bluuebunny/crossref_metadata_2025 huggingface dataset:
Termination of second trimester pregnancy with mifepristone and gemeprost
Authors: GEMZELL‐DANIELSSON KRISTINA , ÖSTLUND EVA
Published: March 2003

Background. Earlier controlled clinical trials have demonstrated that combined treatment with the antiprogestagen, mifepristone and a suitable prostaglandin reduce the induction to abortion time in second trimester abortion. The aim of this study was to describe the results of the 197 consecutive second trimester terminations performed in routine clinical practice at our Department from 1996 to 1998.

Methods. The report is based on 197 consecutive second trimester abortions including live pregnancies and missed abortions, carried out in 192 women. The women were treated with 600 mg mifepristone followed 24 to 48 hours later by 1 mg gemeprost administered every 6 hours four times. If abortion had not occurred, 1 mg gemeprost was administered every 3 hours for the next 12 hours. After expulsion of the fetus a surgical evacuation of the uterus was routinely performed up to 18 weeks gestation and thereafter when needed. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and expulsion of the fetus.

Results. The median abortion time was 9.0 (1.4–40.5) hours for primigravidae and 7.2 (0–152.5) hours for multigravidae. The medium number of gemeprost pessaries to induce abortion was two and all except seven women aborted within 24 hours. Significantly more abortions occurred before 6, 7 and 8 hours in multigravidae than among primigravidae. The induction to abortion interval was also significantly shorter for nulliparous than for parous women. Except for one case of heavy bleeding, no serious complications occurred.

Conclusion. The study confirms the efficacy and safety of mifepristone, together with gemeprost, for termination of second trimester pregnancy when routinely used in the clinic.
Medium‐term follow‐up of women with menorrhagia treated by rollerball endometrial ablation
Authors: EL SENOUN GHADA S. A. , MOUSA HATEM A. , MAHMOOD TAHIR A.
Published: March 2003

Background. To assess medium‐term efficacy of rollerball endometrial ablation in a district general hospital.

Method. From March 1992 to June 1997, 91 women underwent rollerball endometrial ablation for uncontrolled menorrhagia unresponsive to medical treatment. Each was sent a detailed questionnaire after at least 18 months (range 18–55). There was an overall response rate of 88% (80/91). Case notes were reviewed to collect additional data related to pre‐operative management and actual operative procedure. The main outcome measures included treatment satisfaction, relief of symptoms, improvement in health related quality of life, at least 18 months after surgery.

Results. Thirty‐five of the 80 women (44%) had achieved amenorrhea. Ten women required further treatment; of these seven had a hysterectomy (9%). None of the non‐responders had a hysterectomy. Following rollerball endometrial ablation, many women reported improvement in cyclical pelvic pain (73%), pre‐menstrual symptoms (65%), ability to do housework (85%), and an improved sexual life (96%). Seventy‐nine (99%) women were able to return to normal work within 4 weeks following surgery. The majority of them remained satisfied with treatment (79%) and they would recommend it to a friend (91%).

Conclusions. Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the treatment of menorrhagia in selected cases. Longer‐term follow up is still needed to establish the ultimate effectiveness of the procedure.
Fibroids treated by uterine artery embolization
Authors: LUND NIELS , JUSTESEN PER , ELLE BO , THOMSEN STEN GROVE , FLORIDON CHARLOTTE
Published: March 2003

An increasing number of reports indicate that uterine fibroids can be successfully treated with uterine artery embolization (UAE). UAE seems to be a promising treatment for women who want to retain their uterus. This review summarizes the technical considerations and the results. UAE is a radiological procedure using angiography for visualization of the blood circulation. Subsequently, the flow through the uterine arteries is blocked resulting in infarction of fibroids. Success rates of 87% have been achieved with an average 57% reduction of fibroid volume. Complications have been few compared to hysterectomy and patient satisfaction is high. However, none of the reports include controls. Further studies are needed to optimize patient selection and to evaluate long‐term results.
Female urinary incontinence – the role of the general practitioner
Authors: SEIM ARNFINN , HUNSKAAR STEINAR
Published: March 2003

Subject. Urinary incontinence is a frequent disorder among adult females, but very few of the incontinent women have consulted a doctor.

Discussion. This paper reviews and discusses the possible roles of the general practitioner in the diagnostic and therapeutic work with women with urinary incontinence. Some characteristics of general practice and the selection process from primary care to the specialist level are described. The selection process (gatekeeper function) of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital‐based research back to general practice. Recommendations and guidelines for diagnosis or therapy developed at secondary or tertiary care levels may be inappropriate at the primary care level, with a significantly different clinical picture of this condition.

Results. Several studies show that most women seeking help in general practice can be satisfactorily treated at this level of care with fairly simple treatments, and that treatment is effective also in the long term. Some women with urinary incontinence need to be referred primarily to a specialist, or later if the response to treatment is disappointing.

Recommendations. Based on literature studies and the authors' own experiences from clinical work and research, recommendations are presented for a basic evaluation and treatment of women with urinary incontinence who seek help in general practice.
Hysterectomy on benign indication in Denmark 1988–1998
Authors: Gimbel Helga , Settnes Annette , Tabor Ann
Published: March 2003

Background. The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication.

Methods. Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on the female population distribution were obtained from the Danish National Population Register.

