bluuebunny/crossref_metadata_2025_split huggingface dataset:
Apoptotic and morphological features of the umbilical artery endothelium in mild and severe pre‐eclampsia
Authors: Yuluğ Esin , Yenilmez Engin , Unsal Mesut A. , Aydin Sevim , Tekelioglu Yavuz , Arvas Haluk 
Published: December 2009

AbstractBackground. The pathology of the umbilical arterial endothelium in normal pregnancy and in pregnancy complicated with pre‐eclampsia remains unclear. In this study the changes that occur in the umbilical artery endothelial cells were examined and endothelial cell morphology and apoptosis were compared among control, mild, and severe pre‐eclamptic subjects. Methods. Umbilical cords with a gestational age of between 35 and 40 weeks were collected from women with normal pregnancies (n=17), mild pre‐eclampsia (n=10), and severe pre‐eclampsia (n=12). We studied the umbilical artery endothelial cells using flow cytometry, and light and electron microscopy. Apoptosis was measured using flow cytometry and the terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling technique. The Kruskall–Wallis variance analysis and Mann–Whitney U‐tests as post hoc were applied. Results. In mild pre‐eclamptics, the endothelial cells appeared ultrastructurally separated. A dilated endoplasmic reticulum, swollen mitochondria, and vanished mitochondrial cristae were observed. In severe pre‐eclamptics, the cells were disorganized, highly contracted and vacuolated, separated from each other, and protruding prominently into the lumen. The percentages of endothelial cells that underwent apoptosis in mild (p<0.017) and severe pre‐eclamptics (p<0.017) were higher than those in the controls. These apoptosis values were highest in severe pre‐eclamptics (p<0.0001). Conclusion. Apoptosis and structural disruptions in the arterial endothelium of severe pre‐eclamptics were prominent in all subjects. Increased endothelial apoptosis and structural disruptions are clinically related to intensity of pre‐eclampsia, and may be associated with adaptation of the endothelial cells to pre‐eclampsia.
Birth outcomes in adolescent pregnancy in an area with intense malaria transmission in Tanzania
Authors: Uddenfeldt Wort Ulrika , Warsame Marian , Brabin Bernard J. 
Published: December 2009

AbstractBackground. Although the effects of malaria for the mother and young baby are well described in developing countries, there is very little data on the consequences for adolescent pregnancies. This paper analyses birth outcome in adolescent pregnancy in an area of Tanzania with intense malaria transmission. Methods. A cross‐sectional descriptive analysis of 528 adolescents and 1,156 adults, malaria prevalence, and birth weight outcomes for women delivering in Kilosa Hospital between June 2001 and October 2002. Results. This area has high malaria transmissions with some seasonality. Adolescent primigravidae had higher parasite prevalence than adolescent secundigravidae (41.3% versus 28.1%, p>0.05), and than adult primigravidae (41.3% versus 31.5%, p=0.007). Low birth weight prevalence was highest among adolescents delivering during the malaria season (odds ratio 1.7, 95% CI 1.1–2.6, p=0.02), and was double that of adult primigravidae (31.5% versus 15.9%, p=0.021). The prevalence of parasitemia (p=0.003) and low birth weight (p=0.033) declined with increasing age amongst adolescent primigravidae. Adjusted logistic regression showed a 1.4‐fold increased risk of low birth weight amongst adolescents (95% CI, 0.98–1.96). Conclusions. Failure to prioritize adolescent malaria will seriously limit the success of malaria control programs in pregnancy.
Adverse maternal and neonatal outcome of prolonged course of magnesium sulfate tocolysis
Authors: Nassar Anwar H. , Sakhel Khaled , Maarouf Hoda , Naassan Georges R. , Usta Ihab M. 
Published: December 2009

