bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost‐minimisation analysis of vaginal wall repair in an inpatient or outpatient regimen
Authors: SØRENSEN JAN , AXELSEN SUSANNE MAIGAARD 
Published: May 2007

AbstractBackground. The study's objective was to compare the cost of vaginal wall repair under local anesthesia, undertaken in either an inpatient or an outpatient regimen. The perspective used was that of a department of gynecology over the short and medium term.Methods.The analysis was based on 2 consecutive cohorts of inpatients and outpatients treated in a Danish university hospital. Data on resource use were collected from clinical records and via a patient telephone survey. Salary and drug costs were estimated from national sources. Costs for consumables, complications and overnight stays were estimated from local data. The analysis compared the costs of inpatient and outpatient surgery relating to staff time, anesthesia, operation, recovery, overnight stays and complications. Multiple regression was employed to adjust for confounding variables.Results.The average cost was estimated to be 10,400 DKK per inpatient and 6,100 DKK per outpatient (2004 price level: 1€ = 7.50 DKK). Costs relating to overnight stays and staff costs during operation were the largest contributors to the cost difference. Total cost was significantly associated with type of regimen (in‐ or outpatient), type of operation and complications. After adjustment for confounding variables, the cost difference was estimated at 3,700 DKK (95% bootstrap confidence interval: 2,500–5,000 DKK). The risk of complication was similar for the 2 regimens.Conclusion.Vaginal wall repair under local anesthesia, undertaken in an outpatient regimen, appears to be less costly than in an inpatient regimen.
Suboptimal care in stillbirths – a retrospective audit study
Authors: SAASTAD ELI , VANGEN SIRI , FRØEN J FREDERIK 
Published: May 2007

AbstractBackground. Stillbirth rates have decreased radically over the last decades. One reason for this is improved perinatal care. The aim of this study was to explore whether sub‐optimal factors in stillbirths were more frequent among non‐western than western women. Methods. Population‐based perinatal audit of 356 stillbirths after gestational week 23, in 2 Norwegian counties during 1998–2003 (4.2 per 1,000 deliveries); of these 31% were born to non‐western women. By audit, the stillbirths were attributed to optimal or sub‐optimal care factors. Multivariate methods were used to analyse the data. Results. Sub‐optimal factors were identified in 37% of the deaths. When compared to western women, non‐western women had an increased risk of stillbirth (OR: 2.2; 95% CI: 1.3–3.8), and an increased risk of sub‐optimal care (OR: 2.4; 95% CI: 1.5–3.9). More often, non‐western women received sub‐optimal obstetric care (p<0.001), as e.g. failure to act on non‐reassuring fetal status or incorrect assessment of labour progression. A common failure in antenatal care for both groups was unidentified or inadequate management of intrauterine growth restriction or decreased fetal movements. Non‐western women were less prone to attend the program for antenatal care or to take the consequences of recommendations from health professionals. Inadequate communication was documented in 47% of non‐western mothers; an interpreter was used in 29% of these cases. Conclusions. Non‐western women constituted a risk group for sub‐optimal care factors in stillbirths. Possibilities for improvements include a reduction of language barriers, better identification and management of growth restriction for both origin groups, and adequate intervention in complicated vaginal births; with increased vigilance towards non‐western women.
Cesarean section on maternal request: reasons for the request, self‐estimated health, expectations, experience of birth and signs of depression among first‐time mothers
Authors: WIKLUND INGELA , EDMAN GUNNAR , ANDOLF ELLIKA 
Published: May 2007

