bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing quality of obstetric care for low‐risk deliveries; methodological problems in the use of population based mortality data
Authors: MOSTER DAG , MARKESTAD TROND , LIE ROLV TERJE 
Published: March 2003

Background. Studies evaluating safety of different birth settings for low‐risk deliveries are often difficult to interpret because of great methodological problems.Objective. To assess potential bias in comparisons of mortality between maternity institutions with different size and level of care, particularly when using various definitions of low‐risk delivery and when studying stillbirth rates.Design. Population‐based study.Population. The population of 1.74 million births in Norway from 1967 to 1996 recorded in The Medical Birth Registry of Norway.Methods. First we explored the problems of properly identifying low‐risk deliveries from population‐based data and calculated adjusted perinatal mortality rates in sub‐populations by excluding different risk factors. Then we measured the difference in apparent low‐risk deliveries between institutions of different size and level of care. Finally we explored bias by using stillbirths and discuss the loss of statistical power by studying only livebirths.Results. The occurrence of a whole spectrum of risk factors differed between small and large institutions, even after adjustment for birthweight. Although the majority of births were from low‐risk deliveries, only 1/10th of all perinatal deaths occurred in this group after admission to a maternity unit. There was a systematic difference in the reporting of time of death for stillbirths between types of institutions; the rate of stillbirths occurring during delivery was higher among small institutions, while large institutions were more often uncertain in classifying time of death for stillbirths.Conclusions. Adjustments for a large number of different risk factors, large sample‐sizes and caution in including stillbirth as outcome measure are needed when comparisons of safety between different sizes of delivery units are made for low‐risk pregnancies.
Relation between viability of vaginal polymorphonuclear leukocytes and presence of histologic chorioamnionitis
Authors: YAMADA TETSUO , MATSUBARA SHIGEKI , MINAKAMI HISANORI , OHKUCHI AKIHIDE , HIRATSUKA MITSUHIRO , SATO IKUO 
Published: March 2003

Background. The number and percentage of viable vaginal polymorphonuclear leukocytes (vPMNs) are known to be increased in women who experience preterm labor. Whether those parameters may be associated with the presence of histologic chorioamnionitis (CAM) is not known.Methods. We investigated prospectively 39 women at 26.3±6.2 weeks of gestation. The following were determined in vaginal washings: total number of vPMNs and the percent that were viable, the pH, and the concentrations of granulocyte elastase and interleukin‐8 (IL‐8). In addition, the white blood cell count and the serum level of C‐reactive protein were determined in peripheral blood. The placenta and the umbilical cord were examined histologically with special reference to the presence of CAM. The optimal cutoff value for prediction of histologic CAM was obtained for each variable using receiver operating characteristic curves. A multivariate logistic‐regression model was used to determine the independent risk factors for this disorder.Results. Histologic CAM was present in ten women (37.1±3.8 weeks) and absent in 29 women (38.2±1.5 weeks). The total number of vPMNs, the percent of viable vPMNs, and the IL‐8 level were all significantly increased in the women with CAM, in contrast to those without CAM. When the optimal cutoff value for each of seven covariates was entered into the model, only the percent of viable vPMNs, ≧11%, demonstrated a significant relationship with histologic CAM (odds ratio 26.9; 95% confidence interval 1.3 to 545; p<0.05).Conclusions. Women with a % viability of vPMNs of ≧11% were at a significantly higher risk for histologic CAM. Data suggest that an influx of PMNs into the vagina occurs continuously in patients with histologic CAM.
Bacterial vaginosis in a family practice population
Authors: SCHMIDT HENRIK , HANSEN JENS G. 
Published: March 2003

