bluuebunny/crossref_metadata_2025 huggingface dataset:
Symphysis‐fundus height: construction of a new Swedish reference curve, based on ultrasonically dated pregnancies
Authors: Steingrímsdottir ThÓRa , Cnattingius Sven , Lindmark Gunilla
Published: November 2007

Repeated measurements of the symphysis‐fundus (SF) distance is generally regarded as an acceptable screening instrument for antenatal detection of intrauterine growth retardation (IUGR). In the present investigation an SF curve is constructed, based on measurements from 1650 Swedish women with ultrasound dated pregnancies. The SF measurements were included in a cross‐sectional stratified manner; only one measurement from each woman was used and the same number of measurements (n=75) was used for each gestational week from 20 through 41. A regression analysis by a polynomial equation of third degree was applied on the means and standard deviations of the SF measurements in each week respectively to construct a graph of fundal height. This SF curve was compared with the SF curve in common use in Sweden (constructed by Westin); in the new curve the mean measurement was about one cm higher up to 37 gestational weeks, after which time the curves almost coincided. Neither did the mean SF height differ between smokers and non‐smokers nor between nulliparous and parous women. The mean SF difference between the heaviest women (≥79 kg) and the lightest (≥53 kg) was about two cm throughout pregnancy. The validity of the constructed SF curve as a screening instrument for IUGR needs to be investigated in a different study.
Umbilical artery Doppler ultrasound predicts low birth weight and fetal death in hypertensive pregnancies
Authors: Torres Pere‐Joan , Gratacós Eduard , Alonso Pedro L.
Published: November 2007

Background. Doppler ultrasound is nowadays common in the management of pregnancies complicated with hypertension, as an indirect assessment of fetal well‐being. However, the value of abnormal umbilical artery Doppler results in predicting poor fetal outcome in hypertensive pregnancies has been studied in only a small number of patients. We designed a study to investigate the relation between abnormal umbilical artery Doppler velocimetry and fetal outcome in hypertensive pregnancies.

Design. A prospective observational study over a 2‐year period was performed at the Hospital Clinic, University of Barcelona. Pulsed Doppler examinations of the umbilical artery were performed in one hundred and seventy‐two hypertensive pregnant women. The physicians managing the case were not aware of the Doppler results. The incidence of low birth weight and fetal death were considered as the main outcome measures.

Results. When low birth weight was used as an end‐point, abnormal resistance index showed a high specificity (95.16%), positive predictive value (83.33%), and negative predictive value (86.76%). Sensitivity was 62.5%. The absence of end‐diastolic velocity predicted low birth weight in 100% of pregnancies and fetal death in 66.66%. All stillbirths had absence of end‐diastolic velocity (sensitivity 100%).

Conclusion. This study demonstrates that umbilical artery Doppler velocimetry is a useful tool to assess fetal well being in hypertensive pregnancies.
Persistent episiotomy granulation polyps; a polysymptomatic clinical entity
Authors: Atia Waheeb Atalla , Tidbury Penelope Jane
Published: November 2007

We describe a number of patients with persistent symptoms of vaginal discharge and discomfort, dyspareunia and postcoital bleeding. They presented 2‐A months following delivery with episiotomy. In these patients, the symptoms were associated with localised granulation tissue polyps, on the episiotomy site. Simple ablation resulted in rapid and effective relief of the symptoms. These lesions may be more common in clinical practice than is suggested by the lack of published reports. They should be looked for in women who may suffer from symptoms for several months after delivery.
Therapeutic and prognostic considerations in primary carcinoma of the vagina
Authors: Leminen Arto , Forss Matti , Lehtovirta Pentti
Published: November 2007

We analyzed 46 patients with primary carcinoma of the vagina treated between 1969 and 1990. Median age of the patients was 67 years (range 33‐89 years). Most (52%) of them were obese and 35% were nulliparous. Four (9%) had suffered from other gynecologic carcinoma and had been operated six to 23 years before the current carcinoma. Forty (87%) patients had squamous cell carcinoma. Stage 0 (carcinoma in situ) was found in three (7%) cases and stage I IV in 21 (54%), 10 (22%). four (9%) and eight (17%,) cases, respectively. Most (81%) of the patients were treated with radiotherapy (alone or in combination with other treatments): combination of brachytherapy and external radiotherapy were used in 45% of the cases. Surgery was used in all stage 0 cases and in 52% of stage I cases. Recurrence of the disease was found in 20 (43%) cases during the follow‐up of 10 years. Most often (40%) site of the recurrence was the vagina. Both 5‐ and 10‐year survival were 38%. Stage and extent of the tumor were independent prognostic factors in stepwise multivariate analysis.
Oral poliovirus vaccination and pregnancy complications
Authors: Harjulehto‐Mervaala Tina , Hovi Tapani , Aro Timo , Saxen Harri , Hiilesmaa Vilho K.
Published: November 2007

Background. To determine whether the effect of live attenuated oral polio virus vaccine given to pregnant women increases pregnancy complications.

Methods. A study of women who had been vaccinated against poliovirus during a national vaccination campaign and who had delivered by cesarean section in three obstetrical hospitals in southern Finland. One thousand seven hundred and forty‐seven vaccinated women (in three study cohorts), and their 2293 nonvaccinated controls (in two reference cohorts) were analyzed. Subjects are out of 22 000 deliveries evaluated earlier.

