bluuebunny/crossref_metadata_2025 huggingface dataset:
Ectopic pregnancy and a sensitive test for urinary human chorionic gonadotropin
Authors: Frost Lars , Mailer Jan
Published: November 2007

A commercially highly sensitive test for human chorionic gonadotropin was used in daily routine to screen for ectopic pregnancy (detection threshold 75 mlU/ml). The test, when used in 120 patients with ectopic pregnancy, had a diagnostic specificity of 100%, sensitivity 96.7%, the predictive value of a positive test was 100%, and of a negative test 90%.
Herpes Simplex Virus IgA in Pregnancy
Authors: Meiland Hanne T. , Hebjørrn Søren , Andersen Susanne Møller , Larsson Anne‐Marie , Norrlind Bodil
Published: November 2007

From 170 pregnant women, cervico‐vaginal secretion, serum and amnion fluid were collected to determine concentrations of herpes simplex virus (HSV) IgA in different risk groups. We found a higher concentration of HSV IgA in cervicovaginal secretions in women with positive cultures, compared with women with negative cultures. Women with a prior history of genital HSV infections also had higher levels of HSV‐IgA in cervico‐vaginal secretions, compared with those with no HSV history, but the differences were not statistically significant. The concentrations of HSV IgA in cervico‐vaginal secretions were not correlated to any other risk group defined in the study. An asymptomatic mother with no previous history of genital HSV infection, but belonging to the risk groups gave birth to an infant who developed neonatal herpes on the 4th day of life. Women at risk for viral shedding during gestation and at the time of delivery cannot be identified solely on the basis of grouping into risk groups and/or on concentration of HSV IgA in cervico‐vaginal secretion.
Effect of Exercise on Placental Blood Flow in Pregnancies Complicated by Hypertension, Diabetes or Intrahepatic Cholestasis
Authors: Rauramo I. , Forss M.
Published: November 2007

The effects of a standardized exercise test on intervillous placental blood flow were studied in 13 hypertensive, 10 diabetic and 8 cholestatic pregnant women in late pregnancy, and the results were compared with those of a normal control group. Analysis of variance for repeated measures revealed that in all the pathologic groups, placental blood flow was lower than in the controls. In all groups placental blood flow rose slightly 1 min after the cessation of exercise. The diabetics showed a decreased placental blood flow 30 min after the cessation of the exercise test (p > 0.021. In diabetics, a fall was found in stroke volume, from 63 ± 12 ml (mean ± SD) before the exercise to 53 ± 11 ml 30 min after the cessation of exercise (p > 0.051, and a rise in peripheral vascular resistance, from 1540± 200 (mean± SD) dynes/cm5 before exercise to 1750 ± 390 dynes/cm5 30 min after the cessation of exercise (p > 0.051. Pre‐eclamptic patients had a higher peripheral vascular resistance than had normal controls. Pre‐eclamptic, diabetic and cholestatic patients had lower cardiac index values than the normal subjects. The difference was significant in the pre‐eclamptic and diabetic patients at 30 min after the cessation of exercise. Maternal heart rate, and systolic, diastolic and mean arterial blood pressures rose significantly from values at rest to values at the end of exercise in all groups. One of the pre‐eclamptic patients showed a 74% decline in placental blood flow 1 min after the cessation of exercise coincident with fetal bradycardia. 30 min after the cessation of exercise the flow was 51% of the pre‐exercise value with reactive fetal heart rate tracing. It is concluded that at least in pregnancies complicated by hypertension or diabetes a submaximal short exercise can cause a fall of cardiac index and placental blood flow and, therefore should be avoided in late pregnancy.
Effect of exercise on Maternal Hemodynamics and Placental Blood Flow in Healthy Women
Authors: Rauramo I. , Forss M.
Published: November 2007

Intervillous placental blood flow responses to standardized exercise during late pregnancy were studied using a Xenon technique in 25 healthy women. Thirteen of them were studied twice between the 32nd and 38th weeks of pregnancy, with mean 32 (range 22 to 40) days between the studies. At the end of a 6–min exercise, mean maternal heart rate had risen from 77±10 (SD) to 154±11 beatshin, amounting to 63% of maximal oxygen uptake. Stroke volume rose by 9%, cardiac output by 65% and cardiac index by 71% as a consequence of exercise, but peripheral vascular resistance declined by 41 %. The placental blood flow was at a similar level after the exercise as before the exercise, being 95±19 (mean±SD) mllmin1100 ml of intervillous space before, 98±24 one min after, and 93 ±16 30 min after the cessation of exercise. No change was found in the level of placental blood flow between the 32–34th and 37– 38th weeks of pregnancy. The placental blood flow had a positive correlation with maternal weight, mean arterial blood pressure and with dia‐stolic blood pressure. Maternal heart rate, cardiac output, cardiac index, placental weight and the birth weight of the infant was not correlated with placental blood flow. It is concluded that in normal pregnancy a short submaximal exercise has little effect on placental blood flow measured after exercise.
Parental Attitudes to Prenatal Information About the Sex of the Fetus
Authors: Sjögren Berit
Published: November 2007

