bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Potential of Cardiotocography (CTG) for Silent Uterine Rupture
Authors: Klein M. , Rosen A. , Beck A.
Published: November 2007

We report on 3 patients with silent rupture of previous uterine scars. Despite continuous monitoring by cardiotocography, diagnosis was not made until the time of surgery. The cesarean section was indicated by the obstetrical‐clinical examination, while CTG offered no evidence of uterine rupture.
Acute RH Isoimmunization Following Abdominal Trauma Associated with Late Abruption Placenta
Authors: Fisher Menachem
Published: November 2007

Acute exacebration of Rh isoimmunization following abdominal trauma is a rare complication of pregnancy. The report describes a case of a mild case of erythro‐blastosis fetalis following maternal exposure to massive fetal‐maternal transfusion, occuring after abdominal injury in motoring accident. Abruptio placenta 7 days following the trauma indicated emergency cesaren section, at which a severely affected fetus (erythroblastosis fetalis) was delivered. Late abruption—in the presence of no other risk factor—is considered to call for prolonged surveillance. Any abdominal trauma in a Rh‐negative woman should alert one to the possibility of massive transplacental hemorrhage and augmentation of the maternal immune response.
Endodermal Sinus Tumor Treated with High Dose Cisplatin
Authors: von Eyben Finn Edler , Siddiqui Mohammed Zaid , Thunold Svein
Published: November 2007

A woman with an endodermal sinus tumor of the ovary stage IV obtained a short but complete remission after treatment with vinblastine, bleomycin and standard dose cisplatin. A second complete remission for 42 + months was obtained with a regimen of vinblastine, bleomycin, etoposide, and high dose cisplatin. This result suggests a dose‐response relationship for cisplatin in ovarian germ cell tumors.
Placental Less and Maternal Hemoglobin Levels: A Comparative Investigation
Authors: Nordenvall Margareta , Sandstedt Bengt
Published: November 2007

A high maternal hemoglobin level during pregnancy has been correlated to a low birth weight and a low placental weight, but has not been investigated in relation to placental factors.

In 330 consecutive deliveries, placental lesions, birth weight and placental weight were studied in a multiple regression analysis in relation to maternal hemoglobin concentration, taking into consideration possible confounding factors such as smoking, hypertensive disorders, weight gain, pri mi parity, gestational age and sex. A high maternal hemoglobin concentration (>130 g/l) was correlated with a low birth weight, acute infarcts and syncytial knots. Intervillous thrombosis was more common in non ‐ smokers and multiparous women, increasing in incidence as gestational age advanced. Infarcts and microscopic perivillous fibrin were correlated with hypertension. Microscopic perivillous fibrin was slightly associated with a high hemoglobin level (>130g/l) in a bivariate analysis. These findings may indicate that a high maternal hemoglobin level impairs the uteroplacental circulation.
Doubling Time And hCG Score For The Early Diagnosis Of Ectopic Pregnancy In Asymptomatic Women
Authors: Tinga Dick J. , Van Lier Jan J. , Debruijn Henk W.A.
Published: November 2007

In a group of 20 asymptomatic women at increased risk for ectopic pregnancy, serum analyses were conducted prospectively early in pregnancy (amenorrhea ≤45 days) at 2‐4‐day intervals, to examine the rate of increase in hCG values. The initial serum hCG level, which was determined at the time of the first transvaginal ultrasound examination, was below the discriminatory zone of 1000 IU/I (2nd International Standard). In 8 out of the 9 women who were ultimately diagnosed as having an ectopic pregnancy, the increase in hCG progressed only slowly, with a doubling time exceeding 2. 2 days. This slow hCG increase occurred in 2 out of the 11 women who were ultimately diagnosed as having an intra‐uterine pregnancy; both women subsequently had an early spontaneous abortion. When Lindblom's hCG score was applied retrospectively to distinguish between intra‐uterine and ectopic pregnancies, the hCG increase in all the ectopic pregnancies was below 190 IU/I per day and in 10 of the 11 women with an intra‐uterine pregnancy above 190 IU/I per day. A slower rate of increase was observed in only one woman with an intra‐uterine pregnancy; she had a spontaneous abortion. The doubling time of hCG and the hCG score are useful diagnostic aids in cases where transvaginal ultrasound has not (yet) given a definite answer regarding the presence of an intra‐uterine pregnancy.
A Comparative Evaluation Of The Multiload 250 And Multiload 375 Intrauterine Devices
Authors: Løvset Tor
Published: November 2007

The experience of 1254 women who had Multiload 250s (MLCu250) and 754 women who had Multiload 375s (MLCu375) inserted by the author was evaluated. The performance of the two Multiload models was similar over 4 years of use, except for a significantly lower (p<0.05) pregnancy rate for the MLCu375 (4‐year cumulative life table rates: 3.0 vs. 5.4 per 100 women). Use of the MLCu250 and MLCu375 provided women with a very safe method of contraception. Many of the removals for medical reasons other than bleeding, pain or pelvic inflammatory disease (PID) appeared to be unrelated to IUD use. Thirty‐nine women had their IUDs removed for suspected PID, but the diagnosis of PID was confirmed in only 44% of these cases. The overall rate of confirmed cases of PID was 0.3 per 100 woman‐years. Except for a higher rate of PID during the first few months of Multiload use, the results of the study did not indicate that IUD use is associated with an increased risk of PID. Multiload use did not impair future pregnancy or affect the outcomes of these pregnancies.
Familial Protein S Deficiency Presenting As Deep Vein Thrombosis Occurring During Pregnancy
Authors: D'angelo Armando , Mari Gilberto , Valle Patrizia Delia , Marassi Alberto , D'angelo Silvana Vigano'
Published: November 2007

