bluuebunny/crossref_metadata_2025 huggingface dataset:
Frontal lobe differences in bipolar disorder as determined by proton MR spectroscopy
Authors: Cecil Kim M , DelBello Melissa P , Morey Rachel , Strakowski Stephen M
Published: March 2003

Objectives: Proton magnetic resonance spectroscopy (MRS) provides insight into neurochemical processes. Imaging and postmortem studies have implicated abnormalities of structure and function within the frontal lobe. Patients with bipolar disorder having a manic or mixed episode were hypothesized to demonstrate metabolic abnormalities within the frontal lobe.

Methods: Seventeen patients with bipolar disorder type I (ages 16–35 years, mean 22 ± 7.3 years) hospitalized for a manic (n = 9) or mixed (n = 8) episode and 21 healthy subjects (ages 16–35 years, mean 21.7 ± 5.2 years) were evaluated with proton MRS. The gray matter medially and white matter laterally within the frontal lobe were sampled. Metabolite concentrations were calculated for each voxel, corrected for cerebral spinal fluid (CSF) contributions to the voxel, and compared between study populations.

Results: Patients demonstrated with multivariate analyses of variance (MANOVA) a significant overall difference in gray matter metabolite concentrations compared with healthy subjects. The largest effect sizes for group differences were found with reductions of N‐acetyl aspartate (NAA) and Choline (Cho) concentrations (f = 0.41 and 0.37, respectively). A significant group difference with MANOVA in white matter metabolite concentrations was also observed with the largest effect size at f = 0.44 for elevation of the composite amino acid (AA) concentration.

Conclusions: A reduction of NAA within the gray matter of patients suggests neuronal dysfunction. Altered phospholipid metabolism suggestive of a trend toward decreased volume is implicated with a reduction of Cho concentrations. Within white matter, composite concentrations of AAs were elevated in patients indicating altered neurotransmission.
First episode bipolar disorder: systematic comparison of incidence with other affective and non‐affective psychoses among an epidemiologically complete, rural population
Authors: Baldwin PA , Scully PJ , Quinn JF , Morgan MG , Kinsella A , O'Callaghan E , Owens JM , Waddington JL
Published: March 2003

Baldwin PA, Scully PJ, Quinn JF, Morgan MG, Kinsella A, O'Callaghan E, Owens JM, Waddington JL. First episode bipolar disorder: systematic comparison of incidence with other affective and non‐affective psychoses among an epidemiologically complete, rural population. Bipolar Disord 2002: 4(Suppl. 1): 39–40. © Blackwell Munksgaard, 2002
Predictors of outcome in a representative population of bipolar disorder
Authors: Frangou Sophia
Published: March 2003

Frangou S. Predictors of outcome in a representative population of bipolar disorder. Bipolar Disord 2002: 4(Supp. 1): 41–42. © Blackwell Munksgaard, 2002
The cytoarchitecture of the superior temporal gyrus in bipolar disorder using GLI‐methodology
Authors: Vogeley Kai , Tepest Ralf , Schneider‐Axmann Thomas , Honer William G , Falkai Peter
Published: March 2003

Vogeley K, Tepest R, Schneider‐Axmann T, Honer WG, Falkai P. Thecytoarchitecture of the superior temporal gyrus in bipolar disorder using GLI‐methodology.  Bipolar Disord 2002: 4(Suppl. 1): . © Blackwell Munksgaard, 2002
What is the role for psychotherapy in bipolar disorders?
Authors: Scott Jan
Published: March 2003

Scott J. What is the role for psychotherapy in bipolar disorders?  Bipolar Disord 2002: 4(Suppl. 1): 105. © Blackwell Munksgaard, 2002
Does inositol signalling have a role in disease susceptibility and drug treatment of bipolar disorder?
Authors: Steen Vidar M
Published: March 2003

Steen VM. Does inositol signalling have a role in disease susceptibility and drug treatment of bipolar disorder?  Bipolar Disord 2002: 4(Suppl. 1): 53–55. © Blackwell Munksgaard, 2002
Are the structural brain deviations associated with bipolar disorder related to susceptibility genes?
Authors: McDonald Colm , Marshall Nicky , Sham Pak , Murray Robin M
Published: March 2003

McDonald C, Marshall N, Sham P, Murray RM. Are the structural brain deviations associated with bipolar disorder related to susceptibility genes?  Bipolar Disord 2002: 4(Suppl. 1): 35. © Blackwell Munksgaard, 2002
Hemoglobin and erythrocyte indices during normal pregnancy and postpartum in 206 women with and without iron supplementation
Authors: MILMAN NILS , BYG KELD‐ERIK , AGGER ANDERS OLE
Published: March 2003

Background. The aim was to define reference values for hemoglobin, hematocrit and erythrocyte indices, i.e. erythrocyte count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), in normal pregnancy and after a normal delivery in non‐iron‐supplemented and iron supplemented women.

Methods. Two hundred and six healthy Danish women included at 9–18 weeks of gestation were allocated to treatment with placebo tablets (n=107) or tablets containing 66 mg iron (n=99). Blood samples were obtained at inclusion, every fourth week during gestation, and 8 weeks postpartum.

