bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in quality of life after hormonal treatment of endometriosis
Authors: Bergqvist Agneta , Theorell Töres 
Published: March 2003

Background. To assess whether hormonal treatment of endometriosis improves quality of life for women with endometriosis.Methods. In a prospective, randomized, double‐blind, double‐dummy study on 48 women with verified endometriosis, the pain pattern and quality of life were registered before, during and after treatment with nafarelin or medroxyprogesterone acetate. The distribution of the studied parameters were tested by means of a Skewness test. ANOVA analysis was used for normally distributed variables and Friedman's analysis and Mann‐Whitney U‐test for non normally distributed variables.Results. There was a difference between the 30 women who participated all through the study and the 18 who dropped out. It was noticeable that anxiety‐depression and sleep disturbances were significantly more common among the drop outs. There was a significant reduction in symptom score during the study, without any significant difference between the treatment groups. The sleep disturbances and anxiety‐depression score improved significantly from before treatment to the end of the follow‐up, but the anxiety‐depression score increased during the nafarelin treatment period. There was a statistically significant improvement of paid working life in the nafarelin treated group. All the other psycho‐social parameters as well as emotional balance improved during the study period without difference between groups.Conclusion. When hormonal treatment is planned it is very important to take into consideration previous psychosocial experiences of the patient. Factors of importance for quality of life such as sleep disturbances and anxiety‐depression improved significantly after treatment with nafarelin or medroxyprogesterone acetate.
Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair
Authors: Ottesen Marianne , Møller Charlotte , Kehlet Henrik , Ottesen Bent 
Published: March 2003

Background. Postoperative care and convalescence recommendations following vaginal surgery are generally not evidence based. The aim of this study was to describe pre and postoperative treatment, and advice and restrictions for the convalescence period, given by Danish hospital‐employed gynecologists, and gynecologists in private practice, to patients undergoing vaginal repair.Method. In 1999 all Danish gynecologists (n=433) received a tested questionnaire about postoperative treatment and convalescence recommendations following vaginal repair. Non‐responders received one reminder.Outcome measures. Pre and postoperative treatment, and expected hospital stay. Furthermore, lifting restrictions, sick leave, and convalescence before resumption of defined activities.Results. The overall response rate was 82%. The expected postoperative hospital stay was median 3 days (range, 1–7) following anterior repair, and 2 days (range, 1–7) following posterior repair. The recommended sick leave was median 6 weeks (range, 2–12) for patients with work with heavy lifts. There were substantial differences in recommendations. Recommended lifting restrictions were median 3 kg (range, 0–20) for median 4 weeks (range, 1–12), and the recommended time till recommencement of sexual intercourse was median 4 weeks (range, 0–12). The recommended convalescence was median 4–5 weeks for strenuous activities, and median 1–2 weeks for non‐strenuous activities, with ranges from 0–24 weeks. The overall, great variance could not be explained by demographic differences between gynecologists.Conclusion. Postoperative treatment, and convalescence recommendations given by Danish gynecologists following vaginal repair, show substantial variability and are based on individual viewpoints. Evidence based guidelines and consensus are desirable.
Perinatal deaths and insufficient antenatal care in Latvia
Authors: Jansone Maira , Lindmark Gunilla , Langhoff‐Roos Jens 
Published: March 2003

Objective. A national audit on perinatal deaths was performed to assess the quality of antenatal care, and to suggest measures for improved antenatal care.Material and methods. Medical records of all the perinatal deaths in Latvia in the years 1995–1996 have been studied. Non‐attenders and attenders of antenatal care were characterized by socio‐economic and medical variables: maternal age, parity, history of perinatal outcome, health status and behavioral hazards during the index pregnancy, length of gestation and birth weight. The Nordic‐Baltic perinatal death classification was used.Results. In 85 of 442 cases (19%) of perinatal deaths women had not taken advantage of antenatal care provided for them. Non‐attenders were more likely to be smokers (p<0.001) and alcohol abusers (p<0.005), above 35 years of age (p<0.005), and had higher parity (p<0.001). Non‐attenders more often had systemic diseases and pregnancy complications. Neonatal complications, such as congenital syphilis (p<0.05) and other infections (p<0.05), were more common among non‐attenders. There was no difference in rates of preterm birth and low birth weight between attenders and non‐attenders.Conclusions. One fifth of mothers with perinatal death did not attend ANC, and in some women who attended ANC, lack of intervention was related to the perinatal death.
Embryo transfer after 2 or 5 days of IVF culture: a retrospective comparison
Authors: Lundqvist Monalill , Rova Karin , Simberg Niklas , Lundkvist ÖRjan 
Published: March 2003