Results. During the last 11 years the incidence rate of hysterectomy performed for benign diseases has been stable. However, the rate of women treated surgically for benign diseases of the uterus has increased by 14%. During the study period the number of total abdominal hysterectomies has decreased by 38%, the number of subtotal abdominal hysterectomies has increased by 458%, the number of vaginal hysterectomies has increased by 107% and two new methods of surgical treatment for benign diseases of the uterus have been introduced. Abdominal hysterectomy still accounts for 80% of the total number of hysterectomies performed in Denmark in 1998. The age distribution for all hysterectomies has changed, from a maximum of 36–45 years in 1988 to 46–55 years in 1998. The age maximum for abdominal hysterectomy corresponds to that of all hysterectomies. For vaginal hysterectomy the age maximum is 56 years or older, while it is 36–45 years for laparoscopic hysterectomy.

Conclusions. The incidence rate of hysterectomy was stable during the study period and the age distribution for all hysterectomies has changed. The study showed a change in the choice of surgical methods, although no evidence supports this practice.
Screening for Chlamydia trachomatis in asymptomatic women in Hungary
Authors: Nyári Tibor , Nyári Csaba , Woodward Mark , Mészáros Gyula , Deák Judit , Nagy Erzsébet , Kovács László
Published: March 2003

Background. A multicenter survey was carried out in order to determine the prevalence and risk factors for Chlamydia trachomatis infection in the population of asymptomatic women in Hungary. Results were used to carry out a cost‐effectiveness analysis of screening for chlamydial infection in women with asymptomatic genital infections.

Methods. The non‐amplified nucleic acid hybridization method (PACE 2 Gen‐Probe) was used to diagnose C. trachomatis and Bayes’ theorem was applied to assess the prevalence of the infection. Multiple logistic regression analysis was performed to differentiate the risk factors for chlamydial infections.

Results. According to the test, the prevalence of Chlamydia trachomatis among 1300 pregnant women was 4.5%. The sensitivity and specificity of the test are estimated to be 70% and 99%, respectively. After Bayes’ correction, the overall estimated prevalence of chlamydial infection was 5.1%. There were significant differences in proportions of chlamydial infection in different regions, and also in different age groups and different family status groups. The highest rate was for women aged below 20 years: 16.9%. Cost‐effectiveness analysis, with associated sensitivity analysis was carried out for women aged below 20 years. Three screening strategies were compared: using the ELISA method, using amplified Gen‐Probe method and no screening. The amplified Gen‐Probe method was best provided, the infection prevalence exceeded 16.7%, the PID rate exceeded 24% and the probability of tubal infertility in untreated women exceeded 25%.

Conclusion. We conclude that screening with amplified Gen‐Probe assays (followed by treatment of positive patients) is the preferred screening strategy for young women in Hungary.
Warm tub bathing during labor: maternal and neonatal effects
Authors: Ohlsson Gun , Buchhave Per , Leandersson Ulf , Nordström Lennart , Rydhström Hakan , Sjölin Ingrid
Published: March 2003

Aim. To study possible detrimental maternal and neonatal effects of immersion in warm water during labor.

Design. Prospective randomized controlled bathing during first stage of labor vs no bathing.

Setting. Obstetrical departments at a university hospital and two central hospitals.

Primary end‐point. Referral of newborns to NICU.

Material and methods. Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeks+0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3–4 cm. Parturients randomized to the ‘no bath’ control group were allowed to use a shower. Rupture of the membranes was not a contra‐indication to participation. Those excluded from randomization were women with intra‐uterine growth retardation, meconium‐stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient.

Main results. On average, parturients stayed in the tub for 50–60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III–IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar <7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0).

Conclusion. In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns’ wellbeing after birth.
Evaluation of an optimal luteal phase support protocol in IVF
Authors: Ludwig Michael , Diedrich Klaus
Published: March 2003

Subject. Luteal phase support has been shown in the past to be an essential part of ovarian stimulation protocols, especially the long protocol. It could be shown that hCG is as effective as is progesterone for luteal phase support but hCG is accompanied by a higher rate of complications.

Methods. Progesterone can be administered in several routes. The oral, intramuscular (i.m.) and vaginal routes have been chosen frequently in the past. The oral route is ineffective, since progesterone has a low oral bioavailability (<10%), and a high rate of metabolites, which may result in side effects such as somnolence etc. Intramuscular administration provides very high serum levels of progesterone and this route is effective with regard to pregnancy rates. Injection of progesterone, however, is painful and cannot be done by the patient herself. The vaginal route is also effective, progesterone can be administered by the patient herself and progesterone is delivered directly to the uterus, where high levels are achieved (first uterine pass effect).

Results. Several studies could show, in the past, that the vaginal administration of progesterone is effective also with regard to the downregulation of uterine contractions. Crinone® 8% Vaginal Gel is especially designed for vaginal use with a special applicator and has to be administered once daily in the morning. It adheres to the vaginal epithelium, and leakage of the gel is substiantially reduced as compared to other drugs like capsules or suppositories.