Women undergoing prenatal diagnosis (n = 198) with amniocentesis or chorionic villous biopsy participated in a study of attitudes to information about the sex of the fetus. The women completed two questionnaires on different occasions and about one fourth of them were also interviewed. Furthermore, 20 of the women's consorts were interviewed. The possibility of obtaining information about the sex of the fetus was reported as unimportant for most of the women (78%). Nevertheless, 58% of them wanted to have the information. In the questionnaires, most of the women (84%) rejected the idea of having a legal abortion because of the fetus's sex. In a discussion during the interview, only 33% of the men and women dismissed the probability that in some situations, parents‐to‐be might wish to choose the sex of their child and to do so by means of prenatal diagnosis. At the same time, 57% of the participants deprecated this use of the diagnostic technique. Thus the participants’ answers were contradictory, indicating split attitudes to this problem. The results suggest that it is possible that people may wish to use PND to select the sex of their child. At the same time the way of answering indicates that there is a moral dilemma.
Preoperative Diagnosis of Ovarian Malignancies with Intravenous Digital Subtraction Angiography
Authors: Iwasaka T. , Kishikawa T. , Uchiyama R. , Kudo S. , Matsumoto S. , Sugimori H.
Published: November 2007

Intravenous digital subtraction angiography was performed on 59 patients with ovarian tumors. Dilatation of the uterine artery and its ovarian branch was relatively frequent in both benign and malignant tumor groups, while dilation of the ovarian artery, and hyper‐vascularity from the uterine artery or the ovarian artery were fairly specific to the malignant tumor group. These five abnormal vascular patterns were evaluated by a scoring system and approximately 75% of malignant and 87% of benign ovarian tumors were correctly diagnosed preoperatively by digital subtraction angiography alone. Intravenous digital subtraction angiography can be applied as an easy, safe, and valuable diagnostic method for ovarian malignancies and can replace conventional pelvic angiography.
Diagnostic Accuracy of Outpatient Endocervical Curettage Using Conventional and Vabra Curettage of the Cervix
Authors: Hald Finn , Kristoffersen Sven Erik , Hairi Jalil , Hansen Mogens Kern
Published: November 2007

With the object of examining the diagnostic accuracy of and pain reaction to endo‐cervical curettage (ECC) either by using a new instrument, Vabra® mc cervix, or with a conventional 3 mm metal curette, 298 patients with histologically verified cervical intra‐epithelial neoplasia (CIN) or cytological suspicion have been involved in a consecutive prospective randomized trial. One hundred and forty‐eight patients underwent curettage with the Vabra instrument (vabrasiol followed by conventional curettage; 150 underwent the same procedure, but in reverse order. In 114 patients, CIN was ascertained in one or both trials. Vabra® mc cervix found normal histology in 23 of these patients (20%), whereas conventional curettage showed normal histology in 58 patients (51%). Quantitatively, Vabra® mc cervix extracted significantly more tissue material than did conventional curettage. The pain intensity when using of Vabra® mc cervix was less servere. The present study showed diagnostic accuracy of Vabra® me cervix to be 80% (95% confidence limits: 63.38–80.73). compared with 49% (95% confidence limits: 35.17–54.35) when using conventional curettage.
Carcinofibroma—A Rare Variant of Mixed Müllerian tumor
Authors: Engdahl Erik , Wolfhagen Ulla
Published: November 2007

We report a case of an endometrial neoplasm of Mullerian origin, consisting of a malignant epithelial component and a benign stromal component.

Only 3 similar cases have been described previously. By comparative study of other, more common mixed Mullerian tumors, we have tried to determine the behavior and management of this neoplasm.
Comparison of Low Molecular Weight Heparin vs. Unfractionated Heparin in Gynecological Surgery
Authors: Borstad E. , Urdal K. , Handeland G. , Abildgaard U.
Published: November 2007

Abstract.In a double‐blind, randomized trial, the antithrombotic effect and haemorrhagic complications of low molecular weight heparin (LMWH) (Heparin fragment 2165, KabiVitrum) and unfractionated heparin (UH) were compared. LMWH (5000 anti‐XaU) was injected every 24 h, UH (5000 IU) every 12 h; both drugs by subcutaneous injection. During 1984–85, 215 patients were examined clinically and by plethysmography. Venography was performed whenever DVT was suspected. None of the patients proved to have DVT. Bleeding complications were found in 54% of the cases. The LMWH group had a statisticaly significant predominance of bleeding complications as reflected by wound haematomas (p = 0.02) and the number of blood transfusions (p = 0.02). The heparin concentration was higher in the LMWH group (mean 0.13 IU/ml) than in the UH group (mean 0.13 IU/ml) measured 2 h after the injection. In the doses administered, LMWH and UH seem effective in the prevention of thrombosis. The increased bleeding tendency in the LMWH group probably was a concequence of the to high dosage.
Outcome of Pregnancy After Infertility
Authors: Varma T. R. , Patel R. H. , Bhathenia R. K.
Published: November 2007

Abstract. Pregnancy following a period of infertility was considered to be an increased risk for the fetus. During a period of 3 years (1983–85), 748 couples were seen at this infertility clinic; 515 women (68.9%) conceived, and were followed up and studied prospectively. Fifteen of these women moved out of the area. We analysed the results of pregnancies for the remaining 500, (Group 1) and compared them with the outcome for the total obstetric population (Group 2) during the same period. Mean age at conception in the infertility group (Group 1) was 31.8 (±2.7, 2 SD) years, as compared with 23.7 (±2.9, 2 SDI in the total hospital obstetric population (Group 2) (p >0.05). The incidences of spontaneous abortion for the two groups (8 and 6.2%) did not differ (p <0.05). However, the incidence of ectopic pregnancy was higher (3.0%) in Group 1 than in Group 2 (1.5%) (p>0.01). The incidence of pre‐existing hypertensive vascular disease (7.7%) complicating pregnancy and multiple pregnancy (4.1%) was significantly higher in Group 1 than in Group 2 (1.5% and 1.4% respectively), (p>0.011. The incidences of induction of labor (29.5%) and elective operative delivery (10.6%) were higher in Group 1 (p>0.011. The incidences of infants with birth weight below the tenth centile (12.9%), of fetal distress in labor (14.6%) and a low Apgar score (0 – 5) (9.5%), were higher in Group 1, but there was no difference in the perinatal mortality rate between the two groups. In general, babies and mothers in the infertility group seemed to fare no worse than those in the total obstetric group delivered at our hospital. This may be because of the intensive antenatal, and intranatal care the patients receive in the infertility group under close supervision by one obstetrician.
Micturition Symptoms and Urinary Incontinence after Non‐Radical Hysterectomy
Authors: Vervest Harry A. M. , Kiewiet de Jonge Michiel , Vervest Ton M. J. S. , Barents Joop W. , Haspels Ary A.
Published: November 2007

