bluuebunny/crossref_metadata_2025 huggingface dataset:
Elective cervical cerclage for prevention of preterm birth: a systematic review
Authors: Bachmann Lucas M. , Coomarasamy Aravinthan , Honest Honest , Khan Khalid S.
Published: December 2004

Background.  Elective cervical cerclage has been purported to prevent spontaneous preterm birth. We present a systematic review to determine the effectiveness of cervical cerclage in preventing spontaneous preterm birth before 34 weeks' gestation.

Methods.  Searches were conducted in MEDLINE, EMBASE, Cochrane Library, and Science Citation Index to identify randomized trials published between 1966 and 2002. All randomized trials that evaluated the effectiveness of elective cerclage compared with no cerclage in women who were at risk of preterm birth before 34 weeks' gestation were included for analysis. Quality assessment and data extraction were performed in duplicate.

Results.  There were seven relevant trials, comprising 2354 women. Meta‐analysis was inappropriate because of large differences in the quality of the studies. However, in the largest single trial of good quality, cerclage was shown to prevent birth before 34 weeks' gestation. In this single study the reported number to be treated to prevent one additional preterm birth before 34 weeks was 24 women (95% CI: 10–61). The results of other trials were consistent with the finding of the largest trial. Data on complications were sparse and inconclusive.

Conclusion.  Our systematic review shows that elective cervical cerclage has a significant effect in preventing spontaneous preterm birth before 34 weeks' gestation. Further research should focus on identification and quantification of possible complications, and of risk factors and tests that identify high‐risk women who would benefit most from cerclage.
Eligibility and willingness of young Icelandic women to participate in a HPV vaccination trial
Authors: Gudmundsdóttir Thorbjörg , Tryggvadóttir Laufey , Allende Maria , Mast Thomas Christopher , Briem Haraldur , Sigurdsson Kristián
Published: December 2004

Background and aims. Cervical cancer is an important health problem worldwide, and the incidence of preinvasive cervical cancer is increasing among young sexually active women. The causal association between human papilloma virus (HPV) and cervical cancer makes it theoretically possible to eradicate the disease through vaccination. The aim of this study was to analyze the eligibility and willingness of 18–23‐year‐old Icelandic women to participate in a vaccination trial to prevent HPV infection and to assess knowledge of HPV.

Material and methods. A questionnaire was formulated with questions on demographics, HPV knowledge, sexual behavior, attitude towards HPV vaccination, and other health‐related issues. The questionnaire was tested on a subgroup of women before being mailed to 300 women aged 18–23 years, randomly selected by date of birth from the total population living in the Capital area of Reykjavík.

Results. The response rate of the mailed questionnaire was 54%. Of respondents, 96% reported having had sexual debut and 39% were aged 15 years or younger at first intercourse. Knowledge of HPV infections and associated diseases was limited, indicating the need for an educational campaign. Although 60% of the respondents were willing to participate in a HPV vaccination trial, the eligibility rate for the invited women was estimated to be approximately 13% (95% CI: 9–17%) after accounting for various exclusion criteria such as number of sexual partners, abnormal Pap smears, planning a pregnancy, or travelling abroad for more than 6 months.

Conclusions. Icelandic women between 18 and 23 years of age have a sexual behavior profile and lifestyle that may decrease their eligibility in future prophylactic HPV vaccine trials. Improved education about HPV infection and its consequences is needed. Future trials may need to include younger women to improve recruitment.
Maternal prepregnancy body mass index and psychomotor development in children
Authors: Neggers Yasmin H. , Goldenberg Robert L. , Ramey Sharon L. , Cliver Suzane P.
Published: December 2004

Background. In a prospective study, the association between maternal nutritional status and psychomotor development of low‐income African–American children was evaluated. We hypothesized that low maternal body mass index (BMI) would predict worse neurodevelopmental status in children, while higher maternal BMIs would be associated with better neurodevelopmental outcomes.

Methods. Psychomotor tests for general intelligence and motor skills were given to 355 children at a mean age of 5.3 years. Maternal nutritional status was assessed by prepregnancy body mass index (BMI) and weight gain during pregnancy.

Results. Fifty‐four percent of the women in this study were overweight or obese. The means of the general IQ, nonverbal and verbal ability, and Gross Motor Scales of the children were 82.1 ± 12.6, 87.4 ± 15.7, 80.1 ± 10.8 and 332.3 ± 13.2, respectively. Seventeen percent of the children had general IQ scores of less than 70. To our surprise, in multiple regression analyses, adjusting for other covariates, maternal prepregnancy BMI was a significant negative predictor of IQ (β = − 0.25, P = 0.001) and nonverbal ability (β = − 0.29, P = 0.02). The IQ and nonverbal scores of children of women who were obese before pregnancy were approximately 5 units lower than for children whose mothers had a normal prepregnancy BMI. The other significant predictors of IQ and nonverbal scores of the children were childcare status (β = 3.5, P = 0.04 and β = 0.26, P < 0.0001, respectively) and the mother's receptive language scores (β = 5.2, P = 0.01 and β = 0.25, P < 0.0001, respectively).

