bluuebunny/crossref_metadata_2025 huggingface dataset:
Phylogeographic patterns in reptiles on the New England Tablelands at the south-western boundary of the McPherson Macleay Overlap
Authors: Colgan D. J. , O'Meally D. , Sadlier R. A.
Published: December 2009

Phylogeographic studies of eastern Australia have generally supported earlier biogeographical studies based on taxon distributions by concurring in the placement of significant intraspecific boundaries. Such studies may potentially clarify biogeographic boundaries that are presently unclear, such as the poorly defined southern edges of the McPherson Macleay Overlap. Here we investigate reptile phylogeography in the northern tablelands of New South Wales to study the south-western boundaries of the Overlap as these are especially uncertain. Cytochrome b sequences from Ctenotus robustus, C. taeniolatus and Oedura lesueurii, three lizard species widespread across the New England Tablelands, were analysed by examining single-strand conformational polymorphism and DNA sequencing. In both O. lesueurii and C. taeniolatus most deeper nodes within species define geographically localised clades. This was not the case for C. robustus. Boundaries between sister-group clades were discovered in multiple locations in the region – between Glen Innes and Armidale, between Armidale and Tamworth and to the south of the Liverpool Plains. The boundaries in C. taeniolatus and O. lesueurii were probably formed in at least two different periods. The phylogeographic patterns may be partly explained by glacially induced aridity cycles in the early Pleistocene or before.
A three-dimensional geometric morphometric analysis of variation in cranial size and shape in tammar wallaby (Macropus eugenii) populations
Authors: Hadley Claire , Milne Nick , Schmitt Lincoln H.
Published: December 2009

This study uses geometric morphometric techniques to examine cranial size and shape variation in nine isolated populations of the tammar wallaby (Macropus eugenii). A set of 36 three-dimensional landmarks were digitised on 143 tammar crania from two mainland and seven island populations. While there was no evidence of island dwarfism or gigantism, cranial size increased with both increasing island size and increasing latitude. As latitude increased, the palate narrowed relative to the nasal bones, cranial flexion and nasal height increased, and the zygomatic arches spread out laterally from the cranium. Overall, the anterior nasal aperture (nares) narrowed with increasing latitude. Mean shapes were calculated for each population, and pair-wise comparisons were made; most of these were significantly different. There was a clear tendency for island populations and those with greater geographic separation to show greater shape differentiation. Thus, regional and population differences in the cranial size and shape of tammar wallabies provide examples of selection, founder effect and random genetic drift.
Interactions between chuditch (Dasyurus geoffroii) and introduced predators: a review
Authors: Glen A. S. , de Tores P. J. , Sutherland D. R. , Morris K. D.
Published: December 2009

The chuditch is a carnivorous marsupial that has suffered catastrophic decline since European settlement in Australia. The impacts of introduced foxes and feral cats are thought to have contributed to this decline. Although chuditch populations appear to respond favourably to fox control, ecological theory predicts that other predators, including feral cats, are also likely to increase in abundance when foxes are removed. The flow-on effects of these predicted increases are not known, but are potentially significant for chuditch and for other native fauna. Here, we review the evidence for limiting effects of foxes and feral cats on chuditch populations. We also discuss the likely effects on chuditch populations (direct and indirect) of current fox control practices. Using recent advances in carnivore community ecology, we make testable predictions regarding likely interactions within the predator guild. Experiments should adopt a whole-of-community approach, seeking to clarify the effects of fox control on the entire suite of native and introduced predators, as well as on the abundance and diversity of prey.
Comparative temperature in funnel and pit traps
Authors: Thompson Graham G. , Thompson Scott A.
Published: December 2009

The temperature in pit and funnel traps with various shade-cover treatments on the two hottest days in Perth in the summer of 2008/09 were examined. Lethal temperatures for small mammals and reptiles were experienced in pipe and bucket pit-traps and funnel traps without covers on both days. Funnel traps with shade covers provided similar or better protection from solar radiation than buckets, pipes and funnel traps without covers. A breeze reduced temperatures in funnel traps more than it did in bucket and pipe pit-traps. It is recommended that all funnel traps deployed during fauna surveys be protected by a shade cover and during hot conditions a second shade cover should be used.
Acute temperature quotient responses of fishes reflect their divergent thermal habitats in the Banda Sea, Sulawesi, Indonesia
Authors: Eme John , Bennett Wayne A.
Published: December 2009

We measured metabolic rates of six Indo-Pacific fishes from different thermal habitats at 26°C and after acute transfer to 32°C. Temperature–metabolism relationships were expressed as temperature quotients (Q10) and ranged from ~1.0 in tidepool-dwelling common (Bathygobius fuscus) and sandflat (Bathygobius sp.) gobies to 2.65 and 2.29 in reef-associated white-tailed humbug (Dascyllus aruanus) and nine-banded cardinalfish (Apogon novemfasciatus), respectively. Squaretail mullet (Liza vaigiensis) and blackspot sergeant (Abudefduf sordidus) displayed Q10 responses of 2.03 and 1.26, respectively. Bathygobiids and blackspot sergeant inhabit mangrove tidepools during daytime low tides and experience temperature fluctuations approximately twice (12°C) the maximum experienced by inhabitants of patch reef or seagrass and squaretail mullet (1–6°C), a mangrove transient that avoids shallow, insolated daytime low tides. The low Q10 responses of the bathygobiids and blackspot sergeant suggest that their metabolic rates are relatively temperature-insensitive over the thermal range tested. Our data support the hypothesis that fish metabolic responses are tailored to specific thermal habitat conditions.
Quantum entanglement beyond Gaussian criteria
Authors: Gomes R. M. , Salles A. , Toscano F. , Souto Ribeiro P. H. , Walborn S. P.
Published: December 2009

