bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of stress and state anxiety on the outcome of IVF‐treatment: Psychological and endocrinological assessment of Swedish women entering IVF‐treatment
Authors: CSEMICZKY GYÖRGY , LANDGREN BRITT‐MARIE , COLLINS AILA 
Published: March 2003

Background. Comparing stress levels in women entering IVF treatment with those of fertile controls as well as relating these levels to the outcome of IVF.Methods. State anxiety and personality profiles as well as stress hormones were studied in 22 normally menstruating women entering IVF treatment for tubal infertility. Their personality profiles as well as state anxiety scores measured before entering IVF treatment were related to the outcome of treatment. Twenty‐two fertile women served as controls. Stress markers were serum prolactin and cortisol. These were estimated by radioimmunoassay. The psychological evaluation included the Karolinska Scales of Personality (KSP) and state anxiety as measured by the STAI questionnaire. Basal FSH on cycle day 3 and E2 and P4 AUC during the luteal phase were evaluated as hormonal predictors for the outcome of IVF treatment.Results. Comparison of the personality profiles of the two groups, showed that infertile women had significantly higher scores of suspicion (p>0.05), guilt (p>0.05), and hostility (p>0.01), but lower somatic anxiety (0.05) and indirect aggression (0.05) than fertile controls. The infertile women also had significantly higher levels of prolactin and cortisol throughout the menstrual cycle. Serum cortisol, prolactin and FSH levels on cycle day 3 did not differ between the women who conceived after IVF treatment and those who did not conceive. However, significant differences were found in E2 and P4 AUC (p>0.01) in the luteal phase between those women who became pregnant and those who failed. There was a trend (p<0.06) toward higher state anxiety levels among the women who did not succeed in becoming pregnant after IVF treatment.Conclusions. The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.
Symphyseal distention in relation to serum relaxin levels and pelvic pain in pregnancy
Authors: BJÖRKLUND KENNETH , BERGSTRÖM STAFFAN , NORDSTRÖM MARIE‐LOUISE , ULMSTEN ULF 
Published: March 2003

Objective. To elucidate whether there is an association between symphyseal distention, circulating relaxin levels and pelvic pain in pregnancy.Methods. Serum relaxin and symphyseal width were assessed in 19 consecutive referral cases with severe pelvic pain at 35 weeks of pregnancy and in a cohort of 49 women at 12 and 35 weeks of pregnancy. The referral cases were received over a period of two years and four months and the cohort was recruited over a period of two months. Relaxin was measured with an ELISA test and symphyseal width assessed using ultrasonography. All women with pelvic pain were clinically assessed. The women were divided into three groups; Group A (n=38), cohort cases with no or mild pain; Group B (n=11), cohort cases with disabling pain; and Group C (n=19), referral cases.Results. At 35 weeks of pregnancy, mean symphyseal width was 4.5 mm (s.d. 1.0 mm) in Group A, 5.7 mm (s.d. 2.6 mm) in Group B, and 7.4 mm (s.d. 3.5 mm) in Group C. The difference between Groups A and B is statistically significant (p=0.044) as is that between Groups A and C (p<0.0001). Serum relaxin levels were not associated with symphyseal distention or disabling pain.Conclusion. Severe pelvic pain during pregnancy was strongly associated with an increased symphyseal distention. However, the severity of pain did not predict the degree of symphyseal distention in the individual case, indicating that other mechanisms are also involved. Serum relaxin levels were not associated with the degree of symphyseal distention or with pelvic pain in pregnancy.
Saline infusion sonohysterography in endometrial cancer: assessment of malignant cells dissemination risk
Authors: ALCÁZAR JUAN LUIS , ERRASTI TANIA , ZORNOZA AMAIA 
Published: March 2003

