bluuebunny/crossref_metadata_2025 huggingface dataset:
Tiagabine in treatment refractory bipolar disorder: a clinical case series
Authors: Suppes Trisha , Chisholm Karrie A , Dhavale Dawn , Frye Mark A , Altshuler Lori L , McElroy Susan L , Keck Paul E , Nolen Willem A , Kupka Ralph , Denicoff Kirk D , Leverich Gabrielle S , Rush A John , Post Robert M
Published: March 2003

Objectives:  Anticonvulsants have provided major treatment advances for patients with bipolar disorder. Many of these drugs, including several with proven efficacy in bipolar mania or depression, enhance the activity of the γ‐amino butyric acid (GABA) neurotransmitter system. A new anticonvulsant, tiagabine, has selective GABAergic activity and is approved for patients with partial epilepsy. Few reports of its potential effectiveness in bipolar disorder, however, have been published. We sought to evaluate the effectiveness of tiagabine added to ongoing medication regimens in patients with bipolar disorder inadequately responsive to or intolerant of usual treatments.

Methods:  Seventeen treatment‐refractory patients participating in the Stanley Foundation Bipolar Network (SFBN) long‐term follow‐up study were offered open treatment with add‐on tiagabine after discussion of the risks, benefits, other treatment options and giving informed consent. Patients’ clinical symptoms and somatic complaints were closely monitored with SFBN longitudinal and cross‐sectional ratings. Four patients discontinued low‐dose tiagabine prior to the second visit and were excluded from data analysis.

Results:  Thirteen patients received a mean of 38 days of treatment at a mean dose of 8.7 mg/day of tiagabine. On the Clinical Global Impression Scale for Bipolar Disorder Overall category, three (23%) patients showed much or very much improvement and 10 (77%) patients showed no change or worsening. Three significant adverse events were noted, including two presumptive seizures.

Conclusions:  Open add‐on tiagabine for treatment‐refractory patients with bipolar disorder demonstrated limited efficacy with the majority of patients showing no change or worsening of clinical symptoms. In addition, patients experienced serious side‐effects attributed as likely due to the medication, which resolved without lasting consequence when tiagabine was discontinued.
Gabapentin augmentation therapy in bipolar depression
Authors: Wang Po W , Santosa Claudia , Schumacher Matthew , Winsberg Mirène E , Strong Connie , Ketter Terence A
Published: March 2003

Background:  Gabapentin (GBP) may be useful in bipolar disorders, including as adjunctive therapy for bipolar depression, although controlled studies suggest inefficacy as primary treatment for mania or treatment‐resistant rapid cycling.

Methods:  We performed a 12‐week trial of open GBP (mean dose 1725 mg/day) added to stable doses of mood stabilizers or atypical antipsychotics in 22 (10 women, mean age 38.4 years) depressed [28‐item Hamilton Depression Rating Scale (HDRS) >18] bipolar (10 bipolar I, 12 bipolar II) disorder outpatients. Mean illness duration was 18.6 years; current depressive episode duration was 18.0 weeks. Prospective 28‐item HDRS, Young Mania Rating Scale (YMRS) and Clinical Global Impression – Severity (CGI‐S) ratings were obtained.

Results:  Overall, HDRS ratings decreased 53% from 32.5 ± 7.7 at baseline to 16.5 ± 12.8 at week 12 (p < 0.0001). Twelve of 22 (55%) patients had moderate to marked improvement (HDRS decrease=50%) with HDRS decreasing 78% from 27.9 ± 6.2 to 6.2 ± 4.5 (p < 0.0001). Eight of 22 (36%) patients remitted (HDRS≥8). In non‐responders, HDRS decreased from 38.0 ± 5.4 to 28.9 ± 6.7 (p=0.005). Ten of 13 (77%) mild to moderately depressed (baseline HDRS >18 and <35) patients responded, while only two of nine patients (22%) with severe depression (HDRS ? 35) responded (p < 0.03). Both groups, however, had similar, statistically significant HDRS decreases. GBP was well tolerated.

Conclusion:  Open adjunctive GBP was effective and well tolerated in patients with mild to moderate bipolar depression. This open pilot study must be viewed with caution, and randomized controlled studies are warranted.
The Maudsley bipolar disorder project. A survey of psychotropic prescribing patterns in bipolar I disorder
Authors: Frangou Sophia , Raymont Vanessa , Bettany David
Published: March 2003

Objectives:  The outcome of Bipolar 1 Disorder (BD1) is greatly dependent on the adequacy and appropriateness of its treatment. As the treatment choices in BD1 disorder are increasing the aim of this study was to examine the current use of the pharmacological agents in BD1 patients and its association with clinical characteristics.

Methods:  Case note review of the pharmacotherapy of a sample of BD1 patients from a specified South London sector of a National Health Service Trust.

Results:  Half of the patients were on mood‐stabilizers (usually lithium) and their use was associated with female gender and multiple admissions. Antipsychotics were more commonly used in patients with psychotic features and multiple manic episodes. Antidepressants were rarely prescribed alone and were not associated with increased number of manic episodes. Combination treatments were mostly used in patients in acute episodes and with multiple hospitalizations.

