bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between personal learning curves for abdominal and laparoscopic hysterectomy
Authors: LEMINEN ARTO 
Published: March 2003

Background. To compare personal learning curves for abdominal and laparoscopic hysterectomy.Methods. The first 200 patients scheduled for abdominal hysterectomy and the first 200 patients scheduled for laparoscopic hysterectomy by a single operator were compared using learning curves according to operation time, operative blood loss, and occurrence of complications.Results. Learning curves for both types of hysterectomy were rather similiar, but the learning of the laparoscopic procedure seemed to be quicker. With increasing experience the operating time decreased by 25% in abdominal and by 41% in laparoscopic hysterectomies. The mean operating time in abdominal hysterectomy was 74 min and 70 min in laparoscopic hysterectomy. Operative blood loss decreased by 50% and 44%, respectively. The mean operative blood loss was smaller (203 vs 295 ml, p<0.0001) in laparoscopic hysterectomy. Increased experience had no effect on complication rates in abdominal hysterectomies, but a decrease of 44% was seen in laparoscopic hysterectomies (p<0.05). The overall complication rate (26% vs 22%) were similar for the two techniques, and only a few patients (1.5% vs 1%) had major (bladder or ureteric) complications.Conclusions. A trained gynecologist can learn the laparoscopic technique for hysterectomy at least as quickly as the abdominal technique.
A population based study of Swedish women’s opinions about antenatal, delivery and postpartum care
Authors: Ladfors Lars , Eriksson Margareta , Mattsson Lars‐Åke , Kylebäck Katarina , Magnusson Lena , Milsom Ian 
Published: March 2003

Objective. To investigate the views and experiences of Swedish women regarding antenatal, delivery and postpartum care.Study design. A random sample of women from the birth cohorts 1955, 1959, 1963, 1967 and 1971 resident in the city of Göteborg (n=2880) was invited by letter to complete a questionnaire regarding antenatal, delivery and postpartum care.Results. The overall response rate was 73% and 1130 (54%) of the 2109 responders had given birth to at least one child. Eighty‐one percent of parous women answered that checking blood and urine samples, fetal heart rate, and the measurement of fundal height were the most important procedures in antenatal care. A majority had a positive attitude towards the use of electronic fetal heart rate monitoring (parous 85%; nulliparous 84%). Sixty percent of parous women were aware that ultrasound examination was voluntary and a majority (90%) had a positive attitude towards ultrasound scanning. Forty‐three percent of parous women wanted antenatal clinics to be open until 8.00 p.m. A minority of both parous (4%) and nulliparous (4%) women were interested in home delivery. There were more parous (33%) than nulliparous (12%) women who expressed no anxiety at all about the next delivery. Seventy‐nine percent of the parous women reported that they would like to have a planned visit with a delivery ward midwife before the next delivery. About 80% reported that they would feel very safe if their partners were present at the delivery (nulliparous 79%; parous 84%). Eighty‐five percent preferred a single room or a room together with only one other woman in the postnatal ward. Seventy‐two percent of the women wanted to stay 72 hours or less in the postpartum ward and 24% thought there had been too many visitors during the postnatal period. Over 80% were very positive towards breast‐feeding. Approximately 80% of all women considered regular contractions up to twelve hours to be acceptable before delivery.Conclusions. This study has provided some useful information about women’s opinion regarding antenatal, delivery and postpartum care which may be taken into account when instigating changes in the maternity care system.
Changes in markers of anemia and iron metabolism and how they are influenced by antianemics in postpartum period
Authors: Mára Michal , Živný Jaroslav , Eretová Vladimíra , Kvasnička Jan , Kužel David , Umlaufová Anna , Márová Eva 
Published: March 2003

