bluuebunny/crossref_metadata_2025 huggingface dataset:
Book Review
Authors: Haram Kjell
Published: November 2007

Briggs Gerald G, Freeman Roger K, Yaffe Sumner J, eds. A Reference Guide to Fetal and Neonatal Risk. Drugs in Pregnancy and Lactation. 4th edn. No figures or illustrations. 975 pages. Baltimore: Williams & Wilkins, 1994. Hard cover. Price: GBP 72.00.
Perturbed (procoagulant) endothelium and deviations within the fibrinolytic system during the third trimester of normal pregnancy
Authors: Sørensen Jannie Dalby , Secher Niels Jørgen , Jespersen Jørgen
Published: November 2007

Purpose. To evaluate the endothelial cell state and the possible relation to placental function in the third trimester of normal pregnancy by an indirect assessment of endothelial cell function.

Study‐design. Twenty‐six pregnant women entered the study in the 30th week of pregnancy. Von Willebrand Factor, urate and key hemostatic variables were quantified at entry, and during the 33rd and 37th weeks of pregnancy.

Results. Levels of von Willebrand Factor, PAI‐1 antigen, t‐PA antigen; variables produced by the endothelial cell, increased during the third trimester of pregnancy. Serum urate, which is correlated with clinical outcome of pregnancy, increased during the study period and correlated directly with von Willebrand Factor and PAI‐1 antigen, respectively. There was an inverse correlation between the concentrations of placenta‐derived PAI‐2 antigen and urate.

Conclusions. In healthy human pregnancy the markers of endothelial related processes of coagulation and fibrinolysis pointed towards a procoagulatory state of the endothelial cell. However, the balance between fibrin formation and resolution seemed to be maintained in uncomplicated pregnancy. Our study indicated an association between this change of endothelial cell function and placental function.
The diagnostic value of amniotic fluid Gram stain examination and limulus amebocyte lysate assay in patients with preterm birth
Authors: Hazan Yenon , Mazor Moshe , Horowitz Shulamith , Leiberman Joseph Reuben , Glezerman Marek
Published: November 2007

The purpose of this study was to determine the value of Gram stain examination and Limulus amebocyte lysate (LAL) test in the detection of intraamniotic infection. Ninety women with preterm labor and intact membranes (n=55) or preterm premature rupture of membranes (PROM) (n=35) who delivered prematurely were included in the study. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as for mycoplasmas. Amniotic fluid analysis included Gram stain examination and limulus amebocyte lysate tests. The prevalence of positive amniotic culture was 32.2% (29/90) and the most common isolate was Ureaplasma urealyticum. Patients with preterm PROM group had a higher rate of infection than those with preterm labor and intact membranes 57.1% (20/35) vs. 16.4% (9/55), respectively (p=0.0001). We found a lower gestational age at delivery and lower mean birth weight in neonates born to mothers with a positive amniotic fluid culture than those with negative amniotic fluid culture. The combined use of Gram stain examination and LAL test had a sensitivity and specificity of 51.7%. (15/29) and 95.1% (58/61) respectively for the detection of positive amniotic fluid culture. We conclude that Gram stain examination and LAL test are rapid, simple and specific tests that can be used to detect microbial invasion of the amniotic cavity except in patients with mycoplasmas infections.
Transvaginal sonography in the management of ectopic pregnancy
Authors: Sadek Abdel Latif , Schiøtz Hjalmar A.
Published: November 2007

During a 3‐year period, 525 women referred to our department with abdominal pain and/or vaginal bleeding in the first trimester of pregnancy were evaluated by transvaginal sonography. Ectopic pregnancy was suspected and laparoscopy done when sonography showed an empty uterus or pseudosac together with free pelvic fluid and/or a tubal mass. Fifty‐seven patients fulfilled these criteriae. Among these patients, sonography showed an empty uterus in 48. pseudosac in five, a non‐diagnostic intrauterine echo in four, a tubal mass in 45 and free pelvic fluid in 54.

Laparoscopy confirmed ectopic pregnancy in 53 patients (93.0%). There were only five tubal ruptures. Pelvic blood was found in all of the 54 patients with free fluid on sonography; i.e. in 51 of 53 patients with ectopic pregnancy and in three with miscarriage. Forty‐nine patients with ectopic pregnancy were managed by laparoscopy and four by laparotomy. All were hemodynamically stable. The diagnostic sensitivity and specificity of vaginal sonography for ectopic pregnancy was 96.2% and 99.4%, respectively, for the finding of free pelvic fluid, and 81.1%. and 99.6% for a tubal mass. All patients with ectopic pregnancy were correctly selected for laparoscopic management. Transvaginal sonography is a valuable tool in the early diagnosis of ectopic pregnancy.
In vitro production of cyclic AMP and steroids from an ovarian Sertoli‐Leydig cell tumor
Authors: Abrahamsson Gun , Dahlgren Eva , Hahlin Mats , Knutson Folke , Norström Anders , Janson Per Olof
Published: November 2007

A 27 year old nulliparous woman with a history of chronic anovulation and signs of virilization with a markedly elevated serum level of testosterone, underwent a laparotomy with peroperative bilateral ovarian vein catheterization and bilateral bisection of both ovaries. A solid, 1.5 cm, well delimited tumor located centrally in the right ovary, was excised. Testosterone levels in ovarian venous blood from the tumor bearing side, were 88.4 nmol/1 and from the contralateral ovary 3.9 nmol/1. Histopathological examination showed a Sertoli‐Leydig cell tumor which was radically extirpated. Postoperatively, the serum levels of androgen normalized, the woman had regular cycles, became pregnant and delivered a normal female baby. Pieces of tumor tissue were incubated for 2 h, with and without addition of gonadotropins and adrenocorticotropic hormone (ACTH). Human chorionic gonadotropin (CG), follicle stimulating hormone (FSH) and adrenocorticotropic hormone (ACTH) caused significant increases in cyclic monophosphate (cAMP) production in tumor tissue in vitro, as compared to controls. Furthermore, ACTH also significantly stimulated 17β‐estradiol production. In tumor cells cultured for 48 h, FSH slightly, but not significantly, increased the production of progesterone.