AbstractObjective. The purpose of this study was to investigate first‐time mothers undergoing cesarean section in the absence of medical indication, their reason for the request, self‐estimated health, experience of delivery, and duration of breastfeeding. We also aimed to study if signs of depression postpartum are more common in this group. Method. In a prospective cohort study 357 healthy primiparas from two different groups, “cesarean section on maternal request” (n = 91) and “controls planning a vaginal delivery” (n = 266) completed three self‐assessment questionnaires in late pregnancy, two days after delivery and 3 months after birth. Symptom scores from the Edinburgh postnatal depression scale at three months after birth were also investigated. Results. Women requesting cesarean section experienced their health ass less good (p<0.001) and were more often planning for one child only (p<0.001). They more often reported anxiety for lack of support during labor (p<0.001), for loss of control (p<0.001), and concern for fetal injury/death (p<0.001). After planned cesarean section women in this group reported a better birth experience compared to women planning a vaginal birth (p<0.001). They were breastfeeding to a lesser extent three months after birth (p<0.001). There were no differences in signs of postpartum depression between the groups three months after birth (p = 0.878). Conclusion. The knowledge gained from this study may help in understanding why some women prefer to give birth with elective cesarean section. It also elucidates the need for awareness of professional support during vaginal birth.
Effects of maternal central hemodynamics on fetal heart rate patterns
Authors: TAMÁS PETER , SZILÁGYI ANDRÁS , JEGES SÁRA , VIZER MIKLÓS , CSERMELY TAMÁS , IFI ZSOLT , BÁLINT ANDRÁS , SZABÓ ISTVÁN 
Published: May 2007

AbstractBackground. This study was undertaken to evaluate the effects of maternal central hemodynamics on fetal heart rate patterns near term, with special regard to the maternal body position. Methods. Brief non‐stress test and bioimpedance cardiography were carried out in the supine position, then repeated in a full left lateral decubitus position of mothers with singular, 36–39 week‐old normal pregnancies in 106 cases. Computer‐aided data were processed by SPSS statistic program. Results. Due to the appearance of inferior vena cava syndrome, examinations had to be interrupted in 6 cases. Analysis of 100 complete registrations revealed a significantly increased number of accelerations, overall and short‐term variations, and longer high episodes with lower basal fetal heart rates were found in the lateral decubitus than in the supine maternal position. Turning to the left resulted in a significant increase of the stroke volume; however, due to decreasing pulse rate, the cardiac output remained unchanged. Parameters of non‐stress test showed correlations to hemodynamic indices. In the supine position, the short‐term variation correlated with cardiac output (r = 0.232, p = 0.020); in the left lateral position, the number of accelerations correlated with stroke volume (r = 0.221, p = 0.027) and cardiac output (r = 0.220, p = 0.028). Changes of stroke volume due to altered body position correlated to similar changes of overall variation (r = 0.264, p = 0.018), and marginally to those of short‐term variation (r = 0.221, p = 0.051). Conclusion. Maternal central hemodynamics influences fetal heart rate patterns in connection with different maternal body position.
Self‐administered measurement of symphysis‐fundus heights
Authors: BERGMAN EVA , KIELER HELLE , PETZOLD MAX , SONESSON CHRISTIAN , AXELSSON OVE 
Published: May 2007

AbstractBackground. Antenatal identification of infants small for gestational age (SGA) improves their perinatal outcome. Repeated measurement of symphysis‐fundus (SF) heights performed by midwives is the most widespread screening method for detection of SGA. However, the inefficiency of this method necessitates improved practices. Earlier start and more frequent SF measurements, which could be accomplished by self‐administered measurements, might improve the ability to detect deviant growth. The present study was set up to evaluate whether pregnant women can reliably perform SF measurements by themselves.Method. Forty healthy women with singleton and ultrasound‐dated pregnancies from 2 antenatal clinics in Uppsala, Sweden, were asked to perform 4 consecutive SF measurements once every week, from 20 to 25 weeks of gestation until delivery. The self‐administered SF measurements were recorded and systematically compared with midwives’ SF measurements.Results. Thirty‐three pregnant women performed self‐administered SF measurements over a 14‐week period (range: 1–21). The SF curves constructed from self‐administered SF measurements had the same shape as previously constructed population‐based reference curves. The variance for self‐administered SF measurements was higher than that of the midwives.Conclusions. Pregnant women are capable of measuring SF heights by themselves, but with higher individual variance than midwives. Repeated measurements at each occasion can compensate for the higher variance. The main advantage of self‐administered SF measurements is the opportunity to follow fetal growth earlier and more frequently.
Sequence variants in exons of the BMP‐15 gene in Chinese patients with premature ovarian failure
Authors: ZHANG PENG , SHI YU‐HUA , WANG LAI‐CHENG , CHEN ZI‐JIANG 
Published: May 2007