Most of the attention given to continuous variable systems for quantum information processing has traditionally been focused on Gaussian states. However, non-Gaussianity is an essential requirement for universal quantum computation and entanglement distillation, and can improve the efficiency of other quantum information tasks. Here we report the experimental observation of genuine non-Gaussian entanglement using spatially entangled photon pairs. The quantum correlations are invisible to all second-order tests, which identify only Gaussian entanglement, and are revealed only under application of a higher-order entanglement criterion. Thus, the photons exhibit a variety of entanglement that cannot be reproduced by Gaussian states.
Mutation patterns in cancer genomes
Authors: Rubin Alan F. , Green Phil
Published: December 2009

Recent large-scale cancer sequencing studies have focused primarily on identifying cancer-associated genes, but as an important byproduct provide “passenger mutation” data that can potentially illuminate the mutational mechanisms at work in cancer cells. Here, we explore patterns of nucleotide substitution in several cancer types using published data. We first show that selection (negative or positive) has affected only a small fraction of mutations, allowing us to attribute observed trends to underlying mutational processes rather than selection. We then show that the increased CpG mutation frequency observed in some cancers primarily occurs outside of CpG islands and CpG island shores, thus rejecting the hypothesis that the increase is a byproduct of island or shore methylation followed by deamination. We observe an A→G vs. T→C mutational asymmetry in some cancers similar to one that has been observed in germline mutations in transcribed regions, suggesting that the mutation process may be influenced by gene expression. We also demonstrate that the relative frequency of mutations at dinucleotide “hotspots” can be used as a tool to detect likely technical artifacts in large-scale studies.
Three‐dimensional power Doppler measurement of perfusion of the periurethral tissue in incontinent women – a preliminary report
Authors: Liang Ching‐Chung , Chang Shuenn‐Dhy , Chang Yao‐Lung , Wei Tien‐Yung , Wu Hsien‐Ming , Chao An‐Shine
Published: December 2009

Background. This study was designed to test the hypothesis that decreased periurethral vascularization and blood flow might lead to urinary incontinence. Three‐dimensional color histogram may better quantify the vasculature than traditional two‐dimensional Doppler ultrasound imaging.

Methods. Between June 2002 and July 2003, 57 patients were invited to undergo three‐dimensional power color Doppler study of the periurethral vessels before surgery. In group 1, 29 women with stress urinary incontinence underwent tension‐free vaginal tape procedures and in group 2, 28 continent women underwent other procedures for treatment of benign gynecologic disease and without urological problems. We used 3 indices of color histogram to quantify the vascularization and blood flow within a tissue block from the bladder neck to the urethral meatus and the periurethral area within 5 mm of the urothelium borders. The values of 3 indices of histogram, vascularization index, flow index and vascularization‐flow index, were analyzed.

Results. Judging from the values of vascularization index, flow index and vascularization‐flow index generated in our study, significantly decreased periurethral vasculature was found in women with stress urinary incontinence and women in the postmenopausal status as compared with women in the continent group and those in the premenopausal status, respectively (p<0.05).

Conclusions. Three‐dimensional histogram measurement revealed less periurethral vessels and flow in women suffering from stress urinary incontinence, a finding that might play a role in the pathogenesis of stress urinary incontinence.
A longitudinal study of antioxidant status during uncomplicated and hypertensive pregnancies
Authors: ROES EVA MARIA , HENDRIKS JAN C.M. , RAIJMAKERS MAARTEN T.M. , STEEGERS‐THEUNISSEN REGINE P.M. , GROENEN PASCAL , PETERS WILBERT H.M. , STEEGERS ERIC A.P.
Published: December 2009

Background. To study the possible involvement of an (im)balance between oxidants and antioxidants in pre‐eclampsia concentrations of intra‐ and extracellular blood antioxidants in women with uncomplicated and hypertensive pregnancies, they were studied preconceptionally and throughout pregnancy. Methods. In uncomplicated pregnancies (n=19) and hypertensive pregnancies (n=6) concentrations of whole blood and plasma thiols, plasma vitamins E and C, hemoglobin, and hematocrit were assessed at preconception, 6, 10, 20, and 37 weeks of gestational age, as well as six weeks postpartum. A repeated mixed model was used for statistical analysis. Results. Vitamin C and most whole blood and plasma thiol concentrations decreased during pregnancy, while vitamin E, whole blood oxidized cysteinyl‐glycine and the ratio of free to oxidized homocysteine revealed a linear increase during pregnancy. Postpartum plasma cysteine and vitamin C levels and the ratio of free to oxidized levels of cysteine, cysteinyl‐glycine, and glutathione were significantly (p<0.05) lower as compared to preconceptional levels, whereas whole blood oxidized cysteine, cysteinyl‐glycine and glutathione levels, and whole blood and plasma homocysteine levels were significantly (p<0.05) higher six weeks after delivery. Plasma cysteine and homocysteine, and whole blood oxidized cysteine and homocysteine levels were significantly (p<0.05) higher at 37 weeks of gestational age in the hypertensive group compared to those in the uncomplicated group. There were no other differences between the hypertensive and uncomplicated groups. Conclusion. In normal pregnancy there seems a balance between antioxidant and oxidant concentrations despite modest oxidative stress. In mildly hypertensive pregnancies a marginal imbalance may occur.
The role of mediolateral episiotomy during labour. Analysis of risk factors for obstetric anal sphincter tears
Authors: Aukee Pauliina , Sundström Helena , Kairaluoma Matti V.
Published: December 2009

