bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of epidural analgesia during labor on pelvic floor function after vaginal delivery
Authors: Sartore Andrea , Pregazzi Roberto , Bortoli Paolo , Grimaldi Eva , Ricci Giuseppe , Guaschino Secondo 
Published: December 2004

Background. Aims of this study were to determine the rate of symptoms related to perineal trauma (anal and stress urinary incontinence) and to assess pelvic floor muscle function in women who underwent epidural analgesia.Methods. Comparative design comprising 70 matched pairs of primiparous mothers. Each woman was questioned about urogynecologic symptoms and examined by digital test, vaginal perineometry and uroflowmetric stop test score 3 months after vaginal delivery. Urogenital prolapse was defined in accordance with the Baden and Walker's ‘Halfway System Classification’. Statistical analysis was performed using Fisher's exact test to compare the two groups and simple logistic regression models to estimate the odds ratios of every variable considered in respect of the control population.Results. No significant difference was found in the incidence of stress urinary incontinence, anal incontinence and vaginal prolapse in the two study groups. No significant differences were found between the study groups with regard to the digital test, vaginal manometry and urine stream interruption test.Conclusions. Use of epidural analgesia is not associated with symptoms related to perineal trauma and pelvic floor muscle weakness.
Dinoprostone versus misoprostol: a randomized study of nulliparous women undergoing induction of labor
Authors: Lokugamage Amali U. , Forsyth Sophie F. , Sullivan Keith R. , El Refaey Hazem , Rodeck Charles H. 
Published: December 2004

Background. The objectives of the study were to compare the efficacy and safety of intravaginal misoprostol and intravaginal dinoprostone for induction of labor and to quantify the clinical response to suspicious cardiotocographic (CTG) readings.Methods. One hundred and ninety‐one patients were randomized to receive either 50 µg misoprostol initially then a further identical dose 6 h later or 2 mg dinoprostone initially followed by 1 mg 6 h later, over a period of 24 h. If not in labor after 24 h, then both arms of the study would thereafter receive dinoprostone alone as per hospital protocol.Results. The induction to delivery interval (1047 vs. 1355 min, p = 0.01), delivery within 12 h (35.4% vs. 18.9%, p = 0.02) and delivery within 24 h (83.3% vs. 63.3%, p = 0.01) were all shorter in the misoprostol arm. There were no differences in rates of oxytocin augmentation ( p = 0.47), tachysystole ( p = 0.32) and hyperstimulation syndrome ( p = 0.82). There was an increase in the median number of times a doctor was called to advise on a suspicious CTG in the misoprostol group (1 vs. 2 occasions, p = 0.052), but there was no difference in neonatal outcome.Conclusions. Intravaginal misoprostol led to a shorter, more efficient labor, and although there was more anxiety related to the CTG, there was no increase in neonatal adverse effects.
A comparison of three methods to evaluate maximum bladder capacity: cystometry, uroflowmetry and a 24‐h voiding diary in women with urinary incontinence
Authors: Ertberg Pia , Møller Lars Alling , Lose Gunnar 
Published: December 2004

Background. Maximum bladder capacity (MBC) is an important parameter in the evaluation of lower urinary tract function. Yet, there is no consensus on how to measure MBC. The aim of this study was to compare estimates of the maximum bladder capacity (MBC) using cystometry, uroflowmetry, and a 24‐h voiding diary in women with urinary incontinence.Methods. From 1 January 1998 to 31 December 1998 a retrospective review comprising 60 incontinent women in whom cystometry, uroflowmetry, and a 24‐h voiding diary were performed were evaluated.Results. Median age was 55 years (range: 34–90 years). In women with detrusor instability (DI), MBC was significantly higher when measured using a voiding diary (median: 400 ml) as compared with cystometry (median: 215 ml) (p = 0.017). A ‘Bland–Altman plot’ demonstrated poor agreement between MBC in women with DI measured using a voiding diary and cystometry, respectively. The cystometric MBC was significantly higher in women with a stable detrusor (373 ml) as compared with women with DI (215 ml) (p = 0.0027). However, in women with or without DI there were no differences between MBC measured either using a voiding diary (400 vs. 360 mL) or by uroflowmetry (260 vs. 254 ml), respectively.Conclusions. A low cystometric MBC in women with DI may be an ‘artefact’ caused by the cystometric procedure (catherization and filling). The question is which measure of MBC is the best for clinical and scientific purposes.
Cigarette, alcohol, and caffeine consumption: risk factors for spontaneous abortion
Authors: Rasch Vibeke 
Published: December 2004

