bluuebunny/crossref_metadata_2025 huggingface dataset:
Chlamydia trachomatis: A practical obstetric/gynecologic management approach
Authors: Meriwether C.D. , Evans M.I. , Sokol R.J.
Published: April 2004

Chlamydia trachomatis has assumed a critically important role in the pathogenesis of gynecologic/perinata/neonatal infectious morbibidity. C. trachomatis is responsible for several infectious syndromes in the non‐pregnant woman, the mother and her offspring. Detection and treatment of chlamydia infections are as important as that of other sexually transmitted diseases (STDs) such as GC, syphilis, trichomoniasis, etc. An appreciation of the seriousness of the resulting disorders and a high index of suspicion are absolute prerequisites for successful management.
Congenital adrenal hyperplasia: The surgical treatment of vaginal stenosis
Authors: Rock J.A. , Schlaff W.D.
Published: April 2004

Ten postpubertal women with congenital adrenal hyperplasia (CAH) had significant vaginal stenosis after at least one previous attempt at vaginal reconstruction. Two women had had two unsuccessful surgical attempts to obtain a vagina of adequate size to allow sexual relations. This report describes a surgical procedure to exteriorize the vagina. With post‐operative vaginal dilatation and proper patient counseling, this combined approach has resulted in a vagina of adequate size to allow comfortable intercourse.
Non‐vascular transplantation of the rabbit uterus
Authors: Confino E. , Vermesh M. , Thomas W. , Gleicher N.
Published: April 2004

Transplantation of the uterus may be an optimal solution in young hysterectomized patients, in women with agenesis of the uterus or in severe uterine anomalies. In the human model, attempted tubal and ovarian homografts have usually failed. Eighteen rabbits underwent unilateral non‐vascular uterine transplantation. Four rabbits underwent total unilateral uterine autograft. Three uteri showed severe inflammation and necrosis 72, 1 week and 1 month postoperatively. Thereafter, the operative technique was modified to avoid contamination from the vagina and four rabbits underwent supravaginal unilateral non‐vascular autograft. Three uteri had preserved endometrial and myometrial structure on relaparotomy. The following four rabbits underwent homotransplantation of the uterus and showed acute rejection of the transplant. Under cyclosporine therapy three homotransplanted rabbits developed pelvic abscesses while three other rabbits showed preserved myometrial and endometrial structures.
Determination of trace and bulk elements in plasma and erythrocytes of diabetic pregnant women by pixe method
Authors: Gödény Sándor , Borbély‐Kiss Ildikó , Koltay Ede , László Sándor , Szabó Gyula
Published: April 2004

Proton‐Induced X‐ray Emission (PIXE) analysis of blood samples from diabetic pregnant women was carried out. Elements S, Ca, P, K, Cl, Fe, Zn, Cu, Rb and Br were detected in red blood cells, while S, Ca, P, K, Cl, Fe, Zn, Cu, Ni, Br in the plasma. The concentrations of P, S, Ni, Cu were found to be higher, while those of K, Fe, and Zn were lower in diabetic plasma than in controls. Significantly higher concentrations were measured for P, S, Cl, Fe, Zn and Rb in diabetic erythrocytes compared to normals. Statistical evaluation of the results also indicated significant alteration in the changes of concentrations throughout the pregnancy. Diabetes also resulted in changes in most of the correlations observed in normal pregnancy between the concentrations of elements.
Rapid regression through bromocriptine therapy of a suprasellar extending prolactinoma during pregnancy
Authors: Tan Seang Lin , Jacobs Howard S.
Published: April 2004

A 29‐year‐old woman is described who presented with amennorrhea and galactorrhea with a large prolactinoma which regressed on bromocriptine therapy. Treatment with bromocriptine was stopped when pregnancy was diagnosed but 6 weeks later the prolactinoma had regrown with suprasellar extension and lateral invasion of the cavernous sinus. When treatment with bromocriptine was reinstituted symptoms subsided within 24 h and serum prolactin concentrations fell from 54,000 mM/l to 2800 mU/l within 5 days and 500 mU/l 2 days after that. Pregnancy proceeded without complications and she entered spontaneous labor at term and delivered a healthy baby. One year after delivery, on treatment with bromocriptine, her serum prolactin concentration remains within the normal range and the CT scan shows persistence of a small prolactinoma, confined to the pituitary fossa. Bromocriptine should be the primary treatment for prolactinomas regardless of tumor size and may be safely stopped when pregnancy is desired. If pituitary tumor complications occur during pregnancy, reintroduction of treatment with bromocriptine should again be the treatment of choice.
Time to conception after IUD removal: Importance of duration of use, IUD type, pelvic inflammatory disease and age
Authors: Andolsek Lidja , Teeter Rebecca A. , Kozuh‐Novak Mateja , Wheeler Robert , Fortney Judith A. , Rosenberg Michael J.
Published: April 2004

Some investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while others have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). To study the effect of length of IUD use, IUD type and the modifying influences of age and PID history on time required to conceive, we followed women trying to become pregnant after removal of their IUD. Five hundred forty women in Ljubljana, Yugoslavia who were first fitted with an IUD between 1964 and 1972 and had their IUD removed in order to become pregnant were followed through 1980. We found no relationship between the duration of IUD use or type of IUD used, but increasing age and a history of PID each decreased the montly probability of conception. These findings, along with other recent work, indicate that IUDs are a safe and efficacious contraceptive for women at low risk for sexually transmitted diseases.
Twin birth weight discordancy in Nigeria
Authors: Fakeye Olurotimi
Published: April 2004

