bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertension and pre‐eclampsia in women with gestational glucose intolerance
Authors: Suhonen Lauri , Teramo Kari
Published: November 2007

The relationship between pregnancy‐induced hypertension (and pre‐eclampsia) and gestational glucose intolerance was examined prospectively in 81 women with gestational diabetes mellitus. A borderline group consisted of 203 women with a single abnormal value on an oral glucose tolerance test. Controls consisted of 327 healthy women with normal glucose tolerance test at 28–32 weeks of gestation. The women with gestational diabetes were older (p > 0.01) and their prepregnancy weight and body mass index were higher (p > 0.001) than those in the control group. Also the women in the borderline group had higher prepregnancy weight (p > 0.01) and body mass index (p > 0.001) than the women in the control group. However, the pregnancy weight gain was lower in the gestational diabetics than in the control women (p > 0.001). Birth weight, birth trauma, low Apgar scores and hypoglycemia did not differ between the groups. However, hyperbilirubinemia occurred more frequently (28.4% vs. 3.7%, p > 0.001) in the gestational diabetics than in the controls. The frequency of both chronic hypertension (2.5% vs. 0.3%, p > 0.05) and pregnancy induced hypertension and pre‐eclampsia (19.8% vs. 6.1%, p > 0.001) were higher in the gestational diabetes group, but not in the borderline group when compared with the controls.
Continuous progesterone exposure associated with high contraction frequency in human term myometrial strips
Authors: Löfgren Mats , BÄckstrÖm TorbjÖrn
Published: November 2007

It has been shown that progesterone slightly reduced the work of human term myometrial strips. In vitro 5α‐pregnane‐3,20‐dione and 3α‐hydroxy‐5α‐pregnan‐20‐one, two major extra‐hepatic metabolites of progesterone, had only minor effects or none at all. The myometrial strips were stored and superfused in a progestin‐free buffer until the onset of contractions when progestin superfusion was commenced. In vivo the human myometrium is never deprived of the influence of these steroids, either prior to or during labor. In the present investigation we studied whether progesterone and the two named progesterone metabolites would have a different effect when the myometrial strips were not deprived of steroid. Muscle biopsy samples from the lower uterine segment were immediately placed and stored in buffer containing progesterone, 5α‐pregnane‐3,20‐dione, or 3α‐hydroxy‐5α‐pregnan‐20‐one. The strips were then bisected; one half was superfused with progestin buffer, and the other half with plain buffer to serve for control purposes.

In strips continuously exposed to progesterone, the onset of contractions was delayed, compared with their progesterone‐depleted controls. This was as expected, according to current opinion regarding progesterone and parturition. Once muscular contractions were established, the contraction frequency was significantly higher, due to a shorter muscular relaxation time, in the progesterone‐superfused strips than in the controls and strips treated with progesterone metabolite superfusion. This was unexpected and can be interpreted as if continuous presence of progesterone facilitates human myometrial contraction frequency once contractions have started. Conversely, the 5<x‐progesterone metabolites showed no effect or minor effects.
Low‐back pain of pregnancy
Authors: Orvieto Raoul , Achiron Anat , Ben‐Rafael Zion , Gelernter Ilana , Achiron Reuwen
Published: November 2007

Background. Low‐back pain (LBP) is a commonly observed symptom during pregnancy. Despite its high frequency the extent of the problem is less well documented and detailed studies concerning related risk factors are scarce. Furthermore, efforts to address the problem are hampered by the inability to predict accurately which pregnancies are at risk. This study was conducted in order to assess the frequency, manifestations and the contribution of various factors to the development of LBP during pregnancy.

Methods. The study included 449 pregnant women who were consecutively referred for an antenatal ultrasonographic examination for various reasons. A simple questionnaire which consisted of several items along with ultrasonographic measurements was devised to evaluate the incidence of and risk factors for LBP during pregnancy.

Results. 246 (54.8%) women reported LBP in the present pregnancy. Factors which were found to be significantly associated with an increased risk to develop LBP during pregnancy included low socioeconomic class, existence of LBP before the first pregnancy, during previous pregnancy, and interim pregnancies. Moreover, in nulliparous women, body mass index (BMI) was found to be significantly higher in women suffering from LBP. A tendency was observed between posterior/fundal location of the placenta to the presence of LBP during pregnancy. This tendency was also observed among parous but not among nulliparous women. Among pregnant women with LBP, pain radiation correlated significantly to fetal weight. Moreover, this correlation was also of statistical significance in nulliparous women with anterior placental location. Back care advice given to women suffering from LBP was found to significantly reduce LBP. The age, number of prior pregnancies, gestational age, average maternal height, weight and BMI were not found to be risk factors in LBP. Furthermore, we found no influence of previous abortion/s, instrumental delivery, previous cesarean section, or a history of epidural anesthesia during a previous labor were risks to develop LBP in the subsequent pregnancy.

Conclusions. In the present pregnancy, LBP during pregnancy was associated with a history of LBP various socioanthropometric measures, as well as several ultrasonographic and obstetrical data. Back care advice offered to pregnant women who are prone to develop LBP during pregnancy, as early in their pregnancy as possible, may prevent or result in less ‘troublesome’ and ‘severe’ LBP during pregnancy.
Smoking cessation in pregnancy: Intervention among heavy smokers
Authors: Valbös Annelill , Nylander Gro
Published: November 2007

Objective. To investigate the effects of a low cost multicomponent intervention program among pregnant heavy smokers.