Conclusion. This study of low‐income African–American children indicates that obese women are at risk of having children with diminished intellectual ability, but not motor skills.
Intraoperative surgical complication during cesarean section: an observational study of the incidence and risk factors
Authors: Bergholt Thomas , Stenderup Jens Karl , Vedsted‐Jakobsen Agnete , Helm Peter , Lenstrup Carsten
Published: December 2004

Background. The study was intended to estimate the incidence of intraoperative surgical complications with the impact of the educational level of the surgeon and a history of previous cesarean section on intraoperative complications at cesarean childbirth.

Methods. In the period between August 1st 1995 and July 30th 1996, 7782 women gave birth at the three Obstetric Departments in Copenhagen County, Denmark, of which 929 (11.9%) were delivered by cesarean section. These women served as the study population, and their medical records were reviewed and data obtained immediately after delivery.

Results. The overall intraoperative complication rate was 12.1%. The rate of complications in emergency cesarean sections was 14.5% compared with 6.8% in the elective group. The educational level of the surgeon and a history of previous cesarean section were not found to be significantly associated to intraoperative complications. Low station of the presenting part of the fetus, high fetal birth weight, fetal distress and dystocia as indications and increasing maternal age were significant risk factors of lacerations. Placenta previa and placental abruption as indications, increasing prepregnancy body mass index, as well as low and high birth weight were significant risk factors for intraoperative blood loss more than 1 l. Duration of regular painful contractions had a preventive effect.

Conclusion. Utero‐cervical lacerations and blood loss of more than 1 l were the most frequent intraoperative complications in cesarean section in the present study. The educational level of the surgeon or history of a previous cesarean section were not significantly related to these complications.
Menorrhagia: an update
Authors: Oehler M. K. , Rees M. C. P.
Published: December 2004

Menorrhagia is defined as a ‘complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles’. Objectively it is a total menstrual blood loss equal to or greater than 80 ml per menstruation. It is estimated that approximately 30% of women complain of menorrhagia. Excessive bleeding is the main presenting complaint in women referred to gynecologists and it accounts for two‐thirds of all hysterectomies, and most of endoscopic endometrial destructive surgery. Thus, menorrhagia is an important healthcare problem. Its etiology, investigation, medical and surgical management are described. In approximately 50% of cases of menorrhagia no pathology is found at hysterectomy. Abnormal levels of prostaglandins or the fibrinolytic system in the endometrium have been implicated. Effective medical treatments suitable for long‐term use include intrauterine progestogens, antifibrinolytic agents (tranexamic acid) and nonsteroidal anti‐inflammatory agents (mefenamic acid). Over the past decade there has been increasing use of endometrial destructive techniques as an alternative to hysterectomy. Their further refinement and the advent of fibroid embolization has increased the options available to women.
Intrapartum influences on cesarean delivery in multiple gestation
Authors: Williams Keith P. , Galerneau France
Published: December 2004

Objective. To evaluate which intrapartum factors influence the method of delivery in a group of twin pregnancies eligible for vaginal delivery.

Study design. Over a 10‐year period, 967 consecutive twin pregnancies at gestational age ≥32 weeks with twin A presenting as a vertex and eligible for vaginal delivery were reviewed. Excluded were 40 (4.1%) patients who underwent a repeat and elective cesarean section. All patients who underwent a cesarean section were placed into one of two groups according to the method of delivery of both twins: group 1, cesarean section/cesarean section delivery; and group 2, vaginal/cesarean section delivery. The impact of the following intrapartum factors on the type of delivery were assessed: (1) presentation of the 2nd twin: vertex vs. breech vs. other; (2) experience of the obstetrician: ≤€10 years vs. > 10 years in practice; (3) multiparity: nulliparous vs. multiparous; (4) incidence of epidural usage; (5) induction vs. spontaneous labor; and (6) difference in fetal weight between twin B and twin A: <€25% difference vs. ≥ 25% difference. The chi‐square statistic was used to compare differences in the incidence of cesarean section between the groups.

Results. Total incidence of cesarean section was 266/927 (28.7%). Risk of delivering by a combined vaginal delivery and cesarean section was reduced if the presentation of twin B was vertex or breech (RR: 0.114; 95% confidence interval: 0.049–0.266) or if an epidural was used (RR: 0.380; 95% confidence interval: 0.163–0.883).

In twin gestations eligible for vaginal delivery the risk of requiring delivery by cesarean section for both twins is reduced if the presentation of twin B was vertex (RR: 0.782; 95% confidence interval; 0.631–0.968), if an epidural was used (RR: 0.461; 95% confidence interval: 0.375–0.566), or if the birthweight discrepancy was <€25% (RR: 0.695; 95% confidence interval: 0.524–0.922).

Conclusion. Twin gestations with twin B presenting as vertex or breech or with an epidural were less likely to undergo combined vaginal delivery and cesarean section. The liberal use of epidural anesthesia may reduce the need for cesarean section in patients with twin gestations considered good candidates for vaginal delivery.
Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women
Authors: Eva Uustal Fornell , Gun Wingren , Preben KjØlhede
Published: December 2004

Background. Urinary incontinence is common in women. How often incontinence occurs has been only briefly investigated. Studies on the prevalence of fecal incontinence are few. The epidemiology of genital prolapse symptoms is unknown. This epidemiological study describes a general population of women aged 40 and 60 years with regard to the prevalence and frequency of urinary and fecal incontinence and the prevalence of genital prolapse symptoms.