Subjects with congenital deficiency of protein S, a natural anticoagulant which serves as a co‐factor for the antithrombotic activity of activated protein C, are at risk of thrombosis. We describe a family in which deep vein thrombosis ‐occurring during pregnancy in three members with abnormally low protein S activity ‐ was the only manifestation of congenital heterozygous protein S deficiency. Early diagnosis and active treatment of protein S deficiency should be pursued in any woman with a family history of thrombosis, who is planning pregnancy.
Book Reviews
Authors: Bergsjø Per
Published: November 2007

Book reviewed in this article:

Phelan JP, Clark SL (Eds.). Cesarean Delivery. 570 pages, tables, figures. New York: Elsevier Science Publishing Co., Inc., 1988.

Kline J, Stein Z, Susser M. Conception to Birth: Epidemiology of Prenatal Development. Monographs in Epidemiology and Biostatistics, Volume 14. 433 pages, figures, tables. Oxford: Oxford University Press, 1989. Hardback, £42.50.

Lilford RJ.: Prenatal Diagnosis and Prognosis. 245 pp., tables, figures. London: Butterworths 1990. £39.50.

Hall MH (Ed).: Antenatal Care. Balliere's Clinical Obstetrics and Gynaecology. International Practice and Research. Voilume 4INumber 1. March 1990. 233 pp. London: Bailliere Tindall; 1990. Price: £22.50.
Familial Cancer Aggregation in Cases of Adenocarcinoma Corporis Uteri
Authors: Boltenberg Anette , Furgyik Stefan , Kullander Stig
Published: November 2007

In a detailed prospective interview study, all newly diagnosed cases of adenocarcinoma corporis uteri at Malmo during a 2‐year period (n = 51) were analysed with regard to the occurrence of tumors in first‐degree relatives. The families of the proband's male consorts were used as controls. Sisters and mothers of probands had tumors (particularly of the corpus uteri or breast) more often than had controls. Colon and prostate cancer also figured in family histories of proband relatives, more often and with earlier age at onset than in controls. Nine patients (18%) either had additional concomitant malignancies, or had had such malignancies previously. Familial cancer predisposition was associated with poorly differentiated anaplastic cancer of the corpus uteri with poor prognosis. Three cases of familial cancer (CFS) observed at Malmo are also described, in which the probands presented with adenocarcinoma corporis uteri. The findings suggest that a hereditary, cancerpredisposing factor (gene) is involved in a significant proportion of cancer corporis uteri, and that it is expressed in a heterogeneous tumor pattern, predominantly at sites sensitive to hormonal influences.
One‐Stage Ultrasound Screening in Pregnancy: An evaluation
Authors: Rasmussen Svein , Dalaker Knut , Berge Lillian Nordbø , Lundgren Randi , Løvslett Kjell
Published: November 2007

A one‐stage ultrasound screening program was evaluated, using a pregnancy/perinatal database containing information from 2766 pregnancies and deliveries. Among women who did not have a second‐trimester ultrasound examination, labor was induced for presumed post‐term pregnancy in 4.0% versus 1.6% of pregnancies in the screening group (p = 0.007). In the group with second‐trimester ultrasound scanning other than screening, the frequency was 3.2%. Of women with spontaneous labor or who were induced for presumed post‐term pregnancy, 3.8% in a screening group and 8.0% in a group with other second‐trimester ultrasound examination were post‐term according to BPD measurements (p = 0.0003).

In the screening group, 6.2% of liveborn singletons were small for gestational age(less than the 10th percentile) compared with 8.5% in the non‐screening group (p<0.05).

A subset of 365 screened women with optimal menstrual history had spontaneous labor or were induced for presumed post‐term pregnancy. According to menstrual history and ultrasound examination, 7.4% and 3.8% of these were post‐term, respectively (p = 0.04).

It is concluded that the main value of screening lies in a more accurate dating of pregnancy, even when menstrual history is optimal, with a lower incidence of induced labor for believed post‐term pregnancies. In addition, there may be an improvement in the obstetric management of pregnancy, reflected in our study as a lower incidence of small for gestational age infants.
Zinc and Birth Weight in Uncomplicated Pregnancies
Authors: Lao T. T. , Loong E. P. L. , Chin R. K. H. , Lam C. W. K. , Lam Y. M.
Published: November 2007

The relationship between zinc status and birth weight in uncomplicated pregnancies was studied in 59 nulliparous and 27 multiparous Chinese women with singleton pregnancies, delivered at term. Maternal and umbilical cord blood, maternal pubic hair and a segment of the umbilical cord were collected at delivery for analysis. The zinc concentration was significantly higher (p<< 0.0001) in the plasma of newborn infants (13. ± 2.8 μmol/l) than in maternal plasma (9.3 ± 2.2 nmol/l), while the converse was found in tissue (60.8 ± 17.0 vs 208.1 ± 96.2 µg/g, p<< 0.0001). There was no significant correlation between birth weight and either maternal or newborn plasma or tissue zinc concentrations. Parity had no significant effect on maternal or newborn zinc concentrations in tissue and plasma.
Blood Pressure, Metabolic Variables and Adipose Tissue Distribution in Pre‐And Post‐Menopausal Women
Authors: Armellini Fabio , Micciolo Rocco , Ferrari Paolo , Zamboni Mauro , Gottardi Luisa , Cavallo Eugenio , Bosello Ottavio
Published: November 2007

