who underwent cesarean section prior to or during labor, were excluded from the study. Of the 1200 vaginal deliveries, 1017 (84.8%) were normal spontaneous deliveries, while 183 (15.2%) were instrumentally assisted. Data were contemporaneously collected and analyzed for the presence of severe pelvic floor damage, maternal hemorrhage, maternal fever, delayed involution of the uterus, fetal acidosis and APGAR score, and the necessity for admitting the newborn to the intensive care unit (NICU). A second stage duration of > 2 hr was considered to be prolonged.

Results. The mean duration of the second stage of labor was 70 min (range 2–387, SD 73 min). For 952 patients (79.3%), the second stage was less than 2 h. For 47 patients (3.9%), it exceeded 4 h. A prolonged duration of the second stage was not associated with low Apgar scores 5 and 10 min postpartum (P = 0.76 andP = 0.38, respectively), a higher incidence of umbilical artery pH levels of < 7.20 (P = 0.60), nor with an increased rate of admission to the NICU (P = 0.24). A significant increase in the rate of maternal blood loss was noted after long second stages (1.84 g/dl median difference between the intrapartum and postpartum hemoglobin level) in comparison to patients with normal duration of second stage (0.79 g/dl), both by univariate (P < 0.0001) and multivariate (P < 0.001) analysis. The incidence of third degree anal sphincter tears was significantly correlated with a prolonged duration of second stage in univariate analysis (7.7%,P = 0.001), but not in multivariate analysis after allowing for duration of the second stage, maternal age, birth weight, episiotomy, and mode of delivery (P = 0.26).

Conclusion. There is no evidence that prolonged second stage of labor is a serious disadvantage to the fetus, if adequate monitoring is provided. Because the increase of maternal morbidity in patients with prolonged labor may be partially attributed to a higher rate of operative procedures in these patients, interventions should not be solely based on the elapsed time after full cervical dilatation.
What is quality in maternity care? An international perspective
Authors: Pittrof Rüdiger , Campbell Oona M. R. , Filippi Véronique G. A.
Published: March 2003

This paper delineates important considerations for having a better understanding of quality in maternity care. High quality requires providing a minimum level of care to all pregnant women and their new born babies and a higher level of care to those who need it; obtaining the best possible medical outcome of mother and baby; providing care which satisfies users and providers; and maintaining sound managerial and financial performance. While all these aspects are important, prioritizing among interventions to improve them will be influenced by cultural values, expectations and available resources.
Can changes in sex hormone binding globulin predict the risk of venous thromboembolism with combined oral contraceptive pills?
Authors: Odlind Viveca , Milsom Ian , Persson Ingemar , Victor Arne
Published: March 2003

Background. Recent studies have indicated that the risk of thromboembolic disease (VTE) in users of combined oral contraceptive pills (COCs) varies not only with estrogen dose, but also with the progestogen in pills with the same estrogen dose. The aim of this article is to discuss sex hormone binding globulin (SHBG) as a marker of estrogenicity and as a surrogate indicator for the potential risk of VTE in users of COC.

Material and methods. Using data from the literature, we investigated the relationship between the risk of VTE with various COCs and their effects on SHBG. We also collected data on the effects on SHBG by some combined preparations, where there are no VTE data.

Results. There appears to be a relationship between the risk of VTE and the effect on SHBG. Monophasic preparations containing levonorgestrel, having the lowest risk of VTE, cause an average SHBG increase of around 50%. COCs containing desogestrel or gestodene cause an average SHBG increase of 200–300%. A preparation with cyproterone acetate, carrying a higher risk of VTE than desogestrel and gestodene, cause a 300–400% SHBG increase. With the recently developed combined preparations, there is a 150% SHBG increase with norgestimate and a 250–300% increase with drosperinone and dienogest.

Conclusions. We propose that the change in SHBG with a COC could be interpreted as a measure of total estrogenicity and used as a predictor of the risk of VTE. Preparations containing drosperinone, dienogest, cyproterone acetate and norgestimate are equally or more estrogenic than the more thoroughly studied COCs, containing desogestrel or gestodene and should not be considered a safer substitute.
Patterns of depressed mood across the menopausal transition: approaches to studying patterns in longitudinal data
Authors: Woods Nancy Fugate , Mariella Anne , Mitchell Ellen Sullivan
Published: March 2003

To date many researchers have focused on depression as a discrete episode, attempting to relate its occurrence to a transition in menopausal stage or other factors that might account for its occurrence. Characterizing change over time requires consideration of pattern or trajectory, not merely discrete events. The purposes of this paper are to:

1) to explore methods for intraindividual and interindividual (group) analysis of patterns of depressed mood among midlife women

2) to identify challenges for analytic strategies for understanding depressed mood as it is experienced by midlife women, with special concern for its relationship to the menopausal transition.