Design. A randomized controlled experimental trial.

Setting. The National Hospital, Oslo, Norway.

Subjects. 104 pregnant women smoking 10 cigarettes or more daily at the time of routine ultrasound screening around the 18th week of pregnancy.

Intervention. Around the 18th week of gestation the women received information about the dangers of smoking in pregnancy together with a self‐help manual. The manual was developed especially for pregnant women to aid smoking cessation during a 10 day program. A control ultrasound was performed around the 32nd week of pregnancy. Two encouraging reminders were mailed to them before and after the control ultrasound.

Main outcome measures. Changes in smoking pattern were investigated at delivery time. Smoking cessation, reduction, increase and no change in smoking consumption was registered.

Results. 20% stopped smoking and 65% reduced their smoking in the intervention group compared to 4% and 38% respectively in the control group. 11% in the intervention group did not change their smoking habit and 4% increased their consumption compared to 36% and 22% respectively in the control group. The differences were highly significant.

Conclusion. This low cost multiple intervention model seems more effective than other intervention models investigated in Norway. The resources invested are probably within the limits of the common pregnancy health care.
Epidural analgesia in active management of labor
Authors: Cammu Hendrik , Verlaenen Hilde , Amy Jean‐Ja cques , De Koster Katelijne , Derde Marie‐Paule , Buekens Pierre
Published: November 2007

Objectives. To examine the determinants of epidural analgesia in the active management of labor. To examine the association of epidural with instrumental delivery and cesarean section. Study Design. Observational study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A thousand consecutive nulliparous women at term, were assessed.

Results. Requests for epidural anesthesia were predominantly expressed at the time the patient was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caused labor to be subjectively more arduous. In induced labor, the same observation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when the incidence of operative delivery was adjusted for the use of oxytocin, the significance between patients with epidural versus the others abated.

Conclusion. The use of oxytocin in active management of labor results in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.
Relative macrosomia identified by the individualised birthweight ratio (IBR): A better method of identifying the at risk fetus
Authors: Sanderson David A. , Wilcox and Mark A. , Johnson Ian R.
Published: November 2007

Objective. To assess the effectiveness of a newly developed individualised birthweight ratio (IBR), which corrects for physiological birthweight determinants, in identifying infants at risk from the complications of macrosomia.

Design. Prospective observational study.

Setting. Obstetric unit, Nottingham City Hospital.

Subjects. 2835 women delivered between December 1991 and July 1992 and the infants of 624 of these, selected by virtue of their birthweight for gestation and IBR centile positions.

Main outcome measures. Skinfold thickness and ponderai index measurements, operative delivery, shoulder dystocia, fetal trauma, impaired glucose tolerance.

Results. Using an IBR above the 90th centile as a cut off results in 2.4% of infants being reclassified as normally grown and 3.1% are reclassified as large. The IBR des not result in the identification of any more infants with abnormal ponderai indices or skinfold thicknesses than birthweight for gestation. It does, however, identify more of the infants at risk of operative delivery, shoulder dystocia, fetal trauma and impaired glucose tolerance.

Conclusion. The IBR significantly improves upon birthweight for gestation in identifying infants who suffer from the complications of relative macrosomia.
Placebo‐controlled trial of active immunization with third party leukocytes in recurrent miscarriage
Authors: Christiansen Ole B. , Mathiesen Ole , Husth Merete , Lauritsen J. Glenn , Grunnet Niels
Published: November 2007

Objective. To investigate whether active immunization with third party leukocytes improves pregnancy outcome in women with unexplained recurrent miscarriages.

Design. A double‐blind prospective placebo‐randomized trial.

Patients. Sixty‐six patients with unexplained recurrent miscarriages achieved pregnancy after having received active immunization or placebo.

Interventions. Among the patients who achieved pregnancy, 43 were immunized with third party leukocytes and 23 received autologous leukocytes.

Main outcome measures. Frequency of new miscarriages in actively immunized women compared with placebo.

Results. In the total group of patients, 71% of the actively immunized patients had a successful pregnancy compared with 48% of the placebo treated patients (not significant, RR = 0.6; 95% confidence limits = 0.3–1.1). In a subgroup of patients with primary recurrent miscarriages the success rate was 76% compared with 38% in the placebo group (p<0.02, RR = 0.4; 95%) confidence limits = 0.2–0.9). In this subset of patients, median birthweight was also significantly higher in actively immunized patients than in placebo treated patients (3445 g versus 3000 g;p<0.05).