The study was performed on 289 female patients (aged 20‐60) of a family doctor in Castel D'Azzano, a small town near Verona. The following variables were considered: body mass index (BMI), tricepital, subscapular, hypomesogastric, epimesogastric, supra‐iliacal and epitrochanteric skinfolds, waist, umbilical and bitrochanteric circumferences, cholesterol, triglycerides, HDL‐cholesterol, glyce‐mia, uricemia and blood pressure. A significant worsening with age was observed in the mean values of the variables. This worsening was particularly evident in women over 50. The population was subdivided according to presence or absence of menopause; the two groups were then matched for age. None of the variables showed significant differences. Our results did not confirm any of the many effects that menopause is supposed to have regarding metabolic and blood pressure alterations.
Reduced Use of Diagnostic Obstetric Ultrasound in Norway: Result of Consensus Panel Recommending Routine Screening in Pregnancy?
Authors: Backe Bjørn , Nafstad Per , Saetnan Ann Rudinow
Published: November 2007

Purpose: To investigate the practice of obstetric ultrasound in Norway before and 2 years after a consensus conference recommending routine screening.

Material, method: Two national representative materials sampled with a 2‐year interval are compared.

Results: The average number of examinations was reduced from 2.46 to 2.23 (p<=0.014). Obstetrical institutions practising screening examined their patients less frequently than non‐screening institutions (2.10 vs. 2.75 times, p<p0.001), whereas in 1986 the converse was the case.

Conclusions: Screening has become more widespread, and a more rational practice has developed.
Cervical Pregnancy Successfully Treated with Chemotherapy
Authors: Bakri Younes N. , Badawi Anga
Published: November 2007

A case of cervical pregnancy in a 16‐year‐old woman is reported. Nonsurgical management with actinomycin‐D, methotrexate and cyclophosphamide chemotherapy resolved the pregnancy without significant morbidity. Subsequent pregnancy occurred with premature birth of viable normal infant.
Sonographic dating of pregnancies among women with menstrual irregularities
Authors: Waldenström Urban , Axelsson Ove , Nilsson Staffan
Published: November 2007

In order to study the benefit of sonographic dating, 277 women with irregular periods and 264 women with a scanty last bleeding had gestational age and estimated day of delivery (EDD) estimated from both last menstrual period (LMP) and measurement of fetal Biparietal Diameter (BPD) in the second trimester. For the women with irregular periods, the two estimates differed by more than 7 days for 51.6%, and more than 14 days for 25.6%. Corresponding figures for women with a scanty last bleeding were 44.3% and 21.6%, respectively. In general, the BPD estimates were better than the LMP estimates (P=<0.001) in predicting day of delivery, especially when the differences between the estimates exceeded 7 days. For women with irregular periods, post‐term pregnancies decreased, from 20.2% according to the LMP estimate to 2.5% according to the BPD estimate. Corresponding figures for women with a scanty last bleeding were 16.7% and 4.5%, respectively. According to the LMP estimate, 64.8% of the women with irregular periods and 69.3% of the women with a scanty last bleeding gave birth within ±14 days of EDD. Corresponding figures for the BPD estimate were 83.6% and 88.3%, respectively. The conclusion is that sonographic dating of pregnancies among women with irregular periods and women with a scanty last bleeding substantially improve the accuracy of term prediction.
Human papillomavirus types in cervical biopsy specimens from Pap‐smear‐negative women with external genital warts
Authors: Petersen Carsten Sand , Lindeberg Henning , Thomsen Henrik Klem
Published: November 2007

Cervical biopsy specimens were taken from 55 Pap‐smear‐negative women with external genital warts in order to diagnose a concomitant cervical human papillomavirus (HPV) infection. HPV‐DNA was demonstrated by in situ hybridization in 17 (31%) of the samples: HPV types 16/18in9, HPV types 6/11 in 5 and double infection (16/18 and 6/11) in 3. HPV‐DNA was found in 10 (43%) of 23 biopsy specimens with koilocytotic atypia and in 5 (29%) of 17 specimens showing chronic inflammatory reaction, whereas only 2 (13%) of 15 women with normal cervical histology had HPV‐DNA in the biopsy specimen. Overall histology and in situ hybridization indicated the presence of a cervical HPV infection in at least 30 (55%) of the 55 women examined. Colposcopic examination revealed abnormal acetowhite epithelium in 17 (74%) of 23 women with koilocytosis and/or HPV‐DNA positivity, compared with 7 (32%) of 22 HPV‐DNA‐negative women with histology showing either chronic inflamatory changes or normal epithelium (p < 0.01). It is concluded that a cervical focus of HPV infection is frequent among Pap‐smear‐negative women with external genital warts.
Six cases of massive feto‐maternal bleeding causing intra‐uterine fetal death
Authors: Marions Lena , Thomassen Peter
Published: November 2007

Six patients in whom intra‐uterine fetal death (IUFD) near term resulted from massive feto‐maternal hemorrhage are reported. Two of the mothers were Rh‐negative, which necessitated the administration of large volumes of anti‐D. In order to detect such patients, the Kleihauer‐Betke test should be performed in all cases of IUFD of unknown etiology.
The scientific basis of antenatal care: Report from a state‐of‐the‐art conference*
Authors: Lindmark Gunilla , Cnattingius Sven
Published: November 2007

