bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of parity on birthweight using successive pregnancies
Authors: Wilcox Mark A. , Chang Allan M. Z. , Johnson Ian R. 
Published: November 2007

Objective. Accurate assessment of the difference in birthweight between first and second live‐births to the same woman having excluded the effects of physiological factors known to affect birthweight.Design. Retrospective longitudinal observational study.Results. The mean crude birthweight difference between first and second pregnancies was an increase of 138 g. Significant differences between the paired pregnancies were found in maternal booking visit weight, blood pressure, maternal age and gestation at delivery. Independent factors affecting difference in birthweight were gestation at delivery, maternal booking weight and baby's sex. Regression towards the mean was demonstrated which meant that a woman delivering a first baby weighing more than 3720 g could expect a lighter baby for her second delivery provided that all other factors remained constant.Conclusions. In general terms a woman is more likely to deliver a heavier baby in her second pregnancy than in her first pregnancy. However, maternal physiological factors differ in the two pregnancies and these differences have additional effects on birthweight. The effects of both these observations are tempered by regression towards the mean which has a profound influence in predicting the likely change in birthweight between first and second pregnancies. Clinical decisions should not be based on the assumption that a second baby will inevitably be heavier than the first baby.Setting. Three large obstetric units in the East Midlands of the United Kingdom. Subjects and methods. Women in whom data were recorded for their first two pregnancies on the UK East Midlands Obstetric database which resulted in the delivery of a liveborn, singleton and congenitally normal baby. Six thousand five hundred and thirty such cases were identified, of which 3457 had complete datasets and delivered both babies at term (259 to 300 days). An analysis was performed of changes between the paired pregnancies of physiological factors known to affect birthweight. Regression analyses were used to enable prediction of the second birthweight with the knowledge of the first birthweight.
How should we investigate women with postmenopausal bleeding?
Authors: Gupta Janesh Kumar , Wilson Sheena , Desai Pershant , Hau Cathy 
Published: November 2007

Objective. To evaluate the optimum method(s) of investigating women with postmenopausal bleeding.Design. Prospective study of 76 postmenopausal women. Setting. Teaching Hospital.Interventions. All women had pipelle endometrial biopsy in outpatient clinic. Prior to inpatient hysteroscopy and uterine curettage, each woman had pelvic ultrasonography to measure the endometrial thickness and to exclude ovarian pathology.Results. Pipelle biopsy was successful in 70% of cases and has a sensitivity of 70%. Hysteroscopy has superior diagnostic capabilities allowing direct visualisation of the endometrial cavity with directed biopsies. Endometrial thickness of >5 mm used as an indicator of endometrial pathology compared to uterine curettage has a sensitivity of 83%, a specificity of 77%, and a positive predictive value of 54%. Ultrasound also detected five ovarian tumors, two of which were malignant and three missed by pelvic examination alone.Conclusions. We recommend the routine use of pelvic ultrasonography in all women with postmenopausal bleeding as it is an invaluable diagnostic tool in excluding ovarian pathology. In addition, sampling of the endometrial cavity, preferably with outpatient hysteroscopy, is mandatory for histological diagnosis. Overall, the combination of ultrasound and outpatient endometrial sampling would spare hospital admission for at least 60% of women with postmenopausal bleeding.
Anticoagulant therapy in pregnancy
Authors: Lécuru Fabrice , Desnos Michel , Taurelle Roland 
Published: November 2007

Background To investigate the adverse effects of anticoagulant therapy during pregnancy in a tertiary care center.Material and methods A prospective study was carried out between 1 January 1977 and 31 December 1994 and included 54 pregnancies in 50 women treated with anticoagulants. In Group I (n=43) oral anticoagulants were replaced for heparin from the sixth until the end of the twelfth week of gestation. In Group II (n= 11) the pregnancy was diagnosed after the ninth week of gestation and acenocoumarol was not substituted. All patients received vitamine K antagonists during the second and third trimesters. Heparin was given after 36 weeks of pregnancy until the tenth day in the postpartum period. Statistical comparisons used Chi square test (with the Yates correction when appropriate) and Student t test. Results. Mechanical heart valve prosthesis was the most frequent indication (68%). There was one artificial heart valve thrombosis during first trimester in Group I and none in Group II (p=0.45). One spontaneous abortion occurred in each group (p=0.86). Seven cardiac complications (13.7%) occurred during the second and third trimesters. We recorded no thrombotic episode of an artificial heart valve after the first trimester of pregnancy. Hemorrhagic complications occurred in mid pregnancy (one case=2%) and during peripartum (eight cases=16%). Two maternal deaths occurred in the postpartum period, both were linked with the anticoagulant therapy. There was one coumarin embryopathy (Group II: 9%), but no neonatal mortality.Conclusions (1) Hemorrhagic complications occur among 16% of patients receiving anticoagulant therapy during pregnancy. (2) Delivery and postpartum are the most critical periods.
The occurrence of placental abruption in Norway 1967‐1991
Authors: Rasmussen Svein , Irgens Lorentz M. , Bergsjø Per , Dalaker Knut 
Published: November 2007

