bluuebunny/crossref_metadata_2025 huggingface dataset:
Erythromycin versus metronidazole in the treatment of bacterial vaginosis
Authors: Wathne Bjarne , Holst Elisabeth , Hovelius Birgitta , Mårdh Per‐Anders
Published: November 2007

Of 101 women, 15–50 years of age, presenting with vaginal discharge, 34 had bacterial vaginosis and were randomly assigned to a seven‐day course of oral treatment with either erythromycin (0.5 g b.i.d.) or metronidazole (0.4 g b.i.d.) in a single‐blind, cross‐over study. Treatment failure (≥ three clinical signs of bacterial vaginosis) occurred in 13 (81%) of 16 patients given erythromycin, as compared with three (17%) of 18 women treated with metronidazole (p< 0.001). Persistence of Gardnerella vaginalis, Mobiluncus species and/or Mycoplasma hominis was found in 14 of 16 patients treated with erythromycin, and in four of 16 patients treated with metronidazole. Treatment with metronidazole was successful (≤ two clinical signs of bacterial vaginosis) in eight of 10 cases of erythromycin treatment failure. Neither of two cases of metronidazole treatment failure was cured with erythromycin. At three‐month follow‐up of 31 women, persistence or recurrence of bacterial vaginosis was diagnosed in 11 cases (36%).
Gynecological problems of mentally retarded women
Authors: Huovinen Kari J. L.
Published: November 2007

Two hundred and fifty‐five mentally retarded women (cases) and their age‐matched control women with no mental retardation (controls) requiring the assistance of a gynecological consultant were studied. Reasons for consultation, heights, weights, blood pressures, smoking histories, medications, gynecological findings and therapeutic measures recommended after examination were recorded. In comparison to the group of non‐mentally retarded control women the group of mentally retarded women had no deliveries at all, the number of pregnancies was 118.3 times less (p< 0.001), abortion 20 times less (P< 0.01), gynecological laparotomies 4.3 times less (p < 0.05) and diagnostic curettages 25.7 times less often (p < 0.001), but the number of lynestrenol induced therapeutic amenorrhea (TA) 123 times more (P< 0.001), anticonvulsive drug therapy 91 times more (P<0.001), polypharmacy 22 times more (P<0.01) and virginal gynecological status 11.7 times more often (P<0.001). Further, among the mentally retarded cases than non‐mentally retarded controls, contraception was 58 times less (p<0.05), not smoking 1.2 times (p<0.001), the incidence of genital infections 2.9 times and tumors of all kind 4.6 times less common (p<0.001). Of the present mentally retarded women 67.5% had at least once in their life received lynestrenol for TA. Autopsy confirmed arterial diseases occurred in two out of four mentally retarded patients aged 44 and 45 years, who were current lynestrenol users and died during the study period. Therapeutic amenorrhea exhibited a clinical picture of depressed pituitary gonadal axis.
Synchronous intrauterine and tubal pregnancies with subchorionic hematoma
Authors: Gemer Ofer , Zohav Efraim , Calman Dan , Sassoon Essi , Segal Shmuel
Published: November 2007

A case of a heterotopic pregnancy is presented. Clinical manifestations included vaginal bleeding, and on ultrasonography a subchorionic hematoma was demonstrated. The subchorionic hematoma may be regarded as blood draining from the tubal pregnancy through the uterus.
Malaria in pregnancy
Authors: Prien‐Larsen Jens C. , Stjernquist Martin
Published: November 2007

One case of malaria in pregnancy at 23 weeks of gestation in a woman returning from Ghana is presented. The patient complained of diarrhea and abdominal pain and was admitted to the department of Gynecology and Obstetrics. Under suspicion of appendicitis an exploratory laparotomy was performed. Diagnosis was missed and treatment delayed five days. Outcome was favorable for both woman and fetus.
Management of vulvar carcinoma radiation toxicity, results and failure analysis in 44 patients (1980–1989)
Authors: Snijders‐Keilholz Tonny , Trimbos J. Baptist , Hermans Jo , Leer Jan Willem H.
Published: November 2007

A retrospective analysis was performed on 44 patients with squamous carcinoma of the vulva (1980–1989). Patients were divided into two subgroups. group I (n = 39) treated with curative intent with surgery alone or with surgery combined with radiotherapy and group II (n = 5) treated with palliative intent with irradiation alone. The five‐year cancer‐specific survival rate for group I was 65%. Although this is a group of elderly patients. it was concluded that curative therapy should he aggressive and concessions which lead to suboptimal treatment should be avoided. It is essential to achieve free surgical margins. If it is decided to irradiate, no concessions should he made with respect to dose or overall treatment time. Poor results were obtained in the group treated with palliative intent with a six week treatment scheme of live fractions/wk. All irradiated patients suffered from moist desquamation as acute side‐effect. Serious late side‐effects did not occur.
Endometrioid carcinoma arising from endometriosis of the sigmoid colon during estrogenic treatment
Authors: Duun S. , Roed‐Petersen K. , Michelsen J. Wllk
Published: November 2007

A case ofendomctrioid carcinoma arising from endometriosis of the sigmoid colon is reported. The patient had been treated with unopposed continuous estrogen injection for twenty years after bilatcral salpingooophorectomy because of severe endometriosis. The pathology. pertinent literature and implications of the present case are discussed.
Laparoscopic tubal anastomosis: reversal of sterilization
Authors: Istre Olav , Olsboe Frode , Trolle Birgitta
Published: November 2007

A case of laparoscopic reversal of tubal sterilization is reported. The patient was a 38 year old woman sterilized by bipolar diathermia two years earlier. Refertilization was performed by laparoscopic end to end anastomosis of one tube. Postoperatively. the patient had one menstruation and then achieved an intrauterine pregnancy. The laparoscopic method of refertilization saves expensive hospitalization costs.
Low dose iron supplementation does not cover the need for iron during pregnancy
Authors: Thomsen Jösrn Kvist , Prien‐Larsen Jens Christian , Devantier Agnete , Fogh‐Andersen Niels
Published: November 2007

Objective ‐ To determine: 1) if 18 mg iron daily is sufficient to cover the iron need during normal pregnancy, and 2) if women, who will not need iron supplementation during pregnancy, can be identified by early screening.