AbstractBackground. Magnesium sulfate continues to be widely used as a tocolytic agent despite a paucity of evidence supporting its use. Many practitioners use prolonged courses of magnesium sulfate, sometimes for months. This study was conducted to determine maternal and neonatal outcome of patients exposed to prolonged tocolytic magnesium sulfate. Methods. A retrospective review of maternal and neonatal charts (1995–2003) of pregnancies that received tocolytic magnesium sulfate. Cases who received magnesium sulfate >48 h (n=78) were compared to controls who received it ≤48 h (n=77) for maternal side effects and neonatal outcome. Results. Cases were more likely to be nulliparous (55.1% versus 37.7%, p=0.044), multiple gestations (33.3% versus 10.4%, p=0.001), and of lower gestational age (29.0±3.9 versus 30.5±3.8 weeks, p=0.017) compared to controls. The median magnesium sulfate infused was 154 (78–5,500) versus 54 (8–86) g (p<0.001) and the highest maternal magnesium level was 6.5±1.7 versus 5.6±1.9 mg/dl (p=0.002) in cases and controls, respectively. Cases were more likely to have ≥1 adverse side effect (30.8% versus 15.6%, p=0.045). The median neonatal magnesium level was significantly higher in cases (3.3 (1.4–7.2) versus 2.6 (1.1–5.2) mg/dl, p=0.016); however, neonatal mortality and other neonatal morbidity rates were similar in both groups. Abnormal bone mineralization was encountered in 3 neonates (cases). Conclusions. Maternal morbidity rate is higher with prolonged intake of tocolytic magnesium sulfate compared to ≤48‐h regimen. Despite similar neonatal morbidity and mortality rates, bone demineralization in the neonates may be encountered.
Therapeutic group psychoeducation and relaxation in treating fear of childbirth
Authors: SAISTO TERHI , TOIVANEN RIIKKA , SALMELA‐ARO KATARIINA , HALMESMÄKI ERJA 
Published: December 2009

AbstractBackground. The increase in the numbers of women fearing childbirth and requesting cesarean sections call for new forms of antenatal treatment. Methods. Finnish nulliparous women experiencing severe fear of childbirth (experimental group, n = 102) attended 5 group sessions with a psychologist, once together with a midwife, during the third trimester. One session was held 3 months after the delivery. Each session consisted of a discussion of fear and feelings towards the impending birth and parenthood in a psychotherapeutic atmosphere and of relaxation exercises focused on an imaginary childbirth. The results were compared with those of 85 women treated for fear of childbirth by 2 appointments with an obstetrician (conventional treatment). Results. Before the sessions, among the women in the experimental group, scored fear of childbirth, on a scale of one to ten, was 6.9±2.0 (SD), which is similar to the score of those receiving conventional treatment (6.0±1.6). After the sessions, 84 women in the experimental group (82.4%) and 57 in the conventional treatment group (67.1%) chose to have a vaginal delivery (p = 0.02). The women in the experimental treatment group rated the helpfulness of the sessions 8.5±1.6 on a scale where 10 was maximum help and 1 no help at all, and mentioned “sharing their feelings” twice as often as “receiving information” as the most helpful factor in relieving fear. Conclusions. Group psychoeducation and relaxation exercises were well received and rated as very helpful. More cesarean section requests were withdrawn than in the comparison group and in previous studies.
Polycystic ovary syndrome and metformin in pregnancy
Authors: Lilja Anna E. , Mathiesen Elisabeth R. 
Published: December 2009

AbstractThe diagnostic criteria of polycystic ovary syndrome incorporate hyperandrogenism, polycystic ovaries, anovulation and irregular menstrual bleeding and the syndrome is a recognized reason behind infertility. The biguanide metformin has encouraging effects on several metabolic aspects of the syndrome, including insulin sensitivity, plasma glucose concentration and lipid profile. Moreover, metformin improves the ovarian function in women diagnosed with polycystic ovary syndrome. Hence, metformin is considered an agent for ovulation induction among these patients. However, even higher ovulation frequencies have been observed when metformin has been adjuvant to clomifene therapy. Metformin‐induced ovulation presumably brings about resumption of regular menstrual cycles and improved conception rates. Polycystic ovary syndrome patients are presumably more likely than healthy women to suffer from pregnancy‐related problems like early pregnancy loss, gestational diabetes mellitus and hypertensive states in pregnancy. Recent data suggest sparing effects of continued metformin therapy throughout pregnancy on early pregnancy loss and gestational diabetes mellitus, but its impact on hypertensive complications to pregnancy appears less evident. Instead, metformin might even induce pre‐eclampsia or exert no effect on blood pressure. Conclusion. So far, evidence for safety of continued therapy throughout gestation is insufficient, and existing papers are limited in design and might mask for fetal toxic outcomes due to metformin therapy. Prior to a recommendation of sustained metformin therapy throughout pregnancy, randomized placebo‐controlled double‐blinded clinical trials are awaited with interest, so that present assumptions on efficiency can be clarified, in order to assure efficient and safe management of pregnant polycystic ovary syndrome patients.
Latzko operation for vault vesicovaginal fistula
Authors: ANSQUER YAN , MELLIER GEORGE , SANTULLI PIETRO , BENNIS MALIKA , MANDELBROT LAURENT , MADELENAT PATRICK , CARBONNE BRUNO , MATHEVET PATRICE 
Published: December 2009