Conclusions. Since progesterone is as effective as hCG for luteal phase support but provides a higher safety with regard to ovarian hyperstimulation syndromes, and vaginal progesterone is as effective as intramuscular progesterone, vaginal progesterone should be the standard choice for luteal phase support. Crinone® 8% seems to be the most comfortable way of vaginal administration of progesterone for luteal phase support in IVF cycles.
Clinical management of PCOS
Authors: Tan Wei Ching , Yap Christine , Tan Ann Sian Ann
Published: March 2003

The polycystic ovary syndrome (PCOS) is a heterogeneous condition with genetic predisposition. It is characterized by a myriad of symptoms including oligomenorrhea or amenorrhea, anovulation or infertility, hirsutism or acne. Insulin resistance appears to be an important factor in PCOS though the lack of an etiology has led to symptom oriented therapy which includes lifestyle modification, the use of cyclical progestagens and antiandrogens. Ovulation induction by drug therapy and ovarian drilling aims to treat subfertility in women with PCOS. Therapeutic approaches to PCOS remain an ongoing source of debate. Insulin sensitizing agents may bring new hope in therapy. Future research is aimed at shedding light on the pathophysiology so as to optimize treatment of women with PCOS.
Mouse embryo toxicity of IL‐6 in peritoneal fluids from women with or without endometriosis
Authors: Wu Ming‐Yih , Chen Shee‐Uan , Chao Kuang‐Han , Chen Chin‐Der , Yang Yu‐Shih , Ho Hong‐Nerng
Published: March 2003

Background. To determine whether there is a factor (or factors) in the peritoneal fluid of endometriosis patients that impairs embryo growth and embryo implantation.

Methods. Growth and development of two‐cell mouse embryos which were cultured in media with peritoneal fluid from women with or without endometriosis and interleukin‐1‐beta (IL‐1β), interleukin‐6 (IL‐6), and tumor necrosis factor‐alpha (TNF‐α) levels in conditioned media were measured.

Results. The blastocyst rate in the non‐endometriosis group was 46.4±31.1%, and that of the endometriosis group was 54.6±28.7%. Logistic regression analysis using the criteria of blastocyst development in 454 embryos, showed that the peritoneal fluid from endometriosis could promote (p=0.015) but IL‐6 could arrest embryo growth to blastocyst (p=0.025). IL‐1β and TNF‐α levels had no significant effect on blastocyst formation.

Conclusion. Peritoneal fluid from women with endometriosis was not toxic to mouse embryo development. However, IL‐6 in the peritoneal fluid deteriorated the growth and development of mouse embryos.
Vaginal palpation of pelvic floor muscle strength: inter‐test reproducibility and comparison between palpation and vaginal squeeze pressure
Authors: Bø Kari , Finckenhagen Hanne Borg
Published: March 2003

Background. Vaginal palpation is commonly used in clinical practice to teach and evaluate pelvic floor muscle strength, and several grading systems have been developed. The aim of the present study was to test inter‐rater reproducibility of the modified Oxford grading system and compare results from vaginal palpation with squeeze pressure measurement.

Methods. Twenty female physical therapy students, mean age 25.1 years (range 21–38) participated in the study. Two experienced physical therapists conducted the palpation test in random order. Muscle strength was classified according to a 6‐point scale (modified Oxford grading system). Results from the palpation test were compared with measurement of vaginal squeeze pressure using a vaginal balloon connected to a fiberoptic microtransducer (Camtech AS, Sandvika, Norway). To ensure validity of pressure measurement only contractions with simultaneous observation of inward movement of the perineum were registered.

Results. The inter‐rater reliability for vaginal palpation was 0.70 measured by Spearman’s rho (p<0.01). Cohen’s Kappa was κ=0.37 (SEM 0.16). There was agreement between the physical therapists in nine subjects (45%). In all but one subject the disagreement was one category. Mean maximal strength for the group was 19.7 cm H2O (95% CI: 16.5–22.9). There were no differences between weak, moderate, good and strong muscle contraction classified by palpation test when comparing results from the vaginal squeeze pressure (p=0.66).

Conclusions. Vaginal palpation is mandatory when teaching correct pelvic floor muscle contraction. However, the present results indicate that the method is not reproducible, sensitive and valid to measure PFM strength for scientific purposes.
Evidence for a suppression of apoptosis in early postnatal life
Authors: Malamitsi‐Puchner Ariadne , Sarandakou Angeliki , Tziotis John , Trikka Panagioula , Creatsas George
Published: March 2003

Background. In fetal life the rates of proliferation and apoptosis are high. We studied if the rate of apoptosis decreases after birth, by measuring the soluble (s) forms of Fas‐Fas ligand and Tumor necrosis factor receptor 1 (TNFR1)‐TNF‐α which attenuate apoptosis.

Subjects and methods. Blood was drawn from the umbilical cord and from a peripheral vein on day 1 and 4 of life in 35 infants and sFas, sFas ligand, sTNFR1 and sTNF‐α were determined by enzyme immunoassays. Data were analyzed by paired t‐test and Pearson’s correlation analysis.

Results. sFas and sTNF increased significantly from birth to day 4 of life (p=0.033 and p<0.0001 respectively), while sTNFR1 increased significantly from birth to day 1 of life (p<0.0001) followed by a significant decrease on day 4 of life (p<0.0001). The levels of sFas and sTNF‐α on day 1 correlated with those on day 4 (r=0.677, p<0.0002 and r=0.525, p<0.007 respectively). sFAS ligand was not detectable in any specimen.