Design ‐ In a prospective study the women were randomized to receive either 18 or 100 mg iron daily from the 16th week until delivery. Investigations were performed in the 16th, 30th, and 38th week.

Subjects ‐ Healthy nulliparae (n = 43) experiencing a normal singleton pregnancy. Only women with a normal hemoglobin concentration and intact iron stores (S‐Ferritin 15 ug/ I) in the 16th week were included.

Variables ‐ These measurements were done consecutively: 1) the total hemoglobin mass (with carbon monoxide), 2) S‐Ferritin, 3) S‐Transferrin, 4) S‐Iron, 5) red cell indices (hemoglobin concentration, hematocrit, MCV, MCHC).

Results ‐ Changes in red cell indices and S‐Transferrin were equal in the two groups. There was no significant difference in S‐Ferritin in the 16th week. In the 30th week 3 women (14%) in the 100 mg group and 11 (52%) in the 18 mg group had empty iron stores (p<0.05). The numbers were 1 (5%) and 15 (72%) in the 38th week (p< 0.0001). The increment in total hemoglobin mass was equal in the two groups from the 16th to the 30th week (13% in the 100 mg group and 12% in the 18 mg group). From the 30th to the 38th week the increment in total hemoglobin mass was largest in the 100 mg group (8.1% versus 2.7%, p<0.05). Conclusion ‐ Despite a normal hemoglobin concentration and intact iron stores in the 16th week, an iron supplementation of 18 mg daily is not sufficient to cover the iron need in many pregnant women in the 3rd trimester.
A longitudinal follow‐up of bacterial vaginosis during pregnancy
Authors: Platz‐Christensen Jens Jørgen , Pernevi Peter , Hagmar Björn , Andersson Eira , Brandberg Åke , Wiqvist Nils
Published: November 2007

Bacterial vaginosis (BV) has been considered by many investigators to be a risk factor for preterm labor. We have followed vaginal pH and the persistence of clue cells in Papanicolaou stained smears in 119 pregnant women during the course of pregnancy. Of 19 patients with clue cells in their smears during the first trimester, 11 (58%) still had clue cells at the second visit during the third trimester. Of the 100 patients without clue cells during their first trimester, none exhibited clue cells during the third trimester. If the persistence of clue cells is truly a risk factor for adverse pregnancy outcome, screening in the first trimester would identify a risk group of 15%. This risk group diminishes to 9% at the time of the third trimester. Vaginal pH >4.5 had a recovery sensitivity of 76% and specificity of 83%. If clue cells can be considered as the identifying standard for bacterial vaginosis, the sensitivity and specificity of pH is 89% and 94%, respectively. The establishment of the diagnosis of BV during pregnancy and, in some cases, the treatment of the condition may be important as routine procedures in the antenatal center.
Atrial natriuretic peptide (ANP) decrease during normal pregnancy as related to hemodynamic changes and volume regulation
Authors: Thomsen JØrn Kvist , Fogh‐Andersen Nlels , Jaszczak Poul , Glese Jørn
Published: November 2007

Background. Volume regulation and hemodynamic functions change during pregnancy, leading to marked increases in blood volume and cardiac output, peripheral vasodilatation and reduced sensitivity to angiotensin. Atrial natriuretic peptide (ANP) is intimately involved in fluid and sodium homeostasis and exerts marked relaxant activity on vascular smooth muscle pre‐contracted with angiotensin. This study was performed to clarify the rôle of ANP as a regulator of maternal physiology.

Methods. 40 normal primigravidae were examined five times during pregnancy plus 12 weeks after delivery. Each time were measured: ANP, aldosterone, renin, blood volume (carbon monoxide), cardiac output (Doppler), blood pressure and sodium excretion. Interdependence of the changes in ANP and in the other parameters was tested using Spearman's rank correlation test on the delta (δ)‐values (the differences between investigations).

Results. P‐ANP in the 20th week was 11.4 (8.5−18.9) pmol 1−1 (median, 25 and 75 percentiles), the same as 12 weeks after delivery, 11.5 (9.6−15.2) pmoll−1, and in a non‐pregnant control group, 10.4 (9.0−12.5) pmol l−1 (n = 20). All measurements of P‐ANP during the 3rd trimester were lower than in the 20th week and 12 weeks after delivery,p<0.0001 (Wilcoxon matched‐pairs test). There was a negative correlation between changes in P‐ANP and changes in: a) blood volume, R = −0.69, /?< 0.0001, b) aldosterone, R = −0.58, p<0.0001, c) renin, R= – 0.54, p<0.001, d) cardiac output, R= – 0.61, P<0.0001. There was a positive correlation between changes in P‐ANP and changes in: a) fractional excretion of sodium, R = 0.54, p< 0.0001, and b) total peripheral resistance, R = 0.52, p<0.0001.

