bluuebunny/crossref_metadata_2025 huggingface dataset:
Preinductive Cervical Ripening With PgE2 Gel in Term Pregnant Women with Ultrasonically Diagnosed Intra‐Uterine Growth‐Retarded Fetuses
Authors: Almström H. , Ekman G. , Granström L.
Published: November 2007

Intra‐uterine growth retardation (IUGR), often combined with other pregnancy‐related complications, constitutes a rather common indication for labor induction. The objective of this prospective study was to evaluate a strict intracervical application of 0.5 mg PgE2 in gel for cervical ripening and labor induction. Eighty term pregnant women with an ultrasonically diagnosed IUGR (<‐2 SD) and an unripe cervix were given PgE2‐gel. The main indication for labor induction was IUGR, but 26 women had other complications. IUGR was verified at delivery in 50 women (study group), whereas 30 women (control group) gave birth to infants of normal birth weight (>‐2 SD). The cervical ripening effect did not differ between the groups. In the study group, 19 nulliparous and 15 parous women out of 50 had a favorable cervix after 12 h and were delivered within 24 h of gel application. The corresponding result for the control group was 11 nulliparous and 8 parous women out of 30. Failed induction was registered in 2 and one woman respectively. On the other hand, the number of instrumental deliveries was greater in the study group, 11 caesarean sections (CS) and seven ventouses, compared with one CS and three ventouses in the control group (p < 0.05). The frequency of operative deliveries for fetal distress (ODFD) was higher among the women with verified IUGR (14/50) than in the controls, where the corresponding figure was 3/30. No side effects were observed. We conclude that strict intracervical application of 0.5 mg PgE2 is a safe and effective method for cervical ripening and labor induction in women with IUGR.
Comparison Between Cytobrush® and Papaplast® in Sampling Vaginal Smears
Authors: Hjersing Mats , Holm Erik , Larsson Goran
Published: November 2007

The ability of Cytobrush® and Papaplast® to collect endocervical cells in vaginal smears was tested in a prospective randomized comparative study including 107 women. Endocervical cells were found more often and in greater numbers with Cytobrush, also in women over 50 years of age. Papaplast missed endocervical cells twice as often as did Cytobrush. The use of the latter instrument meant that the number of repeat smears necessitated due to the absence of endocervical cells could be considerably reduced, with consequent improvement in the cost/benefit ratio.
Long‐term treatment with transcutaneous estradiol and oral medroxyprogesterone acetate
Authors: Pedersen O. Due , Jensen H. Kålund
Published: November 2007

In an open prospective study with therapeutic monitoring, 34 women with climacteric symptoms, FSH>40 IU/L and LH>25 IU/L were treated for 12 months with an cstradiol‐depot‐patch (Estraderm TTS) SO micrograms twice a week and medroxyprogesterone acetate 10 mg tablets from 12th to 25th day of cycle. During the first months a significant improvement was seen in hot flushes and other climacteric inconveniences in terms of Kupperman's menopause index.

During the study period FSH and LH were suppressed and the estrogen values were normalized. The fraction of free estradiol compared to protein bound estradiol remained unchanged during the whole treatment.

The serum‐lipids and serum‐SHBG at inclusion were within normal limits and did not change during 12 months of treatment. Thus from these parameters no sign of any liver induction was seen. Ten patients had short term skin symptoms while four withdrew from the study because of persistent skin symptoms.

Nine patients withdrew From the study, in five cases this was related to the therapy while in the other four it was due to other causes.

Twenty‐five (74%) women wished to continue the treatment after 12 months.
Choriocarcinoma associated with ectopic pregnancy after tubal sterilisation
Authors: Kocukozkan T. , Savan K. , Aydin E. , Sonmez S. , Duran B. , Kaygi O.
Published: November 2007

A 33‐year‐old highly parous woman developed severe abdominal pain and signs of circulatory collapse 10 months after tubal sterilisation in the absence of symptoms of pregnancy. A ruptured ectopic pregnancy sited interstitially in the right tube and extending into the myometrium and parametrium was found at laparotomy. Histopathologic examination revealed an ectopic pregnancy consisting of choriocarcinoma ‐ a rare but life‐threatening combination in a sterilised woman.
Effects in vitro of progesterone and two 5α‐reduced progestins, 5α‐pregnane‐3,20‐dione and 5α‐pregnane‐3α‐ol‐20‐one, on contracting human myometrium at term
Authors: Löfgren Mats , Holst Juhani , Bäckström Torbjörn
Published: November 2007

Progesterone is known to prevent labour at term in domestic animals, but its effect in primates is uncertain. 5α‐reduced progesterone metabolites are more potent central nervous system depressants than progesterone is itself. Progesterone and its 5α‐reduced metabolites also relax pregnant rat myometrium in vitro. The serum concentration of the initial 5α‐reduced metabolite, 5α‐pregnane‐3,20‐dione, is high during pregnancy, but decreases significantly prior to parturition. The next metabolite, 5α‐pregnane‐3α‐ol‐20‐one, has anaesthetic properties in human beings. The purpose of this study was to ascertain whether these progesterone metabolites also suppress contracting human uterine muscle at term. An in vitro model was devised. Strips of human myometrial muscle were mounted in organ chambers and after regular contractions had become established, the strips were superfused with progestin solutions. The progestins were dissolved in the buffer using an ultrasound bath. Progesterone, used as reference substance, slightly reduced the measured amount of muscular work performed per contraction, recordable after 18 min of exposure (p<0.05). Similar results have been reported previously in the literature; 5α‐pregnane‐3α‐ol‐20‐one showed the same tendency though not significant at the 5% level. 5α‐pregnane‐3,20‐dione evidently reduced the contraction frequency after 10 min of exposure (p<0.05). None of the substances affected the duration of the contraction. These 5α‐reduced progesterone metabolites are thus not potent inhibitors of contracting human term myometrium in vitro.
Emergency cervical cerclage using a metreurynter in patients with bulging membranes
Authors: Higuchi Motokazu , Hirano Hideto , Maki Masahiro
Published: November 2007

