bluuebunny/crossref_metadata_2025 huggingface dataset:
Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single‐blind study
Authors: LUND IRÉNE , LUNDEBERG THOMAS , LÖNNBERG LENA , SVENSSON ELISABETH
Published: December 2009

Background. The efficacy of acupuncture on low‐back and/or pelvic pain in late pregnancy is reviewed in few reports. Our aim was to evaluate the effects of two different acupuncture stimulation modes on pelvic pain intensity and some emotional symptoms due to the pain condition. Methods. In a prospective randomized controlled single‐blind study, pregnant women with pelvic pain, median gestational age 26 weeks (range 18–35), were given 10 acupuncture treatments. Needles were inserted subcutaneously over acupuncture points without further stimulation (superficial, n=22), or intramuscular and stimulated repeatedly until a perceived sensation of numbness, de qi, (deep, n=25). Self‐reported pain intensity at rest and during daily activities was assessed on a visual analog scale. The variables pain, emotional reactions, and loss of energy were assessed according to the Nottingham Health Profile questionnaire. Changes in assessed variables were analyzed with a nonparametric statistical method allowing for analysis of systematic group changes separated from additional individual changes. Results. After acupuncture stimulation, significant systematic group changes towards lower levels of pain intensity at rest and in daily activities as well as in rated emotional reaction and loss of energy were seen. The results also showed additional individual changes in most variables. In this study, no differences between the effects induced by the superficial and deep acupuncture stimulation modes were observed. Conclusion. Acupuncture stimulation that is individually designed may be a valuable treatment to ameliorate suffering in the condition of pelvic pain in late pregnancy.
Multiple pregnancy in rural Burkina Faso: frequency, survival, and use of health services
Authors: JAHN ALBRECHT , KYNAST‐WOLF GISELA , KOUYATÉ BOCAR , BECHER HEIKO
Published: December 2009

Objective. To assess the birth of twins in rural Burkina Faso with respect to prevalence, mortality, and provision of obstetric care. Methods. A descriptive demographic analysis of population‐based and health service data was performed with multivariate modeling by Poisson regression. Health service data were derived from a document review in health facilities in the Nouna District for the years 1994–2001. The district hospital provides obstetric care for the entire district with its 252,000 population (1998). Population‐based data (deliveries, live births, deaths) were derived from the demographic surveillance system in the surveillance area within the Nouna District, Burkina Faso (population under surveillance: 30,988 in 1998). All births in the period from January 1, 1993 to December 31, 1998 (9,457 recorded deliveries with 9,610 live births) were included and followed up until April 30, 2002. The main outcome measures were the prevalence of twin delivery as well as age‐ and sex‐specific mortality risks. Results. Mortality of twins is high, with one out of three dying before reaching the age of five years – 2.5 times the mortality risk of singletons. Among twins, mortality is particularly high in the neonatal period (RR 5.16; CI: 3.6–7.5) and in twins born to mothers above the age of 35 (RR 5.12; CI: 3.5–7.6). The overall population‐based prevalence of twin delivery is 1.6% (CI: 1.4–1.9) versus a hospital‐based prevalence of 2.8% (CI: 2.2–3.1). Despite this moderate trend towards hospital‐based obstetric care, most twins (90.5%) are still delivered outside a hospital setting. Conclusions. The high neonatal mortality in twins points to the need for special care in pregnancy, child birth, and postpartum. Maternity services fail to adequately cover the vast majority of multiple pregnancies and deliveries.
Cervical cancer incidence in Denmark over six decades (1943–2002)
Authors: KYNDI MARIANNE , FREDERIKSEN KIRSTEN , KRÜGER KJÆR SUSANNE
Published: December 2009

Introduction. The purpose of the study was to describe developments in the incidence of invasive cervical cancer in Denmark, focusing on histological types, over a period of 60 years. We also describe developments in the incidence of carcinoma in situ and mortality. Material and methods. The study is based on the Danish Cancer Registry database of 39,623 reported cases of invasive cervical cancer diagnosed among Danish women in the period 1943–2002. The most important variables and measures are age‐specific and age‐standardized incidence and estimated annual percent changes in incidence. Results. A significant reduction in incidence of invasive squamous cell carcinoma among women over 30 during the last 35 years and in incidence of invasive adenocarcinoma among women over 40 during the last 15 years has been seen. In both histological subgroups the relative estimated annual percent change in incidence was largest in the period 1988–2002 as compared to 1968–1987, coinciding with an increase in the number of Danish women covered by the organized screening program. Women 20–29 years old showed a relatively stable squamous cell carcinoma incidence but an increasing adenocarcinoma incidence throughout the study period. Conclusions. These results suggest that the increasing coverage of the Danish organized screening program is associated with a significant reduction in incidence of invasive squamous cell carcinoma among women over 30, and of invasive adenocarcinoma among women over 40. So far, squamous cell carcinoma incidence and adenocarcinoma incidence among women 20–29 years old seem quite unaffected by the organized screening program.
Maternal and fetal outcome after severe anemia in pregnancy in rural Ghana
Authors: GEELHOED DIEDERIKE , AGADZI FLORENCE , VISSER LUCIA , ABLORDEPPEY EMELIA , ASARE KOFI , O'ROURKE PETER , VAN LEEUWEN JULES SCHAGEN , VAN ROOSMALEN JOS
Published: December 2009