In the cell culture, [3H]‐thymidine incorporation into deoxyribonucleic acid (DNA) was stimulated by IGF1α but not by hCG and FSH.

It is concluded that Sertoli‐Leydig cell tumors may be sensitive to gonadotropins and ACTH and that their small size, solid shape and intra‐ovarian localization can cause diagnostic difficulties.
Estrogen and progestagen modify the hemodynamic response to mental stress in young women
Authors: Manhem Karin , Hansson Lennart , Milsom Ian , Pilhall Martin , Jern Sverker
Published: November 2007

Objective. To evaluate separately the effects of estrogen and progestagen on the cardiovascular response to a standardized mental stress test.

Methods. Seven women were studied during the early follicular phase (day 1‐4) of three different menstrual cycles after randomized oral administration of either 6 mg estradiol valerate or 15 mg norethisterone acetate or placebo. Heart rate and blood pressure were recorded at rest for 2 hours after administration and throughout the stress test. Forearm plethysmography was recorded at rest and during stress.

Results. Estrogen had no effect on heart rate or blood pressure at rest. After estrogen administration the increases in heart rate (Δ14 bpm/10 bpm; p<0.01) and diastolic blood pressure (Δ14 mmHg/9 mmHg: p≥0.06) from baseline to stress were augmented compared to those observed after placebo administration. Heart rate, systolic and diastolic blood pressures reached higher levels during stress after estrogen administration compared to placebo (Δ5 bpm, and Δ7 mmHg and A5 mmHg respectively; p<0.05). Estrogen administration also caused a prolongation of the diastolic blood pressure response to stress. Progestagen compared to placebo induced an increase in heart rate already at rest (Δ4 bpm; p<0.01), and heart rate was maintained on a higher level throughout the stress test (p<0.05). Blood pressure at rest and pressor responses to stress were not significantly changed after progestagen administration.

Conclusions. The results indicate that estrogen is responsible for the enhanced cardiovascular responses to stress, whereas progestagen provokes a parallel upward shift of basal heart rate which is independent of level of activation.
Book Review
Authors: Drtlukrr Kiwi
Published: November 2007

Klimek, Rudolf. Monitoring of Pregnancy and Precition of Birth‐date. Enzymatic and Ultrasonographic Methods.
Quantitative and functional assessment of anti‐RhD: a comparative study of non‐invasive methods in antenatal prediction of Rh hemolytic disease
Authors: Filbey Derek , Garner Stephen F. , Hadley Andrew G. , Shepard Sarah L.
Published: November 2007

Study objective. To investigate if the prediction of hemolytic disease of the newborn (HDN) in infants of RhD immunized women has been improved by introduction of AutoAnalyzer quantitation and may be further improved by the use of a functional assay.

Methods. Manual antibody titration. AutoAnalyzer quantitation and chemiluminescence test (CUT) were compared by testing 42 sera from 38 RhD immunized mothers. The sera were also screened for the presence of monocyte‐reactivc antibodies which have the potential to protect the unborn.

Results. Among the 42 infants there were 19 unaffected by HDN and 23 affected by HDN. Manual titration correctly predicted the occurrence of HDN in 29/42 (69%), AutoAnalyzer was correct in 28 42 (67%) and CLT showed correct predictions with 30/42 (71%). In babies born without signs of HDN. maternal monocyte‐reactive antibodies were found in 13/18 cases. The majority (9/13) were HLA class I‐specific, the remaining four antibodies were either HLA class II or monocyte‐specific. In affected HDN group, 8/16 monocyte‐reactive antibodies were HLA class II or monocyte‐specific.

Conclusions. AutoAnalyzer and CLT improve the ability to discriminate unaffected babies from those affected by RhD HDN, when compared to manual titration. A protocol for the laboratory management of RhD immunized women is proposed that includes these tests to further improve the prediction of HDN. This study has also highlighted the need for more investigations into the protective role of monocyte‐reactive antibodies in HDN.
Central and peripheral hemodynamics in severe preeclampsia
Authors: Yang Jenn‐Ming , Yang Yuh‐Cheng , Wang Kuo‐Gon
Published: November 2007

Background. Doppler velocimetry, a new tool for measuring blood flow, vascular resistance, and central hemodynamics can be applied to monitor those patients at risk and provide therapeutic concepts for preeclampsia. This study was designed to use a Doppler velocimetry stud to correlate the relationship between central hemodynamics, uteroplacental circulation, and the perinatal outcome in severe preeclampsia.

Methods. Thirty‐one patients with severe preeclampsia, not superimposed with any medical disorder and not on antihypertensive treatment prior to admission, were enrolled in this study. On admission, laboratory determination of the maternal blood chemistry and hematogram. together with a Doppler ultrasound study of the maternal hemodynamics, and umbilical and uterine arteries, were performed. Antihypertensive agents including hydralazine, atenolol, and labetolol were given according to the state of the maternal central hemodynamics. Data were collected on the general status of the patients, the results of the Doppler ultrasound study, and the perinatal outcome.