Data from the Seattle Midlife Women's Health Study were used to illustrate approaches to intraindividual and interindividual analysis of patterns of depressed mood. For most women, menopausal transition was not a time when there was a new episode of depression. Instead, a minority of women showed evidence of becoming depressed once the transition had begun. The most prevalent pattern was that of non‐depressed mood across the years of the menopausal transition. Association of several factors with a pattern of depressed mood included life stressors, perceived poor health, and vasomotor symptoms.
Validity of a rheumatic disease diagnosis in the Medical Birth Registry of Norway
Authors: Skomsvoll Johan F. , ØStensen Monika , Baste Valborg , Irgens Lorentz M.
Published: March 2003

Background. In our population‐based study of pregnancy outcome in women with rheumatic disease we based our assessment on the Medical Birth Registry of Norway (MBRN). We evaluated the MBRN as a source of data for such epidemiologic research by assessing the validity of a diagnosis of rheumatic disease in the MBRN against a gold standard. The validity may also be interpreted as a quality indicator, reflecting an obstetrician's attention to rheumatic diseases in pregnancy.

Methods. Using the mother's national identification number the MBRN was linked with local hospital databases (gold standard), which contained data of mothers with rheumatic disease. The sensitivity of the MBRN was calculated as the proportion of all cases registered locally with a diagnosis of rheumatic disease notified to the MBRN. The correctness of type differentiation was calculated as the proportion of all cases notified to the MBRN that was correct with respect to the type of rheumatic disease.

Results. Among 169 mothers, 149 had a diagnosis in the MBRN, representing a sensitivity of 88.2%. Altogether, 97.3% of the diagnoses (145/149) were correct with respect to the type of rheumatic disease.

Conclusion. Taken in to consideration the limitations of the study, namely the small numbers studied, we assume a rather high validity of rheumatic disease diagnoses in the MBRN, probably reflecting a high level of attention in the obstetric care for these patients.
Comparison of ultrasonography, hysteroscopy, and biopsy in the diagnosis of endometrial lesions in postmenopausal tamoxifen‐treated patients
Authors: Giorda Giorgio , Crivellari Diana , Veronesi Andrea , Perin Tiziana , Campagnutta Elio , Carbone Antonino , Scarabelli Carlo
Published: March 2003

Background.  At present, no proven recommendations can be made for the surveillance of tamoxifen‐treated women. The aim of the present study was to evaluate ultrasonography and hysteroscopy in this setting.

Methods.  Three hundred and ten postmenopausal patients using tamoxifen underwent vaginal ultrasonography, hysteroscopy, and endometrial biopsy; 274 were asymptomatic and 49 had abnormal bleeding. Ultrasonographic endometrial thickness and echotexture were recorded. Hysteroscopic endometrial appearance, presence of focal endometrial lesions and polyps were also recorded. General or selective endometrial biopsy was performed. Ultrasonographic and hysteroscopic follow up was provided.

Results.  At ultrasonography, mean endometrial thickness was 10.8 mm. At hysteroscopy, cystic atrophy and suspect focal lesions were detected in 49.2% and 5.3% of women, respectively. Polyps were present in 44.8% of women; 38.9% of these polyps were missed at ultrasonography, whereas 11.4% were suspected but were not found at hysteroscopy. At biopsy, non‐atypical hyperplasia and atypical changes were found in 4.8% and 1.3% of patients, respectively. Three carcinomas were found, all in asymptomatic women. Logistic regression analysis showed that only suspect focal lesions at hysteroscopy were significantly associated with abnormal histology. With a 6‐mm cut‐off value for endometrial thickness, negative and positive predictive values for ultrasonography in detecting hyperplastic or neoplastic changes were 96% and 8%, respectively; the corresponding values for hysteroscopy were 96% and 65%. No additional carcinoma was found at follow  up.

Conclusions.  No single ultrasonographic feature (echotexture and borders) is significantly associated with the detection of endometrial hyperplasia or carcinoma; hysteroscopy, although not predictive unless revealing a focal lesion, is more accurate in detecting polyps and hyperplastic changes.
Cord blood thyroid‐stimulating hormone level in twin pregnancy
Authors: Chan Louis Yik‐Si , Chiu Pui Yu , Lau Tze Kin
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 28–32. © Acta Obstet Gynecol Scand 2003

Background.  Cord blood thyroid‐stimulating hormone level is elevated among neonates who undergo more perinatal stress. The aim of this study was to investigate the effect of twin pregnancy on the cord blood thyroid‐stimulating hormone level.