Background. To determine and evaluate the prevalence of bacterial vaginosis diagnosed according to three sets of diagnostic criteria in three well‐defined groups of non‐pregnant women attending a family practice, and to determine the proportion of women diagnosed with bacterial vaginosis during a year involving the entire population registered at the practice.Methods. During a year, bacterial vaginosis was diagnosed both according to the composite clinical diagnosis, a new wet mount diagnosis, and Nugent's Gram stain diagnosis for bacterial vaginosis in women of reproductive age attending with new episodes either of abnormal vaginal discharge, other genito‐urinary symptoms, or for a routine check‐up.Results. In non‐pregnant women, bacterial vaginosis was diagnosed in a third of those with abnormal vaginal discharge (n=189), and in a tenth of those without, regardless of whether they had other genito‐urinary symptoms (n=186) or not (n=273). Including all examined women, at least 11%, 13%, and 16% of the 880 women registered at the practice, were diagnosed with bacterial vaginosis according to the composite clinical, the wet mount, and the Gram stain diagnoses, respectively. The results were based on the 57% of the women who attended during the year. The prevalence data differed significantly according to which diagnostic method we used, the composite clinical lowest, the wet mount intermediate, and the Gram stain highest.Conclusion. Both well‐defined criteria of inclusion and unison diagnostic procedures are necessary for reliable comparison and generalization of prevalence data of bacterial vaginosis.
Factors associated with pregnancy termination in Ukrainian women
Authors: MOGILEVKINA IRYNA , HELLBERG DAN , NORDSTROM MARIE‐LOUISE , ODLIND VIVECA 
Published: March 2003

Objectives. To study differences in social and demographic characteristics between women undergoing an induced abortion and antenatal care attendants in the Ukraine.Design. Hospital‐based unmatched case control study.Methods. From a survey including 1,694 women of fertile age, who attended five women's clinics in the Donetsk region, Ukraine, we studied those who came for termination of pregnancy (n=919) and for antenatal care (n=478). The data were obtained through an anonymous self‐questionnaire. From the 192‐item questionnaire questions dealing with social and demographic characteristics, previous pregnancy experience, and attitude towards abortion were analyzed. Multiple logistic regression was used to analyze the risk of pregnancy termination.Results. Termination of pregnancy was associated with being single (OR=11.8). Both previous childbirth and previous induced abortion were other determinants as well as being younger than 19 years old (OR=3.8), having a positive attitude towards abortion (OR=2.7), and sharing apartment with parents (OR=1.9). A higher risk for an induced abortion was found among women with a history of previous induced abortion(s). Neither income nor educational level was identified as a risk factor for pregnancy termination.Conclusion. This study demonstrated major social and demographic differences between women attending for abortion and antenatal care patients, and highlights some of the factors influencing the decision to terminate a pregnancy.
Postpartum chills phenomenon: Is it a feto‐maternal transfusion reaction?
Authors: Ravid Dorit , Gidoni Yariv , Bruchim Ilan , Shapira Hava , Fejgin Moshe D. 
Published: March 2003

Objective. To examine the theory that the postpartum shivering phenomenon is related to feto‐maternal bleed during the third stage of labor.Methods. One hundred laboring low‐risk women who had a normal vaginal delivery were observed for the presence of postpartum chills. The duration of the first and second stages of labor changes in body temperature, maternal and fetal blood types and the use of epidural anesthesia were recorded. Following the delivery maternal blood was examined for the presence of fetal red blood cells using the Kleihauer‐Betke stain.Results. Complete data was available in 97 patients. Post‐partum chills occurred in 31 of them (32%). Women with and without chills were similar in their maternal and gestational age, the use of epidural anesthesia, and length of second stage of labor. Women with chills delivered smaller babies but the difference did not reach significance. Maternal‐fetal blood group incompatibility was significantly more common among shivering than non‐shivering women (48% vs. 20% respectively, p=0.006). Kleihauer‐Betke test was positive in 11 women. The only two women in this group who experienced chills had maternal‐fetal blood group incompatibility.Conclusion. Post‐partum chills are a common phenomenon. It may be the clinical presentation of feto‐maternal transfusion reaction. The small number of positive Kleihauer‐Betke tests may reflect its low sensitivity in the detection of small feto‐maternal bleeds.
Doppler assessment of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction
Authors: Madazli Riza , Uludağ Seyfettin , Ocak Vildan 
Published: March 2003

