bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective comparison of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence
Authors: Su Tsung‐Hsien , Wang Kuo‐Gon , Hsu Chin‐Yuan , Wei Hsiao‐Jui , Hong Bin‐Kuan 
Published: March 2008

Objective. To compare prospectively the results of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence and to evaluate the efficacy, technique, and functional and anatomical changes after these two procedures.Materials and methods. Ninety‐two patients with urodynamically proven genuine stress incontinence participated in this study, with 46 patients randomly allocated to laparoscopic colposuspension, and the other 46 patients to the traditional procedures. All patients had repeat studies at least 3 months after operation.Results. The bladder neck position was significantly elevated after operation either at rest or during straining in both groups (all p<0.001), but it was higher in the traditional group than the laparoscopy group during straining (p<0.05). Comparison of urodynamics before and after operation in both groups showed significantly increased minimal urethral resistance and improved pressure transmission ratios at the proximal urethra (Q2). The blood loss was less in the laparoscopy group. The duration of bladder drainage after laparoscopic colposuspension was shorter, and was not affected by subsequent laparotomy. The operative time was almost the same. The success rate of the laparoscopy group was lower than that of the traditional group (80.4% vs. 95.6%, p=0.044). The complication rates were 10.8% and 17.4% respectively.Conclusion. Laparoscopic colposuspension is an effective method for the treatment of GSI, as documented by anatomical and functional assessments. However, the success rate is still lower than for the traditional procedure.
An economic evaluation of laparoscopy and open surgery in the treatment of tubal pregnancy
Authors: Mol Ben W.J , Hajenius Petra J. , Engelsbel Simone , Ankum Willem M. , Van der Veen Fulco , Hemrika Douwe J. , Bossuyt Patrick M.M. 
Published: March 2008

Background. Laparoscopy has generally replaced open surgery in the treatment of ectopic pregnancy. This study assesses the impact of the introduction of laparoscopy in the surgical treatment of tubal pregnancy on costs.Methods. Consecutive patients undergoing primary surgery for tubal pregnancy between January 1992 and December 1995 were included in the study. Surgery was performed laparo‐scopically or by open surgery. Cost for each treatment was calculated by multiplying resources used with calculated resource unit prices. The analysis was stratified for radical and conservative surgery.Results. Data of 255 patients were analysed. Tubal pregnancy was successfully treated in all patients. Costs per patient were US$ 3,490 for radical open surgery, US$ 1,872 for radical laparoscopic surgery, US$ 3,420 for conservative open surgery and US$ 2,125 for conservative laparoscopic surgery. Differences in costs were caused by a decreased duration of hospital stay after laparoscopy, and, in case of conservative surgery, by an increased persistent tropho‐blast rate after laparoscopy.Conclusions. Laparoscopy is equally effective as open surgery in the treatment of tubal pregnancy, and considerably reduces costs
Ultrasonic and magnetic resonance imaging of fetal sacrococcygeal teratoma
Authors: Kirkinen Pertti , Partanen Kaarina , Merikanto Juhani , Ryynänen Markku , Haring Pertti , Heinonen Kirsti 
Published: March 2008

Objective. To evaluate ultrasonic and magnetic resonance imaging (MRI) and Doppler examination in fetal sacrococcygeal teratoma (SCT), in respect to the postnatal findings and histological type of the tumor.Study design. Nine pregnancies complicated by histologically mature fetal sacrococcygeal teratoma in four cases and by immature/malignant teratoma in five cases. Transabdominal ultrasonic imaging and Doppler velocity waveforms were recorded during the second or last trimester in all cases, first trimester ultrasound examination was carried out in six cases and last trimester MRI in five cases. These findings were compared with postnatal and operative findings of the children.Results. Ultrasound examination did not reveal intrapelvic parts of SCT, but this was possible by MRI. Velocity waveforms of the tumor arteries were similar in all histological types and the resistance index varied from 60 to 70. The mean gestational age at antepartal diagnosis was 25.2 weeks. Large tumor size with relatively large proportion of solid components was often recognized in cases with malignant/immature histology.Conclusions. Antepartal MRI is useful for examination of fetal SCT, but reliable differentiation of mature and immature SCT is not possible antepartally.
Jugular venous blood flow velocity waveforms in human fetuses between 20 and 42 weeks of pregnancy
Authors: Gross Beth , Petrikovsky Boris M. , Forman Frimmit , Pellerito John , Mandel Francine S. , Goldman Mitchell 
Published: March 2008