Background. Anemia in pregnancy contributes to poor outcome for mother and child in low‐income countries. This study analyzes adverse maternal and fetal outcome after severe anemia in pregnancy in rural Ghana. Methods. A cohort study in two (sub)district hospitals, including 157 pregnant women exposed to severe anemia (Hb < 8.0 g/dl) and 152 nonexposed pregnant women (Hb ≥ 10.9 g/dl), matched for age and parity strata. Adverse outcomes analyzed were postpartum hemorrhage, need for blood transfusion, maternal mortality, low birth‐weight, and perinatal mortality. Results. Compared to nonexposed women, exposed women had an increased risk of maternal death (5/157 versus 0/152). Fetal outcome did not significantly differ between the study groups, although perinatal mortality was increased with exposure to Hb < 7.0 g/dl (OR 3.1; 95%CI 1.0–9.4), and low birth‐weight was increased with exposure to Hb < 6.0 g/dl (OR 2.5; 95%CI 1.2–5.4). Overall fetal outcome was significantly better when hemoglobin prior to childbirth was at least 8.0 g/dl (OR 3.9; 95%CI 1.6–9.6), body mass index at least 20 kg/m2 (OR 2.8; 95%CI 1.5–5.3), and number of antenatal visits at least 4 (OR 2.0; 95%CI 1.1–3.7). Conclusions. Severe anemia in pregnancy results in relatively poor maternal and fetal outcome. Apparently maternal risks increase prior to fetal risks. In order to improve maternal and fetal outcome, it is recommended that district hospitals in low‐income countries make prevention, early diagnosis, and treatment of severe anemia in pregnancy a priority.
Does laparoscopic removal of nonendometriotic benign ovarian cysts affect ovarian reserve?
Authors: SOMIGLIANA EDGARDO , RAGNI GUIDO , INFANTINO MIRCO , BENEDETTI FRANCESCA , ARNOLDI MARIANGELA , CROSIGNANI PIER GIORGIO
Published: December 2009

Background. The objective of this study was to investigate whether laparoscopic excision of nonendometriotic benign ovarian cysts is associated with a significant injury to ovarian reserve. Methods. Women selected for IVF‐ICSI cycles who previously underwent laparoscopic excision of a monolateral nonendometriotic benign ovarian cyst were retrospectively identified. The operated ovary and the contralateral intact gonad of the same patient were compared in term of basal ovarian volume before initiating ovarian stimulation and number of dominant follicles at the time of human chorionic gonadotropin administration. Non‐parametric Wilcoxon Rank test was used to investigate differences between the two ovaries. Results. Seventeen cases were recruited. The numbers of dominant follicles were 4.6±2.5 and 2.7±2.4 in the control ovary and in the previously operated ovary, respectively (p=0.01). This drop corresponded to a mean reduction of 42% (95% confidence interval: 10–74%). Basal volumes of the intact and the operated gonads were 5.7±3.3 and 3.4±2.3 cm3 respectively (p=0.01), corresponding to a mean reduction of 39% (95% confidence interval: 12–66%). Conclusions. Laparoscopic excision of nonendometrioid benign ovarian cysts is associated with a significant injury to ovarian reserve.
Chronic malnutrition in pregnant adolescents in rural Malawi: An anthropometric study
Authors: KALANDA BONIFACE F. , VERHOEFF FRANCINE H. , BRABIN BERNARD J.
Published: December 2009

Background.The anthropometry of adolescent pregnancy has been little described in developing countries. This paper outlines the anthropometry of adolescents living in poor rural communities in southern Malawi.Methods.A cross‐sectional descriptive analysis of 991 women who attended for their first antenatal visit before 18 weeks’ gestation at two rural hospitals. Of these, 190 were adolescent (12–19 years).Results.Of adolescent attendees, 82.6% were primigravidae, and 77.9% were illiterate. Adolescents had a higher prevalence of low values for weight for age, mid‐upper arm circumference (bothp<0.01), and body mass index (p=0.06) than nonadolescent women. At all maternal ages, illiterate women were shorter than literate women. Percentile values for adolescents for weight, height and upper‐arm circumference and body mass index showed consistent evidence of chronic undernutrition during adolescence. The age‐specific cross‐sectional curves provide evidence for continued linear growth until early adulthood.Conclusions.Chronic undernutrition and illiteracy were common amongst adolescent pregnant women in these communities where childbearing starts early in adolescence. The nutritional consequences of this for these young mothers and their offspring are considerable. Innovative health and literacy strategies are required to address this problem.
Accuracy of serum uric acid determination in predicting pre‐eclampsia: A systematic review
Authors: Cnossen Jeltsje S. , de Ruyter‐Hanhijärvi Hanna , van der Post Joris A. M. , Mol Ben W. J. , Khan Khalid S. , ter Riet Gerben
Published: December 2009

Background. Pre‐eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early prediction of pre‐eclampsia may be used to target high‐risk women for effective preventative treatments. Hyperuricemia is associated with pre‐eclampsia and it has been tested in early pregnancy for its ability to predict the later onset of the disease.

Objective. To systematically review the accuracy of determining serum uric acid before the 25th gestational week in predicting pre‐eclampsia.