Results. Vaccinated sectioned women did not show an excess of pregnancy complications. The mean rate of cesarean sections was 18.4% in the study cohorts and 18.9% in the reference cohorts counted from the 22 000 deliveries.

Conclusions. Oral live attenuated polio virus vaccine does not increase pregnancy complications and is considered a safe alternative for vaccinating pregnant women.
Preventing the recurrence of atonic postpartum hemorrhage: a double‐blind trial
Authors: Van Selm Maria , Kanhai Humphrey H.H. , Keirse Marc J.N.C.
Published: November 2007

Background. We conducted a double‐blind randomized controlled trial to compare a conventional regimen of oxytocin and ergometrine with administration of the prostaglandin E2 analogue, sulprostone, for prophylaxis of postpartum hemorrhage in high‐risk women.

Methods. Women with a history of postpartum hemorrhage ≥1000 were assigned to two coded prophylactic regimens. Drugs, given respectively at delivery of the anterior shoulder and after delivery of the placenta, were oxytocin and ergometrine in the control group, and sulprostone and placebo in the experimental group. Eighty‐one women, 69 of whom actually participated in the trial, were investigated. Both the women and the caregivers were unaware of treatment allocation.

Results. Although the trial was terminated prematurely there was a slight, but not statistically significant, preference for the sulprostone regimen in terms of blood loss and use of blood transfusion. No serious adverse effects were noted with either of the two regimens.

Conclusion. Prostaglandins may be more effective for preventing recurrence of severe postpartum hemorrhage than the oxytocin and ergometrine combination, but they do not eliminate the risk entirely.
The influence of social class on parity and psychological reactions in women coming for induced abortion
Authors: Hamark Bengt , Uddenberg Nils , Forssman Lars
Published: November 2007

Objective. To test the hypothesis that the correlation between legal abortion and socio‐economic conditions, known from the time when abortion was restricted, has current validity. To evaluate the effect of social class on network support and psychological reactions.

Design. Consecutive sampling and semistructured personal interviewing.

Subjects. 444 women living in the city of Gothenburg and applying for legal termination of pregnancy in the first trimester.

Setting. The department of gynaecology at a university hospital with primary care responsibility for legal abortions.

Results. The 667 health administration districts of Gothenburg were ranked into four groups according to the mean income. Women living in lower socio‐economic districts were younger. Irrespective of age, previous experience of induced abortion was more common among them (p<0.001). Unsatisfactory network response or support was common (37%), but equally shared between the social classes. Discontinuation of oral contraception during the previous six months was twice as common among teenagers (40.0%) as among other women (p<0.001) but without social differences. Pitman's permutation test was used for statistical analyses. Conclusion. Socio‐economic conditions have a strong and inverse correlation to previous experience of induced abortion. Psychological reactions and needs did not vary with class.
Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets is equally effective
Authors: Rix Per , Ladehoff Poul , Møller Anna Margrethe , Tilma Karen Andersen , Zdravkovic Milica
Published: November 2007

Background. Prostaglandin E2 for local application has been widely used for preinduction cervical ripening in cases presenting with an unfavorable cervical state. The optimal way of administering prostaglandin E2, however, remains unclear. The aim of this study was to compare the effect of multiple application of 0.5 mg Minprostin® intracervical Gel to the effect of 3 mg Minprostin® vaginal tablets in priming the uterine cervix and inducing labor in an open, prospective, randomised study.

Methods. PGE2 was applied up to three times a day for two days until ripening was obtained or labor induced. In case no progress took place amniotomy was performed and i.v. oxytocin stimulation one hour later if necessary. A total of 208 pregnant women, consecutively admitted for induction of delivery, with Bishop Scores 0‐5, were included.

Results. Minprostin® gel (group I) and Minprostin® tablets (group II) were equally effective in ripening the cervix. Delivery within 48 hours was achieved in 59% and 63% respectively. The mean number of applications was 2.6 (s.d. 1.6) and 2.7 (s.d. 1.3) respectively. In case more than four doses were required no further effect was seen on delivery rates. Rates of cesarean section (performed in 15% and 18% respectively), labor induction (3%/1%), drop outs (14%/12%) and failed inductions (10%/5%) were comparable. Patients in group I had a significantly lower demand for analgesia. A significantly shorter induction‐delivery interval in group II was seen in patients with preinduction Bishop scores 3‐5 compared to patients with Bishop scores 0‐2. Side effects were few. Both procedures appear safe. Conclusions. Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets in cases presenting with an unfavorable cervical state is equally effective.
Effect of vaginal misoprostol application for cervical softening in pregnancy interruption before ten weeks of gestation
Authors: Ficicioglu Cem , Taşdemir Murat , Taşdemir Seval
Published: November 2007

Objective. To determine the effect of vaginal misoprostol application for cervical dilatation and to determine the lime taken for pregnancy interruption.

Methods. 200 μg misoprostol and gyno‐flor vaginal tablet, employed to create acidic milieu, were applied into the posterior fornix of 40 women with gestational age of 5 to 10 weeks. Placebo was applied vaginally to 20 women who made up the control group. All cases were examined 5 hours later. The cervical dilatation, presence of fetoplacental material in the vagina, extrauterine cervical bleeding and the time necessary for dilatation and suction curettage were investigated.