Background. The object of this study was to examine the occurrence of iron deficiency anemia in women after spontaneous delivery, changes in clinical and laboratory indicators of anemia in postpartum period and their possible control by administration of peroral antianemics.Methods. Ninety pregnant women at 35th to 39th week of gestation were randomly divided into three groups and extensively examined in a laboratory. After delivery, the mothers were examined four times at monthly intervals until the end of the third postpartum month. At the same time, they were examined for their subjective feeling of health, with some focus on typical anemic symptoms. Women in the first group were treated with 80 mg of elemental iron a day for the first two months after childbirth. Women in the second group were treated with 80 mg of elemental iron+0.35 mg of folic acid a day for the same period of time. Women in the control group did not use any medication. McNamara test was used to evaluate the portion of anemic and sideropenic women and for comparison between individual groups.Results. Findings of the study have shown a faster adjustment of laboratory and clinical indicators of postpartum anemia in women treated with iron. We did not observe the only, sovereign marker of iron deficiency (sideropenic) anemia in the early postpartum period.Conclusions. We recommend flat administration of iron to all women after spontaneous delivery. Postpartum substitution with iron should last at least three months because of long‐lasting sideropenia. Adding folic acid to iron does not have any significant impact during the postpartum period.
Effects of erythromycin on stretch‐induced contractile activity of isolated myometrium from pregnant women
Authors: Celik Husnu , Ayar Ahmet , Sapmaz Ekrem 
Published: March 2003

Background. Despite the fact that preterm labor and birth account for the vast majority of neonatal morbidity and mortality the currently available treatment options are still far from satisfactory. The aim of this study was to investigate the effects of erythromycin on stretch‐induced contractions of pregnant human myometrial strips, obtained at cesarean section.Method. Myometrial strips were suspended in an organ bath under 3 g tension and the effects of erythromycin (0.1, 0.2, 0.5, 1.0 mM) on stretch‐induced isometric contractions were evaluated. Results were statistically analyzed using Kruskal Wallis analysis of variance and Wilcoxon Rank tests where appropriate.Results. Erythromycin caused a significant decrease in the peak amplitude, while causing an increase in frequency of stretch‐induced myometrial contractions in a dose dependent manner in vitro.Conclusions. Results from this preliminary study suggest that erythromycin may have additional beneficial effects in infection related preterm labor cases, however, further studies are needed for clarifying the usefulness of erythromycin as a tocolytic agent.
Mode of delivery in breech presentation at term: Increased neonatal morbidity with vaginal delivery
Authors: Herbst Andreas , Thorngren‐Jerneck Kristina 
Published: March 2003

Objective. To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presentation in a Scandinavian clinic with a high rate of vaginal breech delivery.Methods. A retrospective study including 1050 term singleton breech pregnancies delivered at a Swedish tertiary referral center during 1988 to 2000. For 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) were delivered vaginally. In 327 (31%) cases a cesarean section was planned and performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological morbidity. Long term sequels among infants with a complicated neonatal course were also identified.Results. Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vaginal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarean delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity was 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptoms and six cases of brachial plexus palsy) compared to one case (cerebral symptoms) after a planned cesarean. These differences were all statistically significant (p≤0.002). Of the neurologically affected neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up.Conclusion. Neonatal morbidity may be reduced with planned cesarean delivery in breech presentation, also in a Scandinavian setting.
Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia
Authors: Clark T. Justin , Mann Christopher H. , Shah Neil , Khan Khalid S. , Song Fujian , Gupta Janesh K. 
Published: March 2003