The perinatal outcomes for 56 birth‐weight discordant twin pairs among 622 total twin deliveries that occurred over an 18‐month period at the University of Ilorin Teaching Hospital are analyzed. The incidence of twin birth‐size discordancy was 9%. Mean birth‐weight (kg) was 2.78 ± 0.5 for the heavier twin and 1.90 ± 0.5 for the smaller twin, with a mean intra‐pair birth‐weight difference of 0.88 kg (31.7% of the heavier twin). Perinatal mortality in the smaller infants was increased above the mean for all twin births. There were no perinatal deaths among the heavier infants. Discordant twinning was associated with high parity and a disproportionate increase of unlike‐sex pairs. These observations suggest the preponderance of discordancy in dizygotic twinning. Increased awareness and surveillance for discrepant twin pairs are suggested in order to improve perinatal outcome.
Ovarian function immediately after the menarche
Authors: Borsos A. , Lampé L.G. , Balogh A. , Csoknyay J. , Ditroi F.
Published: April 2004

Estrone and pregnanediol‐glucuronide values of early morning urine samples collected from young girls in the perimenarche were determined by radioimmunological technique. A total of 58 teenage girls started collecting urine samples after their menarche at various times. Of these, 9 completed collection within 100 days of the onset of the first menstrual period. In 3 cases, insignificant changes in estrone and pregnanediol levels were noted. Normal estrone values were found in 3 cases together with pregnanediol levels suggestive of ovulation. In 2 further cases the possibility of ovulation without follicular release was suggested. The results indicate that ovarian activity is unpredictable immediately following the menarche. Between very low levels of sexual steroid hormone production and those normally observed in adult females, all transitional values could be found.
Peridural morphine analgesia by means of a subcutaneously tunnelled cannula
Authors: Hamar O. , Csömör S. , Kazy Z. , Vigváry Z.
Published: April 2004

Peridural morphine analgesia is a well tested method of pain relief for patients with gynecological tumors which are in an advanced stage. Traditional methods of fixation can slightly inconvenience the patient when cleaning and dressing procedures are being carried out, and the cannula can be displaced or damaged.

Fifty patients were treated with subcutaneously tunnelled peridural cannula. The procedure and its favorable results are described.
Antenatal iron supplementation in sickle cell disease
Authors: Akinyanju O.O. , Nnatu S.N.N. , Ogedengbe O.K.
Published: April 2004

Fourteen pregnant women with sickle cell disease (11 SS and 3 SC) were randomized into two groups to receive routine antenatal supplementation either with ferrous gluconate or with placebo tablets. Their hemoglobin levels and bone marrow iron content were determined prenatally and 6 weeks post partum. The fetal weights and the incidence of pain crisis in both groups were recorded. Using an iron content grading from 0 to 5, no marrow of any subject showed iron depletion. The placebo group showed an aggregate postnatal loss of 4 grades of iron repletion while the iron supplemented group showed an aggregate gain of 2 grades. There were no significant differences between the birth weight or the incidence of pain crises in both groups.

We conclude that routine iron supplementation is not justified in pregnant women with sickle cell disease, as it would tend to increase already adequate or excessive iron body stores. We recommend that a clear need for iron should be established before iron supplementation is prescribed to them.
Childbirth following primary cesarean section — evaluation of a scoring system
Authors: Dhall K. , Mittal S.C. , Grover V. , Dhall G.I.
Published: April 2004

Of 1184 cases with previous cesarean section, 590 were selected for trial of vaginal delivery and 594 for repeat cesarean section. Of the former group, 76.6% had successful vaginal delivery. Incidence of uterine wound dehiscence and of perinatal mortality was highest in cases with primary classical cesarean section. Factors like indications for previous cesarean section, history of intercurrent vaginal delivery, weight of baby and period of gestation had positive correlation with delivery outcome.
Factors associated with clinical reactions to rubella vaccination in women
Authors: Nakazono N. , Fujimoto S. , Wakisaka A. , Ishii K. , Ichinoe K. , Aizawa M.
Published: April 2004

Two types of rubella vaccine were given to 272 seronegative healthy Japanese adult women. Clinical and laboratory studies on clinical reaction after vaccination were carried out on HI antibody response, HLA types, basal body temperature (BBT), menstrual cycles and serum progesterone levels of vaccinees. Clinical reactions were not associated with HLA types of vaccinees, but arthropathy occured significantly more often in women vaccinated at the progestational stage than in women vaccinated at the estrogenic stage.
The correlation of serum estrogens and androgens with bone density in the late postmenopause
Authors: Deutsch S. , Benjamin F. , Seltzer V. , Tafreshi M. , Kocheril G. , Frank A.
Published: April 2004

A pilot group of 16 women in the late postmenopause were evaluated for bone density by computerized axial tomography (CT) scanning and for hormonal milieu. A highly statistically significant positive correlation between lumbar‐3 spongiosum density and both dehydroepiandrosterone‐sulfate (DHEA‐S), r = 0.67; P < 0.005 and androstenedione (A), r = 0.56; P < 0.03 was found. No such correlations were observed with estradiol (E2), estrone (E1) or an array of other hormones. The results of this preliminary report indicate a clear association of weak androgens with bone density in the late postmenopause.
Effect of mode of delivery on incidence of respiratory distress syndrome
Authors: Curet L.B. , Zachman R.D. , Rao A.V. , Poole W.K. , Morrison J. , Burkett G.
Published: April 2004