Conclusion. The increasing concentrations of the soluble molecules, sFas, sTNF‐α and sTNFR1 might indicate that apoptosis may be downregulated in early postnatal life.
Androgen levels of preeclamptic patients in the third trimester of pregnancy and six weeks after delivery
Authors: Serin İbrahim Serdar , Kula Mustafa , Başbuğ Mustafa , Ünlühizarci Kürşat , Güçer Şükran , Tayyar Mehmet
Published: March 2003

Background. The aim of this study was to measure the circulating levels of androgens in the third trimester of pregnancy and six weeks after delivery and to discuss androgen contribution in the pathogenesis of preeclampsia.

Methods. Twenty‐two preeclamptic and 20 normotensive women completed this prospective study. Blood samples were drawn in the third trimester (28–32 gestational weeks) and six weeks after delivery. Serum total testosterone (T), free testosterone (fT) dehydroepiandrosterone sulfate (DHEAS), androstenodione (A), sex hormone binding globulin (SHBG) and estradiol (E2) levels were measured. The statistical analyses of the data were performed by using Wilcoxon Rank test within the groups, Student unpaired t test and Chi‐square test between the groups with the SPSS program.

Results. T and fT levels were found to be significantly higher (p<0.05) in preeclamptic women in the third trimester compared to the values of normotensive controls. However, there were significant decreases (p<0.05) in T and fT levels six weeks after delivery, reaching values not significantly different from normotensive subjects (p>0.05). Futhermore, SHBG, DHEAS, A and E2 levels were not significantly different (p>0.05) between the groups in the third trimester or six weeks after delivery.

Conclusion. We conclude that higher blood androgen levels measured in preeclamptic patients may be implicated in the pathogenesis of preeclampsia.
Antenatal diagnosis of hereditary fetal growth retardation with aminoaciduria, cholestasis, iron overload, and lactic acidosis in the newborn infant
Authors: Fellman Vineta , Visapää Ilona , Vujic Mihailo , Wennerholm Ulla‐Britt , Peltonen Leena
Published: March 2003

Objective. A prenatal diagnosis of the fetus for a mother of two previously deceased infants who died from the recently described autosomal recessive disease (OMIM 603358). The infants presented with intrauterine growth retardation, aminoaciduria, cholestasis, iron overload, severe lactic acidosis, and early death (GRACILE syndrome).

Study design. DNA was extracted from the fibroblasts and tissue samples of the deceased infants, parental leukocytes, and from a chorion villus biopsy in the next pregnancy. Haplotypes were determined using the relevant markers flanking the disease‐associated region of chromosome 2.

Results. Both deceased infants were homozygous for the four critical markers. The fetal haploptypes were identical to those of the siblings and the pregnancy was terminated. The iron content of the fetal liver was increased (5000 µg/g) compared with the controls, with a marked iron accumulation in the Kupffer cells.

Conclusions. Antenatal diagnosis can be performed based on linkage analysis in families with at least one affected child because the disease locus has been assigned to a restricted chromosomal region. Typical histological abnormalities may be present in early fetal life.
Women's expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content
Authors: Hildingsson Ingegerd , Waldenström Ulla , Rådestad Ingela
Published: March 2003

Background. Antenatal care has undergone continuous development over the past decades, but little is known about women's views and expectations. The objective of this study was to explore women's expectations on antenatal care, preferences regarding number of visits and attitudes to continuity of midwife caregiver in a national sample of Swedish‐speaking women.

Methods. All Swedish‐speaking women booked for antenatal care during 3 weeks spread over 1 year (1999–2000) were invited to participate in the study. A questionnaire was mailed shortly after the first visit.

Results. Three thousand and sixty‐one women completed the questionnaire, corresponding to 91% of women who consented to participate after exclusion of reported miscarriages. Checking the baby's health was the most important aspect of antenatal care, followed by checking the mother's health and making the partner feel involved. Seventy per cent preferred to follow the standard schedule of antenatal visits, 23% preferred more and 7% fewer visits. In primiparas, age < 25 years, a previous miscarriage and assisted conception were associated with a wish for more visits; in multiparas, previous miscarriage, previous stillbirth and a previous negative birth experience. A wish for fewer antenatal visit was associated with age over 35 years and unfortunate timing of pregnancy among primiparas, and with having more than two children and unfortunate timing of pregnancy in multiparas. Most women (97%) saw continuity of midwife caregiver during pregnancy as important.

Conclusion. Women had high expectations of antenatal care in terms of possibilities of preventing fetal morbidity, a result that may reflect worries about the baby's health rather than a realistic assessment of the potential of antenatal care procedures. One‐third of the women wanted more or fewer visits than the standard schedule, and special attention should be paid to women with a previous stillbirth, miscarriage or a negative birth experience. The Swedish system with continuity of midwife carer during pregnancy was much appreciated.
Fast track vaginal surgery
Authors: Ottesen Marianne , Sørensen Mette , Rasmussen Yvonne , Smidt‐Jensen Steen , Kehlet Henrik , Ottesen Bent
Published: March 2003

Objective. Our aim was to describe the need for postoperative hospitalization after vaginal surgery for utero‐vaginal prolapse with well‐defined charts for postoperative care.

Design. A prospective, descriptive study. Consecutive women admitted for first‐time vaginal surgery for utero‐vaginal prolapse at a public university hospital in Copenhagen, Denmark, underwent surgery and postoperative care in a fast track setting from September 15, 1999 to June 15 2000.