Background. The goal of the study was to measure the blood flow parameters of the fetal internal jugular vein during the second half of normal pregnancy using Doppler ultrasound.Methods. Jugular blood flow was analyzed in 95 normal singleton fetuses between 20 and 42 weeks gestation. Color and pulsed Doppler ultrasound was used to obtain jugular venous waveforms at the level of the mid‐neck. Peak velocities, ratios of velocities, and time‐averaged maximum velocities were measured.Results. Jugular venous waveforms in healthy fetuses consist of three phases ‐ the first forward peak occurs during ventricle systole; the second forward peak occurs during early diastole and the third peak occurs during atrial contraction. Forty‐eight percent of the fetuses demonstrated absent flow during atrial contraction; 32% of fetuses demonstrated forward flow during atrial contraction and finally 20% of fetuses demonstrated flow reversal during atrial contraction.Conclusions. The reported jugular venous profile may serve as a foundation for future studies of jugular blood flow in high risk fetuses.
Hemoconcentration in smoking mothers is associated with impaired fetal growth
Authors: Zarén Birgitta , Lindmark Gunilla , Bergsjø Per 
Published: March 2008

Objective. To examine the effect of maternal smoking on the relationship between maternal hemoglobin levels and pregnancy outcome.Design. A prospective study of healthy parous women from early pregnancy and of their infants.Setting. Three Scandinavian university hospitals covering all deliveries from well defined geographical areas.Subjects. Smoking (669) and non‐smoking (368) mothers, para 1 and 2 and with >37 weeks of gestational length.Main outcome measures. Birth weight and placental weight. Ponderal Index and Placental Index as measures of possible discordant fetal and placental growth.Results. In non‐smoking mothers the hemoglobin levels in the three trimesters had no relation to birth weight. In smoking mothers a significantly lower birth weight was seen with a high hemoglobin level in the third trimester, but hemoglobin levels in early or mid‐pregnancy had no association to birth weight. Smoking mothers also had a significantly greater fall in hemoglobin concentration from first to second and third trimester as compared to non‐smokers although ferritin levels were similar in smokers and non‐smokers, implying similar iron stores. The ratio of placental weight to the weight of the newborn was significantly higher in smokers, but no association was found to different hemoglobin levels.Conclusions. Fetal growth impairment associated with maternal smoking is even more pronounced in smoking mothers with high hemoglobin levels in late pregnancy. Smoking mothers were also found to have disproportional fetal/placental growth with relatively high placental weights. In non‐smoking mothers hemoglobin levels had no relation to birthweight.
Continued pregnancy among abortion applicants
Authors: Söderberg Hanna , Andersson Christina , Janzon Lars , Sjöberg Niels‐Otto 
Published: March 2008