Emergency cervical cerclage was performed in 26 women between 18 and 32 weeks of gestation who had fetal membranes bulging through a widely dilated cervix. A bulging bag was pushed into the uterine cavity by a new method, using a metreurynter. The average prolongation of pregnancy after the operation in the 26 women was 41 days (ranging from 2 to 115 days). All pregnancies resulted in the live birth of altogether 28 babies. The neonatal survival rates at gestational ages of ≤26 (including two sets of twins), 27–29, and ≥30 weeks at the time of cervical cerclage were 80.0 (12/15), 85.7 (6/7), and 100% (6/6), respectively. Ten (83.3%) of the 12 infants who survived from patients receiving cerclage at a gestational age of ≤26 weeks are alive and well. The average duration of pregnancy after cerclage was 60 days when cervical dilation was ≤5 cm at operation, in contrast to 5.4 days in patients with cervical dilation of ≥6 cm, suggesting that emergency cervical cerclage could be suitable in the presence of a cervical dilation of 5 cm or less.
Doppler blood flow changes and placental morphology in pregnancies with third trimester hemorrhage
Authors: Malcus Peter , Laurini Ricardo , Marŝál Karel
Published: November 2007

Combined real‐time ultrasound and pulsed Doppler ultrasound examinations were performed in 67 patients with third trimester hemorrhage and other symptoms related to placental abruption, starting from the onset of symptoms to delivery. In 52 of the cases, placental morphology was investigated by light microscopy. Thirteen patients were ultimately given the diagnosis abruptio placentae. None of the morphological placental changes considered had any statistical relationship to placental abruption. Patients with placental centrocotyledon hemorrhages and infarction more often had abnormal umbilical artery flow velocity waveforms at the onset of symptoms, and more frequent abnormal arcuate artery flow velocity waveforms were found among those with placental infarction alone. Abnormal flow velocity waveforms in the umbilical and arcuate arteries were associated with placental abruption, both at the onset of symptoms and at the final examination before delivery. The results indicate an increased risk for placental abruption if the arcuate and/or umbilical artery flow velocity waveforms are abnormal in patients with third trimester hemorrhage.
Effect of predilatation of the uterine cervix by laminaria tent on activity of the placenta
Authors: Jonasson Aino , Pschera Helmut , Carlström Kjell
Published: November 2007

Serum concentrations of hCG were determined in blood samples taken 18–20 h and immediately before vacuum aspiration in 45 women in gestational weeks 7–9, admitted for legal abortion. In 35 of the women, a laminaria tent was inserted for cervical dilatation immediately after the first blood sampling. Serum hCG values decreased significantly in the women pretreated with laminaria tent, but were unchanged in the untreated women. This finding may indicate that pretreatment with a laminaria tent induces a partial placental detachment.
Description, evaluation and clinical decision making according to various fetal heart rate patterns
Authors: Lidegaard Øjvind , Bøttcher Lars Meinert , Weber Tom
Published: November 2007

At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter‐observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline and the presence of silent or sinusoidal pattern (87–94% on an arbitrary 0–100% scale), and low regarding the assessment of variability and type of deceleration (50–72%). The degree of agreement in interpreting heart rate patterns was 59% (on an arbitrary 0–100% scale). Senior residents generally interpreted the changes as indicative of less serious fetal stress than did their junior colleagues, explaining why junior residents 30% more frequently than their older colleagues found an indication for Cesarean section. Relatively low regional inter‐observer agreement scores were primarily due to low agreement between departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising prospect.
Gestational choriocarcinoma in a tubal ectopic pregnancy
Authors: Bakri Younes N. , Amri Aladin , Mulla Jalila
Published: November 2007

A case is reported of a gestational choriocarcinoma arising in a tubal ectopic pregnancy of 7 weeks' gestation. Unilateral salpingectomy and single‐agent actinomycin‐D chemotherapy achieved a cure. A follow‐up 4 years later revealed no evidence of recurrence, with two normal births within that period. The current trend to treat ectopic pregnancy by conservative surgery necessitates monitoring of β‐HCG titres in order to avoid missing a choriocarcinoma developing in an ectopic gestation, even though this is a very rare condition.
Polymerase chain reaction and direct DNA tests in detection of human papillomavirus (HPV) DNA in cytologically normal and abnormal cervical smears: From the Scandinavian Multicenter Study Group
Authors:   SCANDINAVIAN MULTICENTER STUDY GROUP, Kallio Arja
Published: November 2007