Methods. A multimodal rehabilitation model with emphasis on information, standardized general anesthesia, reduced surgical distress, optimized pain‐relief, early oral nutrition and ambulation, minimal use of indwelling catheter and vaginal packing.

Outcome measures.  Postoperative hospital stay, complications, re‐admission, success rate, patients' satisfaction and acceptability.

Results. Forty‐one women with a median age of 69 years (range, 44–88 years) were included. All underwent anterior and/or posterior vaginal repair. Nineteen (46.3%) underwent vaginal hysterectomy, and eight (19.5%) underwent the Manchester procedure. Postoperative hospital stay was median 24 hr. Only three (7.3%) were discharged later than 48 hr. No re‐admissions occurred. The most frequent complications were urinary retention exceeding 450 ml, and urinary tract infection (12.2%, and 9.8%, respectively). Short‐term success rate was 97.6%. Patients' satisfaction rates were 85.4–95.1%. The median score of acceptability was 10 on a 0–10 points scale.

Conclusion. The need for postoperative hospitalization was median 24 hr after vaginal surgery in a fast track setting, independently of the complexity of the procedure performed. Short‐term success rate, satisfaction rates, and acceptability were all excellent. Follow up has been established to evaluate long‐term success rates and recurrence.
The levels of five markers of hemostasis and endothelial status at different stages of normotensive pregnancy
Authors: Hayashi Masatoshi , Inoue Teruo , Hoshimoto Kazunori , Hirabayashi Hideo , Negishi Hideaki , Ohkura Takeyoshi
Published: March 2003

Background.  Urinary 11‐dehydrothromboxane B2/creatinine (11‐DTXB2/Cr) is a marker for in vivo platelet activation and vascular constriction, blood thrombomodulin (TM) for endothelial damage and associated thrombosis, thrombin–antithrombin complex (TAT) for thrombin formation, and β‐thromboglobulin (β‐TG) and platelet factor 4 (PF‐4) for in vivo platelet activation and releasing reaction. Little is known about the quantitative relationship among them during pregnancy. The present study investigated levels of five markers at different stages of normotensive pregnancy.

Methods.  Subjects were 17 healthy non‐pregnant women (Group 1, control) and 67 women carrying single fetuses in normotensive pregnancy. Of the pregnant women, 17 were in the 20th week of gestation (Group 2), 20 were in their 30th week (Group 3), and 30 were in their 36th week (Group 4). Urinary and circulating blood levels of 11‐DTXB2/Cr, TM, TAT, β‐TG, and PF‐4 were measured simultaneously.

Results.  The 11‐DTXB2/Cr and TAT levels showed elevated values at the 20th and 30th weeks of gestation, and markedly elevated values at the 36th week, whereas the TM level remained constant throughout pregnancy. The β‐TG and PF‐4 levels maintained stable values at the 20th week, but showed elevated values at the 30th and 36th weeks.

Conclusions.  Platelet aggregation, vascular constriction, and thrombin formation (detected by 11‐DTXB2/Cr and TAT) appear to be enhanced as early as the 20th week of gestation, continuously enhanced by the 30th week, and markedly enhanced by the 36th week. Platelet activation and releasing reaction (determined by β‐TG and PF‐4) gradually enhanced from the 30th to 36th weeks. In contrast, endothelial damage and associated thrombosis (detected by TM) were minimal throughout pregnancy. Investigating these markers of hemostasis and endothelial function in normotensive pregnancy may provide insights into related disease states.
Symptomatic venous thromboembolism in Chinese patients after gynecologic surgery: incidence and disease pattern
Authors: Chan Louis Yik Si , Yuen Pong Mo , Lo Wing Kit , Lau Tze Kin
Published: March 2003

Background.  Venous thromboembolism is a common cause of postoperative morbidity and mortality in Caucasian populations, but it is widely believed that this complication is rare in Chinese.

Methods.  We conducted a retrospective study from January 1998 to December 2000. Women with thromboembolic diseases after gynecologic surgery were identified and their medical records were reviewed.

Results.  During the study period, thirty‐one women were diagnosed as having thromboembolic disease after gynecologic surgery. Over the study period, the total number of operations was 6077, giving an incidence of 5.10/1000 operations. There were two cases of pulmonary embolism and the others had deep vein thrombosis of which 90% were limited to calf veins only. The incidences were significantly higher in 1999 and 2000 (7.59 and 6.85/1000 operations, respectively) than that in 1998 (1.7/1000 operations) (P = 0.015), after a case of maternal death due to pulmonary embolism in early 1999. Most cases of thromboembolism were diagnosed after major surgery for malignancy (n = 14) or benign conditions (n = 12). In the remaining cases, three had evacuation of the uterus for retained products of conception and two had laparoscopy for suspected ectopic pregnancies.

Conclusions.  Thromboembolic disease is not uncommon among Chinese women after gynecologic surgery. The incidence is similar to that of the Caucasian population, although the sites of vascular occlusion were different. The long belief that thromboembolism is rare among Chinese is at least partly due to under‐diagnosis.
C‐reactive protein: a serological marker for preterm delivery?
Authors: Hvilsom Gitte B. , Thorsen Poul , Jeune Bernard , Bakketeig Leiv S.
Published: March 2003

Background.  We studied the association between the C‐reactive protein level in the maternal serum early in the second trimester with that in preterm delivery.