Background. To determine risk factors for third‐degree and complete third‐ or fourth‐degree anal sphincter tears in vaginal delivery.

Methods. This is a retrospective comparative study. Fifty‐three women who had sustained an anal sphincter tear were compared with 9,178 women without such a complication between August 1997 and October 2001. Obstetric data was collected from an electronic database. The main outcome measures were odds ratios.

Results. In the whole study population, odds ratios (ORs) for third‐degree tears were: primiparity, 8.34 (95% confidence interval [CI] 3.98–17.48); vacuum extraction, 5.22 (95% CI 2.69–10.13); parietal presentation, 3.97 (95% CI 1.16–13.64); and birth weight >4,000 g, 3.77 (95% CI 2.11–6.68); and for complete third‐ or fourth‐degree tears odds ratios were 5.42, 2.98, 5.64, and 3.01, respectively. In multivariate analysis, mediolateral episiotomy appeared to be protective as regards third‐degree tears (OR 0.37 [95% CI 0.2020–0.70]).

Conclusions. Vacuum‐assisted vaginal delivery bears an increased risk of third‐degree anal sphincter tears in a maternity unit where forceps are not used. Restricted use of mediolateral episiotomy may have a protective effect on the perineum.
Longitudinal trends in cervical histological lesions (CIN 2–3 +): A 25‐year overview
Authors: SIGURDSSON KRISTJAN , SIGVALDASON HELGI
Published: December 2009

Background. Trends in CIN 2–3+ lesions affect the choice of target age group and screening interval. Methods. The following analyses were performed for CIN 2_/3_/ following 1st to 5th screening visits in the 20–34/35–69 age groups during 1979–2002: a) the relative risk of age and calendar year; b) the cumulative incidence rate after normal or low or higher grade cytology; c) the proper screening interval to detect these lesions at a fixed risk level after normal screening visits; d) the predictive power of these lesions for diagnosis of cancer after first biopsy; e) the prevalence rates in the 20–24/25–29 year age groups at first and at al1 subsequent screening visits. Results. The cumulative rate decreased with the number of screening visits and advancing age. After normal and low‐grade cytology the cumulative rate increased linearly but slowly with time but after higher grade cytology the rate was relatively stable within one year. Age and calendar year are important risk factors in younger women. The prevalence of CIN 2–3+ increased significantly at 1st visit in the 20–24 age group at the same time as the population prevalence in the 25–29 age group decreased significantly. CIN 2 was at lower risk than CIN 3 of being diagnosed with cancer. Conclusions. The results indicate that screening should preferably start before age 25 with a maximum interval of 3 years, whereas the interval can be extended to 4–/5 years at age 35–40. CIN 2 have a different risk profile compared to CIN 3.
Predictors of anxiety and depression following pregnancy termination: a longitudinal five‐year follow‐up study
Authors: BROEN ANNE NORDAL , MOUM TORBJÖRN , BÖDTKER ANNE SEJERSTED , EKEBERG ÖIVIND
Published: December 2009

Background. The aims of the study were to assess anxiety and depression in women who had experienced either a miscarriage or an induced abortion, to compare the women's level of distress with that of a general population sample, and to find predictors of anxiety and depression six months and five years after the event. Methods. A prospective, longitudinal follow‐up study. Women who experienced miscarriage (n=40) and induced abortion (n=80) were interviewed ten days (T1), six months (T2), two years (T3), and five years (T4) after the event. On each occasion, they completed the Hospital Anxiety and Depression Scale and the Life Events Scale. Paired‐sample t‐test, logistic regression, and multiple linear regression statistical tests were used. Results. Women with miscarriage had significantly more anxiety and depression at T1 than the general population, while women with induced abortion had significantly more anxiety at all time points and more depression at T1 and T2. In both groups, important predictors of anxiety and depression at T2 and T4 were recent life events and poor former psychiatric health. Childbirth events between T1 and T4 had no significant influence on the scores. For women with induced abortion, doubt about the decision to abort was related to depression at T2 (p<0.05), while a negative attitude towards induced abortion was associated with anxiety at T2 (p<0.05) and T4 (p<0.05). Conclusion. Correlates of anxiety and depression may be used to better identify women who are at risk of negative psychological responses following pregnancy termination.
Angiographic embolization for obstetrical hemorrhage: effectiveness and follow‐up outcome of fertility
Authors: Shim Jae‐Yoon , Yoon Hyun‐Ki , Won Hye‐Sung , Kim Sun‐Kwon , Lee Pil Ryang , Kim Ahm
Published: December 2009