Abstract. The effects of 554 non‐radical vaginal and abdominal hysterectomies on micturition symptoms and urinary incontinence were studied. From the urological point of view, two groups of women may be distinguished prior to hysterectomy: one without urological symptoms and the second with urological complaints (present in no less than 57% of all women and differing significantly from the distribution of urological symptoms in the normal population). In the first group, frequency developed significantly more often than nocturia, dysuria, stress incontinence and nocturnal and diurnal urge incontinence. The type of hysterectomy was not related to this development, except that urgency more often followed vaginal hysterectomy. In the second group, highly significant improvement and disappearance of symptoms was observed. Age, parity, menopausal status, the presence of myomas, height, weight and body mass index had no influence.
Induced Anovulation As Treatment Of Premenstrual Tension Syndrome: A double‐blind cross‐over study with GnRH‐agonist versus placebo
Authors: Hammarbäck Stefan , Bäckström Torbjörn
Published: November 2007

Abstract. A treatment with the GnRH‐agonist, buserelin, was given intranasally in a dosage of 400 g once daily, to induce anovulation in 26 women with premenstrual tension syndrome; 23 patients completed the study course. The design was double‐blind and crossover. Daily symptom ratings were made for two pretreatment, diagnostic cycles and continued for up to six cycles or 6 months. The rating scale used was an earlier described visual analogue scale. Blood samples for estradiol and progesterone radio‐immunoassay were taken once weekly throughout the study. Results show beneficial effects of both placebo and GnRH‐agonist, compared with the pretreatment situation. The GnRH‐agonist was, however, significantly better than placebo. At the end of the treatment periods the patients while still taking placebo, still showed cyclical symptom changes, whereas during the GnRH‐agonist treatment the cyclical changes had disappeared. The results indicate that a factor from the corpus luteum must be involved in the etiology of cyclical mood changes. The results also show that inhibition of ovulation by mean of GnRH‐agonists is one possible way to treat premenstrual tension syndrome.
The Combination of Pregnancy and Acute Salpingitis in a Case of Uterus Didelphys
Authors: Andersen Erik Søgaard , Nielsen Gunner Lauge
Published: November 2007

Abstract. A pregnant woman, with a uterus didelphys, developed abdominal pain. Laparotomy disclosed a severe infection of the tube of the non‐pregnant horn. The diagnosis of acute salpingitis should be considered when a patient with a uterus didelphys develops unilateral abdominal pain. The present case seems to prove the blocking effect of an intra‐uterine pregnancy on an ascending infection.
ULTRASOUND‐GUIDED PERCUTANEOUS NEPHROSTOMY IN THE TREATMENT OF ADVANCED GYNECOLOGIC MALIGNANCY
Authors: Pedersen H. , Juul N.
Published: November 2007

Abstract. Adjuvant to cancer therapy, 35 percutaneous ultrasound‐guided nephrostomies have been applied in 21 patients with ureteral occlusions or lesions secondary to advanced gynecologic malignancies. Application of the catheters was uncomplicated. Dislodgement of the catheters was the major problem with this technique, occurring in 9 cases. There were no serious complications. In 14 patients, normal ureteral function was restored after the cancer therapy, 2 had to be nephrectomized, and in 5 patients the nephrostomies had to remain permanently. It is concluded that nephrostomy is a useful tool in the management of advanced gynecologic malignancies in patients who have a prospect of cure or a period of meaningful tumor regression.
PERORAL LYNESTRENOL AND ARTERIAL DISEASE IN MENTALLY RETARDED WOMEN
Authors: Huovinen Kari , Autio Seppo , Kaprio Jaakko
Published: November 2007

Abstract. Autopsy findings from 170 non‐smoking and mentally retarded women aged 12–51 years were analysed for any epidemiological association between the use of peroral lynestrenol for inducing therapeutic amenorrhea (TA) and arterial disease Eighty‐six women had received lynestrenol continuously for an average of 81 months (range 2–220 months) and the other 84 had not After exclusion of 6 cases with known risk factors (diabetes, hypertension) predisposing to arterial disease, pathological arterial changes were found in 16 patients, 10 of them belonging to the TA group and 5 to the non‐lynestrenol group The incidence of arterial disease at autopsy at the age of 35 or more was 8/19 in TA patients and 1/15 in non‐lynestrenol patients (p = 0.078) The benefits of prolonged TA induced by lynestrenol in this group of patients must be weighed very carefully against the Dossible risks involved
The Effect of Permixon on Androgen Receptors
Authors: El‐Sheikh M. Magdy , Dakkak M. R. , Saddique A.
Published: November 2007