Conclusion. Decrease in p‐ANP is one of the mechanisms whereby blood volume is increased and maintained during pregnancy. The competitive relationship between ANP and the renin‐aldosterone system in regulating sodium balance and fluid volume is preserved during pregnancy. The results substantiate the physiological importance of ANP as a regulator of blood volume. ANP does not function as a vasodilatator during pregnancy.
The amnion produces little of the prostaglandin e2 detected on the decidual side of human fetal membranes
Authors: Sullivan M. H. F. , Kent A. S. H. , Lumb M. R. , Roseblade C. K. , Elder M. G.
Published: November 2007

Cultured intact fetal membrane disks initially produced high levels of prostaglandin E2 (PGE2) on the fetal and maternal sides which declined during four days of culture. The transfer of a bolus of PGE2 from the fetal side to the maternal side of the membrane ranged from 1% to 3% after 24 hours of culture, and was a minimum over the period of 48–72 hours from the start of the incubation. To assess the handling of PGE2 synthesised by the amnion, 3H‐arachidonic acid was incorporated into cultured amnion and into the amnion side of cultured intact fetal membrane disks. Labelled amnion released 3H‐PGE2 on both sides of the tissue, whereas similarly labelled cultured intact fetal membrane only had detectable levels of 3H‐PGE2 on the fetal side. It was calculated that no more than 9.7 ± 1.4% of the PGE2 synthesised by the amnion crossed to the maternal side of the membrane without being metabolised during the transfer through the membrane. These results are consistent with similar indirect methods which suggested that PGE2 from the amnion may have only a limited role in human labor, and indicates the importance of using appropriate culture systems to investigate intra‐uterine prostaglandin production.
Fertility outcome after treatment of tubal pregnancy by laparoscopic laser surgery
Authors: Langebrekke Anton , Sørnes Torgrim , Urnes Arne
Published: November 2007

In 150 women with tubal pregnancy consecutively treated over a two year period by laparoscopic techniques, 74 were treated conservatively by linear salpingotomy with carbon dioxide laser laparoscopy and 76 cases non‐conservatively through the laparoscope by salpingectomy. Between 15 and 37 months later all patients were contacted by means of questionnaires to evaluate subsequent fertility outcome. Sixty‐six percent (38/58) of those women who desired pregnancy after conservative laparoscopic treatment achieved an intrauterine pregnancy. The corresponding rate for women who desired pregnancy after salpingectomy was 45% (18/40). The recurrent ectopic pregnancy rates in the two groups were 7% (4/58) and 10% (4/40), respectively. This study confirms that tubal pregnancy can be appropriately managed by laparoscopic laser surgery with the advantages of minimal invasive techniques.
Effect of norethisterone and levonorgestrel in low‐dose multiphasic oral contraceptives on serum lipids
Authors: Wiik Pål , Nordby Jan , Paulsen Jan Erik
Published: November 2007

In a parallel, multicenter study in Norway and Finland involving a total of 196 healthy women (mean age 22.4 years, range 18–30), the effects on serum lipids and lipoproteins of two multiphasic oral contraceptives containing ethinyl estradiol (EE) but different progestins were examined. One formulation contained EE 35 μg and norethisterone (NET) 0.5 mg on days 1–7 and days 17–21 and elevated NET 1.0 mg during the midphase (days 8–16). The other formulation contained EE 30 μg on days 1–6 and days 12–21 and 40 μg on days 7–11 and phased levonorgestrel (LGN): 50 μg (days 1–6), 75 μg (days 7–11) and 125 μg (days 12–21). Both formulations induced significant elevation of total cholesterol (6.7 and 4.1%), Apo B (8.1 and 7.0%) as well as HDL (6.4 and 3.7%) for the EE/NET and EE/LGN formulation respectively. Mean serum levels of triglycerides were significantly elevated (58 and 47%). However, all mean serum lipid and lipoprotein values remained within the normal range, and no change in the calculated cholesterol ratio (HDL/total cholesterol) nor lipoprotein ratio (HDL/(HDL+LDL)) was observed. No significant difference between the formulations could be detected with respect to the effect on serum lipids and lipoproteins measured. The change in total cholesterol was smaller than reported in many studies of monophasic preparations. Taken together, these data suggest that only small alterations in lipid metabolism are elicited by these oral contraceptives.
No effect of single dose ofloxacin on postoperative infection rate after first‐trimester abortion
Authors: Nielsen Ingrid Kirstine , Engdahl Erik , Larsen Torben
Published: November 2007

In a double‐blind stratificated, placebo controlled study the efficacy and safety of a single oral dose of ofloxanin (Tarivid) (400 mg) in preventing postabortal pelvic inflammatory disease (P‐PID) in women with induced first‐trimester abortions were assessed. The tablets were given 11/2‐2 h before the abortion, and the women were followed one month after the operation. Group I consisted of 308 with previous PID. Ofloxacin tablets were given to 149 women and 159 women received placebo tablets. In the ofloxacin group 20 women (13.4%) and in the placebo group 27 women (17%) developed P‐PID, a non‐significant difference (p = 0.39). Group II consisted of 765 women without a history of PID. Ofloxacin tablets were given to 376 women and 389 women received placebo tablets. Thirty‐five women (9.3%) in the ofloxacin group and 46 women (11.9%) in the placebo group developed PID, a nonsignificant difference (p = 0.26). A single oral dose of ofloxacin (400 mg) did not reduce the incidence of P‐PID either among women with previous PID or among women without previous PID.
Difficulties in the antenatal assessment of neonatal alloimmune thrombocytopenia
Authors: Marzusch Klaus , Fischer Juergen , Dietl Johannes , Wiest Elfriede , Völklein Karl , Schnaidt Martina
Published: November 2007