Methods.  The present study is a prospective nested case‐control study including 84 singleton, preterm deliveries (cases) and 400 singleton, term deliveries (controls), based at the Odense University Hospital, Denmark. These cases were identified from a cohort of 2846 women, monitored from their first prenatal care visit until their delivery. All the participants were examined at enrollment (median 16.3 weeks of gestation). Conventional statistical methods were used for analyses.

Results.  We found statistically significant differences in the C‐reactive protein levels measured in early pregnancy between the women delivering preterm and those delivering at term. Different statistically significant odds ratios of between 1.7 and 2.0 were calculated, depending on the C‐reactive protein level's cut‐off value, and ranged from 5.6 mg/l (75th percentile) to 16.4 mg/l (95th percentile). The highest level was achieved at the 85th percentile (7.6 mg/l); odds ratio 2.0 (95%CI, 1.2–3.5).

Conclusion.  A high C‐reactive protein level at the beginning of a pregnancy is associated with a nearly twofold increased risk of preterm delivery; however, the clinical value at this point is still limited.
Maternal height, birthweight and cephalo pelvic disproportion in urban Nigeria and rural Malawi
Authors: Brabin Loretta , Verhoeff Francine , Brabin Bernard J.
Published: March 2003

Background. Cephalo pelvic disproportion (CPD) has been attributed to short stature. It has been suggested that nutritional supplementation to promote linear growth would increase birthweight and the risk of CPD. The objective of this study was to examine the factors associated with CPD, with particular reference to birthweight, stature, parity and maternal age.

Design. Factors associated with CPD were analyzed using data abstracted from a detailed early hospital report from Ibadan, Nigeria and from a recent rural pregnancy study conducted in the Shire Valley, Malawi.

Results. In Nigeria, of 107 CPD cases admitted to hospital in Ibadan during 1953–54, 79% were women > 20 years. Birthweight values increased significantly with age and parity. In 19.6% of cases, the baby had a low birthweight (< 2500 g). In Malawi, among the 1523 women delivering, the incidence of CPD was 2.3%. Of the 35 cases of CPD, only four were adolescents. Birthweights increased with increasing parity, age and height (p < 0.001). In 6.4% of CPD cases, the baby had a low birthweight. Nulliparity (OR 4.0; CI 1.7–9.3; p = 0.0001), birthweight ≥ 3400 g (OR 4.6; CI 2.1–10.0; p = 0.0001) and height ≤ 154 cm (OR 3.8; CI 1.8–7.9; p = 0.0003) were associated with an increased risk of CPD. Adolescent mothers were less likely to experience CPD (OR 0.3; C.I. 0.8–0.9; p = 0.03).

Conclusions. Adolescents are not at high risk of CPD. Nutritional supplementation of girls and adolescents should not be discouraged for fear of increasing the risk of CPD by improving birthweight. When CPD is present, it may result from childhood rickets and calcium deficiency.
Longitudinal study of menopause and sexuality
Authors: McCoy Norma L.
Published: March 2003

Longitudinal study of the menopause and sexuality involves many problems that may account for the small number of such studies. In seeking subjects, the mention of sexuality is best delayed until the initial interview when subjects can be informed of the strict confidentiality of the data and be assured that having a sex partner is not a requirement for participation. It is best if subjects are required to be early perimenopausal with regular menstrual cycles but with a change in cycle length and/or flow. Important demographic variables of interest are ethnicity, education, socioeconomic status, health, and partner status. Subjects who have had reproductive surgery or use medications likely to affect sexuality are properly excluded from study or studied as a separate group. Measures include daily calendars for prospective recording of menstruation and sexual behavior as well as repeated questionnaires assessing menopausal symptoms and sexuality; questionnaires should be designed to obtain data concerning sexual interest, sexual attractiveness, and sexual response. It is desirable to measure sex hormone levels at regular intervals if possible. Technological advances have added new and better methods of data collection and have increased the chance of getting accurate prospective data. Nonetheless a good relationship with the investigator is important in obtaining subject co‐operation and avoiding attrition. Future studies need to attempt to collect data from sex partners of subjects as well as explore the effects of different sex hormone products and regimens on sexual attractiveness, sexual interest, and sexual response.
Consequenses for HRT following the HERS II and WHI reports: The primum non nocere is important, but translation into quo vadis is even more essential
Authors: Skouby Sven O.
Published: March 2003

In the Nordic countries the prevalence of hormonal replacement therapy (HRT) use in women from 50 to 70 years of age is slightly above 30% evaluated by sales figures and with some variation between the five countries.

The premise for this commentary is to discuss the best clinical practice when prescribing HRT to post menopausal women following the publication of the most recent evidence from two well conducted randomized placebo controlled trials, namely the Heart and Estrogen/Progestin Replacement Study II (HERS II) and the Women's Health Initiative study (WHI ).
Predictive power of clomiphene citrate challenge test for failure of in vitro fertilization treatment
Authors: Csemiczky György , Harlin Jonas , Fried Gabriel
Published: March 2003

Background.  To evaluate the impact of ovarian reserve on the outcome of in vitro fertilization (IVF) treatment in 140 women, in a total of 279 treatment cycles.