Results. In 33 (82.5%) of the cases cervical bleeding, in 21 (52.5 %) of the cases fetoplacental material on the cervix and or in the vagina were detected in women of misoprostol group, while neither cervical bleeding nor fetoplacental material on the cervix and/or in the vagina was detected in the placebo group. In the misoprostol group the time taken for the operation was significantly (p<0.005) shorter than that of the control group.

Conclusion. Vaginal application of misoprostol shortens the time needed for the termination of the gestation by its facilitating effect on cervical dilatation.
Relaxant effect of nitric oxide and prostacyclin on serotonin‐induced vasocontraction of human umbilical artery
Authors: Okatani Yuji , Watanabe Kazushi , Nakano Yuji , Sagara Yusuke
Published: November 2007

Background. We investigated the effect of nitric oxide and prostacyclin, which are endothelium‐derived vasodilators, on serotonin (5‐HT)‐induced vasocontraction, and 5‐HT1‐serotoninergic receptor mediated relaxation in the human umbilical artery. Methods. Serotonin‐stimulated vasocontraction was measured in umbilical artery segments treated with and without 1) L‐arginine (10−4 M∼10−2 M), a precursor of nitric oxide synthesis: 2) methylene blue (10−5 and L‐NG‐monomethyl arginine (LNMA, 2×10−4 M), which are specific inhibitors of nitric oxide action and nitric oxide synthesis, respectively; and 3) tranylcypromine (2× 10−7 M. 2×10−5 M), an inhibitor of prostacyclin synthesis. 4) Vessels were pretreated with M1. an inhibitor of 5‐HT2 serotoninegic receptors, and then prostaglandin F2 α (9.0×10−7 M). Finally, we measured the 5‐HT1 receptor‐mediated relaxation induced by 5‐HT.

Results. Treatment with L‐arginine significantly inhibits 5‐HT‐induced contraction in a dose‐dependent manner. Treatment with methylene blue and LNMA significantly potentiated 5‐HT‐induced contraction. Tranylcypromine caused no significant changes in 5‐HT‐induced vasocontraction. 5‐HT1 serotoninetic receptor‐mediated relaxation was found at higher concentrations of 5‐HT (greater than 4.94× 10−5 M).

Conclusions. Our results suggest that nitric oxide may exert a strong relaxant effect on 5‐HT‐induced vasocontraction compared with prostacyclin in human umbilical artery.
Local administration of prostaglandin E2 for cervical ripening and labor induction: the appropriate route and dose
Authors: Nuutila Mika , Kajanoja Pauli
Published: November 2007

Background. Although there are many comparative studies concerning the local administration of prostaglandin E2 gel for cervical ripening and labor induction, the safety, efficacy and the appropriate route and dose of the gel are still debated.

Patients and methods. One hundred and ten women with high‐risk pregnancy and unripe cervix received prostaglandin E2 gel 1 mg intravaginally (n=35), 2 mg intravaginally (n=36) and 0.5 mg intracervically (n=39), maximally three times at 6‐hour intervals for cervical ripening prior to labor induction. The safety, efficacy and optimal dose were assessed. Results. The 2 mg intravaginal gel and the 0.5 mg intracervical gel were equally effective and more effective than the 1 mg intravaginal gel in labor characteristics such as ripening time and cesarean section rate, but not in labor time. However, the failure rate (labor could not be induced) was highest in the intracervical group (10.3%) compared to the intravaginal groups (2.9% and 2.8%), although the differences were not statistically significant. In the two intravaginal groups three and five patients received the third gel application and one patient in both groups could not be induced. In the intracervical group the ripening of the cervix failed in all patients, who received the third gel. The neonatal outcome was uneventful in all groups. There were two cases of uterine hypertonus associated with fetal bradycardia, one in the intracervical and one in the 2 mg intravaginal group. Thus careful fetal monitoring is necessary. Furthermore, the vaginal route has the advantage of an easier technique of administration and obviously lower risk for inadvertent extraamnial instillation.

Conclusion. We recommend the use of multiple applications of 2 mg intravaginal prostaglandin E2 gel as a safe, effective and easy method for preinduction cervical ripening in high‐risk pregnancies. More than three gel applications hardly increase the efficacy.
Reduction of bone mineral density by gonadotropin‐releasing hormone agonist, nafarelin, is not completely reversible at 6 months after the cessation of administration
Authors: Taga Michiyoshi , Minaguchi Hiroshi
Published: November 2007

Study Objective. To determine the reversibilty of bone mineral density after the cessation of GnRH agonist treatment for endometriosis.

Design. Longitudinal trial with 6‐month treatment period and 6‐month follow‐up.

Patients. 28 Japanese premenopausal women with endometriosis.

Interventions. Daily dose of 400 μg nafarelin was administered for 6 months. Measurement and main results. The spine bone mineral density was measured by dual energy X‐ray absorptiometry, and blood and urinary bone metabolic parameters were analyzed. The decrease of lumbar bone mineral density, which took place during treatment, continued during the first 3 months after the cessation of treatment and did not return to the initial baseline level even at 6 months after the withdrawal of treatment. The biochemical parameters, which showed a state of enhanced bone turnover during nafarelin treatment, almost returned to the pretreatment level 6 months after the termination of treatment.

Conclusion. These results indicate that relatively long period of bone metabolic change might be required to alter the actual bone mineral density after GnRH analog administration.
Management of urinary bladder injuries in laparoscopic assisted vaginal hysterectomy
Authors: Lee Chyi‐Long , Lai Ying‐Ming , Soong Yung‐Kuei
Published: November 2007

Background. To illustrate our experience and evolution in management of urinary bladder injury in laparoscopically assisted vaginal hysterectomy.