Background. This study was undertaken to describe the results of angiographic embolization for obstetrical hemorrhage and the follow‐up outcome of fertility. Methods. Consecutive patients who received angiographic embolization for the management of obstetrical hemorrhage at a single tertiary center were included in this study. Medical records were reviewed to collect the clinical data and details on the procedure. Patients were interviewed by telephone to obtain the long‐term outcomes for complications, menstruation, desire for conception, and subsequent pregnancies. Results. Embolization was successful in 42 (86%) of 49 patients with obstetrical hemorrhage resulting from various causes. The main cause of hemorrhage was uterine atony (n=24). The success rate was significantly lower in cases with abnormal placentation than in other causes of hemorrhage (p<0.05). The procedure took an average of 45.6 min (range, 20–120 min). There were no major complications related to the procedure. We were able to follow‐up 48 patients. Among 37 patients with preserved uteri, menstruation resumed spontaneously in 36 patients. Nine patients became pregnant, of which six gave birth to healthy babies and three ended in early miscarriage. Conclusions. Angiographic embolization is an effective noninvasive method for the management of obstetrical hemorrhage and a useful technique for preserving fertility.
Changes in the prevalence of pre‐eclampsia in Akershus County and the rest of Norway during the past 35 years
Authors: Dahlstrøm Berit L. , Ellström Engh Marie , Bukholm Geir , Øian Pål
Published: December 2009

Background. Pre‐eclampsia, the etiology of which is unknown, is an important cause of maternal morbidity and mortality. In Norway there has been a substantial change in lifestyle since 1970. Akershus is a growing urban county. The aim of this study was to identify changes in the prevalence of pre‐eclampsia in Akershus County and the rest of Norway during the past 35 years. Methods. The study is population‐based and retrospective. Deliveries are registered per inhabitant and pre‐eclampsia per delivery. Prevalence and prevalence ratios are calculated with 95% confidence intervals. Poisson regression analysis is used for assessment of trends. Results. The frequency of deliveries declined from 1.9% to 1.4% for Akershus County and from 1.7% to 1.3% in the rest of Norway. The prevalence of pre‐eclampsia increased from 3.1% to 3.7% for Akershus County and from 3.3% to 4.5% in the rest of Norway. Conclusions. The increase in the prevalence of pre‐eclampsia and the difference between Akershus and the rest of Norway are not likely to be explained by changes in genetic material. Altered registration routines throughout Norway since 1998 may influence the observations, and better registration routines may contribute to the observed lower prevalence in Akershus. Changes in lifestyle factors most likely explain the overall increase in the prevalence of pre‐eclampsia.
Vesicoamniotic shunting using a double‐basket catheter appears effective in treating fetal bladder outlet obstruction
Authors: Won Hye‐Sung , Kim Sun‐Kwon , Shim Jae‐Yoon , Lee Pil Ryang , Kim Ahm
Published: December 2009

Background. To estimate the effect of vesicoamniotic shunting using a double‐basket catheter on treating fetal bladder outlet obstruction.

Methods. A retrospective study involving 8 prenatally diagnosed bladder outlet obstruction cases that underwent vesicoamniotic shunt placement using a double‐basket catheter from 1998 to 2004. Patients were followed‐up for prenatal and neonatal outcome analyses.

Results. Vesicoamniotic shunting was performed in 8 fetuses aged between 13.7 and 25.4 weeks' gestation (mean±SD, 19.7±3.5 weeks). Final diagnoses included 5 posterior urethral valves, 1 cloacal anomaly, 1 urethral stenosis, and 1 unknown. There were no maternal complications associated with the procedures. One woman diagnosed as having a fetus with posterior urethral valves decided to terminate her pregnancy and one fetus died in uterus spontaneously. Six women delivered live babies, and one baby required postnatal ventilatory support. Postnatal follow‐up ranged from 3 to 60 months. Of the 6 newborns, 4 survived with normal renal function, 1 had renal insufficiency, and 1 died of renal failure at 3 months of age.

Conclusions. Vesicoamniotic shunt placement using a double‐basket catheter may be effective in improving perinatal and neonatal outcomes through long‐term decompression of the fetal urinary tract in carefully selected cases.
Increased ENA‐78 in the follicular fluid of patients with endometriosis
Authors: WUNDER DOROTHEA M. , MUELLER MICHAEL D. , BIRKHÄUSER MARTIN H. , BERSINGER NICK A.
Published: December 2009