The detectability of human papillomavirus DNA from cervical smears was studied by DNA tests of varying sensitivity. The results were correlated with cervical cytologic abnormalities. A total of 326 women examined at the gynecological outpatient clinics of five Scandinavian hospitals were enrolled in the study on the basis of previous pathological cervical smear or clinically suspected human papillomavirus (HPV) infection. The cervical smears were examined for HPV‐DNA of types 6/11, 16 or 18 by two direct DNA tests, the AffiProbe HPV test and the ViraType test. The proportion of HPV‐DNA‐positive women with normal cytology, benign atypia (mild nuclear and cytoplasmic changes without signs of dysplasia) and dyskaryosis were 16% (12/77), 27% (42/156) and 37% (30/81), respectively. The smears negative for HPV types 6/11, 16 or 18 and those yielding discrepant results in the two commercial tests were also analysed by the polymerase chain reaction (PCR) method. By PCR analysis, the HPV 6/11, 16 or 18 DNA positivity increased from 27% to 41%. The increase was particularly pronounced among the women with dyskaryosis in cytology.
Pseudotumors of the umbilical cord and fetal membranes
Authors: Clausen Ingo , Thomsen Sten Grove
Published: November 2007

Antenatally diagnosed pseudotumors, i.e. non‐neoplastic tumors, of the umbilical cord and fetal membranes may when scanned by ultrasound have an appearance leading to misdiagnosis. In the present cases, a hematoma in the fetal membranes was interpreted as a chorioangioma, and a cystic mass inside the umbilical cord caused by degeneration of Wharton's jelly was regarded as an omphalomesenteric or allantoic cyst. The two cases are presented. Color Doppler evaluation seems advisable.
Hemodynamic collapse following labetalol administration in preeclampsia
Authors: Olsen Karsten Skovgaard , Beier‐Holgersen Randi
Published: November 2007

On the 3rd day after a cesarean section, because of pre‐eclampsia, blood pressure was still high, oral labetalol 100 mg with an 8‐hour interval was given, followed by 50 mg i. v. administered over 10 min, twice with a 5‐hour interval. The last injection was immediately followed by an atrio‐ventricular tachycardia with massive decrease in blood pressure. The reason for this is discussed.
Contraception after thirty‐five
Authors: Luukkainen Tapani
Published: November 2007

Our knowledge about the safety, the incidence of side effects, and the effectiveness of contraceptive methods for women in premenopause, or during the last decade of their reproductive life, has not been a primary interest for research and development in fertility control. The main purpose of trials for the evaluation of new contraceptive methods is to test their effectiveness, and therefore only women below 38 years of age are accepted. Furthermore, when new methods are being tested, only healthy women are accepted, and those having health problems of almost any kind are excluded. Therefore our knowledge about the contraceptive methods in women over 40 years of age is scanty and comes from trials with a long‐lasting follow‐up on healthy women who can use the method without problems until they are 45 or reach menopause. We have very limited reported information on the use of contraceptives by women who have cardiovascular disease, diabetes, liver problems, etc. Therefore the main body of experience in this review comes from healthy women between 35 and 44. On the other hand, one should remember that these women have a high motivation to use contraceptive methods and therefore the continuation rate in the trials is high. This compensates for the relatively small number of acceptors by giving more women‐years in follow‐up. Continuation rate and the proper use of methods are directly correlated to increase in age, socioeconomical status, and to education of users. Highly educated women in this age group have very low failure rate with almost any method.
Lynestrenol induced therapeutic amenorrhea: Effects of dose reduction on serum sex‐hormones and lipids
Authors: Huovinen Kari J. L. , Lähteenmäki Pekka , Kärkkäinen Joma , Tikkanen Matti J.
Published: November 2007

The effect of reducing the dose of peroral lynestrenol by half on serum sex‐hormone, lipid and lipoprotein status was studied in 21 mentally retarded women with therapeutic amenorrhea (TA). They had previously received 5 or 10 mg peroral lynestrenol daily for periods ranging from 32 to 196 months.

Dose halving of lynestrenol resulted in an increase in serum total testosterone (T) by 16% (p<0.05). sex‐hormone binding globulin (SHBG) by 39% (p<0.01) and high‐density lipoprotein cholesterol (HDL.‐C) by 28% (p < 0.001). Both the mean serum total and free concentrations of norethisterone (NET and tNET) decreased by 60% (p<0,001). The serum concentrations of 17‐beta‐estradiol (E2), its free fractions (fE2) and free T (fT) were not significantly altered. Significant correlations were observed between the change in HDL‐C and the change in T (r = 0.45, p<0.05), between the change in SHBG and the change in T (r = 0.62, p < 0.01), ff (r = 0.43. p < 0.05) and Ez (r = 0.51, p<0.05).

The elevation of HDL‐C was probably caused by the reduced serum NET concentrations. This also resulted in an increase in serum SHBG concentration, which is regarded as an indicator of the overall estrogen/androgen ratio.
Reproductive patterns amoneu Swedish women born 1936–1960
Authors: Högberg Ulf , Sandström Anita , Nilsson Nils Gunnar
Published: November 2007

An analysis was made of a cross‐sectional survey of 4,299 women born in Sweden in the period 19361960, regarding their reproductive performance. Fecundability was only 12% lower for women in the 30–39 year age interval than for women up to 29 years of age. Cumulative pregnancy rates for individual years fell in the range 93–96%. No difference in fecundability could be discerned between women born in 1936–45 vis‐à‐vis 1946–60. Primary and secondary infertility were noted for 6.6% and 11.0% respectively of the entire population surveyed. Primary infertility, more prevalent among those born in 194660, was found to be related to a higher level of education, an urban life style and low age at first coitus. The risk of suffering a spontaneous abortion increased with advancing maternal age.
Consumer's attitude to hysterectomy: The experience of 678 women
Authors: Nathorst‐Böös Jorgen , Fuchs Tommy , von Schoultz Bo
Published: November 2007