AbstractBackground. Various surgical procedures are currently performed for the treatment of posthysterectomy vesicovaginal fistula. Most of them are carried out via an abdominal incision. Objective. Report of our experience with Latzko's operation, a simple purely transvaginal procedure. Methods. Retrospective study of vesicovaginal fistulas treated by a Latzko procedure between June 1991 and June 2005. Results. Eleven patients were operated on. Two (18%) had a prior failed attempt of vesicovaginal fistula repair. Mean size of the fistulas was 12±11 mm (range: 2–40 mm). Mean operative duration was 62±33 min (range: 20–110 min). All fistulas healed. No intraoperative complications were observed. There was only one postoperative complication, a lower urinary tract infection in one patient. Mean hospital stay was 6±4 days (range: 2–12 days). Conclusions. The Latzko procedure is an efficient, safe, and simple technique for the management of vault vesicovaginal fistulas, and can therefore be proposed as the first‐line surgical treatment.
Personality and mode of delivery
Authors: WIKLUND INGELA , EDMAN GUNNAR , LARSSON CHRISTINA , ANDOLF ELLIKA 
Published: December 2009

AbstractBackground. Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning.Method. Three hundred and twenty‐eight pregnant women from two different groups, “cesarean section on maternal request” (n = 84), and “vaginal delivery group” (n = 242) completed the self‐report inventory Karolinska Scales of Personality at 37–39 gestational weeks in pregnancy.Results. A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p<0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p<0.003) and Socialization (p<0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale.Conclusion. Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not.
Food for thought in women's health. The gynecologist: the new European gatekeeper in Chlamydia trachomatis infection
Authors: POLYZOS NIKOLAOS P. , VITTORAKI ANGELIKI , TSAPPI MARIA , MAURI DAVIDE , SPILIOPOULOU ANASTASIA , TZIORAS SPYROS , KAMPOSIORAS KONSTANTINOS , IOAKEIMIDOU ALIKI 
Published: December 2009

AbstractGenital Chlamydia trachomatis infection is the principal cause of bacterial sexually transmitted disease in industrialized countries. A wide spectrum of pathologic conditions has been associated with the disease ranging from urethritis, cervicitis, to pelvic inflammatory disease, ectopic pregnancy, tubal infertility and cervical neoplasia.Screening for genital Chlamydia infection may prevent its serious complications. The need of a comprehensive European screening policy has been recently underlined by PACMeR's scientific committee. Anyhow invitational screening programs are only at the beginning. Chlamydia trachomatis control “orphan” and women's health at risk.Until organized programs are developed, implementation of opportunistic screening is mandatory. Since the infection is more commonly observed among juvenile females proper testing of the young women is recommended. As asymptomatic young women in reproductive age are more eager to visit gynaecologists for periodical gynaecological examination and councelling (cervical cytology, breast examination, contraception and family planning), gynaecologist represents the only specialist able to provide early diagnosis of Chlamydia trachomatis.Gynaecologists are called to play a new role in public healthcare, being “gatekeepers” for the early detection of the disease, emphasizing their crucial part in young women's health.
Evaluation of stress urinary incontinence by computer‐aided vector‐based perineal ultrasound
Authors: CHEN HUEY‐YI , HUANG YU‐LEN , HUNG YAO‐CHING , CHEN WEN‐CHI 
Published: December 2009

