bluuebunny/crossref_metadata_2025 huggingface dataset:
Lithium stimulates the first meiotic division in mouse oocytess
Authors: Bagger Peter Valdemar , Byskov Anne Grete , Christiansen Morten Dyrved , Bang Lotte , Mortensen Lene
Published: November 2007

Cumulus enclosed oocytes, cumulus enclosed oocytes denuded of their cumulus and cumulus free oocytes from 21 day old unstimulated mice were cultured for 18 hours in control medium supplemented with lithium chloride, dbcAMP and forskolin at various concentrations. In control medium 66% of the cumulus enclosed oocytes, 93% of the denuded oocytes, and 94% of the cumulus free oocytes resumed meiosis (germinal vesicle breakdown), whereas the levels of polar body formation were 27%, 12% and 39%, respectively. In the presence of lithium significantly more cumulus enclosed oocytes and cumulus free oocytes resumed meiosis and formed a polar body, whereas lithium had no effect on the denuded oocytes. Forskolin and dbcAMP stimulated resumption of meiosis and cumulus expansion in the cumulus enclosed oocytes and inhibited resumption of meiosis in the cumulus free oocytes. Lithium more or less eliminated this inhibitory effect of both forskolin and dbcAMP in the cumulus free oocytes. The results indicate (i) that activation of the cAMP second messenger path in the cumulus cells induces them to synthesize a meiosis inducing substance(s) which stimulates the oocyte to resume meiosis, and (ii) that other second messenger systems than the cAMP pathway, e.g. the phosphatidylinositol cycle, are involved in resumption of meiosis and polar body formation. We conclude that lithium enhances the capability of mouse oocytes for resumption of meiosis and polar body formation.
Maternal and neonatal C‐reactive protein after interventions during delivery
Authors: Kääpä Pekka , Koistinen Eeva
Published: November 2007

To evaluate the effects of interventions during delivery on the maternal and neonatal C‐reactive protein (CRP) we prospectively measured CRP by immunoturbidometry in 238 mother‐infant pairs (179 normal vaginal deliveries, 36 cesarean sections and 23 vacuum extractions) at 24 and 72 hours after delivery. We additionally measured CRP in peripheral maternal and neonatal blood immediately after birth in 29 uncomplicated vaginal deliveries. CRP values in the mothers and their offspring were low at birth, but rose significantly during the first day after vaginal delivery. Cesarean section induced a pronounced elevation of maternal CRP, but had no effect on neonatal values. Delivery by vacuum extraction produced a transient elevation of both maternal and neonatal CRP at 24 hours after birth. Neonatal CRP values were not associated with presence or size of superficial birth tissue trauma evaluated simultaneously with blood sampling. Increased CRP release in mothers and their infants after interventions during delivery may be associated with varying degrees of tissue trauma and can complicate assessment of the presence of infection.
Progesterone receptor content in endometrial carcinoma correlates with serum levels of free estradiol
Authors: Nyholm Henrik C. J. , Nielsen Anette L. , Lyndrup Jens , Thorpe Susan M.
Published: November 2007

Objective. To study a possible relationship between serum levels of estrogens and androgens and the tumor content of estrogen receptors and progesterone receptors in endometrial cancer.

Study design. Fifty postmenopausal patients were included. Receptors were determined biochemically in tissue cytosol by dextran charcoal‐coated assay and immunohistochemically on frozen sections. Serum sex hormones were measured by radioimmunoassays. Main findings. Tumor biochemical progesterone receptor content correlated positively (p < 0.05) with free estradiol serum levels. No correlations were observed between estrogen receptor content and any of the serum sex hormones. The progesterone/estrogen receptor ratio, calculated from the biochemical values, correlated positively (p < 0.05) with the serum levels of free estradiol. This relation was not affected by tumor histologic grade or stage. Furthermore, this ratio correlated positively with body mass index, probably reflecting a correlation between body mass and serum estrogens. Biochemical and immunohistochemical receptor values were correlated.

Conclusions. These findings suggest that hormonal regulation of receptor levels may remain preserved in at least some endometrial cancer cells.
Pregnancy in a non‐communicating uterine horn mimicking incarceration with sacculation of a retroflexed uterus
Authors: Nwosu Uchenna C. , Thatcher Samuel
Published: November 2007

Incarceration and sacculation of a retroflexed gravid uterus is relatively benign, in contrast with pregnancy in a rudimentary uterine horn which can lead to perforation and hemorrhage. We report a case of pregnancy in an incarcerated sacculated non‐communicating rudimentary horn mimicking incarceration with sacculation of a retroflexed gravid uterus. Both physical and sonographic findings were unhelpful in the differential diagnosis. Therefore, decision for laparotomy in such cases should be based on severity of symptoms.
Pre‐pregnancy risk factors of small‐for‐gestational age births among parous women in Scandinavia
Authors: Bakketeig Leiv S. , Jacobsen Geir , Hoffman Howard J. , Lindmark Gunilla , Bergsjø Per , Molne Karre , Rødsten Judith
Published: November 2007