Study objective To study secular trends of placental abruption (PA), the effects of demographic variables and the use of cesarean section (CS) associated with PA.Design A population based cohort study.Setting The Medical Birth Registry of Norway.Patients 9.592 cases of PA of a total of 1.446,154 births notified, i.e. all births in Norway 1967‐1991.Main results The PA proportion was 6.6 per 1000 births of a gestational age of 16 weeks or more, ranging from 5.3 in 1971 to 9.1 in 1990. Birth order two had the lowest proportion and it increased by maternal age. The PA proportion decreased by gestational age from 86.4 per 1000 below 28 weeks to 3.4 in term pregnancies. The PA proportion per 10,000 pregnancies at risk increased from 1.3 in the 28th week to 14.1 in the 42nd week. A secular trend of a decreasing but still high relative risk of PA in SGA‐births (< the 10 birthweight percentiles) and larger infants in PA‐cases was noted. To an increasing extent, PA‐cases in university hospitals were referred cases. The CS rates in PA‐births at any gestational age increased from 1967 through 1991. The relative risk of PA of Apgar score <7 after five mintues, adjusted for gestational age, was 7.8.Conclusions Inspite of an increasing CS rate, an increasing proportion of PA was noted from 1967 through 1991. The proportion was lowest for birth order two and increased by maternal age. To an increasing extent. PA births were centralised. SGA. prematurity and asphyxia were major problems associated with PA. A tendency towards larger infants and a decreasing relative risk of PA in SGA‐births might be attributable to improvements in antenatal care.
Perinatal mortality and case fatality after placental abruption in Norway 1967‐1991
Authors: Rasmussen Svein , Irgens Lorentz M. , Bergsjø Per , Dalaker Knut 
Published: November 2007

Study objective To study national secular trends in Norway of perinatal mortality and case fatality due to placental abruption (PA) and associations with cesarean section (CS).Design A population based cohort study.Setting The Medical Birth Registry of Norway.Patients 9,592 cases of placental abruption (PA) of a total of 1,446,154 births notified in Norway 1967‐1991.Main measures Comprehensive perinatal mortality (all stillbirths ≥ 16 weeks of gestation and early neonatal deaths) and standard perinatal mortality (all stillbirths ≥ 28 weeks of gestation and all early neonatal deaths). Case fatality rate.Main results From 1967 through 1991, the standard perinatal mortality rate due to placental abruption (PA) in Norway decreased from 2.5 per 1000 births (13.5% of all deaths) in 1967 to 0.9 (13.2%) in 1991. The comprehensive perinatal mortality rate decreased from 3.2 to 1.7 per 1000. The proportion of all perinatal deaths due to PA increased from 11.4% in 1967‐1971 to 13.9 in 1987‐1991. The case fatality rate decreased from 470.8 per 1000 cases in 1967‐71 to 217.0 in 1987‐91 and decreased in all gestational age categories. Case fatality in PA with cesarean section (CS) was generally lower than in PA without CS, regardless of gestational age.Conclusions Placental abruption is an important cause of perinatal mortality in Norway. Our results are in favor of an active approach with frequent use of cesarean section, also at lower gestational ages. The decreasing case fatality rate by year of birth in all gestational age groups may be attributed to improved obstetric and perinatal care.
The intensity of labor pain in grand multiparas
Authors: Ranta P. , Jouppila P. , Jouppila R. 
Published: November 2007