Conclusions:  In ordinary care, the treatment of BD1 is often driven by symptoms and falls short of the existing practice guidelines.
Subtraction libraries for the molecular characterization of gene–environmental interactions in bipolar disorder
Authors: Yolken Robert H
Published: March 2003

Yolken RH. Subtraction libraries for the molecular characterization of gene–environmental interactions in bipolar disorder.  Bipolar Disord 2002: 4(Suppl. 1): 77–80. ©Blackwell Munksgaard, 2002

Objectives:  We endeavoured to identify gene–environmental interactions related to bipolar disorder.

Methods:  We generated subtraction libraries from the frontal cortex of brains obtained postmortem from individuals with bipolar disorder and age‐ and sex‐matched unaffected controls.

Results:  There are a number of RNA transcripts which are apparently up‐regulated or down‐regulated in the frontal cortex of individuals with bipolar disorder as compared with the controls. Many of these transcripts are involved in processes crucial to brain function. Several are also related to pathways involved in infections or the inflammatory response in environmental stimuli.

Conclusions:  Bipolar disorder may involve a complex set of interactions between genes which affect brain function and infections which control the expression of these genes.
Transcranial magnetic stimulation in patients with bipolar depression: a double blind, controlled study
Authors: Dolberg OT , Dannon PN , Schreiber S , Grunhaus L
Published: March 2003

Dolberg OT, Dannon PN, Schreiber S, Grunhaus L. Transcranial magnetic stimulation in patients with bipolar depression: a double blind, controlled study.  Bipolar Disord 2002: 4(Suppl. 1): 94–95. © Blackwell Munksgaard, 2002
Interferon‐alpha, cytokines and possible implications for mood disorders
Authors: Schaefer Martin , Schmidt Folkart , Neumer Ruth , Scholler Gudrun , Schwarz Markus
Published: March 2003

Schaefer M, Schmidt F, Neumer R, Scholler G, Schwarz M. Interferon‐alpha, cytokines and possible implications for mood disorders.  Bipolar Disord 2002: 4(Suppl. 1): 111–113.  © Blackwell Munksgaard, 2002
Fetal fibronectin as a predictor of term labor:
Authors: KISS HERBERT , AHNER REGINE , HOHLAGSCHWANDTNER MARIA , LEITICH HARALD , HUSSLEIN PETER
Published: March 2003

Objective. Accurately predicting the onset of delivery continues to be problematic notwithstanding the clinical relevance of this capability, especially with regard to the elective induction of labor. While the assessment of the cervix according to Bishop, to date, constitutes the single generally recognized method, the determination of fetal fibronectin (FFN) cervicovaginal secretions promises greater precision in this context.

Design. English‐language medical literature was analyzed using the search parameter ‘fetal fibronectin’, ‘term delivery’, ‘induction of labor’, ‘labor’, and ‘birth’, respectively. All those original reports examining cervicovaginal FFN that were originally published in English and followed a prospective design were subsequently included in the study at hand. These reports were evaluated in regard to their findings on the predictive value of FFN for spontaneous delivery and induction of labor.

Results. A total of eight reports were included in the present study: five of these, covering a total of 480 patients, discussed the relationship between FFN and the spontaneous onset of labor; the other three addressed the subject of FFN and the induction of labor (300 patients). All reports clearly related the presence of FFN in cervicovaginal secretions to the imminent onset of delivery; three studies, furthermore, demonstrated a correlation with the spontaneous onset of labor, with a sensitivity greater than 90%. In case of the studies concerning induction of labor, a positive FFN result was accompanied by a significantly shorter interval until delivery than a negative FFN result.

Conclusion. Determining the presence of FFN in cervicovaginal secretions promises to provide an indicator relating to the prediction of term labor, as well as to the prediction of successful labor induction.
Shoulder dystocia – malpractice or acceptable risk?
Authors: SKOLBEKKEN JOHN‐ARNE
Published: March 2003

Background. In 1988 a new patient insurance system was introduced in Norway. It was initially described as an ‘objectified’ system, similar to one based on the no‐fault principle. Early doubts were raised about the system's status, as it contains rules stating that compensation will not be given if the medical intervention is adequate and the involved risk is acceptable. This study was undertaken to examine the practice of these rules.

Methods. An archival study was performed on the 41 shoulder dystocia cases that had been closed in the decade from 1988–1997. These cases were selected as shoulder dystocia was found to be the obstetrical event most often leading to a decision on acceptable risk.

Results. The most common injury in these cases was Erb's palsy, but fatalities and brain injuries were also observed. Compensation was given in nine cases, whereas it was denied due to an acceptable medical risk in the remaining cases. Indications of inconsistency among the reached decisions were found, and judged to be a result of differences of opinion between expert witnesses on the adequacy of the obstetrical practice.

Conclusions. Doubts are raised as to whether similar decisions are reached in similar cases. Shoulder dystocia may be an acceptable risk in the sense that it is hard to predict and prevent. Whether the consequences of such a risk should be compensated, remains a political and economical issue. Present thinking leads to decisions that create a divide between the lucky unlucky and the plainly unlucky.
Vulvar vestibulitis: medical, psychosexual and psychosocial aspects, a case‐control study
Authors: DANIELSSON INGELA , SJÖBERG INGA , WIKMAN MARIANNE
Published: March 2003

Background. Vulvar vestibulitis is suspected to be increasingly prevalent among young women, but the etiology is still unclear. The aim of this study was to explore the differences in medical, psychosexual and psychosocial factors between women with vulvar vestibulitis and a control group.