In this paper we present a patient with an initially questionable history of neonatal alloimmune thrombocytopenia (NAT) due to materno‐fetal HPA‐la (PLAl) incompatibility. No circulating antibodies were detectable in untreated maternal serum, but an adsorption/elution technique enabled the demonstration of the platelet‐specific anti‐HPA‐la (anti‐PLAl) in maternal serum. Cordocentesis at 35 weeks of gestation revealed a fetal platelet count of 18 × 109/1. Intrauterine platelet transfusion with HPA‐Ia (PLAl)‐negative donor platelets was performed prior to cesarean section.
Evidence for altered transcapillary fluid balance in women with the premenstrual syndrome
Authors: Tollan Anne , Øian Pal , Fadnes Hans O. , Maltau Jan M.
Published: November 2007

Redistribution of body fluids has been suggested us a possible pathophysiological mechanism for the premenstrual syndrome (PMS). To elucidate this hypothesis, transcapillary fluid balance was studied in ten women with well defined PMS. Wick‐methods were used for measuring colloid osmotic and hydrostatic interstitial pressures on the thorax and on the leg. The capillary filtration coefficient was measured by strain gauge plethysmography. From the follicular to the luteal phase the interstitial colloid osmotic pressure on the leg was significantly reduced (mean 3.6 mm Hg, p = 0.005), whereas the interstitial colloid osmotic pressure on the thorax remained constant. The capillary filtration coefficient increased 30% (mean 5.3 × 10−10 ml/min/100 gm/mm Hg, p = 0.04) from the follicular to the luteal phase. No change was observed in body weight. These findings indicate an instability of vascular regulation in women with premenstrual syndrome, and lend support to the hypothesis that redistribution of fluid, rather than water retention, is responsible for the subjective symptoms such as bloatedness, in the premenstrual syndrome.
Vitamin D deficiency amongst Pakistani women in Oslo
Authors: Brunvand Leif , Haug Egil
Published: November 2007

To evaluate the vitamin D status in pregnant Pakistani women living in Oslo, we measured levels of serum calcidiol, calcitriol, vitamin D binding protein (DBP), osteocalcin, free calcium (Ca2+), phosphorous, alkaline phosphatase and intact parathyroid hormone (PTH). Thirty Pakistani and 23 Norwegian women who delivered vaginally after uncomplicated pregnancies were included.

The serum levels of calcidiol were significantly lower in the Pakistani group (p > 0.0001) as compared with the Norwegians, the mean values being 15.1 nmol/1 and 43.1 nmol/1, respectively. PTH levels were above 5.5 pmol/1 in 13 of the Pakistanis, none of the Norwegians. There were no differences in calculated free calcitriol, free calcium and inorganic phosphorus between the groups. Alkaline phosphatase was high, while osteocalcin was low in both groups, but there were no significant differences between the groups.

This study shows that there is a widespread vitamin D deficiency amongst pregnant Pakistani women living in Oslo, indicating the need for vitamin D supplementation to these women and their children.
Factors influencing vaginal cytology, pH and bacterial flora in elderly women
Authors: Milsom Ian , Arvidsson Leif , Ekelund Peter , Molander Ulla , Eriksson Olle
Published: November 2007

Objective. To evaluate factors influencing the vaginal micro‐environment in elderly women. Study design. Vaginal pH, cytology (Karyopyknotic index, KPI) and bacterial cultures were assessed in 350 women (age 72.2 ± 1.4 years, range 65–84 years) who were not taking estrogens. Results. Vaginal pH was 6.5 ± 0.1, KPI was 3.0 ± 0.9% and bacteria of fecal type dominated. However, in some women the vaginal micro‐environment resembled that of fertile women, with a predominance of laclobacilli (n = 68), low pH (n = 41) and an increased maturation index (n = 57). KPI was higher (p > 0.001) in women weighing ≥ 85 kg, or with a body mass ≥ 9th decentile or with a diastolic blood pressure ≥ 100 mmHg and in women (p > 0.05) with a high menopausal age (≥ 53 years). Vaginal pH was lower (p > 0.001), KPI was higher (p > 0.01) and there was an increased (p >0.05) presence of lactobacilli in smokers compared to non‐smokers.

Conclusions. The latter finding is somewhat paradoxical as cigarette smoking has previously been shown to negatively influence estrogen metabolism. The influence of cigarette smoking on the vaginal micro‐environment may be a direct local effect of nicotine.
Hormonal replacement therapy and sexuality in a population of Swedish postmenopausal women
Authors: Lindgren R.
Published: November 2007

All women (n = 2465) living in the community of Linköping, Sweden, aged 55, 57, 59 and 65 years were studied in a cross‐sectional trial concerning the prevalence of vasomotor symptoms, hormonal replacement therapy (HRT) and sexual activities. After one reminder, answers were received from 1867 (76%) women. In all, 51% of the women reported vasomotor symptoms. Ten percent of the women used HRT at the time of the survey. Another 10% of the women had previously used oral HRT but had abandoned treatment. One third of these women reported no vasomotor symptoms when they abandoned treatment. One fifth ceased treatment after recommendation from their physician and another fifth because of ‘fear’ of hormonal treatment.