Results. All hematologic indices were significantly lower in placebo‐treated than in iron‐treated women. In placebo‐treated women, the 5th percentile for hemoglobin was 110 g/L in the 1st trimester; in the 2nd trimester it was 105 g/L in the first and the second, and 103 g/L in the last third; in the 3rd trimester, it was 102 g/L in the first, 100 g/L in the second, and 101 g/L in the last third; postpartum it was 113 g/L. In iron‐treated women, the 5th percentile for hemoglobin was 111 g/L in the 1st trimester; in the 2nd trimester it was 109 g/L in the first, 106 g/L in the second, and 103 g/L in the last third; in the 3rd trimester, it was 105 g/L in the first and second, and 110 g/L in the last third; postpartum it was 123 g/L.

Conclusions. Hematologic reference values should be derived from iron replete women.We suggest that the lowest critical hemoglobin value in iron‐treated pregnant women should be 110 g/l (6.8 mmol/L) in the 1st trimester, and 105 g/L (6.5 mmol/L) in the 2nd and 3rd trimester.
The influence of stress and state anxiety on the outcome of IVF‐treatment: Psychological and endocrinological assessment of Swedish women entering IVF‐treatment
Authors: CSEMICZKY GYÖRGY , LANDGREN BRITT‐MARIE , COLLINS AILA
Published: March 2003

Background. Comparing stress levels in women entering IVF treatment with those of fertile controls as well as relating these levels to the outcome of IVF.

Methods. State anxiety and personality profiles as well as stress hormones were studied in 22 normally menstruating women entering IVF treatment for tubal infertility. Their personality profiles as well as state anxiety scores measured before entering IVF treatment were related to the outcome of treatment. Twenty‐two fertile women served as controls. Stress markers were serum prolactin and cortisol. These were estimated by radioimmunoassay. The psychological evaluation included the Karolinska Scales of Personality (KSP) and state anxiety as measured by the STAI questionnaire. Basal FSH on cycle day 3 and E2 and P4 AUC during the luteal phase were evaluated as hormonal predictors for the outcome of IVF treatment.

Results. Comparison of the personality profiles of the two groups, showed that infertile women had significantly higher scores of suspicion (p>0.05), guilt (p>0.05), and hostility (p>0.01), but lower somatic anxiety (0.05) and indirect aggression (0.05) than fertile controls. The infertile women also had significantly higher levels of prolactin and cortisol throughout the menstrual cycle. Serum cortisol, prolactin and FSH levels on cycle day 3 did not differ between the women who conceived after IVF treatment and those who did not conceive. However, significant differences were found in E2 and P4 AUC (p>0.01) in the luteal phase between those women who became pregnant and those who failed. There was a trend (p<0.06) toward higher state anxiety levels among the women who did not succeed in becoming pregnant after IVF treatment.

Conclusions. The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.
Symphyseal distention in relation to serum relaxin levels and pelvic pain in pregnancy
Authors: BJÖRKLUND KENNETH , BERGSTRÖM STAFFAN , NORDSTRÖM MARIE‐LOUISE , ULMSTEN ULF
Published: March 2003

Objective. To elucidate whether there is an association between symphyseal distention, circulating relaxin levels and pelvic pain in pregnancy.

Methods. Serum relaxin and symphyseal width were assessed in 19 consecutive referral cases with severe pelvic pain at 35 weeks of pregnancy and in a cohort of 49 women at 12 and 35 weeks of pregnancy. The referral cases were received over a period of two years and four months and the cohort was recruited over a period of two months. Relaxin was measured with an ELISA test and symphyseal width assessed using ultrasonography. All women with pelvic pain were clinically assessed. The women were divided into three groups; Group A (n=38), cohort cases with no or mild pain; Group B (n=11), cohort cases with disabling pain; and Group C (n=19), referral cases.

Results. At 35 weeks of pregnancy, mean symphyseal width was 4.5 mm (s.d. 1.0 mm) in Group A, 5.7 mm (s.d. 2.6 mm) in Group B, and 7.4 mm (s.d. 3.5 mm) in Group C. The difference between Groups A and B is statistically significant (p=0.044) as is that between Groups A and C (p<0.0001). Serum relaxin levels were not associated with symphyseal distention or disabling pain.

Conclusion. Severe pelvic pain during pregnancy was strongly associated with an increased symphyseal distention. However, the severity of pain did not predict the degree of symphyseal distention in the individual case, indicating that other mechanisms are also involved. Serum relaxin levels were not associated with the degree of symphyseal distention or with pelvic pain in pregnancy.
Saline infusion sonohysterography in endometrial cancer: assessment of malignant cells dissemination risk
Authors: ALCÁZAR JUAN LUIS , ERRASTI TANIA , ZORNOZA AMAIA
Published: March 2003

Background. To assess the risk of malignant cells dissemination in patients with endometrial cancer undergoing saline infusion sonohysterography (SIS).

Methods. Fourteen consecutive patients (mean age: 58.1 years, range: 41–74 years) diagnosed as having a clinical stage I endometrial carcinoma and scheduled for surgical staging were entered in this study. SIS was performed at the time of laparotomy just when the abdomen was opened and prior to the start of the surgical procedure. 10–20 mL of saline was infused. All fluid spilled from the fimbrial ends of the fallopian tubes was collected and analyzed for the presence or absence of malignant endometrial cells. Samplings were also taken from ascites, if found, or cytological washings, prior to and after SIS.

Results. SIS could be satisfactorily performed in all patients. There was no spillage from either tube in nine patients. Mean fluid volume obtained from the other five patients was 4.4 mL. Cytologic analysis revealed the presence of malignant cells in the spilled fluid in one case (7.1%, one out of fourteen).