Background. To determine the accuracy of outpatient endometrial biopsy in diagnosing endometrial hyperplasia in women with abnormal uterine bleeding.Design. Systematic quantitative review of published medical literature.Data sources. Relevant papers were identified through electronic scanning of MEDLINE (1980–1999) and EMBASE (1980–1999), manual searching of bibliography of known primary and review articles and contact with manufacturers.Review methods. Studies were selected if accuracy of outpatient endometrial biopsy, in women with abnormal pre or postmenopausal uterine bleeding, was estimated compared to a reference standard, which was endometrial histology obtained by tissue sampling under anesthesia. Quality assessment and data extraction were performed in duplicate. Diagnostic accuracy was determined by pooled likelihood ratios (LR) for positive and negative test results for endometrial hyperplasia.Results. There were 881 subjects in 8 diagnostic evaluations reported in 6 primary studies. Postmenopausal women represented 25% of the participants studied. There were 43 patients in whom outpatient sampling was inadequate. A positive test result on outpatient biopsy diagnosed endometrial hyperplasia with a pooled LR of 12.0 (95% CI 7.8–18.6) while a negative test result had a pooled LR of 0.2 (95% CI 0.1–0.3). With a positive test result, the posttest probability of endometrial hyperplasia was 57.7% (95% CI 41.1%–72.7%) while it was 2.2% (95% CI 0.9%–4.1%) with a negative test.Conclusion. Outpatient endometrial biopsy has modest accuracy in diagnosing endometrial hyperplasia. Therefore, additional endometrial assessment should be undertaken, especially if symptoms persist or intrauterine structural abnormalities are suspected.
Hyrtl’s anastomosis, the only connection between the two umbilical arteries. A study in full term placentas from AGA infants with normal umbilical artery blood flow
Authors: Ullberg Ulla , Sandstedt Bengt , Lingman Göran 
Published: March 2003

Background. The aim of this study was to describe the variable anatomy in the anastomosis between the umbilical arteries for better understanding of the physical characteristics of the umbilical flow velocity waveform (FVW).Methods. The arterial system of 67 placentas from pregnancies with normal umbilical FVW and resulting in a full‐term AGA infant was visualized by angiography. The method allowed study of the anatomy of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each umbilical artery.Results. In 60 cases there was one anastomosis between the umbilical arteries, in one case there were two, in four the anastomosis was absent, and another two cases had a single umbilical artery. The anastomosis was represented by a vessel, a fenestration or coalescence of the umbilical arteries. In case the anastomosis diameter was of at least that of the umbilical arteries, they supplied in mean 26% and 74% (±8.2%) of the placental area respectively. When the anastomosis diameter was smaller than that of the umbilical arteries their supply areas were in mean 41% and 59% (±6.0%) respectively. In placentas lacking anastomosis the two umbilical arteries supplied 45% and 55% (±2.6%) respectively, indicating a higher degree of symmetry.Conclusions. By using angiography we were able to demonstrate the variable anatomy of the anastomosis of Hyrtl. We found the occurrence and width of the anastomosis was correlated to the symmetry in size between the supply areas of each umbilical artery.
Levels of dimethylarginines and cytokines in mild and severe preeclampsia
Authors: Ellis Joy , Wennerholm Ulla‐Britt , Bengtsson Anders , Lilja Håkan , Pettersson Anders , Sultan Bo , Wennergren Margareta , Hagberg Henrik 
Published: March 2003

Background. The objectives were 1. to evaluate if the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine was altered in mild and severe forms of preeclampsia, and 2. to assess the relationship between dimethylarginines and the cytokine response in preeclampsia.Methods. Asymmetric and symmetric dimethylarginine were measured with high performance liquid chromatography in women with mild (n=13) and severe (n=32) preeclampsia and in normotensive pregnant controls (n=20). Interleukin‐4, ‐6, ‐8, ‐10 and tumor necrosis factor‐α were analyzed by immunoassays in women with mild (n=8) and severe (n=17) preeclampsia and in normotensive pregnant controls (n=14). The Mann Whitney U‐test and Spearman Rank test were used for statistical analysis.Results. The plasma levels of dimethylarginine were increased in preeclamptic subjects. The elevation of symmetric dimethylarginine was more pronounced than that of asymmetric dimethylarginine. The control levels of interleukin‐6, ‐8 and ‐10 were significantly higher at term than at gestational week 32–36. Interleukin‐6 and ‐8 were significantly elevated in subjects with severe, but not mild, preeclampsia, whereas TNF‐α and IL‐10 were not significantly altered. Symmetric dimethylarginine levels correlated significantly with arterial blood pressure and serum levels of creatinine and uric acid. Dimethylarginine levels in plasma were, however, not related to the cytokine response.Conclusions. Plasma concentrations of both asymmetric and symmetric dimethylarginine were significantly elevated both in mild and severe preeclampsia. Symmetric, but not asymmetric, dimethylarginine correlated to the severity of the condition. Plasma levels of interleukin‐6 and ‐8 were also elevated in severe preeclampsia but no direct correlations were found between these cytokines and dimethylarginines.
An increasing proportion of infants weigh more than 4000 grams at birth
Authors: Ørskou Janne , Kesmodel Ulrik , Henriksen Tine Brink , Secher Niels Jørgen 
Published: March 2003