Permixon, the liposterolic extract of the plant Serenoa Repens is a recently introduced drug for the treatment of benign prostatic hyperplasia. The effect of Permixon on dihydrotestosterone and testosterone binding by eleven different tissue specimens was tested. The drug reduced the mean uptake of both hormones by 40.9% and 41.9% respectively in all tissue specimens. Since hirsutism and virilism are among other gynecological problems caused either by excessive androgen stimulation or excess endorgan response, we suggest that Permixon could be a useful treatment in such conditions and recommend further investigations of the possible therapeutic values of the drug in gynecological practice.
Uterine Microcurettage with Combined Endometrial Histopathology and Cytology
Authors: Löfgren Olof , Ah Per , Lonescu Adrian , Skjerris Johannes
Published: November 2007

A new disposable mechanical curette, the Inocurette', was used to obtain endometrial samples for histopathology and cytology. The instrument was tested on 120 patients; 37 patients were known from a previous conventional curettage (D & CI to have an endometrial cancer and 83 patients were referred to the County Hospital of Trelleborg for curettage because of dysfunctional bleedings. In all 120 patients a D & C followed the microcurettage procedure. The samples were randomized, coded and analyzed blind without any clinical information. In all but 3 patients with a known endometrial cancer, sufficient microcurettage sample material for either histopathology or cytology was obtained. In all but one of these 34 patients either a malignant diagnosis or seriously atypical cells were found. Using only cytology five out of 34 samples were designated adequate but normal. In a further 5 of the 37 patients the samples obtained at the subsequent D & C were inadequate for diagnosis; one sample was denoted as normal. In the 83 patients with dysfunctional bleedings, sufficient material for diagnosis after microcurettage, cytology and D & C was obtained in 74, 83 and 79 patients respectively. One endometrial cancer was disclosed by all three methods. Lnocurette® sampling causes little discomfort and requires no special training. The combined microcurettage—cytology procedure may be recommended as an alternative to conventional curettage, though, for the time being, D & C should not be replaced for cytology alone.
Albumin Binding of Madds‐A Measure of Bilirubin Binding‐In Women During Pregnancy and After Delivery and in Their Infants
Authors: Ebbesen Finn , Hess Jane , Brodersen Rolf
Published: November 2007

The purpose of this study was to investigate the binding potential of MADDS (monoacetyldiaminodiphenyl sulphone) to albumin, a measure for binding of unconjugated bilirubin, in healthy women during pregnancy, during and after delivery, and in their infants. The serum concentrations of unconjugated bilirubin, reserve albumin for binding of MADDS and total albumin were measured in: (a) 21 non‐pregnant women; (b) 16 pregnant women in the 16th‐24th, 28th‐32nd, and 36th‐38th gestational weeks, and at the time of delivery from both mother and infant; and (c) 15 women at the time of delivery, and 24 and 72 hours after delivery. The bilirubin concentrations did not change during pregnancy or at delivery and were very small compared with the concentrations of reserve albumin for binding of MADDS and total albumin. Therefore, the ratio of reserve albumin to total albumin was an expression of the binding potential of the albumin for MADDS in women. During pregnancy, the reserve albumin decreased equal to total albumin, so that the ratio was not significantly changed (p > 0.051. In contrast, at delivery the reserve albumin was significantly lower (p < 0.01) than in the 36th‐38th gestational weeks, without any significant difference in total albumin, i.e. the ratio was significantly lower than during pregnancy (p < 0.01). During the first 3 days after delivery the reserve albumin increased significantly (p<0.05), also without any significant change in total albumin, so that the ratio increased significantly (p<0.05) and was normalized.

The binding potential for MADDS to albumin in newborn infants was even lower than that of their mothers. Since the binding‐potential is reduced in both mother and infant at delivery, a relation is suggested.
Ureteral Obstruction Caused by Endometriosis
Authors: Rosenbeck John , Himmelstrup Birgitte
Published: November 2007

A case of endometriosis causing ureteral obstruction in a young woman was observed for 3.5 years. The conclusion is that early diagnosis is important and that intraveneous pyelography must be carried out at the slightest suspicion. In some cases initial treatment with Danazol alone can be tried. Otherwise the treatment must be surgical, possibly combined with Danazol.
Decrease in Serum Concentration of 5α‐Pregnane‐3,20‐Dione Prior to Spontaneous Labor
Authors: Löfgren Mats , Bäckström Torbjörn , Joelsson Ingemar
Published: November 2007

Serum 5α‐pregnane‐3,20‐dione (5αDHP) and progesterone (P) concentrations before spontaneous labor were studied in 13 women whose pregnancy and delivery were uncomplicated. Blood samples were drawn twice weekly from the 36th week of gestation up to the onset of spontaneous labor. P and 5αDHP values were analysed by applying RIA methods. Mean serum 5αDHP concentrations declined significantly during the last week of pregnancy, from 135±12 nmol/l 5 days prior to spontaneous labor, to 111 ±10 nmol/l on the day spontaneous labor started (p < 0.005). No significant changes in progesterone concentration occurred during the observation period. These results suggest a change in 5aDHP production preceding the onset of spontaneous labor.
Antepartum Looping of the Umbilical Cord
Authors: Hansen Henrik Sørup , Hillersborg Bendt
Published: November 2007

A case is presented in which the number of fetal movements decreased in the 36th week of pregnancy. On the basis of the cardiotocographic and ultrasonographic findings, cesarean section was performed, revealing loops of the umbilical cord resulting in pronounced asphyxia. Attention is drawn to the possibilities for antenatal diagnosis of umbilical cord complications.
Comparison Between The Outcome Of Antenatal Care Led Primarily By District Physician Or By Obstetrician
Authors: Håkansson Anders
Published: November 2007