To study the etiology and consequences of intrauterine growth retardation (IUGR), a prospective study was organized by the National Institute of Child Health and Human Development, NIH, with the Universities of Trondheim and Bergen in Norway, Uppsala in Sweden, and Alabama in the United States. This paper reports on the Scandinavian portion of the study. 6,354 women were referred to the study and 5,722 women, who were expecting their second or third child between January 1986 and March 1988, were eligible and made their first appointment for the study. Of these, 1,945 women and their births were selected for follow‐up at four prenatal visits, delivery, and during the first year of life. This report analyzes the relative impact of various maternal pre‐pregnancy risk factors associated with SGA birth. For example, mothers who smoked cigarettes around the time of conception, but who had none of the other major risk factors, nearly doubled their risk of SGA birth. A previous low birth weight (LBW) delivery increased the risk nearly two and a half times among non‐smokers. If a mother both smoked and had a previous LBW, the relative risk rose to nearly five and a half. Low maternal pre‐pregnancy weight (> 50 kg) increased the risk of SGA birth almost twofold among non‐smokers, while low pre‐pregnancy weight and smoking together increased the risk of SGA birth fourfold. A low weight mother who smoked and also had a previous LBW delivery, had a risk of SGA birth that was nearly six times that of a mother without those characteristics.
Outpatient CO2 laser excisional conization for cervical intraepithelial neoplasia under local anesthesia
Authors: Helkjaer Poul E. , Eriksen Poul Sindberg , Thomsen Carl F. , Skovdal Jan
Published: November 2007

Aim and objective. To evaluate the feasibility of CO2 laser excisional conization in patients with cervical intraepithelial neoplasia (CIN) in an outpatient setting under local anesthesia. Design. A prospective study of women with cervical intraepithelial neoplasia over one year recording early and late complications, cure rate, and patients' compliance. The procedure was performed with a Coherent CO2 laser connected to the colposcope with a micromanipu‐lator. The equipment attaining 19,700 W/cm2, spot diameter 0.43 mm, focus distance 300 mm, and continuous beam.

Results. The material included 81 women. Seventy‐eight women were treated as outpatients, while three women were admitted for 24 hours observation due to surgical and technical complications during the treatment. Sixty‐six percent of the women had bleeding less than 10 ml during the treatment. One woman was admitted 24 hours after surgery due to bleeding requiring suturing. Median operation‐time was 11 minutes (range 3–60). All specimens contained CIN. In 76% of the cases the pre‐ and postoperative diagnosis were identical. Twelve specimens had CIN in one or both margins. Abnormal cytology after conization was found in three cases (4.2%). High patient compliance was found as 92% of the treated women would choose the same kind of treatment if it had to be repeated.

Conclusion. High success rate, few complications and high patient compliance make the procedure adequate as a routine procedure in treatment and diagnosis of CIN.
The localization and concentration of copper in the fallopian tube in women with or without an intrauterine contraceptive device
Authors: Wollen Anne‐Lone , Sandvei Roar , Skare Arne , Justesen Nils‐Petter Berg
Published: November 2007

The localization and concentration of copper in cryostat sections of human fallopian tubes from women using an intrauterine contraceptive device (IUCD) and controls was determined by light microscopic‐ and atomic absorption spectrophotometric techniques. The copper was visually accumulated in the epithelium and the copper concentration in the tubal tissue was increased in the IUCD user group.

We also measured the concentration of copper and ceruloplasmin in serum, but there was no statistical difference between the two groups studied. Our results indicate that the IUCD has effects beyond the uterine cavity. The accumulation of copper may be associated with earlier observations of the morphological changes and infiltration of inflammatory cells observed in the fallopian tube in IUCD users.
Blood flow velocities in human intraplacental arteries
Authors: Kirkinen Pertti , Kurmanavichius Juozas , And Albert Huch , Huch Renate
Published: November 2007

Objective. To characterise the physiological findings of blood circulation in intraplacental arteries in normal and complicated pregnancies.

Design. A descriptive cross‐sectional study. Umbilical and intraplacental artery resistance index (RI) Doppler recordings during the last trimester of pregnancy.

Subjects. Forty‐nine normal pregnancies and ten pregnancies complicated by fetal growth retardation.

Results. RI values decreased from the proximal umbilical artery to the distal umbilical artery and to intraplacental arteries. All of these vessels had decreasing RI values towards the end of pregnancy. In pathological pregnancies an abnormal flow pattern in umbilical arteries could be associated with either an abnormal or normal flow pattern in the intraplacental arteries.