Methods.  The study group consisted of 24 910 singleton and 543 twin neonates over a 4‐year period. The effect of twin pregnancy on the cord blood thyroid‐stimulating level was evaluated. Linear regression analysis was used to control for the effect of mode of delivery, birth weight, and infant sex.

Results.  The median cord blood thyroid‐stimulating hormone levels (interquartile range) in the singletons and in the twins were 5.8mIU/l (4.2–8.6) and 5.6mIU/l (4.3–7.5), respectively. Linear regression analysis revealed no significant difference between singleton and twin cord blood thyroid‐stimulating hormone levels (p = 0.23). Cord thyroid‐stimulating hormone levels tended to be higher in second‐born twins (p = 0.08) and monochorionic twins (p = 0.097) compared with singleton neonates. Twins with more than 20% weight discordance were associated with a significantly higher cord blood thyroid‐stimulating hormone level (p = 0.035).

Conclusion.  Cord blood thyroid‐stimulating hormone level is elevated in some subgroups of twins who are at higher risk of adverse perinatal outcomes. However, the overall effect of multiple pregnancy on the cord blood thyroid‐stimulating hormone level is small. Cord blood thyroid‐stimulating hormone screening for congenital hypothyroidism is also valid in twin pregnancies.
Pathology of the Female Genital Tract
Authors: Bergsjø Per
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 100. © Acta Obstet Gynecol Scand 2003
Obstetrics by Ten Teachers
Authors: Bergsjø Per
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 101. © Acta Obstet Gynecol Scand 2003
Color Doppler ultrasonography in ocular Behçet's disease
Authors: Çelebi Serdal , Akfırat Murat , Çelebi Harika , Alagöz Gürsoy
Published: March 2003

Purpose: The aim of this prospective study was to assess the ocular hemodynamic changes in patients with Behçet's disease who had involvement of the posterior segment by color Doppler ultrasonography.

Methods: The present study was carried out in 32 eyes of 24 patients with ocular Behçet's disease and 42 eyes of 21 persons as a healthy age‐matched control group. In order to detect the hemodynamic changes in ocular Behçet's disease, peak systolic and end‐diastolic velocities (PSV, EDV; cm/sec), resistive and pulsatile indices (RI, PI), and PSV/EDV ratio of central retinal artery (CRA), short posterior ciliary artery (PCA) and ophthalmic artery (OA) were determined.

Results: The mean PSV and EDV (8.1±2.6 and 2.7±0.1 cm/sec, respectively) in the CRA were significantly lower in patients with Behçet's disease than in healthy controls (11.5±2.2 and 3.5±1.0 cm/sec, respectively, p<0.001). For the PCA, these values (12.7±4.2 and 4.3±1.1 cm/sec, respectively) were significantly lower in the patient group than in the control the group (18.2±4.2 and 6.1±2.5 cm/sec, respectively, p<0.001). In the patient group, a statistically significant decrease compared to the control group was detected in the mean PSV of the OA (31.8±8.2 and 35.8±0.6 cm/sec, respectively, p<0.02). However, no significant difference in the other parameters of these vessels was observed between groups.

Conclusions: These results demonstrate the presence of some circulatory changes in the flow velocities of the CRA, PCA and OA in patients with Behçet's disease when compared with control subjects.
Pigmented spindle cell naevus of Reed presenting in the conjunctiva
Authors: Seregard Stefan
Published: March 2003

Purpose: This study aimed to present the clinical and histopathological features of a pigmented spindle cell naevus (PSCN) appearing in the conjunctiva.

Methods: Histopathological examination of the lesion following excision and review of the pertinent literature.

Results: The features were consistent with those previously recognized in the skin as the PSCN of Reed.

Conclusion: The PSCN can appear in the conjunctiva and should not be confused with conjunctival melanoma.
Results of transantral orbital decompression in patients with thyroid‐associated ophthalmopathy
Authors: Tallstedt Leif , Papatziamos Georgios , Lundblad Lars , Änggård Anders
Published: March 2003

Purpose: To present the results of orbital decompression in patients with thyroid‐associated ophthalmopathy (TAO).

Methods: Transantral orbital decompression was performed in 63 patients with TAO. In 40 patients (63%) the operation was made because of progressive ophthalmopathy not responding to medical therapy, and in 23 patients (37%) the operation was made for rehabilitative reasons. The long‐term hypesthesia engaging the infraorbital nerve was assessed with a questionnaire using a Visual Analogue Scale (VAS).