Background. It is known that endometriosis is an inflammatory disease and those patients seem to have lower pregnancy rates. The aim of the study was to investigate the concentrations of chemokines and proinflammatory cytokines in the follicular fluid of patients with and without endometriosis. Methods. Follicular aspiration, recovering follicular fluid during assisted reproductive treatment, follicular fluid storage and analysis of chemokines and proinflammatory cytokines were carried out. Tumor necrosis factor‐α, interleukin‐1β, interleukin‐6, interleukin‐8, interleukin‐15, leukemia inhibitory factor, epithelial neutrophil‐activating peptide 78, regulated upon activation, normal T‐cell expressed and secreted, and growth‐regulated oncogene‐α were analyzed in the follicular fluid and compared between women with (n=47) and without endometriosis (n=279). Results. The above cytokines were detected in the follicular fluid samples. Epithelial neutrophil‐activating peptide 78 levels were significantly higher in follicular fluid from endometriosis patients than from controls (p=0.008). Increases (to twice the control level) were also observed for tumor necrosis factor‐α and for interleukin‐6. Conclusions. Increased follicular fluid levels of epithelial neutrophil‐activating peptide 78, tumor necrosis factor‐α and interleukin‐6 indicate that these cytokines may influence oocyte quality and fecundability of women with endometriosis by deteriorating the microenvironment in the human follicle.
Risk factors in developing pregnancy‐related pelvic girdle pain
Authors: Albert Hanne B. , Godskesen† Mona , Korsholm Lars , Westergaard Jes G.
Published: December 2009

Background. In this prospective epidemiologic cohort study the aim was to identify possible risk factors for developing four different syndromes of pelvic girdle pain during pregnancy. Methods. Over a one‐year period a total of 2,269 consecutive pregnant women – at week 33 of gestation – responded to a structured questionnaire and underwent a thorough physical examination. Women who at baseline reported daily pain from pelvic joints and had corresponding objective findings were allocated, according to symptoms, into one of four classification groups, and followed up with questionnaires and physical examinations up to two years after delivery. Results. Multivariate analysis could distinguish the four pelvic pain sub groups from the “Pelvic healthy” group with respect to 13 of 24 variables. The pelvic girdle syndrome group revealed a history of previous low back pain, trauma of the back or pelvis, multiparae, had a relatively higher weight, a higher level of self reported stress and of job At a higher risk of developing symphysiolysis were women who were multiparae, had a relatively higher weight, and were smokers. If a woman had vocational training or a professional education, was stressed, had a poorer experience of previous delivery, had previous low back pain, trauma of back, or previous salpingitis, she had an increased risk of developing one‐sided sacroiliac syndrome. The risk factors for developing double‐sided sacroiliac syndrome were previous low back pain and trauma of the back or pelvis, multiparae, poorer relationship with spouse, and less job satisfaction. Conclusions. This study demonstrates no single dominant risk factor for developing pelvic girdle pain in pregnancy, but reveals a set of physical and psychosocial factors. The risk factors for developing pelvic girdle pain in general are: history of previous low back pain, trauma of the back or pelvis, multivariate, higher level of stress, and low job satisfaction.
Intrapartum transfer from a birth centre to a hospital – reasons, procedures, and consequences1
Authors: DAVID M. , BERG G. , WERTH I. , PACHALY J. , MANSFELD A. , KENTENICH H.
Published: December 2009

Background. Investigation of the reasons for the transfer of women from a birth centre to a hospital in the course of childbirth as well as modalities and effects. Patients and method. In the prospective investigation from September 1, 1999 to August 31, 2001, information was collected for all women in Berlin and Bavaria transferred intrapartum from a birth centre to a hospital concerning the reason for the transfer, stage of delivery at the start of transfer, details of the transport, accompaniment, state of mother and medical diagnosis on arrival at the hospital, further progress of delivery, and the condition of the baby postnatum. Comparison groups were formed by all birth centre deliveries in Berlin and Bavaria 1999/2000 (n=3060) and hospital deliveries in Berlin and Bavaria 1998/1999 (selected data, n = 89 696 births). Results. Three hundred and sixty transfer cases could be evaluated, and a majority of these were nulliparous. The most frequent reasons for transfer were prior premature rupture of membranes and failure to progress in labor. Fifty‐seven percentages of the women who were transferred subsequently delivered spontaneously, with an episiotomy rate of approximately 30%. 1‐min Apgar value ≤ 7 were frequently in nulliparous and multiparous patients in the transfer group than in the comparison groups, as were 5‐min Apgar values ≤ 7 and pH < 7.10 in arterial cord blood in particular for nulliparous in the transfer group. Hospitalisation of neonates born to the transfer group and in particular the nulliparous was significantly more common. Conclusions. Women delivering in a birth centre represent in general a low‐risk group as a result of careful preselection by the centres. However, some neonatal data and the high rate of operative deliveries (cesarean section, forceps, and vaginal extraction) indicate that the intrapartum‐transferred women, in particular when nulliparous, represent than a special high‐risk group.
Perceived health, sick leave, psychosocial situation, and sexual life in women with low‐back pain and pelvic pain during pregnancy
Authors: Mogren Ingrid
Published: December 2009

Background. Low‐back pain and pelvic pain (LBPP) is a common problem during pregnancy. The aim of the study is to investigate perceived health, sick leave, psychosocial situation, and sexual life among women experiencing LBPP during pregnancy.

Methods. All women who gave birth at one of two hospitals in northern Sweden from 1 January 2002 to 30 April 2002 were invited to complete a questionnaire on their obstetric history, pregnancy, and delivery. Univariate and multivariate logistic regressions were performed in order to calculate odds ratio (OR) and its 95% confidence interval (CI) where applicable. Pearson's chi‐square test was performed where applicable.