Background. The aim of the study was to determine the best use of information obtained from Doppler studies of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction.Methods. The study group consisted of 100 pregnant women with intrauterine growth restricted fetuses. Doppler flow velocity waveforms were obtained from the umbilical artery, middle cerebral artery and thoracic aorta. The pregnancies were grouped according to the umbilical artery Doppler results. There were 29, 30 and 41 fetuses with normal and high PI (pulsatility index), and absent end‐diastolic velocity (AEDV) in the umbilical artery, respectively.Results. Birth weight and umbilical vein pH at birth significantly decreased and perinatal mortality rates significantly increased with the worsening of the diastolic flow in the umbilical artery (p<0.01). Increased umbilical artery PI was significantly associated with increased thoracic aorta PI and decreased middle cerebral artery PI (r=0.75 and −0.55, p<0.01 respectively). Perinatal mortality due to fetal asphyxia in fetuses with AEDV in the umbilical artery and in both the umbilical artery and thoracic aorta was 39.5% and 50%, respectively. Detection of AEDV in the thoracic aorta was found to be the most significant predictive factor of perinatal deaths.Conclusions. The degree of abnormality of the Doppler findings parallels the severity of fetal compromise. Growth restricted fetuses with AEDV detected both in the umbilical artery and thoracic aorta are severely compromised and time gained in utero has no benefit for these fetuses.
Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment
Authors: Olofsson Jan I. , Sundström Poromaa Inger , Ottander Ulrika , Kjellberg Lennart , Damber Mats‐Göran 
Published: March 2003

Background. The improved possibility of an early diagnosis of ectopic pregnancy by use of serial quantitative beta‐subunit human chorionic gonadotropin hormone levels together with transvaginal ultrasound has opened up options for conservative treatment. Systemic methotrexate treatment of unruptured ectopic pregnancy has emerged as a safe and effective alternative to surgical procedures. The aim of the present study was to investigate the effectiveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5‐year follow‐up period.Methods. All patients presenting to the Department of Obstetrics and Gynecology, Umeå University Hospital, with signs and symptoms of ectopic pregnancy between January 1, 1995 and December 31, 1997 were included in this prospective study. Patients with ectopic pregnancy were either managed expectantly, treated with methotrexate or by laparoscopic or open surgery (salpingostomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m2.Results. One hundred and seven patients presented with signs and symptoms of a possible ectopic pregnancy, of these 89 patients eventually were diagnosed as having an ectopic pregnancy. Twenty‐six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management.Success rate in the methotrexate group, after one or more injections, was 77% (20 patients out of 26). The mean time to resolution was 24±9 days. There was no difference in pregnancy rate following methotrexate treatment compared to surgical treatment.Conclusions. Systemic single‐dose methotrexate treatment is a safe treatment option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.
A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrhage
Authors: Lokugamage Amali U. , Sullivan Keith R. , Niculescu Iosif , Tigere Patrick , Onyangunga Felix , Refaey Hazem El , Moodley Jagidesa , Rodeck Charles H. 
Published: March 2003

Background. Post partum hemorrhage is a major cause of maternal death, particularly in developing countries, and most cases are due to an atonic uterus. Hemorrhage can occur despite active management of the third stage of labor. Presently, misoprostol (Cytotec, Searle Pharmaceuticals) is the only thermostable uterotonic agent potentially available which would be economically beneficial for developing countries where refrigeration of drugs poses a problem. The objective of the study was to compare intra‐muscular Syntometrine (Sandoz Pharmaceuticals) (ampoule=5 iu oxytocin and 500 mcg ergometrine maleate) plus Syntocinon (Sandoz Pharmceuticals) (10 iu oxytocin diluted in 500 ml normal saline) intravenous infusion versus 800 mcg misoprostol per rectum for treatment of primary post partum hemorrhage in a developing country.Methods. Randomized single blinded two‐center study, set in both a township and teaching hospital in South Africa. Sixty‐four women with primary post partum hemorrhage due to an atonic uterus were recruited. The primary outcome measure was whether the hemorrhage ceased within 20 minutes of administering the first line treatment, once hemorrhage was clinically recognized.Results. There was a 28.1% difference between the misoprostol arm and the Syntometrine and Syntocinon arm (p=0.01). This result had a greater than 80% power. Misoprostol performed better.Conclusion. 800 mcg misoprostol per rectum is effective at treating primary post partum hemorrhage.
Early pregnancy termination with mifepristone and misoprostol in Norway
Authors: Bjørge Line , Johnsen Synnøve Lian , Midbøe Grete , Augestad Grete , Økland Ingrid , Helland Harald , Stray‐Pedersen Sverre , Iversen Ole Erik 
Published: March 2003