Results: The mean proptosis reduction was 3.2 mm (range 0–8 mm). Twenty‐one patients had impaired visual acuity preoperatively, and 20 improved. Altogether 30 patients (40%) had worsened ocular motility postoperatively. Forty‐three patients did not have diplopia in the primary position preoperatively, and new diplopia developed in 22 of these (51%). Hypesthesia in the infraorbital nerve area was reported for half of the operated sides, but was a major cause of distress (VAS‐scoring >5) to eleven patients.

Conclusions: Transantral orbital decompression is indicated in patients with progressive TAO or in patients with prominent exophthalmos, and results in a good proptosis reduction, but the risk of postoperative diplopia is significant. Postoperative hypesthesia is common but often not a major problem.
Colour Doppler imaging of the ocular circulation in diabetic retinopathy
Authors: MacKinnon Jane R. , McKillop Graham , O'Brien Colm , Swa Kenneth , Butt Zahida , Nelson Patricia
Published: March 2003

Purpose: To measure blood flow velocity in the ophthalmic artery (OA) and central retinal artery (CRA) in patients with diabetic retinopathy.

Subjects and Methods: 62 age‐matched subjects divided into 3 groups: non‐diabetic controls (n=17); diabetics with no clinical retinopathy or background changes (n=24); diabetics with either pre‐proliferative or proliferative retinopathy (n=21). Colour Doppler imaging was performed on supine patients by one masked observer using the Acuson 128 machine.

Results: There was a statistically significant (p<0.05) decrease in both the peak systolic velocity (PSV 0.073 m/s) and end diastolic velocity (EDV 0.014 m/s) of the central retinal artery in the pre‐proliferative/proliferative group compared to the no retinopathy/background retinopathy group (PSV 0.096 m/s, EDV 0.024 m/s) and the control group (PSV 0.142 m/s, EDV 0.029 m/s). The resistance index of the ophthalmic artery was significantly increased in both the pre‐proliferative/proliferative (0.81) and the no retinopathy/background group (0.81) compared to controls (0.72).

Conclusion: Reduced blood flow velocity was found in the CRA of diabetic patients and appeared to become further reduced with the progression of retinopathy. This suggests that monitoring with Colour Doppler imaging may have predictive power in identifying those at greatest risk of developing sight threatening proliferative disease. The resistance index of the OA was increased in diabetics compared to controls.
Comparative studies on pattern VECP between patients with ischemic optic neuropathy and optic neuritis
Authors: Takasoh Michihiko , Mizota Atsushi , Adachi‐Usami Emiko
Published: March 2003

Purpose: To evaluate whether and how VECPs are useful in differentiating ION from ON.

Methods: We retrospectively studied 27 patients with non‐arteritic ION and 69 patients with ON using pattern visually evoked cortical potentials (PVECPs) to 3 rev/sec stimulation (transient) and 12 rev/sec stimulation (steady‐state).

Results: In patients with ION, non‐recordable responses were found in 25% of those with transient VECP and in 74% of those with steady‐state VECP. In ON patients, non‐recordable responses were found in 34% of those with transient VECP and in 64% of those with steady‐state VECP. The average peak latency of P100 component in those with ION was significantly shorter than in those with ON. The amplitude ratio (affected eye/fellow eye) of steady‐state VECP was significantly higher in those with ION than in those with ON. The amplitude ratio of P100 showed no significant differences between groups.

Conclusion: The P100 peak latency of transient VECPs and the amplitude of steady‐state VECPs have the potential to differentiate between ION and ON.
Contrast sensitivity function in patients with beta‐thalassemia major
Authors: Gartaganis Sotirios P. , Zoumbos Nikolaos , Koliopoulos John X. , Mela Ephigenia K.
Published: March 2003

Purpose: To investigate contrast sensitivity function in patients with beta‐thalassemia major, after regular transfusion and chelation therapy.

Methods: We measured contrast sensitivity at four spatial frequencies in 30 patients with beta‐thalassemia major and in 30 matched normal control subjects. All subjects underwent an ophthalmic examination that included fluorescein angiography. The contrast sensitivity results from the two groups were compared between them. Patients' contrast sensitivity values were correlated to the variables age, duration of transfusion, duration of chelation therapy and serum ferritin levels, to select the important predictors.

Results: Contrast sensitivity function in all beta‐thalassemic patients was significantly lower (p<0.0001) compared to the normal control subjects, for all spatial frequencies tested. The most important predictor of contrast sensitivity loss was patients' age.

Conclusion: Contrast sensitivity testing can detect early changes in the visual function of beta‐thalassemic patients and should be considered as a monitor for patients under chronic transfusion‐chelation therapy.