Results. Most women were married or cohabiting (98%), and reported a ‘very good’ or ‘good’ partner relationship (96%) and a satisfying sexual life before pregnancy (91%). Only a few women reported perceived health as ‘quite poor’ or ‘poor’ before pregnancy (2%); however, this proportion increased during pregnancy (13%). In general, satisfying sexual life declined during pregnancy, which was also the case for the assessment of perceived health during pregnancy. Women with LBPP during pregnancy had an increased risk of reporting poor health (OR = 3.05, 95% CI = 1.70–5.46). Overall, 68% of women had been on sick leave, and 22% had received maternity allowance. Women with LBPP reported sick leave in 72% of the participants.

Conclusions. LBPP demonstrates a negative impact on perceived health and sexual life during pregnancy. A great majority of pregnant women were on sick leave at some time during pregnancy. These consequences make LBPP a major public health issue.
Pica in pregnancy in a privileged population: myth or reality
Authors: MIKKELSEN TINA BROBY , ANDERSEN ANNE‐MARIE NYBO , OLSEN SJURDUR FRODI
Published: December 2009

Background. In the literature pica is reported to be prevalent in pregnant women. Most studies have focused on less privileged populations, but is pica prevalent among privileged pregnant women? Methods. 100,000 pregnant women in the Danish National Birth Cohort were asked about pica in a food frequency questionnaire mailed in gestation week 25. Results. The response rate of the questionnaire was 70% of Danish National Birth Cohort participants. Only 14 women reported to have eaten substances that were clearly not foods, i.e. 0.02% had pica in this cohort of well nourished Danish women. Conclusion. It seems that, in privileged populations, pica is more a myth than a reality.
A boy or a girl? A Hungarian survey regarding gender selection
Authors: Fejes Imre , Szöllosi János , Závaczki Zoltán , Koloszár Sándor , Pál Attila
Published: December 2009

Background. Infertile Hungarian couples were surveyed with regard to their opinion of preconception gender selection by the separation of X‐ and Y‐bearing sperm populations. Methods. Self‐completion of a questionnaire. Group 1: subjects presenting for infertility examination; Group 2: presenting for homologous intrauterine insemination. Results. As concerns the gender of the firstborn, 13.8% of those in Group 1 preferred a boy and 10.3% a girl, while 75.9% had no preference. The male preference was higher in Group 2: 33.3% preferred a boy and 7.4% a girl while 59.3% had no preference (χ2, p<0.05). In the event of a wish for more offspring, 91% in Group 1 and 94% in Group 2 did not have a wish for only one particular gender. In Group 2, 30.8% were willing to pay the extra costs for a gender selection procedure as compared with only 10.8% of the couples in Group 1 (χ2, p<0.05). If the National Health Fund fully covered the costs, 53.4% in Group 1 and 38.5% in Group 2 would request the procedure for nonmedical reasons, while 94.6% and 97.4% of them, respectively would so for medical reasons. Conclusions. Our findings revealed a trend to preference for firstborn males, although couples wishing more than one offspring prefer equal numbers of male and female children. The utilization of preconception gender selection, therefore, would not seem to appreciably affect the natural male/female ratio. Genetic indications exert significant effects on the decision regarding sex selection procedures.
The clinical utility of maternal self‐reported personal and familial psychiatric history in identifying women at risk for postpartum depression
Authors: DENNIS CINDY‐LEE , ROSS LORI E.
Published: December 2009

Background. To determine whether maternal self‐reported data on personal and family psychiatric history would significantly predict postpartum depressive symptomatology at 8 weeks postpartum and to examine which of these variables were the most predictive for inclusion in an obstetrical clinical assessment aimed at early identification of postpartum depression. Methods. As part of a longitudinal study, a population‐based sample of 622 women completed mailed questionnaires at 1 and 8 weeks postpartum. Results. At 8 weeks postpartum, mothers who indicated that they had any personal psychiatric history were almost four times more likely to exhibit depressive symptomatology (Edinburgh Postnatal Depression Scale score > 9) than those with no previous mental health difficulties (odds ratio [OR] 3.65, 95% CI 2.30–5.82). Any family psychiatric history was not a significant risk factor. Variables most predictive of depressive symptomatology at 8 weeks, explaining 42% of the variance, included: maternal antenatal depression (OR 3.77, p = 0.03), maternal history of postpartum depression (OR 2.21, p = 0.02), and Edinburgh Postnatal Depression Scale score >9 at 1 week postpartum (OR 18.23, p<0.001). Conclusions. The results suggest that maternal variables, particularly those related to the index and past pregnancies, not family psychiatric history, are the best predictors of postpartum depressive symptoms. These findings highlight the importance of assessing symptoms of depression and anxiety during pregnancy and the early postpartum period, in order to facilitate timely identification of women at risk for developing postpartum depression.
Feasibility of myomectomy performed by minilaparotomy
Authors: Fambrini Massimiliano , Penna Carlo , Pieralli Annalisa , Andersson Karin L. , Zambelli Valentina , Scarselli Gianfranco , Marchionni Mauro
Published: December 2009

