bluuebunny/crossref_metadata_2025_split huggingface dataset:
Termination of second trimester pregnancy with mifepristone and gemeprost
Authors: GEMZELL‐DANIELSSON KRISTINA , ÖSTLUND EVA 
Published: March 2003

Background. Earlier controlled clinical trials have demonstrated that combined treatment with the antiprogestagen, mifepristone and a suitable prostaglandin reduce the induction to abortion time in second trimester abortion. The aim of this study was to describe the results of the 197 consecutive second trimester terminations performed in routine clinical practice at our Department from 1996 to 1998.Methods. The report is based on 197 consecutive second trimester abortions including live pregnancies and missed abortions, carried out in 192 women. The women were treated with 600 mg mifepristone followed 24 to 48 hours later by 1 mg gemeprost administered every 6 hours four times. If abortion had not occurred, 1 mg gemeprost was administered every 3 hours for the next 12 hours. After expulsion of the fetus a surgical evacuation of the uterus was routinely performed up to 18 weeks gestation and thereafter when needed. The induction to abortion time was defined as the interval between the insertion of the first gemeprost pessary and expulsion of the fetus.Results. The median abortion time was 9.0 (1.4–40.5) hours for primigravidae and 7.2 (0–152.5) hours for multigravidae. The medium number of gemeprost pessaries to induce abortion was two and all except seven women aborted within 24 hours. Significantly more abortions occurred before 6, 7 and 8 hours in multigravidae than among primigravidae. The induction to abortion interval was also significantly shorter for nulliparous than for parous women. Except for one case of heavy bleeding, no serious complications occurred.Conclusion. The study confirms the efficacy and safety of mifepristone, together with gemeprost, for termination of second trimester pregnancy when routinely used in the clinic.
Medium‐term follow‐up of women with menorrhagia treated by rollerball endometrial ablation
Authors: EL SENOUN GHADA S. A. , MOUSA HATEM A. , MAHMOOD TAHIR A. 
Published: March 2003

Background. To assess medium‐term efficacy of rollerball endometrial ablation in a district general hospital.Method. From March 1992 to June 1997, 91 women underwent rollerball endometrial ablation for uncontrolled menorrhagia unresponsive to medical treatment. Each was sent a detailed questionnaire after at least 18 months (range 18–55). There was an overall response rate of 88% (80/91). Case notes were reviewed to collect additional data related to pre‐operative management and actual operative procedure. The main outcome measures included treatment satisfaction, relief of symptoms, improvement in health related quality of life, at least 18 months after surgery.Results. Thirty‐five of the 80 women (44%) had achieved amenorrhea. Ten women required further treatment; of these seven had a hysterectomy (9%). None of the non‐responders had a hysterectomy. Following rollerball endometrial ablation, many women reported improvement in cyclical pelvic pain (73%), pre‐menstrual symptoms (65%), ability to do housework (85%), and an improved sexual life (96%). Seventy‐nine (99%) women were able to return to normal work within 4 weeks following surgery. The majority of them remained satisfied with treatment (79%) and they would recommend it to a friend (91%).Conclusions. Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the treatment of menorrhagia in selected cases. Longer‐term follow up is still needed to establish the ultimate effectiveness of the procedure.
Female urinary incontinence – the role of the general practitioner
Authors: SEIM ARNFINN , HUNSKAAR STEINAR 
Published: March 2003

Subject. Urinary incontinence is a frequent disorder among adult females, but very few of the incontinent women have consulted a doctor.Discussion. This paper reviews and discusses the possible roles of the general practitioner in the diagnostic and therapeutic work with women with urinary incontinence. Some characteristics of general practice and the selection process from primary care to the specialist level are described. The selection process (gatekeeper function) of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital‐based research back to general practice. Recommendations and guidelines for diagnosis or therapy developed at secondary or tertiary care levels may be inappropriate at the primary care level, with a significantly different clinical picture of this condition.Results. Several studies show that most women seeking help in general practice can be satisfactorily treated at this level of care with fairly simple treatments, and that treatment is effective also in the long term. Some women with urinary incontinence need to be referred primarily to a specialist, or later if the response to treatment is disappointing.Recommendations. Based on literature studies and the authors' own experiences from clinical work and research, recommendations are presented for a basic evaluation and treatment of women with urinary incontinence who seek help in general practice.
Hysterectomy on benign indication in Denmark 1988–1998
Authors: Gimbel Helga , Settnes Annette , Tabor Ann 
Published: March 2003