Conclusions. Blood flow in intraplacental arteries can be recorded by sensitive color Doppler in normal pregnancies, but in complicated pregnancies variation of the Doppler findings, together with imaging difficulties of intraplacental arteries, seem to impair the applicability of this examination as a diagnostic tool.
Rates of cesarean section and perinatal outcome: Perinatal mortality
Authors: Iffy Leslie , Apuzzio Joseph J. , Mitra Subash , Evans Hugh , Ganesh Vijaya , Zentay Zoltan
Published: November 2007

A comparison of relevant statistics from National Maternity Hospital, Dublin, Ireland and University Hospital, Newark, New Jersey, USA, for the years 1983‐1989, revealed that after removal of major confounding factors, such as a fourfold difference in < 2500 gram births and an about tenfold discrepancy in the frequency of lethal congenital defects, the perinatal survival rates in all weight categories were significantly higher in the American center. The findings suggest that optimum perinatal results could not be achieved in an American high risk center with the approximately 6% abdominal delivery rate favored in Dublin. The same data also suggest, however, that the 17.5% rate of abdominal deliveries in Newark was unnecessarily high. The favorable impact of the relatively liberal use of cesarean section might have been derived in this study from a marked reduction of in utero losses, in the absence of an identifiable effect upon the rate of neonatal mortality.
Maternal age and duration of labor
Authors: Rasmussen Svein , And Leif Bungum , Høie Karin
Published: November 2007

The computerized records of a population of 7214 women who were delivered during the period 1987‐1991 were analysed. We studied the possible relationship of the duration of the first and second stages of labor to maternal age. In para 0, para 1 and para 2+ mothers we found an independent positive correlation between the second stage duration and maternal age. By multiple stepwise regression analysis maternal age turns out to be one of the most influential maternal characteristics of the second stage of labor. No correlation was found between maternal age and the duration of the first stage.
Methotrexate treatment of ectopic pregnancy
Authors: Floridon Charlotte , Thomsen Sten Grove
Published: November 2007

The last decade has witnessed an increasing number of reports indicating that ectopic pregnancy (EP) can be successfully and safely treated with methotrexate (MTX). This review summarizes the results. In large series, as many as 45% of a population of women with EP has been treated with MTX. Success rates of 82–95% have been achieved. Tubal patency on the affected side was preserved in 79–91% of the cases. Preliminary assessment of subsequent fertility suggests that 47–69% will obtain an intrauterine pregnancy. Complications have been only few and of minor importance. However, the majority of reports do not include controls. Randomized studies are needed to optimize patient selection, treatment regimens, long‐term toxicity, future fertility, and cost‐benefits.
Urinary trypsin inhibitor may have a protective effect on endothelial cells in preeclampsia
Authors: Maradny Emad El , Kanayama Naohiro , Halim Abdul , Maehara Kayoko , Terao Toshihiko
Published: November 2007

Urinary trypsin inhibitor is a glycoprotein which has an inhibitory effect on many enzymes, especially neutrophil elastase. The concentration of urinary trypsin inhibitor in serum (maternal and fetal), urine and amniotic fluid was measured in 20 cases of preeclampsia and compared with levels in normal pregnancy. Urinary trypsin inhibitor levels were significantly increased in the maternal and fetal serum of preeclamptic patients compared to normal pregnancy (p < 0.0001), as well as in urine and amniotic fluid of the same patients. Relative fluorescence release of a calcium chelating agent (fura‐2) from human umbilical vein endothelial cell cultures was significantly increased by preeclamptic serum compared to serum of normal pregnant women (p < 0.03). After incubation of urinary trypsin inhibitor with the cultures, significant decrease of fura‐2 release was observed (p < 0.03).

Urinary trypsin inhibitor has an effect on suppression of activated neutrophils, elastase production and may have a protective effect on endothelial cells.
Disturbed zinc metabolism and reduced birthweight related to raised maternal serum alpha‐fetoprotein in normal human pregnancies
Authors: Bloxam David L. , Williams Norman R. , Waskett Rosie J. D. , Stewart Simon G.
Published: November 2007

The hypothesis was examined that altered maternal zinc metabolism is involved in the low birthweight associated with raised maternal serum alpha‐fetoprotein (MSAFP). Mothers with clinically normal pregnancy and normally formed infant but with raised MSAFP (> 90th percentile) had lower than normal plasma zinc concentration, raised leucocyte zinc and disturbed zinc‐albumin relationship. They delivered offspring with lower birthweights than did women with normal MSAFP concentration, due both to shorter pregnancy and slower intrauterine growth. These results and others identify a subgroup of mothers associated with low infant birthweight, those with raised MSAFP, who have altered zinc distribution.
Increased concentration of the free β‐subunit of human chorionic gonadotropin in hyperemesis gravidarum
Authors: Goodwin Thomas Murphy , Hershman Jerome M. , Cole Laurence
Published: November 2007

Objective. The amount of free β subunit hCG (free β) has been reported to be increased in trophoblast disease and Down's syndrome, conditions also associated with high total hCG. Increased total hCG has been reported in hyperemesis gravidarum. We sought to determine if sera from singleton gestations with hyperemesis gravidarum contained a higher proportion of free β hCG compared to controls of comparable gestational age.

Methods. Sera from 39 patients with hyperemesis gravidarum was compared with that from 23 control subjects of comparable gestational age with respect to β hCG and its subunits (free β and free α).