Methods. A case‐control study was made with 38 women with vulvar vestibulitis and 71 healthy age‐matched controls. All the women answered a structured questionnaire about their medical and gynecological history which included psychosexual and psychosocial background factors and current aspects as well.

Results. Women with vulvar vestibulitis have very much the same psychosocial and sexual background factors as their controls, whereas there are many differences in their medical background factors, both gynecological and others. It is very clear that they suffer from many other somatic symptoms more often than their controls.

Conclusions. There are no indications of a primary sexual disturbance in women with vulvar vestibulitis. However, the finding that women with vulvar vestibulitis have many different somatic symptoms indicates a psychosomatic strain in the illness. Regardless of whether this is primary or secondary, it should be taken into consideration when treating the patients.
Pro et contra pelvic floor exercises for female stress urinary incontinence
Authors: MOURITSEN LONE , SCHIØTZ HJALMAR A.
Published: March 2003

Pelvic floor exercises are now established as a first line treatment for female urinary stress incontinence. This treatment modality can give substantial improvement in many patients. However, the incontinence is often not completely cured and the treatment requires a long term effort by the patient, which many are unable or unwilling to make. This paper discusses the pros and cons of pelvic floor exercises for stress incontinence and offers some guidelines for the selection of patients while emphasizing the importance of guided, intensive exercises and motivation to achieve the treatment goal.
The prevalence of urinary incontinence
Authors: MILSOM IAN
Published: March 2003

Urinary incontinence is one of the most important health problems confronting modern society. More than 50 million men and women throughout the world are afflicted. Population studies have demonstrated that approximately 10% of all women suffer from urinary incontinence. Prevalence figures increase with increasing age and in women aged ≥70 years more than 20% of the female population are affected. Urinary incontinence not only causes considerable personal suffering for the individual afflicted but is also of immense economic importance for the health service. The annual cost of urinary incontinence in Sweden in 1990 accounted for 2% of the total health care costs.
Apolipoprotein D expression in endometrial carcinomas
Authors: Rojo Julio Vázquez , González Luis O. , Lamelas Maria L. , Merino Antonio , Vizoso Francisco
Published: March 2003

Background. Apolipoprotein D is a protein component of the human plasma lipid transport system but is also associated with a more favorable prognosis in breast cancer and ovarian cancer women. This study was undertaken to examine the tumoral expression of apolipoprotein D in endometrial cancer and to analyze the possible correlation with tumor and patients characteristics as well as androgen receptors and its prognostic significance.

Methods. Immunohistochemical evaluation was used to examine apolipoprotein D expression in paraffin blocks from 58 endometrial carcinomas.

Results. A total of twenty (34%) tumors stained positively. Staining was localized in tumor cells. No significant correlation was found between apo D expression and patients or tumor characteristics and androgen receptor status. In addition, apolipoprotein D expression was not associated with patient prognosis.

Conclusions. Apolipoprotein D is expressed by a significant percentage of endometrial carcinomas without apparent association with other clinicopathologic parameters or with outcome of patients.
Twin pregnancy: the role of ultrasound in management
Authors: Sperling Lene , Tabor Ann
Published: March 2003

Determination of chorionicity is one of the most important issues in the management of twin pregnancy.

Modern ultrasound equipment has made it possible to accurately assess placentation already in the first trimester with the lambda sign. With regard to prenatal diagnosis, it is important to know the chorionicity in order to calculate the risk of chromosomally abnormal fetuses.

Accurate chorionicity offers the obstetricians the opportunity to observe the monochorionic twins more intensively than is required for twins with dichorionic placentation. This review gives an update of the state of the art for clinicians caring for twin pregnancies.
Effects of umbilical arterial resistance on its arterial blood flow velocity waveforms
Authors: Mine Makiko , Nishio Junko , Nakai Yuichiro , Imanaka Motoharu , Ogita Sachio
Published: March 2003

Background. We propose to clarify the effect of umbilical arterial resistance on umbilical arterial blood flow patterns in normal pregnant women.

Subjects. Pulsed Doppler examination was administered to 145 pregnant women of between 28 and 31 weeks of normal gestation without any prenatal complications.

Methods. The arterial flow velocity waveforms from two different arteries, one in the intra‐abdominal portion and the other at the placental insertion, were sampled with the color flow mapping method, and the peak systolic velocity and the resistance index were calculated.

Results. The peak systolic velocity and resistance index on the placental side were significantly lower than those of the fetal side.

Conclusion. A major difference exists between the umbilical arterial flow velocity waveforms on the fetal and placental sides, which might be caused by difference in the umbilical arterial resistance.
Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles
Authors: Khalil Mohammed Rohi , Rasmussen Per Emil , Erb Karin , Laursen Steen Broch , Rex Sven , Grabow Westergaard Lars
Published: March 2003

Objective. To identify prognostic factors influencing the outcome of infertility treatment using intrauterine insemination with donor semen (IUI‐D).

Design. Retrospective study of all patients undergoing IUI‐D between August 1st, 1990 and July 31st, 1998.

Setting. University‐affiliated infertility clinic.

Patients. Three hundred and five couples undergoing 1131 IUI‐D treatment cycles.

Main outcome measures. Type of hormonal treatment, number of follicles, length of follicular phase, endometrial pattern, female age, infertility diagnosis and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations.