Results. Patients were divided into three groups based on the systemic vascular resistance. The left ventricular function and cardiac index declined with increase in vascular resistance. The high‐resistance group had a significantly high incidence of infants small for gestational age. Poor fetal growth in the high‐resistance group could be attributed to the summation of underperfusion due to decreased uteroplacental blood flow and was frequently associated with maternal hemoconcentration.

Conclusions. Although global vasospasm has been considered to be the basic pathophysiology of preeclampsia, the central hemodynamics varies between, and even in the same, patients. Regional vasospasm in the uteroplacental circulation occurs earlier than in the systemic circulation as a whole. A high cardiac‐output in low systemic‐vascular‐resistance might compensate in those pregnancies with high uterine artery resistance to maintain adequate uteroplacental perfusion.
Pregnancy outcome after laser surgery for cervical intraepithelial neoplasia
Authors: Forsmo Siri , Hansen Marit H. , Jacobsen Bjarne K. , Øian Pal
Published: November 2007

Background. Little is published about obstetrical problems after treatment of cervical intraepithelial neoplasia with the CO2‐laser. The aim of this study was to determine the risk of low birth weight in the subsequent pregnancy after laser conization or vaporization in a follow‐up study of women treated for cervical intraepithelial neoplasia (CIN).

Methods. Of 319 women treated for CIN with the CO2‐laser in the Department of Obstetrics and Gynecology, University Hospital of Tromsø, Norway and followed for pregnancy outcome, 87 women had given birth (after 24th week) four to nine years after treatment. Sixty‐five women had undergone conization and 22 women had been treated with vaporization. For each delivery, two controls matched for parity, age (±3 years) and place of delivery were identified. The material was analyzed as a matched cohort study.

Results. A strong relationship was found between conization and low birth weight. Mean birth weight after conization was 3185 g vs 3473 g in the control women (p=0.03). Thirteen (20%) infants from women subject to conization had birth weight less than 2500 g. Relative risk of birth weight<2500 g was 2.2 (1.04‐4.5) after conization, for<2000 g and<1500 g the risk was 3.5 (1.02‐12.0) and 10.0 (1.2‐85.6), respectively. Four women (6.2%) with normal deliveries prior to conization experienced one or several stillbirths after treatment. No difference in birth weight was observed for women after vaporization compared to their controls. Conclusion. Excisional surgery on the cervix increases the risk for low birth weight in subsequent pregnancies. Pregnant women with prior conization need careful antenatal care.
Oral contraceptives and risk of breast cancer
Authors: Tómasson Helgi , Tómasson Kristinn
Published: November 2007

Background. The goal of this study is to quantify the risk of breast cancer related to use of oral contraceptives while adjusting for known risk factors, e.g. age at first delivery, number of children, and family history, as well as minimising memory bias.

Methods. A historical prospective study design was used. Data collected over a period of 25 years in the screening program of a cancer detection clinic for women aged 25‐69 years were utilised. Information on breast cancer among those attending the screening program was searched for in the national cancer registry. Women with breast cancer were matched on date of birth with on average 5.3 control women who were still alive when the diagnosis was made. Mothers and sisters of cases and controls were identified through a national genealogy registry.

Results. The odds ratio of developing breast cancer among women with a first degree relative with breast cancer was about 2, but for those ever using oral contraceptives it was 0.92 and even lower (0.50‐0.75) if the cancer was diagnosed before the age of 45 years.

Conclusions. Use of oral contraceptives (OC) does not seem to increase the risk of developing breast cancer among women in Iceland.
Controversies in Assessment of Ovarian Tumors with Transvaginal Color Doppler Ultrasound
Authors: Tekay Aydin , Jouppila Pentti
Published: November 2007

Background. The observations made in the late 1980s indicated that the transvaginal color Doppler ultrasound can be used in the detection of ovarian cancer. This has generated a stream of clinical trials. The conflicting results of numerous publications, however, have led to a major controversy. The aim of this communication is to review the literature and our own observations in order to provide more insight into the subject.

Results. The performance characteristics of the 32 previous transvaginal color Doppler ultrasound studies showed a considerable heterogeneity: the sensitivity was 25%‐100%, the specificity was 46%‐100%. the positive predictive value was 28.6%‐100% and the negative predictive value was 63%‐100%. The accuracy varied between 57% and 100%. An indisputable overlap was found between the ranges of pulsatility index (PI) and resistance index (RI) values from the benign and malignant adnexal tumors. The RI was <0.40 in 43% of benign tumors and in 25% of the normal vascular ovaries.

Conclusion. The current cut‐off levels for PI or RI values should not be used in clinical decision making due to their poor specificity.
Endometrial Destruction by Hyperthermia — a Possible Treatment of Menorrhagia
Authors: Friberg Brut , Persson Bertil R. R. , Willén Roger , Ahlgren Mats
Published: November 2007

Background. Treatment of menorrhagia by heat‐destruction of the endometrium, intended to be an alternative to hysterectomy, was investigated in an experimental study. Method. A specially designed catheter (Cavatermtm) with a silicone balloon containing a self‐regulating heating element is inserted into the uterus, filled with glycine to a pressure of around 180 mmHg and heated to about 75°C. We investigated the treatment effect in vitro in five extirpated uteri (series A) and in vivo in three patients treated peroperatively just before hysterectomy, temperatures being monitored in the surrounding tissues (series B). In both series we monitored the following variables: heating‐power, balloon‐pressure, temperature of the heating element (around 85d`gC) and the temperatures at five locations from top to bottom of the balloon surface.

