bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid prenatal diagnosis of chromosome aneuploidies by interphase fluorescence in situ hybridization: a one‐year clinical experience with high‐risk and urgent fetal and postnatal samples
Authors: BRYNDORF THUE , LUNDSTEEN CLAES , LAMB ALLEN , CHRISTENSEN BRITTA , PHILIP JOHN 
Published: March 2003

Objectives. To evaluate the clinical utility of rapid prenatal and postnatal detection of common chromosome aneuploidies by interphase fluorescence in situ hybridization (FISH) analysis with DNA probes.Design. Four hundred and seventy‐seven high‐risk and/or urgent amniotic fluid, chorionic villus and fetal and postnatal blood samples were prospectively examined by FISH with probes specific for chromosomes 13, 18, 21, X, and Y and results were reported within 48 hours. All FISH results were followed by conventional chromosome analysis, if possible.Setting. Cytogenetic service laboratory at the tertiary referral center, Rigshospitalet in Copenhagen.Main outcome measures. The fraction of clinically significant chromosome aneuploidies that was detected by FISH analysis, and the fraction of terminations that was based on FISH and ultrasound results rather than on conventional cytogenetic results.Results. The FISH assay detected 76% of the clinically significant chromosome abnormalities as determined by subsequent cytogenetic analysis. Seventy‐two percent of the terminations of the chromosomally abnormal pregnancies were based on FISH and ultrasound results rather than on conventional cytogenetic results.Conclusion. FISH analysis is a clinically useful adjunctive tool to conventional pre‐ and postnatal cytogenetic analysis. The assay rapidly detects the majority of clinically significant chromosome abnormalities, thus facilitating difficult pre‐ and postnatal clinical decisions.
A hypothesis to explain the occurrence of inner myometrial laceration causing massive postpartum hemorrhage
Authors: HAYASHI MASATOSHI , MORI YOSHIOMI , NOGAMI KEN‐ICHI , TAKAGI YOSHITAKE , YAOI MASAYUKI , OHKURA TAKEYOSHI 
Published: March 2003

Background. Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. Postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women.Methods. The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle.Results. The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels.Conclusions. We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.
Perinatal deaths in the Faroe Islands during 1986–95
Authors: JOENSEN FRÓĐI , OLSEN SJÚRĐUR FRÓĐI , HOLM TURIĐ , JOENSEN HØGNI DEBES 
Published: March 2003

Objective. To examine causes of perinatal mortality in the Faroe Islands, where it has been increased compared to other Nordic societies.Method. Cases were classified according to a fetal/obstetric, a fetal/neonatal, and a fetal/obstetric/neonatal classification (classifications C1, C2, and C3, respectively).Setting. The Faroe Islands 1986–1995; as reference materials were used a) the preceding decade in the Faroes and b) a parallel period in Denmark.Subjects. We examined all available information regarding each case from hospital records, midwife records, birth certificates, death certificates and autopsy records.Results. The perinatal mortality was 10.3 per 1,000 total births (83/8,096) compared with 13.7 (102/7,458) in the preceding decade; the fall could be attributed to fewer cases with preeclampsia, antepartum bleedings (C1) and antepartum asphyxia (C2) and the number fell despite an increased occurrence of cases attributed to congenital malformations. Perinatal mortality in Denmark was 8.3 (4,574/550,971), where rates were lower of cases with congenital malformations and fetoplacental dysfunction, but where the rate was higher of cases related to preterm birth (C3).Conclusions. Although the perinatal mortality rate still is higher in the Faroes than Denmark, the rate had fallen in the Faroes from 1976–85 to 1986–1995. The fall was mainly due to fewer cases attributable to antepartum asphyxia, preeclampsia, antepartum bleedings, and hyaline membrane disease, a pattern compatible with a more efficient perinatal service in the Faroes in the latter period.
Predictive value of a screen for gestational diabetes mellitus: influence of associated risk factors
Authors: JIMÉNEZ‐MOLEÓN JOSÉ J. , BUENO‐CAVANILLAS AURORA , LUNA‐DEL‐CASTILLO JUAN D. , LARDELLI‐CLARET PABLO , GARCÍA‐MARTÍN MIGUEL , GÁLVEZ‐VARGAS RAMÓN 
Published: March 2003