Results. Throughout the nine year period the overall clinical pregnancy rate per cycle was 22.3%, with an increase from 12.9% in 1990 to 34.6% in 1998. The multiple birth rate was 20.6%. The birth rate per couple was 61.1% after a mean of 3.2 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the sixth treatment cycle. The following parameters were positively and significantly correlated to a successful outcome of IUI‐D: i) the first treatment cycle– compared to the following up to six treatment cycles; ii) number of mature follicles– more than one – at the time of insemination, however, with an unacceptable high rate of multiple pregnancies when more than 3 mature follicles were present; iii) time of insemination after the 12th day in the cycle; iv) insemination after ovulation has occurred and; v) female age under 30 years.

Conclusions. IUI‐D is a simple and inexpensive treatment giving acceptable pregnancy rates for up to six treatment cycles if at least 2 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, and ovulation has occurred at the time of insemination, which ought to take place after cycle day (cd) 12 with at least two million motile spermatozoa.
Prognosis in four syndromes of pregnancy‐related pelvic pain
Authors: Albert Hanne , Godskesen Mona , Westergaard Jes
Published: March 2003

Background. The aim of the present study was to describe, on the basis of specific classification criteria and for a period of two years after delivery, the prognosis for women suffering from pregnancy‐related pelvic joint pain, and to describe the characteristics influencing the prognosis.

Methods. One thousand seven hundred and eighty‐nine pregnant women who were booked for delivery at Odense University Hospital formed a cohort to investigate the prognosis. Women whose reported daily pain from pelvic joints could be objectively confirmed were divided, according to symptoms, into five subgroups (n=405) – four classification groups (pelvic girdle syndrome, symphysiolysis, one‐sided sacroiliac syndrome and double‐sided sacroiliac syndrome) and one miscellaneous. The women in the five subgroups were re‐examined at regular intervals for two years after delivery or until disappearance of symptoms (whichever was less). Thre hundred and forty‐one women from the 5 subgroups participated in the postpartum follow‐up.

Results. The majority (62.5%) of women in the four classification groups experienced disappearance of pain within a month after delivery. Two years after parturition 8.6% were still suffering from pelvic joint pain (determined subjectively and objectively). Persistence of pain was found to vary significantly from one classification group to another. None of those initially classified as suffering from symphysiolysis had pain 6 months after delivery in comparison to the 21 percent of those with pelvic girdle syndrome who continued to have pain at the two‐year mark.

Conclusions. This study shows that pregnancy‐related pelvic joint pain had an excellent postpartum prognosis (in general) in three out of four classification groups. The women with pelvic girdle syndrome (pain in all 3 pelvic joints) had a markedly worse prognosis than the women in the other three classification groups. High number of positive test and a low mobility index were identified as giving the highest relative risk for long term pain.
Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women
Authors: Panesar Nirmal S. , Li Chi‐Yin , Rogers Michael S.
Published: March 2003

Objective. To determine the relative importance of thyroid hormones and human chorionic gonadotropin in the etiology of hyperemesis gravidarum.

Design. A prospective study comparing the hormonal status in women with hyperemesis gravidarum (5–18 weeks), with healthy pregnant controls, matched for gestational age. Sensitive thyroid stimulating hormone, free thyroxine, free triiodothyronine and total beta human chorionic gonadotropin were measured by immunoassays. The hormone results for hyperemesis gravidarum group (n=58) were compared with pregnant control women (n=58) using the Mann Whitney test. Stepwise logistic regression analysis was performed to determine which variables were significantly associated with hyperemesis gravidarum and to estimate the probability of each woman having hyperemesis gravidarum. The strength of the resulting association was tested by generating a receiver operating characteristic curve for predicting hyperemesis gravidarum using these probabilities.

Results. Maternal age and all hormones were significantly different between the hyperemetic and control groups. However, logistic regression analysis demonstrated that only maternal age, free thyroxine and thyroid stimulating hormone were significant independent variables. The area beneath the receiver operating characteristic curve for prediction of hyperemesis gravidarum was 0.84.

Conclusion. Human chorionic gonadotropin is not independently involved in the etiology of hyperemesis gravidarum but may be indirectly involved by its ability to stimulate the thyroid. Differences in maternal age and thyroid function are highly discriminatory with regard to hyperemesis gravidarum.
Women with a history of placental abruption: when in a subsequent pregnancy should special surveillance for a recurrent placental abruption be initiated?
Authors: Rasmussen Svein , Irgens Lorentz M. , Albrechtsen Susanne , Dalaker Knut
Published: March 2003

Background. It is common to admit to hospital or start intensive ambulatory antenatal care of pregnant women with a previous placental abruption using the gestational age of the previous placental abruption as a starting point. In some instances, close surveillance may be commenced much earlier. There is no consensus when in a subsequent pregnancy such measures should be initiated.

Objective. The analyses aimed at the prevention of complicated (preterm, small for gestational age, or perinatal death) recurrent placental abruptions, assessing at which time in a subsequent pregnancy special surveillance should start in order to anticipate and prevent a recurrence.

Design. A cohort study based on the Medical Birth Registry of Norway. Calculation of gestational age specific risks of placental abruption in a second pregnancy and estimation of when to initiate surveillance in order to reduce an increased risk of recurrent placental abruption to the initial level of initial abruption in the second pregnancy.