Results. After 30 min in vitro treatment at 75°C, the endometrium was partly destructed, and condensed. Histological examination showed smooth muscle cells to be destroyed to a depth of 2‐5 mm close to the endometrium.

With in vivo treatment for 30 min at a heating power of about 20 W (resulting in balloon surface temperatures of 58‐65°C). the increases in temperature of the surrounding tissue were too small to measure accurately (±1°C). Histological examination showed destruction of cells in the corpus uteri to a maximum depth of 8 mm.

Conclusion. Findings in in vitro and in vivo experiments suggest that 30 min heating of the endometrium to 58‐65°C with an intrauterine silicone balloon filled with a liquid to a pressure of 180 mmHg exerts therapeutic effects on both endometrium and uterine cavity smooth muscle cells without damage to surrounding tissues.
The hazards of reproduction in space
Authors: Sullivan Richard
Published: November 2007

NASA Medical Standards for space Might (JSC 11570) specifically disqualify any flight crew member who is pregnant. A variety of factors led to this recommendation including the effects of radiation exposure on fetal development. Additionally, other concerns such as toxic chemical exposure, microgravity. pregnancy accidents, plus alterations in breathing gas mixtures and decompression preclude pregnant flight crew members from missions in the forseeable future.

The future of space travel will require reproduction beyond the confines of earth's environment. This makes it all the more necessary to identify the potential hazards associated with reproduction m space.
The cytological screening history of 469 patients with squamous cell carcinoma of the cervix uteri; does interval carcinoma exist?
Authors: Kenter Gemma G. , Schoonderwald Ernst M. , Koelma Ingeborg A. , Arentz Nelleke , Hermans Jo , Fleuren Gert Jan
Published: November 2007

Background. To determine whether interval carcinomas occurred and to determine the level of screening‐participation by women who developed a cervical carcinoma.

Methods. A retrospective study of the cytological history of 469 patients diagnosed between January 1980 and December 1989 with cervical squamous cell carcinoma in 12 hospitals in the western part of The Netherlands. Clinical data, and cervical smear histories in 3.5 years preceding the diagnoses were obtained. Cervical smears diagnosed as Pap I, II or IIIA were traced for review.

Results. 306 patients data were completed. Two hundred and twenty‐three patients (72.9%) had never been screened and 83 patients (27.1%) had had at least one smear, of which 39 were normal. The percentage of women over 54 was higher in patients who had never been screened (58%) than in those screened (46%). Women over 54 were in higher Figo stage. Interval carcinoma was proven in six of 306 (2%) patients. Of the normal smears 53% were false negative.

Conclusion. The high number of non‐participants still forms the main reason for the failure of cervical cancer screening. Secondly, the assumed existence of frequent interval carcinoma could not be demonstrated. There are grounds for changing the age limits of the current Dutch screening program without changing the screening interval.
Plasma platelet aggregating factor and platelet aggregation studies in pre‐eclampsia
Authors: Ahlawat Sunita , Pati Hara Prasad , Bhatla Neerja , Fatima Lali , Mittal Sunita
Published: November 2007

Objective. A plasma platelet aggregating factor (PAF) has been implicated in the pathogenesis of platelet activation in thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Similar mechanism may be operative in pre‐eclampsia. Methods. Coagulation profile and detailed in vitro platelet aggregation with various agonists were studied. PAF was demonstrated by spontaneous aggregation of normal platelets with test plasma. Non‐parametric Wilcoxon's rank sum test and Krauskal Wally's one way analysis of variance were applied.

Result. Twenty‐two pre‐eclamptic patients and 20 normal pregnant controls were studied. Anti‐thrombin III levels were within normal range and fibrin degradation products were only border line raised (>10 <40 μg/ml) in 14 (65.4%) patients. In vitro platelet aggregation was abnormal in 17 (77.2%) patients. PAF was demonstrable in 10 of 22 (45.5%) patients.

Conclusion. Platelet aggregation studies indicated the presence of both activated (hyperaggregable) as well as exhausted (hypoaggregable) platelets in circulation. PAF demonstrable in 45.4% pre‐eclampsia patients would suggest its role in the pathogenetic mechanism of platelet activation in this disease.
Cytogenetic evaluation of cystic hygroma associated with hydrops fetalis, oligohydramnios or intrauterine fetal death: the roles of amniocentesis, postmortem chorionic villus sampling and cystic hygroma paracentesis
Authors: Chen Chih‐Ping , Liu Fen‐Fen , Jan Sheau‐Wen , Lee Chen‐Chi , Town Dai‐Dyi , Lan Chung‐Chi
Published: November 2007

Background. Pregnancies complicated by fetal cystic hygroma in the second and third trimesters are often associated with hydrops fetalis, oligohydramnios or intrauterine fetal death which may make genetic assessment more difficult. We investigated the roles of amniocentesis. postmortem chorionic villus sampling and cystic hygroma paracentesis in cytogenetic evaluation of cystic hygroma under such circumstances.

Methods. Thirty‐five fetuses of cystic hygroma associated with hydrops fetalis, oligohydramnios, or intrauterine fetal death were studied. All fetuses were delivered at Mackay Memorial Hospital, Taipei, Taiwan between January, 1987 and July, 1995. Data collected included maternal age, prenatal sonograms, gestational age at diagnosis, fetal karyotypes and diagnostic procedures.