Results. Hyperemesis patients and controls were comparable with respect to age, weight and gestational age. The concentration of hCG was greater in hyperemesis patients (9237 ± 3613 ng/ml, mean ± s.d.) compared to controls (5543 ± 2290, p < 0.005) as was the concentration of free β hCG (101±70 ng/ml vs. 31 + 31,p < 0.001). Free α did not differ between hyperemesis patients and controls (399±231 ng/ml vs. 377±214). A percent free β greater than 0.6 was found in 33/39 hyperemesis patients (85%) compared to 5/23 controls (22%),p < 0.001. Conclusion. Increased free β hCG is found in hyperemesis gravidarum. This finding, strengthens the association of hyperemesis with abnormal metabolism of hCG.
No relation between maternal weight gain and stillbirth
Authors: Rydhström Håkan , Tydén Tommy , Herbst Andreas , Ljungblad Ulf , Walles Bengt
Published: November 2007

Background. To evaluate the relationship between stillbirth in singleton pregnancy (≥28 weeks gestation) and maternal weight (weight gain) from 24 completed weeks.

Results. Mothers experiencing stillbirth had a significantly lower mean body weight at 24 weeks gestation than control mothers (63.5 kg vs 67.3 kg; t = 2.4,p < 0.05). No significant difference between cases and controls was found in mean weight gain during pregnancy from 24 completed gestational weeks to delivery, even when the last three measurements before delivery for cases and controls were compared separately.

Methods. All fetal deaths (n = 210) at five delivery units during seven years in southern Sweden were analysed. To each case a control mother was selected, the only matching criteria being parity and place of delivery. Regression analysis was used for comparison of body weight gain in cases and controls.

Conclusion. There is no difference in body weight gain between mothers with stillbirth and mothers giving birth to a live infant.
Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scores
Authors: Korhonen Juha , Kariniemi Veikko
Published: November 2007

Background. We wanted to conduct a prospective study on the dynamics of emergency cesarean section (ECS) in terms of fetal survival and morbidity.

Methods. The study covered 101 cases of ECS in Helsinki City Hospital, in which the time of alarm, the starting time of the operation, the time of birth, the umbilical arterial gas values, and Apgar scores were known. This group consisted of 60 cases with the operating team in the hospital (group 1) and 41 cases with the team on call (group 2). Means of the parametric variables were compared by the analysis of variance using separate or pooled t‐tests after Levene's test of variances. Difference between the rate of adverse outcome (dead or handicapped) in each group was calculated using chi‐square test.

Results. In group 1, the time between the clinical decision and the time of delivery (mean±s.e.mean) was 13.5±0.7 min, in group 2, 23.6±0.9 min. The groups did not differ in terms of birthweight, placental weight, Apgar scores, and umbilical arterial gas values, except for pO2. The mean pO2 in group 1 was lower (1.9±0.1 kPa) than in group 2 (2.5±0.2 kPa). p=0.0023. In group 2, one infant was handicapped by hypoxic ischemic encephalopathy and three fetuses had died in utero. The rate of survivors was significantly higher when the operating team was in hospital (p=0.05).

Conclusion. The risk of fetal loss is evident when the operating team is on call outside the hospital, at least if the alarm to operation interval exceeds 20 minutes. The present study suggests that 24‐hour services of anesthesia and operating theater personnel are crucial for optimal management of emergent situations in the delivery room.
Ultrasonographical and hormonal description of the normal ovulatory menstrual cycle
Authors: Bakos Oddvar , Lundkvist Örjan , Wide Leif , Bergh Torbjörn
Published: November 2007

Objective. To describe the changes in uterine volume, endometrial thickness and follicular size during the normal menstrual cycle by use of transvaginal ultrasonography and to correlate these changes with the endocrine events in the same cycle.

Methods. A group of 23 healthy women with normal body mass index and with a history of regular menstruations were monitored with repeated hormonal and vaginal ultrasonographical investigations during the menstrual cycle.

Results. Sixteen of the women fulfilled the hormonal criteria for ovulation. The mean length of the cycles was 28 days (range 25–30 days) with a mean length of the follicular and the luteal phases of 14.4 days (range 12–17 days) and 13.5 days (range 12–16 days), respectively. The estradiol level in serum the day before the peak of the luteinizing hormone varied between 490 and 1710 pmol/1 (mean 1087 pmol/1). Ultrasonographically, the most clinically relevant changes were the increase in diameter of the dominant follicle and the growth of the endometrium. At ovulation the dominant follicle had a mean diameter of 21.4 mm (range 17.4–27.0), whereas the endometrium had a mean thickness of 12.8 mm (range 10.0–15.9). When analysed over the entire follicular phase, the serum estradiol concentration correlated both with the diameter of the dominant follicle (r = 0.93, p = 0.0001) and with the thickness of the endometrium (r = 0.79, p = 0.0001). However, no such correlations were found when only the last part of the follicular phase was analysed. In the luteal phase there was no correlation between the size of the corpus luteum and the serum concentration of progesterone.