AbstractBackground. In this study, we compared the differences in dynamic changes of the bladder neck between women with and without urodynamic stress incontinence by computer‐aided vector‐based perineal ultrasound.Methods. The function and morphology of the lower urinary tract were assessed in 48 women with or without urodynamic stress incontinence by urodynamic study and computer‐aided vector‐based perineal ultrasound.Results. Patients in the urodynamic stress incontinence group had a significantly higher parity and higher prevalence of funneling of the bladder neck than participants in the control group (p<0.05). After adjusting for parity, women with a corrected bladder neck movement ≥10 mm were 9.0 times more at risk of having urodynamic stress incontinence than women with a corrected bladder neck movement <10 mm (p < 0.05). If we used corrected bladder neck movement ≥10 mm as the cut‐off point for diagnosis of urodynamic stress incontinence, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 77.8%, 66.7%, 87.5%, 50%, and 75%, respectively.Conclusions. The increase in corrected bladder neck movement is associated with functional impairment of urethral closure. Computer‐aided vector‐based perineal ultrasound is valuable in assessing anatomic change of the bladder neck, but it is not a sensitive tool for predicting urodynamic stress incontinence.
High risk of cervical pathology among women with postmenopausal bleeding and endometrium ≤4.4 mm: long‐term follow‐up results
Authors: EPSTEIN ELISABETH , JAMEI BABAK , LINDQVIST PELLE G. 
Published: December 2009

AbstractBackground. To determine the risk of endometrial and cervical pathology during long‐term follow‐up in women with postmenopausal bleeding and thin endometrium (≤4.4 mm), and to determine the incidence and significance of re‐bleeding. Methods. Retrospective study including all women (n = 332) with postmenopausal bleeding and thin endometrium examined at the Department of Obstetrics and Gynaecology at Malmö University Hospital from 1992 until 2002. Follow‐up was accomplished by searching the medical records, the local registry of cytology and pathology, and the regional cancer registry up to November 15, 2005. Results. At the first visit, cervical cancer was diagnosed in 1.5% (5/332) and endometrial cancer in 0.9% (3/332) of the women. During follow‐up, cervical cancer was detected in 2/313 (0.6%) of the women; no additional case of endometrial cancer was found. In the region, the expected incidence of cervical and endometrial cancer during follow‐up was 0.23 (standard incidence ratio [SIR], 8.7; 95% CI 1.1–31.4) and 1.34 (SIR, 0.0; 95% CI 0.0–2.7), respectively. Thirteen percent (41/313) of the women sought medical care because of re‐bleeding. Endometrial pathology was found in 16% (4/25) and cervical pathology in 11% (3/28) of these women. Conclusions. Cervical cancer was twice as common as endometrial cancer in women with postmenopausal bleeding and a thin endometrium. During follow‐up, the risk of endometrial cancer was as expected, whereas the risk of cervical cancer was higher than expected. The results support that the diagnostic focus should be directed at excluding cervical pathology and that repeated diagnostic procedures be performed in cases of re‐bleeding.
Self‐reported nicotine exposure and plasma levels of cotinine in early and late pregnancy
Authors: GEORGE LENA , GRANATH FREDRIK , JOHANSSON ANNA L.V. , CNATTINGIUS SVEN 
Published: December 2009