Conclusions. Active immunization did not provide any benefit in the overall group of women with recurrent miscarriages. However, among women with primary recurrent miscarriages it may improve outcome with respect to the number of livebirths and birthweight.
The effect of tranexamic acid on measured menstrual loss and endometrial fibrinolytic enzymes in dysfunctional uterine bleeding
Authors: Gleeson Noreen c. , Buggy Fiona , Sheppard Brian L. , Bonnar John
Published: November 2007

Fibrinolytic activity of the menstrual fluid is increased in dysfunctional uterine bleeding (DUB). We measured the effect of tranexamic acid on the menstrual blood loss and endometrial fibrinolytic enzymes in women with DUB (< 80 ml menstrual loss /cycle). Endometrial biopsies were taken between 24 and 36 hours after the onset of menstruation. Enzyme activity was assayed by measuring the rate of conversion of Glu‐plasminogen to plasmin, using a chromogenic plasmin substrate. Antigen levels were measured using an enzyme linked immunoassay (ELISA) technique. Tranexamic acid reduced menstrual blood loss by 58% (P<0.05). Endometrial tissue plasminogen activator activity and antigen and plasminogen activator inhibitor ‐ type 1 antigen levels were significantly decreased by tranexamic acid. The effect of tranexamic acid on the fibrinolytic enzymes at local endometrial level may be responsible for its success in the treatment of menorrhagia.
Uterine and ovarian blood flow measurement. Does the full bladder modify the flow resistance?
Authors: Battaglia Cesare , Artini Paolo G. , D'ambrogio Gerardo , Galli Paolo A. , Genazzani Andrea R.
Published: November 2007

Doppler ultrasound is a non‐invasive technique for investigating artery blood flow variations. In 39 normoovulatory patients we investigated the correlation between bladder distension and uterine/ovarian blood flow resistance. The patients were scanned transabdominally or transvaginally both with full and emptied bladders. Pulsatility Index was significantly higher iii patient5 with a full bladder than in the same group after they had emptied their bladders. The present study showed that the full bladder modifying pelvic anatomy and/or increasing sympathetic tone is responsible of a high blood flow resistance in the uterine artery.
Does the loop electrosurgical excision procedure adversely affect the histopathological interpretation of cervical conization specimens?
Authors: Chen Ruey‐Jien , Lee Evelyn Fung , Shih Jin‐Chung
Published: November 2007

Objective. To assess the suitability of conized specimens obtained by loop electrosurgical excision procedure for histopathological interpretation.

Methods. We evaluated the histological pictures of 215 tissue sections obtained by loop electrosurgical excision procedure. These sections came from 32 cases of patients with various degrees of cervical intraepithelial neoplasia. All women included in our study had a satisfactory colposcopy and no cytological or colposcopic evidence of invasive cancer. We quantified the thickness of thermal damage in the tissue sections using a stage‐mounted. calibrated grid microscope.

Results. At its greatest extent, thermal damage occurring next to incision lines ranged from 160 to 520 μ (mean 762, SE 14 μ). Two different zones of thermal damage were produced by LEEP: the carbonization and coagulation zones. The carbonization zone was located at the outermost layer and was very thin. measuring from 10 to 30 μ in depth. The coagulation zone was adjacent to the carbonization zone, was eosinophilic, and was significantly deeper than the carbonization zone at its points of greatest thickness (150 to 500 μ; p<0.0001, Student's t‐test). The depth of the coagulation zone correlated significantly with the depth of the carbonization zone (p = 0.041. least linear correlation). Tissue distortion was present in 53% (17/32) of the cases, and appeared only in the coagulation zone.

Conclusion. Tissue structure from the diseased portions of the conized specimens was generally veil preserved. The area of thermal damage was limited and thus did not result in diagnostic problems. We conclude that LEEP is a reliable method for obtaining tissue samples for histopathological examination.
Clinical care of diabetic pregnancies in Northern Finland 1967‐1987
Authors: Anttila Marjatta
Published: November 2007

Diabetic pregnancies are risk pregnancies with increased perinatal mortality and perinatal morbidity. The purpose of this study was to evaluate retrospcctively the outcome of 567 diabetic pregnancies in the area of Oulu University Hospital periodically from 1967 to 1987.
Maternal health care program and markers for late fetal death
Authors: Walles Bengt , Tyden Tommy , Herbst Andreas , Ljungblad Ulf , Rydhstrøm HÅKan
Published: November 2007

Objective. To identify markers for late fetal death, a multicenter study was performed, based on routinely obtained data from maternal health care units.

Material and methods. Prospectively recorded data were obtained from maternal health care units belonging to five delivery units. In all, 233 consecutive cases of singleton pregnancy involving late fetal death (≥28 weeks) were identified between 1983 and 1989. As a control for each case, the next consecutive mother giving birth to a live infant at the same delivery unit was selected, the sole matching criterium being parity.

Results. After exclusion of pregnancies with lethal malformations or trauma, 205 cases remained for the statistical analysis. Two main subgroups were identified: mothers with placen‐tal abruption (n = 44), and pregnancies with no obvious reason for fetal death (n = 101). An increased risk for late fetal death was evident in expectant mothers ≥40 years (10 vs 1; χ2 = 7.6, p < 0.01), and in smokers where an association was seen to placental abruption. A significantly increased risk was also seen in women with medical treatment for essential hypertension (8 vs 1; χ2=5.6, p < 0.05). On the other hand, we found no correlation between pro‐teinuria, glucosuria, decreasing symphysis‐fundal height, or changes in the Hb, on the one hand, and late fetal demise, on the other. There was no overrepresentation of post dated pregnancy (by ultrasound early in the second trimester) among the cases. Nor did post dated pregnancies (≥42 weeks) estimated from first day of last menstrual period (but not post dated by ultrasound) imply a higher rate of fetal death, as has been suggested in previous studies. Conclusion. In the present material, there was no sign of systematic error in the evaluation of data routinely obtained from the antenatal clinics and maternity units. Apart from placental abruption in smokers, a high maternal age, and medical treatment for essential hypertension, deviating data were recorded as often among controls as among cases. No correlation was evident between a post date pregnancy and fetal demise. A short symphysis‐fundal height was recorded as often among controls as among cases and the even distribution of fetal birthweight in case pregnancies around the standard curve for the normal population is noteworthy.
Onset and duration of hypoalgesia following application of lidocaine spray on genital mucosa
Authors: Van, Der Burght Michael , Schønemann Niels Kim , Laursen Jutta Kudahl , Arendt‐nielsen Lars , Bjerring Peter
Published: November 2007