Conclusions. Vaginal ultrasonography is a practical and reliable method to monitor structural changes in the ovaries and the uterus during the menstrual cycle. The results are of clinical importance for a better understanding of the physiological changes and helpful when monitoring induction of ovulation in assisted reproduction.
The cosmetic outcome of the scar formation after cesarean section: percutaneous or intracutaneous suture?
Authors: Lindholt Jes S. , Möller‐christensen Torben , Steele Richard E.
Published: November 2007

Three methods of skin closure after cesarean section were tested and compared in a prospective trial. Eighty‐nine (82.5%) appeared for follow‐up investigation 4–5 months after delivery. The mean scar width was significantly narrower after phannenstiel incision compared with percutaneous nylon sutures after lower midline incision, 3.1 mm versus 11.3 mm. Intracutaneous continuous PDS‐suture after lower midline incision produced scars 40% narrower than with percutaneous sutures, 6.8 versus 11.3 mm. 37.5% of the women sutured intracutaneously complained over persistent secretion after discharge from the hospital. Some of these complaints were probably due to the introduction of new materials and skin closure technique. None consulted a physician with their complaints, i.e. the complications were sub‐clinical. Exclusion of the women with persistent secretions from the material led to significantly narrower scars compared with percutaneous closure, 4.5 versus 11.1. Thus, even better results can be expected as experience with the technique increases. Observer and patient satisfaction with the cosmetic outcome were measured independently on a ‘Lasa‐line’. Their opinions coincided; the order of acceptability was worst with percutaneous wound closure after lower midline incision, next best with intracutaneous closure after lower midline incision, and best after phannenstiel incision with intracutaneous closure.
Pregnancy after cardiac surgery in patients with secondary pulmonary hypertension due to a ventricular septal defect
Authors: Alahuhta Seppo , Jouppila Pentti
Published: November 2007

Pulmonary hypertension is defined as pulmonary artery pressure greater than 30/15 mmHg. The etiologies of pulmonary hypertension can be divided into primary and secondary ones. The causes of the latter include long‐lasting left‐to‐right shunts (congenital cardiac defects e.g. ventricular septal defect), pulmonary thromboembolism and severe pulmonary disease (1). Women with pulmonary hypertension often tolerate the physiological changes of pregnancy poorly. We describe the intrapartum management and outcome of two patients who had undergone successful surgical closure of a ventricular septal defect several years earlier. They both had developed pulmonary arterial hypertension preoperatively but had an uneventful recovery and were clinically asymptomatic before pregnancy.
Delayed maternal death after perimortem cesarean section
Authors: Chen Hsin‐Fu , Lee Chien‐Nan , Huang Guang‐Da , Hsieh Fon‐Jou , Huang Su‐Cheng , Chen Hsi‐Yao
Published: November 2007

We report a case of perimortem cesarean section performed on a multigravida with congestive heart failure. This patient had a past history of repeated episodes of acute myocarditis and this time, congestive heart failure attacked her at the 36th week of gestation. The maternal condition deteriorated rapidly with frequent attacks of ventricular fibrillation and cardiac arrest, which gradually became unresponsive to active cardio‐pulmonary resuscitation (CPR). The fetal condition also worsened accordingly. Cesarean section was therefore performed and a 2590 gm depressed female baby was delivered in less than one minute after skin incision and about twenty‐seven minutes after the maternal condition became extremely unstable. The Apgar scores were 1 at one min, 4 at five min and 6 at ten min. The mother improved soon after delivery of the fetus and her consciousness returned. However, her condition deteriorated again and she died four hours after operation. The fetus survived and follow‐up 21 months after delivery was normal.
Severely impaired fetal growth is preceded by maternal hemodynamic maladaptation in very early pregnancy
Authors: Duvekot Johannes J. , Cheriex Emile C. , Pieters Frans A. A. , Peeters Louis L. H.
Published: November 2007

Objective. To test the hypothesis that in pregnancies complicated by intrauterine growth retardation (IUGR) maternal cardiovascular adaptation is already abnormal in the first weeks of pregnancy.

Setting. University Hospital Maastricht, Maastricht, The Netherlands.

Subjects. Fourteen healthy pregnant women, recruited from the subfertility clinic. Ten pregnancies were uneventful and four pregnancies resulted in the birth of growth retarded infants.

Methods. Maternal cardiovascular status was followed longitudinally by combined M‐mode and Doppler echocardiography. Studies were performed weekly between the fifth and 10th week, at 14, 25 and 35 weeks and postpartum. Differences between the two groups were analyzed by nonparametric tests.

Results. In early pregnancy, the IUGR group differed from the normal group by a consistently smaller left atrial diameter and a cardiac output that failed to increase. Postpartum the subjects in the IUGR group had a significantly smaller left atrial diameter and faster mean circumferential fiber shortening.

Conclusion. Maternal hemodynamic adaptation in the first weeks of pregnancy is defective in IUGR pregnancies, presumably associated with a concomitant inadequacy of the vascular filling state.
The cervical smear record: Its relevance to the subsequent development of cervical neoplasia
Authors: Bertelsen B. , Hartveit F.
Published: November 2007

Background. Our aim was to investigate the previous smear history in women with cervical intraepithelial neoplasia grade 1–3 or squamous carcinoma and define its relevance to the lesion present in 1989.

Methods. All 850 women with a laboratory record of cervical intraepithelial neoplasia or cervical squamous carcinoma in 1989 were studied. We retrieved their cytological and histological cervical diagnoses for the period 1981 to 1992 from the laboratory files. On this basis we assessed their previous smear history and short term clinical outcome.