The routine program for antenatal care consists of a number of scheduled visits aiming at detection of symptomless complications such as hypertension and deviation in fetal growth, as well as giving psychosocial support and health education. In a Swedish state‐of‐the‐art conference in May 1990, the scientific basis of this routine program was critically evaluated. It was clearly demonstrated that the scientific evidence to support present timing and contents of routine visits is unsatisfactory, and that there is a great need for evaluation both of single diagnostic procedures and intervention and of programs of antenatal care. Evaluations of antenatal care should consider not only pregnancy outcome but also patient satisfaction and cost‐benefit analysis. Long‐term follow‐up studies are urgently needed, not only of the effects of complications but also of antenatal diagnosis and interventions.
Surveillance of smoking during pregnancy in Sweden, 1983‐1987
Authors: Ericson Anders , Gunnarskog Jan , Källén Bengt , Otterblad‐Olausson Petra
Published: November 2007

Since 1982, prospective information on smoking during early pregnancy is reported to the Swedish Medical Birth Registry for nearly all (93%) women who give birth. The present paper studies the validity of this information: effects on birthweight and perinatal mortality are very similar to those described previously in the literature. For each parity class, smoking decreases in inverse proportion to increasing maternal age; for each maternal age class, smoking increases with parity. A slight reduction in smoking rate is observed between 1983 and 1987, most pronounced for young women. There are marked geographic and social differences in the rate of smoking during pregnancy. This dataset can be used in the future to monitor the prevalence of smoking, and to study various factors associated with smoking and the impact of countermeasures taken against smoking during pregnancy. It can also be used to study possible associations between maternal smoking and rare events like congenital malformations and child cancer.
Excretion of phenoxymethylpenicillin in the vaginal fluid of hysterectomized women
Authors: Sjöberg Inga , Hakansson Stellan
Published: November 2007

The excretion of phenoxymethylpenicillin in vaginal fluid was determined in 19 hysterectomized women, 8 totally and 11 subtotally operated. Phenoxymethylpenicillin was found in the vaginal fluid in high concentrations in both groups of women and it was concluded that the substance penetrates the vaginal wall. Concentrations were significantly higher in the most distal part of the vagina. The possible mechanisms for this phenomenon are discussed.
Patterns of research: Oral contraceptives and cervical cancer
Authors: Sillero‐Arenas M. , Rodriguez‐Contreras R. , Delgado‐Rodriguez M. , Bueno‐Cavanillas A. , Galvez‐Vargas R.
Published: November 2007

Original papers on the oral contraceptive use‐cervical cancer relationship are analysed. The purpose of this study was to ascertain the biases of the original articles collected in relation to various characteristics of any investigation. Papers were located by using MEDLINE, reviewing the references of each article identified by MEDLINE, and then reviewing the contents of those journals in which an original could be published. Fifty‐five publications (from 49 original studies) were graded as to quality and classified as biased or unbiased. Nineteen studies were considered unbiased. The most common biases identified were confounding, detection bias, and misclassification bias. The pattern of research/publication has changed since the association began to be analysed: articles shift from gynecological to cancer and epidemiological journals; the number of studies performed by gynecologists alone and pathologists alone decreases, while studies performed by epidemiologists alone or in collaboration with gynecologists increase. This collaboration produced studies with fewer biases. It is suggested that the abovementioned collaboration should be increased to improve access to, and then the application of the results obtained in the original studies on oral contraceptives and cervical cancer.
Angiosarcoma of the vagina: A light and electronmicroscopy study
Authors: Tohya Toshimitsu , Katabuchi Hldetaka , Fukuma Keizo , Fujisaki Shunichi , Okamura Hltoshi
Published: November 2007

A 73‐year‐old woman, whose medical history reported radical hysterectomy and radiotherapy for squamous cell carcinoma of the cervix uteri 20 years earlier, was found to have an angiosarcoma of the vagina. The histological diagnosis was confirmed by immunohistochemical staining of tumor cells for factor VIH‐related antigen and ultrastructurally defined vasoformative structures. Primary angiosarcoma of the vagina is quite rare and reported in only two published cases. The present case is a third in general, and the first report confirmed by light microscopy, immunohistochemical, and electronmicroscopy studies.
Hemodynamic measurements with Swan‐Ganz catheter in women with severe proteinuric gestational hypertension (pre‐eclampsia)
Authors: Hjertberg Ragnhild , Belfrage Patrick , Hägnevik Kerstin
Published: November 2007

Ten women with severe pre‐eclampsia, i.e. a blood pressure ≥ 150/110 mmHg or 140/90 mmHg and proteinuria > 3 g/24 h were, after initial antihypertensive treatment, centrally monitored with a pulmonary artery catheter (Swan‐Ganz). All had been normotensive in early pregnancy. Mean age was 29 years (range 23–37). Mean gestational age upon admission was 29 weeks (range 23–36) and 7 of the women were nulliparous. Nine of the 10 patients had subjective symptoms, e.g headache and/or epigastric pain. All were considered in need of intensive care. Two patients were found to have an abnormal coagulation and liver function. All patients had normal serum creatinine values despite proteinuria. Hypertension was treated with dihydralazine and/or labetalol. Volume substitution was carried out with plasma and albumin. The women could be divided into two groups: 5 patients where progress of the disease despite therapy led to delivery within 24 h, and 5 patients whose diastolic blood pressure could be stabilized around 100 mmHg after treatment and pregnancy could be prolonged by 5‐13 days. Common for all patients was a hyperkinetic circulation with an increased cardiac output despite a variety of central pressures. Invasive monitoring of central pressures with a Swan‐Ganz catheter demonstrated that the clinical status could be stabilized and the pregnancy prolonged in 5 of the 10 women with severe pre‐eclampsia. The variety of the central hemodynamic values illustrates clearly that treatment has to be individualized regarding antihypertensive medication, fluids and diuretics. This can be done by means of the Swan‐Ganz catheter in order to optimize treatment and clinical status before delivery in these severely ill patients.
Urodynamic assessment and lateral urethrocystography: A comparison of two diagnostic procedures for female urinary incontinence
Authors: Grischke Eva‐Maria , Anton Hans , Stolz Wolfgang , von Fournier Dietrich , Bastert Gunther
Published: November 2007