Background. There is a need for solid evidence of the relative advantages of universal vs. selective screening for gestational diabetes mellitus. Our study of a broad obstetric population determines the positive predictive value of the 50‐g oral glucose challenge test for screening in the presence and absence of classical gestational diabetes risk factors.Methods. A retrospective cohort study was carried out with a total of 2,574 pregnant women. Clinical information was obtained from hospital records and each patient's medical history, and gestational diabetes risk factors were quantified for each pregnant woman. The positive predictive value of a screen was determined with respect to the number of risk factors.Results. Age 30 or over, family history of diabetes, obesity ( BMI≥27) and previous fetal macrosomia were established as the most frequent risk factors. Just over half (54.2%) of our population presented one or more risk factors. Screening covered 75% of the population, and was positive in 15% of the cases. Diagnosis was confirmed in 64 cases, 57 of them at risk, and seven with no risk factors. We obtained an overall positive predictive value of 21.8% (CI 17.3–27.0). This figure increases with the number of risk factors, from 12% for the women with no risk factors, to 40% for those presenting three or more risk factors.Conclusions. A selective screening program that takes into account the clinical background and characteristics of each pregnant woman allows a high yield of true positives while reducing the possible undesirable effects associated with false positives.
Intrapartum external cephalic version of footling‐breech presentation
Authors: KANETI HAGAI , ROSEN DORON , MARKOV SHLOMO , BEYTH YORAM , FEJGIN MOSHE D. 
Published: March 2003

Background. External cephalic version is attempted prior to the onset of labor. Women who present in labor with footling breech presentation are usually delivered by cesarean section. We present our experience of external version in women in labor.Material and methods. External cephalic version was attempted in thirteen patients in labor with footling breech presentation with the breech out of the pelvis.Results. The procedure was successful in twelve of the thirteen patients. Ten of them delivered vaginally. There were no maternal or neonatal complications.Conclusions. It may be reasonable to attempt external cephalic version in patients in labor prior to performing a cesarean section.
Ethical implications of aggressive obstetric management at less than 28 weeks of gestation
Authors: Ahner Regine , Bikas Diana , Rabl Michaela , Al‐Kouatly Huda B. , Krauss Alfred N. , Mccullough Laurence B. , Chervenak Frank A. 
Published: March 2003

Background. The purpose of this study is to evaluate the outcome of infants born between 23 and 28 completed weeks of gestational age for whom aggressive obstetric management was performed.Methods. Prenatal data were collected retrospectively from medical records. Neonatal mortality, early morbidity, and the outcome at one year corrected for postconceptional age (corrected age) were determined.Results. Ninety‐seven infants were included in the study. Serious early morbidity decreased with increasing gestational age. All the infants born prior to 24 weeks showed serious early morbidity: only 26% of the infants born at 24 weeks or later did. There was a significant decline in mortality with increasing gestational age, as there was also in birth weight (p<0.001, p<0.001). Sixty‐seven percent of the infants prior to 24 weeks showed disability at one year corrected age whereas only 13% at 24 weeks or older did. The likelihood of having a surviving child without disability was 12.5% at 23 weeks, 39% at 24 weeks, 50% at 25 weeks, 52% at 26 weeks, and 70% at 27 weeks.Conclusion. Viability of fetuses at 23 and 24 weeks of gestation remains ethically and clinically controversial. It cannot be reliably established at that time that there is a fair balance of clinical goods over harms for the survivor at 23 weeks. On the other hand we should continue to treat fetuses at 24 weeks as viable, because 50% of them survived and 78% of those survived without disability. Neonatal mortality and survival with disability further decreases with increasing gestational age.
Does exposure to magnesium sulfate in utero decrease the risk of necrotizing enterocolitis in premature infants?
Authors: Ghidini Alessandro , Espada Roberto A. , Spong Catherine Y. 
Published: March 2003