Background. To assess the risk of malignant cells dissemination in patients with endometrial cancer undergoing saline infusion sonohysterography (SIS).Methods. Fourteen consecutive patients (mean age: 58.1 years, range: 41–74 years) diagnosed as having a clinical stage I endometrial carcinoma and scheduled for surgical staging were entered in this study. SIS was performed at the time of laparotomy just when the abdomen was opened and prior to the start of the surgical procedure. 10–20 mL of saline was infused. All fluid spilled from the fimbrial ends of the fallopian tubes was collected and analyzed for the presence or absence of malignant endometrial cells. Samplings were also taken from ascites, if found, or cytological washings, prior to and after SIS.Results. SIS could be satisfactorily performed in all patients. There was no spillage from either tube in nine patients. Mean fluid volume obtained from the other five patients was 4.4 mL. Cytologic analysis revealed the presence of malignant cells in the spilled fluid in one case (7.1%, one out of fourteen).Conclusions. Our data show that a small but real risk of malignant cell dissemination exists in patients with endometrial carcinoma who undergo SIS.
Mean cell volume and gamma‐glutamyl transferase are superior to carbohydrate‐deficient transferrin and hemoglobin‐acetaldehyde adducts in the follow‐up of pregnant women with alcohol abuse
Authors: SARKOLA TAISTO , ERIKSSON C. J. PETER , NIEMELÄ ONNI , SILLANAUKEE PEKKA , HALMESMÄKI ERJA 
Published: March 2003

Background and Objective. To compare the usefulness of carbohydrate‐deficient transferrin (CDT), the ratio of CDT to total transferrin, and hemoglobin‐acetaldehyde adducts with mean cell volume (MCV) and gamma‐glutamyl transferase (GGT) in the follow‐up of alcohol abuse during pregnancy.Methods. Forty‐four pregnant drug and alcohol abusing female patients attending a special outpatient clinic were followed from the 8th to 24th gestational week onwards. A population of sixty‐two healthy pregnant women was recruited to assess the effect of gestation on the markers.Results. Eight of thirteen heavy drinking (8 drinks/week) patients delivered infants with fetal alcohol effects (FAE). MCV and GGT were higher among heavy drinking patients than in moderately drinking (<8 drinks/week) patients (92±4 vs 90±3 fl and 31±34 vs 16±10 U/L, respectively), and in patients delivering infants with FAE compared with patients delivering healthy infants (95±3 vs 90±3 fl and 34±26 vs 15±10 U/L, respectively). Hemoglobin‐acetaldehyde adducts, CDT, and the ratio of CDT to total transferrin were neither associated with the reported level of alcohol consumption nor with the occurrence of FAE. In the receiver operating characteristics analysis MCV was found to be superior to CDT and the adducts, and GGT superior to the adducts, in identifying heavy drinking and in predicting FAE. In the control population, both CDT and total transferrin were found to rise during pregnancy, whereas the ratio of CDT to total transferrin was found to decline. The upper reference range of 33 U/L for CDT was considerably higher than that of non‐pregnant women (26 U/L).Conclusion. MCV and GGT appear to be the most efficient laboratory markers for detecting excessive alcohol consumption and the adverse effects of alcohol on the fetus.
Epidemiology of fetal death in Latin America
Authors: CONDE‐AGUDELO AGUSTIN , BELIZÁN JOSÉ M. , DÍAZ‐ROSSELLO JOSÉ L. 
Published: March 2003

Background. To identify risk factors associated with fetal death, and to measure the rate and the risk of fetal death in a large cohort of Latin American women.Methods. We analyzed 837,232 singleton births recorded in the Perinatal Information System Database of the Latin American Center for Perinatology and Human Development (CLAP) between 1985 and 1997. The risk factors analyzed included fetal factors and maternal sociodemographic, obstetric, and clinical characteristics. Adjusted relative risks were obtained, after adjustment for potential confounding factors, through multiple logistic regression models based on the method of generalized estimating equations.Results. There were 14,713 fetal deaths (rate=17.6 per 1000 births). The fetal death risk increased exponentially as pregnancy advanced. Thirty‐seven percent of all fetal deaths occurred at term, and 64% were antepartum. The main risk factors associated with fetal death were lack of antenatal care (adjusted relative risk [aRR]=4.26; 95% confidence interval, 3.84–4.71) and small for gestational age (aRR=3.26; 95% CI, 3.13–3.40). In addition, the risk of death during the intrapartum period was almost tenfold higher for fetuses in noncephalic presentations. Other risk factors associated with stillbirth were: third trimester bleeding, eclampsia, chronic hypertension, preeclampsia, syphilis, gestational diabetes mellitus, Rh isoimmunization, interpregnancy interval<6 months, parity ≥4, maternal age ≥35 years, illiteracy, premature rupture of membranes, body mass index ≥29.0, maternal anemia, previous abortion, and previous adverse perinatal outcomes.Conclusions. There are several preventable factors that should be dealt with in order to reduce the gap in fetal mortality between Latin America and developed countries.
Apoptosis, cellular proliferation and expression of p53 in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause
Authors: WU XUXIA , BLANCK AGNETA , OLOVSSON MATTS , MÖLLER BJÖRN , FAVINI ROBERTA , LINDBLOM BO 
Published: March 2003