Results. In women with a complicated (preterm, small for gestational age, or perinatal death) first delivery, the risks of an initial and recurrent complicated placental abruption in the second pregnancy were 7/1000 and 33/1000, respectively (relative risk 4.9). To reduce the recurrence risk in a second pregnancy to 7/1000, special surveillance six weeks prior to the gestational age of the initial abruption would be necessary. In women with an uncomplicated first delivery, the risks in the second pregnancy of an initial and recurrent complicated abruption were 3 and 19/1000, respectively (relative risk 7.1). To reduce the recurrence risk to 3/1000, surveillance at least 12 weeks prior would be necessary.

Conclusion. The increased recurrence rate would necessitate increased awareness in terms of special surveillance in the second pregnancy. In pregnancies at risk of a recurrent placental abruption, monitoring up to three months before the gestational age of the initial abruption is necessary.
The significance of asymptomatic bacteremia for the newborn
Authors: Petanović Mirna , Žagar Živojin
Published: March 2003

Background. So far, there has been no systematic detection of asymptomatic bacteremia in pregnant women. Consequently, its possible effects on newborn infants have not been discussed. The aim of this study was to determine the incidence of asymptomatic bacteremia in pregnant and parturient women and neonates as well as to assess its influence on the health condition of newborn infants during the first three months of life.

Methods. A total of 626 blood cultures were taken from 353 pregnant women (with single‐fetus pregnancy)and their newborns: 156 during pregnancy, and immediately after delivery from 235 mothers and their 235 newborns. Blood culture results were clinically and statistically analyzed along with data on the development of the newborns.

Results. Positive blood culture was found in 12% of pregnant women, in 19% of parturient women and 25% of the newborns.

The most often isolated bacteria were: Staphylococcus epidermidis in 36 cases (18%), Escherichia coli in 35 cases (17.5%) and Enterococcus in 20 cases (10%).

Asymptomatic bacteremia was found to be in a statistically significant correlation with signs and symptoms of life‐threatening conditions (p<0.01), early‐onset and late‐onset infections and other disorders occurring in newborn infants (p<0.05), mostly of the female sex.

Conclusion. It seems that asymptomatic bacteremia cannot be considered harmless but appears to influence the health of newborns.
The relationship between cervical dilatation, interleukin‐6 and interleukin‐8 during term labor
Authors: Hebisch Gundula , Grauaug Alfred A. , Neumaier‐Wagner Peruka M. , Stallmach Thomas , Huch Albert , Huch Renate
Published: March 2003

Background. To determine interleukin‐6 and interleukin‐8 levels in amniotic fluid, retroplacental blood and maternal serum and relate these values with cervical dilatation in term labor.

Methods. Prospective study. n=78 healthy women undergoing term cesarean section, divided into four groups: controls,n=42, (elective cesarean section; no contractions, membrane rupture or cervical dilatation); latent labor,n=12, (latent phase labor; cervix <2 cm dilated); established labor, n=12, (active labor, cervix 2–5 cm); advanced labor,n=12, (active labor, cervix >5 cm). Interleukin‐6 and interleukin‐8 were determined by ELISA (pg/ml), placenta and placental bed biopsy examined histopathologically, and amniotic fluid also microbiologically. Results were expressed as median and ranges or mean and standard deviations, as appropriate. For statistical analysis, Mann‐Whitney U‐tests or Kruskal‐Wallis tests were used as applicable (Statview 4.5). Power and linear regression analyses were performed. p<0.05 was considered significant, p<0.001 highly significant.

Results. Compared with controls, IL‐6 and IL‐8 increased significantly with cervical dilatation in all compartments tested for almost all labor groups (p<0.05 to p<0.0001). Significant changes were also seen between latent and advanced labor groups in some compartments (p<0.05), but not between established and advanced labor groups. Intrauterine infection was excluded in any of the patients clinically and on histopathological or microbiological analysis of placentae and amniotic fluid.

Conclusions. In term labor without intraamniotic infection, interleukin‐6 and interleukin‐8 at the fetomaternal interface and in maternal serum rise significantly with cervical dilatation. These cytokines could be used as markers of active labor if vaginal examination is not applicable.
Volume sonography of the pelvic floor in nulliparous women and after elective cesarean section
Authors: Ochsenbein Nadin , Kurmanavicius Juozas , Huch Renate , Huch Albert , Wisser Josef
Published: March 2003

Objective. To describe the sonographic appearance of the pelvic floor which has not been stressed by forces of labor or vaginal delivery in pregnant women and after childbirth.

Subjects and methods. In a prospective observational study 14 nulliparous women during first trimester pregnancy and 26 primiparous women after elective cesarean were examined within the first week postpartum. The integrity of the internal anal sphincter expressed as the ratio between the anterior and the posterior internal anal sphincter muscle thickness (a/p‐ratio), asymmetry of the levator ani muscle and the paraurethral fixation of the lateral vaginal edges at the arcus tendineus were assessed using volume sonography.

Results. The a/p‐ratio in nulliparous women was significantly higher (p<0.01) than after elective cesarean section. Asymmetry of the levator ani muscle did not differ between both groups but was more frequently in the nulliparous patients with an odds‐ratio of 1.16 (CI 0.74–1.82). In both groups of women the paraurethral fixation of the lateral vaginal edges were above the suburethral level of the vagina.