Methods. Four hundred and twenty‐two women underwent laparoscopically assisted vaginal hysterestomy with or without adnexectomy during the period March 1991‐September 1994. The indicators for hysterectomy included adenomyosis myoma uteri, intractable menorrhagia, endometriosis and severe pelvic adhesion. There are six cases of urinary bladder injuries resulting from our 422 cases of laparoscopically assisted vaginal hysterectomy.

Results. The first two cases of urinary bladder injuries were repaired through exploratory laparotomy. The third case was repaired through laparoscopic intracorporeal suture. The technique of the automatic linear stapler through laparoscopy was used in case 4. The last two cases were repaired vaginally. All these patients recovered well after primary repair with an indwelling catheter for five to seven days regardless of the method of repair. The operation time for repairing the injuries is shortest in vaginal approach.

Conclusions. The urinary bladder injury is one of the most common complications associated with laparoscopically assisted vaginal hysterectomy. Early detection and treatment enable complications to be overcome easily. As the laparoscopist acquires further experience in dealing with these complications, the urinary bladder injury may be managed laparoscopically. However, vaginal approach may be an easier way in dealing with this complication. Thus most laparotomy or high technique laparoscopically repair could be avoided.
A prospective study of antibodies against parvovirus B19 in pregnancy
Authors: Skjöldebrand‐Sparre Lottie , Fridell Eva , Nyman Margareta , Wahren Britta
Published: November 2007

Background. Parvovirus infection during pregnancy has been reported to be associated with spontaneous abortion and fetal loss.

Objective. To show the incidence of antibodies against Parvovirus B19 early in pregnancy and sero‐reactivities during and after pregnancy.

Study design. In a prospective study during a non‐epidemic period, 457 women admitted to an antenatal care center were included. Serum samples were collected at 7‐13, 21, and 33 weeks of gestation, and 7‐9 weeks after delivery.

Method. Samples were evaluated for parvovirus specific IgG and IgM against two different parvovirus antigens.

Results and conclusion. Parvovirus specific antibodies were present in 81% of the women in the first sample. Six women (six of 88 susceptible, 6.8%) seroconverted and 28 women (28/ 369. 7.6%) boosted their antibody response during or after pregnancy. All gave birth to healthy infants.

One woman free of symptoms experienced an intrauterine fetal death at 37 weeks of gestation. She had no rise in B19 antibodies during pregnancy, but parvovirus DNA was found in maternal serum samples and in the placenta.
Prospective study of incidence and predisposing factors for clavicular fracture in the newborn
Authors: Many Ariel , Brenner Steven H. , Yaron Yuval , Lusky Ayala , Peyser M. Reuben , Lessing Joseph B.
Published: November 2007

Objective. To determine the incidence of clavicular fractures, associated fetal and maternal risk factors and its connection with quality care control.

Results. Forty‐six (1.5%) newborns were found to have clavicular fractures. When compared to the control group, they were found to have a higher birthweight (3710±352gm vs 3235±405gm) an older maternal age (30.5±5 vs 27.7±6), a longer second stage of labor (34 min vs 23 min). higher rate of instrumental deliveries (13/46 vs 6/52) and shoulder dystocia (6/46 vs 1/52). Nearly 80% of newborns with clavicular fractures weighed less than 4000 gm. Multivariate analysis demonstrated two independent variables; birthweight over 3500 gm and maternal age >29.

Conclusion. Clavicular fractures are associated with higher birthweight, older maternal age, longer second stage of labor, instrumental deliveries and shoulder dystocia. However, in most cases this injury cannot be predicted prior to delivery and thus cannot be an indicator of quality control.

Subjects and methods. A total of 3030 newborns delivered vaginally were evaluated for clavicular fractures by three separate physicians. The study group included all newborns with fractured clavicle. A control group consisted of 52 newborns delivered vaginallly with no history of fractures. Maternal records were evaluated for possible predisposing factors.
The effect of post‐natal exercises to strengthen the pelvic floor muscles
Authors: Mordved Siv , Bo Kari
Published: November 2007

Background. The purpose of the present study was to evaluate the effect of post‐natal pelvic floor muscle exercise.

Methods. A prospective comparison design comprising 66 matched pairs (n=132) of mothers, divided into a training group (TG) and a control group (CG) was used. The TG attended an eight week special pelvic floor muscle exercise course, training in groups led by a physiotherapist 45 minutes once per week. In addition they exercised at home at least three times per week. The CG followed the ordinary written postnatal instructions provided by the hospital. Pelvic floor muscle strength was measured at the 8th and the 16th week after delivery using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction, were used to control the ability to perform correct pelvic floor muscle contraction. In addition the women were interviewed about breast feeding, menstruation, general physical activity and pelvic floor muscle exercise during pregnancy, between birth and test 1, and between test 1 and test 2. Wilcoxon‐Signed‐Ranks‐Test for matched pairs was performed to compare change in pelvic floor muscle strength within and between groups.

Results. While a statistically significant change in pelvic floor muscle strength was found in both the TG and the CG. the improvement for the training group was significantly greater.