Results. Half the women had a negative record prior to 1989, irrespective of the grade of their lesion in that year. Cervical intraepithelial neoplasia grade 1 had previously been found in 16%, grade 2 in 10%, and grade 3 in 7%. These levels were not related to the grade present in ′89, but as in those with a negative record, were proportional to the number of women examined, and thus reflect the frequency of such lesions in the screened population in general. In all, 310 were treated operatively for cervical intraepithelial neoplasia grade 3 following abnormal findings in 1989. In such cases abnormal findings were also common in ′88, although 45% of them still had a negative smear history. The group with no previous record, i.e. unscreened, contained significantly more invasive cases.

Conclusions. In women with cervical intraepithelial neoplasia in 1989, their previous smear history did not indicate the grade of lesion present. The relevance of their previous abnormal slides to that lesion is thus questionable. The findings, however, suggest that progressive lesions may be acute in origin, superimposed in some cases on a history of similar morphological abnormalities.
Alloimmunization during pregnancy treated with high dose intravenous immunoglobulin
Authors: Gottvall Tomas , Selbing Anders
Published: November 2007

Background. High dose intravenous immunoglobulin has been reported to be advantageous in the treatment of alloimmunization during pregnancy. The mode of action is unknown.

Method. High dose intravenous immunoglobulin was used as the sole prenatal treatment in six severely rhesus(D) sensitized pregnant women. Maternal and fetal anti‐D concentrations as well as fetal hemoglobin concentrations were studied. Seven pregnancies in rhesus(D) sensitized women served as controls. They received no treatment because they had milder forms of erythroblastosis fetalis or, in one case, a rhesus(D) negative fetus.

Result. No obvious inhibitory effect of the treatment on maternal anti‐D production and transplacental anti‐D passage to the fetus was found. The fetal hemoglobin concentrations remained stable at about 80 g/L (hematocrit 27%) in five of six treated patients while there was a significant decrease in the control group.

Conclusion. High dose intravenous immunoglobulin treatment seems to act mainly on fetal red cell destruction rate, possibly by blocking Fc receptor mediated macrophage phagocytosis. We claim that the treatment can successfully be used to prevent further deterioration of fetal anemia in rhesus(D) immunizations if started before severe fetal anemia (hemoglobin concentration < 70 g/L. hematocrit < 23%) and imminent hydrops fetalis arises.
Morphometric analysis of gap junctions in nonpregnant and term pregnant human myometrium
Authors: ÇLiray H. Nadir , Güner Haldun , Håkansson Hanna , Tekelioglu Meral , Roomans Godfried M. , Ulmsten Ulf
Published: November 2007

Background and methods. Some structures in the human myometrium, namely; caveolae, extracellular space and gap junctions were quantified in tissues from nonpregnant women, women who were not in labor, and women in spontaneous labor or oxytocin‐induced labor, in order to reveal morphologic differences that would contribute to explaining the events leading to labor. Transmission electron micrographs taken from tissues from twenty‐four pregnant and ten nonpregnant women were studied.

Results. Differences were observed in cell growth which was accompanied by enlargement of the extracellular space, and in gap junctions. Gap junctions were demonstrated in nonpregnant women, and even in one postmenopausal woman. Their frequency and size increased gradually between groups of pregnant women in the order of non‐labor, oxytocin‐induced labor and spontaneous labor. The increase in size of the junctions was less than the increase in number.

Conclusions. Gap junctions are most frequently found in human myometrial cells in spontaneous labor, which strongly suggests a role for these structures in the termination of pregnancy. The effect of oxytocin on the appearance of gap junctions was negligible; hence, the contribution of oxytocin to establish myometrial contractile synchronicity is thought to be minor. Caveolae are probably not relevant for the initiation of labor as their distribution did not differ between the groups.
Standing and walking at work and birthweight
Authors: Henriksen Tine Brink , Hedegaard Morten , Secher Niels Jørgen
Published: November 2007

Objectives. To study the influence of standing and walking at work on birthweight for gestational age.

Methods. A prospective cohort of 8711 women with singleton pregnancies was established (1989‐91). Information about medical and obstetrical history, lifestyle factors and work related exposures were collected at 16 gestational weeks. The 4249 respondents who worked during pregnancy formed the basis of the analyses.

Results. After adjustment for confounders and gestational age at delivery, infants of women standing >5 hours per workday had birthweights 49 g lower (95% confidence interval (CI): −108 to 10) than those of women standing ≤2 hours. Infants of women walking >2 but >5 hours per workday had higher birthweights (35 g, CI: 8‐63) than those of women with both shorter and longer hours of walking per day. Some women were unable to separate periods of standing from walking; a combined measure of these two exposures was created to reflect exposure intensity. Women who reported >5 hours of both standing and walking had infants with significantly lower birthweight (−119 g, CI: −230 to −8) compared to those of women who reported ≤2 hours on either of the exposures.

Conclusions. Our study suggests that standing at work affects birthweight. Prolonged hours of walking and standing decrease birthweight for gestational age, whereas some degree of walking seems beneficial in terms of increased birthweight.
Iron deficiency among pregnant Pakistanis in Norway and the content of phytic acid in their diet
Authors: Brunvand Leif , Henriksen Christine , Larsson Marie , Sandberg Ann‐Sofie
Published: November 2007

Background. To test the hypothesis that iron deficiency is more common among pregnant Pakistani than pregnant Norwegian women in Oslo; and to determine whether differences in the diet can explain some of the differences in stored iron.