Methods. We searched Medline, Embase, Cochrane Library, Medion, bibliographies of review articles and eligible primary studies, and contacted experts in the field. Language restrictions were not applied. Reviewers working independently selected studies, extracted data and assessed validity according to eight criteria. Sensitivities and specificities were plotted in a Receiver Operating Characteristic plot.

Results. We identified five primary articles, with a total of 572 women, including 44 who developed pre‐eclampsia. Study populations differed clinically, with incidences ranging from 3.4% to 40.1%. Sensitivity ranged from 0.0% to 55.6% and specificity ranged from 76.9% to 94.9%. Clinical heterogeneity and poor reporting precluded sensible pooling of data. In particular, consecutive entry of eligible women, blind assessment of the reference standard, and treatment to prevent pre‐eclampsia were poorly reported.

Conclusion. Contrary to previous reviews, we conclude that there is currently insufficient evidence to draw firm conclusions about the accuracy of serum uric acid determination in predicting pre‐eclampsia.
Bleeding disorders among young women: A population‐based prevalence study
Authors: FRIBERG BRITT , KRISTIN ÖRNÖ ANN , LINDGREN ANNIKA , LETHAGEN STEFAN
Published: December 2009

Background. Bleeding problems are prevalent in the general population but may indicate a general bleeding disorder. Our aim was to describe the prevalence of perceived bleeding symptoms, including menorrhagia, in young healthy females. Methods. By aid of school nurses we distributed a questionnaire to all girls (n=1,410) in the first grade of the upper secondary schools in the town of Malmö, Sweden. We received 1,019 (72%) responses. The questionnaire consisted of 17 main questions addressing general bleeding problems, menses and menstrual bleeding problems, family history, and other health related questions. Results. The mean age of the girls was 16.7 years. Eight girls had a previously diagnosed bleeding disorder and had a higher frequency of most bleeding symptoms. Seventy‐three percent of girls experienced at least one bleeding symptom, 43% had more than one symptom, 23% were troubled by more than two symptoms, and 10% more than three symptoms. Thirty‐seven percent experienced heavy menstruation and of these 22% had different drugs as treatment for menorrhagia. Thirty‐eight percent had a family history of heavy menstruation and half of them suffered from heavy menstruation themselves. Conclusions. Bleeding symptoms were relatively prevalent in this population and similar to other population‐based studies.
Impaired glucose tolerance is associated with changes in clinical and biochemical parameters in women with polycystic ovary syndrome
Authors: Walch Katharina , Grimm Christoph , Nagele Friedrich , Huber Johannes , Wölfler Monika , Vytiska‐Binstorfer Elisabeth , Unfried Gertrud , Hefler Lukas
Published: December 2009

Background. To characterize the phenotype of women with polycystic ovary syndrome with and without impaired glucose tolerance by determining various polycystic ovary syndrome‐associated clinical and laboratory parameters.

Methods. In a prospective clinical study, we evaluated a series of 102 Caucasian women with polycystic ovary syndrome. Women completed a detailed questionnaire and underwent a standardized oral glucose tolerance test. Various polycystic ovary syndrome‐associated laboratory values such as hormonal and metabolic parameters were determined in these women and correlated to clinical data and the presence/absence of impaired glucose tolerance. Furthermore, the insulin resistance was calculated using the homeostasis model assessment index and correlated with clinical and biochemical parameters.

Results. Eighty‐eight (86.3%) and 14 (13.7%) women were diagnosed as having non‐impaired glucose tolerance and impaired glucose tolerance, respectively. Presence of impaired glucose tolerance was associated with an increased body mass index, increased body weight, elevated serum levels of bioavailable testosterone, insulin like growth factor‐1, insulin, HbA1c, leucocytes, uric acid, alkaline phosphatase, hepatic C‐reactive protein, and decreased serum levels of sex‐hormone binding globulin. No association was ascertained with subfertility, hirsutism, and menstrual irregularities. We ascertained a positive correlation between the homeostasis model assessment index and body mass index, body weight, alkaline phosphatase, and hepatic C‐reactive protein.

Conclusions. Impaired glucose tolerance seems to be associated with a specific phenotype within polycystic ovary syndrome. This phenotype is more likely to present with biochemical parameters similar to an inflammatory reaction and a metabolic disorder.
Variation of force applied during external cephalic version with different patients’ characteristic and outcome of version
Authors: LEUNG TAK YEUNG , SAHOTA DALJIT SINGH , CHAN LIN WAI , FOK WING YEE , LAW LAI WA , LAU TZE KIN
Published: December 2009