Objective. To study the association between cigarette, alcohol, and caffeine consumption and the occurrence of spontaneous abortion.Methods. The study population consisted of 330 women with spontaneous abortion and 1168 pregnant women receiving antenatal care. A case‐control design was utilized; cases were defined as women with a spontaneous abortion in gestational week 6–16 and controls as women with a live fetus in gestational week 6–16. The variables studied comprise age, parity, occupational situation, cigarette, alcohol, and caffeine consumption. The association between cigarette, alcohol, and caffeine consumption was studied using logistic regression analyzes while controlling for confounding variables. In addition stratified analyzes of the association between caffeine consumption and spontaneous abortion on the basis of cigarette and alcohol consumption were performed.Results. Women who had given birth twice or more previously had increased odds ratio (OR), 1.78 (1.27–2.49), whereas women who were students had decreased OR, 0.55 (0.34–0.91) for having spontaneous abortions. Regarding lifestyle factors, the adjusted ORs among women who consumed 5 units or more alcohol per week or 375 mg or more caffeine per day were 4.84 (2.87–8.16) and 2.21 (1.53–3.18), respectively. Women who smoked 10–19 cigarettes and 20 or more cigarettes per day did not have significantly increased ORs for having spontaneous abortions, after adjusting for other risk factors.Conclusion. Consumption of 5 or more units alcohol per week and 375 mg or more caffeine per day during pregnancy may increase the risk of spontaneous abortion.
Randomized trial in multiparous patients: investigating a single vs. two‐dose regimen of intravaginal misoprostol for induction of labor
Authors: Lokugamage Amali U. , Forsyth Sophie F. , Sullivan Keith R. , El Refaey Hazem , Rodeck Charles H. 
Published: December 2004

Background. Multiparous patients have a higher risk of hyperstimulation and uterine rupture than nulliparous patients. The minimum possible dose of uterotonic drug should be used in induction of labor for multiparous patients to avoid excessive uterine activity, which could increase both maternal and fetal risks.Methods. One hundred and four women were randomized to either a single dose of 50 µg of intravaginal misoprostol in 24 h, or two consecutive doses of intravaginal 50 µg misoprostol 6 h apart.Results. The mean induction to delivery interval (789 min [95% CI: 637–941] vs. 576 min [95% CI: 484–667], p = 0.018) and delivery rate within 12 h (63% vs. 83%, p = 0.035) were higher in the two‐dose group. The oxytocin augmentation rate (14% vs. 2%, p = 0.03) was higher in the single‐dose group. There was a higher rate of clinician input related to suspicious cardiotocographic readings in the single‐dose arm ( p = 0.04). There was no statistical difference ( p > 0.05) between the one‐ and two‐dose regimens with respect to the rates of tachysystole (21% vs. 15%), hyperstimulation (3.9% vs. 0%), and meconium staining at delivery (9.8% vs. 13.2%).Conclusions. The two‐dose regimen was most efficient, but both regimens were well tolerated by the fetuses.
Plasminogen activator inhibitor type 1 (PAI1) and platelet glycoprotein IIIa (PGIIIa) polymorphisms in Black South Africans with pre‐eclampsia
Authors: Pegoraro Rosemary J. , Hira Bavna , Rom Lee , Moodley Jack 
Published: December 2004