Conclusions. Our data show that a small but real risk of malignant cell dissemination exists in patients with endometrial carcinoma who undergo SIS.
Mean cell volume and gamma‐glutamyl transferase are superior to carbohydrate‐deficient transferrin and hemoglobin‐acetaldehyde adducts in the follow‐up of pregnant women with alcohol abuse
Authors: SARKOLA TAISTO , ERIKSSON C. J. PETER , NIEMELÄ ONNI , SILLANAUKEE PEKKA , HALMESMÄKI ERJA
Published: March 2003

Background and Objective. To compare the usefulness of carbohydrate‐deficient transferrin (CDT), the ratio of CDT to total transferrin, and hemoglobin‐acetaldehyde adducts with mean cell volume (MCV) and gamma‐glutamyl transferase (GGT) in the follow‐up of alcohol abuse during pregnancy.

Methods. Forty‐four pregnant drug and alcohol abusing female patients attending a special outpatient clinic were followed from the 8th to 24th gestational week onwards. A population of sixty‐two healthy pregnant women was recruited to assess the effect of gestation on the markers.

Results. Eight of thirteen heavy drinking (8 drinks/week) patients delivered infants with fetal alcohol effects (FAE). MCV and GGT were higher among heavy drinking patients than in moderately drinking (<8 drinks/week) patients (92±4 vs 90±3 fl and 31±34 vs 16±10 U/L, respectively), and in patients delivering infants with FAE compared with patients delivering healthy infants (95±3 vs 90±3 fl and 34±26 vs 15±10 U/L, respectively). Hemoglobin‐acetaldehyde adducts, CDT, and the ratio of CDT to total transferrin were neither associated with the reported level of alcohol consumption nor with the occurrence of FAE. In the receiver operating characteristics analysis MCV was found to be superior to CDT and the adducts, and GGT superior to the adducts, in identifying heavy drinking and in predicting FAE. In the control population, both CDT and total transferrin were found to rise during pregnancy, whereas the ratio of CDT to total transferrin was found to decline. The upper reference range of 33 U/L for CDT was considerably higher than that of non‐pregnant women (26 U/L).

Conclusion. MCV and GGT appear to be the most efficient laboratory markers for detecting excessive alcohol consumption and the adverse effects of alcohol on the fetus.
Epidemiology of fetal death in Latin America
Authors: CONDE‐AGUDELO AGUSTIN , BELIZÁN JOSÉ M. , DÍAZ‐ROSSELLO JOSÉ L.
Published: March 2003

Background. To identify risk factors associated with fetal death, and to measure the rate and the risk of fetal death in a large cohort of Latin American women.

Methods. We analyzed 837,232 singleton births recorded in the Perinatal Information System Database of the Latin American Center for Perinatology and Human Development (CLAP) between 1985 and 1997. The risk factors analyzed included fetal factors and maternal sociodemographic, obstetric, and clinical characteristics. Adjusted relative risks were obtained, after adjustment for potential confounding factors, through multiple logistic regression models based on the method of generalized estimating equations.

Results. There were 14,713 fetal deaths (rate=17.6 per 1000 births). The fetal death risk increased exponentially as pregnancy advanced. Thirty‐seven percent of all fetal deaths occurred at term, and 64% were antepartum. The main risk factors associated with fetal death were lack of antenatal care (adjusted relative risk [aRR]=4.26; 95% confidence interval, 3.84–4.71) and small for gestational age (aRR=3.26; 95% CI, 3.13–3.40). In addition, the risk of death during the intrapartum period was almost tenfold higher for fetuses in noncephalic presentations. Other risk factors associated with stillbirth were: third trimester bleeding, eclampsia, chronic hypertension, preeclampsia, syphilis, gestational diabetes mellitus, Rh isoimmunization, interpregnancy interval<6 months, parity ≥4, maternal age ≥35 years, illiteracy, premature rupture of membranes, body mass index ≥29.0, maternal anemia, previous abortion, and previous adverse perinatal outcomes.

Conclusions. There are several preventable factors that should be dealt with in order to reduce the gap in fetal mortality between Latin America and developed countries.
Apoptosis, cellular proliferation and expression of p53 in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause
Authors: WU XUXIA , BLANCK AGNETA , OLOVSSON MATTS , MÖLLER BJÖRN , FAVINI ROBERTA , LINDBLOM BO
Published: March 2003

Background. Cell proliferation, apoptosis and expression of p53 proteins were studied in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause.

Methods. Expression of ki‐67 and p53 was analyzed by immunohistochemistry and by immunoblotting. Apoptosis was detected by in situ 3′ end labelling of cells with DNA fragmentation.

Results. In both the proliferative and the secretory phases, ki‐67 expression was higher in leiomyomas than in myometrium and both tissues showed higher expression in the secretory than in the proliferative phase. No difference in apoptotic index was observed between leiomyomas and myometrium or between the proliferative and secretory phases. After menopause, the expression of ki‐67 as well as the apoptotic index was lower than in the proliferative and secretory phases and no significant difference between tissues was seen. Both leiomyomas and myometrium showed negative staining for p53. Immunohistochemical results regarding p53 were confirmed by Western blot.