The effect of route of delivery on incidence of respiratory distress syndrome (RDS) has been controversial. While some investigators have reported no difference in RDS rates in infants born by cesarean section as compared to vaginal delivery, others have shown a significant increase in risk for RDS among infants born by cesarean section. Data from the 297 patients comprising the placebo group in the recently completed collaborative study of antenatal steroid therapy in the prevention of neonatal RDS, were analyzed to determine the effect of mode of delivery on RDS. The results indicate that infants born by cesarean section without labor have a higher risk for neonatal RDS than infants born vaginally or by cesarean section after a trial of labor.
Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios
Authors: Varma T.R. , Bateman S. , Patel R.H. , Chamberlain G.V.P. , Pillai U.
Published: April 2004

We studied a group of 247 patients out of 7725 patients who had an ultrasonic examination between 32 and 36 weeks gestation and were found to have oligohydramnios (amniotic fluid volume (AFV) ⩽ 2.0 cm). We compared the features of labor and mode of delivery and perinatal outcome in this group with that of a normal control group of 247 patients who also had an ultrasonic examination between 32 and 36 weeks gestation and were found to have normal AFV (> 2.0 to < 8.0 cm). The incidence of induction of labor, of elective cesarean section, of pre‐term delivery (< 37 weeks' gestation) was significantly higher in the oligohydramnios group (study group) as compared with the incidence in the control group (P < 0.05). The incidence of fetal distress in antenatal and intrapartum period, pH (⩽ 7.2), of low Apgar score (0–5), of intrauterine growth retardation (IUGR) (< tenth centile) infants, of major fetal anomaly and perinatal mortality rate (PNMR) are significantly higher in the oligohydramnios group as compared with the incidence and PNMR in the normal control group (P < 0.05). The ultrasonic finding of oligohydramnios should alert the clinician regarding the possibility of problems in labor and perinatal period.
In vivo release of beta human chorionic gonadotropin by luteinizing hormone releasing hormone stimulation and its clinical application as a remission criterion in patients with gestational trophoblastic disease
Authors: Kim S.J. , Jung J.K. , Kang B.C. , Namkoong S.E. , Lee J.W.
Published: April 2004

In vivo responses of trophoblasts to luteinizing hormone releasing hormone (LHRH) stimulation in 48 gestational trophoblastic disease patients were observed. Serum beta human chorionic gonadotropin (β‐hCG) levels after LHRH injection were significantly increased in patients with hCG values between 5 and 20 mIU/ml (minimal resistance group) but not in patients whose hCG levels were less than 5 mIU/ml (possible remission group). The sensitivity, specificity and the predictive values of LHRH stimulation test were 75.0, 91.3 and 95.5% in the possible remission group and 87.5, 20.0 and 77.8% in the minimal resistance group.
Occult infiltrating placenta previa percreta: an unusual case highlighting the management problems in a young patient
Authors: Ruparelia B.A. , Chapman M.G.
Published: April 2004

Placenta previa in association with placenta accreta has been recorded on average in 1 in 500 pregnancies; its association with placenta percreta is a much rarer condition. We report an unusual case of placenta previa which presented as a severe form of occult parasitic infiltration, invading the internal iliac vessels. This was followed by life‐threatening complications, despite preventative measures. Use of a prediction index to suspect placenta previa is mentioned.
Breech delivery: a critical evaluation of the mode of delivery and outcome of labor
Authors: Mahomed Kassam
Published: April 2004

This is a retrospective study of 213 term, singleton, uncomplicated pregnancies presenting as breech. Thirty‐two percent had elective cesarean section and 61% of those selected for vaginal delivery actually did so. Events in labor and fetal outcome suggest that vaginal delivery of a breech infant, after careful feto‐maternal assessment, continuous fetal monitoring, adequate progress in labor and delivery by an experienced “midwife”, provides comparable fetal outcome to delivery by elective cesarean section.
Ovarian tumors in pregnancy
Authors: Ashkenazy M. , Kessler I. , Czernobilsky B. , Nahshoni A. , Lancet M.
Published: April 2004

Thirty‐eight women were operated for an ovarian tumor diagnosed during pregnancy, with an incidence of 1/2328 deliveries. The diameter of all tumors was above 5 cm. Of the 31 women operated before delivery, seven were untreated and 24 received supportive progestational therapy. The rate of abortions was 85.7% in the untreated group and 10% in the hydroxy‐progesterone‐caproate group (HPC) (P < 0.02). When the women received a total dose of HPC of more than 300 mg, 9 of 10 pregnancies reached term with a live child. Two ovarian malignancies were found, 5.3% of all cases. In 42.9% of the women there were fertility problems later in life. Ovarian tumors during pregnancy should be removed as soon as possible, irrespective of the age of the pregnancy. If fully progesterone therapy is given, the danger of abortions is reduced to a minimum. Prophylactic antibiotic treatment should also be administered.
The kick chart in high‐risk pregnancies: A two‐year experience in Zimbabwe
Authors: De Muylder X.
Published: April 2004

A kick chart has been recorded by 200 high‐risk pregnancies during their antepartum hospitalization. Except for 19 mothers who presented with an unreliable count, this study suggests a good correlation between an abnormal kick chart and an increased risk of intrauterine death. The obstetrical outcome was much better among the patients with a normal kick chart compared to those with an abnormal count. This easy, cheap, low‐technology test could be useful in developing countries when monitoring of fetal well‐being is required.
Unexpected dystocia secondary to a fetal sacrococcygeal teratoma: A successful outcome
Authors: El‐Shafie M. , Naylor D. , Schaff E. , Conrad M. , Miller D.
Published: April 2004