A total of 678 women were interviewed about symptoms before as well as advantages and disadvantages after abdominal hysterectomy. Medical complications, side effects, days of hospitalization and some possible differences between supravaginal hysterectomy (SVH) and total hysterectomy (TH) were also investigated. TH had been performed in 79% and SVH in 21% of the women. Leiomyoma was the most frequent diagnosis (79%). Heavy menstrual bleeding and dysmenorrhea were the dominant symptoms before surgery. After the operation, 71% of the women had no subjective gynecological complaints. Relief from heavy bleeding and pain was considered the major advantage and as many as 29% of the women experienced no disadvantage at all with the operation. Regarding sexual life, 39% experienced intercourse as much improved or better and 40% as unchanged. An intraabdominal abscess was more often found postoperatively in patients operated with TH than with SVH but with this exception no objective finding favoured one method more than the other. When new, alternative treatments such as endometrial ablation and GnRH analogues are introduced and promoted they should be subjected to careful evaluation and compared with the therapeutic efficacy of hysterectomy.
Rupture of rudimentary horn pregnancy
Authors: Chang Jong‐Chou , Lin Yih‐Chi
Published: November 2007

A rare case of rupture of an noncommunucating rudimentary horn pregnancy is reported. The pregnancy proceeded to 25 gestational weeks, when the rudimentary horn ruptured. The patient had signs and symptoms of massive hemoperitoneurn. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn and the fetus was lying free in the peritoneal cavity, was delivered breech and died 2 hours later. This reproductive complication was treated successfully by prompt exploratory laparotomy. Some of the factors associated with pregnancy in a rudimentary horn are discussed.
Primary non‐Hodgkin lymphoma of the vulva
Authors: Marcos Cristlna , Martinez Luis , Esquivias José Javier , Rosales Miguel Angel , Khoury Jean , Herruzo Alfonso
Published: November 2007

We report a rare case of non‐Hodgkon lymphoma located in the vulva. The diagnosis was supported by the cytological anomalies in material obtained by fine needle aspiration. The tumor was removed with wide excision, and the paticnt was alive and in good health ten months after surgery.
Pheochromocytoma and pregnancy: Report of three cases
Authors: Bakri Younes N. , Ingemansson Stlg E. , Ali Ashraf , Parikh Shirish
Published: November 2007

Three cases of pheochromocytoma associated with pregnancy are reported. Two patients had adrenal pheochromocytoma coexistent with normal pregnancy and one patient had a bladder pheochromocytoma coexistent with molar pregnancy (gestational trophoblastic disease). The diagnosis was made antenatally in the two normal pregnancy patients, both underwent planned tumor resection, one at mid‐trimester, complicated by postoperative miscarriage, while the other had tumor resection during cesarean section at term. Bladder pheochromocytoma, preoperatively mistaken for invasive trophoblastic tumor, was resected at the time of planned abdominal hysterectomy for molar pregnancy, pheochromocytoma was recognized only after microscopic study of the rcscctcd bladder tumor. The three patients survived with no evidence of disease.
Ovarian twin pregnancy
Authors: Ohba Takashi , Miyazaki Kohji , Kouno Takashi , Okamura Hitoshi
Published: November 2007

Ovarian twin pregnancy is quite uncommon. We present a case of an ovarian twin pregnancy associated with pelvic endometriosis. The ultrasonographic findings in our case were similar to those of malignant ovarian tumor. Five cases of ovarian twin pregnancy, including this case, are reviewed.
Locked twins: a successful outcome
Authors: Chia Kee Vui , Jayaratne Tilak
Published: November 2007

Twin interlocking is a rare complication that has a high fetal mortality and morbidity rate. We report a successful outcome of locked twins at 32 weeks gestation following spontaneous labor.
Maternal septicemia with Listeria monocytogenes in second trimester without infection of the fetus
Authors: Frederiksen Birgitte
Published: November 2007

Two cases of scpticcmin with Listeria monocytogenes in two pregnant women at the 20th and 23rd weeks of pregnancy, respectively, are prcsented. The women had delays of 8 and 10 days from onset of symptoms to diagnosis and adequate treatment. Outcome was favorable; both women delivered healthy infants at term.
Conservative treatment of mild and moderate hypertension in pregnancy
Authors: Hjertberg Ragnhild , Belfrage Patrick , Hanson Ulf
Published: November 2007

In a prospective study regarding conservative treatment of mild to moderate hypertension in pregnancy 5244 women were evaluated at delivery. Two hundred and fifty‐eight (4.9%) were registered as hypertensive during pregnancy with a blood pressure (BP) ± 140190 mmHg. One hundred and ninety‐six of these continued their pregnancy without medication and 96/196 were defined as preeclamptic (PE), 45/196 as chronic hypertensive (CH), and 55/196 as having gestational hypertension (GH). In 621258 women anti‐hypertensive treatment was initiated in the mean 6.5 (± 8.7) days after onset of hypertension, due to a BP ± 150/100 mmHg. There was a later onset of hypertension in the untreated group, and BP at delivery differed in the untreated groups (p < 0.001) with the lowest BP in women with mild GH. There was no difference in cesarean section rate in the mild hypertensive group as compared to the normal population. Birth weight and length of pregnancy were significantly lower in the untreated mild hypertensive group as compared to normal pregnant women (p < 0.05). But in the subgroup with mild GH pregnancy length and birth weight did not differ from normal pregnancy. The conclusion from our study is that women with mild hypertension in pregnancy might refrain from antihypertensive therapy if they are closely observed during pregnancy and delivery, especially if there has been no hypertension before pregnancy and no proteinuria develops.
Psychotropic drug use in pregnancy and perinatal death
Authors: Laegreid Liv , Conradi Nils , Hagberg Gudrun , Hedner Thomas
Published: November 2007