Conclusions. Our findings indicate that sex steroids influence the growth of leiomyomas by stimulating cell proliferation rather than by affecting apoptosis. The rate of cell proliferation is higher in fertile age than after menopause and appears to be enhanced under the influence of progesterone.
Note
Birthweight by gestational age in Norway
Authors: SKJÆRVEN ROLV , GJESSING HÅKON K. , BAKKETEIG LEIV S.
Published: March 2003

Objective. To describe birthweight by gestational age in Norway for the period 1967–1998, evaluate secular trends and provide new standards for small for gestational age for 16 to 44 weeks of gestation.

Subjects and methods. The analyses were based on more than 1.8 million singleton births, covering all births in Norway for a 32 year period. Percentiles for birthweight by gestational age were estimated using smoothed means and standard deviations. In the preterm weeks, means and standard deviations were carefully screened for birthweight‐gestational age consistency, adapting a method of Wilcox and Russell. Differences in birthweight by gestational age for stillbirths and livebirths in extremely preterm weeks (16–28) are presented, and the effects of cesarean section are evaluated. We observed a clear increase in birthweight by gestational age for all term weeks, but a decrease for most of the preterm weeks over the same period. This decrease was related to the increase in deliveries by cesarean section.

Conclusions. Percentiles for birthweight by gestational age are presented for clinical use, based on a current period 1987–98, covering 20–44 completed gestational weeks. In the final standards we excluded stillbirths, infants born with malformations and cesarean sections. Birthweights in the Scandinavian populations are high and standards from other populations may not be representative, especially for the term weeks. Also, the secular changes demonstrated in this study indicate that old birthweight by gestational age standards need revision, especially due to changes in obstetrical routines influencing preterm data.
Maternal reproductive history: a registry based comparison of previous pregnancy data derived from maternal recall and data obtained during the actual pregnancy
Authors: KRISTENSEN PETTER , IRGENS LORENTZ M.
Published: March 2003

Objective. To compare the quality of data on previous pregnancies, based on maternal recall, to that of actual data in previous birth records, and to quantify to which extent recall based data bias results in epidemiologic studies on adverse reproductive outcomes.

Methods. Through linkage between agricultural censuses and the Medical Birth Registry, we identified 87,113 Norwegian female farmers with 174,764 single births in 1967–1991, including 533 late abortions (16–27 weeks). Data were linked into sibship records. In routine birth records, mothers provide information at each birth on previous fetal loss. Thus, we had information both based on recall and on the actual record.

Results. Among all mothers with a loss documented in previous records, 73.5% had a recall of previous loss (sensitivity), while 74.3% of all mothers reporting a previous loss also had a loss in previous sibship records (positive predictive value). Late abortion after a previous loss according to the sibship record was more frequent than after a previous loss based on maternal recall (18.3 vs. 10.8 per 1000). There was a particular lack of recall for previous losses of short gestational age or when the current birth was a late abortion; both conditions tended to deflate the association between a previous and a current adverse outcome. Grain farming was associated with late abortion in mothers with previous loss in sibship records (odds ratio, 2.6) but not among mothers without previous loss (odds ratio, 1.0). When information on previous loss was based on maternal recall the odds ratios were 1.4 and 1.3, respectively.

Conclusions. Consecutive sibship records give more valid information than data derived from maternal recall.
Hyperemesis gravidarum in a contemporary population in Oslo
Authors: VILMING BENTE , NESHEIM BRITT‐INGJERD
Published: March 2003

Background. Sociodemographic studies of hyperemesis gravidarum are conflicting. During the last few years, there has been a clinical impression in Norway that immigrants are more afflicted than ethnic Norwegians.

Methods. Of 175 patients hospitalized with the diagnosis hyperemesis gravidarum 1993 – 1997, 120 had complete records and were compared to a control group of 115 patients without hyperemesis gravidarum, drawn at random from the labor ward protocol. Variables: Ethnicity, age, height, weight at the beginning and at the end of pregnancy, body mass index, gravidity, parity, smoking, gestational age at labor, birth weight, placental weight. The patient's first name was used as an indication of ethnicity. Having a non‐Norwegian name means, in the majority of cases, being a first generation immigrant from a developing country. Statistics: SPSS statistical package for regression analyses, the chi‐square test with Yates correction and the Mann‐Whitney U‐test.

Results. Risk factors for hyperemesis: non‐Norwegian name (OR 3.4, 95% CI 1.5–7.6), female sex of the infant (OR 2.6, 95% CI 1.3–5.3), gravidity number (OR 1.4, 95% CI 1.1–1.9). These two last variables were of significance only in patients with a Norwegian name. The hyperemesis group had a lower weight gain and birth weight. In a stepwise multiple regression birth weight (g) was dependent on weight increase (kg) (B=19.0, p=0.001), weight in early pregnancy (kg) (B=8.0, p=0.02) and parity (B=107.1, p=0.02). Hyperemesis, when corrected for weight increase, did not influence birth weight.

Conclusions. Risk factors vary between different populations. Hyperemesis patients are at risk of having infants with reduced growth.
Smoking during pregnancy increases the risk of preterm births among parous women
Authors: KOLÅS TORIL , NAKLING JAKOB , SALVESEN KJELL Å.
Published: March 2003

Background. We wanted to study a possible association between smoking during pregnancy and preterm birth.