Conclusions. It was concluded that a specially devised pelvic floor muscle strength training programme can add significantly to physical recovery after childbirth.
Effects of endothelin‐1 and the ETA receptor antagonist BQ‐123 on resistance arteries from normal pregnant and preeclamptic women
Authors: Wolff Kerstin , Kublickiene Karolina‐Rasa , Kublickas Marius , Lindblom Bo , Lunell Nils‐Olov , Nisell Henry
Published: November 2007

Objective, To compare the effect of endothelin on isolated resistance arteries from different vascular beds in normal and preeclamptic women before and after pretreatment with the ETA receptor antagonist BQ‐123.

Materials and methods. Resistance arteries from myometrial and omental biopsies obtained at cesarean section of normal pregnant and preeclamptic women were dissected and mounted in organ baths for recording of isometric tension. The contractile response to endothelin‐1 in presence and absence of BQ‐123 was recorded.

Results. Endothelin‐1 induced similar concentration‐dependent contractions in all arteries investigated. In women with preeclampsia the contractile response induced by endothelin‐1 was significantly higher in omental as compared to myometrial vessels. Pretreatment with BQ‐123 significantly shifted the concentration‐response curve to the right but only reduced the maximum contractile response in omental vessels.

Conclusion. Endothelin‐1 is a potent constrictor of resistance arteries from different vascular beds in normal pregnancy and preeclampsia. The contractile effect is at least in part mediated by ETA receptors, since it was significantly reduced after pretreatment with BQ‐123. In preeclamptic but not in normal pregnant women the response to endothelin‐1 was reduced in myometrial as compared to omental arteries, possibly secondary to receptor down regulation.
A comparative study of obstetric outcome of patients with pregnancy induced hypertension: economic considerations
Authors: Omu Alexander E. , Al‐Othman Saed , Al‐Qattan Fawzia , Al‐Falah Fatma Z. , Sharma Prem
Published: November 2007

Background. Hypertension in pregnancy is associated with increased maternal and fetal morbidity and mortality. The aim of this prospective study was to evaluate the obstetric outcome of patients with pregnancy induced hypertension (PIH) that delivered at the Maternity Hospital Kuwait within a period of six months and evaluate the economic implications of present management strategies.

Methods. This was a comparative study with age and parity, as matching variables, in 224 pregnant hypertensive women and 224 normotensive controls.

Results. During the study period, the incidence of PIH was 4.9 percent. They were more associated with diabetes mellitus and multiple pregnancy than controls (p<0.02). About 43 percent of the hypertensive parturients used antihypertensive therapy. More of them had induction of labor (p<0.001), preterm delivery (p<0.002) and cesarean section (p<0.001), and babies with low birthweight (p<0.01). In the linear regression analysis, hypertension in pregnancy gave rise to more hospitalisation, intrauterine growth retardation and operative deliveries than the normotensive controls. The perinatal mortality was higher (p<0.001).

Conclusion. Despite the economic expenditure of about five times more for hypertensive women in pregnancy than in controls, both obstetric and neonatal outcome, are still significantly worse in the former. This study therefore advocates more research into the prevention, prediction and management, including neonatal care, of hypertensive disorders of pregnancy.
Maternal and perinatal implications of the use of human recombinant erythropoietin
Authors: Braga Jorge , Marques Ricardo , Branco Anabela , Gonçalves Joaquim , Lobato Luísa , Pimentel Joao Pedro , Flores Maria Manuel , Gonçalves Eduardo , Jorge Carlos Santos
Published: November 2007

Background. The use of human recombinant erythropoietin (rHuEPO) in pregnant patients has been limited by the fear of eventual maternal and fetal repercussions (either direct or indirect).

Methods. The authors present their experience with the use of rHuEPO during pregnancy, with two pregnant women with kidney transplants and in three others with chronic renal insufficiency (one with diabetic nephropathy, another dialysis dependent), all with hematocrit below 30% and adequate iron reserves.

Results. Three of the patients had needed blood transfusions before beginning therapy, and another needed transfusion after significant metrorrhagia. The length of the treatment varied between 2 and 23 weeks and the hematocrit at delivery varied between 26% and 36%. Secondary effects (appearance or worsening of hypertension and seizures) were nil. There was one fetal death at 23 weeks of pregnancy (following an abruptio placentce), two neonates weighing between the 5th and the 10th percentiles, and three needing phototherapy (1 to 2 days). One year after birth, all showed a normal ponderal and neurologic development.

Conclusions. Among the cases presented, no maternal and perinatal complications attributable to rHuEPO were registered. It is important that institutions report their experiences with the use of rHuEPO, given its restrictive indications and the limited experience of each institution.
The effects of parity on birthweight using successive pregnancies
Authors: Wilcox Mark A. , Chang Allan M. Z. , Johnson Ian R.
Published: November 2007

Objective. Accurate assessment of the difference in birthweight between first and second live‐births to the same woman having excluded the effects of physiological factors known to affect birthweight.

Design. Retrospective longitudinal observational study.

Results. The mean crude birthweight difference between first and second pregnancies was an increase of 138 g. Significant differences between the paired pregnancies were found in maternal booking visit weight, blood pressure, maternal age and gestation at delivery. Independent factors affecting difference in birthweight were gestation at delivery, maternal booking weight and baby's sex. Regression towards the mean was demonstrated which meant that a woman delivering a first baby weighing more than 3720 g could expect a lighter baby for her second delivery provided that all other factors remained constant.