Data from the Medical Birth Registry of the National Board of Health and Welfare for the years 1979–83 were studied. Comparison was made between women from one area, where the district midwife and the district physician were in charge of the antenatal care, and another area, where it was the district midwife and the obstetrician who were primarily responsible for the antenatal care. All births included in the analysis took place in the same maternity department, the numbers of births in the two areas being 3,861 and 3,041, respectively. The study was unable to reveal any difference in the outcome of pregnancy between the two areas. Thus, antenatal care led primarily by the district physician (referring complicated pregnancies to the obstetrician) seemed to be just as satisfactory as that led primarily by the obstetrician. A greater proportion of women in the latter group had ‘abnormal’ deliveries, for which there was no apparent cause.
An Objective Evaluation of Flurbiprofen and Tranexamic Acid in the Treatment of Idiopathic Menorrhagia
Authors: Andersch Björn , Milsom Ian , Rybo Göran
Published: November 2007

The effect of flurbiprofen (100 mg × 2 for 5 days) was compared with tranexamic acid (1.5 g × 3 for 3 days, 1 g × 2 days 4 and 5) in the treatment of 15 women with idiopathic menorrhagia. The mean blood loss during two medication‐free periods was 295 ± 52 ml. A significant (p < 0.01) reduction in menstrual blood loss was recorded during treatment with both flurbiprofen and tranexamic acid. The menstrual blood loss was significantly (p < 0.01) lower during treatment with tranexamic acid (155 ± 33 ml) than with flurbiprofen (223 ± 44 ml). Various side effects were recorded by 7 of 15 women during treatment with tranexamic acid and by 4 women of 15 during treatment with flurbiprofen. Many women with menorrhagia suffer simultaneously from dysmenorrhea. Thus although tranexamic acid was generally more effective in reducing menstrual blood loss, flurbiprofen provides an important therapeutic alternative to antifibrinolytic agents, especially in patients with concomitant dysmenorrhea.
Transperitoneal Ovum Migration in Women with Unilateral Congenital Ovarian Absence
Authors: Ben‐Nun Isaac , Fejgin Moshe , Gruber Arieh , Ben‐Aderet Noah
Published: November 2007

A rare case of transperitoneal ovum migration resulting in an intra‐uterine pregnancy is presented. A woman with left congenital ovarian absence and a surgically removed right oviduct, conceived following microsurgical repair of left tubal occlusion.
How to Grae with Risk Factors for Perinatal Mortality
Authors: Bergsjø Per
Published: November 2007

A risk factor is any ascertainable characteristic or circumstance of a person or group of persons that is known to be associated with an abnormal risk of having, developing, or being especially adversely affected by a morbid process (1). Risk factors may be causally or indirectly connected with the unwanted outcome, but any strategy for a counterattack must start with the identification and ranking of such factors. For perinatal death the analysis must consider the child itself, its mother, circumstances around the pregnancy and birth, and more remotely but increasingly important, social and economic conditions.
Are There Two Biological Parts in the Second Stage of Labor?
Authors: Piquard F. , Schaefer A. , Hsiung R. , Dellenbach P. , Haberey P.
Published: November 2007

In 228 patients, fetal blood pH, pCO2 and lactic acid were measured in two distinguishable parts of the second stage of labor. The ‘first’ part begins at full cervical dilatation and ends when the mother starts her first voluntary bearing down efforts. In our study, the fetal acid‐base status did not change in this part, regardless of a late developing hypoxia. In contrast, higher levels of lactic acid and pCOz and lower pH values were observed in the ‘final’ part of the second stage, indicating increasing acidosis. In this ‘final’ part, the fetuses with clinical signs of distress, as defined by an ominous Apgar score at birth, showed quicker and larger acid‐base shifts than did the normal fetuses. Thus the two parts of the second stage of labor actually differ in their potential to stimulate fetal acidosis. Since such fetal acidosis may develop especially during the ‘final’ part of labor, we have concluded that special particular attention should be devoted to this part.
Can We Expect To Lower Perinatal And Neonatal Mortality?
Authors: Georgsdóttir Ingibjörg , Geirsson Reynir Tómas , Jóhannsson Jóhann Heidar , Biering Gunnar , Snædal Gunnlaugur
Published: November 2007

In a retrospective study of all perinatal and neonatal deaths in Iceland in 1976–85, the circumstances surrounding each death were carefully evaluated to assess the quality of care given and to identify cases of suboptimal care. In 1976–80, 87 or 35% of peri‐ and neonatal deaths were associated with suboptimal care and 46 or 29% of peri‐ and neonatal deaths in 1981–85. Most of the infants weighed more than 1500 g. Suboptimal care was most commonly seen in conjunction with antenatal care in both five‐year periods, with a 25% (N.S.) reduction of cases in 1981–85. Suboptimal intrapartum care was significantly reduced (p<0.05) and there was a substantial reduction (62%), although not significant (0.1 >p>0.05), of suboptimal neonatal care between the two periods. A few cases were attributable to maternal decisions taken against medical advice, most of them in the latter period. Perinatal care improved during the study period. The task of further lowering perinatal mortality rates depends on vigilance to abnormal findings in routine antenatal care.
Hypergonadotropinemia With Estradiol Secretion In Peri‐ And Postmenopausal Period
Authors: Ushiroyama Takahisa , Yoshikawa Motonobu , Saeki Michio , Okuda Kiyoji , Sugimoto Osamu
Published: November 2007