Methods. A population based prospective study was performed among 7,236 consecutive pregnancies over seven years delivered at one birth clinic. Smoking habits were obtained at a routine ultrasound examination around 18 gestational weeks, and preterm birth was defined as delivery of a child between 24 and 37 gestational weeks. We estimated relative risk (odds ratio) between smoking, possible confounding variables and preterm birth using multiple logistic regression analysis.

Results. Overall, 1,769 (25%) women said that they smoked every day during their pregnancy. The smoking women had an increased risk of preterm delivery compared with non‐smokers (odds ratio 1.53, 95% confidence interval 1.24, 1.89). However, this association was only demonstrated among the multiparous women (odds ratio 1.88, 95% confidence interval 1.39, 2.54). The association was statistically significant after adjusting for maternal age, diabetes, cervical conization, preeclampsia, placental abruption and placenta previa in a multivariate analysis, and we observed a dose‐response effect of maternal smoking on preterm birth among multiparous women.

Conclusion. For multiparous women smoking during pregnancy increases the risk of preterm delivery, and there seems to be a dose‐response effect of smoking.
High‐density vaginal Ureaplasma urealyticum colonization as a risk factor for chorioamnionitis and preterm delivery
Authors: ABELE‐HORN MARIANNE , SCHOLZ MICHAEL , WOLFF CHRISTINE , KOLBEN MARTIN
Published: March 2003

Background. The aim of this case control study was to investigate the influence of genital Ureaplasma urealyticum colonization on pregnancy outcome.

Methods. One hundred and seventy‐two women colonized with Ureaplasma urealyticum without co‐existing other infections and 123 women with negative cultures for Ureaplasma urealyticum were enrolled. In a multivariate analysis the influence of quantitative Ureaplasma urealyticum colonization level was determined.

Results. Compared to the negative women increasing colonization with Ureaplasma urealyticum was associated with a significant decrease of birth weight (p<0.0001) and gestational age (p<0.0001) and with a significant increase of chorioamnionitis (p<0.0001) and preterm delivery (p<0.001). In a multivariate analysis high‐density Ureaplasma urealyticum colonization was an independent risk factor for chorioamnionitis and preterm delivery, whereas low colonization levels had no effect on an adverse outcome of pregnancy.

Conclusions. The degree of colonization with Ureaplasma urealyticum correlates strongly with an adverse effect on pregnancy outcome.
The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi
Authors: KULMALA TEIJA , VAAHTERA MERIMAARIA , RANNIKKO JUHA , NDEKHA MACDONALD , CULLINAN TIMOTHY , SALIN MARJA‐LEENA , ASHORN PER
Published: March 2003

Objective. To describe and compare the frequency of antenatally identified maternal ‘risk’ characteristics, place of delivery and occurrence of delivery complications.

Methods. A prospective cohort study of 780 pregnant women completing antenatal follow‐up at a rural health center in Malawi.

Results. Three‐quarters of the subjects had at least one commonly accepted risk characteristic. Only 30% of these women, and 22% of those with no risk chracteristics, delivered in a modern health facility. Four women died, 127 experienced other delivery complications and there were 52 perinatal deaths. The ‘at‐risk’ classification had over 80% sensitivity but less than 30% specificity to predict delivery complications or perinatal deaths. The positive predictive values were as low as 20% for delivery complications and 7% for perinatal mortality. Most individual ‘risk’ characteristics were not associated with adverse delivery outcomes, even when adjusted for the place of delivery.

Conclusions. Antenatal risk identification failed to promote safe deliveries because of a poor predictive value of the ‘risk’ variables and the failure of the identified ‘at‐risk’ individuals to deliver in modern health facilities.
A randomized prospective study of misoprostol and dinoproston for induction of labor
Authors: BELFRAGE PATRICK , SMEDVIG ELI , GJESSING LEIF , EGGEBØ TORBJØRN MOE , ØKLAND INGER
Published: March 2003

Background. Misoprostol, a prostaglandin E1 analog registered for the prevention of gastric ulcers in NSAID‐drug users, has been reported to be more effective for labor induction than the standard prostaglandin, dinoproston after vaginal application. There have been some concerns about possible hyperstimulation of the uterine activity and about the safety for the fetus with this new drug.

Methods. Two hundred and ten patients, 36 weeks pregnant or more, with an unfavorable cervix, single pregnancy, and intact membranes were randomized to receive misoprostol, 50 micrograms intravaginally every 6 hours, or dinoproston 0.5 mg intracervically every 12 hours for a maximum of 24 hours, for labor induction.

Results. Time from induction to delivery was shorter in both primigravidae and multigravidae after the application of misoprostol than dinoproston and failed induction was more common after dinoproston than after misoprostol. There were no differences in the condition of the newborns in the two groups, according to Apgar score, umbilical artery pH or referral to the neonatal unit, even if there were more operative deliveries for suspected fetal asphyxia after misoprostol than after dinoproston. We did not find any significant difference in the frequency of uterine hyperstimulation between the two groups.

Conclusions. In the dosage used, misoprostol seems to be an effective agent for induction of labor in patients with an unfavorable cervix. Low cost and ease of administration make this drug a promising alternative for this purpose. Surprisingly, there is little interest from the manufacturer to promote the use of this drug for labor induction.
Comparison between personal learning curves for abdominal and laparoscopic hysterectomy
Authors: LEMINEN ARTO
Published: March 2003

Background. To compare personal learning curves for abdominal and laparoscopic hysterectomy.