Conclusions. In general terms a woman is more likely to deliver a heavier baby in her second pregnancy than in her first pregnancy. However, maternal physiological factors differ in the two pregnancies and these differences have additional effects on birthweight. The effects of both these observations are tempered by regression towards the mean which has a profound influence in predicting the likely change in birthweight between first and second pregnancies. Clinical decisions should not be based on the assumption that a second baby will inevitably be heavier than the first baby.

Setting. Three large obstetric units in the East Midlands of the United Kingdom. Subjects and methods. Women in whom data were recorded for their first two pregnancies on the UK East Midlands Obstetric database which resulted in the delivery of a liveborn, singleton and congenitally normal baby. Six thousand five hundred and thirty such cases were identified, of which 3457 had complete datasets and delivered both babies at term (259 to 300 days). An analysis was performed of changes between the paired pregnancies of physiological factors known to affect birthweight. Regression analyses were used to enable prediction of the second birthweight with the knowledge of the first birthweight.
How should we investigate women with postmenopausal bleeding?
Authors: Gupta Janesh Kumar , Wilson Sheena , Desai Pershant , Hau Cathy
Published: November 2007

Objective. To evaluate the optimum method(s) of investigating women with postmenopausal bleeding.

Design. Prospective study of 76 postmenopausal women. Setting. Teaching Hospital.

Interventions. All women had pipelle endometrial biopsy in outpatient clinic. Prior to inpatient hysteroscopy and uterine curettage, each woman had pelvic ultrasonography to measure the endometrial thickness and to exclude ovarian pathology.

Results. Pipelle biopsy was successful in 70% of cases and has a sensitivity of 70%. Hysteroscopy has superior diagnostic capabilities allowing direct visualisation of the endometrial cavity with directed biopsies. Endometrial thickness of >5 mm used as an indicator of endometrial pathology compared to uterine curettage has a sensitivity of 83%, a specificity of 77%, and a positive predictive value of 54%. Ultrasound also detected five ovarian tumors, two of which were malignant and three missed by pelvic examination alone.

Conclusions. We recommend the routine use of pelvic ultrasonography in all women with postmenopausal bleeding as it is an invaluable diagnostic tool in excluding ovarian pathology. In addition, sampling of the endometrial cavity, preferably with outpatient hysteroscopy, is mandatory for histological diagnosis. Overall, the combination of ultrasound and outpatient endometrial sampling would spare hospital admission for at least 60% of women with postmenopausal bleeding.
Anticoagulant therapy in pregnancy
Authors: Lécuru Fabrice , Desnos Michel , Taurelle Roland
Published: November 2007

Background To investigate the adverse effects of anticoagulant therapy during pregnancy in a tertiary care center.

Material and methods A prospective study was carried out between 1 January 1977 and 31 December 1994 and included 54 pregnancies in 50 women treated with anticoagulants. In Group I (n=43) oral anticoagulants were replaced for heparin from the sixth until the end of the twelfth week of gestation. In Group II (n= 11) the pregnancy was diagnosed after the ninth week of gestation and acenocoumarol was not substituted. All patients received vitamine K antagonists during the second and third trimesters. Heparin was given after 36 weeks of pregnancy until the tenth day in the postpartum period. Statistical comparisons used Chi square test (with the Yates correction when appropriate) and Student t test. Results. Mechanical heart valve prosthesis was the most frequent indication (68%). There was one artificial heart valve thrombosis during first trimester in Group I and none in Group II (p=0.45). One spontaneous abortion occurred in each group (p=0.86). Seven cardiac complications (13.7%) occurred during the second and third trimesters. We recorded no thrombotic episode of an artificial heart valve after the first trimester of pregnancy. Hemorrhagic complications occurred in mid pregnancy (one case=2%) and during peripartum (eight cases=16%). Two maternal deaths occurred in the postpartum period, both were linked with the anticoagulant therapy. There was one coumarin embryopathy (Group II: 9%), but no neonatal mortality.

Conclusions (1) Hemorrhagic complications occur among 16% of patients receiving anticoagulant therapy during pregnancy. (2) Delivery and postpartum are the most critical periods.
The occurrence of placental abruption in Norway 1967‐1991
Authors: Rasmussen Svein , Irgens Lorentz M. , Bergsjø Per , Dalaker Knut
Published: November 2007

Study objective To study secular trends of placental abruption (PA), the effects of demographic variables and the use of cesarean section (CS) associated with PA.

Design A population based cohort study.

Setting The Medical Birth Registry of Norway.

Patients 9.592 cases of PA of a total of 1.446,154 births notified, i.e. all births in Norway 1967‐1991.

Main results The PA proportion was 6.6 per 1000 births of a gestational age of 16 weeks or more, ranging from 5.3 in 1971 to 9.1 in 1990. Birth order two had the lowest proportion and it increased by maternal age. The PA proportion decreased by gestational age from 86.4 per 1000 below 28 weeks to 3.4 in term pregnancies. The PA proportion per 10,000 pregnancies at risk increased from 1.3 in the 28th week to 14.1 in the 42nd week. A secular trend of a decreasing but still high relative risk of PA in SGA‐births (< the 10 birthweight percentiles) and larger infants in PA‐cases was noted. To an increasing extent, PA‐cases in university hospitals were referred cases. The CS rates in PA‐births at any gestational age increased from 1967 through 1991. The relative risk of PA of Apgar score <7 after five mintues, adjusted for gestational age, was 7.8.