Background. The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication.Methods. Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on the female population distribution were obtained from the Danish National Population Register.Results. During the last 11 years the incidence rate of hysterectomy performed for benign diseases has been stable. However, the rate of women treated surgically for benign diseases of the uterus has increased by 14%. During the study period the number of total abdominal hysterectomies has decreased by 38%, the number of subtotal abdominal hysterectomies has increased by 458%, the number of vaginal hysterectomies has increased by 107% and two new methods of surgical treatment for benign diseases of the uterus have been introduced. Abdominal hysterectomy still accounts for 80% of the total number of hysterectomies performed in Denmark in 1998. The age distribution for all hysterectomies has changed, from a maximum of 36–45 years in 1988 to 46–55 years in 1998. The age maximum for abdominal hysterectomy corresponds to that of all hysterectomies. For vaginal hysterectomy the age maximum is 56 years or older, while it is 36–45 years for laparoscopic hysterectomy.Conclusions. The incidence rate of hysterectomy was stable during the study period and the age distribution for all hysterectomies has changed. The study showed a change in the choice of surgical methods, although no evidence supports this practice.
Screening for Chlamydia trachomatis in asymptomatic women in Hungary
Authors: Nyári Tibor , Nyári Csaba , Woodward Mark , Mészáros Gyula , Deák Judit , Nagy Erzsébet , Kovács László 
Published: March 2003

Background. A multicenter survey was carried out in order to determine the prevalence and risk factors for Chlamydia trachomatis infection in the population of asymptomatic women in Hungary. Results were used to carry out a cost‐effectiveness analysis of screening for chlamydial infection in women with asymptomatic genital infections.Methods. The non‐amplified nucleic acid hybridization method (PACE 2 Gen‐Probe) was used to diagnose C. trachomatis and Bayes’ theorem was applied to assess the prevalence of the infection. Multiple logistic regression analysis was performed to differentiate the risk factors for chlamydial infections.Results. According to the test, the prevalence of Chlamydia trachomatis among 1300 pregnant women was 4.5%. The sensitivity and specificity of the test are estimated to be 70% and 99%, respectively. After Bayes’ correction, the overall estimated prevalence of chlamydial infection was 5.1%. There were significant differences in proportions of chlamydial infection in different regions, and also in different age groups and different family status groups. The highest rate was for women aged below 20 years: 16.9%. Cost‐effectiveness analysis, with associated sensitivity analysis was carried out for women aged below 20 years. Three screening strategies were compared: using the ELISA method, using amplified Gen‐Probe method and no screening. The amplified Gen‐Probe method was best provided, the infection prevalence exceeded 16.7%, the PID rate exceeded 24% and the probability of tubal infertility in untreated women exceeded 25%.Conclusion. We conclude that screening with amplified Gen‐Probe assays (followed by treatment of positive patients) is the preferred screening strategy for young women in Hungary.
Warm tub bathing during labor: maternal and neonatal effects
Authors: Ohlsson Gun , Buchhave Per , Leandersson Ulf , Nordström Lennart , Rydhström Hakan , Sjölin Ingrid 
Published: March 2003

Aim. To study possible detrimental maternal and neonatal effects of immersion in warm water during labor.Design. Prospective randomized controlled bathing during first stage of labor vs no bathing.Setting. Obstetrical departments at a university hospital and two central hospitals.Primary end‐point. Referral of newborns to NICU.Material and methods. Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeks+0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3–4 cm. Parturients randomized to the ‘no bath’ control group were allowed to use a shower. Rupture of the membranes was not a contra‐indication to participation. Those excluded from randomization were women with intra‐uterine growth retardation, meconium‐stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient.Main results. On average, parturients stayed in the tub for 50–60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III–IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar <7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0).Conclusion. In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns’ wellbeing after birth.
Evaluation of an optimal luteal phase support protocol in IVF
Authors: Ludwig Michael , Diedrich Klaus 
Published: March 2003

Subject. Luteal phase support has been shown in the past to be an essential part of ovarian stimulation protocols, especially the long protocol. It could be shown that hCG is as effective as is progesterone for luteal phase support but hCG is accompanied by a higher rate of complications.Methods. Progesterone can be administered in several routes. The oral, intramuscular (i.m.) and vaginal routes have been chosen frequently in the past. The oral route is ineffective, since progesterone has a low oral bioavailability (<10%), and a high rate of metabolites, which may result in side effects such as somnolence etc. Intramuscular administration provides very high serum levels of progesterone and this route is effective with regard to pregnancy rates. Injection of progesterone, however, is painful and cannot be done by the patient herself. The vaginal route is also effective, progesterone can be administered by the patient herself and progesterone is delivered directly to the uterus, where high levels are achieved (first uterine pass effect).Results. Several studies could show, in the past, that the vaginal administration of progesterone is effective also with regard to the downregulation of uterine contractions. Crinone® 8% Vaginal Gel is especially designed for vaginal use with a special applicator and has to be administered once daily in the morning. It adheres to the vaginal epithelium, and leakage of the gel is substiantially reduced as compared to other drugs like capsules or suppositories.Conclusions. Since progesterone is as effective as hCG for luteal phase support but provides a higher safety with regard to ovarian hyperstimulation syndromes, and vaginal progesterone is as effective as intramuscular progesterone, vaginal progesterone should be the standard choice for luteal phase support. Crinone® 8% seems to be the most comfortable way of vaginal administration of progesterone for luteal phase support in IVF cycles.
Mouse embryo toxicity of IL‐6 in peritoneal fluids from women with or without endometriosis
Authors: Wu Ming‐Yih , Chen Shee‐Uan , Chao Kuang‐Han , Chen Chin‐Der , Yang Yu‐Shih , Ho Hong‐Nerng 
Published: March 2003