AbstractBackground. The accuracy of maternal self‐reported smoking information, especially exposure to environmental tobacco smoke, has been questioned. This study aimed to validate self‐reported smoking, smoking cessation, and environmental tobacco smoke exposure in early and late pregnancy, using the biomarker cotinine as the gold standard. Methods. Prospective cohort study of 953 pregnant Swedish women between 1996 and 1998. In‐person interviews and cotinine measurements were performed at 6–12 and 31–34 completed weeks of gestation. All women were asked about nicotine exposures throughout pregnancy, including cigarette smoking, oral snuff, nicotine replacement therapy, and environmental tobacco smoke exposure. Results. The validity of self‐reported daily smoking was high in early and late pregnancy. However, among women reporting smoking cessation before the first interview and between the first and second interviews, 13% and 25% misreported active smoking, respectively. According to cotinine measurements, 22% of non‐smoking women were exposed to environmental tobacco smoke in early pregnancy, and 8% were exposed in late pregnancy. Self‐reported information on environmental tobacco smoke exposure in early and late pregnancy misclassified most exposed women as unexposed. Conclusion. The results of this study indicate that self‐reported smoking information among pregnant women can be trusted. However, among women reporting smoking cessation during pregnancy, the misclassification rate increased with recency of quitting. Environmental tobacco smoke exposure was common among non‐smokers, and the low validity of self‐reported environmental tobacco smoke exposure suggests that future studies on environmental tobacco smoke exposure and risks of pregnancy outcomes may have to rely on biomarker assessments.
Impact of menopause on the manifestation and severity of sleep‐disordered breathing
Authors: ANTTALAINEN ULLA , SAARESRANTA TARJA , AITTOKALLIO JENNI , KALLEINEN NEA , VAHLBERG TERO , VIRTANEN IRINA , POLO OLLI 
Published: December 2009

AbstractBackground. Decreased production of female hormones might explain the increased prevalence of sleep‐disordered breathing in postmenopausal women. Objectives. We evaluated, whether menopause has an impact on the manifestation of sleep‐disordered breathing in terms of signs, symptoms, and breathing pattern. Methods. The study was a cross‐sectional study utilizing a patient database, hospital records, sleep studies, and questionnaires. The hospital records and sleep studies were reviewed in 601 consecutive women studied between 1994 and 1998 in a university hospital pulmonary clinic. The records were completed with questionnaires. Results. Nocturnal breathing abnormalities covered a greater proportion of the night in postmenopausal than in premenopausal women (68.1% versus 35.8% of time in bed, p<0.0001), and the prevalence of sleep‐disordered breathing tended to be higher (86.2% versus 79.4% of time in bed, p = 0.057). The body mass indices and the major symptoms of sleep‐disordered breathing were similar in pre‐ and postmenopausal women. Postmenopausal women had less nasal congestion (p<0.001) than premenopausal ones. Body mass index was a significant explanatory factor of daytime sleepiness. Conclusions. Post‐ and premenopausal women present with similar signs and symptoms when referred to sleep studies. However, sleep‐disordered breathing is more severe in postmenopausal than in premenopausal women.
Is sonographic assessment of cervical length better than digital examination in screening for preterm delivery in a low‐risk population?
Authors: MATIJEVIC RATKO , GRGIC OZREN , VASILJ OLIVER 
Published: December 2009

AbstractBackground. This randomized controlled trial compared the diagnostic accuracy of the sonographic assessment of cervical length and clinical digital examination of the cervix in the second trimester regarding the prediction of preterm delivery in a low‐risk population. Methods. In total, 282 unselected, asymptomatic women with singleton pregnancy randomly underwent sonographic cervical length measurement (study group, n = 138) or clinical digital examination (control group, n = 144) in the second trimester. In the study group cervical length ≤5th percentile (≤24 mm) for our population was defined as shortened. In the control group, Bishop score ≥95th percentile (≥4) for our population was defined as high. The primary outcome measure was the diagnostic accuracy of both tests regarding the prediction of preterm delivery (<37 weeks). Results. Shortened cervical length was found in 6/138 (4.3%) women whereas the high Bishop score was found in 17/144 (11.8%) (p = 0.038, Fisher's exact test). The incidence of preterm delivery was 5.7% (16/282). Regarding the prediction of preterm delivery, shortened cervical length and high Bishop score had sensitivity 57.1% versus 33.3% and positive predictive value 66.7% versus 17.6%. Shortened cervical length in comparison with high Bishop score had 12‐fold higher positive likelihood ratio for preterm delivery in a low‐risk population (37.4; 95%CI [8.2–170.7] versus 3.2; 95%CI [1.1–9.2]). Conclusion. Sonographic assessment of cervical length has better diagnostic accuracy in the prediction of preterm delivery compared to digital examination in a low‐risk population.