The psychotropic drug use in mothers to all 73 perinatally dead infants in the city of Gothenburg, Sweden, in 1985–86, was compared to a control group of mothers to 73 surviving infants. Information regarding medication in pregnancy and pre‐ and perinatal data was collected retrospectively. In addition, serum samples obtained in early pregnancy were screened for benzodiazepines Eighteen case‐mothers used psychotropic drugs during pregnancy compared with 7 control‐mothers. The association between psychotropic drug use and perinatal death was significant (p = 0.01). Psychotropic drug use and maternal disorder were closely correlated, but within the case group there were no significant differences between mothers using or not using psychotropic drugs in terms of age, parity or smoking habits. Although the etiology of death could be discussed in the individual infant, we find it noteworthy that the use of psychotropic drugs was so frequent in the mothers of perinatally dead infants.
Monitoring endometrial adenocarcinoma with a four tumor marker combination: CA125, squarnous cell carcinoma antigen, CA19.9 and CA15.3
Authors: Matorras Roberto , Rodríguez‐Escudero Francisco J. , Diez Javier , Genollá Jose , Fombellida Jose Cruz , Ruibal Alvaro
Published: November 2007

The combined value of four tumor markers, in the follow‐up of endornetrial adenocarcinoma, is analyzed. Cancer antigen 125 (CA 125), squamous cell carcinoma antigen (SCC), carbohydrate antigen 19.9 (CA 19.9) and carbohydrate antigen 15.3 (CA 15.3) were used in 213 evaluations from 105 patients. Sensitivity as regards recurrence or progression of disease was 45% (CA125), 9% (SCC), 51% (CA19.9) and 21% (CA 15.3). Specificities as regards the ‘no evidence of disease’ ranged from 95% to 99%. Single tumor marker efficiency ranged from 90% for CA 125 to 84% for SCC (p = 0.08). With the two tumor marker combination sensitivity increased up to 77% achieved with CA 125‐CA 19.9, but efficiency increased only slightly (92.0% for CA 125‐SCC). In the best three tumor marker combination, a sensitivity of 85% was achieved (CA 125‐CA 19.9‐CA 15.3), and an efficiency of 92.2%. The simultaneous use of the four tumor markers did not improve assay results. The possibility of recurrence or progression of disease in some combinations was very low (4.6% when CA 125 and CA 19.9 negative, 3% when CA125, CA 19.9 and CA15.3 negative), a fact to be considered in order to avoid aggressive management in such cases. The tumor markers were of limited value for the prediction of recurrences. The suggestion of recurrence when the increase in tumor markers was the only finding was confirmed in only 7%, while confirmation was made in 100% when there was another pathological finding.
Comparison of low molecular weight heparin vs. unfractionated heparin in gynecological surgery: II: Reduced dose of low molecular weight heparin
Authors: Borstad Ellen , Urdal Knut , Handeland Grethe , Abildgaard Ulrich
Published: November 2007

In a double blind, randomized trial the hemorrhagic complications of a reduced dose of low molecular weight heparin (LMWH) (Fragmin, KabiPharmacia) were compared to those of the conventional dose of unfractionated heparin (UH). 2500 anti‐XaU of LMWH was given once daily and UH in a dose of 5000 anti‐XaU twice daily. During a one year period 141 patients undergoing gynecological surgery were included in this study. The patients were examined clinically for hematomas and for deep venous thrombosis (DVT) on the third and fifth day. Venography was performed when DVT was suspected. No patients developed clinical DVT. One woman in the LMWH group had pulmonary embolism 3 days after the prophylaxis was stopped. Two women in the LMWH group died, one from a stroke on day 2, one from cancer on day 39. There was no significant difference in serious bleeding complications between the two regimens, 20% in the LMWH group and 14% in the UH group. Even with the reduced dose of LMWH the mean plasma concentration of heparin in the LMWH group was higher (mean 0.14 anti‐XaU/ml) than in the UH group (0.029 anti‐XaUlml) 3 hours after injection on the 2nd postoperative day. A reduced dose of LMWH (2500 anti XaU once daily) does not cause more bleeding complications than the conventional heparin rcgimen to prevent thrombosis, as was the case in our previous study with 5000 anti Xa17 of LMWH once daily.
Choriocarcinoma of the cervix
Authors: Lee Jing‐Der , Chang Ting‐Chang , Lai Ying‐Ming , Hsueh Swei , Soong Yung‐Kuei
Published: November 2007

The incidence of primary cervical choriocarcinoma is extremely low, with only approximately 60 cases reported. We present a case of primary cervical choriocarcinoma, which was originally mis‐diagnosed as a cervical pregnancy. After failure of conservative treatment with methotrexate, the patient underwent a hysterectomy, followed by chemotherapy with actinomycin‐D. After twenty months of follow‐up, the patient is in good condition and her serum β‐hCG levels are normal.
Quantity and targetting of antenatal care in Finland
Authors: Hemminki Elina , Gissler Mika
Published: November 2007