Methods. A questionnaire on medical background, urinary and fecal incontinence, and genital prolapse symptoms was sent to 1000 40‐year‐old and 1000 60‐year‐old randomly selected women.

Results. Sixty‐seven per cent answered: 53% were continent for urine; 9% of the 40‐year‐olds and 19% of the 60‐year‐olds had urinary incontinence weekly or more often. Detrusor instability score was significantly higher in the 60‐year‐olds. Incontinence of flatus, weekly or more often, was reported by 9% and 19%, loose feces by 5% and 8%, and solid feces by 0.3% and 1.7% according to the 40‐ and 60‐year‐olds, respectively. Fifty‐three per cent reported no flatus incontinence. Of the prolapse symptoms investigated, 15% of the females reported pelvic heaviness, 4% genital bulge, and 12% use of fingers in the vagina or perineum by defecation.

Conclusions. Incontinence of urine is common in this population. Flatus incontinence is as common, but the concept must be operationalized if used as an endpoint in research. The International Continence Society's (ICS) definition of urinary incontinence is unpractical for use in epidemiological research. We suggest leakage weekly or more often as a criterion for significant incontinence in epidemiological research.
Prospective study of mother‐to‐infant transmission of hepatitis C virus: a 10‐year survey (1990–2000)
Authors: Ferrero Simone , Lungaro Pietro , Bruzzone Bianca Marisa , Gotta Cristina , Bentivoglio Giorgio , Ragni Nicola
Published: December 2004

Background. The purpose of this study was to determine the rate of vertical transmission of hepatitis C virus (HCV). We also aimed to analyze the time of clearance of maternal antibodies in the serum of non‐infected babies.

Methods. Between March 1990 and March 2000, 170 consecutive anti‐HCV‐positive women and their 188 babies entered this prospective study. All women were analyzed for HCV‐RNA using polymerase chain reaction (PCR). The babies were followed‐up until HCV‐antibody clearance or until the diagnosis of HCV infection.

Results. The vertical transmission rate was 2.7% overall, and it was higher in HIV co‐infected women (5.4%, 2/37) than in HIV‐negative women (2.0%, 3/151). All infected infants were born to mothers who had HCV viremia at delivery. The transmission rate was influenced by maternal levels of viremia. 37.2% of uninfected children became HCV‐antibody negative by 6 months and 88.0% by 12 months. Babies born from HCV‐RNA‐positive mothers lost anti‐HCV antibodies later (9.21 ± 3.72 months) than babies born from HCV‐RNA‐negative mothers (7.47 ± 3.46 months) ( p < 0.05, Kolmogorov‐Smirnov test).

Conclusions. The risk of HCV vertical transmission is very low in HCV‐positive/HIV‐negative women and it is restricted to infants born to HCV viremic mothers. High maternal viral load is predictive of the vertical transmission. The clearance time of antibodies in non‐infected babies is significantly longer if the mother is viremic.
Nitric oxide: does it have an etiological role in pre‐eclampsia?
Authors: Rajagopal Mooken , Moodley Jack , Chetty Runjan
Published: December 2004

Aim. To determine evidence of nitric oxide (NO) in decidual biopsies and fetal membranes of preeclamptic women.

Background. Nitric oxide, a potent vasodilator, has been postulated to have a role in the etiology of preeclampsia. Investigations in peripheral blood have led to conflicting results. We therefore decided to study whether immunohistochemically detectable nitric oxide is produced in the decidua and within the fetal membranes.

Methods. Forty‐two pregnant women at 28 weeks gestation or more were enrolled. Twenty were normotensive and 22 had preeclampsia. Women with chronic hypertension, diabetes and multiple pregnancies were excluded. Maternal blood samples prior to cesarean section (CS), decidual biopsies during CS, and fetal membrane specimens were obtained. The tissue specimens were fixed immediately (after delivery of the baby and placenta) in formalin, washed, and embedded in paraffin. Immunohistochemical staining for nitric oxide synthases (NOS) I, II, III was performed and reviewed in conjunction with routine hematoxylin and eosin sections, using light microscopy.

Results. There was no statistically significant difference in the level of immunostaining of nitric oxide synthases in both normotensive and hypertensive patients.

Discussion. The severity of blood pressure did not influence expression of nitric oxide synthases.
Endometrial thermoablation for treatment of menorrhagia: comparison of two methods in outpatient setting
Authors: Vihko Kimmo K. , Raitala Reijo , Taina Esko
Published: December 2004

Background. Menorrhagia is one of the commonest reasons for gynecologic consultations. Inhibitors of fibrinolysis and non‐steroidal anti‐inflammatory drugs (NSAIDs) are generally used as therapy for the condition with an acceptable response in some patients. Endometrial ablation is one choice in patients suffering from menorrhagia. It can be performed in patients with no endometrial histological or anatomical pathology. In this method, the functional endometrial tissue is ablated under general anesthesia in an outpatient setting.