Sacrococcygeal teratoma is a rare cause of dystocia. With recent advances in perinatal care, particularly the increasing use of maternal ultrasound, it is unlikely that unexpected dystocia secondary to this tumor will be seen by many physicians. Recent reports of this type of dystocia are rare and infant mortality secondary to it is high. However, if and when encountered, such dystocia need not imply a bad prognosis for either mother or infant. This is a report of successful management of one case as well as a presentation of recently reported cases and recommendations for management.
The role of the levonorgestrel intrauterine device in the prevention and treatment of iron deficiency anemia during fertility regulation
Authors: Faundes A. , Alvarez F. , Brache V. , Tejada A.S.
Published: April 2004

Hematocrit and blood ferritin were assayed in 43 women using a levonorgestrel intrauterine device (LevoNg‐IUD), 49 using the Copper T‐380 Ag (T‐Cu 380 Ag), 27 using the Lippes loop and 30 non‐IUD users as controls. The mean duration of use was 41 months for the three IUD groups. Women not using IUDs and with similar age, parity, years of schooling and family income as users had a normal mean hematocrit and ferritin, but 30% had low hematocrit (below 38%) and 43% had low ferritin (below 11 ng/ml). After prolonged use of the IUDs, 26% of users of Lippes loop, 22% of users of T‐Cu 380 Ag and only 2% of users of LevoNg‐IUD had subnormal hematocrit; 70%, 55% and 14%, respectively, had low ferritin. Thus, in a population with high incidence of anemia, the use of LevoNg‐IUD appears to reduce the proportion of women with clinical anemia and with depletion of their iron store.
Peer review among district health officers in Maharashtra, India
Authors: Srinivasan V.
Published: April 2004

A management information system in Maharashtra State, India, was used to obtain primary health care performance data for review at monthly meetings of peers, including District Health Officers, Auxiliary Nurse Midwives and Multipurpose Workers. The meetings were conducted in a problem solving, educational atmosphere. The effect of this process was marked improvement in health worker motivation and performance.
Hydatidiform mole in the elderly: Hysterectomy or evacuation?
Authors: Bahar A.M. , El‐Ashnehi M.S. , Senthilselvan A.
Published: April 2004

Ten patients with hydatidiform mole treated by primary hysterectomy were retrospectively compared with 24 patients whose moles were evacuated by suction curettage. All patients were 35 years old or more and were followed up for 1 year following the evacuation. During follow‐up, 10% of the hysterectomized patients needed chemotherapy in comparison with 33.4% of the non‐hysterectomized patients. This difference was not statistically significant. There was also no statistically significant difference when the serial serum beta‐subunit of human chorionic gonadotrophin (β‐hCG) regression rates of the two groups were compared. The study shows that primary hysterectomy does not worsen the prognosis of gestational trophoblastic disease, however, it does not negate the need for careful follow‐up.
Vaginal delivery after cesarean section
Authors: Veridiano N.P. , Thorner N.S. , Ducey J.
Published: April 2004

We retrospectively analyzed 194 pregnancies in women with a history of previous cesarean section (CS) who were offered a trial of labor. We offered every woman a trial of labor as long as she did not have a known previous classical scar. One hundred fifty‐one women delivered vaginally (79%), 24 women had multiple uterine scars. Multiple gestations and breech presentation were not considered a sole indication to perform CS. Fetal and maternal morbidity are presented. We conclude that women with multiple previous CS scars can safely deliver vaginally as can women with unknown uterine scars, with careful intrapartum surveillance. Although our numbers of women with breech presentation and multiple gestations are small, in the absence of significant morbidity, we continue to allow these women to labor and deliver vaginally.
Congenital absence of an ovary in a Nigerian woman
Authors: Dare F.O. , Makinde O.O. , Makinde O.N. , Odutayo R.
Published: April 2004

A case of unilateral absence of the left ovary in a 45‐year‐old grand multiparous Nigerian woman is reported. Congenital absence of a gonad is extremely rare and it indicates a genetic or chromosomal error in the formation of the urogenital ridge.
Prophylactic short course rectal metronidazole for cesarean section. A double‐blind controlled trial of a simple low cost regimen
Authors: de Boer C.N. , Thornton J.G.
Published: April 2004

One hundred and eighty two patients undergoing elective and emergency cesarean section were entered in a randomized double‐blind placebo controlled trial of short course metronidazole rectal suppositories. There was a significant reduction in wound infection, febrile morbidity and postoperative hospitalization in the treated group. The reduction was greatest for serious wound infection. The simplicity and low cost of the regimen make it suitable for hospitals in developing countries.
Uterine myoma in pregnancy: ultrasound study
Authors: Rosati P. , Bellati U. , Exacoustos C. , Angelozzi P. , Mancuso S.
Published: April 2004

In many cases the presence of a myomatous formation in pregnancy begins its effect in a symptomless way and is revealed only by a regular sonographic control or at the time of delivery. In other cases, however, it could represent the cause of several complications, such as increased incidence of abortion extrauterine pregnancy premature breaking of the membranes, premature delivery distocia during delivery or it could itself be the site of necrotic processes. The attitude towards this type of pathology during pregnancy has often varied. The authors report their experiences regarding 408 cases of pregnancies complicated by myoma that were followed with accurate sonographic monitoring and they evaluate the incidence of the principal complications during pregnancy at the time of delivery and the eventual influence on the fetal weight at the time of birth.
The incidence of pregnancy induced hypertension in southeast Turkey
Authors: Sumnulu I. , Ildeniz M. , Özel N.
Published: April 2004