The paper describes the timing of starting antenatal care and the number of visits and their variation measured against womens’ background characteristics in Finland. The main data source was the 1987 nationwide Medical Birth Registry, while some data were from published statistics and the 1988‐90 Medical Birth Registries. These registries cover all antenatal visits, over 80% of which were to special out‐patient maternity centers. In 1987, women started antenatal care early (22% before the eighth and 4% in the 16th or later gestation weeks), and the number of visits was high (mean 15.2 visits). Use of antenatal services has been high at least since the early 1970s. Women coming early (<8 weeks) and at average time (8‐12 weeks) were similar to each other, but women coming late (< 12 weeks) were more often socially disadvantaged and had had more previous births, both in analyses stratified by parity, and in logistic regression analyses adjusting for various confounders. When the relative numbers of visits adjusted for gestation length were considered, the differences between the women with many and few visits were similar to the differences between early and late comers. Timing of starting antenatal care did not correlate with the pregnancy outcome. Women having many visits, adjusted for gestation, had poorer outcomes than women with average visits, and women with few visits were in between.
Pushing method in the expulsive phase of labor: A randomized trial
Authors: Parnell Christine , Langhoff‐Roos Jens , Iversen Randi , Damgaard Pia
Published: November 2007

Background. Pushing in the second stage of labor can be forced or follow the spontaneous urge to bear down. Recent studies have shown that spontaneous pushing results in a longer second stage, fewer CTG changes, higher arterial pH and less damage to the birth canal. Method. Randomized trial of spontaneous vs. forced pushing in 350 primiparous women. Results. There was no difference between the randomized groups in duration of second stage of labor, umbilical arterial pH or damage to the birth canal. Of the women allotted to spontaneous pushing, 65.6% used the closed glottis technique for more than half the expulsive phase. When dividing the women into two groups according to the actual pushing technique used most, open or closed glottis, it turned out that women who used the open glottis technique had a shorter second stage of labor and gave birth to infants with lower birth weight.

Conclusion. Recommending of spontaneous bearing down during the expulsive phase of labor did not result in a significant difference in duration of the second stage of labor, fetal arterial pH or less damage to the birth canal. Women who chose the open glottis technique had a shorter expulsive phase and gave birth to smaller infants than those who used the closed glottis technique.
Induction of abortion in early pregnancy with mifepristone in conjunction with gemeprost
Authors: Somell Christina , Ölund Anders
Published: November 2007

This study was performed to investigate the efficacy of oral mifepristone and vaginal gemeprost for termination of early pregnancy. Eighty women requesting first trimester abortion and with amenorrhea of less than 56 days were included. Gestational age was confirmed with ultrasonography. Mifepristone was administered as a single 600 mg dose followed after 48 hours by a vaginal pessary containing 1 mg gemeprost. One woman did not return for gemeprost and later had a vacuum aspiration performed. There was complete abortion in all remaining women. No serious side effects were registered and the number of women requiring opioid analgesia was low (8%). The conclusion is that this treatment is a genuine alternative to vacuum aspiration but medical supervision is necessary for some time after gemeprost administration.
A modified Raz bladder neck suspension operation: Results of a one to three years follow‐up investigation
Authors: Bosman Gert , Vierhout Mark E. , Huikeshoven Frans J. M.
Published: November 2007

Objective: Long term follow‐up study of stress incontinence operations shows a declining success rate in time, especially for the needle suspension technique. We evaluated the long term results of a modified bladder neck suspension operation.

Methods: From 01‐12‐87 till 01‐12‐89 a total of 42 modified Raz bladder neck suspensions for stress incontinence were performed. Early evaluation at three months had shown a cure rate of 93%. Long term (mean 27 months) results were evaluated using a questionnaire.

Results: Follow‐up of 41 patients showed that ten patients (24%) were cured. Fourteen (34%) considered their situation improved and acceptable, despite mild incontinence. Seventeen patients (40%) considered their situation still unacceptable, half of them (nine patients, 21%) had another operation for incontinence done within two years.

Conclusions: We conclude that this one to three years follow‐up shows that the modified Raz bladder neck suspension, in our hands, has, in spite of a good short term result, a relatively low long term success rate.
High serum ferritin post partum: An acute phase reaction
Authors: Haram Kjell , Sandberq Sverre , Ulstein Maqnar
Published: November 2007

The purpose of the study was to examine the cause of the increased serum ferritin post‐partum observed previously. B‐hemoglobin, B‐leucocytes, S‐ferritin, erythrocyte protoporphyrin and S‐orosomucoid were dermined in the blood of 21 pregnant women in the 39th week of pregnancy, two to four days and six weeks after delivery. The S‐ferritin was increased from 12.1 μg/1 at the 39th week of pregnancy to 30.1 μg/1 post‐partum. The probable reason for this increment is an acute phase reaction since a rise in the concentration of S‐orosomucoid and B‐leucocytes were concurrently observed.
Unrecognized perforation of the uterine and rectal walls by an intrauterine contraceptive device
Authors: Søgaard Kirsten
Published: November 2007

A case of IUD perforation of the uterus to the rectum is described, the perforation not being recognized for 13 years. A way of handling ‘the missing IUD’ is outlined.
Gonadal dysgemiinoma‐seminoma associated with severe hypercalcemia
Authors: Bakri Younes N. , Akhtar M.
Published: November 2007