Background. Cell proliferation, apoptosis and expression of p53 proteins were studied in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause.Methods. Expression of ki‐67 and p53 was analyzed by immunohistochemistry and by immunoblotting. Apoptosis was detected by in situ 3′ end labelling of cells with DNA fragmentation.Results. In both the proliferative and the secretory phases, ki‐67 expression was higher in leiomyomas than in myometrium and both tissues showed higher expression in the secretory than in the proliferative phase. No difference in apoptotic index was observed between leiomyomas and myometrium or between the proliferative and secretory phases. After menopause, the expression of ki‐67 as well as the apoptotic index was lower than in the proliferative and secretory phases and no significant difference between tissues was seen. Both leiomyomas and myometrium showed negative staining for p53. Immunohistochemical results regarding p53 were confirmed by Western blot.Conclusions. Our findings indicate that sex steroids influence the growth of leiomyomas by stimulating cell proliferation rather than by affecting apoptosis. The rate of cell proliferation is higher in fertile age than after menopause and appears to be enhanced under the influence of progesterone.
Note
Birthweight by gestational age in Norway
Authors: SKJÆRVEN ROLV , GJESSING HÅKON K. , BAKKETEIG LEIV S. 
Published: March 2003

Objective. To describe birthweight by gestational age in Norway for the period 1967–1998, evaluate secular trends and provide new standards for small for gestational age for 16 to 44 weeks of gestation.Subjects and methods. The analyses were based on more than 1.8 million singleton births, covering all births in Norway for a 32 year period. Percentiles for birthweight by gestational age were estimated using smoothed means and standard deviations. In the preterm weeks, means and standard deviations were carefully screened for birthweight‐gestational age consistency, adapting a method of Wilcox and Russell. Differences in birthweight by gestational age for stillbirths and livebirths in extremely preterm weeks (16–28) are presented, and the effects of cesarean section are evaluated. We observed a clear increase in birthweight by gestational age for all term weeks, but a decrease for most of the preterm weeks over the same period. This decrease was related to the increase in deliveries by cesarean section.Conclusions. Percentiles for birthweight by gestational age are presented for clinical use, based on a current period 1987–98, covering 20–44 completed gestational weeks. In the final standards we excluded stillbirths, infants born with malformations and cesarean sections. Birthweights in the Scandinavian populations are high and standards from other populations may not be representative, especially for the term weeks. Also, the secular changes demonstrated in this study indicate that old birthweight by gestational age standards need revision, especially due to changes in obstetrical routines influencing preterm data.
Maternal reproductive history: a registry based comparison of previous pregnancy data derived from maternal recall and data obtained during the actual pregnancy
Authors: KRISTENSEN PETTER , IRGENS LORENTZ M. 
Published: March 2003