Results. Of 35 fetuses, all had hydrops fetalis, 19 had suffered IUFD at the time of diagnosis, and 10 had severe oligohydramnios. Cytogenetic studies were performed via amniocentesis, postmortem chorionic villus sampling, or cystic hygroma paracentesis. Successful karyotyping was achieved in 32 fetuses and the karyotype of 45,X was found in 24 fetuses. In cases with IUFD, successful karyotyping rates on cells from amniotic fluid, chorionic villi and cystic hygroma fluid were 88.9% (8 of 9), 69.2% (9 of 13) and 20% (1 of 5), respectively, whereas, in cases with living hydropic fetuses, successful karyotyping was achieved in 12 of 12 amniotic fluid and 5 of 5 cystic hygroma fluid samples.

Conclusions. Amniocentesis is a better method for cytogenetic evaluation of fetal cystic hygroma associated with intrauterine fetal death than postmortem chorionic villus sampling and cystic hygroma paracentesis. However, in the case with a living hydropic fetus and oligohydramnios. cystic hygroma paracentesis appears to be a practical alternative for cytogenetic assessment.
Outcome of short stay surgery in conventional gynecological operations
Authors: Meltomaa Seija S. , Mäkinen Juha I. , Kiilholma Pentti J.
Published: November 2007

Background. To find out the suitability of increasingly common short stay surgery in major conventional gynecological operations.

Methods. A retrospective study of sixty‐six patients who underwent major conventional gynecological operations on a short stay basis between January 1990 and December 1992, in a private hospital, at Turku. Finland, were enrolled to the study. The length of the operation, the time of hospitalization, the duration of the sick leave and possible complications were retrospectively studied. The postoperative long‐term outcome and the satisfaction of the patients with short stay surgery was evaluated with a questionnaire.

Results. The patients were hospitalized for mean 2.6 days. There were no peroperative complications but four patients (6%) needed rehospitalization because of postoperative problems. Five minor complications (two wound infections and three urinary tract infections) were treated in outpatients after discharge. All patients were satisfied with the short stay surgery. The day of discharge was considered suitable by 80% of the patients and most of the patients (97%) would also recommend similar treatment to their acquaintances.

Conclusion. These results suggest that short stay surgery in major gynecological operations can be considered as an alternative to conventional hospitalization.
Semen quality—has it changed during the last decades?
Authors: Ulstein Magnar
Published: November 2007

In the British Medical Journal in 1992 a publication from the Department of Growth and Reproduction, University of Copenhagen, Denmark appeared, with the challenging title: “Evidence for decreasing quality of semen during past 50 years” (1). It was a meta‐analysis of 61 publications from 1938 to 1991, where semen quality of healthy men was studied. Strict selection criteria for inclusion and exclusion were predefined.
Effects of L‐arginine on utero‐placental circulation in growth‐retarded fetuses
Authors: Neri Isabella , Mazza Vincenzo , Galassi M. Cristina , Volpe A. , Facchinetti Fabio
Published: November 2007

Background To evaluate the effects of L‐arginine (ARG) infusion, the nitric oxide as substrate. on the utero‐placental circulation at third trimester.

Methods Three groups of nine pregnant women each were infused i.v. with 30 g ARG, for 30 minutes. One group served as control, and the two remnants were composed by patients with intrauterine growth retardation with (IUGR‐B) or without (IUGR‐A) increased resistances in the utero‐placental circulation. Changes of blood flow velocity waveforms of both uterine arteries and umbilical artery were recorded for 60 minutes. Blood pressure, serum nitrites/nitrates and growth hormone levels were also measured.

Results No hemodynamic changes in utero‐umbilical circulation were observed during infusion in any of the three groups. Considering the uterine arteries separately as placental and non‐placental sided we found a significant decrease of non‐placental side resistances in IUGR‐B women. Indeed, the pulsatility index was lowered by 14%, in respect of baseline value. Serum nitrites/nitrates as well as serum growth hormone levels were significantly increased by ARG, in every woman, irrespective of the presence of fetal growth retardation. Blood pressure remained unaffected during infusion in every woman.

Conclusions These findings suggest that L‐arginine infusion affects utero‐placental circulation in patients with IUGR associated with increased uterine resistances. Such an action is specific and appears possibly to be mediated by a release of nitric oxide.
The pharmacokinetics of oral and intramuscular administration of dexamethasone in late pregnancy
Authors: Elliott Catherine L. , Read Graham F. , Wallace Euan M.
Published: November 2007

Background To compare the pharmacokinetics of orally administered dexamethasone with intramuscular administration in antenatal patients at risk of preterm delivery.

Method Ten antenatal patients at risk for preterm delivery were given two intramuscular and then one oral dose of dexamethasone. Plasma which was collected at set intervals following the first intramuscular dose and the oral dose was assayed for dexamenthasone. The results were analyzed using pharmacokinetic data‐fitting software and pharmacokinetic parameters calculated.

Results After oral administration of dexamethasone the mean maximum plasma concentration obtained was 65% that of the intramuscular dose and the bioavailability of the oral route was calculated as 72% of the intramuscular route. The terminal half‐lives of dexamethasone were similar for both routes.