Background. To investigate how mean birthweight has changed in the past decade, and to describe changes in the proportion of infants with a birthweight above 4000 grams (g).Methods. We analyzed data on 43,561 singleton infants born between 1990 and 1999 at Aarhus University Hospital, Denmark. Information on birthweight, gestational age, stillbirths, malformations, mode of delivery, prelabor intervention, and maternal diabetes was obtained from birth registration forms.Results. For all infants mean birthweight increased by 45 g (95% CI: 20–70 g) from 3474 g in 1990 to 3519 g in 1999. For infants born at term the mean increase was 62 g (95% CI: 41–83 g). During the same period the percentage of infants born with a birthweight above 4000 g increased from 16.7% in 1990 to 20.0% in 1999 (p<0.05). Simultaneously we found a decrease in gestational age and an increase in the frequency of induction of labor. There was a statistically significantly higher risk of giving birth to an infant with a birthweight above 4000 g throughout the decade, when gestational age and prelabor intervention was taken into account.Conclusions. In Denmark mean birthweight has risen during the past decade independently of gestational age and prelabor intervention. Simultaneously the risk of having a baby with a birthweight above 4000 g has increased. Further studies on potential risk factors for birth of large infants are needed.
A Wallace malleable stylet for difficult embryo transfer in an in vitro fertilization program: a case‐control study
Authors: Nielsen Ingrid Kirstine , Lindhard Anette , Loft Anne , Ziebe Søren , Andersen Anders Nyboe 
Published: March 2003

Background. The aim of the study was to evaluate the impact of using a Wallace malleable stylet in combination with an Edwards–Wallace embryo replacement catheter in case of difficult embryo transfer (ET).Methods. A retrospective case‐control study was used. The standard ET procedure at the clinic was to use a single tooth tenaculum, and a speculum to straighten the cervical canal prior to inserting the Edwards–Wallace embryo replacement catheter. In 205 of 2041 (10%) fresh ET difficulties were experienced during ET and a Wallace malleable stylet was used to place the outer catheter sheath correctly. This stylet transfer group was compared with a control transfer group of 410 ET performed just before and after each stylet transfer.Results. No differences in number of transferred embryos, cleavage stage, or embryo morphology score were found between the two groups. We found no differences in implantation rates (20.7 and 19.2% [95% confidence interval (CI) 0.8–1.5]) or delivery rates (29.3 and 25.4% [CI 0.8–1.8]) between the study and control group.Conclusion. Using a Wallace malleable stylet in combination with an Edwards–Wallace embryo replacement catheter in case of difficult ET has no negative impact on implantation and delivery rates.
Transforming growth factor‐beta 1 serum levels in pregnancy and pre‐eclampsia
Authors: Huber Ambros , Hefler Lukas , Tempfer Clemens , Zeisler Harald , Lebrecht Antje , Husslein Peter 
Published: March 2003