Objectives. Medical abortion was first introduced in Norway in April 1998. The aims of this study were to assess the efficacy, side effects, and acceptability of medical abortion using mifepristone orally and misoprostol vaginally in a Norwegian population.Design. The study included the first 226 pregnant women with gestational age of <63 days who requested nonsurgical abortion during the first year in the first Norwegian hospital using this regimen.Methods. All women received a single dose of mifepristone 600 mg orally, followed at 48 hours by 800 μg misoprostol vaginally. Treatment outcome and complications were the principal outcome measures. We also measured the rates of side effects such as abdominal pain and bleeding and the women’s acceptability of treatment.Results. Abortion was successful in 95%, surgical evacuation became necessary in 4%, and the pregnancy continued in one woman. During the study period the method was chosen by 23% of those requesting abortion before 63 days amenorrhea; 80% would use the method again; 81% would recommend it to a friend; in retrospect, 69% would not have been willing to be randomly allocated to either a medical or a surgical method.Conclusions. The combination of orally administrated mifepristone and vaginally administrated misoprostol is an abortion method that is both effective and safe, has few side effects and is well accepted by Norwegian women.
Reproductive hormones and stress urinary incontinence in pregnancy
Authors: Kristiansson Per , Samuelsson Eva , Von Schoultz Bo , Svärdsudd Kurt 
Published: March 2003

Background. The cause of transient stress urinary incontinence during pregnancy remains uncertain. Anatomical change, such as a pressure effect of the enlarged uterus, changes in renal function, and alterations in bladder and urethral function have been proposed. There is little information about the role of reproductive hormones in stress urinary incontinence with onset during pregnancy.Methods. In a prospective, longitudinal, observational cohort study 200 consecutive women attending in early pregnancy were observed by repeated measurements of stress urinary incontinence, its possible determinants as well as serum concentrations of progesterone, estradiol and relaxin.Results. The prevalence rate of stress urinary incontinence increased to a stable level of about 25% from mid‐pregnancy and increased with parity. A higher serum relaxin value early in pregnancy was correlated to a lower prevalence rate of stress urinary incontinence with onset during pregnancy, also when the influence of potentially important factors was taken into account in a multivariate analysis. No significant difference was shown regarding serum concentrations of estrogen or progesterone, maternal age, weight gain, time since last delivery or smoking, although this can be due to a small sample size.Conclusion. The reproductive hormone relaxin might have a role in maintaining urinary continence during pregnancy. A mechanism is uncertain.
Relation of vitamin D receptor FokI start codon polymorphism to bone mineral density and occurrence of osteoporosis in postmenopausal women in Taiwan
Authors: Chen Huey‐Yi , Chen Wen‐Chi , Hsu Cheng‐Der , Tsai Fuu‐Jen , Tsai Chang‐Hai 
Published: March 2003

Background. Osteoporosis is a common disorder with a strong genetic component. Our aim was to evaluate the correlation of the vitamin D receptor FokI start codon polymorphism to bone mineral density and the occurence of osteoporosis.Methods. We determined the vitamin D receptor FokI start codon polymorphism using polymerase chain reaction‐based restriction analysis in 163 postmenopausal women in Taiwan. The vitamin D receptor gene polymorphism was detected by the restriction enzyme FokI, where the F allele indicated the absence of the cuttable site and the f allele its presence. We then related the genotypes to bone mineral density and the occurence of osteoporosis in these women.Results. The allelic frequencies for 163 postmenopausal women in Taiwan were 59.2% for F and 40.8% for f in FokI restriction fragment length polymorphisms. The prevalence of each genotype in the study population was: 42.3% FF, 33.7% Ff and 24% ff. The three genotypic groups differed significantly in bone mineral density at the lumbar spine (P = 0.029). Bone mineral density was highest in the Ff group and lowest in the ff group at the lumbar spine and the femoral neck. The FokI vitamin D receptor genotype showed a significant effect on the prevalence of osteoporosis in the subjects at the lumbar spine. That is, women with genotype ff had a 2.8 times greater risk for osteoporosis (P < 0.05), and those with genotype FF had a 0.8 times greater risk than women with genotype Ff.Conclusion. Our findings indicate that the vitamin D receptor FokI start codon polymorphism is associated with reduced bone mineral density and predisposes women to osteoporosis at the lumbar spine.
Clinical evaluation of MRI in the diagnosis of borderline ovarian tumors
Authors: Takemori Masayuki , Nishimura Ryuichiro , Hasegawa Kazuo 
Published: March 2003

