bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased perinatal mortality among sub‐Saharan immigrants in a city‐population in Sweden
Authors: ESSÉN BIRGITTA , HANSON BERTIL S. , ÖSTERGREN PER‐OLOF , LINDQUIST PELLE G. , GUDMUNDSSON SAEMUNDUR 
Published: March 2003

Background. The aim of the study was to investigate whether the maternal country of origin affected the risk for perinatal mortality and to determine its relationship to risk factors.Methods. A study of 15,639 deliveries in Malmö, Sweden. Data regarding demographic factors, life‐style and perinatal risk factors, together with data pertaining to outcome was obtained from the Malmö database and the Swedish Medical Birth Register.Results. Perinatal mortality was increased among infants to women of Foreign origin as compared to those delivered by women of Swedish origin (OR 1.5, CI 1.0–2.2). Even after adjustments for maternal background and risk factors (diabetes, anemia, pre‐eclampsia, placental abruption and small‐for‐gestational age), the increased risk of perinatal mortality among women of Foreign origin remained statistically significant. Women from sub‐Saharan Africa, comprising 7.3% of all immigrants, differed from all other subgroups of women of foreign origin by having a higher risk of adverse outcome (small‐for‐gestational age OR 1.9, CI 1.0–3.6, neonatal distress OR 2.7, CI 5.1–4.8 and perinatal mortality OR 4.3, CI 2.1–8.6).Conclusions. Women of foreign origin, especially from sub‐Saharan Africa, have a higher risk of perinatal mortality than native Swedish women. The differences in mortality could not be explained by risk factors. The results suggest that women and newborns from sub‐Saharan Africa should be given more intense surveillance on all levels of perinatal care in order to reduce perinatal mortality.
Alteration of sonographic texture of the endometrium in post‐menopausal bleeding
Authors: SHEIKH MEHRAJ , SAWHNEY SUKHPAL , KHURANA ASHOK , AL‐YATAMA MAJDA 
Published: March 2003

Background. The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling.Methods. Two hundred and seven consecutive cases of postmenopausal bleeding were evaluated by transvaginal ultrasound. Endometrial thickness was measured as the maximum anteroposterior thickness of the endometrium including both the anterior and posterior layers, in the sagittal long axis view. The morphology of the endometrium was studied and categorized as homogeneous, focally increased echogenecity, diffusely increased echogenecity or diffusely inhomogeneous. Patients were followed up for clinical course and endometrial histopathology.Results. Textural inhomogeneity was observed in all the three cases of endometrial cancers with endometrial thickness of less than 6 mm, and, in ten out of 11 cases of a more than 6 mm thick endometrium. On the other hand the endometrial texture was homogeneous in all cases of endometrial atrophy/tissue inadequate for diagnosis, with thickness of less than 6 mm.Conclusion. This study adds the dimension of abnormal echogenecity of the endometrium to the currently followed criterion of endometrial thickness with a view to enhance accuracy, both for a better prediction of atrophy and a higher prediction for endometrial cancer. Expectant management can be offered to patients with a homogeneous endometrium which is 6 mm thick or less. Aggressive evaluation for a malignancy must be made if there is a focal increased echogenecity or a diffuse increased echogenecity even in a thin endometrium.
Hormonal predisposition to menstrual dysfunction in collegiate dance students
Authors: TO WILLIAM W. K. , WONG MARGARET W. N. , LAM IVY Y. L. 
Published: March 2003