Background. The objective of this study is to assess whether antenatal exposure to magnesium sulfate may decrease the risk of necrotizing enterocolitis in preterm infants.Methods. We have compared the rate of magnesium sulfate exposure before birth among 23 consecutive infants diagnosed with necrotizing enterocolitis with that of 46 controls matched by gestational age at delivery and gender. Relevant obstetric and neonatal variables were compared between the two groups using chi‐square and Fisher’s exact test for categorical data, and one‐way analysis of variance for continuous variables, with a two‐tailed p‐value <0.05 considered significant.Results. No significant differences were present between the two groups in mode of delivery (p=0.9), rate of Apgar score at five minutes below seven (p=0.4), prenatal exposure to indocin (p=0.5) or steroids (p=0.6), or neonatal administration of surfactant (p=0.1). Similar proportions of babies with necrotizing enterocolitis and controls were diagnosed with respiratory distress syndrome (p=0.5), intraventricular hemorrhage grades three or four (p=0.9), and sepsis (p=0.6). Babies with necrotizing enterocolitis had a significantly longer hospital stay (74.6±64.0 vs. 41.9±37.0 days, p=0.01) and intubation period (31.4±24.1 vs. 16.8±15.6 days, p=0.01) than controls. The rates of prenatal exposure to magnesium sulfate were similar in the necrotizing enterocolitis and control groups (30% vs. 39% respectively, p=0.4). Power analysis demonstrated that 385 babies would be required in each group to reach statistical significance (α=0.05, β=80%).Conclusion. In this retrospective case‐control study, maternal administration of magnesium sulfate prior to delivery does not appear to confer a significant protective effect for the neonatal occurrence of necrotizing enterocolitis.
Huge acoustic neurinomas presenting in the late stage of pregnancy
Authors: Beni‐Adani Liana , Pomeranz Shlomo , Flores Ivan , Shoshan Ygal , Ginosar Yehuda , Ben‐Shachar Inbar 
Published: March 2003

Background. Even though vestibular schwannomas rarely present during pregnancy, symptoms may appear or worsen particularly in this period. The clinical picture may include tinnitus, hearing abnormalities, and in large tumors, brain‐stem and cerebellar compression with involvement of additional cranial nerves. Large vestibular schwannomas (also known as Acoustic Neurinomas) present a great challenge in peripartum management of both the mother and the fetus.Material and method. We present a case of a 24‐year old woman, with headache, papilledema, ataxia, and multiple cranial nerve weakness, diagnosed in the 35th week of pregnancy. MRI demonstrated a huge vestibular schwannoma compressing the brainstem and causing obstructive hydrocephalus.Result. In the presence of high intra‐cranial pressure a ventriculo‐peritoneal shunt was first inserted, enabling delay of tumor surgery until after delivery. A successful elective cesarean section followed at 37 weeks, and radical tumor surgery was performed a week later. Maternal and fetal outcome were excellent.Discussion. The options, sequence and timing of the neurosurgical and obstetrical interventions are discussed. Other reports of large vestibular schwannomas that presented during pregnancy are reviewed. Advances in neurosurgery, neuroradiology, neuroanesthesiology and obstetrics are highlighted, and their impact on outcome is discussed in comparison to the poor results reported in the past. Emphasis is made on the importance of early diagnosis, that necessitates high‐index of suspicion by the obstetrician, in any pregnant woman presenting abnormal neurological signs.Conclusion. We conclude that with a cooperative team approach, maternal and fetal prognosis can today be excellent, even in cases of large vestibular schwannomas diagnosed in the late stage of pregnancy.
Prospective, randomized study to evaluate the success rates using hCG, vaginal progesterone or a combination of both for luteal phase support
Authors: Ludwig Michael , Finas Astrid , Katalinic Alexander , Strik Dominika , Kowalcek Ingrid , Schwartz Petra , Felberbaum Ricardo , Küpker Wolfgang , Schöpper Beate , Al‐Hasani Safaa , Diedrich Klaus 
Published: March 2003