Methods. A cross sectional study in the 18th week of pregnancy. Thirty‐eight Pakistani women and 38 Norwegian women referred to routine ultrasound examination at Aker and Ullevål Hospitals in Oslo participated. Analysis was undertaken of phytate (inositol hexaphosphate) and its degradation products in bread and chapatti.

Results. Twenty‐six (68%) of the Pakistani and six (17%) of the Norwegian women had ferritin levels below 12 ug/1 and a highly significant difference in serum ferritin was found between the groups (p<0.001). Only one of the Pakistani and seven of the Norwegian women were supplemented with iron and there were no significant differences in the dietary intake of hem iron, non‐hem iron, organic fiber, tea, ascorbic acid, meat or cereals. The content of inositol hexaphosphate (phytate) and inositol pentaphosphate, well known inhibitors of iron absorption, were measured in bread and chapatti and the estimated dietary intake was much higher in the Pakistani group, mean (95% CI) was 1175 umol/day (933‐1417) and 507 umol/day (417‐597) respectively, p<0.001.

Conclusions. Iron deficiency seems to be far more common among pregnant Pakistanis in Norway than among pregnant Norwegians. We speculate that the main reasons for this are a combination of a higher parity and a less common use of iron supplementation in pregnancy in the Pakistani group, and a higher content of phytate in the Pakistani diet.
In vitro fertilization/embryo transfer in unexplained infertility and minimal peritoneal endometriosis
Authors: Tanbo Tom , Omland Anne , Dale Per Olav , Åbyholm Thomas
Published: November 2007

Background. To compare the outcome of in vitro fertilization /embryo transfer (IVF‐ET) in unexplained infertility and infertility associated with minimal peritoneal endometriosis.

Methods. A retrospective analysis comparing results of stimulation, sperm characteristics, cleavage, implantation and pregnancy rates in patients with unexplained infertility and peritoneal endometriosis associated infertility Couples with tubal infertility constituted a control group.

Results. In the unexplained infertility and endometriosis groups similar response to stimulation. similar sperm characteristics and cleavage rates were observed. Compared with tubal infertility lower sperm motility was seen in the unexplained infertility group. Both non tubal infertility groups had lower cleavage rate than was seen in the control group. No differences in pregnancy rate were observed, but a significantly higher implantation rate was seen in unexplained infertility compared with tubal infertility.

Conclusions. Couples with unexplained infertility and infertility associated with minimal peritoneal endometriosis have similar outcomes in an IVF‐ET set up. Significantly lower cleavage rates in these groups compared with tubal infertility indicate gamete defects as possible causes of infertility.
Circulating oxytocin and vasopressin is influenced by ovarian steroid replacement in women
Authors: Bossmar Thomas , Forsling Mary , Åkerlund M.
Published: November 2007

Background: The posterior pituitary hormones appear to be involved in the etiology of primary dysmenorrhoea, but mechanisms regulating their release, particularly the influence of ovarian steroids, are not fully understood.

Methods. The effect of 17β‐estradiol and medroxyprogesterone alone and in combination on oxytocin and vasopressin levels was therefore studied in 10 postmenopausal women.

Results. Transdermal treatment with estradiol alone by means of patches in a dose of 100 ug/ 24 h for five days resulted in an elevation of the mean plasma concentration of this hormone from undetectable to 262 pmol/1 and increase in mean circulating levels of vasopressin from 0.82 to 1.22 pmol/1 and of oxytocin from 2.50 to 3.98 pmol/1. Oral administration of medroxyprogesterone in a dose of 10 mg per day for 5 days, which resulted in a mean plasma level of 4.3 nmol/I, suppressed vasopressin concentrations to 0.60 pmol/1. When given after five days of treatment with estradiol, medroxyprogesterone also antagonized the stimulatory effect of the estrogen on vasopressin secretion. Medroxyprogesterone alone increased the plasma oxytocin concentration to 3.26 pmol/1, but the progestogen did not significantly influence the stimulatory effect of estradiol on oxytocin secretion.

Conclusions. It is concluded that posterior pituitary hormone secretion is influenced by estradiol and progestogens, and that this may be a mechanism for the involvement of ovarian hormones in the etiology of primary dysmenorrhoea.
Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth
Authors: Tetzschner Tine , Sørensen Michael , Rasmussen Ole Ø. , Lose Gunnar , Christiansen John
Published: November 2007

Aim. To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. Methods. Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency.

Results. Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p<0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies >2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies >2.0 milliseconds (odds ratio 2.18, p<0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuumextraction could not be related to either fecal incontinence or pudendal nerve function.

Conclusion. The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.
Perceptions and satisfaction among Norplant users in Finland
Authors: Slhvo Sinikka , Ollila Eeva , Hemminki Elina
Published: November 2007

Objective. This study was designed to assess users' perceptions of and satisfaction with the Norplant contraceptive implant.