AbstractBackground. The bone morphogenetic protein‐15 (BMP‐15) gene is thought to be one of the important candidate genes involved in premature ovarian failure (POF). However, to date, there has been no consensus on the relationship between mutations in BMP‐15 and ovarian dysfunction. Objective. To analyse mutations in the BMP‐15 gene in Chinese women with POF. Materials and methods. We sequenced the BMP‐15 gene protein coding region of 92 patients and 76 healthy controls that cycle regularly. Results. No mutations were found in the BMP‐15 gene protein coding region. There was no difference in the incidence of single nucleotide polymorphism (SNP) rs 17003221 (C→T) in exon 2 (p>0.05), or SNP rs (3810682C→G: ss16336587) in the putative promoter region of exon 1, between the two groups. However, the allele gene frequency in SNP rs (3810682C→G: ss16336587) was C (97.92%) and G (2.08%), respectively, in Chinese women, which is different from other races. Conclusions. Our findings indicate that mutations in BMP‐15 exons, or changes in BMP‐15 pro‐peptide, are rare in Chinese women with POF. In addition, our data suggest that the 2 SNPs are not related to POF in Chinese women, while providing evidence for SNP variation between different races.
Extraperitoneal laparoscopic para‐aortic lymphadenectomy as a diagnostic procedure for lymph node recurrence of gynaecological cancers
Authors: SANJUÁN A. , ILLA M. , TORNÉ A. , MARTÍNEZ ROMÁN S. , JURADO M. , LEJARCEGUI J.A. , PAHISA J. 
Published: May 2007

AbstractObjective. The aim of this study was to evaluate the feasibility of extraperitoneal laparoscopic para‐aortic lymphadenectomy for lymph node recurrence of gynecological cancers. Methods. Seven patients underwent extraperitoneal laparoscopic para‐aortic lymphadenectomies for suspected lymph node recurrence, detected by magnetic resonance image or CT scan. The suspicious nodes were removed through an extraperitoneal laparoscopic approach. Results. The median age of patients was 51 years (range: 39–67). The median operating time was 207 min (range 120–300). There were no intraoperative or postoperative complications. The median nodal yield was 7.3 (range: 1–15). The median hospital stay was 2.5 days (range: 2–3). Histological examination revealed metastasis in 6 of the 7 patients. Conclusion. The extraperitoneal laparoscopic para‐aortic lymphadenectomy for lymph node recurrence of gynecological cancers is a safe and feasible procedure which should be considered in the case of possible recurrence.
New insights into fatigue and health‐related quality of life after delivery
Authors: JANSEN A.J. GERARD , DUVEKOT JOHANNES J. , HOP WIM C.J. , ESSINK‐BOT MARIE‐LOUISE , BECKERS ERIK A.M. , KARSDORP VERONIQUE H.M. , SCHERJON SICCO A. , STEEGERS ERIC A.P. , VAN RHENEN DICK J. 
Published: May 2007

AbstractBackground. A delivery has a major impact on the health‐related quality of life (HRQoL) of the new mother, especially on fatigue. A common complication during delivery that might have a relationship with maternal morbidity is blood loss. The objectives were to investigate fatigue and HRQoL in women after vaginal delivery (VD), elective caesarean section (CS) and emergency CS, and its relationship with postpartum hemoglobin (Hb) levels during the first 6 weeks postpartum. Methods. Some 141 patients (71 after VD, 36 after elective CS and 34 after emergency CS) completed the HRQoL questionnaires MFI and EQ‐5D between 12 and 24 h after VD and 24–48 h after CS (t = 0). At 1, 3 and 6 weeks postpartum these questionnaires were repeated, together with the SF36. Results. Patients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and >6 weeks after emergency CS. Mean mental HRQoL scores of the study groups were similar or even better compared to reference values. The significant correlation between Hb level and mean physical HRQoL scores found at t = 0 had disappeared at 1 week postpartum. Conclusions. Results of this study provided insights into the natural course of fatigue and HRQoL postpartum. Important differences in fatigue and HRQoL scores were observed between the 3 modes of delivery. These HRQoL measures can be used in future clinical trials to assess the effects of interventions postpartum.
Sentinel node and vulvar cancer: a series of 47 patients
Authors: NYBERG REITA H. , IIVONEN MARJO , PARKKINEN JYRKI , KUOPPALA TAPIO , MÄENPÄÄ JOHANNA U. 
Published: May 2007