We compared urodynamic findings and results of lateral urethrocystography in 84 case. The aim of the study was to establish a possible correlation between anatomic findings and functional results. Clinically, a significantly greater increase in the normal axis of urethral inclination was noted in patients with a urodynamic diagnosis of stress incontinence than in patients with urge incontinence or for normal urodynamic findings. Lateral urethrocystography vis‐à‐vis urodynamic assessment proved to be a method having high sensitivity (91%) but low specificity. These two methods supply different but complementary data. Together with the patients' medical history, the assessment of their complaints, clinical vaginal examination. and clinical stress test, they offer valuable information for an efficient therapeutic concept.
Metastasis in skeletal muscle secondary to squamous‐cell carcinoma of the uterine cervix
Authors: Thomsen Carl Frederik T. , Skovdal Jan , Schultz Henrik
Published: November 2007

Skeletal muscle metastases are rare, but occur most often with lymphomas, as well as being occasionally described secondary to breast, lung, prostatic, colonic, pancreatic and renal cell carcinomas ‐ but not uterine cancers. A case of skeletal muscle metastasis is presented, originating from a primary squamous‐cell carcinoma of the uterine cervix.
Acta fifty years ago Fistulas, pelvic hyperalgesia, uterine rupture and giant babies
Authors: Bergsjø Per
Published: November 2007

Volume XXI of Acta Obstetricia et Gynecologica Scandinavica was printed in Mercators Tryckeri in Helsinki, the three first fasciculi in the year 1941, and the fourth in 1942. The two first articles in Fasc. I were transactions of the congress of the Scandinavian Society for Obstetrics and Gynecology in Oslo, June 20‐July 1, 1939
Metabolism of prostaglandin E2 on the fetal and maternal sides of intact fetal membranes
Authors: Sullivan M. H. F. , Roseblade C. K. , Elder M. G.
Published: November 2007

The metabolism of prostaglandin E2 (PGE2) added to the chorio‐decidual side or the amnion side of the intact fetal membrane was compared. Similar rates of metabolism were found when the PGE2 was added to the fetal side or the maternal side of the membrane, even though the amnion (on the fetal side of the membrane) contains no metabolizing enzymes. The appearance of PGE2 metabolites on the opposing side of the membrane was also independent of whether the PGE2 was added to the fetal or maternal side, which suggests that the chorion, which lies between the amnion and the decidua, is the major determinant of the rate of metabolism of PGE2. Furthermore, it might be expected that less PGE2 metabolism subsequent to diffusion across the membrane may occur on the amnion side, since this tissue contains no metabolizing enzymes, but no evidence for this was found. PGE2 synthesized by the amnion would therefore have little effect on PGE2 levels on the maternal side of the fetal membrane, and may not be directly involved in labour.
The effect of magnesium on maternal blood pressure in pregnancy‐induced hypertension A randomized double‐blind placebo‐controlled trial
Authors: Rudnicki Martin , Frölich Anne , Fischeh Wiggo , Rasmussen  , McNair Peter
Published: November 2007

The effects of magnesium were compared with those of placebo in a randomized double‐blind controlled study of 58 patients with pregnancy‐induced hypertension, of whom 27 received magnesium and 31 placebo. Twenty patients in each group were nulliparas. The treatment comprised 48 h of either intravenous magnesium or placebo infusion followed by daily oral magnesium or placebo tablets until one day after delivery. Magnesium supplementation significantly reduced maternal mean arterial blood pressure (MAP). The gestational age at delivery was the same in both groups, whereas the relative fetal birth weight among nulliparas was reduced in the placebo group. Unbalanced analyses of variance suggested an influence of magnesium supplement on birth weight. The infants in the magnesium supplemented group spent fewer days in the neonatal intensive care unit. There were no perinatal deaths. Magnesium appeared to be beneficial in the management of pregnancy‐induced hypertension. The better outcome associated with magnesium supplementation may not have been due to reduction of MAP and further studies are needed to clarify whether magnesium influences birth weight.
Phase III clinical trial with a new oral contraceptive containing 150 μg desogestrel and 20 μg ethinylestradiol
Authors: Lammers Paul , ten Berg Monique op
Published: November 2007

Results are presented of a Phase III international multicentre trial to study the effect of a new low‐dose oral contraceptive (OC) containing 20 μg ethinylestradiol and 150 μg desogestrel (Mercilon®) regarding efficacy, cycle control, blood pressure, and acceptability. Altogether 1,684 women from 12 European countries were included in the study. Four pregnancies occurred, 3 of them patient failures, one tablet failure. The overall Pearl Index was 0.20. The frequency of irregular bleeding was comparable to that recorded with other commonly used low‐dose OCs. No serious side effects occurred. The incidence of the most frequently reported subjective side effects ‐ headache, nausea and breast tension ‐ was already low after the first cycle of treatment and decreased to below pretreatment levels with continued use. There was a small increase in mean body weight, which was confined essentially to young women. The preparation did not affect the mean systolic or diastolic blood pressure.