Background. To determine whether there is a factor (or factors) in the peritoneal fluid of endometriosis patients that impairs embryo growth and embryo implantation.Methods. Growth and development of two‐cell mouse embryos which were cultured in media with peritoneal fluid from women with or without endometriosis and interleukin‐1‐beta (IL‐1β), interleukin‐6 (IL‐6), and tumor necrosis factor‐alpha (TNF‐α) levels in conditioned media were measured.Results. The blastocyst rate in the non‐endometriosis group was 46.4±31.1%, and that of the endometriosis group was 54.6±28.7%. Logistic regression analysis using the criteria of blastocyst development in 454 embryos, showed that the peritoneal fluid from endometriosis could promote (p=0.015) but IL‐6 could arrest embryo growth to blastocyst (p=0.025). IL‐1β and TNF‐α levels had no significant effect on blastocyst formation.Conclusion. Peritoneal fluid from women with endometriosis was not toxic to mouse embryo development. However, IL‐6 in the peritoneal fluid deteriorated the growth and development of mouse embryos.
Vaginal palpation of pelvic floor muscle strength: inter‐test reproducibility and comparison between palpation and vaginal squeeze pressure
Authors: Bø Kari , Finckenhagen Hanne Borg 
Published: March 2003

Background. Vaginal palpation is commonly used in clinical practice to teach and evaluate pelvic floor muscle strength, and several grading systems have been developed. The aim of the present study was to test inter‐rater reproducibility of the modified Oxford grading system and compare results from vaginal palpation with squeeze pressure measurement.Methods. Twenty female physical therapy students, mean age 25.1 years (range 21–38) participated in the study. Two experienced physical therapists conducted the palpation test in random order. Muscle strength was classified according to a 6‐point scale (modified Oxford grading system). Results from the palpation test were compared with measurement of vaginal squeeze pressure using a vaginal balloon connected to a fiberoptic microtransducer (Camtech AS, Sandvika, Norway). To ensure validity of pressure measurement only contractions with simultaneous observation of inward movement of the perineum were registered.Results. The inter‐rater reliability for vaginal palpation was 0.70 measured by Spearman’s rho (p<0.01). Cohen’s Kappa was κ=0.37 (SEM 0.16). There was agreement between the physical therapists in nine subjects (45%). In all but one subject the disagreement was one category. Mean maximal strength for the group was 19.7 cm H2O (95% CI: 16.5–22.9). There were no differences between weak, moderate, good and strong muscle contraction classified by palpation test when comparing results from the vaginal squeeze pressure (p=0.66).Conclusions. Vaginal palpation is mandatory when teaching correct pelvic floor muscle contraction. However, the present results indicate that the method is not reproducible, sensitive and valid to measure PFM strength for scientific purposes.
Evidence for a suppression of apoptosis in early postnatal life
Authors: Malamitsi‐Puchner Ariadne , Sarandakou Angeliki , Tziotis John , Trikka Panagioula , Creatsas George 
Published: March 2003

Background. In fetal life the rates of proliferation and apoptosis are high. We studied if the rate of apoptosis decreases after birth, by measuring the soluble (s) forms of Fas‐Fas ligand and Tumor necrosis factor receptor 1 (TNFR1)‐TNF‐α which attenuate apoptosis.Subjects and methods. Blood was drawn from the umbilical cord and from a peripheral vein on day 1 and 4 of life in 35 infants and sFas, sFas ligand, sTNFR1 and sTNF‐α were determined by enzyme immunoassays. Data were analyzed by paired t‐test and Pearson’s correlation analysis.Results. sFas and sTNF increased significantly from birth to day 4 of life (p=0.033 and p<0.0001 respectively), while sTNFR1 increased significantly from birth to day 1 of life (p<0.0001) followed by a significant decrease on day 4 of life (p<0.0001). The levels of sFas and sTNF‐α on day 1 correlated with those on day 4 (r=0.677, p<0.0002 and r=0.525, p<0.007 respectively). sFAS ligand was not detectable in any specimen.Conclusion. The increasing concentrations of the soluble molecules, sFas, sTNF‐α and sTNFR1 might indicate that apoptosis may be downregulated in early postnatal life.
Androgen levels of preeclamptic patients in the third trimester of pregnancy and six weeks after delivery
Authors: Serin İbrahim Serdar , Kula Mustafa , Başbuğ Mustafa , Ünlühizarci Kürşat , Güçer Şükran , Tayyar Mehmet 
Published: March 2003