A case is reported, of a 25‐year‐old phenotypic female, karyotypic male patient with metastatic gonadal dysgerminoma‐seminoma and severe hypercalcemic paraneoplastic syndrome. Patient manifested normal female external genitalia, vagina, uterus, and fallopian tubes but with 46 XY karyotype. Adnexal gonads were calcified. External beam radiation therapy resolved the hypercalcemic state. Exploratory laparotomy after irradiation revealed gonado‐blastoma originating from dysgenetic gonads.
Bone loss, contraception and lactation
Authors: Mehta Suman
Published: November 2007

Loss of bone mass with age, is a universal phenomenon and is more pronounced in women than in men. The condition where the bone loss has proceeded to the extent that fractures occur is termed osteoporosis. As the number of elderly persons in the population increases, its magnitude is likely to increase, both in the developing and the developed countries.

Bone mass increases rapidly in childhood and the adolescent years, reaching a peak in the third decade of life, and begins to decline soon thereafter. Several factors are thought to influence bone loss: these include race, diet, smoking, and physical exercise. Although the rate of bone loss accelerates in the immediate postmenopausal period, the process actually begins in the premenopausal years. By the time osteoporosis is clinically apparent and manifested by fracture, it probably cannot be reversed. The peak adult bone mass achieved, and the subsequent rate of bone loss are the major factors that determine a woman's susceptibility to postmenopausal osteoporosis. A primary cause of bone loss after menopause is the associated decline in ovarian function.

Scanty information is available on the factors that affect bone mineral density or initiate bone loss before menopause, although both estrogens and progestins have been shown to prevent bone loss in postmenopausal women.

Available data on the relationship between steroid hormone contraceptive use and bone massldensity is limited to combined oral contraceptives and one report related to the use of depot medroxy progesterone acetate. While there are several studies which show that oral contraceptive preparations have a beneficial effect on bone mass, there are many other studies which fail to demonstrate such an effect. The divergent findings from the research to date reflect the dificulties in controlling not only for the many variables in studies based on small numbers, but also drawing inferences from studies which were undertaken during periods when changes in pill dosages/ formulations occurred and diagnostic techniques improved, plus the complex nature of the disease itself. It is not yet clearly understood if the possible protection conferred by steroidal contraception persists throughout the postmenopausal years — a period when there is acceleration of bone loss and whether or not this beneficial effect is specific to the trabecular bone which is more sensitive to metabolic influences.

The effect of lactation on bone mass is not well understood. (Cross‐sectional and longitudinal studies report conflicting effects, both beneficial and adverse.) The association may be mediated not only through intake of calcium during lactation, the duration of lactation, and age at lactation, but the anatomic site and the technique employed to measure bone mass are important considerations. No single study has addressed all these factors together. Most of them have dealt with small numbers of subjects with low statistical power to detect small or even medium changes in bone maddensity.
Inter‐ and intra‐observer variation of colpo‐cysto‐urethrography diagnoses
Authors: Mouritsen Lone , Strandberg Charlotte , Jensen Anette Reimer , Berget Arne , Frimodt‐Møller Cai , Folke Kirsten
Published: November 2007

To evaluate the reliability of diagnosing type of bladder suspension defect in incontinent women by means of voiding colpo‐cysto‐urethrography (CCU), 93 CCU‐series with exposures at rest, coughing, withholding and voiding were diagnosed. Three senior and one junior radiologists, a gynecologist and a urologist diagnosed the CCU‐series twice with 3‐6 months interval. The main diagnostic possibilities were anterior bladder suspension defects, posterior defects and normal, which were in accordance with general practice of choosing an abdominal suspension operation for the anterior suspension defects and a vaginal operation for the posterior defects. The intra‐observer agreement varied between 99% and 72%, i.e. 1/5 to 1/ 4 of the patients changed from one main diagnostic group to another at the two examinations. The inter‐observer agreement varied between 43% and 60%. Information of clinical patient data, given to the two clinicians, did not change their CCU‐diagnoses significantly. We concluded, that CCU should not be recommended as a routine for evaluation of type of suspension defect since the intra‐inter‐observer variation was around 25% and 50% respectively. CCU might still be useful preoperatively in selected cases, since it gives an excellent visualisation of bladder base anatomy.
Prognostic factors related to recurrent endometrial carcinoma following initial surgery
Authors: Vavra Norbert , Denison Ursula , Kucera Herwig , Barrada Monir , Kurz Christine , Salzer Heinz , Sevelda Paul
Published: November 2007

Site of recurrence and histological type are significant prognostic factors for survival in recurrent endometrial carcinoma.

The aim of this retrospective analysis of 56 patients suffering from recurrences of endometrial carcinoma following initial surgery was to establish the prognostic relevance that the following factors had on the survival rate: age, primary tumor stage, histological assessment (papillary vs non‐papillary), postoperative adjuvant radiation therapy, recurrence free interval (<24 months, >24 months) and localisation of recurrence. The univariate analysis showed a significantly longer median survival time after recurrence for the following parameters: local recurrence vs extra vaginal recurrence (77.5 months vs 15.7 months, p=0.02), non‐papillary vs papillary carcinoma (36.1 months vs 7.7 months, p=0.02), no adjuvant irradiation vs adjuvant irradiation (82.0 months vs 8.8 months, p = 0.007). Patients after adjuvant radiation treatment and patients suffering from papillary carcinomas have a significantly higher proportion of patients with distant metastasis (patients with adjuvant radiation treatment: Chi‐square test: p = 0.001; patients suffering from papillary carcinomas: p=0.033).