Background. To compare the degree of force applied during external cephalic version, between different patients’ characteristic and outcomes of version. Methods. It is a prospective observational study in a cohort of patients undergoing external cephalic version at or above 36 weeks of gestation. During external cephalic version, the operator wore a pair of pressure‐sensing gloves which had ultra‐thin piezo‐resistive pressure sensors positioned on the palmer surface. Readings from each of the sensors were recorded in real time throughout each version attempt and analyzed by a computer program. The pressure exerted on individual sensors over time, the pressure–time integral (PTI; mmHg s), was calculated for each sensor from the start to the end of each version attempted. The degree of force applied for each attempt (PTI‐A) was represented by the sum of pressure–time integrals across all sensors. PTI‐A was analyzed in relation to different patients’ characteristics and outcome of version. Results. Ninety‐two patients were recruited, 73% of whom had a successful external cephalic version. The median PTI‐A of the successful attempt in women who completed version after 1 and 2 attempts were 17,180 and 17,736 mmHg s, respectively. They were significantly lower than that of the women who required 3 or more attempts for a successful version (32,351 mmHg s), as well as the highest PTI‐A among all attempts received by women who finally had a failed version (31,638 mmHg s) (p<0.05, Kruskal–Wallis Test and Dunn test). Within the same subject, there was no difference in PTI‐A between the successful attempt and the preceding failed attempt, suggesting that the failure may not be due to insufficient force but rather to inefficient application of the force. Uterine tone was found to be the only clinical variable that was significantly associated with the degree of applied force during a version (p<0.05). A tenser uterus was associated with a stronger applied force. Conclusion. The degree of force required for a successful version is highly variable, being lowest when version can be completed within 2 attempts, but doubled when 3 or more attempts are required. Failure of version is usually not due to inadequate force but inefficient application of force. Uterine tone is significantly related to the degree of applied force, with stronger force being exerted when the uterus is tense.
Postoperative voiding, bacteriuria and urinary tract infection with Foley catheterization after gynecological surgery
Authors: SCHIØTZ HJALMAR A. , TANBO TOM G.
Published: December 2009

Background. The use of bladder drainage to avoid urinary retention after gynecological surgery is more or less custom based, and duration of drainage varies considerably. In this paper the use of 1‐day drainage by transurethral Foley catheter was investigated with regard to impaired voiding, asymptomatic bacteriuria, and urinary tract infection. Furthermore, the use of methenamine hippurate was studied with regard to postoperative asymptomatic bacteriuria and urinary tract infection. Methods. This summary is based on six published papers totaling 917 patients. In three case series, 1‐day catheterization was used in women undergoing gynecological laparotomy, colposuspension, or vaginal plastic surgery. To compare 1‐ and 3‐day Foley catheterization, two open, randomized trials were performed on women undergoing vaginal plastic surgery or colposuspension. The last study was a double‐blind trial between methenamine hippurate and placebo as prophylaxis against urinary tract infection and asymptomatic bacteriuria using 1‐day catheterization. Results. Postoperative voiding problems and urinary tract infection occurred infrequently with 1‐day catheterization, and no more frequently than with catheterization for three days. Methenamine hippurate decreased the incidence of urinary tract infection and asymptomatic bacteriuria by 80 and 40%, respectively. Conclusions. One‐day bladder drainage by transurethral Foley catheter may be used routinely in common gynecological surgery with a low rate of voiding problems, asymptomatic bacteriuria, and urinary tract infection. Methenamine hippurate prophylaxis effectively reduces postoperative urinary tract infection.
Patient‐controlled epidural analgesia in labor does not always improve maternal satisfaction
Authors: NIKKOLA EEVA , LÄÄRÄ ARJA , HINKKA SUSANNA , EKBLAD ULLA , KERO PENTTI , SALONEN MARKKU
Published: December 2009

Background. We investigated whether patient‐controlled epidural analgesia in labor with bupivacaine and fentanyl provides more satisfaction to mothers than intermittent bolus epidural analgesia or patient‐controlled epidural analgesia with plain bupivacaine. Methods. Ninety mothers with term, uncomplicated pregnancies were randomized to receive intermittent bolus epidural analgesia (bupivacaine + fentanyl), patient‐controlled epidural analgesia (bupivacaine + fentanyl), or patient‐controlled epidural analgesia (bupivacaine). Pain during labor was evaluated with a visual analog scale. Obstetric and neonatal outcomes were recorded. After delivery, the mothers were given a questionnaire covering the following themes: experience of labor pain, feeling of control, fears and expectations associated with pregnancy/with delivery/with becoming a mother, as well as pain, physical condition and emotions after delivery. To elaborate on these answers, 30 mothers were further randomized to a semistructured interview, in which the same topics were discussed. The main outcome measure was maternal satisfaction. Results. The intermittent bolus epidural analgesia group felt they could influence labor most (p=0.03), and in the interview they expressed most satisfaction. In this group, the total drug utilization was smallest (bupivacaine: p<0.0001 comparing all groups, fentanyl: p=0.03 comparing the two fentanyl‐receiving groups). No differences in pain occurred. Vomiting (p=0.04) and pruritus (p<0.0001) were more common or more severe in the groups receiving fentanyl. Conclusions. We found no advantages for patient‐controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction.
Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography
Authors: HAYAKAWA HIROMI , ITAKURA ATSUO , MITSUI TAKASHI , OKADA MAYUMI , SUZUKI MASAKI , TAMAKOSHI KOJI , KIKKAWA FUMITAKA
Published: December 2009