Background. To determine whether prolongation of embryo culture in vitro from day 2 to day 5 after ovum pick‐up (OPU) and fertilization can improve the results of in vitro fertilization (IVF), and the morphology of the spare embryos on day 2 can predict the developmental capacity during prolonged culture. We also wanted to consider this as a strategy to avoid twin pregnancies if it could be possible to transfer only one blastocyst at a time in the future.Methods. A retrospective analysis with embryo transfer timed according to the weekday of OPU. Embryo transfer was performed on day 2 in 103 cases and on day 5 in 120 cases. Only one cycle per couple was included.Results. The pregnancy rates per embryo transfer on day 2 (27/103, 26%) and day 5 (36/120, 30%) were similar. There were significantly more miscarriages in the day 5 (50%) than in the day 2 group (22%, p = 0.02), but there was no significant difference in the baby take home rate (20% in day 2 group, 15% in day 5 group). The morphological appearance of the embryos on day 2 was poorly correlated to the developmental potential during prolonged culture in vitro. On day 5, transfer of one or two blastocysts resulted in a pregnancy rate that tended to be higher than that after transfer of morulae only.Conclusion. Prolongation of embryo culture from day 2 to day 5 did not improve the clinical outcome of the IVF treatment when measured as baby take home rate. Therefore, for the time being, this strategy does not increase our chances to move towards single embryo transfer.
Induction of labor in toxemia with misoprostol
Authors: SAHIN H. GULER , SAHIN HUSEYIN AVNI , KOCER MUSTAFA 
Published: March 2003

Background.  To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in toxemia of pregnancy with a modified Bishop score of ≤4.Methods.  A hundred preeclamptic women with a modified Bishop score of ≤4 were randomized into two groups of 50 patients one group receiving 50 μg intravaginal misoprostol 4 times at 4 hour intervals, the second group receiving oxytocin infusion for induction of labor starting from 1 mIU/per minute, increasing it every 30 minutes with 2 mIU/per minute increments up to maximum of 30 mIU/per minute. Modified Bishop scores 12 hours after induction, the time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann Whitney‐U, Chi‐Square and hypothesis tests about differences for two proportions (t test) to determine differences between the two groups. p≤0.05 was considered significant.Results.  Misoprostol was significantly superior for induction of labor in toxemia of pregnancy with modified Bishop score of ≤4. After 12 hours median modified Bishop scores of misoprostol administered group and oxytocin administered group were 7 and 4 respectively. Misoprostol administered group 1 was significantly better than oxytocin administered group 2 (p=0.027). The rate of patients who were in labor after 12 hours were 94% and 80% in group 1 and 2 respectively and the difference showed significant difference (p<0.05). The median time from induction to delivery was 14 hours and 16 hours in the misoprostol and oxytocin administered group respectively with significant difference between the groups (p=0.003). The rate of vaginal delivery was significantly higher in the misoprostol administered group 1 (82%) when compared with the oxytocin administered group 2 (66%) (p<0.05). The 1 and 5 minutes median Apgar scores were 5–7 and 6–7.5 in group 1 and 2, respectively with no significant differences between the groups (p=0.96, p=0.64). The rate of admission to neonatal intensive care unit was similar in both groups. The complication rates were similar in all groups and no significant detrimental effects were noted.Conclusions.  Intravaginal misoprostol is an efficacious, cheap and safe method of induction of labor in toxemia of pregnancy with modified Bishop score of ≤4.
Effects of hormones on uPA, PAI‐1 and suPAR from cultured endometrial and ovarian endometriotic stromal cells
Authors: Guan Yong‐Mei , Carlberg Magdalena , Bruse Christine , Carlström Kjell , Bergqvist Agneta 
Published: March 2003

