bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy outcome in renal allograft recipients in Nor
Authors: Haugen Guttorm , Fauchald Per , Sødal Gunnar , Leivestad Torbjørn , Moe Narve
Published: November 2007

Background. To study the influence of pre‐conceptional health status and immunosuppressive drug regimen on pregnancy outcome in renal allograft recipients.

Methods. The study includes all pregnancies in renal allograft recipients in Norway in the period 1973‐1991. The data were collected from the patient records. Serum‐creatinine values, proteinuria. blood pressure, recent graft rejection, and immunosuppressive drug regimen before pregnancy as well as the interval from transplantation until pregnancy were related to the frequency of deliveries at term, preterm deliveries, and of induced and spontaneous abortions

Results. 54 pregnancies in 37 renal allograft recipients resulted in 31 term deliveries, 12 preterm deliveries, four spontaneous, and seven induced abortions. One induced abortion due to psychosocial reasons was excluded from the calculations. Post‐transplant intervals less than two years as compared to longer intervals were associated with an increased frequency of spontaneous and induced abortions (6/13 vs 4/40. p < 0.01) and a non‐significant increase in the relation between preterm and term deliveries (3/4 vs 9/27). The few women with proteinuria, elevated serum‐creatinine values, and hypertension before pregnancy had an increased number of adverse pregnancy results. The women receiving cyclosporine A experienced a larger frequency of spontaneous and induced abortions (7/18 vs 3/35, p< 0.05) and an increase in the relation between preterm and term deliveries (714 vs 5/27, p<0.01) as compared to the women who received prednisolone and azathioprine only.

Conclusions. The results demonstrate the importance of pre‐conceptional consultation and may indicate a harmful effect of cyclosporine A on pregnancy outcome.
A prospective study of fertility and outcome of pregnancy after discontinuation of oral contraception in relation to elective orthopedic surgery
Authors: Dale O. , Skjeldestad F. E. , Rossvoll I.
Published: November 2007

Objective. To evaluate the risk of unwanted pregnancies, their outcome and the rate of resuming contraception after discontinuation of oral contraception (OC) prior to elective surgery.

Design. A six months prospective follow‐up study.

Setting. Orthopedic unit, operating on a total of 897 women during a period of 24 months.

Subjects. Seventy‐eight healthy women in whom OC was stopped prior to elective orthopedic surgery.

Outcome. Pregnancy rate, pregnancy outcome and reinstitution rate of OC.

Results. Complete outcome data are available for 73 (93.5%) of 78 women who were asked to participate in the study. Five pregnancies were reported, giving a cumulated six month pregnancy rate of 6.8%. Three pregnancies were completed to term, one was ectopic and one terminated by induced abortion. Within six months after the operation the cumulative user rate of oral contraceptives was 74.2%. None of the women were readmitted to hospitals for severe illness during the study period.

Conclusions. The women resumed oral contraceptives relatively soon after their first postoperative menstrual cycle. This may explain why the pregnancy rate during the first six postoperative months appears low.
Bacterial vaginosis and cervical intraepithelial neoplasia
Authors: Platz‐Christensen Jens Jörgen , Sundström Eva , Larsson Per‐Göran
Published: November 2007

Methods. In an attempt to investigate an association between the finding of clue cells in Papanicolaou‐stained (PAP) smears and cervical intraepithelial neoplasia (CIN), a total of 6I50 smears from 1976 were re‐investigated.

Results. Clue cells representing bacterial vaginosis were present in 10% of the PAP‐smears. CIN II and III alone, as well as all CIN cases, were more common in women with bacterial vaginosis (p< 0.001). Histologically CIN III/carcinoma in situ was found in nine patients with and in 16 patients without bacterial vaginosis. The relative risk of having CIN III/ carcinoma in situ if the women had bacterial vaginosis was 5.0 with 95% confidence interval of 2.2‐11.6.

Conclusions. The possibility exists that bacterial vaginosis is in some way associated with the development of cervical intraepithelial neoplasia, i.e. as a cofactor to human papilloma virus. Therefore. bacterial vaginosis must be taken in consideration in future studies on CIN.
Lymphoepithelial‐like carcinoma of the uterine cervix
Authors: Martinez‐Leandro E. P. , Martorell M. , Alemany P. , Salvador I. , Garcia‐Guardiet E.
Published: November 2007

Lymphorpithelial‐like carcinoma of the uterine cervix is very rare in Caucasian women. We present a new case in a 74 year‐old European. Morphologically the undifferentiated carcinoma was accompanied by intense lymphocytic infiltration. Immunohistochemically the tumor expressed epithelial markers such as cytokeratin CAM 5.2. and a large proportion of cells expressed the proliferating cell nuclear antigen. The accompanying lymphocytic reaction was composed predominantly of T‐lymphocytes which express the UCHLI antigen. The in situ hybridization of the Epstein‐Barr virus genome and the human papillomavirus proved negative.
Pseudo‐sinusoidal heart rate associated with major cardiac anomalies
Authors: Groutz Asnat , Peltz Rivka , Luxman Dov , Wolf Yoram , Wolman Igal , Gordon David , David Menachem P.
Published: November 2007

Pseudo‐stinusoidal fetal heart rate (pseudo‐SHR) pattern, characterised by intermittent episodes of sinusoidal heart rate and normal fetal heart rate (FHR), is considered benign although 11.s pathophysiologic mechanism remains obscure. We present a case of pseudo‐SHR episodes throughout all stages of labor associated with multiple major cardiac anomalies. We suggest that when confronted with repeated episodes of pseudo‐SHR pattern, the possibility of an underlying cardiac anomaly should be considered.
Renin gene restriction fragment length polymorphisms do not show linkage with preeclampsia and eclampsia
Authors: Arngrimsson Reynir , Geirsson Reynir T. , Cooke Alexander , Connor Michael , Bjornsson Steingrimur , Walker James J.
Published: November 2007

Objective. To investigate linkage between the renin gene restriction fragment length polymorphisms in families with a history of preeclampsia/eclampsia.