Methods. We compared two methods that are widely used in Finland (Menotreat® and Cavaterm®) in thermoablation of endometrial tissue in 31 patients that were randomized into two treatment groups.

Results. Endometrial ablation was effective in the treatment of menorrhagia in patients with normal endometrial structure. About 70% of the patients described the result of the treatment as ‘very good’. Only one patient underwent a hysterectomy during the 6‐month follow‐up period because of problems related to uterine bleedings. The two methods were similar in efficacy and patient acceptance.

Conclusions. Both thermoablation techniques were well accepted by our patients and showed similar and good efficacy and patient acceptance.
Fear of childbirth: a neglected dilemma
Authors: Saisto Terhi , Halmesmäki Erja
Published: December 2004

Severe fear of childbirth complicates 6% to 10% of parturients and is manifested as nightmares, physical complaints and difficulties in concentrating on work or on family activities. Very often fear of childbirth leads to request for an elective cesarean section (CS). In Finland, Sweden, and the United Kingdom, fear of childbirth or maternal request is the reason for about 7–22% of CS births. Fear of childbirth is as common in nulliparous as in parous women. Fear of labor pain is strongly associated with the fear of pain in general, and a previous complicated childbirth or inadequate pain relief are the most common reasons for requesting a CS among parous women. Previous psychological morbidity and a great number of daily stressors expose a woman to a great risk of fear of childbirth. Fear of childbirth is not an isolated problem but associated with the woman's personal characteristics, mainly general anxiety, low self‐esteem, and depression, and dissatisfaction with their partnership, and lack of support. Also the partners of women with fear have a certain pattern of low psychological well‐being, resulting in low life‐satisfaction, dissatisfaction with partnerships, and depression. A vivid debate about the woman's right to choose the mode of delivery is going on in obstetric literature, but discussion on the reasons for women to request a CS, or on the possibilities to help them overcome the fear of vaginal childbirth is scanty. Preliminary Swedish and Finnish reports demonstrated the results of treatment during pregnancy, when more than half of the women withdrew their request after being able to discuss their anxiety and fear, and vaginal deliveries after treatment were successful.
Randomized, prospective, double‐blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse
Authors: Miskry Tariq , Magos Adam
Published: December 2004

Background. To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse.

Method. In a two‐center prospective, double‐blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function.

Results. There were no significant differences in peri‐operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly.

Conclusions. Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without.
Reactions to awareness of activated protein C resistance carriership: a descriptive study of 270 women
Authors: Lindqvist Pelle G. , Dahlbäck Björn
Published: December 2004

Background.  Around 25 million Caucasian women are carriers of the FV Leiden mutation that causes activated protein C (APC) resistance. This is a heritable condition with a lifelong increased risk of venous thromboembolism. We performed this study to investigate women's reactions to their awareness of being APC‐resistant and the consequences of this awareness.

Methods.  All APC‐resistant women (n = 270) included in a prior study on APC resistance and pregnancy (n = 2480) were invited by written questionnaire to describe their reactions to having APC resistance, how this had changed their lives, and how they experienced our information. Answers were obtained from 215 of the 270 women (80%).

Results.  More than 94% of the APC‐resistant women were satisfied with knowing themselves to be APC‐resistant and pleased that they had enrolled in the study. Of the women on combined oral contraceptives (COC), 84% changed their method of contraception, but 16% continued on COC. One‐third of the women reported becoming more worried or afraid of getting pregnant again as a result of their awareness of being APC‐resistant. The proportion of women who sought legal abortions during a 2‐year period after receiving this information was similar in both subgroups: 4.4% (12/270) vs. 4.3% (94/2210), p = 0.9.

Conclusions.  We conclude that most APC‐resistant women were pleased to learn of their APC resistance status, that there was not an increased incidence of legal abortions, but almost one‐third reported being more worried or afraid of getting pregnant again.
Embryo transfer by midwife or gynecologist: a prospective randomized study
Authors: Bjuresten Kerstin , Hreinsson Julius G. , Fridström Margareta , Rosenlund Björn , Ek Ingvar , Hovatta Outi
Published: December 2004

Background.  Embryo transfer (ET) in assisted reproduction treatments has traditionally been performed by gynecologists in the Nordic countries. As gynecologists often have a busy schedule, midwives and nurses have become increasingly important in performing the treatment, providing subject information, ultrasound monitoring and assistance at ET.

As part of the continuous development of our IVF treatment we have carried out a prospective randomized pilot study where either a midwife or a gynecologist has performed ET. The aim of this study was to see if a skilled IVF midwife could perform ET with similar results to a gynecologist.

Methods.  On the day of oocyte aspiration the subjects were randomized, by means of closed envelopes, for ET to be performed either by a midwife or a gynecologist. A total of 102 subjects were included in the study, 51 for ET by a skilled midwife and 51 by a gynecologist. There were no differences in the groups in respect to ET routine and catheters used.