Methods.  All women underwent a clomiphene citrate (CC) challenge test to assess their ovarian reserve before IVF treatment. One hundred and eighteen women (84%) had normal basal follicle stimulating hormone (FSH) levels (3.1–10.0 IU/l) and 22 women (16%) had elevated FSH levels (> 10.0–24.0 IU/l). The FSH levels measured on cycle day 10 showed that 106 (76%) of the women could be regarded as having a normal ovarian reserve and 34 (24%) a diminished ovarian reserve.

Results.  In the group with diminished ovarian reserve, pregnancies and live births were dramatically lower than in the group with normal ovarian reserve. Counting only the first cycle (n = 140), the number of ongoing pregnancies and live birth rate were highly different between the two groups: 3% vs. 36% (1/33 vs. 28/78). Counting all treatment cycles (n = 210 + 69) the clinical pregnancy rate in the diminished ovarian reserve group was 6%–31% compared with the normal woman (4/69 compared 65/210). The number of started treatment cycles per woman were similar in the two groups. The length of the ovarian stimulations were slightly longer in the group with elevated FSH compared with the group with normal FSH levels. The number of cancellations resulting from insufficient ovarian response was significantly higher in the group with diminished ovarian reserve (n = 38, 55%) compared with the normal women (n = 32, 15%) (p < 0.0001). In addition, the average E2 levels before oocyte pick up were significantly lower in the group of women with diminished ovarian reserve compared with normal women (p < 0.0001). Calculation of the sensitivity and specificity of the CC test showed that an abnormal test has a high probability for a negative treatment outcome. The number of retrieved, fertilized oocytes, the number of divided oocytes, and the number of embryo transfers in the first as well as in all cycles differed significantly between the two of groups women (p < 0.001–0.009).

Conclusions.  We found that the CC challenge test is a useful tool in assessing a woman's ovarian capacity before infertility treatment. The predictive value of the test for a negative outcome of IVF treatment was strong. We recommend performing the test before infertility treatment. This may prevent unnecessary treatment trials and unrealistic expectations from both patients and doctors.
Frequency of denial of pregnancy: results and epidemiological significance of a 1‐year prospective study in Berlin
Authors: Wessel Jens , Endrikat Jan , Buscher Ulrich
Published: March 2003

Background.  There has been an increasing number of reports on denial of pregnancy. However, only very few studies have involved a large number of patients. To date, no reliable calculation of this condition's general frequency, also from an epidemiological perspective, has been available.

Methods.  A prospective case sampling was performed between 1 July 1995 and 30 June 1996 in the metropolitan area of Berlin. All institutions in which deliveries have taken place were engaged. The lower limit for inclusion was the 20th week of gestation as the first physician's earliest diagnosis of pregnancy. Furthermore, the woman herself must not have had any subjective perception.

Results.  Recruited women were divided into three groups. Altogether 62 cases and 29 462 deliveries within the 1‐year study period were valid for the frequency calculation, leading to a ratio of 1 : 475 (all cases) and of 1 : 2455 for totally unexpected births with a viable newborn (intrapartal diagnosis of the pregnancy).

Conclusions.  This first prospective, population‐based study has also certain epidemiological relevance. From projecting the ratio of 1 : 475 for all of Germany, approximately 1600 cases of denied pregnancies per year are diagnosed, at the earliest, from the 20th week of gestation. Totally unexpected deliveries of a viable fetus without any presumption of being pregnant with 300 projected yearly births would occur threefold more often than triplets. Occurrence of denied pregnancy seems yet to be similar across different socio‐demographic conditions. The common view that denied pregnancies are exotic and rare events is no longer valid. More studies of similar design are needed.
Cytogenetic studies in patients with reproductive failure
Authors: Düzcan Füsun , Atmaca Münevver , ÇEtin G. Ozan , Baǧci Hüseyin
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 53–56. © Acta Obstet Gynecol Scand 2003

Background. Cytogenetic studies in patients with reproductive failure

Aim.  To investigate the contribution of chromosomal abnormalities in sub fertility and in couples with repeated abortions.

Methods. Hundred and 13 couples who had at least two or more spontaneous abortions and 65 women and 63 men with infertility were analyzed cytogenetically.

Results. Major chromosomal rearrangements were found in 8% and minor variants in 6% in the study population. Major chromosomal aberrations were judged to explain 4.9% of recurrent abortions and 13% of infertility. Chromosomal abnormalities in infertile men occurred in 5% and in infertile women in 21.5%. The chromosomal abnormalities were structural (57%), numerical (18%) or mosaics (25%).

Conclusions. Chromosomal aberrations in recurrent abortions are mostly structural ones and those in female infertility mosaicism of sex chromosomes. Turner's syndrome, Turner variants and XY females are detected as a cause of female infertility. The structural and numerical aberrations of either sex or autosomal chromosomes were found in infertile men.
Endometrial ablation with NovaSure™ GEA, a pilot study
Authors: Busund Bjorn , Erno Lars Espen , Grønmark Anne , Istre Olav
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 65–68. © Acta Obstet Gynecol Scand 2003

Objective. A prospective, single‐arm, multicenter, controlled, observational pilot study to assess the safety and efficacy of the NovaSure™ Global Endometrial Ablation (NovaSure™ GEA) system in women with severe menorrhagia secondary to dysfunctional uterine bleeding (DUB).

Setting. University tertiary referring center and central hospital.