Objective. To evaluate the effect of dance training on menstrual function in teenage dance students and to identify risk factors associated with menstrual dysfunction.Methods. Dance students from a collegiate school of performing arts were recruited when they were first admitted to the school. Basic epidemiological data and menstrual history were gathered using a structured questionnaire. The subjects' self image appraisal was scored utilizing the Offer Self Image Questionnaire. Anthropometric measurements, body fat percentages and hormonal profiles were measured. The subjects were followed up after 12 months of intensive dance training, and the menstrual pattern, self image scoring and fat composition assays were repeated.Results. A total of 50 students completed the study. The mean age was 18.9 years (s.d. 1.86). While all were eumenorrheic at first assessment, eight were amenorrheic and eight were oligomenorrheic at the second assessment, giving an incidence of menstrual dysfunction of 32%. A general reduction in weight and body fat composition was observed after training. Those with menstrual dysfunction did not differ from those that remained eumenorrheic in their basic anthropometric parameters, nor was the serial change in these parameters in the second assessment different between the two groups. Psychological assessment scores also showed an identical trend. All hormonal values were within the normal range, but the group with menstrual dysfunction showed a significantly higher LH/FSH ratio (p=0.012) and DHEAS levels (p=0.036) at the pre‐training assessment while other hormonal parameters did not differ.Conclusion. The incidence of menstrual dysfunction in adolescent dance students undergoing intensive training was high. Those with pre‐existing hormonal predisposition prior to entering training appeared particularly at risk.
Embryo quality and developmental potential is compromised by age
Authors: Ziebe Søren , Loft Anne , Petersen Jørgen Holm , Andersen Anne‐Grethe , Lindenberg Svend , Petersen Karsten , Andersen Anders Nyboe 
Published: March 2003

Aims. The aim of this retrospective study was to assess whether and how the age of the woman affects the quality and developmental potential of the oocytes and embryos in an ART program.Method and material. A total of 878 IVF cycles was included as a consecutive series of single transfers (n=292), dual transfers (n=366) and triple transfers (n=220), where all the transferred embryos in each cycle were of identical quality score and identical cleavage stage.Results. We found a highly significant decrease in oocyte recovery with increasing age with about one oocyte per 2.3 years (95% CI 1.8 years to 3.1 years, p<0.0001). Further, we found that the number of oocytes that cleaved declined significantly with increasing age with one per 3.7 years (95% CI 2.7 years to 5.5 years, p<0.0001). This decline was mainly due to the decline in number of oocytes retrieved as the ratio of aspirated oocytes that cleaved with increasing age (approx. −0.04/10 year 95% CI: −0.10; +0.009) was not significantly different (p=0.10). The percentage of transfers using fragmented embryos did not increase significantly with increasing age (p=0.08). The odds of fragmentation increased by 3% per year. The average number of embryos transferred decreased significantly (p=0.03) with age from approximately 2.1 at the age of 25 to approximately 1.8 at the age of 40. In a selected subgroup of embryos all consisting of good quality embryos, a significant decrease was found in implantation rate with increasing age (approx. −0.08/10 years, 95% CI: −1.6; +0.00, p=0.05). Of the 357 pregnancies achieved in this study we found a significantly decreased ongoing pregnancy rate and a significantly increased abortion rate with increasing age (p=0.03). The decrease in the rate of ongoing pregnancies was almost linear, decreasing by approximately 1.5% per year.Conclusions. We conclude that age has an impact throughout a woman’s reproductive life and that it is important to realize that the age‐related decline in fertility may start already in the late twenties and not in the mid‐thirties as is generally assumed.
Third and fourth degree perineal tears
Authors: Jandér Charlotte , Lyrenäs Sven 
Published: March 2003

Background. Tears of the anal sphincter are a feared complication of vaginal delivery, as many as 50% of these patients experience incontinence as an after‐effect. Identifying significant predictor factors leading to third or fourth degree perineal tears during vaginal delivery was the objective of this study.Methods. During a two‐year period (1995–1996), a third or fourth degree perineal rupture occurred in 214 women (3.7%) after vaginal delivery. Data from these deliveries were collected and compared to data from deliveries without anal sphincter tears in order to identify risk factors. A stepwise logistic regression model was used for the analysis.Results. Independent risk factors of significance were vaginal nulliparity, a squatting position on a delivery chair, maternal age exceeding 35 years, baby’s birth weight over 4000 g, vacuum extraction (both outlet and mid release), median episiotomy, oxytocin augmentation and birthing between 3 a.m. and 6 a.m.Conclusions. This study identified several factors associated with anal sphincter tears. Median episiotomy should be avoided. Delivery, while squatting on a low chair, should be used with caution. A woman with one or more risk factors requires caution by birth attendants during delivery. Gynecologists should consider the option of cesarean section instead of vacuum extraction, especially when mid release is needed in the presence of macrosomia. A continuous audit regarding instrumental delivery technique is necessary.
Conduct of labor and rupture of the sphincter ani
Authors: Parnell Christine , Langhoff‐Roos Jens , Møller Henrik 
Published: March 2003