Objective. Ultrasound examination is an objective method for assessment of uterine scar defects. The present study was conducted to compare single‐layer interrupted sutures (Group A) with double‐layer interrupted sutures (Group B) and our new method (Group C) as well as other perioperative parameters in relation to risk of wedge defects in scars. Methods. We have introduced a new myometrium closure procedure consisting of continuous suture with decidual closure followed by interrupted myometrium suture. In this prospective study, women undergoing cesarean operation (n=137) were examined by transvaginal ultrasound one month after surgery to assess the appearance of lower uterine scars. Multivariate logistic regression analysis was performed to identify associations of perioperative parameters and methods for lower myometrium closure with abnormal wedge formation. Results. Wedge defects were observed in a total of 27 patients (19.7%). The analysis revealed Groups B and C to have reduced risks with odds ratios of 0.28 and 0.077, respectively, as compared to Group A. Furthermore, increasing gestational week at delivery, plural fetal pregnancies, premature rupture of membranes and pre‐eclampsia were also linked with an increased risk, with odds ratios of 1.4–8.9. Conclusion. The incidence of uterine scar defects 1 month after cesarean sections varies with the method applied for myometrial suture and perioperative variables. The data suggest that methods for myometrium closure as well as other factors influence the condition of myometrial healing.
Symphysis–fundus measurements for detection of small for gestational age pregnancies
Authors: BERGMAN EVA , KIELER HELLE , PETZOLD MAX G. , SONESSON CHRISTIAN , AXELSSON OVE
Published: December 2009

Background. In Sweden measurements of the symphysis–fundus (SF) distance are used to detect small for gestational age (SGA) pregnancies. The aim of this study was to evaluate the efficiency of Swedish ultrasound‐based SF reference curves in detecting SGA pregnancies.

Methods. To assess the sensitivity for detection of SGA pregnancies we performed a case–control study. Through the Swedish Medical Birth Register we identified all singleton SGA infants born in Uppsala in 1993–1997 and randomly recruited non‐SGA singleton infants as controls. We included 169 term and 73 preterm SGA cases and 296 controls, all born at term. The reference curves constructed by Steingrimsdottir (S curve) and Kieler (K curve) were evaluated. Gestational age at the first alarm in the preterm SGA group was recorded.

Results. In term pregnancies the S curve showed a sensitivity of 32% and specificity of 90% at a cut‐off of −2 SDs. The corresponding values for the K curve were 51% and 83%, respectively. In preterm SGA pregnancies the sensitivity of the S curve was 49% and of the K curve 58%. The first alarm below 2 SDs was noted before 32 weeks in 37% with the S curve and 43% with the K curve for preterm SGA pregnancies.

Conclusions. Both tested Swedish SF reference curves had low sensitivities for term SGA pregnancies. Sensitivity was higher for the preterm group and SF measurements seem to be better for detecting the most severe cases of SGA.
Effectiveness of cervical cancer screening in Iceland, 1964–2002: a study on trends in incidence and mortality and the effect of risk factors
Authors: SIGURDSSON KRISTJAN , SIGVALDASON HELGI
Published: December 2009

Background. Data on cervical cancer screening programs that have covered a whole nation over a prolonged time are scarce. The effectiveness of a 40‐year established nationwide cervical screening program has been evaluated to define optimal age limits and screening intervals. Methods. Trends in incidence and mortality by calendar time, age, histology, stage and attendance during 1964–2002 and the predictive power of calendar year, age, stage and histology on the cause‐specific mortality rate were analyzed. Results. The rate of squamous cell carcinoma decreased significantly, but the rate of adenocarcinoma increased. The age‐specific incidence and cause‐specific mortality decreased significantly for all age groups except those women aged 20–29 years. An increased age‐specific incidence rate, confined to stage I, was observed in the age group 20–39 years after 1980 and a positive correlation was observed between early attendance and the rate of microinvasive squamous (stage IA) cell carcinoma and adenocarcinoma in this age group. The cumulative incidence of invasive disease started to increase two years after the last negative smear. Stage was the strongest risk factor, followed by age and calendar time, and to a lesser degree histology. Conclusions. The results confirm the effectiveness of the screening program and support the recommendation that screening should commence below age 25 with a maximum of 3‐year initial screening intervals. The interval can then be extended after age 40 and stopped after age 65.
Performance of acupuncture as labor analgesia in the clinical setting
Authors: NESHEIM BRITT‐INGJERD , KINGE RAGNHILD
Published: December 2009

Background. Three randomized controlled trials have shown that acupuncture during labor can reduce the use of epidural analgesia and meperidine. To supplement these trials, we have designed an observational study to answer the research question: “Do laboring women in a normal hospital setting who receive acupuncture require less epidural analgesia than those who do not receive acupuncture?”

Methods. Setting: Delivery ward of a tertiary care University hospital in Norway. Subjects: All attempted vaginal labors during the period 01.12.99–31.12.03 (n=17,741). Statistical analysis: Multivariate logistic regression analysis.

Results. The dependent variable in the regression analysis was use of epidural analgesia. The independent variables were: use of acupuncture, use of nitrous oxide, use of meperidine, parity, ethnicity, age, duration of pregnancy, type of labor (induced or not), and duration of first stage of labor. In the multivariate analysis the odds ratio for having an epidural was 0.6 (95% CI 0.5–0.7) for the patients having acupuncture compared to those not having acupuncture.