Problem.  To investigate whether endometriotic stromal cells release the urokinase plasminogen activator, soluble urokinase plasminogen activator receptor and plasminogen activator inhibitor‐1. If so, to establish if there are any differences between endometrial stromal cells from women with and without endometriosis, and whether the release is hormonally regulated.Method.  Biopsies were obtained from endometriotic tissue and from endometrium from women with and without endometriosis. Stromal cells were isolated, incubated and treated with estradiol‐17β, progesterone or raloxifen. Incubation media collected at 0, 24, 48 and 72 h were analyzed by enzyme‐linked immunosorbent assay.Results.  All these types of stromal cells released the urokinase plasminogen activator, soluble urokinase plasminogen activator receptor and urokinase plasminogen inhibitor‐1. There was a significantly higher release of urokinase plasminogen inhibitor‐1 and lower release of urokinase plasminogen activator and soluble urokinase plasminogen activator receptor in endometriotic cells. The release of urokinase plasminogen activator from endometrial stromal cells decreased during the study period both in control cultures and in cultures treated with progesterone or estradiol‐17β, but not in cultures treated with raloxifen nor in endometriotic cultures. The given hormones did not influence the release of the soluble urokinase plasminogen activator receptor. Progesterone significantly increased the urokinase plasminogen inhibitor‐1 release in endometrial cells from both patient categories, and raloxifen significantly reduced the urokinase plasminogen inhibitor‐1 release from stromal cells from both tissue categories from endometriotic patients. Estradiol‐17β had no effect.Conclusions  This study shows that stromal cells from endometrium and endometriotic tissues release the urokinase plasminogen activator, soluble urokinase plasminogen activator receptor and urokinase plasminogen inhibitor‐1. The release is partly hormonally regulated, but differently in endometriotic than in endometrial cells.
Doppler ultrasonography in singleton pregnancies at risk of intrauterine growth retardation – a national estimate
Authors: Westergaard Hanne Brix , Langhoff‐Roos Jens 
Published: March 2003

Background.  In order to assess the organizational and economical implications of Doppler ultrasonography used in high risk pregnancies, a national estimate of the use in singleton pregnancies with risk of small for gestational age (>2 SD below mean birthweight) (SGA) or intrauterine growth retardation (IUGR) was needed.Methods. Through retrospective analyzes of both national registry data, and local clinical and ultrasonic records from Copenhagen University Hospital annual populations of singleton pregnant women with suspected IUGR and/or infants born SGA were described. The antenatal care program for assessing pregnancies with suspected IUGR was described.Results.  In 1996 2.8% of all singleton infants were born SGA. The population had increased risk of perinatal mortality and morbidity, and about 40% had labor induced or were delivered by caesarean section, compared to 15% of the infants with normal birthweight. In the local population 79 (3.3%) of singleton infants were born SGA and 2/3 of these were considered SGA or IUGR before delivery. Of all singleton pregnancies, a total of 88 (3.7%) were assessed by ultrasonic fetometry because of a risk or clinical suspicion of SGA, and 49 (55.7%) of these pregnancies resulted in a SGA infants. Combining national and local data it is estimated that in Denmark, about 2000 women (3.1%) will be referred for ultrasonic fetometry each year because of a risk or clinical suspicion of SGA and have a mean of 2.5 fetometries. About 75% (1500) will be further assessed by Doppler ultrasonography and have a mean of 3.4 Doppler examinations.Conclusion.  The annual number of Doppler ultrasonography examinations in singleton pregnancies with increased risk of or signs of IUGR is estimated to be about 5000.
Gestational diabetes mellitus and fetal death in Mozambique: an incident case‐referent study
Authors: Challis Kenneth , Melo Armandio , Bugalho Antonio , Jeppsson Jan O. , Bergström Staffan 
Published: March 2003