Lidocaine spray is used as a topical analgesic prior to minor surgical procedures performed on genital mucosa. In this study onset and duration of hypoalgesia on the genital mucosa was investigated by spraying lidocaine solution on the mucous membranes of female genitals with subsequent measurements of pin prick pain thresholds induced by argon laser stimulation. A dosage of 50 mg of lidocaine spray was administered to the genital mucosa of the inside of the labiae minora. Repeated measurements of pain threshold were performed until normal sensitivity was reached. Analgesia to 1.5 W laser stimulation was obtained in all volunteers after an average of 2.7 min±1.3 min (s.d.) (Range: 1–4 min). The effect lasted 29.7 min± 8.9 min (s.d.)(Range 12–45 min). The application of lidocaine spray produced a painful, smarting sensation which, however, disappeared again after 15–30 seconds. The study suggests that minor surgery should not be performed earlier than 4 min after application of lidocaine spray and it is recommended that it should be remembered that the duration of analgesia varies between individuals and thus may be very short in some patients.
Psychological responses following medical abortion (using mifepristone and gemeprost) and surgical vacuum aspiration a patient‐centered, partially randomised prospective study
Authors: Henshaw Richard , Naji Simon , Russell Ian , Templeton Allan
Published: November 2007

Background. A substantial body of objective data now exists to support the consensus view that induced abortion results in a low incidence of psychiatric morbidity. However, these data do not include more recent advances in abortion technology. Medical abortion entails a participatory role on the part of the woman, who may perceive more pain or see products of conception. The physical and psychological events experienced by women undergoing this procedure may lead to differences in psychopathology.

Methods. 363 women undergoing legal induced abortion up to 63 days gestation were allocated by a prospective partially randomised design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration performed under general anesthesia. This study design allowed women with a preference for a particular method to undergo that method; women without preferences were allocated at random. Women completed sensitive and reliable psychometric instruments (the Hospital Anxiety and Depression Scale and a semantic differential rating scale designed to measure self‐esteem) prior to abortion and 16 days later.

Results. There were no significant differences between women allocated at random to medical abortion or vacuum aspiration in post‐abortal anxiety, depression or low self‐esteem. Women with high levels of mood disturbance prior to abortion, who were smokers or who had medical complications following abortion were at highest risk of post‐abortal mood disorder. Conclusions. Medical abortion is as psychologically safe as surgical vacuum aspiration. The quantitative findings of the study support the consensus view that abortion is associated with high incidence of psychological benefit, whichever method is used.
The diagnostic value of transvaginal sonography in the diagnosis of endometrial malignancy in women with peri‐ and postmenopausal bleeding
Authors: Taipale Pekka , Tarjanne Heikki , Heinonen Ulla‐Marja
Published: November 2007

The purpose of this study was to evaluate transvaginal sonography and curettage in the diagnosis of endometrial malignancy in women with peri‐, and postmenopausal bleeding. Diagnostic curettage has been the method of choice to diagnose endometrial cancer. The purpose of this study was also to evaluate the value of transvaginal sonography in decreasing the number of curettages, because the costs of curettage are huge today and only 10% of the women in this group will be diagnosed with endometrial cancer. Transvaginal sonography was performed on 353 women with peri‐ or postmenopausal bleeding before curettage. Endometrial malignancy was found in 42 patients, in 12/242 (5%) of women aged less than 60 years and 30/111 (27%) of women aged 60 years or more. All the patients with endometrial cancer had an endometrial thickness of 6 mm or more measured by transvaginal sonography. The sensitivity of ultrasound to detect malignancy was 100%, the specificity was 43.4%, the positive and negative predictive values were 19.2% and 100%. If the limit of 6 mm of endometrial thickness had been used in this study, 38.2% of the curettages could have been avoided.
The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn:
Authors: Filbey Derek , Hanson Ulf , Wesström Góran
Published: November 2007

Background All maternal red cell antibodies found during pregnancy in a 12 year period have been compiled. The efficacy of the current antenatal screening and management programme has been ascertained by reviewing the outcome of all newborns to these immunized mothers.

Method. Patient selection was carried out by computerised searching for all known records of registered antibodies during the study period. Each mother's obstetric record and her baby's hospital file was studied and relevant clinical treatment and laboratory data on both mother and child was recorded and analysed.

Results. Eight hundred and twenty‐one alloantibodies were detected in 629 immunized pregnant women with 753 fetuses. An overall antibody incidence of 0.57% was observed which included 373 clinically significant antibodies found in 261 mothers (0.24%). Multiple antibodies were present in 8.2% of all samples. Anti‐D, by itself or in combination with other Rh‐antibodies, caused more severe forms of hemolytic disease of the newborn (HDN) with 46% of all Rh‐positive babies having phototherapy and 29% having exchange transfusion. Three of 18 Fya‐positive infants required phototherapy and one required exchange transfusion and in the 16 Kell‐positive babies, three required phototherapy and one required exchange transfusions.