Methods. Nine Icelandic families with at least three affected females in two or three generations were investigated. DNA from lymphocytes was digested with the endonuclease restriction enzyme Bgl I and restriction fragments were transferred by Southern Blotting. Hybridisation was effected with the 32P‐oligonucleotide‐labeled diallelic genomic probe pHRnX 0.8. LOD scores were calculated by the Liped program for two forms of inheritance patterns. Affected sib pairs were analysed.

Results. Frequencies of the 9.0 kb and 5.0 kb alleles were 0.67 and 0.33, with no significant differences between affected females and spouses and combined LOD scores of −2 for recombination values of 3%. Allele sharing in affected sibs was not different from the expected random assortment.

Conclusion. The linkage analysis provides evidence to exclude alteration of the renin gene in pregnancy as being directly responsible for the manifestations of preeclampsia or eclampsia in these families.
Atrial natriuretic peptide, blood volume, aldosterone, and sodium excretion during twin pregnancy
Authors: Thomsen Jørn Kvist , Fogh‐Andersen Niels , Jaszczak Poul
Published: November 2007

Background. The reports on plasma concentrations and physiological function of atrial natriuretic peptide (ANP) during pregnancy are conflicting. In a recent prospective study, including 40 healthy primigravidae, we found a highly significant decrease in the plasma concentration of ANP (p‐ANP) during the third trimester and the results indicated that ANP takes part in regulation of blood volume and renal function during pregnancy as in the nonpregnant state. In order to test these results, a study was performed in primigravidae with twin pregnancy to test if the accentuated physiological changes here were followed by a corresponding greater decrease in p‐ANP.

Methods. Ten healthy primigravidae with twin pregnancy were examined four times during pregnancy plus 12 weeks after delivery. Each time the following were measured: p‐ANP, aldosterone, renin, blood volume (carbon monoxide), cardiac output (Doppler), blood pressure and sodium excretion. Interdependence of the changes in ANP and in the other parameters was tested using Spearman's rank correlation test on the delta (Δ)‐values (the differences in measurements between investigations). The results were compared to the results obtained during singleton pregnancy using the Mann‐Whitney rank sum test.

Results. All pregnant values of p‐ANP during twin pregnancy were lower than 12 weeks after delivery, p < 0.01. In the 20th, 28th, and 32nd week p‐ANP was lower in twin pregnancy than in singleton pregnancy, p < 0.05. There was a negative correlation between changes in p‐ANP and changes in: a) blood volume, R=‐0.8, p < 0.0001, b) aldosterone, R=‐0.66, p < 0.0001, c) renin, R=‐0.52, p < 0.01, d) cardiac output, R=‐0.68, p < 0.0001. There was a positive correlation between changes in p‐ANP and changes in: a) fractional excretion of sodium, R = 0.73, p < 0.0001, and b) total peripheral resistance, R = 0.61, p < 0.0001.

Conclusion. The results suggest that the competitive relationship between ANP and the renin‐aldosterone system in regulating sodium balance and fluid volume is preserved during pregnancy. The vasodilatation during pregnancy is not mediated by ANP.
Choice of contraceptive modality by women in Norway
Authors: Skjeldestad Finn Egil
Published: November 2007

Study objective. To investigate the use of contraception in a representative sample of Norwegian women.

Outcome measures. Frequency distribution of contraceptive methods by age, marital status and parity strata.

Material. A sample of 4,933 women were selected at random from the Central Population Register as participants in the second Norwegian fertility study (1988). The response rate was 81% (n=4,019) and personal interviews of contraceptive use were carried out among 2,782 women who were fecund, sexually active and not pregnant. These women comprise the study population.

Results. 2,782 women were sexually active during the last month prior to the interview and thus in potential need of contraception. More than 50% of the women used either oral contraceptives (21%) or IUDs (30%). The use of oral contraceptives decreased linearly with age from a user rate of 60% among women 20‐24 years old to 1.5% among women 40‐44 years of age. The use of IUDs increased from 6% in the youngest age group to nearly 40% among women aged 30‐39 years of age. Oral contraceptives were preferentially used by childless women or those with only one child, while IUDs were most often used by women with two or more children. The sterilisation rate increased by age and in the 40‐44 age group one out of every three women was sterilised. Non‐use was most frequent among the subgroups of women who planned children in the future. Use of condoms and other coitus‐dependent contraceptives varied less with age, marital status and parity than did the use of OC, IUDs or sterilisation.