Objective. To evaluate the clinical potential of contrast‐enhanced MRI with Gd‐DTPA (gadopentetate dimeglumine) in the diagnosis of borderline ovarian tumors.Methods. Thirteen patients with 14 borderline ovarian tumors were evaluated with serum levels of four tumor markers (CA125, CA19‐9, SLX and CEA) and contrast‐enhanced MRI.Results. Among the 13 patients, five had normal serum levels of all four tumor markers, and five had high serum levels of plural tumor markers. The positive rates of CA125, CA19‐9, SLX, and CEA were 46.2% (6/13), 38.5% (5/13), 30.8% (4/13), and 7.7% (1/13), respectively. With contrast‐enhanced MRI, all 13 patients were diagnosed as having malignant tumors using the widely accepted criteria of MRI findings for the diagnosis of malignant ovarian tumors.Conclusions. In the present study, all 14 borderline tumors had similar MRI findings to those of malignant tumors and were diagnosed as ovarian cancers with contrast‐enhanced MRI, unrelated to the serum levels of tumor markers.
Correlation of survivin mRNA detection with histologic diagnosis in normal endometrium and endometrial carcinoma
Authors: Lehner Rainer , Enomoto Takayuki , Mcgregor James A. , Shroyer Laurie , Haugen Bryan R. , Pugazhenthi Umarani , Shroyer Kenneth R. 
Published: March 2003

Background. The objective of this study was to determine if survivin mRNA expression is a marker of endometrioid adenocarcinoma and if survivin mRNA levels correlate with tumor grade and stage.Methods. Twenty‐six samples of endometrioid adenocarcinoma and 18 cases of benign endometrium were obtained at surgery. RNA was extracted from tissues and was used for quantitative real‐time RT‐PCR, targeting a 91‐bp sequence of survivin mRNA and the levels were standardized to the levels of ribosomal RNA. Statistical analysis of the correlation between histologic diagnosis and the corrected survivin mRNA levels was performed by the Fisher Exact test and the Kruskal–Wallis test.Results. Survivin mRNA was detected in all specimens. Survivin mRNA levels were increased in proliferative endometrium (P = 0.0509) and was increased in correlation with ascending grade in endometrioid adenocarcinoma (P = 0.01).Conclusion. Survivin mRNA is not a specific marker of endometrial cancer, but may reflect an important mechanism in tumor progression of the endometrial mucosa.
Under‐reporting of direct and indirect obstetrical deaths in Austria, 1980–98
Authors: Karimian‐Teherani Daniela , Haidinger Gerald , Waldhoer Thomas , Beck Adolf , Vutuc Christian 
Published: March 2003

Background.  Under‐reporting and misclassification of maternal deaths are common, even in countries with a high quality of death statistics. The aims of this study were to determine to what extent maternal deaths are under‐reported in Austria and to determine factors that might explain under‐reporting.Methods.  Confidential enquiries on maternal deaths for the period 1980–98 were linked with the official mortality statistics from Statistics Austria. Maternal deaths were classified as direct and indirect obstetric deaths.Results.  Between 1980 and 1998 a total of 119 maternal deaths (112 direct and seven indirect obstetric deaths) were registered at Statistics Austria. Confidential inquiries into maternal deaths accumulated 191 maternal deaths (an additional 43 direct obstetric deaths and 29 indirect obstetric deaths). Total under‐reporting was 38% (95% CI 31–45). Significantly more indirect obstetrical deaths were under‐reported (81%; 95% CI 64–92) than direct obstetrical deaths (28%; 95% CI 21–36).Conclusions.  This study demonstrates the shortcomings of official registration of maternal deaths. Thus, maternal mortality cannot be seen as a reliable basis for health policy decisions.