Results.  No significant differences were observed in subject characteristics as regards age, method of pituitary down‐regulation or proportion of IVF/ICSI cycles. Similar clinical pregnancy rates between ETs performed by midwives vs. gynecologists, 31% vs. 29%, respectively, were seen. Subject experience as judged by a questionnaire also showed high acceptance of ET by a midwife.

Conclusion.  The results show that it is a feasible option to allow midwives to carry out ETs.
Feasibility of simultaneous application of fetal electrocardiography and fetal pulse oximetry
Authors: Luttkus Andreas K. , Stupin Jens H. , Callsen Tim A. , Dudenhausen Joachim W.
Published: December 2004

Background.  Fetal pulse oximetry measures arterial oxygen saturation during delivery. The fetal electrocardiogram STAN S21 analyzes the repolarisation segment of ECG (ST) waveform, which is altered by the intramyocardial potassium release resulting from metabolic acidemia. This study aimed to evaluate the feasibility of a simultaneous application of pulse oximetry and fetal electrocardiography and to estimate any agreement between both methods indicating fetal compromise.

Methods.  In an observational trial 35 fetuses were simultaneously monitored by pulse oximetry (OBS‐500) and electrocardiography. The evaluation focused on signal output and on the coincidence of desaturation in fetal pulse oximetry and on ST events. Desaturation was defined as a drop of at least 20% of oxygen saturation from base line level occurring within 1 min (steep desaturation) or duration of time (s) with oxygen saturation below the threshold of 30%. Statistical analysis was performed with the Mann–Whitney U‐test for continuous variables.

Results.  Signal output of the simultaneous application of both sensors was not significantly reduced in the electrocardiogram and in pulse oximetry (8% vs. 12% reduction). In 15 of the 35 fetuses, ST events indicating fetal hypoxia occurred. In these cases, pulse oximetry showed significantly more episodes of desaturation in comparison with fetuses without ST events. Median saturation during the ST events was significantly lower than in the recordings without ST events (60% vs. 74%, p < 0.05). In the umbilical artery these neonates showed significantly lower pH (7.19 vs. 7.33, p < 0.001), significantly higher lactate (5.1 vs. 3.4 mmol/l, p < 0.05) and significantly lower base deficit (−9.4mmol/l vs. −4.0 mmol/l, p < 0.001) levels.

Conclusions.  The combination of fetal pulse oximetry and fetal electrocardiography appears feasible and indicates signs of intermittent hypoxia. These findings may encourage the development of technology that combines these different methods of monitoring.
Effects of androgens on aromatase activity and 11C‐vorozole binding in granulosa cells in vitro
Authors: Kirilovas Dmitrijus , Naessen Tord , Bergström Mats , Bonasera Thomas A. , Bergström‐Pettermann Elisabeth , Holte Jan , Carlström Kjell , Simberg Niklas , Långström Bengt
Published: December 2004

Background. Locally produced androgens and estrogens are important in the hormonal regulation of follicular development. The present study aimed to further elucidate the mechanism through which androgens exert their ambivalent effects on aromatization.

Methods. Non‐cultured human granulosa‐luteal cells (GC) were treated with different concentrations of androstenedione (A4), testosterone (T), 5α‐androstane‐3,17‐dione (5α‐A) and dihydrotestosterone (DHT). The effects on aromatase activity were evaluated in a tritiated water assay (incubation time 2 h) and the availability of aromatase active sites was measured in a radiotracer‐binding assay using the non‐steroidal competitive aromatase inhibitor [11C]‐vorozole (incubation time 15 min).

Results. A4, T and 5α‐A caused dose‐dependent inhibition of both aromatase activity and [11C]‐vorozole binding; IC50‐values for both inhibition processes were calculated for these three steroids, revealing A4 as the most potent inhibitor and T and 5α‐A as moderate inhibitors. At low concentrations (0.01 and 0.1 µM), DHT stimulated aromatase activity but did not affect [11C]‐vorozole binding. At the higher concentrations tested (1 and 10 µM) DHT suppressed both processes thus weakly binding the aromatase active site.

Conclusion. Because the incubation time in the tritiated water assay was short, the stimulation by DHT at low concentrations might therefore most likely include mechanisms other than new synthesis of aromatase protein such as allosteric action of DHT upon aromatase or liganded androgen receptor–aromatase interaction.
Short convalescence after vaginal prolapse surgery
Authors: Ottesen Marianne , SØrensen Mette , Kehlet Henrik , Ottesen Bent
Published: December 2004

Objective. Retrospectively to describe the recommended convalescence according to patients who had undergone vaginal prolapse surgery in 1996–98, and prospectively to describe the need for and limiting factors for convalescence after vaginal prolapse surgery in 1999–2000 at a Danish University Hospital.

Methods. The retrospective study included a validated, postal, questionnaire and review of patient files. In the prospective study, we followed consecutive women after vaginal surgery in a fast‐track setting using a multimodal rehabilitation model with well‐defined recommendations for the convalescence period.