Conclusion. The user pattern concerning different contraceptive methods reflects the general guidelines for contraceptives in Norway. The fact that nearly 70% of the women were in one of the three categories ‐ OC or IUD users, or one of the partners was sterilised ‐ reveals that the awareness and knowledge of modern contraception is high in Norwegian society.
Tubal patency studied by ultrasonography: A pilot study
Authors: Friberg Britt , Joergensen Connie
Published: November 2007

Transvaginal hysterosalpingoultrasonography (HSUG) was performed using a uterine cannula and Ringer's solution (Kabi Baxter) as a contrast agent in 14 women consulting for infertility. The results were compared with those of chromopertubation at laparoscopy/ laparotomy. With HSUG, the uterine cavity was always well visualized, though it was more difficult to evaluate tubal status. As compared with those of the other methods, HSUG findings manifested total agreement in 50% of cases, total disagreement in 22%, and partial agreement in the remaining 28%. The method was well tolerated by the women studied, and six out of nine women who had previously undergone hysterosalpingography (HSG) found HSUG to cause less discomfort. Thus, the findings suggest that HSUG might prove useful as a means of ascertaining tubal status at an early stage in infertility evaluations.
Relief of dysmenorrhea associated with septate uteri after abdominal or hysteroscopic metroplasty
Authors: Fedele Luigi , Bianchi Stefano , Bocciolone Luca , Di Nola Giuliana , Arcaini Luisa , Franchi Dorella
Published: November 2007

We analyzed the postoperative modifications of dysmenorrhea in 90 patients with septate or subseptate uterus, but no other genital or pelvic disorders, who underwent metroplasty according to Tompkins (n = 28) or hysteroscopic metroplasty (n = 62). The frequency of dysmenorrhea fell from 50% to 32.1% after the Tompkins procedure and from 54.8% to 17.7% after hysteroscopic metroplasty. The severity of dysmenorrhea evaluated with two scales, one linear and one multidimensional, showed a significant postoperative decrease in both the groups. In view of the limited cost and low risks of hysteroscopic metroplasty, primary dysmenorrhea associated with septate or subseptate uterus may be considered an indication for this intervention.
The rôle of ultrasound scan in childhood ovarian tumors
Authors: Lauszus Finn , Balslev Thomas , Johansen Anders
Published: November 2007

Seven cases with childhood ovarian tumors are presented. All underwent an ultrasound scan which gave the the preliminary diagnosis of ovarian tumor. Treatment differs according to the status of the child and whether malignity is involved. The numerous differential diagnoses must be kept in mind. The management of children with an unexplained abdominal mass should include an ultrasound scan.
Antithrombin III in fetuses and newborn children
Authors: Latin Višnja , Jankovicá Djurdja , Červar Mila , Bernt Tatjana , Fuduricá Ivan
Published: November 2007

Antithrombin III (AT III) was measured in plasma of healthy fetuses between 20‐29 weeks of gestation, in plasma of suspected growth retarded or malformed fetuses between 30‐39 weeks of gestation, in healthy newborn infants after delivery, and in healthy infants during the first year of life. Measurements were performed with an AT III assay (Orion Diagnostica, Espoo, Finland Turbox) on nephalometer Turbox. The results were expressed as a percentage of the mean adult value (300 mg/1) and statistically analysed with the non‐parametric Kruskal‐Walles test. AT III levels in fetuses were low but increasing. They continued to increase after birth (F = 34.53 p < 0.001) and reached adult values in the age between the tenth and twelfth month of life.
Multiple leiomyomata of the urinary bladder in a hysterectomized woman
Authors: Larsson GÖRan
Published: November 2007

A 47 year‐old previously hysterectomized para 0 gravida 0 presented with hematuria, abdominal pain and a palpable pelvic mass. Cystoscopy was normal. An ovarian tumor was suspected. At operation three leiomyomata originating from the bladder wall were found. This is a rare disease with only about 160 cases hitherto reported in the literature. The present case represents, as far as I know, the first case of multiple bladder leiomyoma reported in a woman. Bladder leiomyomata are a very rare differential diagnosis to ovarian tumors.
The role of cordocentesis in assessment of mosaicism found in amniotic fluid cell culture
Authors: Shalev E. , Zalel Y. , Weiner E. , Cohen H. , Shneur Y.
Published: November 2007

Chromosomal mosaicism presents one of the most difficult problems in prenatal cytogenetic diagnosis, requiring the differentiation of true mosaicism from pseudomosaicism. To overcome associated problems and to prevent termination of normal pregnancies, we investigated 23 pregnancies in which true mosaicism has been found in amniotic fluid cell culture. A fetal blood sample was obtained by cordocentesis for rapid karyotyping, and meticulous sonographic examinations were carried out for detecting fetal abnormalities. The 23 cases in which mosaicisms were found in amniocytes involved five cases with sex chromosomal abnormalities, twelve with autosomal trisomy, four with autosomal structural defects, one with a supernumerary marker and one with tetraploidy. The karyotype from fetal leukocytes confirmed the diagnosis of mosaicism in only three out of 23 cases. These three included: two autosomal trisomies (47,XY+ 13/47,XY + 21 and 46,XY/47,XY + 21) and one sex chromosome mosaicism (45,X/46,XY). These were all selected for elective termination of pregnancies by the parents’ request. Post abortion karyotype re‐confirmed previous karyotype. The other twenty lymphocyte karyotypes were normal, and of these, 19 patients gave birth at term, and one delivered prematurely due to premature rupture of membranes. All 20 born infants were found normal by both neonatal examination and re‐karyotypes.

We conclude that finding of mosaicism in amniotic fluid culture requires further investigation. Furthermore, in the presence of amniotic fluid cell true mosaicism and normal karyotype in fetal blood, continuation of the pregnancy is safe and to be recommended.
Uro‐genital microbial colonization and threatening preterm delivery
Authors: Svare Jens , Andersen Lars F. , Langhoff‐Roos Jens , Madsen Hans , Jensen Elsebeth T. , Bruun Brita , Lind Inga
Published: November 2007

Objective. To examine whether there is a relationship between the urogenital microbial colonization and threatening preterm delivery.