Background. Association of fibrin abnormalities with pre‐eclampsia prompted this study to examine whether polymorphisms in the plasminogen activator inhibitor Type 1 and platelet glycoprotein IIIa genes constitute risk factors for this condition.Methods. A group of 151 Black Zulu‐speaking pre‐eclamptics was examined for 4G/5G plasminogen activator inhibitor Type 1 and PlA1/A2 platelet glycoprotein IIIa polymorphic alleles using standard techniques. Results were compared with those found in 217 ethnically matched healthy normotensive pregnant women who had normal full‐term gestations.Results. Pre‐eclamptic patients had a slightly higher frequency of the 4G plasminogen activator inhibitor Type 1 allele (15%) compared with the controls (12%); this was reflected also in the heterozygote frequency (28% and 22%) for the patients and the controls, respectively. These differences were not significant. Only 2% of this population was found to be homozygous for the 4G allele. No differences were observed in the platelet glycoprotein IIIa polymorphism genotype and allele frequency distribution between the patients and the controls.Conclusions. Neither the 4G allele of the plasminogen activator inhibitor Type 1 nor the PlA2 allele of the platelet glycoprotein IIIa have any significant role as risk factors in the patho‐etiology of pre‐eclampsia in Black South Africans, although these genes cannot yet be excluded as contributory to this disorder. It is possible that the underlying causes of pre‐eclampsia may vary between different ethnic populations.
Clinical symptoms after anal sphincter rupture: a retrospective study
Authors: Wagenius Johanna , Laurin Jan 
Published: December 2004

Background. To evaluate the current anal sphincter function, the frequency of urinary incontinence and of dyspareunia in patients with earlier anal sphincter rupture following vaginal delivery.Design. Retrospective case–control study between 1994 and 1999 at the Central Hospital of Helsingborg, Sweden.Participants. Two hundred and eighteen women with a history of obstetric anal sphincter rupture and 436 matched controls.Methods. Postal questionnaire regarding anal incontinence, urinary incontinence, dyspareunia and lifestyle alterations. Obstetric data were collected from hospital records.Results. Of the 654 women included, 534 (82%) responded at a median follow up of 4 ears. Anal incontinence was significantly more common among patients with sphincter rupture. Sixty‐one (33%) reported incontinence of flatus and 39 (21%) incontinence of liquid stools compared with 53 (15%) and 26 (7%) in the control group. Dyspareunia was reported by 26 (14%) patients and 20 (6%) controls. The symptoms of dyspareunia seemed to decrease with time. There was no significant difference in urinary incontinence between the two groups. A third of the women in the case group claimed that their problems with anal incontinence affected their daily lives, but only a few had asked for medical assistance.Conclusions. Anal sphincter rupture is strongly associated with anal incontinence and dyspareunia several years postpartum. The complaints affect the daily lives of these women to a great extent.
Histopathological changes in ovary and endometrium after tubal ligation: a rat model
Authors: Duran Bulent , Demirkoprulu Nihal , Guvenal Tevfik , Arici Sema , Tuncer Ersin , Cetin Meral , Timuroglu Timucin 
Published: December 2004

Background. To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.Methods. Twenty‐four female Wistar albino rats weighing 220–260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary.Results. We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05).Conclusion. Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.
Influence of leptin and the TNF system on insulin resistance in pregnancy and their effect on anthropometric parameters of newborns
Authors: Melczer Zsolt , Bánhidy Ferenc , Csömör Sándor , Tóth Péter , Kovács Margit , Winkler Gábor , Cseh Károly 
Published: December 2004