Background The purpose of the current study was to investigate differences in pain experiences and requirements for pain control in parturients with different birth experience. Previous studies have shown that the labor pain experience is significantly less intense in multiparas than in primiparas and requirements for analgesic treatment have therefore been assumed to be minimal in this group.Methods The pain experience during labor was assessed by 70 consecutive grand multiparas (a minimum of five previous deliveries) compared to that of primiparous (n = 70) and II‐V parous women (n = 70). Pain intensity was repeatedly assessed on a pain intensity scale (0‐10) according to the progress of cervical dilatation at the first and second stage of labor. Results. During the latent phase of cervical dilatation (0 to 3 cm) grand multiparas had a median pain score of 3 compared to 4 in II‐V paras and 6 in primiparas (p < 0.001). At the end of the first stage and during the second stage the intensity of pain in grand multiparas was significantly higher compared to that in primiparas (median scores 7 to 8 vs 6 to 7, p < 0.05). Epidural blocks were administered to 40% of primiparas, 3% of II‐V paras and to no grand multiparas (p < 0.0001). Twenty‐one percent of grand multiparas rated their pain as intolerable (pain scores 9 to 10) during the second stage compared to 10% of primiparas (p < 0.05). On the third day after delivery. 47% of grand multiparas regarded their analgesia insufficient.Conclusions The majority of parturients, including grand multiparas, suffered from intense pain during labor. After delivery, a significant number of grand multiparas felt that they had received insufficient pain relief.
Plasma lipids, lipoproteins and apolipoproteins in hirsute women
Authors: Castelo‐Branco Camil , Casals Elena , de Osaba Maria J. Martinez , Sanllehy Carolina , Fortuny Albert 
Published: November 2007

Objective To determine whether lipid alterations in hirsute women are due to excessive androgen, low estrogen or to a combination of these abnormalities. Design. Cross sectional study.Patients Forty‐five hirsute women between 15 and 39 years of age.Main outcome measures FSH, LH, 17β‐estradiol, PRL, testosterone, androstenedione, DHEAS, 17‐OH‐progesterone, sex hormone binding globulin, cholesterol, LDL, HDL, triglycerides, and apolipoproteins A‐I and B.Results Testosterone was correlated with triglycerides (r: 0.76, p < 0.01), HDL (r: −0.61, p < 0.01) and LDL (r: 0.50, p < 0.05). Both HDL (r: 0.66, p < 0.01) and LDL (r: −0.57, p < 0.01) were correlated with estradiol. Total cholesterol was also correlated with estradiol (r: −0.52, p < 0.05). Cross adjusted correlations revealed that, after adjusting for estradiol, lipids were associated with testosterone and that estradiol was also correlated with lipids when adjusted for testosterone.Conclusion The results suggest that altered lipids in women with hyperandrogenism could result from independent effects of androgens and estrogens.
Ocular hypertensive effect of menopause with and without systemic hypertension
Authors: Qureshi Imran Ahmad 
Published: November 2007

Background Mean intraocular pressure in postmenopausal women is higher than that in menstruating women. Intraocular pressure is positively correlated with systemic blood pressure. No previous study has compared intraocular pressure in postmenopausal women with systemic hypertension and those without.Purpose To investigate the effects of menopause on intraocular pressure in subjects with and without high blood pressure, after eliminating those factors that can affect intraocular pressure.Methods Normotensive menstruating and menopausal, along with hypertensive menopausal subjects of the same age groups were studied. Intraocular pressure was measured with the Goldmann applanation tonometer.Results The mean intraocular pressure of the normotensive and hypertensive postmenopausal women were 0.73 ≥ 0.27 (p < 0.05). and 1.09 ≥ 0.34 (p < 0.01) mmHg higher than normotensive menstruating women respectively. The mean intraocular pressure of hypertensive postmenopausal women was 0.36 ≥ 0.15 mmHg (p < 0.05) higher than that of normotensive postmenopausal women.Conclusions Menopause significantly increases intraocular pressure. Mean intraocular pressure of hypertensive postmenopausal women was significantly (p < 0.05) higher than that of normotensive postmenopausal women. Knowledge of the normal level of intraocular pressure during various stages of female sexual life may help glaucoma screeners.
Symptomatic genital papillomavirus infection in a community
Authors: Persson Göran , Andersson Karin , Krantz Ingela 
Published: November 2007