This new preparation has thus proved to be an effective, safe and well‐accepted ultra low‐dose oral contraceptive.
Laparoscopic surgery in ectopic pregnancy: A randomized trial versus laparotomy
Authors: Lundorff Per , Thorburn Jane , Hahlin Mats , Källfelt Bjorn , Lindblom Bo
Published: November 2007

A randomized, prospective clinical trial was conducted to compare the efficacy of laparoscopic treatment with conventional conservative abdominal surgery for tubal pregnancy. Entry criteria were: size of the ectopic gestation < 4 cm, hemodynamic stability, accessibility for laparoscopic treatment and a trained laparoscopist on duty. There was no difference between the groups regarding gestational duration, size and location of the ectopic gestation, or the mean preoperative hCG values. The groups differed with respect to total operation time (73 min for the laparoscopy group vs. 88 min for the laparotomy group), hospital stay (2.2 vs. 5.4 days) and convalescence period (11 vs. 24 days). The rates of elimination of hCG was similar in the groups, and there were no statistical difference in the rate of second intervention.
No Benefit From Conservative Management in Nulliparous Women with Premature Rupture of the Membranes (PROM) at Term: A Randomized Study
Authors: Rydhström Håkan , Ingemarsson Ingemar
Published: November 2007

Objective. To compare maternal and fetal outcome in pregnancies with premature rupture of the membranes (PROM) at term with either early induction of labor or conservative management awaiting spontaneous labor.

Design. A prospective randomized trial.

Setting. The University Hospital of Lund, Sweden.

Subjects. Altogether 369 women with singleton pregnancy, cephalic presentation, gestational duration 36–41 weeks, were randomized either to induction of labor (n = 139) or conservative management up to 3 days (n = 138). Those eligible but not participating in the study totalled 92.

Main obstetric measures. Obstetric intervention rate (cesarean section or instrumental delivery) and short‐term neonatal morbidity.

Results. No difference was found in the rate of obstetric intervention between the induction of labor group and the group with conservative management (12.2 vs. 18.8%; X2 = 2.3, p > 0.05). A slightly increased rate of neonatal infections was seen in the latter group (0.7 vs. 4.3%; X2 = 3.2, p < 0.05).

Conclusions. We found no benefit from conservative management for up to 3 days in women with PROM at term, compared with immediate induction of labor. There was no difference in the number of obstetric interventions during labor. The neonatal infectious morbidity was slightly higher in conservatively managed cases.
Nordic in Vitro Fertilization Embryo Transfer (IVF/ET) Treatment Outcomes 1982–1989
Authors: Nygren Karl‐Gösta , Bergh Torbjörn , Nylund Lars , Wramsby Hakan
Published: November 2007

In the four Nordic countries, Denmark, Finland, Norway and Sweden, data were compiled from altogether 30 in vitro fetilization (IVF) clinics regarding their treatment outcomes. Two small, recently established IVF clinics in Finland did not respond to the postal inquiry used for data collection. For each clinic, data were collected from the time they commenced activities until June 1989. Preliminary data for the latter half of 1989 was also gathered. The first IVF‐baby in this data set was born in Gothenburg in 1982. Seven years later, in December 1989, altogether 35 clinics in the four countries were in operation and 1,290 children had been born. The largest number of clinics, 12, was to be found in Sweden but the number of treatment cycles in relation to the population was highest in Norway with about 340 treatments per million inhabitants annually during 1988–89, with Sweden in second place: 190 treatments per million inhabitants. The ratio of private to public clinics was highest in Finland, where four out of ten clinics were privately run. A mean clinical pregnancy rate per embryo transfer of 20% was recorded and 85% were singleton pregnancies. Spontaneous abortions occurred in 25% and the ectopic pregnancy rate was 7% of all clinical pregnancies. The ‘take home baby rate’ for 1988–89 was 13% per embryo transfer. There were no major differences between the four countries.
Transvaginal Ultrasound for Identifying Endometrial Abnormality
Authors: Smith Peter , Bakos Oddvar , Heimer Gun , Ulmsten Ulf
Published: November 2007

Transvaginal ultrasound was used preoperatively to evaluate the endometrium in 96 patients referred for dilatation and curettage. The sonographic display was correlated to the histopathologic diagnosis. In 45 patients with postmenopausal bleeding, 4 patients had adenocarcinoma of the endometrium. All were identified by ultrasound. None of the 22 patients with a normal sonographic appearance had an abnormal histopathologic diagnosis. An endometrial thickness (single layer) cut‐off point of ≥ 4 mm precluded any missed malignancies but halves the number of dilatations and curettages in this post‐meno‐pausal group. The sensitivity of ultrasound in diagnosing endometrial pathology was 100% and the specificity was 61%. The positive and negative predictive values were 39% and 100% respectively. In 51 premenopausal women there was good agreement between histology and ultrasound. In this group a cut‐off point of ≥ 8 mm was used. The sensitivity in diagnosing endometrial pathology was 67% and the specificity 75%. The positive and negative predictive values were 14% and 97%. With further experience, transvaginal ultrasound might be used in clinical routine for diagnosing endometrial pathology.
Laparoscopic Adnexectomy
Authors: Langebrekke Anton , Urnes Arne
Published: November 2007