Study design. The microflora in the urine and endocervix was studied in 43 women with preterm labor. 45 women with preterm premature rupture of the membranes (PPROM) and 80 normal pregnant women at 26‐34 weeks of gestation. Amniotic fluid was examined in 20 of the patients with preterm labor. Data were analyzed by Fisher's exact test (two‐tailed).

Results. The microflora in the urine was not significantly different in patients with preterm labor. PPROM and normal pregnant women. Compared with normal pregnant women, patients with preterm labor had significantly lower prevalences of corynebacteria (p <0.05) and coagulase‐negative staphylococci (p <0.01) in the cervix, while patients with PPROM had significantly lower prevalences of lactobacilli (p, <0.05) and coagulase‐negative staphylococci (p <0.05) in the cervix. Positive amniotic fluid cultures were detected in three of the 20 patients with preterm labor who underwent transabdominal amniocentesis. Evidence of ending colonization was found in two of these cases.

Conclusions. The microbial colonization of the urine was not associated with threatening preterm delivery. Reduced prevalences of lactobacilli. corynebacteria and coagulase‐negative staphylococci in the cervix were associated with threatening preterm delivery.
Falling population incidence of eclampsia; A case‐control study of short term outcome
Authors: Geirsson Reynir T. , Arngrimsson Reynir , Apalset Ellen , Einarsson Atli , Snædal Gunnlaugur
Published: November 2007

Background Eclampsia remains a serious complication of pregnancy and childbirth and factors related to morbidity require continued evaluation.

Design. Retrospective case‐control study on the incidence and outcome of eclampsia.

Setting. A defined total island population over 20 years.

Method. All centrally collected birth registration returns in Iceland for the years 1972‐1991 were reviewed to identify women with the diagnosis of eclampsia, selecting women delivering immediately before and after the eclamptic case as controls. Information from all places where women had delivered was obtained to ensure that no case was missed. Maternity records were reviewed to verify the diagnosis and obtain maternal and neonatal data.

Results. Forty women had eclampsia (0.046′%1 of deliveries). The incidence diminished between the decades 1972‐81 and 1982‐91 (p <0.05). as did the incidence of eclamptic convulsions before delivery. Eclamptic women were more often primiparous. younger and delivered earlier than controls. Preterm delivery and a low ponderal index were more common among offspring of the eclamptic mothers and the male/female ratio was lower.

Conclusion The incidence of eclampsia in the population is falling. Common features related to the condition were confirmed. Severe maternal illness is rare. but the babies often appear growth‐retarded and are delivered preterm.
Who uses norplant: A study from Finland
Authors: Sihvo Sinikka , Ollila Eevn , Hemminki Elina
Published: November 2007

Objective. Although Norplant implantable contraceptives were introduced first in Finland, their use has been infrequent. The objective of this study was to investigate what kind of women use Norplant in Finland, who suggested its use. and from what source women get their information on Norplant.

Methods. A questionnaire was mailed to all women having had Norplant inserted one to two years before the study initiation (June 1992) in seven family‐planning clinics in the Helsinki city area (n = 262). After one reminder, the response rate was 82%.

Results. Most of the users were 25–34 years old, and many of them had had a previous abortion. Half of the women were still considering a (subsequent) child. All the women had used some birth control method before Norplant and reported several problems with it. Women reported that they themselves had chosen Norplant. but physicians and nursing staff in the family‐planning clinic were their most important information sources. Most women considered that they had received sufficient information before insertion regarding both the good and bad aspects of the method.

Conclusion. Women with previous abortions are a special users' group for Norplant. even though most users are in no way exceptional women.
Pulsatile gonadotropin releasing hormone (GnRH)—treatment for hypothalamic amenorrhoea causing infertility
Authors: Skarln Goran , Ahlgren Mats
Published: November 2007

Thirty women with hypothalamic amenorrhoea and infertility were treated with pulsatile GnRH S.C. without monitoring with estradiol and ultrasonography. Ovulation rate per patient was 93%. Ovulation rate per cycle was 90%. Pregnancy rate per ovulatory cycle 30%8. Miscarriage rate 18.5%. 23 children were born including one set of twins. No serious side effects were recorded.
Pregnancy and spontaneous delivery 13 months after heart transplantation
Authors: Ahner R. , Kiss H. , Zuckeamann A. , Wenzl R. , Kurz C. , Laufer G. , Husslein P.
Published: November 2007

This case report is about a 23‐year‐old female patient who underwent heart transplantation because of dilatative cardiomyopathy. Four months after transplantation she conceived. Thirteen months postoperatively, the patient had spontaneous vaginal delivery and gave birth to a child in good physical condition.
Immediate Post Partum thrombosis of the veins of the round ligament imitating an irreducible inguinal hernia
Authors: Buxton N. , Boulougouris P. , Pai K. P. , Morgan R. H. , Menon V.
Published: November 2007

Following delivery, our patient presented acutely with a painful swelling in the groin. Diagnosis could only be established by exploration. Thrombosed veins of the round ligament were found on histology of the swelling. Exploration was necessary to rule out an acute inguinal hernia.
Birth in standing position: A high frequency of third degree tears
Authors: Gareberg Britta , Magnusson Brltt , Sultan Bo , Wennerholm Ulla‐Britt , Wennergren Margareta , Hagberg Henrik
Published: November 2007

Background. During the past years a major change in the use of delivery position has occurred in Sweden. Recumbent delivery positions have been replaced by a variety of positions: squatting, standing, lateral, kneeling and quadruped. The consequences of this shift in obstetrical practice for development of perineal lacerations are largely unknown.