One hundred twenty patients with pregnancy‐induced hypertension (PIH) were delivered during 1986. The incidence of pre‐eclampsia and eclampsia, per 1000 births, was 103 and 19, respectively. Two‐thirds of eclamptics were nulliparous and three‐quarters were < 25 years of age. All patients with eclampsia had convulsions before admission. Although maternal mortality was 4% in patients with pre‐eclampsia and 0% in those with eclampsia, the fetal mortality rate was 32% in pre‐eclamptic and 60% in eclamptic patients.
Serum specific protein 1 and β‐human chorionic gonadotropin concentrations in patients with suspected ectopic pregnancies
Authors: Sterzik K. , Rosenbusch B. , Benz R.
Published: April 2004

To determine the predictive value of serum specific protein 1 (SP1) and β‐human chorionic gonadotropin (β‐hCG) in the diagnosis of ectopic pregnancy, blood was sampled from 82 patients referred for suspected early extrauterine pregnancies. Serum concentrations of SP1 and β‐hCG were determined by EIA and RIA. All patients with early pregnancies had detectable SP1 and β‐hCG levels. An intrauterine pregnancy was found in six patients, and an ectopic pregnancy was confirmed by surgical explorations in 32 of these women. The remaining 40 women had other non‐pregnancy related complaints. In all pregnant patients, the β‐hCG RIA and SP EIA determinations were also found positive. This study demonstrates the high predictive value of serum SP1 and β‐hCG determinations with an acceptable sensitivity and specificity in the diagnosis of suspected early ectopic pregnancies. In addition, the practicability and the easy performance of the enzymoimmunometric SP1 determination renders this test superior over the radioimmunoassay for β‐hCG determination.
A needs assessment study of traditional birth attendants in rural Kenya
Authors: Solomon M.M. , Rogo K.O.
Published: April 2004

For several reasons traditional birth attendants (TBAs) still deliver the majority of women in many developing areas of the world. A needs assessment study of TBAs serving one area of Kenya was conducted for the purpose of designing an appropriate intervention program. Thirty‐six TBAs were interviewed. Together, they had attended to a total of 116 deliveries within 1 month. The local hospital was conducting an average of 37 deliveries per month. Although most TBAs were good at abdominal palpation, they did not conduct routine prenatal checks and rarely referred their clients to hospital. Several risky practices were identified from which a training program has been designed. The findings and their implications are discussed within the context of improved MCH/FP services.
Chlamydia trachomatis infections
Authors: Hossain A.
Published: April 2004

The diversity in chlamydial syndromes and their consequences especially the impact on human reproduction and fertility, the asymptomatic characteristics of infections and the ever‐increasing incidence have been the focus of considerable attention in the 1980s. The current status of the clinical spectrum of ocular‐genital infections due to Chlamydia trachomatis and the laboratory tests for accurate, rapid diagnosis and effective treatment are reviewed.
Pharmacokinetics of meperidine in pregnancy
Authors: Todd E.L. , Stafford D.T. , Bucovaz E.T. , Morrison J.C.
Published: April 2004

The disposition of meperidine was studied in 11 term pregnant humans after the administration of a single 50 mg intravenous dose of meperidine through 48 h post‐injection. Half‐lives of the rapid and terminal elimination phases were calculated as 2.3 and 13.3 h, respectively. These values are much greater than previously reported half‐lives which were based on data collected over less than 8 h after injection. An accurate value for t1/2β may be particularly important in sequential dosing of analgesic medication. These pharmacokinetic constants calculated on data collected through 48 h in this study may have important clinical correlates.
Cesarean section — indications and risks in rural Zaire
Authors: Longombe A.O. , Wood P.B. , Dix R.
Published: April 2004

In a retrospective study in rural Zaire, 10.2% of all deliveries were conducted by cesarean section. Common indications were contracted pelvis and uterine dysfunction (37%) and previous cesarean delivery (32%). Compared with normal delivery, mortality was higher after cesarean section. Cesarean section should only be performed by well‐trained personnel and when vaginal delivery is deemed inappropriate.
Recommendations on breastfeeding promotion among pediatricians
Authors: Anand R.K.
Published: April 2004

Pediatricians often have to treat the severely ill child whose symptoms could have been prevented by exclusive breastfeeding. Nevertheless quite a few pediatricians continue to pass on inappropriate advice on breastfeeding or lack the commitment to its promotion. This paper lists the obstacles that were encountered in breastfeeding promotion among pediatricians in India and gives 17 recommendations for overcoming them.
Timing of ovulation in spontaneous and induced cycles
Authors: Fedele L. , Brioschi D. , Dorta M. , Parazzini F. , Bocciolone L.
Published: April 2004