Objective. A certain proportion of women applying for legal abortion later change their minds. The present study was designed to ascertain whether such women differ from those who choose to terminate their pregnancy, with regard to age, civil status, other demographic characteristics, or reproductive history.Setting. Department of Obstetrics and Gynecology, University Hospital Malmo, Lund University, Sweden.Subjects. All 1,446 abortion applicants attending the abortion clinic at University Hospital Malmö, in 1989.Study design. A comparison of the women who continued the pregnancy and those who underwent abortion, with regard to the above mentioned factors.Methods. Semistructured interviews and statistical analysis.Results. Of this series of urban abortion applicants, almost one in ten underwent a change of mind. Women who chose to continue their pregnancy differed from those who held fast to their initial decision above all with regard to age and family situation. Less important was education, reproductive history, and stated reasons for abortion.Conclusions. To answer the question why some women continue an unwanted pregnancy after a closer consideration is not easy. The complexity of a woman's feeling in the matter seems to be moderated by the kind of support and stability she has in her life situation and also of the stability in relation to her partner. An equally important question is whether this change of mind is associated with a changed attitude to the expected baby (i.e., does an unwanted child become a wanted one?).
Sexuality in women with traumatic spinal cord injury
Authors: Westgren Ninni , Hultling Claes , Levi Richard , Seiger Åke , Westgren Magnus 
Published: March 2008

Background. Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.Methods. Survey of near‐total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self‐rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre‐ and post‐injury and information on sexual matters provided after injury were evaluated in detail. Out of a total of 65 women, 62 participated in the study.Result. Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower‐level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner‐related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.Conclusion. The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.
Scientific basis for the content of routine antenatal care
Authors: Bergsjø Per , Villar José 
Published: March 2008

Background. There is uncertainty concerning antenatal care as a tool to eliminate or alleviate adverse outcomes in the newborn. We identified congenital conditions, intrauterine infections, intrauterine growth retardation, preterm birth and some specific infectious diseases in the mother with a view to prophylactic and other interventions. The value of some special diagnostic tools is also under discussion.Methods.Review of recent literature, especially randomized controlled trials and systematic reviews.Results and conclusions.Genetic abnormalities cannot be prevented after conception, but many of them, and a number of acquired conditions, can be discovered by ultrasonographic and biochemical diagnostics. The advisability of screening must be determined locally for each condition, based on prevalence, treatment options and the legal requirements for abortion. Smoking. excessive alcohol intake, and severe undernutrition cause fetal growth retardation. Interventions to reduce maternal smoking have had limited success. Protein‐energy supplementation only modestly affects birthweight. Routine measurement of uterine height is a good predictor of severe growth retardation and in rural settings of perinatal death. Preterm birth has been linked to ascending infection and subsequent rupture of the membranes. Attempts to eradicate local infections have shown some benefit but results are not convincing yet. Cervical cerclage and betamimetic drugs have little, if any, effect. Claims for reduction of physical strain (standing >5 hours) at work should be supported. Tuberculosis in the mother should be discovered and treated. Malaria prophylaxis during pregnancy will protect the mother and possibly benefit the fetus. Adequate tetanus immunization of all mothers is a high priority intervention in developing countries. In HIV‐positive mothers, Zidovudine ante‐ and perinatally will lower perinatal HIV‐transmission significantly. Risk scoring may help identify some women for referral to higher level of care. Routine ultrasonography does not improve the outcome of pregnancy in terms of live births and morbidity, but may influence mortality through discovery and abortion of fetuses with major malformations. One vaginal examination during pregnancy is recommended but no repeat procedure unless medically indicated.
Effective obstetric paracervical block with reduced dose of bupivacaine: A prospective randomized double‐blind study comparing 25 mg (0.25 %) and 12.5 mg (0.125%) of bupivacaine
Authors: Nieminen Kari , Puolakka Jukka 
Published: March 2008

Background. To study whether paracervical block (PCB) with 12.5 mg (0.125 %) of bupivacaine is as effective as with 25 mg (0.25 %) and if there are differences in fetal heart rate (FMR) patterns between the doses.Methods. A prospective, randomized double‐blind study. Fifty‐two patients received PCB with 25 mg and 45 patients with 12.5 mg of bupivacaine. Pain intensity was assessed by the patients on a horizontal visual analog scale (VAS). Fetal heart rates of the fetuses were analyzed visually concerning basal rate, variability, accelerations, bradycardia, silent pattern and decelerations.Results. The pain relief was statistically significant in both groups up to 120 min after PCB. The VAS‐values were similar in both groups both before and after PCB. Fetal heart rate changes appeared in both groups more frequently after than prior to PCB. In patients receiving 25 mg of bupivacaine there appeared to be more FHR changes than in those receiving 12.5 mg.Conclusions. Paracervical block with 12.5 mg of bupivacaine is an effective method to relieve pain during labor. Fetal heart rate changes seemed to appear less frequently with this reduced dose. It seems that by lowering the dose of bupivacaine it is possible to reduce fetal side‐effects without losing analgesic effect.
Maternal serum levels of interleukin‐6 and clinical characteristics of normal delivery at term
Authors: Arntzen Knut Jørgen , Lien Egil , Austgulen Rigmor 
Published: March 2008