Background.  We studied the contribution of the tumor necrosis factor system and leptin to insulin resistance during the course of normal pregnancy.Methods.  Forty‐five healthy pregnant women (15 in the 1st, 15 in the 2nd2 and 15 in the 3rd3 trimester) and 25 age‐matched healthy nonpregnant women as controls. Twenty‐three newborns delivered by women followed in the 2nd and 3rd trimesters were also investigated.Fasting serum immunoreactive tumor necrosis factor‐α, soluble tumor necrosis factor receptor‐1, soluble tumor necrosis factor receptor‐2, leptin (by enzyme‐linked immunoassay) and C‐peptide (by radioimmunoassay) concentrations in the patients and controls were measured. Body weight, length and head circumference of the newborns were analyzed in connection with the measured maternal parameters.Results.  Significantly elevated tumor necrosis factor‐α, tumor necrosis factor receptor‐1 and ‐2, leptin, and C‐peptide levels were found in the 3rd3 trimester as compared with the 1st1 and 2nd2 trimesters and with the nonpregnant controls. Tumor necrosis factor‐α, tumor necrosis factor receptor‐2, C‐peptide, leptin concentrations and body mass index were found to be in a significant positive linear correlation with each other. Significant negative linear correlations were calculated among maternal serum C‐peptide, tumor necrosis factor‐α and leptin concentrations and the head circumference of the newborns.Conclusions.  In conclusion, increased tumor necrosis factor‐α and leptin levels may contribute to insulin resistance in late pregnancy. Tumor necrosis factor‐α and leptin may be regulators of intrauterine bone development of newborns.
Comparison between two cord blood collection strategies
Authors: Solves P. , Mirabet V. , Larrea L. , Moraga R. , Planelles D. , Saucedo E. , Uberos F. C. , Planells T. , Guillen M. , Andres A. , Monleon J. , Soler M. A. , Franco E. 
Published: December 2004

Background and objectives.  Collection strategy is the first step for collecting good quality cord blood (CB) units. There are two principal different techniques to collect CB from the umbilical vein: in the delivery room while the placenta is still in the uterus by midwives and obstetricians or in an adjacent room after placental delivery by CB‐bank trained personnel. In this study, the benefits and disadvantages between two different CB collection strategies were evaluated in order to improve CB bank methodology.Design and methods.  Valencia CB bank maintains the two different collection strategies aforementioned. Before processing CB units, volume was calculated and samples were drawn for cell counts. After processing and before cryopreservation, samples for cell counts, CD34 analysis, viability, clonogenic assays and microbiology were drawn directly from the bags. We compared the efficiency of the two collection techniques.Results.  Obstetric date and umbilical CB was obtained from 848 vaginal (484 collected in uterus and 364 collected ex uterus). The proportion of excluded CB units before processing was 33% for ex uterus and 25% for in uterus. The difference was statistically significant. A larger volume and a higher number of total nucleated cells, CD34+ cells and CFUs were harvested in the in uterus collection group.Interpretation and conclusions.  Based on our findings, we conclude that the mode of collection influences the hematopoietic content of CB donations. Collection before placental delivery is the best approach to CB collection and allows optimizing CB bank methodology.
Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation
Authors: Nieminen Kari , Huhtala Heini , Heinonen Pentti K. 
Published: December 2004

Background.  To identify risk factors in recurrence and to evaluate anatomic and functional results of vaginal sacrospinous ligament fixation and pelvic floor reconstruction for genital prolapse.Methods.  One hundred and thirty‐eight women underwent surgery for uterovaginal or vault prolapse. Follow‐up data were available for 122 cases; 83% were examined and others were interviewed by telephone. The median (range) follow‐up was 24 (1–141) months. Cox regression was used to identify risk factors associated with recurrence; uni‐ and multivariate regression was used to identify risk factors underlying postoperative infections because infections were found to be a risk factor of recurrence. Recurrence‐free survival was estimated using the Kaplan–Meier method.Results.  Seven (5%) patients suffered severe cardiopulmonary complications including one postoperative death due to a pulmonary embolism. Twenty‐six (21%) patients suffered a recurrence, 14 with cystocele. Ten patients with recurrence were symptomatic and six underwent a re‐operation. The Cox regression model showed that vaginal cuff infection raised the odds ratio (OR) for recurrence to 6.13 [confidence interval (CI) 1.80–20.83] and urinary tract infection to 3.65 (CI 1.40–9.47). In both uni‐ and multivariate analysis, lack of intravenous antibiotic prophylaxis, age less than 73 years and vaginal ulcerations were statistically significant risk factors for postoperative infection. Eleven (33%) out of 33 sexually active women reported improvement and three (9%) complained of dyspareunia.Conclusions.  Transvaginal sacrospinous ligament fixation with pelvic floor repair is an effective means of correcting both vault prolapse and uterine procidentia. Women who wish to preserve coital function will also benefit from this operation. Postoperative infection is an independent and most important individual risk factor underlying recurrence. Prophylactic antibiotics seem to be effective in reducing the rate of postoperative infections.
The use of general anesthesia for the tension‐free vaginal tape procedure and concomitant surgery
Authors: Lo Tsia‐Shu , Lin Cheng‐Tao , Huang Huei‐Jean , Chang Chia‐Lin , Liang Ching‐Chung , Soong Yung‐Kuei 
Published: December 2004