Conclusions. Women having acupuncture as labor analgesia in the clinical setting have a reduced use of epidural analgesia.
COX‐2 and preoperative CA‐125 level are strongly correlated with survival and clinical responsiveness to chemotherapy in ovarian cancer
Authors: RASPOLLINI MARIA ROSARIA , AMUNNI GIANNI , VILLANUCCI ALESSANDRO , BODDI VIERI , TADDEI GIAN LUIGI
Published: December 2009

Background. CA‐125 is elevated in the serum of the majority of ovarian carcinoma patients. Cyclooxygenase‐2 is an enzyme whose synthesis is upgraded by several cytokines, growth factors, and tumor promoters. Methods. We analyzed cyclooxygenase‐2, preoperative CA‐125 levels, and CA‐125 levels during chemotherapy in 41 FIGO stage III, grade 3, ovarian serous carcinoma patients in relation to survival with a logistic regression. The correlation of cyclooxygenase‐2 expression and CA‐125 preoperative level with clinical responsiveness to chemotherapy was studied according to Fisher's exact test. We compared 23 patients living with no evident disease five years after primary treatment to 18 patients who had died of progression of disease no later than two years after primary treatment. Results. Cyclooxygenase‐2 overexpression (p=0.014 and p=0.036) and preoperative CA‐125 level (p=0.012 and p=0.029) were found to be independent predictors of survival in univariate and multivariate analyses. Cyclooxygenase‐2 and CA‐125 level were correlated to responsiveness to chemotherapy (p=0.003 and p=0.036, respectively; Fisher's exact test). The patients with a CA‐125 level <35 U/ml after two cycles of chemotherapy showed a longer survival (p=0.008). The median preoperative CA‐125 was 195 in high survival patients and 650 in low survival patients (p=0.004, Wilcoxon Mann–Whitney test). Conclusions. Cyclooxygenase‐2 overexpression and CA‐125 levels may help the management of ovarian cancer patients, permitting the selection of more aggressive and tailored first‐line therapy.
Chronic hypertension as a risk factor for offspring to be born small for gestational age
Authors: Zetterström Karin , Nordén Lindeberg Solveig , Haglund Bengt , Hanson Ulf
Published: December 2009

Background. Chronic hypertension during pregnancy is associated with an increased risk for birth of small for gestational age offspring. The aim of this study was to determine whether the risk remains after consideration of maternal characteristics and superimposed pre‐eclampsia. Method. A population‐based cohort study based on the Swedish Medical Birth Register 1992–98 and comprising 560 188 women aged 15–44 years with singleton pregnancies including 2,754 women with chronic hypertension. The register contains data of maternal characteristics besides maternal and fetal complications. Multiple logistic regression analysis was used. Small for gestational age was defined as birth weight less than −2SD adjusted for gestational age and sex. Results. Chronic hypertensive women have an independent risk for small for gestational age (OR 3.1; 95% CI 2.7–3.7) when controlling for confounding of maternal characteristics such as age, parity, BMI, smoking, and ethnical origin. After introducing superimposed pre‐eclampsia in the model the risk remains but decreases (OR 2.4; 95% CI 2.1–2.9). Conclusion. Chronic hypertension is an independent risk factor for birth of small for gestational age offspring. Pre‐eclampsia is a strong mediating factor.
Bishop score and the outcome of labor induction with misoprostol
Authors: Szczesny Witold , Kjøllesdal Møyfrid , Karlsson Bengt , Nielsen Sven
Published: December 2009

Background.The aim of the study was to retrospectively identify possible factors for predicting the outcome of induction with misoprostol.

Methods.Fifty micrograms of misoprostol were administered intravaginally every 6 h during the first 2 days of induction, up to a maximum of 4 doses. The Bishop score, indication for induction, gestational length, maternal age, and parity were analyzed. The study involved 99 patients (47 primiparous and 52 multiparous) at term (>36 weeks of gestation) with unripe cervices.

Results.Forty‐five per cent of the patients achieved ripening of cervix and went into labor after a single dose of misoprostol; a further 45% required 2 doses. Nine patients received more than 2 tablets. Ninety‐seven per cent of all vaginal deliveries occurred within the first 2 days of induction. Ninety‐five per cent of the patients delivered vaginally when the Bishop score was >3, compared with 75% of those with a Bishop score of ≤3 (p=0.003). Among factors creating the Bishop scoring system, in logistic regression analysis effacement of the cervix was the only independent, significant predictor of cesarean section (p=0.003, OR = 0.16) even after adjusting for maternal age, which also was a significant predictor in the regression analysis. Eleven patients had previously had a cesarean section; one of them had a uterine rupture with a fatal outcome for the fetus. All women with a previously scarred uterus are now excluded from misoprostol treatment.

Conclusion.Misoprostol 50 μg administered intravaginally every 6 h according to this protocol is highly effective for inducing labor in carefully selected patients with unripe cervices.
Depression in women with endometriosis with and without chronic pelvic pain
Authors: LORENÇATTO CAROLINA , PETTA CARLOS ALBERTO , JOSÉ NAVARRO MARIA , BAHAMONDES LUIS , MATOS ALESSANDRA
Published: December 2009

Aim. The aim of the study is to compare the prevalence of depression in women surgically diagnosed with endometriosis according to the presence or absence of pelvic pain. Methods. This cross‐sectional prospective study evaluated 100 women receiving care at the Outpatients’ Clinic for Endometriosis, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil, equally divided into two groups: one suffering from chronic pelvic pain and the other pain‐free. The Beck Depression Inventory was used in order to measure depression. Results. Depression was detected in 86 and 38% of the women with and without chronic pelvic pain, respectively. Complaints of depression, such as somatic concerns, work inhibition, dissatisfaction, and sadness, were observed at a significantly higher rate in the group with pain. A sensation of failure was the only variable observed more frequently in the pain‐free group. Conclusions. Depression is highly prevalent in women with endometriosis, especially those with pelvic pain. Careful evaluation can identify women with depression who may benefit from treatment.
The Pregnancy Mobility Index: a mobility scale during and after pregnancy
Authors: van de Pol G. , de Leeuw J.R.J. , van Brummen H.J. , Bruinse H.W. , Heintz A.P.M. , van der Vaart C.H.
Published: December 2009