Conclusions These limited data would suggest that if dexamethasone is to be administered orally, which would be both preferable to patients and more economic, then a proportionately increased dose of oral dexamethasone would be required to provide similar maternal plasma pharmacokinetics to the intramuscular dose in current use. Further, larger studies are now required to confirm this.
Hemoglobin concentration in pregnant women
Authors: Bergsjø Per , Seha Ahmada M. , Ole‐kin'ori Naphtal
Published: November 2007

Background Anemia in pregnancy is common in Tanzania. Previous information on distribu‐ton of hemoglobin concentration in total populations is scarce.

Methods Standard measurement of hemoglobin concentration in consecutive first visit at‐tenders at the antenatal care clinic in Moshi, 1991‐1994, for a total of 1800, divided into three series of 600 each.

Results Hemoglobin concentrations ranged from 41 to 146 g/1, mean 96.9 and s.d. 16.3. For international comparison, 74.5% were below 110 g/1 and 7.0% below 70 g/1. The median was 97.0; other percentiles were 10th: 75.0, 90th: 116.0. The distribution did not change with mother's age, but in the years 1991 and 1994 there were more low hemoglobin values than in the intervening years.

Conclusions Low hemoglobin concentrations are prevalent among pregnant women in Moshi, Tanzania. Seven percent were found to have severe anemia, defined as a hemoglobin concentration below 70 g/1.
Relaxin is not related to symptom‐giving pelvic girdle relaxation in pregnant women
Authors: Hansen Annette , Jensen Dorte Vendelbo , Larsen Elisabeth , Wilken‐Jensen Charlotte , Petersen Lone Kjeld
Published: November 2007

Background The pregnancy associated hormone relaxin induces loosening of the pelvic ligaments in several species. This study was undertaken to evaluate whether pregnant women with symptom‐giving pelvic girdle relaxation had increased serum relaxin concentrations during pregnancy.

Method Serum relaxin concentrations were measured in 38 pregnant women with symptom‐giving pelvic girdle relaxation at the time of diagnosis, in the 30th and 38th week of pregnancy as well as 2 and 6 months after delivery. Fourteen pregnant women without symptoms served as a control group. Relaxin concentrations were measured by a homologous enzyme linked immuno‐sorbent assay. All participants were clinically examined including tests for symptom‐giving pelvic girdle relaxation.

Results No differences in serum relaxin concentrations were found throughout pregnancy and after delivery between women with symptom‐giving pelvic girdle relaxation and positive clinical findings where compared to the control group. Moreover, there were no differences in serum relaxin concentrations in women with symptom‐giving pelvic girdle relaxation more than 2 months post partum when compared to women in whom the symptoms disappeared within two months after delivery.

Conclusion The present results do not suggest an important role for relaxin in symptom‐giving pelvic girdle relaxation during human pregnancy.
Elevation of serum creatine phosphokinase and its MB isoenzyme during normal labor and early puerperium
Authors: Abramov Yoram , Abramov Dan , Abrahamov Ayala , Durst Rimona , Schenker Joseph
Published: November 2007

Background Chest pain or discomfort are infrequent complaints among women during labor and early puerperium, but when present they raise the suspicion of myocardial ischemia. The diagnosis of the latter is based upon serum elevation of certain enzymes, such as aspartate amino transferase, lactate dehydrogenase and creatine phosphokinase. Nevertheless, the normal patterns of these enzymes in the serum during labor and early puerperium have not been characterized well.

Objective To determine serum creatine phosphokinase, lactate dehydrogenase and aspartate amino transferase levels in late pregnancy, and throughout labor and early puerperium.

Methods Fifty women having normal pregnancies followed by uneventful vaginal deliveries were prospectively studied for serum lactate dehydrogenase, aspartate amino transferase and creatine phosphokinase including its MB isoenzyme before, during and after labor. Cardiac status was evaluated in all women using serial electrocardiographic and physical examinations.

Results All women were found to have low to normal antepartum serum enzymes levels. However, during labor total creatine phosphokinase increased markedly, reaching a peak of 2‐4 fold baseline levels 24 hours postpartum. It then declined gradually back to baseline. Nulliparous women reached substantially higher levels than muciparous women. The MB or so‐called cardiospecific isoenzyme was found to be an important contributor to creatine phosphokinase surge in most women. Correlation was demonstrated between length of the active phase of labor and both total and MB creatine phosphokinase activity. There was no clinical or electrocardiographic evidence for cardiac muscle damage in any of the study patients. Serum lactate dehydrogenase and aspartate amino transferase were not altered during or after labor.

Conclusions Serum total creatine phosphokinase and its MB isoenzyme increase substantially during normal vaginal labor without evidence of myocardial ischemia. The uterus and placenta, two organs which were reported to embody substantial amounts of these enzymes, and which participate actively in the process of labor, are thought to release these enzymes to the circulation during labor. Knowing the normal patterns of these enzymes in the serum during labor and puerperium may prevent erroneous diagnoses of myocardial ischemia or infarction. Lack of electrocardiographic abnormalities and low lactate dehydrogenase and aspartate amino transferase levels may assist in excluding such diagnoses.
Hysterectomy in a Danish cohort. Prevalence, incidence and socio‐demographic characteristics
Authors: Settnes Annette , Jørgensen Torben
Published: November 2007

Background The aim has been to assess the frequency of hysterectomy in relation to sociode‐mographic characteristics.