Background. Third trimester fetal death is a common problem in Mozambique, occurring in approximately 5% of parturient women.Objective. To elucidate the magnitude of the gestational diabetes mellitus problem, and to estimate its prevalence in a group of women with unexplained late fetal deaths and in women with live fetuses (referents).Methods. An incident case‐referent study of 109 pregnant Mozambican women with fetal deaths and 110 women delivering liveborns, regarding fasting B‐glucose, oral glucose tolerance test and glycosylated hemoglobin.Result. The difference in gestational diabetes mellitus prevalence in the two groups is not significant. The prevalence of gestational diabetes mellitus was high in both groups: 11% and 7%, respectively.
Reference range for cervical length in twin pregnancies
Authors: Fujita Mariza M. , Brizot Maria L. , Liao Adolfo W. , Bernáth Tatiana , Cury Luciana , Neto Jorge D. Banduki , Zugaib Marcelo 
Published: March 2003

Background.  Twin pregnancies are at increased risk of preterm delivery, and cervical length measurement by transvaginal ultrasound examination has been shown to be an effective method of screening for this complication. The aim of the present study is to establish a reference range for cervical length measurement throughout gestation in twin pregnancies.Methods.  Prospective study involving 144 nonselected twin pregnancies that delivered after 34 weeks and underwent ultrasound examination every 4 weeks for transvaginal measurement of cervical length. Mean cervical length measurements, 95% confidence intervals for the estimate and 95% prediction intervals were established throughout gestation by linear regression analysis.Results.  There was a significant correlation between cervical length measurements and gestational age [cervical length (mm) = − 0.758 * gestation age (weeks) + 56.69, r=− 0.43, p < 0.0001], and mean cervical length shortened by approximately 0.8 mm per week, from 47 mm at 13 weeks to 32 mm at 32 weeks. The corresponding lower limits for the 95% prediction intervals were 29 and 15 mm, respectively.Conclusion.  Cervical length shortens gradually throughout gestation in twin pregnancies.
Power spectral analysis of heart rate variability during acute hypoxia in fetal lambs
Authors: Min Seong‐Won , Ko Hong , Kim Chong‐Soo 
Published: March 2003

Backgrounds.  The aim of the current study was to investigate the changes in the power spectral pattern of the heart rate variability of fetal lambs during acute hypoxia and the possible value of power spectral analysis as a quantitative fetal monitoring method.Methods.  Acutely instrumented eight fetal lambs in the third trimester of gestation were subjected to reproducible hypoxia by reducing the maternal placental blood flow with complete obstruction of the maternal abdominal aorta for 60 s. Fetal electrocardiographic data 5 min prior to occlusion, 1 min during occlusion and 1, 5, and 10 min after the removal of occlusion were analyzed using power spectral analysis. Differences among the procedural steps were determined by the Friedman test with multiple comparisons using Duncan's multiple‐range test. Wilcoxon's rank sum test was used for the comparison between low‐and high‐frequency power values at each step. p< 0.05 was considered significant.Results.  Low‐, high‐, total‐frequency power and low‐to‐high frequency ratio all significantly increased with hypoxia compared with the baseline state (p < 0.05). High‐frequency power remained higher than low‐frequency power during the resting state (baseline state, 5 and 10 min after hypoxia).Conclusions.  Increased low‐frequency power and low‐to‐high frequency ratio during hypoxia reflects increased sympathetic activity compared with the baseline state. Higher high‐frequency power during the resting state compared with low‐frequency power reflects active respiratory movement of the fetal lambs near term and increased parasympathetic activity. It appeared possible that power spectral analysis could serve as a useful quantitative tool to monitor the autonomic changes in fetal lambs during hypoxia.
Persistent ectopic pregnancy after linear salpingotomy: a non‐predictable complication to conservative surgery for tubal gestation
Authors: Lund Claus Otto , Nilas Lisbeth , Bangsgaard Nannie , Ottesen Bent 
Published: March 2003