We studied 30 spontaneous cycles, 30 cycles induced with clomiphene citrate, and 30 cycles induced with human menopausal gonadotropin‐human chorionic gonadotropin to evaluate the pattern of the following parameters and their predictive value in timing ovulation: basal body temperature; cervical mucus; mean follicular diameter; serum LH and 17‐β‐estradiol; and urinary LH. Compared with the spontaneous cycles, in the cycles induced with clomiphene citrate the cervical score was significantfy lower on the 4 days preceding ovulation, serum LH was higher in the early follicular phase, and serum 17‐β‐estradiol was significantly higher in the pharmacologically treated cycles. The highest predictive values in all groups of cycles were obtained by considering the following combinations of parameters: serum 17‐β‐estradiol and LH concentrations; mean follicular diameter as shown by ultrasonography and urinary LH as determined by a rapid method.
Pregnancy outcome following Wurm's operation: Elective versus emergency
Authors: Gita R. , Dhaliwal L.K. , Gopalan S.
Published: April 2004

Wurm's technique for correction of an incompetent os during pregnancy is a simple, but not well recognized procedure. In this study, an attempt has been made to evaluate this procedure for elective and emergency cases. Pregnancy outcome of 142 patients who underwent Wurm's operation at the Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh is presented. Twenty pregnancies resulted in abortion, 47 pregnancies terminated preterm and 75 pregnancies continued beyond 37 weeks. A total of 119 live births yielded a success rate of 83.3%. There were three stillbirths and six infants died during the neonatal period resulting in a fetal salvage of 81%. These results are comparable to those reported for other procedures.
Cervical dilatation with Lamicel in first trimester therapeutic abortion
Authors: Skjeldestad F.E. , Tuveng J.
Published: April 2004

Preoperative treatment with Lamicel tent for first trimester therapeutic abortion was evaluated in an open randomized trial and compared with no treatment. Measured by the lowest Hegar moved through the internal os without resistance, the Lamicel group had significantly higher cervical dilatation than the control group (8.2 mm vs. 5.8 mm; P < 0.001). One perforation was observed in the Lamicel (n = 270) group compared to six in the control group (n = 359) (not significant). There was no difference between the groups in the frequency of readmissions to the hospital. During one year of clinical experience with pretreatment of elective abortion with Lamicel per‐ and postoperative complication rates were not reduced.
Post‐cesarean analgesia using a subcutaneous pethidine infusion
Authors: Gleeson R.P. , Rodwell S. , Shaw R. , Seligman S.A.
Published: April 2004

A pethidine infusion administered subcutaneously using a syringe pump was evaluated in 118 women following cesarean section. One hundred three women (87%) were satisfied with their postoperative analgesia. The mean length of infusion was 18.8 h, and the mean total dose of pethidine was 402 mg. Twenty‐seven patients (23%) reported no severe pain postoperatively, the remainder had on average 2.6 h of pain which they described as severe. Of 38 women who had had a previous cesarean section, 19(50%) considered the pump to be an improvement on the analgesia given the previous time. There were no cases of respiratory depression. This mode of analgesia has advantages over conventional intramuscular bolus injections. It was judged acceptable to both patients and ward staff.
Conservative management of an ovarian cyst in late pregnancy
Authors: van Oppen A.C.C. , Holm J.P. , Trimbos J.B. , Kazzas B.A.
Published: April 2004

We report a case of concomitant ovarian tumor and pregnancy. Sonographic examination indicated that the tumor was benign and obstructed the birth canal. After conservative treatment (puncture of the cyst), a normal vaginal delivery was possible. Two days after delivery, salpingo‐oophorectomy was performed because of torsion of the cyst. Pathological examination confirmed the benign nature of the cyst.
Maternal and perinatal complications in neurofibromatosis during pregnancy
Authors: Sharma J.B. , Gulati N. , Malik S.
Published: April 2004

A total of ten patients with lesions of neurofibromatosis during pregnancy were followed up for pregnancy complications. Seven cases (70%) had hypertensive disorders of pregnancy; four had severe PET (pre‐eclamptic toxemia) including one case of eclampsia, one had mild PET and the other two had only mild gestational hypertension. A total of 60% had preterm labor and in none of these did the baby survive; thus perinatal mortality was 600/1000. Mean gestation was 33.0 weeks and mean birthweight was only 1.924 kg. Thus, neurofibromatosis during pregnancy is associated with poor obstetrical outcome and requires greater care.
Influence of high lead and cadmium soil content on human reproductive outcome
Authors: Laudanski T. , Sipowicz M. , Modzelewski P. , Bolinski J. , Szamatowicz J. , Razniewska G. , Åkerlund M.
Published: April 2004

The influence of lead and cadmium on human reproductive outcome was studied in areas of Eastern Poland with high specific soil contamination with these heavy metals. By personal interviews, information on socioeconomic background factors as well as obstetrical and gynecological histories were obtained from 136 women living in villages with high amounts of lead and cadmium and from 269 women of nearby villages with no increased content of these metals. Physical examination and estimations of blood concentrations of lead and cadmium were also performed in 89 and 175 women from these areas, respectively. In the contaminated areas, there were significantly fewer women with three or more pregnancies (39 vs. 52%) and deliveries at full term (35 vs. 44%) than in nearby villages with normal concentrations of these heavy metals, and the weight of preterm newborns was lower (1930 vs. 2225 g). Furthermore, hypertension was more common (15 vs. 22%) and of higher magnitude (mean blood pressure 140 vs. 129 mmHg) in the study group than in the control women. The mean blood concentrations of lead in the two groups, 675 and 621 μg/dl did not differ statistically, whereas the concentrations of cadmium of 29 and 25 μg/dl were significantly higher in the study than in the control group. There was a significant correlation between cadmium levels and number of preterm deliveries. These results suggest that cadmium and lead could be factors of importance in reproductive outcome.
Serum thiocyanate levels in a normal population and in pregnancy in Benin City, Nigeria: preliminary report
Authors: Oforofuo I.A.O. , Omu A.E.
Published: April 2004

Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concentration was higher in Nigerians compared with Caucasians and was significantly higher also in pregnancy. Hypoalbuminemia and dietary consumption of cyanogenic substances in pregnancy probably contributed to the higher thiocyanate levels. This may have a possible significant bearing on the fetal well‐being, particularly fetal birthweight.
Squamous‐cell carcinoma of the endometrium and cervix
Authors: Teixeira M. , Teixeira de Magalhães F. , Pardal‐de‐Oliveira F.
Published: April 2004

We present a case of endometrial squamous‐cell carcinoma in a hysterectomy specimen also showing CIS of the cervix with signs of human papillomavirus infection in a 64‐year‐old woman. The hypothetical histogenetic relationship of both neoplasms is discussed taking together the evidence collected in the very few similar cases on record.
Traditional birth attendant training: sharing experiences
Authors: Kamal I.
Published: April 2004

The experiences in TBA training in five countries are contrasted. Successful training must impart improved skills to the TBAs and follow‐up that both provides continuing support and meets the self‐interest of the TBAs. The preference of mothers for services of TBAs is explained.
Alternative model for low risk obstetric care in Third World rural and peri‐urban areas
Authors: Hyppolito S.B.
Published: April 2004

The Program for Integrated Health Care (PROAIS) has devised ways and means of reaching the traditional birth attendant, here called empiric midwife and training her to offer adequate, hygienic care at delivery for her low‐risk patients. She is taught to recognize the high‐risk patient and to send her to the weekly prenatal clinics staffed by physicians and registered nurses. The empiric midwife can also be taught prenatal care, detection of cervical and breast cancer, family planning, and the importance of breastfeeding. These women are considered colleagues by their formal medical counterparts and are treated as such. More recently some of the more capable have been placed on County Health Department payrolls.
Plasminogen activators and inhibitors in normal late pregnancy, postpartum and in the postnatal period
Authors: Koh C.L.S. , Viegas O.A.C. , Yuen R. , Chua S.E. , Ng B.L. , Ratnam S.S.
Published: April 2004

Tissue plasminogen activator (t‐PA), urokinase plasminogen activator (u‐PA) and plasminogen activator inhibitors (PAI) are elevated in late pregnancy with t‐PA and u‐PA remaining so at 6 weeks postnatal. PAI‐2 remains at postpartum but was absent by 6 weeks postnatal unlike PAI activity which was absent at postpartum and returned to nonpregnant level at postnatal. The potential fibrinolytic response to stress is much reduced in pregnancy thus increasing the risk of thromboembolism.
Management of patients with poor symphysis pubis‐fundus growth by Doppler flow velocimetry of the umbilical artery — an effective method to detect the fetus at risk
Authors: Theron G.B. , Pattinson R.C.
Published: April 2004

This study evaluated Doppler flow velocimetry of the umbilical artery in patients with suspected intrauterine growth retardation as detected by poor symphysis‐fundus growth (SFG). The sensitivity of Doppler in detecting light for gestational age babies and intrauterine growth retardation was poor. Antenatal complications, neonatal morbidity and perinatal mortality occurred significantly more frequently in patients with abnormal flow. Doppler flow velocimetry is an excellent test to identify babies at high risk for perinatal morbidity and mortality, when poor SFG is present.
Maternal tetanus toxoid coverage during pregnancy in Ile‐Ife, Nigeria
Authors: Owa J.A. , Makinde O.O.
Published: April 2004

A cluster survey on maternal tetanus toxoid (TT) coverage was carried out in the Ile‐Ife Central Local Government Area. Out of the 896 mothers of babies 0–12 months old who were interviewed, 668 (74.6%) claimed they received TT during pregnancy, this was confirmed in 37 (4.1%) and in only 25 (2.8%) of these cases could the babies be said to have been protected from neonatal tetanus (NNT) at birth. About 35% of the babies were delivered at home/churches where most babies with NNT are usually born.
Histiocytosis X and vulvar ulceration
Authors: Wong K.K. , Lin H.P. , Looi L.M.
Published: April 2004

Vulvar ulceration is a rare manifestation of histiocytosis X. A 13‐year‐old girl had a nonhealing vulvar ulcer for 1 year. She had been in remission from histiocytosis X and the ulcer was not recognised as a sign of disease recurrence until tissue biopsy was obtained for histopathological and immunohistochemical studies. This article stresses the importance of establishing an accurate diagnosis when chronic vulvar ulcers are encountered and reviews the literature on this uncommon presentation of histiocytosis X.
A randomized comparison of intrauterine and intraperitoneal insemination in the treatment of infertility
Authors: Gregoriou O. , Papadias C. , Konidaris S. , Gargaropoulos A. , Kalampokas E.
Published: April 2004

OBJECTIVE: To compare the pregnancy rates (PRs) between intrauterine insemination (IUI) and intraperitoneal insemination (IPI) in women receiving comparable ovarian stimulation in couples who were infertile for various infertility conditions. METHOD: Fifty‐four couples were treated. Of these, 25 were diagnosed as having unexplained infertility, 21 as having male infertility and 8 as having cervical mucus hostility. RESULT: Nine pregnancies occured with 89 cycles of IUI and 6 pregnancies with 85 cycles of IPI, giving an overall PR of 28%. Twelve of the 15 pregnancies occured during the first treatment cycle and three during the second treatment cycle. There was no significant difference in the (PRs) between the IUI and IPI (P > 0.25). CONCLUSION: Both procedures combined with superovulation proved to be simple, inexpensive safe and worthwhile for infertile couples with unexplained infertility, male infertility and cervical mucus hostility.
Human leukocyte antigen in hydatidiform mole
Authors: Souka A.R. , Kholeif A. , Zaki S. , Rocca M. , Ghanem I.
Published: April 2004