Conclusions. This study gives sonographic features of the pelvic floor in nulliparous women and in primigravidae after elective cesarean section. Data from the post‐cesarean group can serve as reference values for further studies evaluating pelvic floor damage after various modi of vaginal delivery.
Gestational diabetes diagnosed in third trimester pregnancy and pregnancy outcome
Authors: Lao Terence T. , Tam Kar‐Fai
Published: March 2003

Background. The clinical significance of gestational diabetes diagnosed in the third trimester is unclear. A prospective observational study was performed on a cohort of women without pre‐existing gestational diabetes or other medical disorders to examine the effect of gestational diabetes on pregnancy complications and infant outcome.

Methods. Four hundred and eighty‐nine consecutive women were assessed at 28–30 weeks by random glucose screening and/or a 75 g oral glucose tolerance test. The subsequent management was according to established departmental protocols. The outcome of pregnancy was compared among the groups with negative screening, positive screening but normal glucose tolerance, and gestational diabetes which was controlled with diet therapy.

Results. Women with gestational diabetes (n=67 or 13.7%) had significantly increased maternal age, pre‐pregnancy weight and body mass index, hemoglobin levels at booking and at 36–38 weeks, and incidences of parity >1, pre‐eclampsia, and female infants, while the gestational age was shorter and there was no significant difference in the birthweight outcome or neonatal morbidity.

Conclusions. Despite diet treatment, gestational diabetes diagnosed in the last trimester is associated with increased risk of pre‐eclampsia and shorter length of gestation, and this is likely to reflect a pathological process rather than the physiological effect of pregnancy on maternal glucose tolerance.
Is preeclampsia an infectious disease?
Authors: Trogstad Lill I. S. , Eskild Anne , Bruu Anne‐Lise , Jeansson Stig , Jenum Pål A.
Published: March 2003

Background. Studies have suggested a strong paternal factor in the etiology of preeclampsia. If preeclampsia is caused by an infectious agent transmitted by the woman’s partner, seronegative women who may experience primary infection in pregnancy should be at increased risk of preeclampsia as compared to previously infected women. The aim of this study was to assess the impact of being seronegative for some viruses transmitted by close contact on the risk of developing preeclampsia.

Methods. Nine hundred and seventy‐eight women were randomly drawn from a basic study population of 35,940 pregnant women in Norway. A serum sample drawn at the first antenatal visit was analyzed for specific IgG antibodies against herpes simplex virus type‐2, cytomegalovirus and Epstein‐Barr virus. For comparison, antibody status against Toxoplasma gondii was also assessed. Information on preeclampsia in pregnancy was obtained through linkage to the Medical Birth Registry of Norway.

Results. Thirty‐three (3%) women developed preeclampsia. The risk of developing preeclampsia seemed to be increased for women who were seronegative for the viruses studied. Seronegativity for Toxoplasma gondii did not show such a pattern.

Interpretation. Women who are seronegative for antibodies against viral agents transmitted through close contact seem more likely to develop preeclampsia. This finding indicates that women who are seronegative to such agents may acquire primary infection in pregnancy, and subsequently be at increased risk of preeclampsia. This hypothesis could represent a new approach to the causes of preeclampsia, and encourage search for yet unidentified microbes as a possible causal factor.
Histopathological prognostic factors of adult granulosa cell tumors of the ovary
Authors: Fujimoto Toshio , Sakuragi Noriaki , Okuyama Kazuhiko , Fujino Takafumi , Yamashita Kohki , Yamashiro Shigekatsu , Shimizu Michio , Fujimoto Seiichiro
Published: March 2003

Background. The prognostic factors of adult granulosa cell tumor (AGCT) have not been well defined.

Methods. In 27 AGCT patients, we examined clinical stage, microscopic patterns, mitotic index (MI), and lymph‐vascular space invasion (LVSI) to determine whether these factors were related to disease‐free survival (DFS) of patients with AGCT. We also performed immunohistochemical examination for p53.

Results. Seventeen cases represented stage I tumors, four stage II, five stage III, and one stage IV. Patients with stage I disease had more favorable prognosis than those with stage II to IV disease (p=0.034). There was no relation between the microscopic patterns and the DFS. The MI, which was categorized into 3/10high power field (HPF) and 4/10 HPF, was significantly related to patients DFS (p<0.0005). The DFS time for patients with moderate or prominent LVSI was significantly shorter than that for patients with no or minimal LVSI (p<0.0001). By multivariate analysis, MI and LVSI were shown to be independent prognostic factors. Five of seven patients with recurrent tumor had extrapelvic spread; two in the abdominal cavity and three in the liver.

Conclusion. The results of this study suggest that prognosis for patients with AGCT depends on the MI and LVSI. During the follow‐up period of patients, they need to be examined for distant metastasis including liver.
Risk factors and outcome of failure to progress during the first stage of labor: a population‐based study*
Authors: Sheiner Eyal , Levy Amalia , Feinstein Uri , Hallak Mordechai , Mazor Moshe
Published: March 2003

Background.  One of the major indications for Cesarean section (CS) is failure of labor to progress. This study was aimed at defining obstetric risk factors for failure of labor to progress during the first stage, and to determine pregnancy outcome.

Methods.  A population‐based study comparing all singleton, vertex, term deliveries between the years 1988 and 1999 with an unscarred uterus, complicated with failure of labor to progress during the first stage with deliveries without non‐progressive labor (NPL). Multiple logistic regression analysis was performed to investigate independent obstetric risk factors associated with failure of labor to progress during the first stage.