Background. A prospective study was done to compare the efficacy of luteal phase support (LPS) using either three times hCG (group I, n=77), hCG on the day of embryo transfer (ET) in combination with daily vaginal progesterone (group II, n=62) or vaginal progesterone only (group III, n=70).Method. All patients were treated using the long luteal protocol for controlled ovarian stimulation in an IVF (in vitro fertilization) cycle. Patients were randomized to one of these groups when estradiol was <2500 pg/ml and less than 12 oocytes were retrieved (low risk groups). If estradiol was ≥ 2500 pg/ml and/or at least 12 oocytes were retrieved (high risk groups), patients were randomized to receive either hCG in combination with daily vaginal progesterone (group IV, n=83) or progesterone only (group V, n=121). For vaginal progesterone Utrogest® was used (three times daily two capsules containing 100 mg progesterone, 600 mg/d).Results. Demographic data were comparable within the high risk and low risk groups. However, for unknown reasons the fertilization rate was significantly higher in group V (48%) compared to group IV (40%) (p<0.05), leading to a significantly higher cumulative embryo score. There were no statistically significant differences with regard to the main outcome parameter, the clinical ongoing pregnancy rate in the low risk groups (14.3%, 14.5%, 11.4%) and the high risk groups (21.0%, 21.5%), respectively. Using a standardized discomfort scale, there were more complaints towards the end of the luteal phase in the groups receiving hCG only or an additional injection of hCG, when compared to the progesterone only groups.Conclusion. Progesterone only for luteal phase support leads to the same clinical ongoing pregnancy rate as hCG, but has no impact on the comfort of the patient.
Oxidative stress in pre‐eclampsia
Authors: Bowen Robin S. , Moodley Jack , Dutton Michael F. , Theron Annette J. 
Published: March 2003

Background. The objective of this study was to test the hypothesis that maternal plasma, cord plasma and placental tissue lipid peroxidation products are increased and antioxidants are decreased in women with pre‐eclampsia.Methods. Placenta, maternal and cord plasma were collected at delivery from 29 normal, 21 pre‐eclamptic and six eclamptic women. Plasma was collected from 21 non‐pregnant matched controls. The analyses were measured by HPLC and colorimetric assay.Results. Plasma maternal concentrations of uric acid, LPO, MDA, ascorbic acid, vitamin E and cholesterol were not significantly different in pre‐eclampsia as compared with normal pregnancy. Plasma concentrations of ascorbic acid and vitamin E were not significantly different in normal pregnancy as compared with the non‐pregnant controls. Cord plasma concentrations of MDA were significantly higher in eclampsia (1.16±0.26 μmol/l) as compared with normal pregnancy (0.79±0.05 μmol/l, p<0.02) and pre‐eclampsia (0.83±0.05 μmol/l, p<0.05). Cord plasma concentrations of vitamin E were significantly higher in eclampsia (21.3±7.5 μmol/l) as compared with normal pregnancy (10.2±1.1 μmol/l, p<0.01) and pre‐eclampsia (10.4±1.8 μmol/l, p<0.04). Placental concentrations of LPO, MDA and ascorbic acid were not significantly different in pre‐eclampsia as compared with normal pregnancy. Plasma cord concentrations of LPO and placental concentrations of vitamin E were undetected for normal pregnant, pre‐eclamptic and eclamptic women respectively. Uric acid concentrations were significantly increased in eclampsia as compared with the non‐pregnant controls (p<0.0001), normal pregnant controls (p<0.0001) and pre‐eclampsia (p<0.008).Conclusions. The findings in this study do not show any evidence of deficiency in the maternal protective antioxidant systems or increased production of lipid peroxidation products, LPO and MDA in African women with pre‐eclampsia as compared with normal pregnancy. However, there was evidence of increased cord plasma concentrations of MDA and vitamin E in eclampsia as compared with normal pregnancy and pre‐eclampsia. The placenta may be effective in removing MDA. The antioxidant uric acid serves as a protective role whilst the antioxidant and oxidant capacity in the different study groups remained unchanged.
Labor admission test: an assessment of the test’s value as screening for fetal distress in labor
Authors: Blix Ellen , Øian Pål 
Published: March 2003