Background Incidence of condyloma acuminatum is not well known. Descriptive data are usually based on selected groups of patients. This study aims at giving incidence of the clinically defined disease in a well‐defined area, thought to be representative for Sweden outside the capital city.Methods Data from people with condyloma acuminatum seeking medical attention were collected during a two‐year period, 1989‐90, in a middle‐sized urban area in Sweden. A person with symptoms and a clinical picture consistent with condyloma was considered a case.Results Overall incidence was 2.4 per 1,000. The highest age specific incidence occurred in the age group 20‐24 years, 12 per 1,000. Women 15‐19 years old had an incidence of 14 per 1.000. The total female to male ratio was 1.3.Conclusions Women more often than men had a mixture of exo‐ and endophytic condylomata. Condyloma as another and complementary indicator of changing sexual behavior deserves further interest.
Fetal fibronectin and microorganisms in vaginal fluid of healthy pregnant women
Authors: Goffeng Anette Rossel , Holst Elisabet , Milsom Ian , Lindstedt GÖRan , Lundberg Per‐Arne , Anders BjÖRn 
Published: November 2007

Objective. To determine fetal fibronectin in vaginal fluid from healthy women during uncomplicated pregnancy and to investigate possible relationships to gestational age and the vaginal microflora.Materials and methods. Samples of vaginal fluid were collected for fetal fibronectin determination and for quantitative aerobic and anaerobic microbiological culture from 22 women followed longitudinally at 12, 28 and 37 weeks gestation and cross‐sectionally in women at 12 weeks (n=10), 28 weeks (n=10), 37 weeks (n=10), and 39 weeks (n=30) gestation, respectively. Fetal fibronectin was determined by a quantitative enzyme immunoassay (Adeza Biomedical).Results. There were no significant differences between the concentrations of fetal fibronectin in vaginal secretions at any of the four measurement points (12, 28, 37 and 39 weeks gestation). Women with elevated fetal fibronectin concentration (0.05 mg/L) had less often hydrogen peroxide‐producing facultative lactobacilli (p<0.0001), and more often bacterial vaginosis (p<0.02) and Peptostreptococcus species (p<0.002). Bacterial vaginosis (p<0.01) and Candida albicans (p<0.01) were more frequently found in women lacking hydrogen peroxide‐producing lactobacilli.Conclusion. Fetal fibronectin in vaginal fluid was more associated with the vaginal microflora than with the gestational age of the pregnancy. Presence of hydrogen peroxide‐producing lactobacilli seems to be the most important factor for a stable vaginal microflora.
HPV‐types, cytological and histopathological findings in three groups of women with possible HPV‐related disease
Authors: Frederiksson Agneta , Larson Barbro , Persson Elisabeth , Auer Gert , Johansson Bo , Kalantari Mina , Von Krogh Geo , Silfverswärd Claes 
Published: November 2007

Objective. The aim of this investigation was to study three groups of women presenting with possible HPV‐infection with regard to HPV‐types and cervical dysplasia.Methods. Eighty women were included. Eighteen of them were present partners to men with condylomas, 20 had clinical vulvar HPV‐lesions and 42 were referred due to an abnormal PAP‐smear. Samples for HPV‐analysis by PCR‐technique were taken from the vulva, the por‐tio and the cervical canal. A universal HPV‐primer as well as specific primers for HPV 6/11, 16,18, 31 and 33 were utilized. PAP‐smears were taken as well as biopsies from cervix/portio.Results. Seventy‐eight percent had HPV‐DNA identified. Sixty‐seven percent of those with HPV 16 and/or 18 had dysplasia verified by histopathology and 50% of those with 31 and/or 33. Twenty of 21 women with dysplasia had HPV 16, 18, 31 and/or 33 identified. One woman with dysplasia was HPV‐negative. Histopathologically verified CIN were diagnosed in all groups investigated. Women referred for suspicion of CIN significantly more often had HPV detected at the cervix/portio. HPV 6/11 was mostly found in women with condylomas. Apart from this the occurrence of the different HPV types were alike in the three groups.Conclusion. Infection with HPV is a process and the usefulness of different diagnostic methods seems to depend on when during the course of the disease they are used. HPV‐findings in women with dysplasia were all associated with oncogenic virus‐types. High‐risk virus was often found simultaneously with low‐risk virus indicating a covariation in the acquisition of the different HPV‐types.
Transcervical resection of endometrium and fibroids: The outcome of 412 operations performed over 5 years
Authors: Istre Olav 
Published: November 2007