Conclusions Inspite of an increasing CS rate, an increasing proportion of PA was noted from 1967 through 1991. The proportion was lowest for birth order two and increased by maternal age. To an increasing extent. PA births were centralised. SGA. prematurity and asphyxia were major problems associated with PA. A tendency towards larger infants and a decreasing relative risk of PA in SGA‐births might be attributable to improvements in antenatal care.
Perinatal mortality and case fatality after placental abruption in Norway 1967‐1991
Authors: Rasmussen Svein , Irgens Lorentz M. , Bergsjø Per , Dalaker Knut
Published: November 2007

Study objective To study national secular trends in Norway of perinatal mortality and case fatality due to placental abruption (PA) and associations with cesarean section (CS).

Design A population based cohort study.

Setting The Medical Birth Registry of Norway.

Patients 9,592 cases of placental abruption (PA) of a total of 1,446,154 births notified in Norway 1967‐1991.

Main measures Comprehensive perinatal mortality (all stillbirths ≥ 16 weeks of gestation and early neonatal deaths) and standard perinatal mortality (all stillbirths ≥ 28 weeks of gestation and all early neonatal deaths). Case fatality rate.

Main results From 1967 through 1991, the standard perinatal mortality rate due to placental abruption (PA) in Norway decreased from 2.5 per 1000 births (13.5% of all deaths) in 1967 to 0.9 (13.2%) in 1991. The comprehensive perinatal mortality rate decreased from 3.2 to 1.7 per 1000. The proportion of all perinatal deaths due to PA increased from 11.4% in 1967‐1971 to 13.9 in 1987‐1991. The case fatality rate decreased from 470.8 per 1000 cases in 1967‐71 to 217.0 in 1987‐91 and decreased in all gestational age categories. Case fatality in PA with cesarean section (CS) was generally lower than in PA without CS, regardless of gestational age.

Conclusions Placental abruption is an important cause of perinatal mortality in Norway. Our results are in favor of an active approach with frequent use of cesarean section, also at lower gestational ages. The decreasing case fatality rate by year of birth in all gestational age groups may be attributed to improved obstetric and perinatal care.
The intensity of labor pain in grand multiparas
Authors: Ranta P. , Jouppila P. , Jouppila R.
Published: November 2007

Background The purpose of the current study was to investigate differences in pain experiences and requirements for pain control in parturients with different birth experience. Previous studies have shown that the labor pain experience is significantly less intense in multiparas than in primiparas and requirements for analgesic treatment have therefore been assumed to be minimal in this group.

Methods The pain experience during labor was assessed by 70 consecutive grand multiparas (a minimum of five previous deliveries) compared to that of primiparous (n = 70) and II‐V parous women (n = 70). Pain intensity was repeatedly assessed on a pain intensity scale (0‐10) according to the progress of cervical dilatation at the first and second stage of labor. Results. During the latent phase of cervical dilatation (0 to 3 cm) grand multiparas had a median pain score of 3 compared to 4 in II‐V paras and 6 in primiparas (p < 0.001). At the end of the first stage and during the second stage the intensity of pain in grand multiparas was significantly higher compared to that in primiparas (median scores 7 to 8 vs 6 to 7, p < 0.05). Epidural blocks were administered to 40% of primiparas, 3% of II‐V paras and to no grand multiparas (p < 0.0001). Twenty‐one percent of grand multiparas rated their pain as intolerable (pain scores 9 to 10) during the second stage compared to 10% of primiparas (p < 0.05). On the third day after delivery. 47% of grand multiparas regarded their analgesia insufficient.

Conclusions The majority of parturients, including grand multiparas, suffered from intense pain during labor. After delivery, a significant number of grand multiparas felt that they had received insufficient pain relief.
Plasma lipids, lipoproteins and apolipoproteins in hirsute women
Authors: Castelo‐Branco Camil , Casals Elena , de Osaba Maria J. Martinez , Sanllehy Carolina , Fortuny Albert
Published: November 2007

Objective To determine whether lipid alterations in hirsute women are due to excessive androgen, low estrogen or to a combination of these abnormalities. Design. Cross sectional study.

Patients Forty‐five hirsute women between 15 and 39 years of age.

Main outcome measures FSH, LH, 17β‐estradiol, PRL, testosterone, androstenedione, DHEAS, 17‐OH‐progesterone, sex hormone binding globulin, cholesterol, LDL, HDL, triglycerides, and apolipoproteins A‐I and B.

Results Testosterone was correlated with triglycerides (r: 0.76, p < 0.01), HDL (r: −0.61, p < 0.01) and LDL (r: 0.50, p < 0.05). Both HDL (r: 0.66, p < 0.01) and LDL (r: −0.57, p < 0.01) were correlated with estradiol. Total cholesterol was also correlated with estradiol (r: −0.52, p < 0.05). Cross adjusted correlations revealed that, after adjusting for estradiol, lipids were associated with testosterone and that estradiol was also correlated with lipids when adjusted for testosterone.

Conclusion The results suggest that altered lipids in women with hyperandrogenism could result from independent effects of androgens and estrogens.
Ocular hypertensive effect of menopause with and without systemic hypertension
Authors: Qureshi Imran Ahmad
Published: November 2007

Background Mean intraocular pressure in postmenopausal women is higher than that in menstruating women. Intraocular pressure is positively correlated with systemic blood pressure. No previous study has compared intraocular pressure in postmenopausal women with systemic hypertension and those without.

Purpose To investigate the effects of menopause on intraocular pressure in subjects with and without high blood pressure, after eliminating those factors that can affect intraocular pressure.