Results. In the retrospective study, 188 women (79%) with a median age of 66 years (range, 30–88) answered the questionnaire. They had been recommended a convalescence of median 6 weeks (range, 1–12) for most activities. The subjective recurrence rate was 22% within median 6 months (range, 0–24) after first‐time prolapse surgery. In the prospective study, there were 41 consecutive women with a median age of 69 years (range, 44–88). Convalescence was median <1 week for most non‐strenuous activities, <2 weeks for light work and <4 weeks for sexual intercourse, sports and work with lifts exceeding 10 kg. Limiting factors were fatigue and pain. The 1‐year subjective recurrence rate was 17%.

Conclusion. Traditionally, recommended convalescence has been median 6 weeks after vaginal prolapse surgery. Convalescence has been shortened to 1–3 weeks with a multimodal rehabilitation model with revised, non‐restrictive recommendations. Further studies are necessary to evaluate the impact of different convalescence recommendations on the recurrence of prolapse.
Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes
Authors: Jacobsson Bo , Mattsby‐Baltzer Inger , Andersch Björn , Bokström Hans , Holst Rose‐Marie , Nikolaitchouk Natalia , Wennerholm Ulla‐Britt , Hagberg Henrik
Published: December 2004

Background.  Previous studies have shown an association between intra‐amniotic microbial invasion and/or inflammation and spontaneous preterm birth. The aim of this study was to investigate the occurrence of intra‐amniotic microorganisms and cytokines [interleukin (IL)‐6 and IL‐8] in a Swedish population, with low incidence of preterm birth, of women with preterm prelabor rupture of membranes and their correlation to preterm birth.

Methods.  Amniotic fluid was retrieved transabdominally from 58 patients with preterm prelabor rupture of membranes before 34 weeks of gestation. Polymerase chain reaction (PCR) analyses for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. IL‐6 and IL‐8 were analyzed with enzyme‐linked immunosorbent assay (ELISA).

Results.  Microorganisms in amniotic fluid were detected in 13 patients (25%). Patients with bacteria detected in the amniotic fluid had significantly higher levels of IL‐6 and IL‐8. An amniotic fluid concentration of IL‐6 ≥ 0.80 ng/ml [relative risk 1.93, 95% confidence interval (CI) 1.13–3.29, sensitivity 63%, specificity 75%] was associated with an increased risk of delivery within 7 days. There was also an association between IL‐8 and preterm birth (< 34 weeks).

Conclusions.  Intra‐amniotic microbial invasion and inflammation in this population of Swedish women with preterm prelabor rupture of membranes were similar to data reported from populations with a higher incidence of preterm delivery. Amniotic IL‐6 correlated to the presence of microorganisms and delivery within 7 days and IL‐8 to delivery before 34 weeks.
Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants
Authors: Ullberg Ulla , Lingman Göran , Ekman‐Ordeberg Gunvor , Sandstedt Bengt
Published: December 2004

Background.  The aim of this study was to investigate the occurrence and appearance of the anastomosis between the two umbilical arteries in placentas from infants small for gestational age (SGA).

Methods.  The arterial systems of 64 placentas from singleton pregnancies resulting in SGA infants were visualized by angiography. The method allowed study of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each artery. The results were compared with findings in a previous study of appropriate for gestational age (AGA) infants. One‐way analysis of variance (anova) and χ2‐analyses were used for statistics.

Results.  In 56 placentas the anastomosis was represented by a true vessel, in two by a fenestration, and in another two cases by fusion of the umbilical arteries. The anastomosis was absent in one case and another three cases had a single umbilical artery (SUA). When the diameter of the anastomosis was thinner than that of the umbilical arteries, their supply areas were significantly (p ≤ 0.001) more symmetrical than in cases with a wider anastomosis.

The anatomy of the anastomosis and the relationship between its width and the symmetry between the supply areas of each umbilical artery did not differ in placentas from SGA and AGA infants, despite various types of cord insertion and placentation.

Conclusion.  Static measurements of Hyrtl's anastomosis do not indicate a contributing part for intrauterine growth retardation.
Alcohol use as predictor for infertility in a representative population of Danish women
Authors: Tolstrup Janne Schurmann , Kjær Susanne Krüger , Holst Claus , Sharif Heidi , Munk Christian , Osler Merete , Schmidt Lone , Andersen Anne‐Marie Nybo , GrØnbÆk Morten
Published: December 2004

Background. Our aim was to examine the association between use of alcohol and subsequent incidence of primary infertility.

Methods. The study subjects were chosen from a population‐based cohort of Danish women aged 20–29 years. Eligible women were nulliparous and not pregnant (n = 7760). Information on alcohol intake and potential confounders (age, education, marital status, diseases in the reproductive organs, and cigarette smoking) was assessed at enrollment. The incidence of fertility problems during follow‐up was obtained by record linkage with the Danish Hospital Discharge Register and the Danish Infertility Cohort Register. Main outcome measures were hazard ratios of infertility according to alcohol intake at baseline estimated in a multivariate Cox proportional hazards model.

Results. During a mean follow‐up of 4.9 years, 368 women had experienced infertility. Alcohol intake at baseline was unassociated with infertility among younger women, but was a significant predictor for infertility among women above age 30. In this age group, the adjusted hazard ratio for consuming seven or more drinks per week was 2.26 (95% confidence interval: 1.19–4.32) compared with women consuming less than one drink per week.