Objective. To determine whether the conduct of the second stage of labor and delivery technique influences the incidence of rupture of the anal sphincter.Material and method. A total of 1072 primipara delivered vaginally at term at Rigshospitalet in 1998. A questionnaire on prenatal risk factors, conduct of the second stage of labor, and delivery technique was completed by the attending midwife immediately after delivery in 90 cases with rupture of the sphincter and in two subsequent controls (n=164), matched by use of vacuum extractor and episiotomy.Results. Partial or total sphincter rupture was found in 8.4% of primipara who delivered vaginally, in 20.9% of those delivered by vacuum extraction, and in 6.4% of those with episiotomy only. The prenatal risk factors – maternal age, birth weight, shoulder dystocia, and edema of the perineum were found to have a statistically significant effect on the incidence of rupture of the sphincter ani. In non‐instrumental vaginal deliveries easing of the perineum over the caput as it advanced helped prevent a rupture of the anal sphincter. Vacuum extraction performed with the woman in a semi‐recumbant position was associated with an increased risk of rupture of the anal sphincter, whereas attention to the perineum during extraction decreased the risk.Conclusions. The significant effect of prenatal risk factors did not explain a correlation between delivery technique and rupture of the sphincter ani. The present study indicates that a reduction in the incidence of sphincter rupture may be accomplished by improved obstetric care: fewer vacuum extractions and improved delivery technique.
Expression of basic fibroblast growth factor (bFGF), FGF receptor 1 and FGF receptor 2 in uterine leiomyomas and myometrium during the menstrual cycle, after menopause and GnRHa treatment*
Authors: Wu Xuxia , Blanck Agneta , Olovsson Matts , Möller Björn , Lindblom Bo 
Published: March 2003

Background. To investigate whether basic fibroblast growth factor (bFGF) is involved in the growth regulation of human uterine leiomyomas the expression of bFGF and its receptors was measured in leiomyomas and myometrium obtained under different endocrine conditions.Methods. The expression of bFGF, fibroblast growth factor receptor 1 (FGFR1) and fibroblast growth factor receptor 2 (FGFR2) was analyzed by immunohistochemistry and Western blot.Results. Twenty‐seven women with leiomyomas included eight in the proliferative phase, seven in the secretory phase, six after menopause and six after GnRHa treatment. In the proliferative phase, bFGF staining in leiomyomas was significantly stronger than in any other leiomyoma group. After GnRHa treatment, the expression of bFGF in both leiomyomas and myometrium was weaker than in the proliferative phase. The staining of FGFR1 was less intense in proliferative phase myometrium than in myometrium from any other group, significantly weaker than in the secretory phase. The leiomyomas demonstrated homogeneous cytoplasmic FGFR1 staining that was similar in all groups, except in the GnRHa treated patients where a more intense staining was observed, significantly stronger than in proliferative phase leiomyomas. No tissue differences were observed for staining of FGFR2 and no significant differences were observed between the different groups. Slightly less staining of FGFR2 was found in leiomyomas in the secretory phase but it did not reach statistical significance. The specificity of immunostaining was confirmed by Western blot.Conclusions. We suggest that the regulation of bFGF, and to some extent also its receptors in leiomyomas and in myometrium, is influenced by sex steroid hormones. However, the lack of differences in expression between leiomyomas and myometrium favors the view that bFGF does not necessarily contribute to the differences in growth regulation in these tissues.
Insulin‐like growth factor‐binding protein‐1 in cervical secretion as a predictor of preterm delivery
Authors: Kekki Minnamaija , Kurki Tapio , Kärkkäinen Tytti , Hiilesmaa Vilho , Paavonen Jorma , Rutanen Eeva‐Marja 
Published: March 2003