Background. To determine if the labor admission test (LAT) can predict fetal distress in a population of laboring women, and in subgroups of low‐ or high‐risk women, who delivered within six hours or between six and 24 hours after LAT.Methods. The data charts of all women who delivered at Hammerfest Hospital in 1996, 1997 and 1998 were retrospectively read. If the woman was admitted to the hospital because of onset of labor, was in the first stage of labor and delivered within 24 hours after admission, she was included. In the study period, 1639 gave birth and 932 were included in the study. A descriptive analysis of the population and assessment of LAT’s sensitivity, positive predictive value, specificity and negative predictive value at different cut‐off values was done.Results. In the study population 5.8% had fetal distress, and 5.3% had an operative delivery because of fetal distress. LAT’s sensitivity in the whole population was 0.15 and positive predictive value was 0.16. Specificity was 0.95 and positive predictive value was 0.95. In the subgroups of low‐ and high‐risk women, who delivered within six hours or between six and 24 hours after LAT, sensitivity varied between 0 and 0.36, and positive predictive value varied between 0 and 0.27. Specificity varied between 0.92 and 0.96, and negative predictive value varied between 0.89 and 0.97.Conclusions. According to these results, LAT cannot be recommended as a screening test for fetal distress in labor in low‐risk women. Sensitivity is too low, and there are too many false‐positive tests. It is unclear if LAT has benefits among high‐risk women.
Fertility preservation in gynecologic cancer
Authors: Makar Amin PH. , Tropé Claes 
Published: March 2003

Subject. Management of patients with gynecologic cancer can now often be tailored to the extent of the disease and preservation of child‐bearing ability and/or sexual function may be possible for certain women with early invasive disease.Method. A better understanding of the tumor‐biology, and the consideration of different clinicopathologic factors, that bear prognostic significance in therapeutic modalities, will allow more and more individualization of treatment.Discussion. Management of young women with early gynecologic cancer should therefore be individualized with the risk of conservative therapy balanced against the dangers and advantages of more radical therapy. Experts in gynecologic oncology and infertility together with an informed patient and her family should make treatment decisions.Outcome. This article will review the conservative surgical management of early invasive cancers of the ovary, cervix and endometrium, in order to help preserve child‐bearing capacity. In addition, management of gynecologic cancers diagnosed during pregnancy will also be discussed.
Effect of ceramide analogs on interleukin‐1α‐induced production of prostaglandin E2 by amnion‐derived (WISH) cells
Authors: Nakamura Satomi , Kawano Yasushi , Kamihigashi Shoko , Sugano Terumasa , Narahara Hisashi , Miyakawa Isao 
Published: March 2003

Background. Prostaglandin E2 (PGE2) is reportedly synthesized in the amnion, and its levels are increased during labor. Our objective was to measure the level of PGE2 induced by interleukin (IL)‐1α following treatment with ceramide analogs in amnion‐derived cells.Methods. Amnion‐derived (WISH) cells were cultured and stimulated by IL‐1α, IL‐1 receptor antagonist (ra), C2‐ceramide and C6‐ceramide. The levels of PGE2 in the media were measured by ELISA. The induction of prostaglandin H synthase (PGHS)‐2mRNA was detected by reverse transcription and polymerase chain reaction (RT‐PCR).Results. Following stimulation with IL‐1α, the production of PGE2 could not be detected until incubation had continued for 2 h, but this production appeared to continue after 4 h of incubation. The production of PGE2 was significantly increased by IL‐1α, and was suppressed by IL‐1 ra, in a dose‐dependent manner. PGE2 production was significantly increased by IL‐1α and C2‐ceramide as compared with IL‐1α alone. However, PGE2 production was not significantly increased by IL‐1α and C6‐ceramide as compared with IL‐1α alone. PGHS‐2 mRNA were induced by treatment with IL‐1α, and were strongly induced by treatment with IL‐1α and C2‐ceramide by RT‐PCR.Conclusions. Results suggest that IL‐1α induce the PGHS‐2 mRNA and stimulate the production of PGE2 by a mechanism that involves the sphingomyelin‐ceramide system. Ceramide may be important in increasing the production of PGE2 during parturition.