Plasma gonadotropins and estradiol levels were evaluated in 155 peri‐ and postmenopausal women. The average menopausal age was 52.5 years in 56 postmenopausal women. Plasma FSH and LH levels showed hypergonadotropinemia in many premenopausal women 45–49 years old, whose plasma estradiol levels, however, sometimes remained higher than 25 pg/ml. It was observed that 19 of 38 women (50%) had an estradiol level exceeding 25 pg/ml, of those 50–59 years old, whose gonadotropin level showed hypergonadotropinemia in 29 cases (76.3%). Ovarian vein levels of estradiol obtained during laparotomy of 21 patients were significantly higher than peripheral vein concentrations. In 3 of 5 climacteric women with irregular menstrual intervals and whose plasma gonadotropin level was within the postmenopausal range, some degree of estradiol secretion in the ovarian vein was detected. Estradiol was still present in the ovarian vein blood of some postmenopausal women. These data show that the basal gonadotropin level may become high several years before the menopause and that some ovarian function may be preserved after the menopause. Furthermore, it is possible that estrogen secretion may be disturbed by consistent hypersecretion of gonadotropins in the climacteric period.
Pre‐Eclampsia‐A Mitochondrial Disease?
Authors: Torbergsen Torberg , øian Påi , Mathiesen Ellisiv , Borud Olav
Published: November 2007

Mitochondrial dysfunction is a newly found group of inborn errors of metabolism in which there is a failure in the aerobic energy production. Disorders of mitochondrial metabolism exhibit a wide range of clinical symptoms which are related to the nature, severity and tissue distribution of the metabolic defect. Most reported cases are published in the neurological literature. In this report we describe for the first time a family with mitochondrial dysfunction with a high incidence of pre‐eclampsia/ eclampsia. The diagnosis of a mitochondrial disorder is verified by electronmicro‐scopic, electromyographic, histochemical and biochemical examinations. During pregnancy, the energy demand is increased due to both fetal and maternal requirements. A mitochondrial dysfunction, clinically symptomless in the non‐pregnant state, may therefore become manifest during pregnancy. Characteristic features of pre‐eclampsia such as disturbed ion transport, disturbed prostaglandin synthesis, vasoconstriction, platelet aggregation and hyperuricemia may be explained by mitochondrial dysfunction
The Prognosis In Early Endometrial Carcinoma
Authors: Rosenberg Per , Risberg Björn , Askrnalm Leif , Simonsen Ernst
Published: November 2007

278 patients with either stage l or ll endometrial carcinoma treated between January 1979 and January 1982 were reviewed, particularly as regards certain prognostic factors. Uterine papillary serous carcinoma (UPSC), FlGO grade 3, nuclear grade 3, and age were the major independent prognostic factors. UPSC was diagnosed in 8% of the patients. The cancer mortality in the non‐UPSC group was 7%. vs. 41% in the UPSC group. In the latter group all the deaths occurred within 2 1/2 years. Poorly differentiated non‐UPSC had the same cancer death rate as UPSC, but usually had a completely different histological pattern. There was no significant difference in survival between stage I and stage II when corrected for FlGO grade and nuclear grade.
Papilloma Virus Infection Of The Vulva
Authors: Bodén Elisabeth , Rylander Eva , Evander Magnus , Wadell Goran , von Schoultz Bo
Published: November 2007

Analyses of the possible presence of human papilloma virus (HPV) DNA were performed on 84 biopsies from 50 women with clinically and histopathologically suspected HPV infection of the vulva. The colposcopic criteria for inclusion in the study were: acetowhite flat lesions with or without fissures and/or diffuse hyperplastic mucosa with a granulated or filamental surface. Directed biopsies for histopathology and DNA hybridization (dot‐blot and Southern‐blot) were taken. All women had histopathological evidence of HPV infection. Twelve women had cervical and/or vulvar neoplasia. HPV DNA could be demonstrated in the vulvar biopsies from 24 women; 13 women had HPV 16, 3 had HPV 18, HPV 31 and HPV 33, respectively. In addition, 10 biopsies contained HPV DNA of unknown types. Fifty‐five percent of granulated and filamental lesions and 43% of flat lesions with or without fissures were positive for HPV DNA. 34 women had one or more of the following symptoms: itching, burning, dyspareunia, discharge, fissures, dryness and dysuria. Papillomavirus vulvitis is a sexually transmitted disease which may cause recalcitrant symptoms and/or concomitant neoplasia. It is thus important to recognize the different symptoms and signs of this disease.
Changes in Frequency and Indications for Cesarean Section in Norway 1967–1984
Authors: Borthen Ingrid , Lossius Petter , Skjaerven Rolv , Bergsjø Per
Published: November 2007