In the case of local recurrences, a three year survival rate of 54% can be achieved with radiation treatment. Recurrences of papillary endometrial carcinomas and patients suffering from distant metastasis on the other hand, show very low survival rates if they are treated with radiation therapy (papillary carcinomas: three‐year survival rate of 18%, patients suffering from distant metastasis: 19%). These patients should be included in randomised studies with a view to examining the therapeutic effects of either additional or exclusive treatment with chemotherapy.
Abdominal sacral colpopexy with use of synthetic mesh
Authors: Losif Constantin S.
Published: November 2007

Forty patients with post‐hysterectomy vaginal vault prolapse underwent surgery at Lund University Hospital between 1983 and 1991. The standard procedure was an abdominal colposacropexy, using Marlex mesh in 25 cases and Gore‐Tex mesh in 15. There were no intraoperative complications. One patient developed a recurrent vault prolapse and one patient developed a draining sinus in the vaginal apex. The duration of follow‐up has varied between one and ten years. In 39 of the 40 patients (97%), both subjective and objective improvement has been achieved.
Maternal, fetal and amniotic fluid prolactin levels in term and post‐term pregnancies
Authors: Demir Namik , Celiloglu Murat , Thomassen Peter A. B. , Onvural Ata , Erten Oktay
Published: November 2007

Prolactin (PRL) levels in maternal serum, amniotic fluid and mixed cord blood from 11 women with post‐term pregnancies and 64 women with normal term pregnancies were measured by immunoenzymetric assay in order to investigate their possible role in the onset of labor. No differences were found between term and post‐term pregnancies, and it is concluded that PRL probably has no function in triggering labor.
Vulvar leiomyoma
Authors: Neri Alexander , Peled Yoav , Braslavski Diana
Published: November 2007

Since symptoms of benign and malignant conditions in the vulvar area are frequently similar, early diagnosis and treatment are mandatory. A rare case of a bizarre leiomyoma in the area of Bartholin's gland, which presented as a Bartholin's abscess, is described and discussed.
Sacral nervous function, hormonal levels and sexuality in premenopausal women before and after hysterectomy
Authors: Helström L. , Backström T. , Sörbom D. , Lundberg P. O.
Published: November 2007

Objective. To investigate the predictive value of sacral nervous function, result of pelvic examination and hormonal status on sexuality before and after subtotal hysterectomy.

Material and method. One hundred and four women were examined and interviewed one month before and one year after hysterectomy for non‐malignant diseases. Genital examination, sacral nervous function testing including vibrotactility were performed. and sex hormone levels were estimated at each occasion. The results were evaluated and compared using multivariate analyses.

Results. Postoperative experience of multiple orgasm was negatively correlated to three out of five measured factors for pelvic sacral function: i.e. vibrotactility of the clitoris, the external anal reflex and the levator muscle strength. No correlations were found between tests for sacral nervous function and a latent factor for sexuality before and after the operation. Preoperative uterine size did not show correlation to either preoperative or postoperative sexual parameters nor did uterine pain during vaginal examination. The preoperative sex hormone levels, and the result of histopathological examination showed no correlation to sexual variables.

Conclusion. Preoperative somatic findings including sacral nervous function and pelvic muscular strength cannot be used as predictors for sexuality after subtotal hysterectomy.
Endothelin‐1,2 levels in umbilical vein serum of intra‐uterine growth retarded fetuses as detected by cordocentesis
Authors: Schiff Eyal , Weiner Ehud , Zalel Yaron , Mashiach Shlomo , Sibai Baha M. , Shalev Eliezer
Published: November 2007

Introduction: The objective of this study was to determine whether the circulatory levels of endothelins, potent vasoconstrictor polypeptides produced mainly by endothelial cells, are increased in growth‐retarded fetuses.

Study design: Fetal venous serum samples, withdrawn by ultrasound‐guided cordocentesis from 11 growth‐retarded fetuses and 10 normally‐growing fetuses who underwent the procedure because of other unrelated indications, were examined for immunoreactive endothelin‐1,2 by radioimmunoassay.

Results: Higher mean endothelin‐1,2 levels were found in the sera of growth‐retarded fetuses than in controls (16.8 ± 4.2 versus 10.9 ± 4.3 fmol/ml, p = 0.008). Within the growth‐retarded group, there were no differences in endothelin‐1,2 levels in the presence of either abnormal umbilical Doppler, asymmetry of growth‐retardation, maternal signs of preeclampsia, or fetal acidosis.

Conclusion: High levels of endothelin‐1,2 in the fetoplacental circulation may be pathophysiological important in fetal growth retardation. However, the clinical significance of these elevated levels is yet to be determined.
Persistent occiput posterior presentation‐a clinical problem
Authors: Gardberg Mikael , Tuppurainen Marketta
Published: November 2007

In order to find out how often labor is complicated by persistent occiput posterior position, (OPP), and how it affects the course and outcome of labor, the records of 3648 deliveries were reviewed, a frequency of 4.7% was found. Also, the amount of operative deliveries was surprisingly high, less than half of these cases were delivered without operative intervention. Total duration of labor, stage I1 of labor were both significantly longer in the OPP group. The children in the OPP group also were significantly heavier (79 g) than the average birthweight in the whole material.