Sixty‐two percent of the women reported sexual activity. The most common reasons for not having a regular sex‐life were lack of partner or lack of desire.
An ovarian tumor of probable Wolffian origin
Authors: Delaloye Jean‐Francois , Ruzicka Jarmila , de Grandi Pierre
Published: November 2007

The clinico‐pathological features of one rare case of an ovarian tumor of probable Wolffian origin are reported. This tumor arises within the rete ovarii and is predominantly cystic on gross examination. Microscopically these cysts are lined by flattened epithelial cells and are separated by solid areas formed by large tubular glands. It is difficult to recognize this type of tumor on frozen section and to distinguish it from adenocarcinoma of the ovary. Surgery can be limited to total hysterectomy and bilateral salpingo‐oophorectomy. No adjuvant therapy is necessary.
Induced abortion: Effects of marital status, age and parity on choice of pregnancy termination
Authors: Skjeldestad Finn Egil , Borgan Jens‐Kristian , Daltveit Anne Kjersti , Nymoen Erik H.
Published: November 2007

Objective. To study the impact of marital status, age and parity on the decision regarding pregnancy termination over time among pregnant Norwegian women.

Design. National surveillance data of induced abortions and births.

Material. All women terminating their pregnancies (n = 174,590) as registered in the Abortion File in the Central Bureau of Statistics and all women giving birth (n = 639,551) as registered in the Medical Birth Registry of Norway between January 1, 1979 and December 31, 1990 were eligible for the study. Included in the analysis of pregnancy outcome were records with complete information on marital status, age and parity, which comprise 93.8% (n= 163,826) of all women having had an induced abortion and 99.0% (n = 633,542) of all women giving birth during the time period.

Outcome measure. The proportion of pregnancies terminated as induced abortions and the relative risk of pregnant women choosing abortion in strata of marital status, age and parity.

Statistical methods. Trend analysis of the proportion of pregnancies terminated as induced abortions in different time periods in categories of marital status, age and parity.

Results and conclusion. From the first three‐year period 1979‐81 to the last three‐year period 1988‐90 there was a decreasing tendency to choose abortion among unmarried pregnant women above 20 years of age and married women with two or more children. In the other strata of marital status, age and parity there were no changes over the time period, except for married women 20‐24 years of age which was the only group that showed an increasing abortion tendency over the time period.

The prospect of single parenthood was the strongest determinant for choosing abortion independent of age and parity. Within all age groups of married women the abortion tendency increased more with parity than age. Cohabiting women chose abortion significantly more often than married women did. However, the true estimate of choosing abortion among cohabiting women was closer to married women than to single women. In order to find out the importance of other social factors and attitudes in the decision making process regarding pregnancy outcome, adjustments must be made for marital status, age and parity.
Pubertal development in elite juvenile gymnasts: Effects of physical training
Authors: Lindholm Caroline , And Kerstin Hagenfeldt , Ringertz Britt‐Marie
Published: November 2007

Twenty‐two female teenagers engaged in elite gymnast training were prospectively studied during a five‐year period and their pubertal development was recorded. Height and weight, as well as stage of development according to Tanner, were registered every six months. FSH, LH, TSH and prolactin were measured in girls who had not yet had their first menstrual period. Twenty‐two healthy school girls in the same age group who were not actively engaged in physical exercise served as a control group. Pubertal development was completed during the observation period in all the gymnasts but one, who had primary amenorrhea at the age of eighteen. As a group, the gymnasts had a significantly delayed age of menarche compared to the control group and to normal Swedish girls. They also had significantly less body fat and were shorter and lighter than the control group. They grew much more slowly and did not have the distinct growth spurt seen in the controls. The final height of six of the gymnasts was less than the expected height. The frequency of injuries was high in the gymnasts, which might be a result of hard training combined with late menarche and low body fat.
Ehlers‐Danlos syndrome and delivery
Authors: Hordnes Knut
Published: November 2007

Ehlers‐Danlos syndrome (EDS) comprises a group of heritable disorders of connective tissue. The present classification comprises ten or more types, based on a combination of clinical, genetic and biochemical criteria (1). The inheritance is usually autosomal dominant, but rarely recessive and X‐linked recessive cases occur. To some extent, the basic genetic defects involving collagen genes have been identitied (2).
Autonomic cardiovascular control in normal and pre‐eclamptic pregnancy
Authors: Eneroth‐Grimfors Eva , Westgren Magnus , Ericson Mats , Ihrman‐Sandahl Christina , Lindblad Lars Erik
Published: November 2007

Background. Pre‐eclampsia is regarded as a primary placental disorder, in which defect placentation causes endothelial and cardiovascular disturbances. Evidence of disturbed neural cardiovascular control in this condition has been suggested, as well as in other hypertensive diseases. The purpose of the present study was to non‐invasively evaluate the sympatho‐vagal balance during normal and pre‐eclamptic pregnancy.

Methods. In twelve healthy pregnant women, thirteen pre‐eclaniptic women and ten non‐pregnant controls. Heart rate, blood pressure and breathing movements were registered and recorded on B tape recorder for off‐line analysis. Variability in heart rate, blood pressure and breathing movements were computed by an autoregressive spectral analysis algorithm. Heart rate variability was quantitated as the area under the spectral curve, and Student's t‐test was performed on logarithmic values.