Methods Normotensive menstruating and menopausal, along with hypertensive menopausal subjects of the same age groups were studied. Intraocular pressure was measured with the Goldmann applanation tonometer.

Results The mean intraocular pressure of the normotensive and hypertensive postmenopausal women were 0.73 ≥ 0.27 (p < 0.05). and 1.09 ≥ 0.34 (p < 0.01) mmHg higher than normotensive menstruating women respectively. The mean intraocular pressure of hypertensive postmenopausal women was 0.36 ≥ 0.15 mmHg (p < 0.05) higher than that of normotensive postmenopausal women.

Conclusions Menopause significantly increases intraocular pressure. Mean intraocular pressure of hypertensive postmenopausal women was significantly (p < 0.05) higher than that of normotensive postmenopausal women. Knowledge of the normal level of intraocular pressure during various stages of female sexual life may help glaucoma screeners.
Symptomatic genital papillomavirus infection in a community
Authors: Persson Göran , Andersson Karin , Krantz Ingela
Published: November 2007

Background Incidence of condyloma acuminatum is not well known. Descriptive data are usually based on selected groups of patients. This study aims at giving incidence of the clinically defined disease in a well‐defined area, thought to be representative for Sweden outside the capital city.

Methods Data from people with condyloma acuminatum seeking medical attention were collected during a two‐year period, 1989‐90, in a middle‐sized urban area in Sweden. A person with symptoms and a clinical picture consistent with condyloma was considered a case.

Results Overall incidence was 2.4 per 1,000. The highest age specific incidence occurred in the age group 20‐24 years, 12 per 1,000. Women 15‐19 years old had an incidence of 14 per 1.000. The total female to male ratio was 1.3.

Conclusions Women more often than men had a mixture of exo‐ and endophytic condylomata. Condyloma as another and complementary indicator of changing sexual behavior deserves further interest.
Fetal fibronectin and microorganisms in vaginal fluid of healthy pregnant women
Authors: Goffeng Anette Rossel , Holst Elisabet , Milsom Ian , Lindstedt GÖRan , Lundberg Per‐Arne , Anders BjÖRn
Published: November 2007

Objective. To determine fetal fibronectin in vaginal fluid from healthy women during uncomplicated pregnancy and to investigate possible relationships to gestational age and the vaginal microflora.

Materials and methods. Samples of vaginal fluid were collected for fetal fibronectin determination and for quantitative aerobic and anaerobic microbiological culture from 22 women followed longitudinally at 12, 28 and 37 weeks gestation and cross‐sectionally in women at 12 weeks (n=10), 28 weeks (n=10), 37 weeks (n=10), and 39 weeks (n=30) gestation, respectively. Fetal fibronectin was determined by a quantitative enzyme immunoassay (Adeza Biomedical).

Results. There were no significant differences between the concentrations of fetal fibronectin in vaginal secretions at any of the four measurement points (12, 28, 37 and 39 weeks gestation). Women with elevated fetal fibronectin concentration (0.05 mg/L) had less often hydrogen peroxide‐producing facultative lactobacilli (p<0.0001), and more often bacterial vaginosis (p<0.02) and Peptostreptococcus species (p<0.002). Bacterial vaginosis (p<0.01) and Candida albicans (p<0.01) were more frequently found in women lacking hydrogen peroxide‐producing lactobacilli.

Conclusion. Fetal fibronectin in vaginal fluid was more associated with the vaginal microflora than with the gestational age of the pregnancy. Presence of hydrogen peroxide‐producing lactobacilli seems to be the most important factor for a stable vaginal microflora.
HPV‐types, cytological and histopathological findings in three groups of women with possible HPV‐related disease
Authors: Frederiksson Agneta , Larson Barbro , Persson Elisabeth , Auer Gert , Johansson Bo , Kalantari Mina , Von Krogh Geo , Silfverswärd Claes
Published: November 2007

Objective. The aim of this investigation was to study three groups of women presenting with possible HPV‐infection with regard to HPV‐types and cervical dysplasia.

Methods. Eighty women were included. Eighteen of them were present partners to men with condylomas, 20 had clinical vulvar HPV‐lesions and 42 were referred due to an abnormal PAP‐smear. Samples for HPV‐analysis by PCR‐technique were taken from the vulva, the por‐tio and the cervical canal. A universal HPV‐primer as well as specific primers for HPV 6/11, 16,18, 31 and 33 were utilized. PAP‐smears were taken as well as biopsies from cervix/portio.

Results. Seventy‐eight percent had HPV‐DNA identified. Sixty‐seven percent of those with HPV 16 and/or 18 had dysplasia verified by histopathology and 50% of those with 31 and/or 33. Twenty of 21 women with dysplasia had HPV 16, 18, 31 and/or 33 identified. One woman with dysplasia was HPV‐negative. Histopathologically verified CIN were diagnosed in all groups investigated. Women referred for suspicion of CIN significantly more often had HPV detected at the cervix/portio. HPV 6/11 was mostly found in women with condylomas. Apart from this the occurrence of the different HPV types were alike in the three groups.

Conclusion. Infection with HPV is a process and the usefulness of different diagnostic methods seems to depend on when during the course of the disease they are used. HPV‐findings in women with dysplasia were all associated with oncogenic virus‐types. High‐risk virus was often found simultaneously with low‐risk virus indicating a covariation in the acquisition of the different HPV‐types.