Background. The aim of the study was to evaluate whether the phosphorylated isoforms of insulin‐like growth factor‐binding protein‐1 (IGFBP‐1), a protein produced by the decidua, can be detected in cervical secretions of pregnant women with preterm uterine contractions, and whether their presence predicts an increased risk of preterm delivery.Methods. A prospective analysis of sixty‐three women who presented with preterm labor but intact fetal membranes at weeks 22–36+6 days of gestation at the Antenatal clinic at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital. Phosphorylated IGFBP‐1 (phIGFBP‐1) was measured in cervical swab samples obtained at presentation, using an immunoenzymometric assay. The values ≥10μg/L were considered as positive. In addition, 58 asymptomatic women at the same gestational stage were studied as controls. Multiple logistic regression was applied to control for confounding variables and to obtain adjusted odds ratios.Results. The concentration of phIGFBP‐1 in cervical samples ranged from undetectable to 95 μg/L. In 17 of the 63 (27%) women with preterm labor it was ≥10 μg/L. Seven of these 17 (41%) women with a positive phIGFBP‐1 result delivered preterm, all before 35 weeks of gestation. Among the women with preterm labor and a negative phIGFBP‐1 result, three of the 46 (7%) delivered before 37 weeks of gestation (adjusted OR 24, 95% CI 1.2–487), but all after 35 weeks of gestation. In the asymptomatic control population three out of 58 (5%) women had a positive cervical phIGFBP‐1 test result but none delivered preterm. Among the controls with a negative cervical phIGFBP‐1 test result (55 of 58, 95%), one woman delivered preterm (1 of 55, 2%).Conclusions. Pregnant women who are in preterm labor with intact fetal membranes and who have a positive phIGFBP‐1 test result in cervical secretion have an increased risk of preterm delivery.
Manual vacuum aspiration, a safe and effective alternative in early pregnancy termination
Authors: Hemlin Johan , Möller Bo 
Published: March 2003

Background and objective. Vacuum aspiration has become standard surgical procedure for safe early pregnancy termination. Most of these operations are performed in the operating theater using suction curettage and an electric vacuum pump. MVA (manual vacuum aspiration) is an alternative that is well suited for use as a clinical procedure, which could have advantages both for the patient and the health care system. In order to compare conventional VA and MVA in a Swedish setting, a randomized study was undertaken.Methods. Two hundred women requesting abortion in early pregnancy, gestational age less than 56 days, and choosing surgical termination, were randomized to VA or MVA. Main study outcome was frequency of complete abortion but also other variables were recorded.Results. There were no significant differences between the two groups regarding background characteristics. Altogether 91 MVA and 88 VA operations were performed. There was no significant difference in frequency of complete abortion; two patients in each group subsequently needed re‐curettage because of incomplete evacuation. No case of ongoing pregnancy occurred. Two patients in each group received treatment for endometritis. No other complications were recorded.Conclusion. This study indicates that MVA is effective in emptying the uterine cavity, on par with the standard vacuum aspiration. The rate of complications with MVA was on the same low level as with conventional VA.
Blood pressure during pregnancy in a Swedish population; impact of parity
Authors: Strevens Helena , Wide‐Swensson Dag , Ingemarsson Ingemar 
Published: March 2003

Subject. Hypertension represents the most commonly encountered complication of pregnancy. Normal levels of blood pressure (BP) need to be established in each pregnant population in order to recognize pathology. A lack of studies from our own country and certain methodological objections to early studies motivated this study.Patients and methods. Six hundred pregnant women were included in a historical cohort. The maternal BP had been measured with a mercury sphygmomanometer and standardized routines at each antenatal visit. Data regarding age, baseline BMI, weight gain and smoking habits as well as parity had been recorded.Results. BP values were overall somewhat higher than in international studies, the SBP increasing slightly towards term. The diastolic blood pressure (DBP) decreased slightly until 25–28 weeks of gestation. A steady increase thereafter led to values at term 7.3% above initial values. In nulliparae the increase was significantly greater, 9.9% versus 5.4% in multiparae. Primigravidae showed mean DBP levels significantly higher than all multigravidae towards term. The DBP was correlated with the baseline BMI, but not with age or weight gain. In smoking pregnant women the DBP showed a significantly greater initial decrease and failed to follow the subsequent rise to the same degree as in non‐smokers.Conclusion. Slightly higher blood pressure levels were found in this study compared to other international studies. Multiple regression analysis showed that parity, baseline BMI and smoking all significantly influenced the DBP at term. Multiparae have significantly lower DBP levels in pregnancy compared to nulliparae. The first pregnancy seems to have the greatest impact in lowering the blood pressure in subsequent pregnancies.
The quality of life in women suffering from gynecological disorders is improved by means of hysterectomy
Authors: Rannestad Toril , Eikeland Ole‐Johan , Helland Harald , Qvarnström Ulla 
Published: March 2003