Conclusions. These findings suggest that alcohol intake is a predictor for infertility problems among women in the later reproductive age group.
Women's experience of coping with a positive Pap smear: a register‐based study of women with two consecutive Pap smears reported as CIN 1
Authors: Ideström Monica , Milsom Ian , Andersson‐Ellström Agneta
Published: December 2004

Background.  In Sweden approximately 40 000 women receive information annually that their Papanicolaou (Pap) smear test showed dysplasia and about 400 women are diagnosed with invasive cervical cancer. The aim of this study was to evaluate women 5 years after two consecutive Pap smears diagnosed with mild dysplasia (CIN 1), by describing their experience of receiving information about the results of the smear and how examinations, treatment and follow‐up had affected them.

Methods.  A questionnaire was sent in 1999 to 329 women who according to the Department of Clinical Pathology, Karlstad, had two consecutive Pap smears reported as mild dysplasia (CIN 1) during 1993 and who as a result of this finding should have undergone colposcopy and biopsy according to an agreed general program.

Results.  The questionnaire was completed by 242 women (74%). The finding of mild dysplasia was obtained at a screening test in 95%, and 96% reported that they had participated in the follow‐up program. One hundred and eighty‐four women (76%) experienced follow‐up in a positive way. Seventy‐two percent considered they understood the meaning and consequences of having mild dysplasia. Nevertheless, feelings of worry and anxiety affected 59%. For 30% it affected everyday life between being informed of the result of the first Pap smear test and subsequent further investigation. Twenty women (8%) reported a remaining negative influence on sexuality and their experience of sexual intercourse as a consequence of the management of mild dysplasia. This finding was correlated with less satisfaction with follow‐up and a negative influence on self‐esteem.

Conclusion.  Women felt vulnerable when being investigated for intraepithelial neoplasia, but this did not influence willingness to participate in follow‐up. The discovery created unnecessary worry and a negative experience that may be solved by a better‐developed educational program at the time of screening. There were no signs of remaining anxiety 5 years later, but 8% of women reported a remaining negative influence on their sexual life.
Ectopic pregnancy in African developing countries
Authors: Goyaux Nathalie , Leke Robert , Keita Namory , Thonneau Patrick
Published: December 2004

Objective. We have reviewed the scientific literature on ectopic pregnancy (EP) in African countries published over the past 20 years and available from several databases (MEDLINE, EMBASE, POPLINE, and Cochrane Fertility Regulation Group), with the aim of painting a complete picture of the situation (incidence, risk factors, diagnosis, treatment, and complications).

Results. Although hospital‐based African studies indicate EP incidence has probably increased in Africa in recent decades, major methodological limitations in the published literature make it impossible to draw formal conclusions concerning the incidence of EP in Africa in recent years. As in industrialized countries, pelvic inflammatory disease (PID) associated with sexually transmitted diseases (STDs) must be considered as the most important risk factor for EP in developing countries. In African developing countries, a majority of hospital‐based studies have reported EP case fatality rates of around 1–3%, 10 times higher than that reported in industrialized countries. Late diagnosis, leading in almost all cases to major complications, and emergency surgical treatments are key elements accounting for such high fatality rates in women suffering from EP in Africa.

Conclusion. EP should be considered a relevant public health indicator in developing countries, providing an overall picture of the capacity of a health system to deal with the diagnosis and treatment of emergency situations, especially in the field of obstetrics and gynecology.
Phytoestrogens increase the capacity of serum to stimulate prostacyclin release in human endothelial cells
Authors: García‐Martínez María Cinta , Hermenegildo Carlos , Tarín Juan J. , Cano Antonio
Published: December 2004

Background.  Both the estrogen receptor (ER) alpha and beta isoforms are expressed in the endothelium. The ER beta has been assigned a crucial role in normal vascular wall function. Prostacyclin has been ascribed a beneficial effect on vessel wall physiology. Isoflavones bind with higher affinity to ER beta. We investigated the hypothesis that their administration to postmenopausal women can promote endothelial prostacyclin production.

Methods.  Twenty‐five healthy postmenopausal women with mild climacteric symptoms received capsules containing 55 mg/day isoflavones derived from soy and red clover for 6 months. Cultured human umbilical vein endothelial cells (HUVECs) were exposed for 24 h to serum collected before the initiation of therapy and then after 3 and 6 months of continuous therapy. Prostaglandin production was measured in culture medium.

Results.  In the presence of serum obtained after isoflavone treatment, the prostacyclin production increased significantly from 2.7 ± 0.5 ng/mg protein at baseline to 3.4 ± 0.7 ng/mg protein at 3 months (p ≤ 0.05), and to 3.8 ± 0.7 ng/mg protein at 6 months (p ≤ 0.05 vs. baseline and 3 months' treatment).