Background. To evaluate feasibility and clinical outcomes of myomectomy performed through minilaparotomic access in a large series of consecutive patients. Methods. All patients submitted to laparotomic conservative surgery for uterine myomas through an initial minilaparotomic approach (4–8‐cm transverse skin incision) were retrospectively evaluated. Preoperative findings, surgical technique, rate of laparotomic enlargement, operative time, surgical complications and length of recovery were the main analyzed outcomes. Results. One hundred and seventy out of 212 patients experienced minilaparotomic approach for uterine myomatosis. In 97 (57.1%) multiple myomas were present (maximum, 23). The size of the largest myoma ranged from 2 to 19 cm (median 5.6). In 161 (94.7%) patients myomectomy was ended through minilaparotomic access with a mean length of skin incision of 6.2 cm (4–7.8). The correlation between severe obesity and laparotomic enlargement was statistically significant (p<0.05). The mean operative time was 57 min (32–118). One bladder intraoperative injury was successfully managed through minilaparotomic incision. Bowel or vascular complications never occurred. Estimated blood loss was not significant except in three cases (1.9%) requiring transfusion. Febrile complications were observed in nine patients (5.6%). The median postoperative stay in uncomplicated patients was 2.5 days (2–4). Conclusions. Our report supports the wide application of minilaparotomic myomectomy and suggests that more than 85% of women with fit uterine myomatosis could be successfully managed in this way with a failure rate of 5.3% in eligible patients. The main criteria of minimal invasive surgery seem to be by minilaparotomic myomectomy, which should be considered a valid option for uterine myohas conservative treatment.
Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergometrine in the management of the third stage of labor
Authors: FUJIMOTO MIKI , TAKEUCHI KYOUSUKE , SUGIMOTO MAKOTO , MARUO TAKESHI
Published: December 2009

Objectives. To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. Methods. A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15‐month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss >500 ml, and need of additional uterotonic treatment were evaluated. Results. As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss >500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11–0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11–0.85). Conclusions. Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor.
Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial
Authors: HAUGLAND KARI STRAUME , RASMUSSEN SVEIN , DALTVEIT ANNE KJERSTI
Published: December 2009

Background. Low back and pelvic pain is common in pregnancy and postpartum, but there is no well documented effect of treatment in pregnancy. The aim of the study was to assess whether a group intervention program for pregnant women with pelvic girdle pain has any effect on pain and daily function postpartum. Methods. Pregnant women with pelvic pain between the 18th and 32nd week of gestation were invited to participate in a randomized clinical study. Among 958 examined women, 569 (59%) fulfilled the inclusion criteria. Women randomized to the intervention group (n = 275) participated in an education program that consisted of information, ergonomics, exercises, pain management, advice for daily life movement, pelvic belt/crutches, and information about delivery. Women randomized to the control group (n = 285) were not offered any treatment, but were free to seek advice or other treatment. Clinical measures and self‐evaluated utility of the intervention were measured by a visual analogue scale 0–10. Results. Mean debut of pelvic girdle pain in pregnancy was at week 15. Altogether 42% of the women reported problems with low back pain earlier, and 34% reported a family history of pelvic girdle pain in pregnancy. Median visual analogue scale score for all activities at inclusion was 6 both in the control group and the intervention group. At 6 and 12 months postpartum the score was reduced to 1.7/1.6 and 1.1/0.9. In the intervention group, 75% marked a self‐evaluated utility visual analogue scale score >7. In the control group, 60% had searched for alternative treatment. Conclusions. Postpartum pelvic girdle pain improved with time both in the intervention group and the control group, but there were no statistically significant differences between the groups. Self‐evaluated utility of the intervention was, however, high in the intervention group.
Outcome in obstetric care related to oxytocin use. A population‐based study
Authors: Oscarsson Maria E. , Amer‐Wåhlin Isis , Rydhstroem† Hakan , Källén Karin
Published: December 2009

Background. The purpose of this study was to investigate the delivery outcome in relation to oxytocin use in labor. Methods. We studied 106,755 deliveries from 1995 to 2002 in the Perinatal Revision South, a population‐based register comprising information from 10 hospitals in southern Sweden. Results. Oxytocin use in labor increased from 27.6% in 1995/96 to 33.2% in 2001/02 (p<0.000006). Oxytocin was administered to 47.7% of the nulliparas and 18.5% of the multiparas. There were large differences between hospitals (range among nulliparas: 32.6–60.4%; among multiparas: 13.9–27.0%). After exclusion of deliveries with induction of labor and deliveries lasting >12 h, there was a significant association between oxytocin use and Apgar score < 7 at 5 min (OR 2.3; 95% CI 1.8–2.9), need for neonatal intensive care (OR 1.6; 95% CI 1.5–1.7), and operative delivery (OR 4.0; 95% CI 3.7–4.2). Conclusions. In deliveries with relatively short duration (≤12 h), a significant association was seen between oxytocin use and adverse outcome. Even though the results are difficult to interpret, the significant difference between the use of oxytocin in different hospitals, as well as the increase of oxytocin use over time, calls for a randomized controlled study to elucidate the advantages and disadvantages of oxytocin use during labor and delivery.
Smoking and the risk of developing hypertensive diseases in pregnancy: what is the effect on HELLP syndrome?
Authors: LEENERS BRIGITTE , NEUMAIER‐WAGNER PERUKA , KUSE SABINE , RATH WERNER
Published: December 2009