Conclusions. Few antibodies to blood group antigens other than those in the Rhesus system were (bund to cause severe HDN. Antibodies that are generally considered non‐significant did not cause HDN in this study. All antibodies that induced HDN were delected in time so that adequate measures could be taken to reduce the effects in the newborn. The antenatal screening and management programme currently in use is considered to be reliable.
Diagnosis of pelvic masses with transabdominal color Doppler, CA 125 and ultrasonography
Authors: Franchi Massimo , Beretta Paolo , Ghezzi Fabio , Zanaboni Flavia , Goddi Alfredo , Salvatore Stefano
Published: November 2007

Background. The objective of this study was to test the accuracy of transabdominal color Doppler imaging in the prediction of malignancy of adnexal tumors when integrated in combination with CA 125 levels and two‐dimensional ultrasound.

Methods. We considered 129 consecutive patients with a suspected adnexal mass at clinical examination and transabdominal and transvaginal two‐dimensional ultrasound. Serum CA 125 was measured in all cases. All the patients underwent color Doppler imaging to measure the Resistance index of the tumor associated blood flow profile and then surgery and histologic diagnosis.

Results. The median age of the patients was 44 years (range 12–91), 64.3% were premenopausal and the prevalence of malignancy was 28.7%. The sensitivity of color Doppler mapping was 75.7%, specificity 71.7%, positive predictive value 68.3% and negative predictive value 93.0%, compared with 75.7%, 68.5%, 49.1% and 87.5% for CA 125 and 83.8%, 83.7%, 67.4% and 92.8% for two‐dimensional ultrasound. Blood flow was undetectable by color Doppler imaging in 17 of the 129 cases (13.2%). In 55 patients with three concordant tests, the positive and negative predictive values were 100%. When CA 125 values and two dimensional ultrasound results were discordant (35 patients), the color Doppler diagnosis was correct in 88.6% of the cases (93% in premenopausal women).

Conclusion. Color Doppler imaging alone is not better than two‐dimensional ultrasound in predicting malignancy of pelvic masses. Its use together with CA 125 and two‐dimensional ultrasound may improve the accuracy of predictions when the three tests are concordant or when the other two are discordant.
The female corpus spongiosum revisited
Authors: van turnhout Arjen A. W. M. , Hage J. Joris , van Diest Paul J.
Published: November 2007

Background. The extension of the female corpus spongiosum is subject to controversy. The anterior continuation of the vestibular bulbs, or pars intermedia, is not commonly recognized as part of the corpus spongiosum. Some authors deny this part of the corpus spongiosum exists in females.

Material and Methods. To investigate this controversy, anatomic and histologic studies were performed of the female corpus spongiosum. The specimens were taken from female‐to‐male transsexual surgical patients and from fresh female cadavers. They were compared to surgically amputated penises to establish the similarity in male and female anatomy.

Results Conclusions. The female corpus spongiosum is proven to extend anteriorly from the bilateral vestibular bulbs to terminate as the enlarged glans clitoridis. This latter structure also consists of spongious tissue. The spongiosum is hypertrophied in hormonally treated female‐to‐male transsexuals. The cleft vulvar anatomy is homologue to its non‐cleft male counterpart.
Death rates from ischemic heart disease in women with a history of hypertension in pregnancy
Authors: Sjónsdóttir Lilja , Arngrimsson Reynir , Geirsson Reynir T. , Slgvaldason Helgi , Slgfússon Nlkulás
Published: November 2007

Background. Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population‐based study with a long follow‐up time the potential association between hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated.

Methods. All 7543 case records at the main maternity hospital in Iceland during 1931–1947 were reviewed to identify women with hypertension in pregnancy, subdivided by parity and severity of disease into those with eclampsia, preeclampsia and hypertension alone. Information on those who had died was obtained from death certificates, supplemented by autopsy reports and hospital records. Death rates from IHD were compared to population data from public health and census reports during corresponding periods and between study groups.

Results. Of 374 hypertensive women 177 had died. The death rate was slightly higher among women with any hypertension in pregnancy than in the reference population (RR=1.20; 95% CI 1.01–1.42). About half of the increase was attributed to excess mortality from IHD with a relative risk of dying of 1.47 (95% CI 1.05–2.02). The relative risk of dying from IHD was significantly higher among eclamptic women (RR = 2.61; 95% CI 1.11–6.12) and those with preeclampsia (RR=1.90; 95% CI 1.02–3.52) than those with hypertension alone. Parous women at the index pregnancy had a twofold higher risk of dying from IHD than primigravid women (RR = 2.05; 95% CI 1.19–3.55; p = 0.01).

Conclusion. There is an indication of increased death rates among women with a history of hypertension in pregnancy, where ischemic heart disease may be more common than in the general population.
Conjunctiva is an estrogen‐sensitive epithelium
Authors: Vavilis Dlmitrios , Maloutas Stefanos , Nasioutziki Maria , Boni Ekaterini , Bontis John
Published: November 2007

Background. To investigate whether the conjunctival epithelium shows cyclical maturation changes during the ovarian cycle and to study the cytological appearance of the conjunctiva in postmenopausal and pregnant women.

Patients. Fifteen menstruating women with ovulatory cycles, ten postmenopausal women. and twelve pregnant women in the second or the third trimester of their pregnancy.