Results.  Failure to progress during the first stage of labor complicated 1.3% (n = 1197) of all deliveries included in the study (n = 92 918), and resulted in CS. Independent risk factors for failure of labor to progress during the first stage, using a multivariable analysis, were premature rupture of membranes (PROM; OR = 3.8, 95% CI 3.2–4.5), nulliparity (OR = 3.8, 95% CI 3.3–4.3), labor induction (OR = 3.3, 95% CI 2.9–3.7), maternal age > 35 years (OR = 3.0, 95% CI 2.6–3.6), birth weight > 4 kg (OR = 2.2, 95% CI 1.8–2.7), hypertensive disorders (OR = 2.1, 95% CI 1.8–2.6), hydramnios (OR = 1.9, 95% CI 1.5–2.3), fertility treatment (OR = 1.8, 95% CI 1.4–2.4), epidural analgesia (OR = 1.6, 95% CI 1.4–1.8) and gestational diabetes (OR = 1.4, 95% CI 1.1–1.7). Although newborns delivered after failure of labor to progress during the first stage had significantly higher rates of Apgar scores lower than 7 at 1 and 5 min as compared with the controls (18.2% vs. 2.1%; P < 0.001 and 1.3% vs. 0.2%; P < 0.001, respectively), no significant differences were noted between the groups regarding perinatal mortality (0.3% vs. 0.4%; P = O.329). Maternal anemia and accordingly packed cells transfusion (47.4% vs. 22.8%; P < 0.001 and 5.6% vs. 1.0%; P < 0.001, respectively) were higher among pregnancies complicated with failure of labor to progress during the first stage as compared with the controls.

Conclusions.  Major risk factors for failure of labor to progress during the first stage were PROM, nulliparity, induction of labor and older maternal age. Indications for labor induction should be carefully evaluated in order to decrease the rate of operative deliveries.
Risk of intrauterine growth retardation, malformations and other birth outcomes in children after topical use of corticosteroid in pregnancy
Authors: Mygind Helle , Thulstrup Ane Marie , Pedersen Lars , Larsen Helle
Published: March 2003

Background. Topical corticosteroids are frequently used drugs, but little is known of the exposure during pregnancy and birth outcome.

Methods. In a population‐based follow‐up study restricted to primigravida women, we examined the risk of low birth weight, malformations and other birth outcomes following pregnancy upon exposure to topical corticosteroids. We compared the offspring of 363 women exposed to topical corticosteroids during pregnancy with 9263 controls, who received no prescriptions at all.

Results. The prevalence of malformations was 2.9% among 170 infants exposed during the first trimester and 3.6% among the controls. Adjusted odds ratios for low birth weight, malformations and preterm delivery among women receiving weak/medium strong corticosteroids were 0.7 (95% CI 0.17–2.85), 0.93 (95% CI 0.23–3.80) and 1.04 (95% CI 0.56–1.92), respectively, and adjusted odds ratios for strong/very strong corticosteroids were 1.23 (95% CI 0.45–3.37), 0.56 (95% CI 0.14–2.28) and 0.99 (95% CI 0.54–1.84), respectively.

Conclusions. The study showed no increased risk of low birth weight, malformations or preterm delivery in the offspring of women exposed to topical corticosteroid during pregnancy.
Smoking during pregnancy: comparison of self‐reports and cotinine levels in 496 women
Authors: Lindqvist Rune , Lendahls Lena , Tollbom ÖRjan , ÅBerg Hans , Håkansson Anders
Published: March 2003

Objective. To validate self‐reported smoking habits in smoking pregnant women and estimate the prevalence of substantial exposure to passive smoking in non‐smoking pregnant women.

Design. Retrospective, quantitative study, consecutively collected samples.

Setting. One antenatal clinic in Blekinge County, Sweden.

Subjects. 509 pregnant women.

Method. Information about smoking habits were taken from the antenatal records of 496 women (97%). Serum samples from these women were tested for cotinine, a nicotine metabolite.

Main outcome measures. Self‐reported smoking habits and cotinine levels in ng/mL.

Results. Of 407 women, reporting to be non‐smokers, 6% were most likely smokers, and 3% had cotinine levels suggesting exposure to substantial passive smoking. Of 60 women, reporting smoking 1–10 cigarettes per day, 32% were likely to smoke more.

Conclusion. If the true facts about exposure to tobacco smoke are not revealed, a number of women who might benefit from information and support at the antenatal clinic will miss the opportunity of such assistance, resulting in increased risks for both the woman and her fetus.
Maternal mortality in northern rural Tanzania: assessing the completeness of various information sources
Authors: Olsen Bjørg E. , Hinderaker Sven G. , Lie Rolv T. , Bergsjø Per , Gasheka Petro , Kvåle Gunnar
Published: March 2003

Background. To assess the completeness of various information sources and the subsequent estimates on maternal mortality.

Methods. Maternal deaths in the study area, rural northern Tanzania, in 1995 were identified from hospital records, health centers and dispensaries, registration by village leaders, follow up of an antenatal cohort, and a household survey. Data from some of these sources were also obtained in 1996.

Results. In 1995, 22 of a total of 26 maternal deaths were identified at the Haydom hospital. Three of the 15 deaths (20%) reported by the village leaders were not identified at any health facility. Four deaths were found in the antenatal cohort and one death in the household survey. Only two deaths were reported by the official statistics. Of the identified maternal deaths, 85% were found from health facility data. Including data from 1996, a total of 45 maternal deaths were identified; 13 of which were direct and 32 indirect obstetric deaths.