Materials and methods A cross‐sectional survey of 2,403 women selected at random from the population in the western part of Copenhagen County. One thousand seven hundred and sixty‐five Danish women (77%) filled in the questionnaire and took part in the interview. The cohort was followed for eight years through central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used as main statistics. Results. Life time prevalence of hysterectomy was 10.4%. In the prevalence study, hysterectomy on benign diagnoses (85%) was related to short schooling, lack of vocational education. and low social status personally as well as regards the family. In the multivariate analyses school education, vocational education, and ascending social status by marriage were independent explanatory variables. In the incidence study, the crude rate of hysterectomy on benign diagnoses was 3.4 pr. 1000 years, with the 40‐year‐old women having the highest rate (7.8 pr. 1000 years). Risk factors as regards hysterectomy due to bleeding disorders and uterine fibroids at ages <50 (premenopausal) were unemployment and lack of vocational education, only the latter reached significant level in the multivariate analysis. Conclusion. There are social inequalities regarding premenopausal hysterectomy on benign diagnoses, but the socio‐demographic indicators of interest have changed through the last decades. Short schooling and lack of social mobility by marriage were only associated with the hysterectomies performed before 1982. whereas lack of vocational education was related to hysterectomy independent of the calendar period involved. A woman without education has a relative risk of 2.2 (1.1‐4.4) for hysterectomy compared to an educated woman.
Primary cancer of the fallopian tube
Authors: Jereczek Barbara , Jassem Jacek , Kobierska Anna
Published: November 2007

Background Due to rarity of fallopian tube cancer most series on this tumor are small and many problems have remained unsolved. The aim of this report is to review our experience with this neoplasm and to compare it with previously published data.

Methods Retrospective study of 26 patients with fallopian tube cancer treated in one institution between 1974 and 1994. All patients underwent primary surgical treatment and 18 received adjuvant therapy including pelvic irradiation in 14 cases and chemotherapy in four. Results. Relapse occurred in 18 out of 25 followed up patients. Upper abdominal component of relapse was encountered in 12 patients (67%), pelvic component ‐ in eight (44%) and extraperitoneal component ‐ in six (33%). Pelvic relapse occurred in two out of 13 followed up patients treated with postoperative irradiation and in six out of 12 who did not receive postoperative radiotherapy. Survival ranged from 6 to 218 + months (median 23 months). Five‐year actual survival was 33%. There were no 2‐year survivors in patients presenting with stage II‐IV disease. No correlation was found between tumor grade and survival.

Conclusions Fallopian tube cancer is a treatable disease but cure can be only achieved in patients with early tumor. Postoperative radiotherapy may result in better local control but does not preclude extrapelvic dissemination, therefore adjuvant chemotherapy should be considered in high risk patients. Registration of all new cases as well as prospective multicenter studies are warranted to establish optimal management.
The effect of work activity in pregnancy on the risk of fetal growth retardation
Authors: Spinillo Arsenio , Capuzzo Ezio , Baltaro Federica , Piazzi Gaia , Nicola Sabrina , Iasci Angela
Published: November 2007

Background. The relationship between physical activity at work and risk of fetal growth restriction is controversial. For the most part, previous studies investigated the effect of work activity on birthweight alone. We evaluated the impact of type of occupation and physical effort at work on the risk of ultrasonographically confirmed fetal growth retardation among nulliparous women.

Methods. We compared the characteristics of work and the intensity of occupational fatigue (work posture, weekly working hours, physical effort at work) in 349 patients with ultrasonographically confirmed fetal growth retardation and 698 control pregnancies with appropriate fetal growth. Physical demands at work were evaluated by interview at birth. Logistic regression analysis was used to evaluate the association of employment status, type of occupation, and intensity of occupational fatigue with the risk of fetal growth retardation, correcting for potential confounders (maternal age, pre‐pregnancy body mass index, mean weight gain in pregnancy, education, partner's social status, smoking in pregnancy, alcohol use, illicit drug use, time of stopping work, and hypertension).

Results. After adjusting for confounding, the risk of fetal growth retardation was similar between unemployed and formally employed women at the beginning of pregnancy (OR=1.26; 95% confidence interval=0.86‐1.83). However, manual workers were at slightly higher risk of IUGR than not formally employed women (OR=1.81; 95% CI=1.15‐2.85). Among formally employed women, standing or walking at work, and working 30 hours a week were not significantly associated with IUGR. Finally, the risk of IUGR was significantly higher (OR=2.4; 95% CI=1.36‐1.21) among women reporting moderate‐to‐heavy as compared to light physical effort at work.

Conclusion. Formal employment at the beginning of pregnancy is not associated with an increased risk of IUGR. However, moderate‐to‐heavy physical effort at work seems to increase the risk of sonographically confirmed fetal growth retardation.
Central nervous system involvement in gestational trophoblastic neoplasia
Authors: Ayhan Ali , Tuncer Z. Selçuk , Tanir Mete , Erbengi Aykut
Published: November 2007

Background. To review the experience of seven cases of gestational trophoblastic neoplasia with central nervous system involvement.

Methods. Seven patients among 50 cases of malignant gestational trophoblastic neoplasia were analyzed retrospectively in a single institution.