OBJECTIVE: To find any possible association between human leukocyte antigen (HLA) as a genetic marker and the development of hydatidiform mole (HM). METHOD: The lymphocyte microtoxicity technique was used to study the HLA antigens in 3 groups: 18 women with hydatidiform mole and their husbands (study group), 300 normal women (first control group), and 20 normal pregnant women and their husbands (second control group). RESULT: Hydatidiform mole is more frequent in women having HLA A1. The disease is more common in couples with partial compatibility of the B locus. CONCLUSION: HM occurs more frequently in women with certain HLA antigens and when the husband and wife have partial compatibility at the B locus.
Quantification of immunoglobulin A in chorioamniotic membrane of patients with premature rupture of membranes
Authors: Berezoswski A.T. , Cunha S.P. , da Costa J.C. , Bacchi C.E.
Published: April 2004

Objective: The proposal was to study the presence of immunoglobulin A (IgA) in the chorioamniotic membrane of healthy postpartum women with premature rupture of the chorioamniotic membrane (PROM). Method: A single radial immunodiffusion technique was used to quantify the IgA in the chorioamniotic membrane tissues. Results: The level of IgA was approximately 10 times higher in patients whose membranes had been ruptured for > 10 h (24.58 mg/dl). These results were compared with those of a previously published study where the mean of amount of IgA was 2.52 mg/dl in membranes of patients with rupture < 10 h. Our results show that IgA began to rise after 10–15 h following rupture. Conclusion: Although more studies need to be performed our data indicate that the increasing IgA in our patients after 10 h of latency probably represents the beginning of an ascending colonization of bacteria which could be the source of future infection.
A longitudinal study of the hopes and worries of adolescents
Authors: Gillies Pamela
Published: April 2004

This paper describes a longitudinal questionnaire study of the future hopes and worries of 547, 2‐ and 14‐year‐olds from Nottingham, England. Results from interviews with 152 of the 14‐year‐olds are also presented.

More than half of the teenagers spontaneously expressed hopes for and worries about employment and unemployment. One third of adolescents, and more boys than girls, were concerned about war, including nuclear war. Proportions of pupils worried about unemployment, own mortality, lack of money and AIDS increased significantly with age. Interview and questionnaire findings were in general agreement. However, worries such as exam failure, childbirth and unhappy marriage were more prominent at interview and mentioned significantly more frequently by girls than boys.

Worries about employment and nuclear war appear to predominate throughout adolescence, but are not the sole concern of this age group. Consideration should be given to discussing teenage worries in the context of school/family based educational ventures.
Social skills training in schools: an evaluation study
Authors: Verduyn C.M. , Lord W. , Forrest G.C.
Published: April 2004

A study evaluating the effectiveness of a school‐based social skills programme is described. All children in three year bands of an Oxford middle school were screened for behaviour problems. Subjects selected were allocated at random to eight sessions of social skills training with four booster sessions later or to a no treatment control group. Change was assessed by teacher, parent and self‐report measures.

Results suggested a significant improvement in social activity, parental report of social behaviour and self‐esteem in the treatment as compared to the control group, which persisted at 6 month follow‐up. Self‐esteem changes were age and gender related.

Implications for school‐based social skills programmes are discussed.
The challenge of deliberate self‐harm by young adolescents
Authors: Reder Peter , Lucey Clare , Fredman Glenda
Published: April 2004

This paper describes a model of crisis intervention to families of adolescents below the age of 16 who deliberately harm themselves and summarizes the premises which guide our practice. The adolescent's “overdose” is understood as an attempt to resolve relationship conflicts and so the initial interview aims to explore the predicament for the adolescent and the family and decide what further help may be required. Verbatim extracts from one session illustrate this process.
Parent‐child agreement on children's behaviours reported by the child behaviour checklist (CBCL)
Authors: Rey Joseph M. , Schrader Elzbieta , Morris‐Yates Allen
Published: April 2004

The authors examined agreement between parent and child ratings on the Child Behaviour Checklist in a sample of 1299 referred adolescents over a period of three years. Correlations ranged between 0·72 and 0·08 (mean = 0·28), while agreement using kappa was similar but slightly lower (mean = 0·24; range 0·71‐0·07). Agreement on externalizing was higher than on internalizing items, and concordance increased with age for boys, while there were no differences in parent‐child agreement between boys and girls. Agreement was higher for dimensions of behaviour, e.g. depression (r = 0·40).
Ethnic identity and self‐esteem: an exploratory longitudinal study
Authors: Phinney Jean S. , Chavira Victor
Published: April 2004

Recent models of ethnic identity formation in minority youth suggest a progression over time from an unexamined or diffuse stage to an achieved ethnic identity. To examine changes with age in ethnic identity and selfesteem, eighteen adolescents from three ethnic groups (Asian American, Black, and Hispanic) were assessed at age 16 and three years later. Results of this exploratory study showed a significant change to higher stages of ethnic identity over the three‐year period. Self‐esteem and ethnic identity were significantly related to each other at each time period and across the three‐year time span.