Background. During pregnancy, every second woman will experience some degree of back or pelvic pain. While several validated instruments to assess back pain exist for the general population, these are not suitable for application in a pregnant population and have not been validated for this purpose. A pregnant population not only differs from the general population regarding the type of back pain – frequently a pelvic girdle component is added – but pregnant women also have different mobility patterns and expectations. We therefore present in this study a self‐report mobility scale specifically designed for a pregnant population: the Pregnancy Mobility Index. Methods. Longitudinal cohort study including 672 nulliparous women with a singleton low‐risk pregnancy. The Pregnancy Mobility Index consists of items concerning day‐to‐day activities selected through literature research and clinical experience. Participating women completed the questionnaire at 12 and 36 weeks’ gestation and one year after delivery. Reliability, construct and criterion validity were tested. Results. The internal consistency (Cronbach's alpha) was 0.8 or higher. The Pregnancy Mobility Index scales correlated best with the physical and pain scale of the RAND‐36, indicating a good construct validity. The assumptions that the Pregnancy Mobility Index scores increase during pregnancy and decrease after delivery and that women with back or pelvic problems scored higher on the Pregnancy Mobility Index domains than women without back or pelvic pain were confirmed, indicating a good criterion validation. Conclusion. The Pregnancy Mobility Index has been shown to be a reliable and valid questionnaire well suited for use during and after pregnancy.
Grandparents’ age and the risk of Down's syndrome in Norway
Authors: KAZAURA METHOD R. , LIE ROLV T. , SKJÆRVEN ROLV S.
Published: December 2009

Background. High maternal age is a well‐recognized risk factor for Down's syndrome. There are also several studies of a possible effect of paternal age, but no consistent evidence of an association is found. Less is known about any effects of the age of grandparents. Objective. To assess whether maternal or paternal grandparents’ age is associated with the risk of Down's syndrome. Methods. We used logistic regression analyses with data from the Medical Birth Registry of Norway, adjusting for possible confounding factors. Results. We found no evidence of an association with the risk of Down's syndrome either for a maternal grandmother's age (odds ratio 0.9, 95% confidence interval 0.6–1.5 per 10‐year increase in grandmother's age) or for any of the other grandparents’ age. Conclusions. High maternal age remains the only well‐established age‐related risk factor for Down's syndrome. There is little evidence that the increased risk represented by older mothers is passed on to offspring of her non‐affected daughters.
Correlations between umbilical and maternal serum resistin levels and neonatal birth weight
Authors: Cho Geum Joon , Yoo Sang Wook , Hong Soon Cheol , Oh Min‐Jeong , Kim Tak , Kim Hai Joong , Lee Kyu Wan , Kim Sun Haeng
Published: December 2009

Objective. Resistin is a novel hormone secreted by human adipocytes and mononuclear cells. It is expressed in the human placenta, and has been postulated to play a role in the regulation of energy metabolism during pregnancy. However, correlations between umbilical and maternal serum resistin levels and neonatal birth weight remain poorly understood. The purpose of the study was to clarify the correlation between umbilical cord and maternal serum resistin levels and neonatal birth weight. Materials and methods. This study included 37 healthy mothers, neonates. Resistin levels were determined by ELISA, and compared for correlation between umbilical cord and maternal serum resistin levels and neonatal birth weight. Results. The ranges of resistin levels for umbilical and maternal sera were 10.61–40.81 and 1.14–25.54 ng/ml, respectively. Mean umbilical serum resistin level (21.34±1.07 ng/ml) was significantly higher than maternal serum resistin level (10.13±1.12) (p<0.001). Umbilical serum resistin levels were positively correlated with maternal serum resistin levels (r=0.607, p<0.001) and negatively with neonatal birth weight (r= − 0.345, p=0.037). No significant differences in resistin levels were discovered between the female and male neonates. In addition, there were no correlation between the umbilical resistin levels and maternal body mass indices, umbilical leptin levels, or insulin levels. Conclusions. It is suggested that resistin not only affects energy homeostasis by existing in high levels in the fetus, but may play an important role in controlling body weight through effective regulation of adipogenesis by negative feedback.
Pregnancy complications by overweight and residential area. A prospective study of an urban Norwegian cohort
Authors: Clausen Torun , Øyen Nina , Henriksen Tore
Published: December 2009