Background. The aim of this study was to measure the circulating levels of androgens in the third trimester of pregnancy and six weeks after delivery and to discuss androgen contribution in the pathogenesis of preeclampsia.Methods. Twenty‐two preeclamptic and 20 normotensive women completed this prospective study. Blood samples were drawn in the third trimester (28–32 gestational weeks) and six weeks after delivery. Serum total testosterone (T), free testosterone (fT) dehydroepiandrosterone sulfate (DHEAS), androstenodione (A), sex hormone binding globulin (SHBG) and estradiol (E2) levels were measured. The statistical analyses of the data were performed by using Wilcoxon Rank test within the groups, Student unpaired t test and Chi‐square test between the groups with the SPSS program.Results. T and fT levels were found to be significantly higher (p<0.05) in preeclamptic women in the third trimester compared to the values of normotensive controls. However, there were significant decreases (p<0.05) in T and fT levels six weeks after delivery, reaching values not significantly different from normotensive subjects (p>0.05). Futhermore, SHBG, DHEAS, A and E2 levels were not significantly different (p>0.05) between the groups in the third trimester or six weeks after delivery.Conclusion. We conclude that higher blood androgen levels measured in preeclamptic patients may be implicated in the pathogenesis of preeclampsia.
Antenatal diagnosis of hereditary fetal growth retardation with aminoaciduria, cholestasis, iron overload, and lactic acidosis in the newborn infant
Authors: Fellman Vineta , Visapää Ilona , Vujic Mihailo , Wennerholm Ulla‐Britt , Peltonen Leena 
Published: March 2003

Objective. A prenatal diagnosis of the fetus for a mother of two previously deceased infants who died from the recently described autosomal recessive disease (OMIM 603358). The infants presented with intrauterine growth retardation, aminoaciduria, cholestasis, iron overload, severe lactic acidosis, and early death (GRACILE syndrome).Study design. DNA was extracted from the fibroblasts and tissue samples of the deceased infants, parental leukocytes, and from a chorion villus biopsy in the next pregnancy. Haplotypes were determined using the relevant markers flanking the disease‐associated region of chromosome 2.Results. Both deceased infants were homozygous for the four critical markers. The fetal haploptypes were identical to those of the siblings and the pregnancy was terminated. The iron content of the fetal liver was increased (5000 µg/g) compared with the controls, with a marked iron accumulation in the Kupffer cells.Conclusions. Antenatal diagnosis can be performed based on linkage analysis in families with at least one affected child because the disease locus has been assigned to a restricted chromosomal region. Typical histological abnormalities may be present in early fetal life.
Women's expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content
Authors: Hildingsson Ingegerd , Waldenström Ulla , Rådestad Ingela 
Published: March 2003

Background. Antenatal care has undergone continuous development over the past decades, but little is known about women's views and expectations. The objective of this study was to explore women's expectations on antenatal care, preferences regarding number of visits and attitudes to continuity of midwife caregiver in a national sample of Swedish‐speaking women.Methods. All Swedish‐speaking women booked for antenatal care during 3 weeks spread over 1 year (1999–2000) were invited to participate in the study. A questionnaire was mailed shortly after the first visit.Results. Three thousand and sixty‐one women completed the questionnaire, corresponding to 91% of women who consented to participate after exclusion of reported miscarriages. Checking the baby's health was the most important aspect of antenatal care, followed by checking the mother's health and making the partner feel involved. Seventy per cent preferred to follow the standard schedule of antenatal visits, 23% preferred more and 7% fewer visits. In primiparas, age < 25 years, a previous miscarriage and assisted conception were associated with a wish for more visits; in multiparas, previous miscarriage, previous stillbirth and a previous negative birth experience. A wish for fewer antenatal visit was associated with age over 35 years and unfortunate timing of pregnancy among primiparas, and with having more than two children and unfortunate timing of pregnancy in multiparas. Most women (97%) saw continuity of midwife caregiver during pregnancy as important.Conclusion. Women had high expectations of antenatal care in terms of possibilities of preventing fetal morbidity, a result that may reflect worries about the baby's health rather than a realistic assessment of the potential of antenatal care procedures. One‐third of the women wanted more or fewer visits than the standard schedule, and special attention should be paid to women with a previous stillbirth, miscarriage or a negative birth experience. The Swedish system with continuity of midwife carer during pregnancy was much appreciated.