Interventions. Conjunctival and vaginal smears were taken on a near‐daily basis.

Main outcome measures. The percentage of the parabasal, the intermediate and the superficial cells (Maturation Index) in each specimen was determined.

Results. In the conjunctival smears of the menstruating women cyclical maturation changes were noted. These changes were parallel to those of the vaginal smears, but to a minor degree. No cyclical changes were found in either the postmenopausal women or in the pregnant women, showing an extreme shift to the left in the Maturation Index.

Conclusion. Conjunctiva appears to be a relatively estrogen‐sensitive epithelium.
Treatment of premenstrual syndrome by spironolactone: A double‐blind, placebo‐controlled study
Authors: Wang Mingde , Hammarbäck Stefan , Lindhe Bengt‐Åke , Bäckström Torbjörn
Published: November 2007

Background. To reevaluate whether spironolactone, a steroid receptor antagonist, is effective in improving premenstrual syndrome (PMS) in a double‐blind, placebo‐controlled cross over study.

Methods. Thirty‐five women with PMS were given one tablet of 100 mg spironolactone or placebo daily from day 14 of the menstrual cycle until the first day of the following menstruation. Two pretreatment cycles were observed for diagnosis in each woman, followed by 6 treatment cycles with spironolactone and placebo applied in either the first or second 3 months. The assessment of symptoms and diagnosis of PMS were based on prospective daily self‐ratings made by the women using a validated visual analogue scale.

Results. The treatment with spironolactone was associated with an improvement in PMS symptoms compared to placebo as judged by significant decrease in negative mood symptom scores (p < 0.001) and somatic symptom scores (p < 0.001). Of the individual symptoms, spironolactone significantly improved irritability, depression, feeling of swelling, breast tenderness and food craving in comparison to placebo. A lasting effect of spironolactone was observed in women started with spironolactone after cross over to placebo.

Conclusions. Spironolactone appears to be an effective therapy for the negative mood changes and somatic symptoms in PMS.
Human placental lactogen and pregnancy‐associated plasma protein A in first trimester and subsequent fetal growth
Authors: Pedersen Jan Fog , Sørensen Steen , Ruge Susanne
Published: November 2007

Objective. To study in an optimized design the possible relation between serum levels in weeks 8‐14 of human placental lactogen and pregnancy‐associated plasma protein A and fetal size at delivery.

Methods. Analysis of data from 93 normal singleton pregnancies. Gestational age was assessed from a sonographic crown‐rump length measurement. Serum levels of human placental lactogen and pregnancy‐associated plasma protein A were determined by radioimmunoassay, and were expressed in multiples of mean. The relative birth weight was used as an index of fetal growth.

Results. Serum levels of human placental lactogen and pregnancy‐associated plasma protein A showed a negative correlation to gestational age at delivery (p<0.01 andp<0.05, respectively), and there was a positive correlation between the serum level of pregnancy‐associated plasma protein A and relative birth weight (p<0.02).

Conclusions. Higher levels of human placental lactogen and pregnancy‐associated plasma protein A predicted earlier delivery, maybe because of better fetal growth, and higher levels of pregnancy‐associated plasma protein A predicted better fetal growth.
Elevation of oxytocin levels early post partum in women
Authors: Nissen Eva , Lilja Gunilla , Widström Ann‐Marie , Uvnás‐Moberg Kerstin
Published: November 2007

Background. The aim of this study was to determine plasma levels of oxytocin in women immediately after delivery.

Methods. Oxytocin was measured in 18 healthy women at 15 minute intervals after normal vaginal deliveries with healthy infants. The mothers had their infants put skin‐to‐skin on their chests immediately after birth. The infants stayed there up to two hours post partum. Results. There were significant elevations of oxytocin 15, 30 and 45 minutes after delivery (p=0.007, 0.02 and 0.02 respectively) when compared with average pre partum levels sampled approximately 7‐15 minutes before partus. This elevation of oxytocin coincided with the expulsion of placenta. In most women this first elevation was followed by repeated elevations of oxytocin. Oxytocin levels returned to pre partum levels at 60 minutes post partum.

Conclusions. Oxytocin is known to play a role in maternal bonding in animals. Earlier studies indicate that there is a sensitive period for bonding the first hour after giving birth even in women. Our study demonstrates a coincidence of this putative ‘sensitive period’ and high levels of oxytocin.
Human chorionic gonadotropin patterns in early pregnancy after assisted reproduction
Authors: Fridström Margareta , Garoff Leena , Sjöblom Peter , Hillensjö TorbjÖRn
Published: November 2007

Background. Assisted reproduction implies increased risks of pathological pregnancy, necessitating close follow up of early pregnancy. The use of serum hCG levels two and three weeks after embryo transfer for prediction of pregnancy outcome after in vitro fertilization‐embryo transfer (IVF/ET) or gamete intrafallopian transfer (GIFT) was evaluated.

Methods. Three hundred and twenty‐nine treatment cycles were included. Serum samples were obtained on days 14 and 21 after ET and hCG was determined by fluoroimmunoassay. Receiver operating characteristic (ROC) curves were analyzed to find cut‐off levels of hCG giving maximal sensitivity and specificity, identifying a low risk group and a high risk group with regard to pathological pregnancy.