AbstractBackground. There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer. Methods. All charts of the patients operated on for vulvar cancer at Tampere University Hospital from January 1, 2001 through June 30, 2005 were retrospectively reviewed. Demographic, clinical, and histopathological information was collected from each patient. The sentinel lymph node mapping was done intraoperatively either with a combination of the radioisotope and dye techniques (40 patients) or with the dye technique alone (7 patients). The sentinel lymph node was dissected separately for histopathological evaluation, and then a routine inguinal lymphadenectomy was performed. Results. The final FIGO surgical Stage distribution was: Stage I, 11 (23%); Stage II, 14 (30%); Stage III, 21 (45%); and Stage IV, 1 (2%). Sentinel lymph node was identified in 46 (98%) women with either one or both of the methods. In Stage I–II, the sentinel lymph node identification rate was 25/25 (100%) with the combined method. The only patient with unidentified sentinel lymph node had lymphatic spread beyond inguinal area or Stage IV disease. Eighteen of the sentinel lymph nodes (39%) were positive for tumor cells, and in 5 cases additional metastatic nodes were found. One patient with macroscopically enlarged metastatic inguinal nodes and Stage III disease had a negative sentinel lymph node. In the 25 patients with Stage I–II disease, the false‐negative rate of the sentinel lymph node method was 0/4, giving a negative predictive value of 1.00. Conclusions. A sentinel node identification rate of 98% with a false‐negative rate of 0% in the patients with Stage I–II disease is an encouraging finding.
Surgery of borderline tumors of the ovary: retrospective comparison of short‐term outcome after laparoscopy or laparotomy
Authors: ØDEGAARD ELIN , STAFF ANNE CATHRINE , LANGEBREKKE ANTON , ENGH VIBEKE , ONSRUD MATHIAS 
Published: May 2007

AbstractBackground. Laparoscopic management of borderline ovarian tumors is controversial. Objective. To retrospectively compare outcome after surgery by laparoscopy or laparotomy for borderline tumors. Methods. Ovarian tumors from all women operated at Ullevål University Hospital during a five‐year period were re‐evaluated histologically. Patients with borderline FIGO (International Federation of Gynaecology and Obstetrics) stage I tumors were retrospectively compared regarding surgery outcome following laparoscopy or laparotomy. Results. Histological re‐evaluation revealed only 3 misclassifications in 608 patients. Borderline tumors represented 36% of epithelial ovarian malignancies. The 107 borderline stage I included 52 serous, 53 mucinous, and 2 endometrioid tumors. Thirty‐eight patients were operated on primarily by laparoscopy and 69 by laparotomy (including 14 women starting with laparoscopy). In the laparoscopy group, more women were premenopausal (63% versus 35%, p = 0.01) and median tumor diameter was smaller (8.6 versus 16.4 cm, p<0.001) as compared to the laparotomy group. When tumor diameter exceeded 10 cm, intraoperative tumor rupture was significantly more frequent during laparoscopy than during laparotomy (p = 0.01). Less postoperative complications were seen after laparoscopic operations (p = 0.034), but laparoscopic surgeries were less extensive, without hysterectomy, as compared to laparotomy. During the 14–78 months follow‐up time, no relapse occurred in either group. After fertility‐sparing surgery, there was no statistical significant difference regarding successful pregnancies between the two groups. Conclusions. Laparoscopic treatment of borderline ovarian tumors is feasible if tumor is of moderate size (diameter below 10 cm), gives fewer complications, and shorter hospital stay. Long‐term follow‐up of larger materials is needed to determine the ultimate recurrence risk as well as fertility rates.
Accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion in patients with endometrial cancer
Authors: TRAEN KOEN , HØLUND BERIT , MOGENSEN OLE 
Published: May 2007