Method. Retrospective comparison of uncomplicated deliveries in standing (n = 650) and sitting (n = 264) position with respect to third degree lacerations.

Results. The standing and sitting delivery group were similar with respect to maternal, infant and delivery characteristics. The frequency of third degree tears was 2.50% in standing and 0.38% in sitting birth position (p<0.05). In nulliparous women, third degree tears occurred in 4.2% in standing and 1.0% in sitting position.

Conclusion. The present data implies that the risk of third degree lacerations is considerably higher (7x) in standing than in sitting birth positions.
Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesions
Authors: Kierkegaard Ole , Byrjalsen Carsten , Frandsen Kristian H. , Hansen Kristen C. , Frydenberg Morten
Published: November 2007

Objective. To evaluate the diagnostic accuracy of cytology and colposcopy in women with an abnormal cervical smear using histology as the ‘gold standard’.

Design. Survey of consecutively referred women with abnormal smear.

Setting. The out‐patient colposcopical clinic of Herning Hospital, Denmark.

Patients. 813 women with a median age of 29.0 years (range 15‐71 years) with their first abnormal smear.

Results. For detecting cervical high‐grade lesions (HGL) the sensitivity of cytology was 41% (36‐47%). oS colposcopy 67% (62‐72%) and in combination 75% (70‐80%) so at least 25% of HGL were underestimated. Colposcopy underestimated more CIN‐2 than CIN‐3 lesions and more small lesions and lesions in smaller transformation zones. Cytology underestimated more CIN‐2 lesions but equal numbers of small and large lesions and transformation zones.

Conclusion. Colposcopy was a better tool for diagnosing HGL than cytology. but even in combination too many HGL were missed. All women with abnormal cytology should thereUore have colposcopical and histological investigation and prospective studies of the natural history of cervical squamous lesions should include histological evidence.
Non‐traumatic rupture of kidney in pregnancy ‐ case report and review
Authors: Royburt Moshe , Peled Yoav , Kaplan Boris , Hod Moshe , Friedman Shmuel , Ovadla Jardena
Published: November 2007

During pregnancy, dilatation of the urinary collecting system is very common. Acute hydronephrosis is one of the most common causes of severe flank pain in pregnancy. Severe complications of hydronephrosis of pregnancy, such as pain. renal failure or a ruptured collecting system. occur very occasionally. A rare case of spontaneous rupture treated conservatively is presented.
Prenatal diagnosis of urinary tract anomalies: The value of two ultrasound examinations
Authors: Fugelseth Drude , Lindemann Rolf , Sande Hans Andreas , Refsum Sigvald , Nordshus Tore
Published: November 2007

Objective. To determine when fetal urinary tract anomalies were detected by ultrasound screening during pregnancy and to discuss the possible consequences if only one early ultrasound examination is performed.

Design. A retrospective study of 47 cases where fetal urinary tract malformations were diagnosed in a two‐stage screening program (17th and 32nd week of gestation) covering 22,310 women over ten years, 1982‐91.

Setting. Ullevål University Hospital in Oslo which serves as a referral center for obstetric and neonatal diseases.

Results. Urinary tract anomalies were diagnosed in 0.18% of the pregnancies. Of these, 61.7% were found at the second routine ultrasound screening. The most difficult differential diagnoses were those of hydronephrosis without megaureter and a multicystic kidney. Hydronephrosis was found in 51% and a multicystic kidney in 21% of the cases. The tentative prenatal diagnoses were confirmed postnatally in 83% of the cases.

Six of the fetuses had anomalies regarded as incompatible with postnatal life. These pregnancies were terminated, and the diagnoses verified by autopsy. Two other infants died perinatally, one of them as a result of the urinary tract anomalies.

Conclusion. If only one ultrasound scanning had been performed in the 17th week, approximately two‐thirds of the cases would not have been detected. Early intervention and follow‐up after delivery would only have been performed if the infants had developed symptoms or complications related to the urinary tract anomalies.
Acute volume expansion in normal pregnancy and preeclampsia: Effects on plasma atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) concentrations and feto‐maternal circulation
Authors: Grunewald Charlotta , Nisell Henry , Carlstrom Kjell , Kublickas Marius , Randmaa Ivar , Nylund Lars
Published: November 2007

Objective. To compare normal pregnancy with pregnancy‐induced hypertension (PIH)/preec‐lampsia with respect to the effects of acute volume expansion on plasma atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (cGMP) and fetal‐maternal circulation. Design. Observational study.

Setting. University hospital.

Subjects. Fifteen women with PIH/ preeclampsia and 15 healthy pregnant controls. Interventions. Before and after 30 minutes' infusion of a crystalloid solution (15 ml/kg), maternal venous blood was sampled for ANP and cGMP analysis and echocardiography and Doppler investigations were performed.