Background. Gynecological disorders can have adverse effects on a woman’s quality of life. Most hysterectomies are thus performed to enhance women’s quality of life rather than to save life. This study aims at evaluating the long‐term impact of hysterectomy on this outcome variable.Methods. The quality of life in 111 women undergoing hysterectomy for benign reasons was tested before, and six and twelve months after, the operation. A control‐group of non‐hysterectomized women from the normal population was tested once. Ferrans & Powers’ Quality of Life Index, consisting of four life domains, was used. This index has a pre‐set highest possible obtainable score. For the subjects with a high pre‐test score, there was little scope for further measurable improvement after hysterectomy, which gives a false stability in the material. A method for calculating the relative differences was introduced.Results. The health and functioning domain of the quality of life among women awaiting hysterectomy is significantly lower compared to that of the control‐group (p<.01) Both six and twelve months after the hysterectomy, the patients have reached the same level of their health and functioning as the control‐group. Using the relative difference‐form, it is demonstrated that the subjects have obtained significantly higher levels in all the domains of quality of life after hysterectomy.Conclusions. The results of this study show that hysterectomy is associated with a positive long‐term impact on a woman’s quality of life.
Increased acceptance of HRT and improved level of information: a change in Norwegian women's opinion from 1990 to 1997
Authors: Backe Bjørn , Hunskaar Steinar 
Published: March 2003

Aim. To investigate the development in women's attitude to hormone replacement therapy, and the change in views concerning positive and negative effects.Methods. National cohort study based on telephone interviews in 1990 and 1997, of women randomly sampled from the Norwegian telephone book (n=1019 and 1003). The same questions were asked in both studies.Results. In 1997, more women stated radio and television, doctors, friends and relatives as sources of information. The general attitude to hormone replacement therapy had become significantly more positive, and the respondents reported a higher level of information than in 1990. However, some misunderstandings about estrogen therapy still remain; the proportion of women who believed that estrogen treatment reduced the risk for breast cancer increased from 4% in 1990 to 15% in 1997. About one third of women aged 60 or more are current or past users. More than 60% of the women in the youngest age group state that they will consider use of estrogen replacement therapy. About four‐fifths of the women in 1997 stated their willingness to use long term estrogen therapy if osteoporosis could be prevented.Conclusions. Estrogen replacement therapy has become a part of the public debate. A high degree of willingness to use estrogen is demonstrated. The self reported level of information is higher and women are generally more correctly informed about positive and negative effects.
Identification of the major proteoglycans from human myometrium
Authors: Hjelm Ann , Ekman‐Ordeberg Gunvor , Barchan Karin , Malmström Anders 
Published: March 2003

Background. During pregnancy and parturition a remodeling within the extracellular matrix of the cervix and the corpus uteri occurs, which is of fundamental importance to a normal labor. The aim of this study is to identify the major proteoglycans in corpus uteri of non‐pregnant subjects.Methods. From human uterine tissue proteoglycans were extracted and purified using CsCl‐density gradient centrifugation, gel and ion‐exchange chromatography. The proteoglycans were quantified and identified by Alcian Blue before and after ABC‐digestion and by Western blotting.Results. The results showed that the corpus uteri contains a substantial amount of proteoglycans, 1.825 μg/mg wet weight. Decorin is dominating, constituting 63% of the total amount of proteoglycans. Heparan sulphate proteoglycans accounted for 20% and biglycan for 16%. Less than 1% consisted of the large proteoglycan versican.Conclusions. Further investigations must be performed to provide more information of the biological role of the proteoglycans in the uterus, especially during labor, by the presence of heparan sulphate proteoglycans and the minute presence of versican which indicate that the proteoglycan composition and organization is different to that of the cervix.