AbstractBackground and aims. Preoperative prediction of metastases to the regional lymph nodes in women with endometrioid endometrial cancer is a challenge. According to the Danish Gynaecological Cancer Society guidelines, a pelvic lymphadenectomy is warranted in all poorly differentiated tumors and all stage Ic disease. We have evaluated the accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion, in predicting the need for a pelvic lymphadenectomy. Methods. Preoperative tumor grade and intraoperative gross examination of myometrial invasion were prospectively registered in 72 women with stage I endometrioid endometrial cancer, operated between 1 September 2004 and 18 April 2006. The pre‐ and intraoperative findings were compared with the final pathology report. Results. The preoperative prediction of grade (well, moderate or poorly differentiated) was correct in 96% (69/72) of the patients. Gross examination of myometrial invasion correctly differentiated between stage Ia, Ib, and Ic disease in 89% (64/72) of the patients. The combination of preoperative tumor grade and intraoperative gross examination of myometrial invasion, led to wrong clinical decisions in 11% (8/72) of the patients. Three ‘unnecessary’ lymphadenectomies were performed, and 5 patients were primary operated upon without ‘warranted’ lymphadenectomy. Conclusions. Our data suggest that preoperative tumor grade and intraoperative gross examination of the uterus provide useful information for pre‐and intraoperative planning of pelvic lymphadenectomy. However, wrong decisions were made in 11% of the patients, and more reliable evaluation methods are needed.
Misoprostol‐only versus mifepristone plus misoprostol in induction of labor following intrauterine fetal death
Authors: VÄYRYNEN WILMA , HEIKINHEIMO OSKARI , NUUTILA MIKA 
Published: May 2007

AbstractBackground. Both misoprostol‐alone and a combination of mifepristone plus misoprostol have been used in induction of labor in cases of intrauterine fetal death (IUFD). Methods. Data from 130 women with IUFD at 21–42 weeks of gestation were analysed retrospectively. A total of 82 women received 100 μg (median) of misoprostol at 4‐h intervals. Some 48 women received 200 mg of mifepristone, followed 19 h (median) later by single doses of 25 μg of misoprostol at 4‐h intervals. Results. The induction‐to‐delivery time did not differ between the groups (13.3 versus 12.8 h). However, between 21 and 25 weeks of gestation, the induction‐to‐delivery time was shorter with the combination regimen (p = 0.04). The total dose of misoprostol needed was lower in the group pre‐treated with mifepristone (p = 0.0028). The 2 groups did not differ as regards complications experienced during labor and delivery. Conclusions. Both regimens, misoprostol‐only and the combination of mifepristone and misoprostol, are effective and safe in induction of labor after IUFD. Pre‐treatment with mifepristone is more effective at earlier gestational weeks.
Synergistic effect of renin‐angiotensin system and nitric oxide synthase genes polymorphisms in pre‐eclampsia
Authors: BENEDETTO CHIARA , MAROZIO LUCA , CICCONE GIOVANNINO , CHIEPPA GIUSEPPINA , QUAGLIA MARCO , MATULLO GIUSEPPE , BERTOLA LAURA , GUARRERA SIMONETTA , CARTURAN SONIA , STRATTA PIERO 
Published: May 2007

AbstractBackground. Components of the renin‐angiotensin system and endothelial nitric oxide synthase may co‐operate in spiral artery remodelling during placentation, and thus reduce the uteroplacental resistance typical of normal pregnancy. Since lack of such remodelling and abnormal placentation are specific features of pre‐eclampsia, it has been suggested that abnormal function of both components of the renin‐angiotensin system and endothelial nitric oxide synthase may be involved in its pathogenesis. However, previous studies of the association between pre‐eclampsia and polymorphisms of single genes encoding renin‐angiotensin system components and endothelial nitric oxide synthase have yielded conflicting results. The aim of this study was to assess if interactions among different polymorphisms of the renin‐angiotensin system and nitric oxide synthase are involved in the pathogenesis of pre‐eclampsia. Methods. Some 359 pregnant women were enrolled: 103 normotensive, 50 with chronic hypertension, 86 with gestational hypertension, and 120 with pre‐eclampsia. DNA analysis was performed to evaluate angiotensin‐converting enzyme I/D, angiotensin‐II receptor 1 1166A/C, angiotensinogen M235T and endothelial constitutive nitric oxide synthase 4b/a polymorphisms. Odds ratios (OR) with 95% confidence interval (CI) and χ2 tests were calculated. Results. The frequency of single gene polymorphisms was similar in each group. The frequency of pairs including the DD genotype of the angiotensin‐converting enzyme I/D polymorphism plus other homozygous genotypes was significantly higher in pre‐eclamptic patients than in controls (OR = 3.04, 95% CI = 1.16–7.93). Conclusions. Synergism of angiotensin‐converting enzyme I/D and other polymorphisms of renin‐angiotensin system components and nitric oxide synthase may be a risk factor for pre‐eclampsia.