We have studied the cesarean section frequencies and changing spectrum of indications in Norway during six consecutive 3‐year periods from 1967 to 1984. The data set consists of 1,046,162 births notified to the Medical birth registry of Norway, of which 52,426 were specified as cesarean sections, the frequency rising from 1.9% in 1967–69 to 9.7% in 1982–84. A check for completeness of cesarean section notification was made against the birth protocols of the largest obstetrical unit in Norway. The error rate was about 3%. Information on the indication for performing cesarean section was missing in 11.4% of the cases. We grouped thirty‐one specified indications under seven headings. In 1967–69 the operation was most often performed for ‘maternal’ reasons, followed by ‘mechanical’, ‘abnormalities of fetal presentation’ and ‘acute placental’ conditions. Throughout the study period, ‘mechanical’ (which can also be labelled ‘dystocia’) accounted for about one third of the indications for cesarean section, while ‘maternal’ (including high maternal age and pre‐eclampsia) and ‘acute placental’ (placenta praevia and placental abruption) decreased in relative importance. ‘Fetal presentation’ (including twins) doubled its relative share, while increasing from 2.4 per 1000 births in 1967–69 to 24.8 per 1000 births in 1982–84. A steep rise in the group ‘fetal asphyxia’ corresponded to the period when the mess of electronic monitoring devices was introduced, in the early 1970s. ‘Fetal asphyxia’ had a higher relative share of the indications among para 0 mothers than in the total birth population.
Short Umbilical Cord as a Cause of Fetal Distress
Authors: Sørnes Torgrim
Published: November 2007

The purpose of this study was to examine if a short umbilical cord might give rise to fetal distress of such a severity that would necessitate operative delivery. Review of the literature gave little clarification. Out of a database consisting of 7212 births, 5885 were included in the study according to pre‐set criteria. The incidence of operative delivery was then compared with cord length. A significantly higher incidence of forceps deliveries and vacuum extractions was found when cord length was less then 40 cm. The incidence of cesarean section was also higher for the shorter cords. There was no increased need for neonatal resuscitation for the babies with the shortest cords.
Comparison of Smear Specimens with Biopsy Specimens in a Nucleic Acid Hybridization Test for Human Papilloma Virus (HPV) Infection
Authors: Auvinen Eeva , Hukkanen Veijo , Lehmijoki Jorma , Salmi Tuula , Arstila Pertti
Published: November 2007

A total of 323 pairs of specimens from women with Papanicolau class II or III cytology were examined for human papillomavirus (HPV) types 6, 11, 16 and 18 by spot hybridization. Each pair consisted of a representative biopsy specimen and a smear specimen from cervical, vaginal or, more rarely, vulvar lesions. We found a close correlation between HPV findings in biopsies and smears. In 83.9% (271) of the cases, both specimens were either positive for a given HPV type or negative. No discordant HPV‐types in the two types of specimens were found. In 15.8% (51) of the cases, one specimen proved positive for a given HPV‐type while the other specimen from the same patient was negative. In 8.0% (26) of the cases, the biopsy specimen proved positive and the corresponding smear specimen was negative. On the other hand, in 7.7% (25) of the cases we were able to detect HPV DNA in the smear specimen, whereas the corresponding biopsy specimen was negative. We suggest that a smear specimen would be advantageous for screening large groups of patients for the presence of a HPV infection in the genital tract. By using smear specimens together with biopsy specimens it is possible to maximize the number of HPV infection diagnoses.
Simultaneous Tubal and Intra‐Uterine Pregnancy Following in Vitro Fertilization and Embryo Transfer
Authors: Barash Amihai , Shoham (Schwartz) Zeev , Blickstein Isaac , Yamini Matan , Borenstein Richard
Published: November 2007

A case of simultaneous ectopic and intra‐uterine pregnancy following in vitro fertilization and embryo transfer (IVF‐ET) is described. On day 56 after ET the tubal pregnancy ruptured, with massive hemoperitoneum. Following salpingectomy, the intra‐uterine pregnancy continued to term when delivery was carried out by cesarean section owing to non‐progress of labor and suspected fetal distress. The pitfalls in diagnosing a simultaneous pregnancy of this kind following IVF‐ET are discussed.
First Trimester Diagnosis and Early in Utero Treatment of Obstructive Uropathy
Authors: Drugan Arie , Zador Ivan E. , Bhatia Rupinder K. , Sacks Alan J. , Evans Mark I.
Published: November 2007

The earliest diagnosis and treatment of obstructed fetal bladder is reported. Placement of vesico‐amniotic shunt at 14.5 weeks of gestation enabled preservation of bilateral renal function and maintenance of normal amniotic fluid volume with normal pulmonary development. The shunt functioned adequately for more than 12 weeks. At birth, a mild ‘prune’ belly was the only deformity noted.
Doppler Measurements on Branches of the Uterine Artery in Normal, Hypertensive and Growth‐Retarded Pregnancies
Authors: Janbu Torunn
Published: November 2007

The quality and reliability of pulsed Doppler recordings from branches of the uterine artery were tested by studying 37 normotensive pregnancies and 14 complicated by pregnancy‐induced hypertension (PIH) lasting for several minutes. The coefficients of variation of mean velocity and A/B ratio (= peak systolic/end diastolic velocity) were 0.06 and 0.08, respectively. Thus, calculations of A/B ratio from a limited number of heart beats should be reliable. Calculations were then made from uterine artery Doppler recordings in 65 normotensive pregnancies and 32 with PIH. A significantly higher A/B ratio was found in the PIH group. Among the normotensives, no statistically significant difference in A/B ratio was found between those who gave birth to appropriate‐for‐gestational‐age (AGA) and small‐for‐gestational‐age (SGA: <10th centile) infants. In the PIH group a significant difference was found; A/B: 1.95 versus 1.78 in the SGA and AGA groups, respectively. The latter was still significantly higher than the normotensive (= 1.60/. Two PIH subgroups with equivalent blood pressures and proteinuria, but who gave birth to AGA or SGA infants, were compared. A/B ratio from the latter was significantly higher. These findings show that PIH is associated with increased uteroplacental vascular resistance; increased vascular pathology is associated with fetal growth retardation.
Contractile Activity in the Human Uterine Cervix and Corpus During Cervical Dilatation by Laminaria Tent in First Trimester Legal Abortions
Authors: Jonasson A. , Larsson B.
Published: November 2007