Objective. To compare the quality of data on previous pregnancies, based on maternal recall, to that of actual data in previous birth records, and to quantify to which extent recall based data bias results in epidemiologic studies on adverse reproductive outcomes.Methods. Through linkage between agricultural censuses and the Medical Birth Registry, we identified 87,113 Norwegian female farmers with 174,764 single births in 1967–1991, including 533 late abortions (16–27 weeks). Data were linked into sibship records. In routine birth records, mothers provide information at each birth on previous fetal loss. Thus, we had information both based on recall and on the actual record.Results. Among all mothers with a loss documented in previous records, 73.5% had a recall of previous loss (sensitivity), while 74.3% of all mothers reporting a previous loss also had a loss in previous sibship records (positive predictive value). Late abortion after a previous loss according to the sibship record was more frequent than after a previous loss based on maternal recall (18.3 vs. 10.8 per 1000). There was a particular lack of recall for previous losses of short gestational age or when the current birth was a late abortion; both conditions tended to deflate the association between a previous and a current adverse outcome. Grain farming was associated with late abortion in mothers with previous loss in sibship records (odds ratio, 2.6) but not among mothers without previous loss (odds ratio, 1.0). When information on previous loss was based on maternal recall the odds ratios were 1.4 and 1.3, respectively.Conclusions. Consecutive sibship records give more valid information than data derived from maternal recall.
Hyperemesis gravidarum in a contemporary population in Oslo
Authors: VILMING BENTE , NESHEIM BRITT‐INGJERD 
Published: March 2003

Background. Sociodemographic studies of hyperemesis gravidarum are conflicting. During the last few years, there has been a clinical impression in Norway that immigrants are more afflicted than ethnic Norwegians.Methods. Of 175 patients hospitalized with the diagnosis hyperemesis gravidarum 1993 – 1997, 120 had complete records and were compared to a control group of 115 patients without hyperemesis gravidarum, drawn at random from the labor ward protocol. Variables: Ethnicity, age, height, weight at the beginning and at the end of pregnancy, body mass index, gravidity, parity, smoking, gestational age at labor, birth weight, placental weight. The patient's first name was used as an indication of ethnicity. Having a non‐Norwegian name means, in the majority of cases, being a first generation immigrant from a developing country. Statistics: SPSS statistical package for regression analyses, the chi‐square test with Yates correction and the Mann‐Whitney U‐test.Results. Risk factors for hyperemesis: non‐Norwegian name (OR 3.4, 95% CI 1.5–7.6), female sex of the infant (OR 2.6, 95% CI 1.3–5.3), gravidity number (OR 1.4, 95% CI 1.1–1.9). These two last variables were of significance only in patients with a Norwegian name. The hyperemesis group had a lower weight gain and birth weight. In a stepwise multiple regression birth weight (g) was dependent on weight increase (kg) (B=19.0, p=0.001), weight in early pregnancy (kg) (B=8.0, p=0.02) and parity (B=107.1, p=0.02). Hyperemesis, when corrected for weight increase, did not influence birth weight.Conclusions. Risk factors vary between different populations. Hyperemesis patients are at risk of having infants with reduced growth.
Smoking during pregnancy increases the risk of preterm births among parous women
Authors: KOLÅS TORIL , NAKLING JAKOB , SALVESEN KJELL Å. 
Published: March 2003

Background. We wanted to study a possible association between smoking during pregnancy and preterm birth.Methods. A population based prospective study was performed among 7,236 consecutive pregnancies over seven years delivered at one birth clinic. Smoking habits were obtained at a routine ultrasound examination around 18 gestational weeks, and preterm birth was defined as delivery of a child between 24 and 37 gestational weeks. We estimated relative risk (odds ratio) between smoking, possible confounding variables and preterm birth using multiple logistic regression analysis.Results. Overall, 1,769 (25%) women said that they smoked every day during their pregnancy. The smoking women had an increased risk of preterm delivery compared with non‐smokers (odds ratio 1.53, 95% confidence interval 1.24, 1.89). However, this association was only demonstrated among the multiparous women (odds ratio 1.88, 95% confidence interval 1.39, 2.54). The association was statistically significant after adjusting for maternal age, diabetes, cervical conization, preeclampsia, placental abruption and placenta previa in a multivariate analysis, and we observed a dose‐response effect of maternal smoking on preterm birth among multiparous women.Conclusion. For multiparous women smoking during pregnancy increases the risk of preterm delivery, and there seems to be a dose‐response effect of smoking.
High‐density vaginal Ureaplasma urealyticum colonization as a risk factor for chorioamnionitis and preterm delivery
Authors: ABELE‐HORN MARIANNE , SCHOLZ MICHAEL , WOLFF CHRISTINE , KOLBEN MARTIN 
Published: March 2003