We are now performing laparoscopic adnexectomy in selected cases of benign pathology of the adnexa. This report is presented to show that even fairly large tumors may be removed by this technique. It involves 30 cases of tumors having a diameter more than 4 cm that were operated on over a period of 12 months. Cystectomies and cystotomies were not included in this study. Patients were excluded if there was any suspicion of malignancy. Indications for laparoscopy were functional and organic cysts, tubo‐ovarian abscesses, and adnex torsions due to large hydrosalpinx. No complications have been encountered during the laparoscopic operation or during the follow‐up period of 6–18 months.
Normal Pregnancy After Curative Multiagent Chemotherapy for Choriocarcinoma with Brain Metastases
Authors: Bakri Younes N. , Pedersen Poul , Nassar Mahassen
Published: November 2007

A case is reported of a metastatic gestational choriocarcinoma in a 25‐year old woman. Extensive pelvic, pulmonary and brain metastases were associated with clinically manifest thyrotoxicosis. Multiagent chemotherapy alone was successful in achieving a durable remission and euthyroid state. The chemotherapy regimen consisted of a's‐platinum, etoposide, actinomycin‐D. and intrathecal methotrexate (PEA‐M). The Patient conceived 2 years after completing therapy and gave birth at term to a normal infant.
Fetal heart rate response to acoustic stimulation in relation to fetal development and hearing impairment
Authors: Johansson Bertil , Wedenberg Erik , Westin Björn
Published: November 2007

In twelve healthy pregnant women the fetal heart rate response to sound stimulation was tested every second week between the 22nd and the 34th week of the pregnancy. Habituation to the acoustic stimuli used was also investigated at the last examination. A high risk material for hearing impairment comprised 31 pregnant women.

The stimuli were presented by a vibrator placed on the maternal abdomen over the fetal head. As stimuli pure tones were used in the form of pulses of one second at a frequency of 3000 Hz and with an onset and a decay time chosen not to cause audible clicks to a normal ear. The intensity of the tone pulse was set at a level calculated to correspond at the position of the fetal head to 110 dB sound pressure level in free field.

Roughly 50% of the fetuses tested started to react with an increased heart rate in the 24th week of the development. Four weeks later all tested subjects responded to the test stimuli.

Habituation of the motor ‘startle’ response was shown but the fetus heart rate change was consistent over 20 consecutive stimulations one min in between each.

In 31 high risk subjects the responses from three fetuses must be considered as pathologic. These three children exhibited impaired auditory tests after birth and severe hearing impairment at the age of three years. All the others disclosed normal hearing at birth as well as at three years of age. Repeated significant increases in fetal heart rate following acoustic stimulation may appear as an indication of normal function of the hearing organ. Several consecutive acoustic stimulations without any fetal responses in heartbeat rate is an indication of a possible hearing impairment.
Uterine remodelling following conservative myomectomy: Ultrasonographic evaluation
Authors: Beyth Yoram , Jaffe Richard , Goldberqer Shmuel
Published: November 2007

Uterine leiomyomata develop during the reproductive years and may interfere with fertility through mechanisms as yet not fully understood. A developing intramural or large submucosal leiomyoma causes hypertrophy of the myometrium. Conservative myomectomy, as opposed to hysterectomy, is the preferred surgical procedure for patients who wish to preserve their fertility. Ten patients were ultrasonographically evaluated at monthly intervals foltowing myomectomy and the changes in uterine (myo‐metrial) volume were assessed. There was a gradual decrease in uterine volume in all patients during the six months following removal of intramural and submucosal leiomyomata. The most remarkable decrease in size occurred during the initial two to three months for the majority of the patients. The impact of this process on fertility should be further evaluated. One of the intriguing questions is whether the period of uterine shrinkage represents the time of the healing process during which conception should be prevented.
Uterus didelphys with unilateral obstructed hemivagina and renal agenesis on the same side
Authors: Erdoǧan Eftale , Okan Gülin , Daragenli ömer
Published: November 2007

A rare condition, complete or incomplete duplication of uterus and cervix with unilateral vaginal obstruction, is usually associated with ipsilateral renal agenesis. In such kinds of Müllerian and Wolffian duct anomalies as the one reported here with accumulation of menstrual blood in the obstructed vagina, the patient usually complains of a pelvic mass and associated severe and increasing dysmenorrhea. A case, diagnosed and treated at our Department, is presented.
A registry study of very low birthweight liveborn infants in Sweden, 1973–1988
Authors: Ericson Anders , Gunnarskog Jan , Kallen Bengt , Olausson Petra Otterblad
Published: November 2007

Very low birthweight liveborn infants (<1,500 g, VLBW) born in Sweden 1973–88 were identified from the Medical Birth Registry and efforts were made to remove wrongly recorded birthweights −9% of infants with a registered birth weight below 1,500 g were removed. Some VLBW infants were not recorded in the register and the estimate of the prevalence at birth of VLBW infants is therefore slightly underestimated. It increased from about 5.5 per 1,000 during the period 1973–84 to 6.7 per 1,000 during 1987–88. 18% of VLBW infants were involved in multiple births. Median Apgar score at 5 min increased for each 100 g birthweight class. Even at a birthweight between 1,400 and 1,499 g. a low Apgar score at 5 min was seen in 20%. The rate of cesarean section increased between 1973 and 1983 from about 10% to 60%. One‐year survival for infants with a birthweight <1,000g increased from less than 20% in 1973–75 to 50% in the 1986–88 cohorts. Corresponding figures for infants with a birthweight between 1,000 and 1,499 g were 60% and 90%. A markedly better one‐year survival is already evident in the 600–699 g class. On stratifying for 100 g birthweight class, perinatal death risk was higher in hoys than in girls and higher in multiple births than in singletons. An increased rate of congenital malformations was seen in the 1,000–1,499 g class but not in the <1,000 g class.
Sexual function and somatopsychic reactions after local excision of vulvar intra‐epithelial neoplasia
Authors: Thuesen Benedikte , Andreasson Benny , Bock Johannes E.
Published: November 2007