Background. The objective of the present study was to study participation of cytokines and cytokine inhibitors during the process of normal parturition, as assessed by maternal serum levels of interleukin‐1 (IL‐1), interleukin‐6 (IL‐6), tumor necrosis factor (TNF) and soluble tumor necrosis factor receptors (sTNFRs, p55 and p75).Materials and methods. Twenty‐six healthy women in normal term labor were observed during parturition and until 2 h post partum. Serum was sampled every 2 h, and an evaluation of strength and frequency of contractions was performed at the time of sampling. Concentrations of IL‐1, IL‐6, TNF, p55 and p75 were analyzed, and non‐parametric tests were used to study whether any relationship existed between the serum analyzes and the clinical characteristics of parturition.Results. There was a significant association between the strength of contractions and the levels of IL‐6 and p55. In addition, IL‐6 concentrations and frequency of contractions were correlated. Maternal serum levels of IL‐6 and p55 were highest 2 h post partum. TNF activity was detected in samples from nine women, whereas IL‐1 was not found in any sample. Conclusions. The present study suggests a role of IL‐6 and p55 in normal labor. However, as women being studied already were in labor, the study does not allow any conclusions whether observed changes in IL‐6 and p55 levels have a causal relation to the process of labor or if changes are secondary effects of the process itself.
Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?
Authors: Emanuel Mark H. , Wamsteker Kees , Lammes Frits B. 
Published: March 2008

Background. To determine the predictive value of dilatation and curettage (D& C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding.Methods. An observational descriptive study was performed in a large university‐affiliated teaching hospital. The suspicion of intrauterine disorders described in theater‐reports involving D & C was compared with the hysteroscopical findings in 131 premenopausal patients with persistent complaints of abnormal uterine bleeding who were referred by other gynecologists within six months after D & C. Pre‐test probability (prevalence), post‐test probabilities (predictive values) and likelihood‐ratio's were calculated.Results. The pre‐test probability for all intrauterine disorders was 0.49. The post‐test probabilities for a 'suspect’ and a ‘not suspect’ D & C were 0.61 and 0.46 respectively with an overlap of confidence‐intervals. The corresponding likelihood‐ratio's were 1.69 and 0.87 respectively.Conclusions. D & C findings were of no value in the prediction of the presence or absence of intrauterine disorders in this population with persistent complaints.
The clinical significance of an absent end‐diastolic velocity in the umbilical artery detected before the 34th week of pregnancy
Authors: Kurkinen‐Raty Merja , Kivela Aarre , Jouppila Pentti 
Published: March 2008