Results. Heart rate variability contained two major components in power, a low frequency peak predominantly attributed to sympathetic tone, and a high frequency peak reflecting vagal tone. Women with pre‐eclampsia were characterized by a significantly reduced high frequency peak compared to healthy pregnant (p = 0.03) and non‐pregnant (p = 0.02) women. In the low frequency band there were no significant differences in power between the groups. Blood pressure variability did not differ between the groups.

Conclusion. The present results indicate that pre‐eclampsia is associated with decreased vagal control of the heart. Furthermore, the results indicate that pregnancy per se does not change sympatho‐vagal balance.
Societal costs of antenatal and obstetrical care
Authors: Backe Bjorn , Buhaug Harald
Published: November 2007

Perinatal health care is an important part of a nation's health care system. In the Nordic countries this type of health care is provided by the national public health systems without cost for the women. The societal costs of the care provided have, however. not been known. The aim of the present study was to estimate societal costs of antenatal and obstetrical care in a Norwegian county during a twelve month period 1988‐89. A total of 1908 women delivered during the registration period. The mean total cost was estimated to NOK 36.300 per woman. Primary care antenatal visits accounted for 8%. outpatient visits (inclusive ultrasound screening) 4%, and hospital care in connection with delivery represented 36% of the total cost. The major determinant of societal costs was sick leave during pregnancy, contributing 43% to the total cost. This underlines the importance of the ongoing debate about sick leave in pregnancy. The mean cost of primary care based antenatal care, averaging 10.8 visits per woman. was estimated to NOK 2.800. An important factor was use of patients' own time. accounting for 3% of this amount. The prevalence at the time of admission for delivery of five important complications or obstetrical conditions (pre‐eclampsia. placenta previa, intrauterine growth retardation, twin pregnancy, and breech presentation) was recorded. The mean total societal cost for women with the indicator conditions was approximately one fifth greater than for women without any of the indicator conditions.
Post partum platelet count in maternal blood
Authors: Dahlstrøm Berit L. , Nesheim BrittIngjerd
Published: November 2007

Background. Thrombocytopenia in pregnancy, during and after delivery can be an indicator of seriouh preeclampsia or any condition accompanied by disseminated intravascular coagulation (DIC). In order to recognize thrombocytopenia, it is important to know the expected platelet count in healthy women. Literature search gave no information regarding changes of platelel count in healthy women shortly after uneventful pregnancies and uncomplicated deliveries, either vaginal or cesarean section. The intention of this study was to investigate whether there were any such changes.

Methods. Blood samples were taken on admission to the obstetric ward, first and third day after vaginal delivery (11 patients) or cesarean section (11 patients). Platelet count, hemoglobin coilcentration and hematocrit was measured for each blood sample.

Results. There was no significant change in platelet count after vaginal delivery. Following cesarean section there was a median decrease in platelet count of 12.5′%, the first postoperative day, and a median increase of 5% the third postoperative day.

Conclusions. Platelet count remains unchanged after uncomplicated vaginal delivery. Shortly following normal pregnancy and uncomplicated cesarean section platelets should be expected to decrease slightly.
The incidence of repeat induced abortion a prospective cohort study
Authors: Skjeldestad Finn Egil
Published: November 2007

Background. To measure the cumulative incidence of first and second repeat induced abortion and what differentiates first‐time repeaters from non‐repeaters.

Methods. The study population comprised 2925 women who had their first induced abortion at the University Hospital of Trondheim, Norway between January 1, 1987 and December 31. IOYI. Repeat induced abortion within the study period was measured as a cumulative incidence of second and third induced abortion. Survival analyses and logistic regression analysis were applied using ‘repeater’ as the dependent variable.

Result. The cumulative incidence of second induced abortion was 3.7% at end of first year, 7.1% at end of second year, 9.9% at the end of third year, and 12.3% at four completed years of observation. The cumulative incidence of third induced abortion was 0.1% at the end of first year. 0.6% at the end of second, 1.3%, at the end of third and 2.0% at four years of Observation. The cumulative incidence of the third abortion, measured as the time at risk from the second to the third abortion, remained twice that of the cumulative incidence of the second abortion after one year of observation (p< 0.001). At the first abortion. Variables predicting a risk for repeat induced abortion were age, occupational status and becoming pregnant is a result of a contraceptive failure.

Conclusion. Repeat induced abortion is inevitable. The incidence of repeat induced abortions doubled from the second to the third abortion, indicating that the moral threshold for choosing an abortion after recognition of an unplanned pregnancy is the first induced abortion. More detailed studies on the effect of intensified contraceptive counselling programs after the first abortion are needed.
Genetic origin analysis of hydatidiform mole and non‐molar abortion using the polymerase chain reaction method
Authors: Fujita Noriko , Tamura Shozo , Shimizu Nobuyoshi , Nozawa Shlro
Published: November 2007

Objective. The study attempts to determine the genetic origin of hydatidiform mole and non‐molar abortion using the polymerase chain reaction (PCR) method, and reevaluates this method;IS a possible diagnostic tool for hydatidiform mole.

Material and Methods. A total of 71 cases which consists of 21 complete hydatidiform moles, three partial hydatidiform moles, and 47 non‐molar abortions were investigated. The genetic origin Was analyzed by the PCR method applied to the variable number of tandem repeat regions of the Apolipoprotein B gene. the human type‐II collagen gene. and the probe YNZ22. Chromosomal analysis was also performed.