Background. To study the efficacy of performing the TVT procedure and concomitant surgery under general anesthesia in the management of urinary stress incontinent patients.Methods. Eighty‐six women with genuine stress incontinence without pelvic relaxation syndrome were surgically managed. TVT procedures were performed using vigorous manual pressure against the abdominal wall to position and adjust the vaginal tape and ensuring no lifting of the urethra by intraoperative introital ultrasonography. Concurrent gynecologic procedures were performed, if indicated. The urodynamic studies, 1‐h pad‐tests and introital ultrasonography were performed preoperative and 1 year after surgery.Result. Six women were excluded for various reasons. Among 80 patients, 74 (92.5%) were cured, five improved and one failed. No major intra‐or postoperative complications occurred. After surgery, urine leakage observed on the pad‐tests was significantly reduced from a mean of 24 to 1.3 g. The operating time for the TVT procedure was 23 min, and postoperative hospital stay was 2.8 days. The position and mobility of the bladder neck showed no significant difference before and after surgery. De nova detrusor instability was observed in one patient. Spontaneous voiding with adequate volume of postvoid residual urine was noted for all patients by the fourth day postoperatively. Urodynamic parameters related to the voiding dysfunction showed no significant difference pre‐ and postoperatively.Conclusion. With modifications of the technique and the aid of intraoperative ultrasonography, the TVT procedure can be performed under general anesthesia. The procedure is safe, effective, minimally invasive, and has an additional benefit of correcting various coexisting gynecologic disorders in a single operation.
Incidence, treatment and outcome of peripartum sepsis
Authors: Kankuri Esko , Kurki Tapio , Carlson Petteri , Hiilesmaa Vilho 
Published: December 2004

Background and methods.  Clinical and microbiological features of maternal sepsis in the peripartum period (7 days before to 7 days after delivery) were analyzed to determine possible risk factors, optimal treatment and outcome. In 43 483 deliveries during 1990–98, laboratory‐confirmed bacteremia was found in 41 (5.1%) out of 798 clinically suspected septic infections.Results.  Preterm deliveries were associated with a crude 2.7‐fold risk for peripartum sepsis as compared to term deliveries. Antepartum sepsis was associated with a crude 2.6‐fold risk for cesarean section, while postpartum sepsis was 3.2 times more likely to occur after cesarean section than after vaginal delivery. A combination of cefuroxime and metronidazole was used in 80% (33/41) of all treatments. All mothers recovered well, and only one suffered from septic shock.In total, 42 bacterial strains, representing 18 different bacterial species, were isolated from the blood cultures; 37 strains (88%, 37/42) were aerobic and five (12%, 5/42) were anaerobic. The most common species were betahemolytic streptococci, Escherichia coli and Staphylococcus aureus. Most microbes (81%, 34/42) were found to be susceptible to first‐ or second‐generation cephalosporins.Conclusion.  Our analysis shows that peripartum sepsis is associated with preterm pregnancies and cesarean sections. Treatment of peripartum sepsis with second‐generation cephalosporin is usually effective, and the outcome is good.