Results. The group of patients carrying a viable pregnancy had significantly higher hCG levels two and three weeks after ET than the group of patients carrying a pathological pregnancy. Furthermore, the daily increase in hCG was higher. In multiple gestations, the levels of hCG were significantly higher compared to singleton pregnancies. Ninety per cent of the patients with an hCG level ≥150 IU/L 13‐15 days after ET carried a pregnancy to term (the low risk group). Conversely, 50% of the patients with hCG < 150 IU/L carried a pathological pregnancy (the high risk group).

Conclusion. A single determination of the hCG level two weeks after ET, combined with transvaginal ultrasound two to three weeks later, is a reliable follow‐up. In cases of subnormal hCG levels (< 150 IU/L), a second hCG determination one week later followed by sonography is recommended.
Book Reviews
Authors: Bergsjo Per
Published: November 2007

James D, Pillai M. Colour Guide Obstetrics. 147 pages. Illustrations. Edinburgh: Churchill Living stone, 1994. Price GBP 8.50.

Studd J. Progress in Obstetrics & Gynaecology, Volume 11. 467 pages, figures, tables. Edinburgh: Churchill Livingstone 1994. Price: GBP 33.00.
Effects of hydralazine on placental and renal circulation in pre‐eclampsia
Authors: Gudmundsson Saemundur , Gennser Gerhard , Marsal Karel
Published: November 2007

Background. Although hydralazine has been the drug of choice for treating pregnancy‐induced hypertension for some time owing to its effect on peripheral vascular tonus, its effects on utero‐ and feto‐placental circulation are less well understood.

Methods. To evaluate the effect of hydralazine on placental circulation in cases of pre‐eclampsia, Doppler ultrasonography was used to record blood velocity in the arcuate and umbilical arteries in 12 pregnancies complicated by pre‐eclampsia, blood velocity in the maternal renal artery also being examined. The gravidae underwent Doppler ultrasonography after 24 hours bedrest in hospital (baseline values), and again 24 and 72 hours after starting oral hydralazine treatment at doses of 50 mg twice daily.

Results. The gravidae showed increased heart rate and decreased blood pressure in response to treatment, but neither placental nor maternal renal blood velocity waveforms were affected.

Conclusion. The results suggest that at recommended oral doses hydralazine has no effect on placental or maternal renal vascular resistance.
Can maternal antiphospholipid antibodies predict the birth of a small‐for‐gestational age child?
Authors: Schei Berit , Østensen Monika , Moen Torolf , Jacobsen Geir , Bakketeig Leiv S.
Published: November 2007

Background. The aim of this study was to examine the relationship between the maternal level of antiphospholipid antibodies (aPA) measured by anticardiolipin antibodies (aCL) and fetal growth retardation (SGA).

Methods. A nested case control design was carried out in a prospective cohort study of 1552 para I and para II women. The study group consisted of all 138 women who gave birth to a SGA‐child (defined as birthweight <10th percentile). A control group of 276 women was randomly selected from mothers of non‐SGA children. Levels of aPA were measured in banked sera drawn from the women in the 33rd week of pregnancy and compared between cases and controls.

Results. There were 3 (2.5%) sera with aPA above 97.5 percentile among the cases and 3 (1.2%) among the controls. This difference was not statistically significant.

Conclusion. Antiphospholipid antibody measurements obtained at 33 weeks of gestation cannot be used to assess the risk of birth of a small for gestational age infant among parous women.
A comparison between conventional and 24‐hour automatic blood pressure monitoring in hypertensive pregnancy
Authors: Olofsson Per , Persson Kristina
Published: November 2007

Objective. To map the conformity between 24‐hour and conventional blood pressure (BP) monitoring (24BPM, CBPM) in pregnancy. Study design. Prospective comparative.

Material and methods. A standardized single BP measurement and parallel 24BPM and CBPM were carried out in 99 women (125 recordings) hospitalized for hypertension.

Results. Except for BP oscillation amplitude, corresponding variables correlated significantly between the methods. The mean systolic BP (SBP) was significantly higher with 24BPM compared with both CBPM (3.1 mmHg) and with the single BP measurement (4.6 mmHg). The mean diastolic BP (DBP) was significantly lower with 24BPM compared with CBPM (2.4 mmHg) and with the single measurement (2.7 mmHg). If a cut‐off at 140/90 mmHg had been used for the diagnosis of hypertension and with 24BPM as the golden standard, a false positive/negative diagnosis would have resulted in 35%/20% of cases with the single BP measurement, and in 24%/17% with CBPM.

Conclusions. 24BPM and CBPM gave significantly correlated but different values of the BP. The differences were small in terms of absolute mm Hg values, but resulted in a high rate of false positive and false negative diagnoses of hypertension. 24BPM cannot substitute the traditional methods for BP monitoring in pregnancy unless a new definition of hypertension is established.
Inflammatory signs in wet smear and Pap‐smear compared with the histopathology from the female lower genital tract
Authors: Vural GüRcan , Platz‐Christensen Jens Jörgen , Hagmar BjÖRn , Jonassen Fredrik , Warleby Bengt , Andersson Eira
Published: November 2007

In order to define the relationship between various criteria of female lower genital tract inflammation, we examined wet smears, cervical smears and biopsies from 131 patients. The presence of clue cells in rehydrated dry smears showed a positive correlation to the presence of clue cells in Papanicolaou stained smears, and to some extent with cytological evidence of inflammation (Kappa 0.48). Cytological inflammatory findings correlated well with the presence of clue cells in rehydrated dry smears, but signs of inflammation diagnosed by histopathology did not correspond to findings in cytological smears, probably because these methods reveal inflammation at different sites.
Does the intake of nuts and seeds alter the appearance of menarche?
Authors: Soriguer F. J. , Gonzalez‐Romero S. , Esteva I. , García‐arnés J. A. , Tinahones F. , de Adana M. S. Ruiz , Olveira G. , Mancha I. , Vazques F.
Published: November 2007

Background. The nutritional state reportedly influences the age of menarche. In this work we investigated the potential relationship between the intake of various types of foods and the age of menarche, irrespective of body weight.