Results. Genetic origin was determined in 58 out of 71 cases (83.1%). All of the complete hydatidiform moles were androgenic. having only paternal alleles. On the other hand, all the partial hydatidiform moles and non‐molar abortions revealed clear biparental contribution. Besides triploid partial hydatidiform moles, one non‐molar abortion showed two paternal and one Paternal complements.

Conclusion. Our results were compatible with the classical theory of androgenic origin of complete hydatidiform mole; only complete hydatidiform mole is caused by androgenesis. We also found no complete hydatidiform mole of biparental origin. In conclusion, this PCR method brings a new aspect of genetic origin in the diagnosis of trophoblastic disease. It would be interesting to explore how morphologic subgrouping and genetic origin relate to the prognosis of trophoblastic disease.
Prognostic value of steroid hormone receptors concentration in patients with endometrial Carcinoma
Authors: Veôek N. , Nola M. , Maruŝić M. , Luć J. , Babić D. , Petroveĉki M. , Nikolić S. , Marinović T. , Jukić D. , Većek N.
Published: November 2007

The concentrations of progesterone receptors in endometrial tumors of 160 patients were analyzed with respect to survival and presence of clinicopathologic prognostic factors. The concentration of 25 fmol/mg of proteins for progesterone receptors appeared to be most powerful for prediction of survival. The survival was also significantly correlated to age, depth of myometrial invasion and clinical stage of the tumor. Concentration of estrogen receptors could not be correlated with the probability of patients' actuarial survival.
Cervical Pregnancy: Can age and parity be predisposing factors?
Authors: Sönmez A. Suha , Kafkasli Ayslé , Balat Öncan , Saraç Kaya , Uryan Ismail , Turhan Oĉuz , Aydin N. Engin
Published: November 2007

A fifty‐year old woman, gravida 17, para 17. presented with profuse vaginal bleeding following curettage in another hospital. At emergency laparotomy total abdominal hysterectomy and bilateral sallpingooopherectomy was performed because of intractable hemorrhage. Histopathologic examination revealed endocervical placentation and adenomyosis uteri. The case is presented due to its rarity and possible predisposing factors are discussed.
Methotrexate in management of advanced ectopic pregnancy complicated by ovarian hyperstimulation syndrome
Authors: Donderwinkel Peter F. J. , Van der Meer Siepie , Dörr Joep P. J.
Published: November 2007

A case of advanced ectopic pregnancy after in vitro fertilization complicated by an ovarian hyperstimulation syndrome is presented. Methotrexate was given in spite of high levels of hCG and appeared to be successful. Difficulties in the choice between surgical and conservative treatment are discussed.
Laparoscopic removal of ovarian cysts using a zipper storage bag
Authors: Mo Yuen Pong , Rogers Michael S.
Published: November 2007

Laparoscopic surgery has become increasingly popular in the management of pelvic masses. A major problem during laparoscopic surgery is removal of the specimen. The advantages of the bag retrieval technique using commercially available retrieval bag has been described. However, the size of the bags available is limited and they are relatively expensive. We describe the use of a zipper storage bag for the removal of ovarian cysts in 11 patients undergoing operative laparoscopy without spillage of the cyst contents, the need for abdominal wound extension or to perform a culdotomy. The operating time is reduced, compared to ‘purpose designed’ bag retrieval systems. This technique is safe, easy to perform and cost‐effective.
Cervical fetal fibronectin correlates to cervical ripening
Authors: Ekman Gunvor , Granström Lena , Malmström Anders , Sennström Maria , Svensson Jan
Published: November 2007

Aim of study. It is well established that the cervical ripeness is of great prognostic value at labor induction. The available methods of measuring the cervical ripeness are not satisfactory. This study was therefore initiated to investigate if there is any correlation between cervical fetal fibronectin and cervical ripening at term.

Method. Three groups were included in this study: women with unripe cervices, women with spontaneous cervical ripening and those with PGE2‐induced cervical ripening. Fetal fibronectin was measured by ELIZA after sampling from the cervical canal.

Results. The cervical fetal fibronectin was low in women with unripe cervices. In women with favorable cervices a ten fold higher level was found. The fibronectin level was even higher after PGE2‐induced ripening.

Conclusion. Conclusively an increased amount of cervical fetal fibronectin is registered during the cervical ripening process. A level of > 0.80 μg/ml of cervical fetal fibronectin seems to indicate a favorable cervix.
Simulated intraperitoneal absorption of irrigating fluid
Authors: Olsson Joel , Hahn Robert G.
Published: November 2007

Background. Intraperitoneal absorption of electrolyte‐free irrigating fluid may occur secondary to uterine perforation during endometrial resection, but the clinical course of this complication is known from only a few case reports.

Methods. We studied symptoms, biochemical changes and the kinetics of solute equilibration over the peritoneal membrane in 10 healthy awake women who were subjected to an experimental absorption situation by receiving an intraperitoneal infusion of 25 ml/kg of a solution containing glycine 1.5% and ethanol 1% over 20 min. We also compared the use of breath ethanol and serum sodium samples to indicate the presence of irrigating fluid in the peritoneal cavity.

Results. All infusions caused lower abdominal pain. The solute gradients between the peritoneal pool and plasma were reduced according to mono‐exponential functions with a half‐time of 33±5 min for ethanol, 92±9 min for sodium, 103±9 min for potassium, and 124±10 min for amino acids (mean±s.e.mean). Twenty minutes after infusion, the breath ethanol level reached a plateau which could be used to predict the infused volume within ±15% of the true value. In contrast, the serum sodium concentration decreased slowly and was only 3.0±0.7 mmol/l below baseline at 2 hours after infusion.