Background.  The drawback of conservative surgery for ectopic pregnancy (EP) is the risk of persistent trophoblast. The purpose was to characterize patients who develop persistent ectopic pregnancy (PEP) after salpingotomy for EP and to assess prognostic factors.Methods.  The medical records of 417 patients treated by salpingotomy for EP were reviewed. Forty‐eight (11.5%) patients were diagnosed with persistent EP. The data were analyzed using the Mann–Whitney U‐test, Fischer's exact test or the χ2‐test.Results.  Of 417 women, 48 (11,5%) were treated for PEP by either repeat surgery (n= 25) or methotrexate (n= 23). Oral methotrexate failed in 4/19 cases while intramuscular (i.m.) methotrexate was successful in 4/4 cases. Women treated for PEP had a higher preoperative and a slower postoperative decline of serum human chorionic gonadotropin (hCG). Both the preoperative and the early postoperative hCG levels had a low diagnostic sensitivity (0.38–0.66) and specificity (0.74–0.77) for predicting PEP. In multivariate logistic analysis, none of the following clinical variables were predictive of PEP: duration of surgery, laparoscopic approach, history of previous EP, history of previous lower abdominal surgery, ruptured EP, pelvic adhesions, absence of products of conception at microscopy and hemoperitoneum.Conclusions.  Persistent ectopic pregnancy can neither be predicted from clinical variables nor from single measurements of hCG with an accuracy sufficient for clinical use.
Management of missed abortion: comparison of medical treatment with either mifepristone + misoprostol or misoprostol alone with surgical evacuation. A multi‐center trial in Copenhagen county, Denmark
Authors: Grønlund Annelise , Grønlund Lars , Clevin Lotte , Andersen Bodil , Palmgren Nina , Lidegaard ØJvind 
Published: March 2003

Objective.  To compare the efficacy of two different medical treatment regimens: mifepristone 600 mg orally + misoprostol 0.4 mg vaginally (Mf + Ms) or misoprostol 0.4 mg vaginally (Ms) with conventional surgical evacuation (SE) in women with missed abortion.Materials and methods.  Prospective crossover study with alternating regimens every 4 months. The three university clinics of Obstetrics and Gynecology in Gentofte, Herlev and Glostrup of Copenhagen County. During the period October 1999 to October 2000, 176 women with missed abortion accepted to participate in the study.Results.  The proportion of women who needed surgical evacuation after medical treatment, number of women who needed re‐evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, need of analgesics, and the subjective experiences from the participating women. Fifty‐four, 73 and 49 patients were randomized to Mf + Ms, Ms and SE, respectively. Within 1 week, complete expulsion occurred in 40 (74%), 52 (71%), 47 (96%) of the three arms, respectively. Duration of bleeding was 6.9, 7.1 and 2.5 days in the three arms, respectively (p < 0.01). Women with an initial plasma chorionic gonadotrophine (p‐hCG) between 2000 and 20 000 IU/l and a gestational age less than 75 days had a significantly better response to the medical treatment than those not fulfilling these two criteria. Initial p‐progesterone did not correlate with success of medical treatment.Main outcome measures  Proportion of women who needed surgical evacuation after medical treatment, and the number of women who needed re‐evacuation after primary surgical evacuation, duration of vaginal bleeding, treated infections, the need of analgesics, and subjective experiences from participating women.Conclusion.  Vaginal misoprostol 0.4–0.6 mg is effective in most patients with missed abortion. Pre‐treatment with the antiprogesterone mifepristone does not increase the success rate. The selection of women with missed abortion for medical treatment based on gestational age and initial p‐hCG level may increase the success of medical treatment significantly.
Optical coherence tomography and localized defects of the retinal nerve fiber layer
Authors: Teesalu Pait , Tuulonen Anja , Airaksinen P. Juhani 
Published: March 2003

ABSTRACT.Purpose: To test the capability of the optical coherence tomography (OCT) to demonstrate and quantitate retinal nerve fiber layer (RNFL) defects.Methods: The authors examined 6 eyes of 6 chronic open angle glaucoma patients with the OCT. The patients had abnormal Humphrey 30–2 visual fields which corresponded to RNFL defects visible in monochromatic fundus images taken with a digital imaging system. The RNFL images were used for directing the OCT scans to areas where most information was believed to be obtainable. Several linear scans of different lengths across healthy and abnormal RNFL regions were made.Results: When the OCT images were compared to RNFL photographs, the defective areas showed reduced backscattering with the OCT, being distinctly different from the adjacent normal RNFL. Except for one case the RNFL thickness values were smaller in the areas of abnormal appearance compared to areas of normal appearance.Conclusion: This preliminary study suggests that the OCT examination results of the RNFL are in good agreement with the RNFL appearance in monochromatic fundus images.