Millar microtransducers were used in 7 patients to record contractile variations in the cervix and corpus during dilatation of the cervical canal by Laminaria tent preceding first‐trimester vacuum aspiration. The spontaneous contractile activity was registered in a control group of 5 patients without laminaria pretreatment. Two Millar catheters were used. The sensor tip of one Millar catheter was placed extra‐amniotically in the uterine cavity, and the other one in the mid‐cervical canal. Both sensor tips faced the wall of the cervix and corpus. The study showed that laminaria tents not only have a gentle dilatating effect on the cervix, but also induce painless uterine contractions, of amplitudes reaching 20 mmHg, and increased contractile activity in the cervix for the duration of dilatation.
Quality Assurance in a Large American Perinatal Center
Authors: Endler Gerhard C. , Sokol Robert J.
Published: November 2007

The obstetric service of Hutzel Hospital in Detroit, Michigan is responsible for approximately 7,300 deliveries annually. To monitor the quality and appropriateness of patient care, recognize and pursue opportunities for improving care, and resolve identified problems in the obstetric service as well as other clinical areas, the hospital developed a quality assurance (QA) program. The application of clinical indicators represents the principal method by which relevant QA information is obtained. These indicators are designed to identify problems in patient care. The obstetricigynecologic QA committee analyzes the results of this indicator‐based review process as well as other information (appropriateness of surgery, drug usage, transfusions, utilization of hospital resources, etc.) and reports its findings to the full staff of the Department on a monthly basis. If necessary, actions are taken to correct problems. They include lectures, individual counselling, development of guidelines, addition of personnel and/or equipment, and indicated disciplinary actions. These remedial measures have led to improvements in clinical care such as, for example, a more appropriate usage of antibiotics and oxytocin, and stricter adherence to guidelines. More important, however, are the intangible changes in practice patterns that have occurred in that physicians and other members of the health care team tend to render care with an added degree of diligence and circumspection because of their awareness that an effective monitoring process exists.
The Relation Between Life Stress and Hypertensive Complications During Pregnancy
Authors: Nisell H. , Larsson G. , Wager J.
Published: November 2007

The relationship between life stress and hypertensive complications during pregnancy was studied in 345 women. A questionaire was answered in the first trimester. The questions concerned education, employment, social network, traumatic experiences, housing conditions and stress of work. In this way a total life stress score for each woman was obtained. Hypertensive disorders, including chronic hypertension, were found in 63 women (18.3%). No significant difference was evident between women with low and high life stress scores with regard to hypertensive disorders during pregnancy. Nor did pressure changes during pregnancy differ between these groups.
Comparison Between Abnormal Cytology, Colposcopy and Histopathology During Pregnancy
Authors: Lundvall Lene
Published: November 2007

During a 3 year period, 35 pregnant woman with grade III or IV cytological changes found at pregnancy control were followed during pregnancy and up to 4 years after delivery. These 35 patients constitute 0.35% of all the pregnant women admitted for antepartum consultation. Complete regression of dysplasia was seen in one third of the patients. The patients were followed with colposcopy and sometimes punch biopsy and the decision regarding final treatment was postponed until 8 weeks after delivery. No invasive lesion was found, and no recurrences or invasive lesions were found at follow up. It is concluded that cytology and colposcopy with punch biopsy on suspicion of early invasion is an adequate control procedure during the pregnancy at intervals of 2–3 months.
Prenatal Ultrasound Diagnosis of Isolated Arthrogryposis of Feet
Authors: Degani Shimon , Shapiro Israel , Lewinsky Reuven , Sharf Mordechai
Published: November 2007

Prenatal diagnosis of isolated arthrogryposis of the feet at the ankle joint was made by ultrasound and confirmed at birth. The criteria for ruling out joint contracture are absence of fixed limb deformity, and free fetal motion.
Scleroderma and Pregnancy
Authors: Maymon Ron , Fejgin Moshe , Ben‐Aderet Noah , Bahary Charles
Published: November 2007

We describe a rare case of a pregnancy that occured in a patient with scleroderma, and ended in poor fetal outcome.
Do Primiparas and Multiparas Have Realistic Expectats of Labor
Authors: Fridh Gerd , Gaston‐Johansson Fannie
Published: November 2007

Expectations of labor and childbirth can affect the degree of in‐labor pain or discomfort experienced by the mother. By ascertaining whether expectations of labor experience are realistic or not, women can be prepared during the antenatal period to cope better with labor pain. The purposes of this prospective study were to 1) determine if pregnant women had realistic expectations of the labor experience, 2) determine if women who expected to have more pain during labor actually experienced more pain, than those not expecting to experience so much pain, and 3) determine if attending midwives assessed in‐labor pain as intense as the mothers did. Fifty primiparas, 88 multiparas, and 12 full‐time employed mid‐wives participated in the study. The Visual Analogue Scale (VAS) was used to rate the expected and actual in‐labor experience. A 3‐point rating scale was used by the midwives to rate in‐labor pain. Neither primiparas nor multiparas were found to have realistic expectations of the labor experience. Mothers experienced more pain and discomfort than expected, and the multiparas anticipated their need for medication to be greater than what was actually needed. The mothers reported that they felt less lonely and received more support from personnel during labor than they had expected. Multiparas who expected to experience more pain reported more pain than those expecting to experience less pain in stages I and III of labor. There was no significant correlation between midwives' and mothers' rating of the intensity of in‐labor pain during stage III of labor.