Methods. A questionnaire was mailed to all women having had Norplant inserted one or two years before the study initiation in seven public out‐patient family‐planning clinics in the capital area of Finland, of whom 82% responded (n = 207).

Results. Practically all women (97%) had experienced some side‐effects and 72% considered at least one of them to be disruptive. Of these side‐effects, bleeding irregularities proved most often bothersome during the first 6 months of use, but depression and nervousness were relatively more important reasons for early removal. Regardless of the ubiquity of side‐effects, 78% were satisfied with Norplant. High satisfaction was common especially among older users with their second set of capsules. Dissatisfaction with the method was best explained by the experience of unexpected and disruptive side‐effects.

Conclusions. Our results suggest that mental problems related to Norplant use have received too little attention and that satisfaction is highest in carefully selected users among older women.
Gonadal function and morphology in non‐cirrhotic female alcoholics:
Authors: Valimaki Matti J. , Laitinen Kalevi , Tiitinen Aila , Steman Ulf‐HÅKan , Ylöstalo Pekka
Published: November 2007

Objective. To study the occurrence and mechanisms of gonadal dysfunction in women with alcohol abuse.

Design. Prospective study.

Setting. Helsinki University Central Hospital.

Subjects. Fifteen consecutive chronic female alcoholics without liver cirrhosis, admitted for withdrawal treatment, were studied after cessation of alcohol intake. Twelve women had regular menstrual cycles, two appeared to be menopausal and one had hypothalamic amenorrhoea. The women with regular cycles were compared with eleven healthy controls.

Intervention. Blood was sampled for hormone measurements three times on cycle days 5 to 7, 11 to 14, and 19 to 22, and ultrasonography was performed on the same days as the first two hormonal studies.

Main outcome measures. Serum LH, FSH, prolactin, estrone, estradiol, progesterone, testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone‐binding globulin (SHBG). the ovarian volume, the follicular diameter, the endometrial thickness.

Results. During the luteal phase of the menstrual cycle the serum concentration of testosterone was 65% (p<0.01) higher and that of progesterone 23% (p>0.05) lower in patients than in controls. During the follicular phase serum DHEAS level was decreased by 39%) (p<0.05) in patients. Otherwise the serum concentrations of the hormones studied were similar in patients and in controls. As assessed by ultrasonography, patients and controls did not differ with regard to size of the ovaries, follicle development, or the endometrial thickness. Conclusions. Even heavy alcohol use has only minor permanent effects on ovarian function, at least until development of liver cirrhosis.
Is MRI helpful in evaluating the response of cervical cancer to neoadjuvant chemotherapy?
Authors: Vives A. , Castelo‐Branco C. , Iglesias X. , Tomás X. , Palombo H. , Pahisa J. , Lejárcegui J. A. , Salvador A. , Puig‐Tintoré Li
Published: November 2007

Background. To assess the potential role of magnetic resonance imaging (MRI) in evaluating the response of cervical tumor to neoadjuvant chemotherapy.

Methods. We studied 14 patients with locally advanced carcinoma of the cervix. MRI was performed before and after each cycle. All patients underwent laparotomy four weeks after the last cycle. MR images after chemotherapy were compared with surgical‐pathologic findings.

Results. Related to parametrial state after chemotherapy, surgical examination correlated with MRI in nine patients (nine true negative). In three cases parametrial invasion was overestimated (three false‐positive) and in two it was underestimated, so that tumor resection was not possible once laparotomy was performed (two false‐negative). MRI estimation of tumor size was confirmed at pathologic examination in only eight patients, whilst it was overestimated in the other four ones.

Conclusions. These initial results suggest that MRI could not be as precise for cervix cancer staging and evaluation of response to chemotherapy as has recently been postulated. This is especially important since a false negative result may induce the surgeon to perform laparotomy in error in cases of unresectable tumors.
Book Review
Authors: Hordnes Knut
Published: November 2007

Martin DC, editor. Atlas of endometriosis. London: Gower Medical Publishing, 1993. 90 pages, figures, tables, charts. Price, May 1993: GBP 40.00.

Rowe PJ, Comhaire FH, Hargreave TB and Mellows HJ. WHO manual for the standardized investigation and diagnosis of the infertile couple. 83 pages, figures, tables. World Health Organization, New York: Cambridge University Press 1993. Price: USD 24.95.
Placenta previa, maternal smoking and recurrence risk
Authors: Monica G. , Lilja C.
Published: November 2007

In order to assess the risk of placenta previa among women who smoked during pregnancy and to study the recurrence risk of placenta previa, we analyzed data from the Swedish Medical Birth Registry. Among 1,825,998 infants of women delivered in 1973‐1990, 5,683 had placenta previa registered. The overall incidence of placenta previa was 0.3%, the incidence in twin deliveries was also 0.3%. The recurrence rate of placenta previa was 2.4%, which is an eightfold increase compared with the rate of a placenta previa among all births. Maternal smoking was studied for births in 1983‐1990 and appeared as an independent risk factor for placenta previa. A dose‐response between the number of cigarettes smoked during pregnancy and the risk of having a placenta previa was indicated.