Conclusions.  Serum obtained from postmenopausal women treated with isoflavones stimulates the capacity to produce prostacyclin by HUVECs in culture, an effect that could contribute to a beneficial cardiovascular effect of phytoestrogens.
The incidence, risk factors and obstetric outcome in primigravid women sustaining anal sphincter tears
Authors: Gupta Nandini , Usha Kiran Talakere , Mulik Varsha , Bethel Jackie , Bhal Kiron
Published: December 2004

Background.  The incidence of anal sphincter tears is highest among nulliparous women. The aim of this study was to ascertain if there were other factors that increased their risk.

Methods.  This was a retrospective study of all primigravid vaginal deliveries that had sustained an anal sphincter tear (n = 122), compared with deliveries that did not have this complication (n = 16 050). The study sample was drawn from a computerized maternity information database, comprising 52 916 deliveries in the South Glamorgan region during 1990–99. SPSS version 10 was used for statistical analysis.

Results.  The incidence of anal sphincter tears in this study population was 0.8% (122/16172). Postdates (OR = 1.8, 95% CI = 1.3–2.6) and fetal macrosomia (OR = 3.8, 2.4–6) together with induction of labor (OR = 1.5, 1.01–2.2), use of spinal analgesia at delivery (OR = 3.1, 1.1–8.4), assisted vaginal delivery (OR = 1.9, 1.3–2.7; especially the use of forceps, OR = 2.2, 1.3–3.9) and doctor‐conducted deliveries (OR = 2.2, 1.6–3.2) were found to be associated with a significantly higher incidence of anal sphincter tears. Logistic regression revealed fetal macrosomia and doctor‐conducted deliveries to be independent risk factors that, when occurring together, were associated with a fourfold increase in the risk of occurrence of anal sphincter tears.

Conclusions.  This study suggests that careful assessment and counseling of women, particularly > 40 weeks gestation or those potentially having macrosomic fetuses, especially if forceps are to be used for prolonged second stage in primigravid women, may help to identify those at significant risk of anal sphincter tears.
Preeclampsia is associated with increased susceptibility of serum lipids to copper‐induced peroxidation in vitro
Authors: Fainaru Ofer , Lichtenberg Dov , Pinchuk Ilya , Almog Benny , Gamzu Ronni , Kupferminc Michael
Published: December 2004

Background.  Several reports suggest preeclampsia to be associated with oxidative stress. In view of potential experimental artifacts in these studies, we tested the effect of preeclampsia on the oxidizibility of maternal serum lipids, using an optimized ex vivo method.

Methods.  This prospective study included 28 pregnant women with preeclampsia and 28 women matched for maternal and gestational age with normal pregnancies. Venous blood was drawn from the consenting women. Serum levels of lipid peroxidation products and the kinetics of copper‐induced oxidation ex vivo were monitored spectroscopically by continuous recording of absorbance at 245 nm.

Results.  The initial optical density (OD) at 245 nm, attributed to preformed products of lipid peroxidation, was higher in the women with preeclampsia than in the controls (1.26 ± 0.02 vs. 1.17 ± 0.02 OD units; p = 0.01). The lag phase preceding oxidation, reflecting resistance of serum lipids to oxidation, was significantly shorter in the preeclampsia group than in the controls (47.4 ± 2.3 vs. 57.6 ± 4.0 min; p = 0.027).

Conclusions.  High levels of serum hydroperoxides and increased susceptibility of serum lipids to copper‐induced peroxidation ex vivo indicate preeclampsia to be associated with high oxidative stress. The role of this high oxidizibility in the pathogenesis of preeclampsia has yet to be evaluated.
Adult victims of sexual assault: acute medical response and police reporting among women consulting a center for victims of sexual assault
Authors: Schei Berit , Sidenius Katrine , Lundvall Lene , Ottesen Gyda Lolk
Published: December 2004

Background.  The medical response to adult sexual assault should comprise: the collection of forensic evidence, the treatment of injuries, and follow‐up counselling. In the past, victims of sexual assault reporting directly to the police may not have received this total medical care. The Copenhagen Center for Victims of Sexual Assault at Rigshospitalet, Denmark offers a 24‐h service. Medical treatment and psychosocial follow up is offered independent of police reporting. The aim of this study was to assess whether adult sexual assault victims who reported to the police differed from those who did not report to the police.

Methods.  Using clinical records, sociodemographics, characteristics of the assault, and type of preventive medical treatment received were obtained for 156 consecutive women consulting the Copenhagen Center (March 1st to December 31st 2000). Comparisons between characteristics of victims who reported to the police or not were determined.

Results.  Ninety‐four (60.2%) of the women reported to the police. Women who sought services within 24 h of the assault, had experienced use of force, were subjected to assault outdoors, and among whom nongenital injuries were observed were more likely to report to the police (p < 0.05). However, in the multivariate model these associations fell below significance, and only the type of perpetrator remained significantly related to police reporting. The adjusted odds ratio for police reporting when the perpetrator was a friend was 0.4 (95% CI 0.17–0.94). There was no statistical difference between the victims who did or did not report to the police to request prophylactic antibiotics or emergency contraception.

Conclusion.  Observed injuries and requests for prophylactic antibiotics or emergency contraception were not influenced by whether the woman did or did not report directly to the police. Hence the need for medical treatment appears to be similar in the two groups, and available specialized care for victims of sexual assault should not be restricted to those who immediately report to the police.