Background. The aim of this case control study was to investigate the influence of genital Ureaplasma urealyticum colonization on pregnancy outcome.Methods. One hundred and seventy‐two women colonized with Ureaplasma urealyticum without co‐existing other infections and 123 women with negative cultures for Ureaplasma urealyticum were enrolled. In a multivariate analysis the influence of quantitative Ureaplasma urealyticum colonization level was determined.Results. Compared to the negative women increasing colonization with Ureaplasma urealyticum was associated with a significant decrease of birth weight (p<0.0001) and gestational age (p<0.0001) and with a significant increase of chorioamnionitis (p<0.0001) and preterm delivery (p<0.001). In a multivariate analysis high‐density Ureaplasma urealyticum colonization was an independent risk factor for chorioamnionitis and preterm delivery, whereas low colonization levels had no effect on an adverse outcome of pregnancy.Conclusions. The degree of colonization with Ureaplasma urealyticum correlates strongly with an adverse effect on pregnancy outcome.
The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi
Authors: KULMALA TEIJA , VAAHTERA MERIMAARIA , RANNIKKO JUHA , NDEKHA MACDONALD , CULLINAN TIMOTHY , SALIN MARJA‐LEENA , ASHORN PER 
Published: March 2003

Objective. To describe and compare the frequency of antenatally identified maternal ‘risk’ characteristics, place of delivery and occurrence of delivery complications.Methods. A prospective cohort study of 780 pregnant women completing antenatal follow‐up at a rural health center in Malawi.Results. Three‐quarters of the subjects had at least one commonly accepted risk characteristic. Only 30% of these women, and 22% of those with no risk chracteristics, delivered in a modern health facility. Four women died, 127 experienced other delivery complications and there were 52 perinatal deaths. The ‘at‐risk’ classification had over 80% sensitivity but less than 30% specificity to predict delivery complications or perinatal deaths. The positive predictive values were as low as 20% for delivery complications and 7% for perinatal mortality. Most individual ‘risk’ characteristics were not associated with adverse delivery outcomes, even when adjusted for the place of delivery.Conclusions. Antenatal risk identification failed to promote safe deliveries because of a poor predictive value of the ‘risk’ variables and the failure of the identified ‘at‐risk’ individuals to deliver in modern health facilities.
A randomized prospective study of misoprostol and dinoproston for induction of labor
Authors: BELFRAGE PATRICK , SMEDVIG ELI , GJESSING LEIF , EGGEBØ TORBJØRN MOE , ØKLAND INGER 
Published: March 2003

Background. Misoprostol, a prostaglandin E1 analog registered for the prevention of gastric ulcers in NSAID‐drug users, has been reported to be more effective for labor induction than the standard prostaglandin, dinoproston after vaginal application. There have been some concerns about possible hyperstimulation of the uterine activity and about the safety for the fetus with this new drug.Methods. Two hundred and ten patients, 36 weeks pregnant or more, with an unfavorable cervix, single pregnancy, and intact membranes were randomized to receive misoprostol, 50 micrograms intravaginally every 6 hours, or dinoproston 0.5 mg intracervically every 12 hours for a maximum of 24 hours, for labor induction.Results. Time from induction to delivery was shorter in both primigravidae and multigravidae after the application of misoprostol than dinoproston and failed induction was more common after dinoproston than after misoprostol. There were no differences in the condition of the newborns in the two groups, according to Apgar score, umbilical artery pH or referral to the neonatal unit, even if there were more operative deliveries for suspected fetal asphyxia after misoprostol than after dinoproston. We did not find any significant difference in the frequency of uterine hyperstimulation between the two groups.Conclusions. In the dosage used, misoprostol seems to be an effective agent for induction of labor in patients with an unfavorable cervix. Low cost and ease of administration make this drug a promising alternative for this purpose. Surprisingly, there is little interest from the manufacturer to promote the use of this drug for labor induction.