Methods. The first 200 patients scheduled for abdominal hysterectomy and the first 200 patients scheduled for laparoscopic hysterectomy by a single operator were compared using learning curves according to operation time, operative blood loss, and occurrence of complications.

Results. Learning curves for both types of hysterectomy were rather similiar, but the learning of the laparoscopic procedure seemed to be quicker. With increasing experience the operating time decreased by 25% in abdominal and by 41% in laparoscopic hysterectomies. The mean operating time in abdominal hysterectomy was 74 min and 70 min in laparoscopic hysterectomy. Operative blood loss decreased by 50% and 44%, respectively. The mean operative blood loss was smaller (203 vs 295 ml, p<0.0001) in laparoscopic hysterectomy. Increased experience had no effect on complication rates in abdominal hysterectomies, but a decrease of 44% was seen in laparoscopic hysterectomies (p<0.05). The overall complication rate (26% vs 22%) were similar for the two techniques, and only a few patients (1.5% vs 1%) had major (bladder or ureteric) complications.

Conclusions. A trained gynecologist can learn the laparoscopic technique for hysterectomy at least as quickly as the abdominal technique.
A population based study of Swedish women’s opinions about antenatal, delivery and postpartum care
Authors: Ladfors Lars , Eriksson Margareta , Mattsson Lars‐Åke , Kylebäck Katarina , Magnusson Lena , Milsom Ian
Published: March 2003

Objective. To investigate the views and experiences of Swedish women regarding antenatal, delivery and postpartum care.

Study design. A random sample of women from the birth cohorts 1955, 1959, 1963, 1967 and 1971 resident in the city of Göteborg (n=2880) was invited by letter to complete a questionnaire regarding antenatal, delivery and postpartum care.

Results. The overall response rate was 73% and 1130 (54%) of the 2109 responders had given birth to at least one child. Eighty‐one percent of parous women answered that checking blood and urine samples, fetal heart rate, and the measurement of fundal height were the most important procedures in antenatal care. A majority had a positive attitude towards the use of electronic fetal heart rate monitoring (parous 85%; nulliparous 84%). Sixty percent of parous women were aware that ultrasound examination was voluntary and a majority (90%) had a positive attitude towards ultrasound scanning. Forty‐three percent of parous women wanted antenatal clinics to be open until 8.00 p.m. A minority of both parous (4%) and nulliparous (4%) women were interested in home delivery. There were more parous (33%) than nulliparous (12%) women who expressed no anxiety at all about the next delivery. Seventy‐nine percent of the parous women reported that they would like to have a planned visit with a delivery ward midwife before the next delivery. About 80% reported that they would feel very safe if their partners were present at the delivery (nulliparous 79%; parous 84%). Eighty‐five percent preferred a single room or a room together with only one other woman in the postnatal ward. Seventy‐two percent of the women wanted to stay 72 hours or less in the postpartum ward and 24% thought there had been too many visitors during the postnatal period. Over 80% were very positive towards breast‐feeding. Approximately 80% of all women considered regular contractions up to twelve hours to be acceptable before delivery.

Conclusions. This study has provided some useful information about women’s opinion regarding antenatal, delivery and postpartum care which may be taken into account when instigating changes in the maternity care system.
Changes in markers of anemia and iron metabolism and how they are influenced by antianemics in postpartum period
Authors: Mára Michal , Živný Jaroslav , Eretová Vladimíra , Kvasnička Jan , Kužel David , Umlaufová Anna , Márová Eva
Published: March 2003

Background. The object of this study was to examine the occurrence of iron deficiency anemia in women after spontaneous delivery, changes in clinical and laboratory indicators of anemia in postpartum period and their possible control by administration of peroral antianemics.

Methods. Ninety pregnant women at 35th to 39th week of gestation were randomly divided into three groups and extensively examined in a laboratory. After delivery, the mothers were examined four times at monthly intervals until the end of the third postpartum month. At the same time, they were examined for their subjective feeling of health, with some focus on typical anemic symptoms. Women in the first group were treated with 80 mg of elemental iron a day for the first two months after childbirth. Women in the second group were treated with 80 mg of elemental iron+0.35 mg of folic acid a day for the same period of time. Women in the control group did not use any medication. McNamara test was used to evaluate the portion of anemic and sideropenic women and for comparison between individual groups.

Results. Findings of the study have shown a faster adjustment of laboratory and clinical indicators of postpartum anemia in women treated with iron. We did not observe the only, sovereign marker of iron deficiency (sideropenic) anemia in the early postpartum period.

Conclusions. We recommend flat administration of iron to all women after spontaneous delivery. Postpartum substitution with iron should last at least three months because of long‐lasting sideropenia. Adding folic acid to iron does not have any significant impact during the postpartum period.
Effects of erythromycin on stretch‐induced contractile activity of isolated myometrium from pregnant women
Authors: Celik Husnu , Ayar Ahmet , Sapmaz Ekrem
Published: March 2003

Background. Despite the fact that preterm labor and birth account for the vast majority of neonatal morbidity and mortality the currently available treatment options are still far from satisfactory. The aim of this study was to investigate the effects of erythromycin on stretch‐induced contractions of pregnant human myometrial strips, obtained at cesarean section.

Method. Myometrial strips were suspended in an organ bath under 3 g tension and the effects of erythromycin (0.1, 0.2, 0.5, 1.0 mM) on stretch‐induced isometric contractions were evaluated. Results were statistically analyzed using Kruskal Wallis analysis of variance and Wilcoxon Rank tests where appropriate.