Methods. An overall 777 schoolgirls of ages between 8 and 16 years from Benalmádena (Málaga, Spain) were subjected to a cross‐sectional study involving: the age of menarche as the dependent variable; and the weight, body mass index, skinfold thickness, food intake (estimated from weekly food frequency questionnaires), and age of menarche in the proband's mother and sisters as independent variables. Several models were developed in order to calculate the strength of association between the dependent variable (the presence or absence of menarche) and the independent variables.

Results. The average age of menarche was 12.4 years. The intake of the various types of foods was not consistent between the different age groups. In girls of 12 or younger, the age of menarche was found to be related to weight: Odds ratio (OR)=7.06; (Confidence intervals (CI) = 2.80‐17.6). On inclusion of various foods groups, the OR rose to 49.89 (CI=40.85‐60.84). In girls over 12, the age of menarche was essentially related to the intake of nuts and seeds (OR = 0.71, CI=0.40‐0.98). Inclusion of other foods groups decreased the OR (OR = 0.34. CI =0.14‐0.39).

Conclusions. Significant statistical relationship between intake of nuts and seeds and the age of menarche was found.
Effects of single and combined application of anti‐cancer drugs on cervical adenocarcinoma
Authors: Hara K. , Iwasaka T. , Matsuo N. , Nakao Y. , Yokoyama M. , Yamasaki F. , Mvula M. , Sugimori H.
Published: November 2007

Background. Establishment of effective combination chemotherapy regimen for patients with an adenocarcinoma of the uterine cervix has been long‐awaited because there has been no documentation concerning chemosensitivity of this tumor against conventional antitumor agents.

Methods. To search for an effective combination regimen, 15 conventional antitumor drugs were tested for growth inhibitory effects on five different cervical adenocarcinoma cell lines. Results. Etoposide, mitomycin C, adriamycin, epirubicin, and vinblastine, were singularly effective. Effects of combination chemotherapy were also tested using the above five antitumor agents plus interferon‐γ. Etoposide, mitomycin C, and interferon‐γ were the most effective when given in combination.

Conclusions. Combined treatment with the above three drugs seems worthy of consideration for clinical application.
Hemodynamic, hematological and hemorrheological evaluation of post‐term pregnancy
Authors: Battaglia Cesare , Artini Paolo G. , Ballestri Marco , Bonucchi Dario , Galli Paolo A. , Bencini Stefania , Genazzani Andrea P.
Published: November 2007

Objective. To evaluate the hemorrheological modifications in post‐term pregnant women.

Methods. Pregnant women (n=48) at >280 days' gestation, were tested on alternate days by nonstress test; ultrasound assessment of amniotic fluid volume, placental grading, hourly measurement of fetal urine production, and maternal fetal Doppler analysis. We further recorded maternal: plasma viscosimetry, red blood cells, hemoglobin, hematocrit, platelet count, mean platelet volume, fibrinogen, antithrombin III, creatinine, uric acid, plasma calcium. hPL, and estriol. We analyzed the last values obtained within 48 hours prior to delivery.

Results. The subjects were divided into Group I (40 wks to 40 wks + 3 days; n=16); Group II (40 wks+4 days to 41 wks; n=16); Group III (>41 wks; n=16).

The time‐averaged maximum velocity of the fetal descending thoracic aorta was lower at Doppler analysis in Group III (29.0±3.5 cm/s) than in Group I (34.0±4.3 cm/s; p<0.05). A decrease of the middle cerebral/umbilical pulsatility index ratio (1.75 in the Group I vs 1.52 in the Group III; p<0;05) was shown. Furthermore, the incidence of oligohydramnios; Grannum placental grade III; plasma viscosity and coagulation parameters were significantly higher in Group III patients. The plasma viscosity resulted positively correlated with uric acid, and inversely correlated with fibrinogen, antithrombin III and platelet number values. Conclusions. From the present data we conclude that post‐term pregnancy may mimic a mild ‘fetal growth restriction’.
Management of uterine perforations in connection with legal abortions
Authors: Lindell Gunnel , Flam Folke
Published: November 2007

The incidence of uterine perforation while performing legal abortions was evaluated in the Stockholm area. Among 84,850 legal abortions performed during 1982‐1992 there were 145 cases of uterine perforation; 0.17%. In about half of these cases an immediate exploration of the abdomen was decided upon and in 18 patients there were significant bleeding and/or lacerations to organs situated in the pelvis. No case of intestinal perforation was encountered. It is likely that many of these injuries would have healed just as well unattended. Based on this study, the authors advocate a conservative approach in dealing with uterine perforation in connection with vacuum aspiration for legal abortion.