Results. The mean age of the patients at diagnosis was 28.7 years (range: 20‐34). While five of the patients presented initially with symptoms related to cranial involvement, the remaining two developed cerebral metastases during the therapy. In two patients, the presentation was so similar to a primary cranial pathology that craniotomy and biopsy revealed the trophoblastic involvement. The sites of involvement were the parietal lobe in three, temporal lobe in two and frontal lobe in two patients. Besides central nervous system involvement, four had additional lung and one had pelvic metastases. In terms of therapy, while five patients received methotrexate+actinomycin‐D+cyclophosphamide regimen for 3 to 5 courses, only two could be administered additional intrathecal methotrexate. Since one patient exhibited a fulminant clinical course, she could not be delivered a chemotherapy regimen and was lost in two months of initial diagnosis. The other patient was administered modified Bagshawe protocol (5 courses) which was switched to etoposide+methotrexate+actinomycin‐D+vincristine+cyclophosphamide (6 courses) due to development of resistance. She was still alive and free of disease after 24 months of initial diagnosis. Six of the patients were also delivered whole‐brain irradiation simultaneously with chemotherapy.

Conclusions. The prognosis of brain metastases still seems to be poor despite combination chemotherapy and radiotherapy. Measures should be focused on early diagnosis and prophylaxis.
Hysteroscopic surgery in postmenopausal women
Authors: Cravello Ludovic , de Montgolfier RÉMy , D'ercole Claude , Boubli LÉOn , Blanc Bernard
Published: November 2007

Objective. To assess the efficacy of hysteroscopic surgery in postmenopausal women presenting with abnormal uterine bleeding.

Design. A retrospective audit of 102 patients.

Setting. The Department of Obstetrics and Gynecology B, La Conception Hospital, Marseilles, France.

Patients. One hundred and two women between the ages of 47‐67 years with postmenopausal bleeding or bleeding related to hormone replacement therapy were evaluated by pelvic ultrasound and diagnostic hysteroscopy. A benign organic cause was noted in 87 cases (polyps in 51 and fibroids in 36). Fifteen patients had no significant disease.

Interventions. Resection of polyps or fibroids, endometrial ablation.

Results. One hundred and seven procedures were performed on 102 patients. Major operative complications were rare and included one perforation and one case of glycine toxicity. Eighty‐eight patients were satisfied with the results. Six patients were subsequently treated by hysterectomy. Six patients complained of recurrent abnormal bleeding.

Conclusions. This modality of treatment appears to be effective over the long term. The operative criteria should take the causes of bleeding and not just the age of the patient into account.
Ovarian hyperstimulation syndrome (OHSS) in pregnancy not associated with ovulation induction
Authors: Regi Annie , Mathai Matthews , Jasper Padmini , Krishnaswami Hemalatha , Prem Suneeta , Peedicayil Abraham
Published: November 2007

Ovarian hyperstimulation syndrome (OHSS) has gained recent interest because of various ovarian stimulation regimes used for treatment of infertility (1). Ovarian hyperstimulation syndrome is commonly associated with disorders of pregnancy with high levels of serum hCG such as gestational trophoblastic disease, fetal hydrops, multifetal gestation in late months of pregnancy, and conditions associated with large placentae such as diabetes and Rhesus isoimmunization (2). It is very rarely seen in pregnancy where ovulatory drugs or hormones have not been used (3). Oligomenorrhoic anovulation and low age and low weight are other risk factors (4). Ovarian hyperstimulation syndrome is characterized by extremely enlarged ovaries with multiple cysts, increased capillary permeability and loss of fluid and proteins from the intravascular to extravascular space. Clinically OHSS is associated with hypovolemia, oliguria, ascites, abdominal pain, pleural effusion, hemoconcentration and electrolyte imbalances, especially hyperkalemic acidosis (5).
Maternal risk factors for retinopathy of prematurity – a population‐based study
Authors: Holmström Gerd , Thomassen Peter , Broberger Ulf
Published: November 2007

Background. The aim of the study was to investigate maternal risk factors for retinopathy of prematurity (ROP) and also to describe risk factors for prematurity per se in our population. Design. A retrospective, population‐based study.

Material and methods. The study group included the mothers (identified with the help of a National Birth Register) of 202 single‐born preterm infants with a birth weight of 1500 grams or less, from a previous population‐based study. From the same register we also received information on 307 mothers of full term pregnancies for description of risk factors for preterm birth. Data from antenatal clinics, labor rooms and neonatal units were studied.

Results. Univariate analysis of maternal risk factors for ROP revealed a few positive findings. In a further logistic multiple regression analysis, apart from gestational age at birth and birth weight, only essential hypertension prior to pregnancy was a predicting risk factor (odds/ ratio 8.36, 95% confidence interval 1.62‐43.0).

Conclusions. Prematurity per se remains the strongest risk factor for ROP.
A prospective study of high‐ versus low‐dose oxytocin for induction of labor
Authors: Hourvitz Ariel , Alcalay Menachem , Korach Jacob , Barkai Gad , Seidman Daniel S.
Published: November 2007

Background. To assess the efficacy and safety of a high‐dosage oxytocin induction regimen.

Methods. A randomized prospective study of 179 patients who received an initial dose of either 2.5 (n=98) or 1.25 (n=81) mU/minute of oxytocin, with increments of 2.5 mU/minute or 1.25 at 30‐minute intervals.

Results. Failure rates (15.3% versus 19.8%), time to delivery, the number of assisted vaginal deliveries, cesarean sections, and maternal and fetal complications were not significantly different in the two protocols. However, the use of a high oxytocin dose resulted in significantly higher mean peak doses and increased total cumulative amounts. These were associated with a significant need to modify the oxytocin infusion protocol for hyperstimulation and fetal heart rate changes (65.1% versus 46.2%).

Conclusions. Induction with higher dose oxytocin increments did not shorten time to delivery, but was associated with an increase in uterine hyperstimulation. Low‐dose oxytocin was found to be appropriate and safe for labor induction.