Results. Basal median (range) ANP and cGMP levels were significantly higher in the PIH/ preeclampsia group compared to the controls: 6.5 (3.8‐30.4) compared to 3.9 (2.0‐6.7) pmol/1, p≤0.01 and 5.8 (2.4‐11.6) compared to 4.0 (2.3‐10.8) nmol/1, p≤0.05. The response to volume load was enhanced: 4.6 (‐4.5‐21.8) compared to 0.7 (‐4.1‐8.8), p≤0.05 and 2.9 (0.1‐10.9) compared to 1.2 (‐ 5.0‐6.0), p≤0.05, respectively. Systemic vascular resistance was initially higher in the patient group, 22.3 (14.1‐36.7) compared to 15.6 (10.0‐25.5) peripheral resistance units, p≤ 0.01 but the response to volume load was similar in both groups (12‐13% decrease). The pulsatility index of the uterine artery, 0.85 (0.46‐1.38) compared to 0.72 (0.49‐1.26) and umbilical artery 0.89 (0.66‐1.57) compared to 0.97 (0.74‐1.31) did not differ between the groups. Volume expansion did not affect any of these variables.

Conclusions. The pulsatility index of the uterine artery remained unaffected in both preeclamptic patients and healthy controls despite an increase of ANP and cGMP concentration and a systemic vasodilatation during acute volume expansion. This finding may indicate the absence of a vasodilatation of the uteroplacental vascular bed.
An open prospective randomized study of dinoproston and gemeprost in second trimester legal abortions
Authors: Kjølhede Preben , Dahle Lars Olav , Matthiesen Leif , Ryden Gunnar , Ottosen Christian
Published: November 2007

The aim of this open prospective randomized study was to compare two non‐invasive methods for second trimester abortion using gemeprost pessaries (Cervagem®) and dinoproston gel (Cerviprost®) concerning effectiveness, time for abortion, consumption of analgesics, infection‐rate and side‐effects.

Forty women admitted for second trimester legal abortion were allocated to treatment with either gemeprost (20) intravaginally or dinoproston (20) intracervically. All patients were pre‐treated with a 3 mm in diameter Lamicel® tent applied intracervically for about four hours. The success‐rate was 95% for gemeprost and 75% for dinoproston within approximately 48 hours. The median abortion time calculated from the insertion of the Lamicel® tent for the successful cases was 22 h 0 min for gemeprost and 24 h 5min for dinoproston (not significant). The shortest abortion time was found among parous women in the Cervagem® group. The difference between Cerviprost® and Cervagem® in parous women was statistically significant. For nonparous women there were no significant differences in abortion time between the two regimes.

No significant difference was found in the demand of Pethidin® and the infection‐rate between the two groups. No major side effects of the treatment were found.

Even if no significant difference in successful abortions was found, probably due to the small patient material, Cervagem® seems to be the most appropriate of the two non‐invasive methods, because of a 95 per cent success‐rate within 48 hours, but also due to its simplicity in design.
Reactive sacroiliitis as late sequela after severe 3elvic inflammatory disease verified by aparoscopy or laparotomy
Authors: Mozas Juan , Castilla José A. , Alarcón José L. , López José M. , Garcia José L. , Herruzo Alfonso J.
Published: November 2007

Objective. To investigate the frequency of lumbosacral pains and sacroiliitis as late sequela of severe pelvic inflammatory disease (PID) confirmed by laparoscopy or laparotomy.

Design. The sacroiliac joints were examined radiographically and scintigraphically to search for signs of reactive sacroiliitis.

Setting. Department of Obstetrics and Gynecology, Hospital General Virgen de las Nieves, Granada, Spain.

Patients. Thirty‐five out of 70 women admitted with severe clinical symptoms of PID during a five‐year period. PID was confirmed by laparoscopy or laparotomy.

Measurements. The sacroiliac joints were examined radiographically, and bone scintigraphic studies of the pelvic girdle were performed with technetium labelled pyrophosphate.

Results. Twenty out of 35 patients reported lumbosacral pain. The bone scintigraphic findings were positive for sacroiliitis in 18 out of 33 patients (54.6%), and the radiographic findings were positive in 11 women (33.3%).

Conclusions. Patients with previous severe clinical PID complaining of lumbosacral pains may be offered a bone scintigraphy, a sensitive procedure using low‐dose radiation, to search for early signs of reactive sacroiliitis.
Giant ovarian tumor masked by obesity
Authors: Ottesen Marianne , Rose Michael
Published: November 2007

Giant ovarian tumors are rare, but comprise both a clinical as well as a surgical challenge. During the past two decades only 20 cases of ovarian tumors weighing 20 kg or more have been reported. We present a new case, where a giant benign ovarian cystadenoma weighing 28 kg, masked by obesity, was removed. Pathology, complications and treatment of such tumors is discussed. Intact removal and pre‐/intra operative drainage of such tumors are equally good as treatment of choice and each case must, therefore, be considered individually. The overall mortality rate in treating such tumors has decreased markedly during the past century. We recommend abdominal ultrasound scan for diagnosis, which should be kept in mind in severe obesity, especially when disproportionate.
Prenatal muscle relaxation in congenital diaphragmatic hernia
Authors: Andersson Sture , Ämmälä Plrkko , Rautiainen Paula , Peltola Kaija , Lindahl Harry , Teramo Kari
Published: November 2007

An infant with congenital diaphragmatic hernia was given 2 mg vecuronium bromide intramuscularly in utero 40 min before vaginal delivery at 40 weeks gestation. At birth the infant had complete muscle relaxation, which facilitated decompression of the bowel and surgical correction. Prenatal muscle relaxation may improve the care of infants with congenital diaphragmatic hernia
Effects of labor on serum levels of insulin and insulin‐like growth factor‐binding proteins at the time of delivery
Authors: Wang Hsin‐Shih , Lee Jing‐Der , Soong Yung‐Kuei
Published: November 2007

Background. The purposes of this study were to explore whether serum levels of insulin, insulin‐like growth factor‐I (IGF‐I), insulin‐like growth factor‐binding protein‐1 (IGFBP‐1) and IGFBP‐3 in both maternal and fetal compartments were affected by the stress of labor, and to investigate the relationship between the fetal birthweight and serum levels of insulin, IGF‐I and IGFBPs.