The 1995 estimated maternal mortality ratio, based on reports from the multiple source registrations, was 382 (95% confidence interval 250–560) per 100 000 live births. The antenatal cohort yielded an estimate of 322 (95% confidence interval 160–580). The ratio based on official figures for 1995 and 1996 combined was 123 (95% confidence interval 70–200).

Conclusions. Even a high quality routine registration of maternal deaths will miss a small proportion of cases. Investing in better registration of direct and indirect obstetric deaths will give better insight into this important health problem. Estimates based on official reports showed substantial underreporting.
Does urinary incontinence occurrence depend on the menstrual cycle phase?
Authors: Hvidman Lone , Foldspang Anders , Mommsen Soeren , Bugge Nielsen John
Published: March 2003

Background. The aim was to study an eventual co‐variation of menstrual cycle progression and urinary incontinence (UI) occurrence in 20–54‐year‐old‐women, who have regular menstrual cycles, which are not influenced by exogenous sex hormones.

Methods. An age‐stratified random sample of of 3900 women, aged 20–59 years, answered a questionnaire on UI. The present analysis included 821 women, who reported regular menstrual cycles un‐intervened by sex hormone intake.

Results. Five percent of the women reported episodes of UI the day before they answered the questionnaire. Urinary incontinence was unassociated with menstrual cycle characteristics, such as time position from day one in the menstrual cycle, presence and amount of bleeding and the number of sanitory towels or tampons used. There was however, a borderline significant association (P = 0.08) with day 11–15 before the expected next menstrual bleeding.

Conclusions. The present data allow for limited co‐variation, if any, to exist in UI ocurrence with the natural menstrual cycle phases, including the menstruation itself. A hypothesis of a moderate UI increase associated with ovulation however, merits attention.
Physical activity: measurement in mid‐life women
Authors: Guthrie Janet R.
Published: March 2003

Objectives. To review methods of assessing physical activity, and to compare two different questionnaires that were administered in the Melbourne Women's Midlife Health Project (MWMHP).

Methods. Cross‐sectional and subsequent longitudinal population‐based study of Australian‐born women who were aged 45–55 at baseline. Self‐administered modified form of the Minnesota Leisure‐Time Physical Activity questionnaire and interviewer‐administered short physical activity question.

Results. Two hundred and ninety‐two women completed the Minnesota Leisure‐Time Physical Activity questionnaire at both cross‐sectional and 3rd year of follow‐up (L3) and there was no difference in the total mean time spent exercising at both phases [5.9 (SD, 5.7) and 5.8 (SD, 5.0) hours per week, respectively]. The responses to the two questionnaires were significantly associated (β = −0.89, SE 0.17, p < 0.0005). Using the Minnesota Leisure‐Time Physical Activity questionnaire between the cross‐sectional and L3 phases, 10% of the women increased the time they spent exercising by 5 h per week and 10% decreased it by the same amount. Using the short exercise question, 12% of women decreased their participation by two or more sessions per week and 14% increased their participation by this amount between the cross‐sectional and L3 phases.

Conclusion. In this cohort of mid‐life women the short exercise question was comparable in terms of measuring participation and change in physical activity with the more complex Minnesota Leisure‐Time Physical Activity questionnaire.
Expression of αvβ3 and α4β1 integrins throughout the putative window of implantation in a cohort of healthy fertile women
Authors: Nardo Luciano G. , Bartoloni Giovanni , Di Mercurio Silvana , Nardo Filadelfo
Published: March 2003

Background.  Blastocyst implantation is a dynamic process requiring a specific cascade of cellular interactions and endometrial changes. The aim of this prospective observational study was to investigate the endometrial expression of αVβ3 and α4β1 integrins throughout the window of implantation in healthy fertile women.

Materials and methods.  Forty fertile women (mean age 29.7 ± 6.2 years) were recruited for this study. All underwent two endometrial biopsies in a single menstrual cycle. The first biopsy was performed on postovulatory day 6, while the second was taken on postovulatory day 8. Histological dating and immunohistochemical assessments of αVβ3 and α4β1 integrins were analyzed. Oestradiol and progesterone serum concentrations were also measured at the time of biopsy.

Results.  Second endometrial biopsy could not be performed in two of the 40 women (5%) because their menses had started in advance. No inflammatory or reactive phenomena were observed after biopsy. All the samples showed an in‐phase endometrium. αVβ3 integrin expression was found in 21 out of the 38 first biopsies and in all 38 second biopsies (55.2% vs. 100%, p < 0.001). α4β1 integrin expression was not significantly different between first and second biopsies (68.4% and 76.3%, NS). Oestradiol and progesterone serum concentrations were similar throughout the implantation window. Twelve of the 38 women (31.6%) conceived within 12 months of completing the study. All these had significantly higher αVβ3 integrin expressions in mid‐luteal phase biopsies compared with those who did not conceive.

Conclusions.  These immunohistochemical findings demonstrate that both αVβ3 and α4β1 integrins have a spatial and temporal expression throughout the implantation window in the endometrium of fertile women. Moreover, the shortage of αVβ3 integrin expression during the mid‐luteal phase results in a detrimental effect for blastocyst implantation.