Background. The aim of this study was to evaluate the clinical significance of absent or reversed (ARED) flow detected in the late second or early third trimester in the umbilical artery in high‐risk pregnancies.Methods. Eighty‐three women with hypertensive disorders of pregnancy, gestational diabetes or a suspected disorder of the fetus (e.g. small‐for‐gestational age) were included in this retrospeethe study. A constant finding of ARED flow in the umbilical artery was registered with the pulsed Doppler method between the 23 + 0 and 33 + 6 gestational weeks. Perinatal mortality (PNM) rates. Apgar scores and arterial umbilical pH values, birth weights, the frequency of SGA, gestational ages at birth, NICU (=neonatal intensive care unit) days, anomalie fetuses and the mode of delivery were registered. Mann‐Whitney U‐test and χ‐squared test were used for statistical analysis.Results. The PNM in the entire group under study was 19.3% (16 infants/fetuses). The rate of structurally or chromosomally abnormal fetuses was 15.7% (13 infants/fetuses). When anomalie fetuses were excluded the PNM was 18.6%. No non‐anomalic fetuses/newborns were lost in cases in which ARED was detected after the 30th week. No statistically significant difference was observed in PNM and SGA frequencies when comparing AEDV (absent end‐diastolic velocity) fetuses with those who had REDV (reversed end‐diastolic velocity). When anomalie fetuses were excluded the PNM rate in the AEDV group was 8.9% compared with the PNM rate of 35.7% in the REDV group; (p = 0.03).Conclusions An early ARED finding (before the 34th week) in the umbilical artery signifies a marked warning signal of fetal distress. In these cases the rates of perinatal morbidity and mortality arc very high, which is a reflection of the severity of the condition. The majority of fetuses can. however, be saved.
Prenatal diagnosis of urinary tract abnormalities
Authors: Nishi T. 
Published: March 2008

Background. To compare magnetic resonance imaging with ultrasonography for the diagnosis of urinary tract abnormalities.Methods. Two cases of multicystic dysplastic kidney, six cases of ureteropelvic junction obstruction, and one case of autosomal recessive polycystic kidney disease were diagnosed on antenatal ultrasonography and/or magnetic resonance imaging.Results. In case of multicystic dysplastic kidney and ureteropelvic junction obstruction, ultrasonography showed characteristic features of their diseases. Magnetic resonance imaging was insufficient to diagnose these diseases. In a case of autosomal recessive polycystic kidney disease, ultrasonography and magnetic resonance imaging were both useful to show characteristic features of this disease, and thus made it possible to make a correct diagnosis of the disease.Conclusions. For a prenatal fetal diagnosis, it is necessary to observe both fetal anatomy and an evolution of the fetal abnormality. The above mentioned three types of urinary tract abnormalities changed their anatomic configurations and/or texture of urinary tracts as the pregnancies progressed. To observe these changes, the usefulness of ultrasonography is superior to that of magnetic resonance imaging for the present. Although ultrasonography and magnetic resonance imaging show fetal urinary tract abnormalities, these instruments should be used properly during the period of the pregnancy on case‐by‐case bases.
High progesterone is related to effective human labor
Authors: LöFgren Mats , BÄCkströM Torbjörn 
Published: March 2008

Background. The role of progesterone levels during human labor is unclear.Objective. To investigate serum concentrations of progesterone and 5α‐pregnane‐3,20‐dione in normal and abnormal deliveries.Methods. Venous and umbilical cord serum samples were collected from 108 parturient women. In a further 49 deliveries, arterial and venous umbilical cord sera were collected separately. The concentrations of progesterone and 5opregnane‐3,20‐dione were determined by radioimmunoassay. The delivery modes studied were: elective cesarean section; oxytocin‐resistant dystocia; normal but induced delivery, and normal spontaneous delivery.Results. Progesterone concentrations in maternal and umbilical serum were higher following normal labor than after dystocia (p<0.005) and elective cesarean section (p<0.005). The maternal and umbilical progesterone concentrations in dystocia and elective cesarean section were between 77–43 % of those in normal labor. The concentrations did not vary between gestational weeks 37 and 42, within the different modes of delivery. The 5α‐pregnane‐3,20‐dione serum concentration in the fetal compartment was twice that in the maternal compartment (p<0.001); its concentration in venous umbilical serum was higher than in corresponding arterial samples (p<0.001). No distinct differences in the 5α‐pregnane‐3,20‐dione serum concentration were found with regard to parity or mode of delivery.Conclusion. High progesterone concentrations during parturition appear to be related to effective labor. The findings support results from in vitro experiments on human term myometrium.