Methods. Blood samples were collected at the time of delivery from 147 parturients with vaginal delivery and 128 cases of Cesarean section (112 cases without labor and 16 cases with arrest of cervical dilatation during the active phase of labor). Serum concentrations of insulin, IGF‐I, IGFBP‐1 and IGFBP‐3 were determined by radioimmunoassays (insulin, IGFBP‐I and IGFBP‐3) and immunoradiometric assay (IGF‐I).

Results. Maternal circulating IGFBP‐1 levels in parturients with normal spontaneous delivery (NSD) and in subjects receiving Cesarean section (CS) due to arrest of cervical dilatation during active phase of labor were higher than those undergoing scheduled CS without labor. By contrast, insulin levels in both maternal and umbilical cord serum were higher in parturients with CS without labor than those with NSD. No difference in maternal serum IGFBP‐3 levels was observed between NSD and CS at the time of delivery. As for all measurements (insulin, IGF‐I, IGFBP‐1 and IGFBP‐3), serum levels in pregnant women (from both NSD and CS) were strikingly higher than those in the fetus. Serum levels of IGFBP‐I in umbilical cords from both groups of NSD (p<0.02) and scheduled CS (p<0.01) were inversely correlated with birthweight (BW). By contrast, serum concentration of insulin and IGF‐I in umbilical cords from NSD (p<0.005 and p<0.01; respectively) and scheduled CS (p<0.001 and P&<0.05; respectively) were positively related to BW.

Conclusions. From the present results, we conclude that insulin appears to be a regulator for circulating IGFBP‐1 during pregnancy. The fetal growth may not be well reflected by maternal serum IGFBP‐I levels, nor by IGFBP‐3. By contrast, cord serum IGFBP‐1 from CS group without labor may preeminently reflect fetal weight. In additional, serum concentration of insulin and IGF‐I in umbilical cord may also be good indicators to reflect the result of neonatal birthweight.
Couples' willingness to pay for IVF/ET
Authors: Granberg Maria , Wikland Matts , Nilsson Lars , Hamberger Lars
Published: November 2007

Acta Ohstet Gynecol Scand 1995; 74: 199–202. © Acta Obstet Gynecol Scand 1995

Background. Many politicians and decision‐makers in health care consider assisted reproduction an expensive and exclusive treatment despite the results of in vitro fertilizationiembryo transfer (IVF/ET) treatments having improved considerably during the last few years. With the improved results the costs in relation to successful outcome are decreasing.

Aim and Methods. The aim of this study was to evaluate the cost‐benefit of IVF/ET treatments in a group of infertile couples. The benefit was measured as willingness to pay (WTP) for IVF/ET treatment and was related to the cost of IVF/ET. For the calculation of costs, data from one private and one public IVF clinic in Sweden during the period from January 1992 to March 1993 were used.

Results and conclusions. The cost analysis showed a direct cost for IVF/ET of $3,170 per started treatment and $9,410 per delivery. Including the indirect cost, the total cost was $3,880 per started IVFIET treatment and $11,490 per delivery. The survey of the WTP showed that the infertile couples gave high economic priority to infertility treatment. A majority of the couples were willing to pay more for a child than the calculated direct cost.
Serum tetranectin in patients with acute pelvic inflammatory disease (PID): Correlation to clinical and laboratory findings
Authors: Høgdall Claw K. , Christiansen Michael , Brihmer Christina
Published: November 2007

Aim of study. To clarify the impact of the presence of pelvic inflammatory disease (PID) and activation of the acute phase response on the serum level of tetranectin (Se‐TN), a potential new tumor marker for ovarian cancer.

Material and methods. The study group consisted of 70 patients with a laparoscopically verified PID and 47 healthy female controls.

Results. Lower Se‐TN levels were found for the PID group compared to the control group (p<0.0001). It was not possible to relate the decreases in Se‐TN levels to any distinct bacterial strain. Neither was it possible to find any correlation between Se‐TN and severity of PID (p=0.5). A significant positive correlation was found between Se‐TN and ALB (p<0.001). A just significant negative correlation was found between Se‐TN and C‐reactive protein (CRP) (p= 0.04). while no correlation was found with any of the other acute phase reactants. Highly significant correlations were found between all the acute phase reactants and grade of PID.

Conclusions. A slight, but significant reduction in Se‐TN was found in PID patients. The decrease was minor compared to the reported findings of very low Se‐TN levels for ovarian cancer patients. However, the finding is important in the assessment of TN used as a potential screening marker for ovarian cancer, or as a diagnostic tool for pelvic tumors. Furthermore, Se‐TN does not seem to behave as a negative acute phase reactant.
Sonographc assessment of the vaginal vault following hysterectomy
Authors: Haines Christopher J. , Shan Yuen Oi , Hung Tam Wing , Chung Tony K. H. , Leung Denis H.Y.
Published: November 2007

Objective. A prospective study to determine the sonographic appearance of the vaginal vault following hysterectomy.

Methods. A transvaginal sonographic examination of the vaginal vault on the third postoperative day. Follow‐up to determine the incidence of postoperative morbidity.