Results. Erythromycin caused a significant decrease in the peak amplitude, while causing an increase in frequency of stretch‐induced myometrial contractions in a dose dependent manner in vitro.

Conclusions. Results from this preliminary study suggest that erythromycin may have additional beneficial effects in infection related preterm labor cases, however, further studies are needed for clarifying the usefulness of erythromycin as a tocolytic agent.
Mode of delivery in breech presentation at term: Increased neonatal morbidity with vaginal delivery
Authors: Herbst Andreas , Thorngren‐Jerneck Kristina
Published: March 2003

Objective. To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presentation in a Scandinavian clinic with a high rate of vaginal breech delivery.

Methods. A retrospective study including 1050 term singleton breech pregnancies delivered at a Swedish tertiary referral center during 1988 to 2000. For 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) were delivered vaginally. In 327 (31%) cases a cesarean section was planned and performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological morbidity. Long term sequels among infants with a complicated neonatal course were also identified.

Results. Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vaginal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarean delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity was 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptoms and six cases of brachial plexus palsy) compared to one case (cerebral symptoms) after a planned cesarean. These differences were all statistically significant (p≤0.002). Of the neurologically affected neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up.

Conclusion. Neonatal morbidity may be reduced with planned cesarean delivery in breech presentation, also in a Scandinavian setting.
Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia
Authors: Clark T. Justin , Mann Christopher H. , Shah Neil , Khan Khalid S. , Song Fujian , Gupta Janesh K.
Published: March 2003

Background. To determine the accuracy of outpatient endometrial biopsy in diagnosing endometrial hyperplasia in women with abnormal uterine bleeding.

Design. Systematic quantitative review of published medical literature.

Data sources. Relevant papers were identified through electronic scanning of MEDLINE (1980–1999) and EMBASE (1980–1999), manual searching of bibliography of known primary and review articles and contact with manufacturers.

Review methods. Studies were selected if accuracy of outpatient endometrial biopsy, in women with abnormal pre or postmenopausal uterine bleeding, was estimated compared to a reference standard, which was endometrial histology obtained by tissue sampling under anesthesia. Quality assessment and data extraction were performed in duplicate. Diagnostic accuracy was determined by pooled likelihood ratios (LR) for positive and negative test results for endometrial hyperplasia.

Results. There were 881 subjects in 8 diagnostic evaluations reported in 6 primary studies. Postmenopausal women represented 25% of the participants studied. There were 43 patients in whom outpatient sampling was inadequate. A positive test result on outpatient biopsy diagnosed endometrial hyperplasia with a pooled LR of 12.0 (95% CI 7.8–18.6) while a negative test result had a pooled LR of 0.2 (95% CI 0.1–0.3). With a positive test result, the posttest probability of endometrial hyperplasia was 57.7% (95% CI 41.1%–72.7%) while it was 2.2% (95% CI 0.9%–4.1%) with a negative test.

Conclusion. Outpatient endometrial biopsy has modest accuracy in diagnosing endometrial hyperplasia. Therefore, additional endometrial assessment should be undertaken, especially if symptoms persist or intrauterine structural abnormalities are suspected.
Hyrtl’s anastomosis, the only connection between the two umbilical arteries. A study in full term placentas from AGA infants with normal umbilical artery blood flow
Authors: Ullberg Ulla , Sandstedt Bengt , Lingman Göran
Published: March 2003

Background. The aim of this study was to describe the variable anatomy in the anastomosis between the umbilical arteries for better understanding of the physical characteristics of the umbilical flow velocity waveform (FVW).

Methods. The arterial system of 67 placentas from pregnancies with normal umbilical FVW and resulting in a full‐term AGA infant was visualized by angiography. The method allowed study of the anatomy of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each umbilical artery.

Results. In 60 cases there was one anastomosis between the umbilical arteries, in one case there were two, in four the anastomosis was absent, and another two cases had a single umbilical artery. The anastomosis was represented by a vessel, a fenestration or coalescence of the umbilical arteries. In case the anastomosis diameter was of at least that of the umbilical arteries, they supplied in mean 26% and 74% (±8.2%) of the placental area respectively. When the anastomosis diameter was smaller than that of the umbilical arteries their supply areas were in mean 41% and 59% (±6.0%) respectively. In placentas lacking anastomosis the two umbilical arteries supplied 45% and 55% (±2.6%) respectively, indicating a higher degree of symmetry.

Conclusions. By using angiography we were able to demonstrate the variable anatomy of the anastomosis of Hyrtl. We found the occurrence and width of the anastomosis was correlated to the symmetry in size between the supply areas of each umbilical artery.
Levels of dimethylarginines and cytokines in mild and severe preeclampsia
Authors: Ellis Joy , Wennerholm Ulla‐Britt , Bengtsson Anders , Lilja Håkan , Pettersson Anders , Sultan Bo , Wennergren Margareta , Hagberg Henrik
Published: March 2003

Background. The objectives were 1. to evaluate if the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine was altered in mild and severe forms of preeclampsia, and 2. to assess the relationship between dimethylarginines and the cytokine response in preeclampsia.