Eighteen patients, under the age of 60 years, who have been treated with local excision of the vulva, participated in the study in which sexual function and somatopsychic reactions were evaluated by personal interviews. Furthermore both objective and subjective cosmetic results were registered. After this type of operation, fewer than one‐third of the patients had postoperative sexual and somatopsychic problems, whereas more than half of the patients undergoing vulvectomy did report such problems. Fourteen out of 18 patients were satisfied with the cosmetic result and in 12 of the patients no disfiguration was found. This study shows that local excision of intra‐epithelial neoplasia of the vulva is far less sexually traumatic than is vulvectomy.
Pregnancy complicating irradiation‐induced constrictive pericarditis
Authors: Bakri Younes N. , Martan Ahmed , Amri Aladin , Amri M.
Published: November 2007

A case is reported of a 24‐year‐old primigravida who had severe effusive constrictive pericarditis secondary to mediastinal irradiation following chemotherapy for Hodgkin's disease. Pregnancy was threatened by serious maternal cardiovascular complications, and a non‐viable fetus was born spontaneously and prematurely. Patient was completely asymptomatic before pregnancy.
Steroid hormones and gonadotropins in a case of ovarian endometriosis associated with virilization
Authors: Mango D. , Manna P. , Liberati M. , Benedetto M. T. , Ricci S. , Olleja L. , de Nardone Cicco F. , Menini E.
Published: November 2007

The clinical course, the hormone secretion, the testosterone receptors and the enzymatic activities related to androgen metabolism in a 56‐year‐old postmenopausal woman with a history of virilization and ovarian endometrioma are reported. Unexpectedly, at the time of examination, no evidence of biochemical hyperandrogenism was obtained. The uncommon association of virilization and ovarian endometrioma simulating a functioning tumor of the ovary is discussed.
Combined anomalies of the Mullerian and Wolffian systems
Authors: Rabinerson David , Neri Alexander , Yardena Ovadia
Published: November 2007

Combined congenital anomalies of the Mullerian and Wolffian duct systems are a rare phenomenon. We report a case of bicornuate uterus and infected right Gartner duct cyst, associated with agenesis of the left kidney and a left ovarian cyst. The case is discussed in view of its unknown occurrence.
‘Hit and run’ oncogenesis by human papillomavirus type 18 DNA
Authors: Iwasaka T. , Hayashi Y. , Yokoyama M. , Hara K. , Matsuo N. , Sugimori H.
Published: November 2007

Transfection of an immortalized cell line (AE), derived from Syrian hamster embryo cells, with human papillomavirus type 18 (HPV 18) DNA induced morphological transformation and these transformed cells were tumorigenic in nude mice. Southern blot analysis revealed that the transfected viral DNA was retained in all the cell lines tested, however, all these transformed cells contained only less than one copy per cell of viral genome. Eleven cloned cell lines were established from a tumor cell line obtained after explantation of a tumor into a nude mouse. Two lines revealed no viral sequences by both Southern blot hybridization and polymerase chain reaction, whereas the nine others contained the remaining viral sequences. These results are highly suggestive of a ‘hit and run’ oncogenesis by this virus.
Laparoscopic hysterectomy: Initial experience
Authors: Langebrekke Anton , Skår Oskar Johan , Urnes Arne
Published: November 2007

Laparoscopic hysterectomy is now being performed in our department in cases where no malignancy is suspected. This study presents the first 10 cases. Indications for hysterectomy were myomas, meno‐ and metrorrhagia resistant to medical and hysteroscopic treatment, and patients with pain and suspicion of having adenomyosis. No complications have been encountered during the laparoscopic operations, but one patient had a second laparoscopy on the first postoperative day due to postoperative bleeding. Another patient had a postoperative infection leading to a compression of the ureter. This report demonstrates that laparoscopic hysterectomy is a valuable addition to the new procedures in ‘minimal invasive surgery’, but only after long and appropriate training.
Uterine torsion in pregnancy
Authors: Jensen John Grønkjær
Published: November 2007

Torsion of the pregnant uterus is defined as rotation more than 45° around the long axis of the uterus. Uterine torsion is observed in all age groups of the reproductive period, in all parity groups, and at all stages of pregnancy. Torsion from 60° to 720° has been described. It is not possible to clarify why uterine torsion occurs, but numerous abnormalities have appeared with uterine torsion; most often, abnormal fetal presentation, myoma uteri and uterine malformations. The most usual symptoms of uterine torsion are birth obstruction, abdominal pain, vaginal bleeding, shock, and urinary and intestinal symptoms. Elcvcn percent arc asymptomatic. The treatment in the earlier months of pregnancy is immediate laparotomy and detorsion of the uterus and, if practicable, adjunct surgery to climinatc the possible etiologic factors. Near term or during labor ccsarcan section is carried out, and elimination of the possible etiologic factors.

The fetal and maternal mortality rates since 1976 arc 12% and 0% respectively.
Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion
Authors: Petersen Kresten Rubeck , Larsen Gunvor Kramshøj , Nørring Keld , Jensen Flemming Roald
Published: November 2007

We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic diagnosis of advanced ectopic gcstation may be difficult, the possibility of ectopic pregnancy should be considered in cases of unsuccessful attempts of induced abortion.