Objective. To evaluate the value of transcervical resection of endometrium and fibroids in clinical practice.Study design. A retrospective review of operative details of 412 transcervical resections of endometrium and fibroids and clinical outcome from 387 procedures performed over five years is reported.Material and methods. Patients referred due to bleeding disturbance, treated with a standard urological resectoscopes, controlled after 6 and 12 months. Subsequent follow up was performed by questionnaire and patient bleeding diary.Results. Operative complications (perforation, hemorrhage, absorption of more than 1500 ml glycine irrigating fluid) arose in 72 patients (18%). In 52 (14.4%) of 366 patients the outcome was not considered acceptable by either ourselves or the patients. This led to a repeat resection procedure being performed in 31 cases (9.0%) with favorable result in 21(68%) of these cases. Twenty‐one patients (6.1%) underwent a hysterectomy because of a persistently poor outcome. A favorable outcome was then reported in subsequent follow up of 335 patients (91%). In addition, pain associated with menstruation was reduced after the procedure and correlates with achieved result on bleeding intensity.Conclusion. Endometrial resection is safe and acceptable treatment option for both menorrhagia and metrorrhagia associated with dysmenorrhoea.
Gastrin levels in mothers and neonates at delivery in various perinatal conditions
Authors: Morán Carlos , Carranza‐lira Sebastián , Ochoa Raquel , Martínez Juan C. , Herrera Moisés , Fonseca Eugenia , Zárate Arturo 
Published: November 2007

Background. This study was designed to assess the variations of gastrin (Ga) serum levels in mothers and newborns at birth in some perinatal disorders.Materials and methods. Ga levels were measured by RIA in maternal serum, amniotic fluid and cord sera of newborns in 55 cases with the following conditions: normal pregnancy and eutocic vaginal delivery (n=8), repeat cesarean section (n=10), and cardiotogographic register suggestive of fetal compromise (n=15), cephalopelvic disproportion (n=8), preeclampsia (n=7) and postdate pregnancy (n=7). Statistical analysis was performed by Mann‐Whitney U test.Results. Ga levels in cord sera of newborn and amniotic fluid in normal pregnancy and eutocic delivery were significantly higher (p<0.02 and p<0.01, respectively) than those found in patients with repeat cesarean operation. Serum Ga concentrations in women with postterm pregnancy were significantly higher (p<0.02) than in women with prior cesarean section. Ga levels in amniotic fluid samples in the presence of suspected fetal compromise and postdate pregnancy were significantly higher (p<0.001) than those observed in women who had repeat cesarean operation.Conclusion. Vaginal delivery and perinatal pathology may induce hypergastrinemia in both mother and neonate at birth.
Intraamniotic infection in patients with preterm labor and twin pregnancies
Authors: Mazor Moshe , Hershkovitz Reli , Ghezzi Fabio , Maymon Eli , Horowitz Shulamith , Leiberman Joseph Reuben 
Published: November 2007

Background. Microbial invasion of the amniotic cavity plays a major role in the pathogenesis of preterm labor and delivery in singleton pregnancy. Nevertheless, this association is not well established among patients with multiple gestations. The purpose of our study was to explore the role of intraamniotic infection in the setting of twin pregnancies.Methods. Consecutive women with twin gestations, intact membranes and preterm labor who underwent transabdominal amniocentesis under sonographic guidance. Amniotic fluid (AF) was retrieved from both sacs and cultured for aerobic and anaerobic microorganisms as well as for Mycoplasma species. Intraamniotic infection was defined as a positive AF culture for microorganisms. Mann Whitney U test or Student r‐test or Fisher's exact test were utilized for analysis.Results. Amniotic fluid was obtained from 74 patients. Sixty‐eight women delivered prematurely (91.9%). Amniotic fluid culture results were positive for microorganisms in nine cases and all women with intraamniotic infection delivered prematurely as well as 59 (90.7%) patients with negative culture. Among the nine patients with intraamniotic infection, microorganisms were isolated from the presenting sac in five cases (55.6%), from both sacs in three patients (33.3%) and from the upper sac in the remaining case (11.1%). Patients with a positive AF culture had a more advanced cervical dilatation, a shorter interval amniocentesis‐to‐delivery and a higher incidence of clinical chorioamnionitis than those with a negative AF culture.Conclusions. The prevalence of intraamniotic infection and clinical and histological chorioamnionitis in twin pregnancies and preterm labor is similar to singleton pregnancies and preterm labor. Therefore, women with multiple gestations and preterm labor should be managed as singleton pregnancies.