Conclusions. The calculated rates of transperitoneal solute equilibration can be used to assess the need for substitution of electrolytes in patients who absorb irrigating fluid into the peritoneal cavity. Measurement of ethanol in the expired breath is more useful than serum sodium to indicate the existence of such a pool.
Oral contraceptives and low back pain
Authors: Brynhildsen Jan , Ekblad Sara , Hammar Mats
Published: November 2007

Background. Only few indications have appeared in the literature concerning a possible relationship between the use of oral contraceptives and low back pain. In our daily work we often meet women who have been recommended to abandon their use of oral contraceptives depending on coexisting low back pain. In order to assess the opinions of a possible relationship between oral contraceptives and low back pain this study was undertaken.

Methods. A validated questionnaire was sent out to physicians, physiotherapists and midwives dealing with either contraceptive counselling or low back pain. A modified questionnaire was sent to medical‐and physiotherapist students to assess whether the opinions were a result of the education or the working experience.

Results. A total of 225 questionnaires were sent out and 206 (91%) were returned. Sixteen percent thought there was a relationship between the use of oral contraceptives and risk of low back pain. Thirty percent had seen patients with low back pain that was interpreted as being affected by use of oral contraceptives. Twenty‐five percent recommended at least some patients with low back pain to change their contraceptive method. Among the students there was a difference in opinion between the first and the last year students indicating that their opinions had been influenced by their education.

Conclusions. Evidently many professionals dealing with oral contraceptives and low back pain believe that there is a relationship between oral contraceptives and low back pain, despite the lack of scientific evidence. These recommendations might influence the contraceptive safety for the individual woman and the possible relationship between use of oral contraceptives and low back pain should therefore be more thoroughly investigated before general recommendations are given.
Nodal immune reactivity in FIGO Stage I endometrial carcinoma: relationship with myometrial invasion
Authors: Garzetti Giuseppe Gioele , Ciavattini Andrea , Goteri Gaia , Romanini Carlo
Published: November 2007

Background. To evaluate T lymphocyte subsets in pelvic and paraortic lymph nodes, in patients with FIGO stage I endometrial carcinoma at different degrees of myometrial invasion and with lymphovascular space invasion. The aim was to define an eventual modulation of regional immune reactivity useful in the therapeutic approach of the disease.

Methods. Twenty‐two women with FIGO stage I endometroid adenocarcinoma were consecutively recruited and selected for immunological study. All the patients underwent primary surgery characterized by radical hysterectomy (Piver's type III) with bilateral salpingo‐oophorectomy and systematic pelvic plus paraaortic lymphadenectomy. Lymphocyte tipization was performed by Beckton Dickinson monoclonal antibodies (CD4, CD8, CD56 and CD16) immunohistochemically in frozen‐sections (immune assay on lymph nodes). For statistical evaluations, Student's t test and one way analysis of variance were used.

Results. Significantly higher percentages of CD4+ lymphocytes were found in pelvic than in paraaortic lymph nodes; however, by analyzing T lymphocyte content in the different pelvic nodal groups, we also observed significantly higher percentages of CD16 + and CD56 + cells in obturator nodes when compared to iliac stations. A significant increase of CD16 + and CD56+ cell percentages was then defined with respect to myometrial involvement and lymphovascular space invasion, in pelvic nodes.

Conclusions. From our results, we could not define any clinical importance of nodal lymphocyte distribution in patients with early stage endometrial carcinoma; however, the observed nodal immune reactivity in presence of myometrial invasion seems interesting, with or without lymph vascular space involvement as possible expression of neoplastic systemic diffusion.
Hypertensive disorders of pregnancy and stillbirth in North Carolina, 1988 to 1991
Authors: Ananth Cande V. , Savitz David A. , Bowes Watson A.
Published: November 2007

Background. The objectives of this study were (i) to assess the effect of hypertensive disorders of pregnancy on the risk of stillbirth, and (ii) to characterize the relationship between hypertension and stillbirth separately by gravidity, race, ‘explained’ versus ‘unexplained’ causes of stillbirth, and antepartum versus intrapartum stillbirths.

Methods. The study was based on a retrospective cohort of approximately 400,000 pregnancies identified through the birth and fetal death certificates in North Carolina, USA, between 1988 and 1991. Multivariable polytomous logistic regression was used to generate odds ratios comparing stillbirth risk in hypertensive compared to non‐hypertensive mothers, adjusted for potential confounders.

Results. The risk of chronic hypertension was 7.6 per 1000 pregnancies, while pregnancy‐induced hypertension (PIH) and eclampsia were reported in 36.6 and 6.0 per 1000 pregnancies, respectively. Pregnancies among chronic hypertensives were more likely to result in losses after 28 weeks gestation (RR=3.29, 95% CI: 2.43–4.43), while the risk ratio was 2.16 (95% CI: 1.45–3.22) for losses prior to 28 weeks' gestation. Pregnancies to patients with PIH were at 1.42 (95% CI: 1.15–1.79) times greater risk of terminating in late stillbirth, while the risk ratio for eclampsia was 2.23 (95% CI: 1.51–3.30). The risk ratio for ‘explained’ antepartum stillbirth was higher than intrapartum stillbirth for all of the hypertensive diseases.

Conclusions. Hypertensive disorders were found to have a strong adverse impact on stillbirth suggesting that early diagnosis of hypertension during pregnancy and adequate medical intervention may help reduce the risk of stillbirth.