Background. The aim of our study was to investigate the role of smoking in the development of HELLP syndrome, pre‐eclampsia and gestational hypertension. Methods. A self‐administered questionnaire was sent to 2,600 women who had contacted the German Pre‐eclampsia Self‐help Group previously for information on hypertensive disorders in pregnancy and to 1,233 controls. Diagnoses were verified by reviewing medical records and classified according to ISSHP criteria. Student's t‐test, Wilcoxon test, Chi‐square test, and multiple logistic regressions were used for statistical analysis. Results. After matching age, parity, nationality, and education a total of 905 women with a hypertensive disease in pregnancy and 945 controls were evaluated for the present study. In comparison to the patients, controls smoked significantly more often during their pregnancies (8.5%/18%, p<0.0001). Smoking during pregnancy was associated with a decreased risk of developing hypertensive disorders in pregnancy by 56%. The most prominent effect of smoking was on the risk of developing HELLP syndrome (OR 0.19, 95% CI 0.08–0.43) followed by HELLP syndrome + pre‐eclampsia (OR 0.33, 95% CI 0.17–0.63), pre‐eclampsia only (OR 0.46, 95% CI 0.26–0.8), and gestational hypertension (OR 0.66, 95% CI 0.41–1.08). Conclusions. Smoking is associated with an 80% reduction of the risk developing HELLP syndrome. However, pregnant women should be advised to quit smoking. Understanding the different effects of smoking in the etiology of each subtype of hypertensive diseases in pregnancy will improve the knowledge of underlying pathophysiological mechanisms and may help in designing more effective prevention and treatment strategies.
Recombinant factor VIIa in the management of postpartum bleeds: an audit of clinical use
Authors: SOBIESZCZYK SLAWOMIR , BRĘBOROWICZ GRZEGORZ H. , PLATICANOV VILIYAN , TANCHEV STOYAN , KESSLER CRAIG M.
Published: December 2009

Background. This paper presents an analysis of 25 patient cases in which recombinant factor VIIa was used in the management of postpartum hemorrhage, including severe and/or life‐threatening bleeds. Anecdotal experiences in the empirical use of this agent are described and dosing regimens, effects on bleeding, and safety data are presented.

Methods. Data were extracted from the international, internet‐based, voluntary registry, haemostasis.com. Search results were manually cross‐checked against monthly summary reports and cases of confirmed postpartum hemorrhage were analyzed by the authors. Case providers were contacted individually to approve the use of their cases, supply any missing data, and validate the data already held.

Results. Of 43 reported gynecological admissions for hemorrhage, 13 were excluded as they did not relate to childbirth, and 5 due to insufficient data. The remaining 25 records, all associated with postpartum hemorrhage, were submitted by 14 doctors from 5 countries. Following administration of recombinant factor VIIa, bleeding stopped in 18 cases (72%), markedly decreased in 2 (8%), and decreased in 4 (16%). Bleeding increased following recombinant factor VIIa administration in only 1 patient (4%). Requirements for replacement blood products and crystalloids/colloids were also greatly curtailed. A full recovery was achieved by most patients (22/25, 88%) with few complications, even when recombinant factor VIIa was administered as salvage therapy. There were no thrombotic complications associated with recombinant factor VIIa administration.

Conclusions. This review provides the largest aggregate of cases in which recombinant factor VIIa has been used to control obstetrical bleeding. A review of these cases suggests that this agent may be a useful and safe adjunctive therapy in the management of postpartum hemorrhage.
Comparison of ultrasound and autopsy findings in pregnancies terminated due to fetal anomalies
Authors: AMINI HASHEM , ANTONSSON PER , PAPADOGIANNAKIS NIKOS , ERICSON KATHARINA , PILO CHRISTINA , ERIKSSON LARS , WESTGREN MAGNUS , AXELSSON OVE
Published: December 2009

Objective. To compare antenatal diagnoses with autopsy findings in pregnancies terminated after ultrasound detection of fetal anomalies. A second aim was to study the quality of antenatal fetal diagnosis over time. Design. Retrospective, multicenter study over two consecutive six‐year periods in Uppsala and Stockholm. Setting. Cases were identified through fetal autopsy reports. Subjects. Three hundred and twenty‐eight fetuses from pregnancies terminated between 1992 and 2003 because of ultrasonographically diagnosed anomalies. Main outcome measures. The findings at the last ultrasound examination were compared with the autopsy reports. Results. In 299 cases (91.2%) ultrasound findings either exactly matched or were essentially similar to the autopsy findings. In 23 cases (7%) ultrasound findings were not confirmed at autopsy, but the postnatal findings were at least as severe as the antenatal ones. In six cases (1.8%) termination was performed for an anomaly which proved to be less severe than was predicted by ultrasound. The number of such cases was the same in both six‐year periods, while the total number of cases increased from 113 in the first to 215 in the second period. Fetal examination provided further diagnostic information in 47% of the cases. In 10% a syndrome was disclosed. Conclusion. Termination of pregnancy was not always based on a correct antenatal diagnosis. All fetuses but one from terminated pregnancies had evident anomalies. In six cases (1.8%) the decision to terminate was based on suboptimal prognostic and diagnostic information. Fetal autopsy by an experienced perinatal pathologist is essential to provide a definitive diagnosis.