Patients. Forty‐six premenopausal women aged 41.3 years with menorrhagia secondary to DUB unresponsive to medical therapy, who had completed childbearing, with non‐distorted uterine cavities were included in the study.

Methods. Bleeding score was recorded before, 6 and 12 months after treatment. All patients received the treatment under intravenous sedation with para‐cervical block and were treated with Nova Sure endometrial ablation for mean 94 s at the day surgery unit.

Results. No serious intraoperative complications were observed. Treatment time averaged 94 s. Forty‐six patients have completed 6‐months of follow‐up and 45 patients completed the 12‐months follow‐up. 50% of the patients were amenorrheic at 6 months follow‐up and 58% had complete cessation of uterine bleeding (amenorrhea) at 12 months follow‐up.

Conclusions. Preliminary results indicates that the NovaSure GEA System is an effective treatment for DUB, achieving 58% amenorrhea after 12 months.
Retinal detachment after silicone oil removal
Authors: Scholda Christoph , Egger Stefan , Lakits Adalbert , Walch Katharina , Von Eckardstein Eva , Biowski Robert
Published: March 2003

Purpose: To evaluate the causes of retinal detachment after silicone oil removal, to define possible risk factors and the anatomical and functional prognosis of this complication.

Methods: 112 eyes that underwent silicone oil removal were included. The group of eyes with retinal detachment after oil removal (18/112 eyes, 16.1%) was compared with the group with no postoperative retinal detachment.

Results: The most common cause for retinal detachment after oil removal was anterior PVR (77.8%). Initial PVR detachment, advanced PVR stages, anterior PVR, more preceding operations, aphakia/pseudophakia, myopia and shorter duration of the oil tamponade were significantly more represented in the group of eyes with retinal detachment after oil removal. The prognosis of retinal detachment after oil removal is poor.

Conclusion: Some criteria could be regarded as risk factors for retinal detachment after silicone oil removal. Improvement of the results should be possible by considering these factors and by control of reproliferations.
Surgical effects of combined trabeculotomy and sinusotomy compared to trabeculotomy alone
Authors: Mizoguchi Takanori , Nagata Makoto , Matsumura Miyo , Kuroda Shin‐ichirou , Terauchi Hiroo , Tanihara Hidenobu
Published: March 2003

Purpose: To elucidate long‐term surgical results and problems of combined trabeculotomy and sinusotomy in comparison with trabeculotomy alone.

Methods: The study included 91 glaucomatous eyes in 57 patients with primary open angle glaucoma, who underwent either combined trabeculotomy and sinusotomy (40 eyes) or trabeculotomy alone (51 eyes). The mean follow‐up period (±standard deviation) was 46.1±10.4 months (range: 30 to 60 months).

Results: At the final examination, in 37 (93%) of the 40 eyes after combined trabeculotomy and sinusotomy and in 40 (78%) of the 51 eyes after trabeculotomy alone, intraocular pressures were well controlled. The mean intraocular pressures at the end of the first postoperative year were 15.6±3.0 mmHg in the 40 eyes after the combined procedure, and 17.8±3.1 mmHg in the 51 eyes after trabeculotomy alone (p=0.0001, unpaired t‐test). Complications included Descemet's membrane detachment in 1 eye (3%) and 4 eyes (8%), and transient elevation of intraocular pressure to higher than 30 mmHg (IOP spike) in 6 eyes (15%) and 11 eyes (22%), respectively, after the combined procedure and trabeculotomy alone.

Conclusion: Combined trabeculotomy and sinusotomy is a useful surgical modality for the treatment of primary open angle glaucoma to obtain lower intraocular pressure levels than those after trabeculotomy alone.
Peribulbar anesthesia and sub‐Tenon injection for vitreoretinal surgery: 300 cases
Authors: Calenda Emile , Olle Priscille , Muraine Marc , Brasseur Gérard
Published: March 2003

Background and objectives: We carried out a prospective study in order to evaluate the efficacy and safety of peribulbar anaesthesia supplemented by a sub‐Tenon injection in case of inadequate analgesia during vitreoretinal surgery.

Methods: We performed 300 consecutive vitreoretinal procedures. Patients received a mean volume of 17±4.5 ml of a mixture of etidocaine 1%, bupivacaine 0.50% and hyaluronidase (25 UI/ml).

Supplementation was represented by a sub‐Tenon infiltration of lidocaine 2% (2 or 3 ml). This volume was not included in the mean volume.

Results: Analgesia was adequate throughout surgery without any supplementation in 85% of cases and with a sub‐Tenon infiltration in 99%. Akinesia was complete in 82%, mild in 15% and absent in 3% of cases. The sub‐Tenon injection was performed immediately before starting the procedure in 58% of cases and during the surgery with a delay of 80±21 min in 42%. Eleven patients (3.66%) were agitated during surgery and two of them needed a general anaesthesia to allow for the procedure. Generalised epilepsy was encountered in two patients (0.66%) immediately after the peribulbar injection in one patient and 15 min later in the other. The systolic blood pressure severely decreased between 60 to 70 mm Hg 40 min after the accomplishment of the peribulbar in 2 patients and at 90 min in 2 others.

Conclusion: Our results demonstrate that peribulbar anaesthesia alone offers excellent analgesia in 85% of patients and supplemented by a sub‐Tenon injection in 99%.