Background. Health varies in residential areas of different socioeconomic status in the capital of Norway. This study compares risks of pregnancy complications in Oslo according to prevalence of overweight and areas of residency. Methods. Prospective cohort study of 3,677 pregnancies. Pregnancy outcomes were retrieved from medical records after delivery. Statistics were performed by logistic regression analyses. Results. Pregnant women from areas of lower socioeconomic status (Oslo East) had higher prevalence of overweight than women from areas of higher status (Oslo West). Dose–response relationships were found between body mass index and increased risk of pregnancy complications (pre‐eclampsia, gestational hypertension, gestational diabetes mellitus, macrosomia, cesarean deliveries, acute cesarean deliveries, transfer of the newborn to neonatal intensive care unit). Comparing Oslo East with Oslo West the relative risks of pregnancy complications were 1.8 for pre‐eclampsia, 1.6 for gestational diabetes, 1.4 for acute cesarean deliveries, 1.6 for low birth weight (≤2,500 g) and 1.5 for transfer to neonatal intensive care. Adjustment for body mass index did not change the increased risks of pre‐eclampsia, acute cesarean deliveries, low birth weight, or transfer to neonatal intensive care among Oslo East women. Only the increased risk of gestational diabetes could partially be explained by higher body mass index. Conclusions. Residential areas of lower socioeconomic status had higher risk of pregnancy complications. Overweight was a strong independent predictor of pregnancy complications. The higher prevalence of overweight in Oslo East could, however, not explain the increased risk of pregnancy complications.
Randomized study on removable PGE2 vaginal insert versus PGE2 cervical gel for cervical priming and labor induction in low‐Bishop‐score pregnancy
Authors: STROBELT NICOLA , MEREGALLI VIRGINIO , RATTI MARTA , MARIANI SILVIA , ZANI GIULIA , MORANA SERENELLA
Published: December 2009

Background. Dinoprostone vaginal insert has been compared to Dinoprostone cervical gel in few studies, whose cases presented different Bishop scores and gestational ages at admission, and various treatment strategies in control arms. The present study compares the vaginal insert to the cervical gel in patients with low Bishop score at term. Methods. Prospective multicenter randomized trial, with parity‐based randomization. Admission criteria: single pregnancy with Bishop score of 0–4, gestational age of 37–41 weeks, intact membranes, no previous cesarean section, no bleeding or abnormal cardiotocography at admission. Results. Vaginal prostaglandins were required as a second‐line induction procedure in 25% of study patients versus 47.1% of controls (p<0.03, κ2). Study patients experienced shorter induction‐to‐delivery time (920±428 versus 1,266±740 min, p<0,01), with a mean difference of 5 h and 46 min between the groups. Even though patients that received vaginal insert showed a trend of increased incidence of abnormal cardiotocography during labor (12% versus 6.3%) and hyperkinetic labor (11.8% versus 2.1%), the incidence of cesarean sections (21.4% versus 21.6%), cesareans for fetal distress (12.5% versus 11.8%), and umbilical artery pH < 7.10 (4.9% versus 2.5%) was comparable between the two groups. Conclusions. Dinoprostone vaginal insert is more efficient than cervical gel in promoting cervical priming and labor induction in low‐Bishop‐score patients at term. The vaginal insert placement seems to be safe for the mother and the newborn, although larger studies are required to investigate uterine hyperstimulation incidence.
Childbearing and the desire to have children among university students in Finland
Authors: VIRTALA AIRA , KUNTTU KRISTINA , HUTTUNEN TEPPO , VIRJO IRMA
Published: December 2009

Background. The fertility rate in Europe is low and there is concern over the low birth rate in relation to the aging population. The age of childbearing women has increased and infertility is a growing problem. Highly educated women in Finland suffer from childlessness more often than less educated women. The aim of this study was to establish Finnish university students’ actual and desired number of children, and compare the economic and educational situations of students with and without children. Methods. The study population consisted of Finnish undergraduate students under 35 years of age. The randomly selected sample was 5,030 subjects. The data were collected by postal questionnaire, the response rate being 62.7%. Frequency distributions, cross‐tabulations, and descriptive statistics were used. Categorical variables were tested by the Cochran‐Mantel‐Haenzel test. Results. 7.5% of students had children. Almost 90% desired to have children. Parenthood did not correlate negatively with satisfaction with financial situation or completed studies. Conclusion. University students are seldom parents, though they are at the ideal age for childbearing and the majority desire to have children. The risk of unintended childlessness exists, when pregnancies are postponed because of unfinished studies.
Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH
Authors: Daniel Johannes Rönnqvist Per , Birgitta Forsgren‐Brusk Ulla , Elisabeth Grahn‐Håkansson Eva
Published: December 2009

Background. The relationship between lactobacilli and other microbes and the association with vaginal pH in the female genital tract were examined. The study also included evaluation of the possibility of supplying probiotics to the genital tract by using panty liners impregnated with the probiotic strain Lactobacillus plantarum LB931. Methods. This was a randomized, placebo‐controlled, double‐blind, multicenter study involving 191 healthy fertile women. Specified microbes were counted and vaginal pH was measured once a month for five consecutive months. Results. Major individual variations in the genital microflora composition and the vaginal pH were found among the women. The number of lactobacilli was significantly related to vaginal pH (p<0.001) and ∼70% of the women were permanent carriers of individual lactobacilli strains. Women with high numbers of lactobacilli were less prevalent with Group B streptococci than women with low numbers (p=0.036), and these women had a lower mean vaginal pH. The number of lactobacilli also correlated with the prevalence of yeast. LB931 could be found in 86% of the labial samples and 54% of the vaginal samples. Conclusions. High numbers of lactobacilli may contribute to a low vaginal pH and seem to have a negative influence on Group B streptococci. LB931 could be transferred from the panty liners to both the vagina and the labial fold.