Results. An accurate sonographic examination of the vaginal vault was possible in 66/71 cases (92.9%). Fluid collections were visible in 28/66 cases (42.4%), and measured up to 41.1 cm2 in the transverse plane and 30.2 cm2 in the sagittal plane. There was no correlation between the presence of a collection and indices of postoperative morbidity.

Conclusion. Collections of fluid at the vaginal vault are common after hysterectomy, but do not usually contribute to postoperative morbidity.
Impetigo herpetiformis during pregnancy: case report and review of the literature
Authors: Wolf Yoram , Groutz Asnat , Walman Igal , Luxman Dov , David Menachem P.
Published: November 2007

A case of impetigo herpetiformis in pregnancy is reported together with a review of the literature.

The patient was a 25‐year‐old primigravida with pregnancy‐induced hypertension (PIH). At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustules with a neutrophilic infiltrate.

Treatment commenced with intravenous fluids, oral prednisone, and steroid creams. Labor was induced. and a normal delivery of a healthy infant was effected, following which the patient's condition improved rapidly.

The clinical and laboratory features were typical of impetigo herpetiformis as described in the literature. Impetigo herpetiformis is a rare, potentially serious skin disorder occurring particularly during pregnancy, and must be diagnosed early to allow prompt, aggressive treatment.
Depressed serum levels of human placental lactogen in first trimester vaginal bleeding
Authors: Pedersen Jan Fog , Ruge Susanne , Sørensen Steen
Published: November 2007

Background. It has previously been shown that serum levels of pregnancy‐associated plasma protein A (PAPP‐A) are depressed in patients with early pregnancy bleeding and a live gestation. We examined whether human placental lactogen (hPL) levels show a similar pattern. Method. Prospective study in the 8th‐14th gestational week comparing serum levels in 69 women with early pregnancy bleeding with those in 93 control pregnancies.

Results. Serum level of hPL were significantly depressed in women with early pregnancy bleeding (p<0.0001).

Conclusions. The findings suggest a primary affection of the placenta in early pregnancy bleeding.
Sexual life in women after colectomy‐proctomucosectomy with S‐pouch
Authors: Sjögren Berit , Poppen Bertil
Published: November 2007

In a consecutive series, 30 women were interviewed and gynecologically examined after pelvic pouch operation because of inflammatory bowel disease. The examination displayed: colpitis in two. bacterial vaginosis in one and cervical cancer in situ in one of the women. Unwanted infertility was reported by five women, probably due to female factors in three. Sixteen women had felt sexually unattractive by the temporary ileostomy. At follow‐up, after closure of the ileostomy, 23 women experienced a considerable sexual desire, 28 could experience orgasm and 20 nearly always had orgasm at intercourse. Insufficient vaginal lubrication during intercourse was reported by seven women. This could be explained by hormonal or other factors in four women and might be owing to side‐effects of the operation in three. Four women reported slight deep dyspareunia and one superficial dyspareunia. The result indicated a low frequency of sexual problems after pelvic pouch operation.
Endometrial adenocarcinoma with clinical evidence of cervical involvement: Accuracy of diagnostic procedures, clinical course, and prognostic factors
Authors: Leminen Arto , Forss Matti , Lehtovirta Pentti
Published: November 2007

Background. The accuracy of clinical staging is known to be insufficient in stage II endometrial carcinoma. Also the optimal management of this disease is controversial. In this study we evaluate diagnostic accuracy and prognostic factors with special reference to treatment modalities of stage II endometrial carcinoma.

Methods, Of 1297 patients with endometrial adenocarcinoma (EAC) treated between 1970 and 1980 at Departments of Obstetrics and Gynecology, Helsinki University Central Hospital, 140 (11%) cases represented clinical stage II and were retrospectively analyzed. Results. Median age of the patients was 63.5 years (range 40–85 years). Accuracy of Papanico‐laou smear was 50%, and that of endocervical curettage 51%. Most of the tumors were histopathologically pure adenocarcinomas (88%), well differentiated (43%), and superficially invaded to inyometrium (44%). Thirty‐four (24%) of the patients developed a recurrent disease during the first five years afterwards. Median time of recurrency was 17 months (range 4–35 months). The disease free 5‐ or 10‐year survival were 72% and 67%. Survival was significantly correlated with menopausal state (p<0.01), tumor grade (p<0.05), myometrial invasion (p<0.001), surgical stage (p<0.0001), and mode of treatment, i.e. operation done or not (p<0.05). Survival was not affected by the radical nature of the operation (radical vs. simple hysterectomy). When all prognostic variables were analyzed by Cox's regression model (multi‐variate analysis) in 10‐years follow‐up, only menopausal state, myometrial invasion, and mode of treatment. i.e. operation done or not (p<0.01), were independent prognostic factors. Conclusions. The only relevant staging procedure is the histological examination of cervix without the preoperative irradiation. According to our results it seems that simple hysterectomy instead of radical (Wertheim operation) hysterectomy may be a sufficient operative treatment of stage II endometrial carcinoma.
Adenoid cystic carcinoma of Bartholin's gland—a review of the literature and report of a patient
Authors: Duun Susanne
Published: November 2007

A case of adenoid cystic carcinoma of the Bartholin's gland, a rare vulval tumor, is reviewed with respect to clinical and pathological characteristics. Histological transition from normal Bartholin gland to adenoid cystic carcinoma was evident in this case. Local recurrences are common and often precede distant metastases. The recommended primary treatment is vulvectomy, obtaining clear margins and bilateral inguinofemoral node dissection.