Methods. Asymmetric and symmetric dimethylarginine were measured with high performance liquid chromatography in women with mild (n=13) and severe (n=32) preeclampsia and in normotensive pregnant controls (n=20). Interleukin‐4, ‐6, ‐8, ‐10 and tumor necrosis factor‐α were analyzed by immunoassays in women with mild (n=8) and severe (n=17) preeclampsia and in normotensive pregnant controls (n=14). The Mann Whitney U‐test and Spearman Rank test were used for statistical analysis.

Results. The plasma levels of dimethylarginine were increased in preeclamptic subjects. The elevation of symmetric dimethylarginine was more pronounced than that of asymmetric dimethylarginine. The control levels of interleukin‐6, ‐8 and ‐10 were significantly higher at term than at gestational week 32–36. Interleukin‐6 and ‐8 were significantly elevated in subjects with severe, but not mild, preeclampsia, whereas TNF‐α and IL‐10 were not significantly altered. Symmetric dimethylarginine levels correlated significantly with arterial blood pressure and serum levels of creatinine and uric acid. Dimethylarginine levels in plasma were, however, not related to the cytokine response.

Conclusions. Plasma concentrations of both asymmetric and symmetric dimethylarginine were significantly elevated both in mild and severe preeclampsia. Symmetric, but not asymmetric, dimethylarginine correlated to the severity of the condition. Plasma levels of interleukin‐6 and ‐8 were also elevated in severe preeclampsia but no direct correlations were found between these cytokines and dimethylarginines.
An increasing proportion of infants weigh more than 4000 grams at birth
Authors: Ørskou Janne , Kesmodel Ulrik , Henriksen Tine Brink , Secher Niels Jørgen
Published: March 2003

Background. To investigate how mean birthweight has changed in the past decade, and to describe changes in the proportion of infants with a birthweight above 4000 grams (g).

Methods. We analyzed data on 43,561 singleton infants born between 1990 and 1999 at Aarhus University Hospital, Denmark. Information on birthweight, gestational age, stillbirths, malformations, mode of delivery, prelabor intervention, and maternal diabetes was obtained from birth registration forms.

Results. For all infants mean birthweight increased by 45 g (95% CI: 20–70 g) from 3474 g in 1990 to 3519 g in 1999. For infants born at term the mean increase was 62 g (95% CI: 41–83 g). During the same period the percentage of infants born with a birthweight above 4000 g increased from 16.7% in 1990 to 20.0% in 1999 (p<0.05). Simultaneously we found a decrease in gestational age and an increase in the frequency of induction of labor. There was a statistically significantly higher risk of giving birth to an infant with a birthweight above 4000 g throughout the decade, when gestational age and prelabor intervention was taken into account.

Conclusions. In Denmark mean birthweight has risen during the past decade independently of gestational age and prelabor intervention. Simultaneously the risk of having a baby with a birthweight above 4000 g has increased. Further studies on potential risk factors for birth of large infants are needed.
A Wallace malleable stylet for difficult embryo transfer in an in vitro fertilization program: a case‐control study
Authors: Nielsen Ingrid Kirstine , Lindhard Anette , Loft Anne , Ziebe Søren , Andersen Anders Nyboe
Published: March 2003

Background. The aim of the study was to evaluate the impact of using a Wallace malleable stylet in combination with an Edwards–Wallace embryo replacement catheter in case of difficult embryo transfer (ET).

Methods. A retrospective case‐control study was used. The standard ET procedure at the clinic was to use a single tooth tenaculum, and a speculum to straighten the cervical canal prior to inserting the Edwards–Wallace embryo replacement catheter. In 205 of 2041 (10%) fresh ET difficulties were experienced during ET and a Wallace malleable stylet was used to place the outer catheter sheath correctly. This stylet transfer group was compared with a control transfer group of 410 ET performed just before and after each stylet transfer.

Results. No differences in number of transferred embryos, cleavage stage, or embryo morphology score were found between the two groups. We found no differences in implantation rates (20.7 and 19.2% [95% confidence interval (CI) 0.8–1.5]) or delivery rates (29.3 and 25.4% [CI 0.8–1.8]) between the study and control group.

Conclusion. Using a Wallace malleable stylet in combination with an Edwards–Wallace embryo replacement catheter in case of difficult ET has no negative impact on implantation and delivery rates.
Transforming growth factor‐beta 1 serum levels in pregnancy and pre‐eclampsia
Authors: Huber Ambros , Hefler Lukas , Tempfer Clemens , Zeisler Harald , Lebrecht Antje , Husslein Peter
Published: March 2003

Background.  Isoforms of transforming growth factor‐beta (TGF‐β1) are thought to be involved in the pathogenesis of pre‐eclampsia. Data with respect to TGF‐β1 are controversial. We examined the correlation between TGF‐β1 serum levels and the occurrence and severity of pre‐eclampsia.

Methods.  Transforming growth factor‐beta 1 serum levels were measured using a commercially available enzyme‐linked immunosorbent assay in 44 women with pre‐eclampsia and 44 healthy pregnant women. Results were correlated with clinical data.

Results.  No difference in TGF‐β1 serum levels was assessed between women with pre‐eclampsia and healthy pregnant women. Transforming growth factor‐beta 1 serum levels were not associated with the severity of the disease and were not correlated with clinical maternal (blood pressure, proteinuria) and fetal (5‐min APGAR score, umbilical cord pH values, birth weight) parameters.

Conclusions.  Our data support the assumption that in contrast to other isoforms, TGF‐β1, as evidenced by serum TGF‐β1 levels, does not seem to be involved in the pathogenesis of pre‐eclampsia.