Background.  Isoforms of transforming growth factor‐beta (TGF‐β1) are thought to be involved in the pathogenesis of pre‐eclampsia. Data with respect to TGF‐β1 are controversial. We examined the correlation between TGF‐β1 serum levels and the occurrence and severity of pre‐eclampsia.Methods.  Transforming growth factor‐beta 1 serum levels were measured using a commercially available enzyme‐linked immunosorbent assay in 44 women with pre‐eclampsia and 44 healthy pregnant women. Results were correlated with clinical data.Results.  No difference in TGF‐β1 serum levels was assessed between women with pre‐eclampsia and healthy pregnant women. Transforming growth factor‐beta 1 serum levels were not associated with the severity of the disease and were not correlated with clinical maternal (blood pressure, proteinuria) and fetal (5‐min APGAR score, umbilical cord pH values, birth weight) parameters.Conclusions.  Our data support the assumption that in contrast to other isoforms, TGF‐β1, as evidenced by serum TGF‐β1 levels, does not seem to be involved in the pathogenesis of pre‐eclampsia.
Amniotic fluid erythropoietin concentrations differentiate between acute and chronic causes of fetal death
Authors: Teramo Kari A. , Schwartz Robert , Clemons Gisela K. , Widness John A. 
Published: March 2003

Background.  Increased fetal plasma erythropoietin concentration is an indicator of chronic fetal hypoxia. Amniotic fluid erythropoietin levels correlate highly significantly with fetal erythropoietin levels before labor. We studied AF erythropoietin levels after fetal death in order to determine whether this could differentiate between stillbirths from acute or chronic causes.Methods. Amniotic fluid was obtained after fetal death for erythropoietin measurement following fetal death in 21 pregnancies. Two of the pregnancies had twins, of which one infant was born alive. All 22 stillborn fetuses had an autopsy. None had malformations. Without prior knowledge of the results of the erythropoietin analyzes, the causes of fetal death were divided into acute, chronic or unknown groups.Results. Eight pregnancies had an acute cause of fetal death (e.g. cord complication or placental abruption), eight pregnancies had a chronic cause (intrauterine growth restriction or erythroblastosis) and in five pregnancies the cause of fetal death could not be determined. In all eight pregnancies with an acute cause of fetal death, AF erythropoietin levels were normal (< 20 mU/mL). In contrast, six of the eight pregnancies with a chronic cause had AF erythropoietin levels above normal (range from 49.9 mU/mL to 391 mU/mL). In the five pregnancies with an unknown cause of fetal death, AF erythropoietin levels were normal in three and elevated in two.Conclusions. Elevated AF erythropoietin levels, identified after fetal death, suggest that the fetus died from a chronic hypoxic event, whereas normal AF erythropoietin levels suggest that the fetus died from an acute event.
Preoperative serum SCC, CA125, and CA19‐9 levels and lymph node status in squamous cell carcinoma of the uterine cervix
Authors: Takeda Mahito , Sakuragi Noriaki , Okamoto Kazuhira , Todo Yukiharu , Minobe Shin‐Ichiro , Nomura Eiji , Negishi Hiroaki , Oikawa Mamoru , Yamamoto Ritsu , Fujimoto Seiichiro 
Published: March 2003

Background.  We wanted to investigate the clinical usefulness of determining the pretreatment levels of multiple serum tumor markers in predicting lymph node status and the prognosis for patients with cervical carcinoma.Methods.  The preoperative serum levels of squamous cell carcinoma antigen (SCC), cancer antigens CA125 and CA19‐9 were assayed simultaneously in 103 patients with stages IB to IIB cervical SCC undergoing radical hysterectomy. The cut‐off values of SCC, CA125, and CA19‐9 in this study were 1.5 ng/ml, 35 U/ml, and 37 U/ml, respectively. The relation between preoperative tumor marker levels and histopathologic prognostic factors including lymph node metastasis and patient survival was studied.Results.  Preoperative serum SCC, CA125, and CA19‐9 levels were significantly related to the FIGO stage. In addition, serum SCC and CA125 levels were significantly related to tumor diameter, depth of cervical stromal invasion, lymph‐vascular space invasion, and lymph node metastasis. We subsequently created a double‐tumor‐marker (DTM) index, which incorporated the number of positive markers of SCC and CA125. The DTM index was strongly related to the number of positive pelvic lymph nodes (p = 0.0002) and to the site of positive nodes (none vs. pelvic only vs. common iliac/paraaortic) (p = 0.0005). Probability of lymph node metastasis according to the DTM index = 0, 1, and 2 was 6/48 (12.5%), 14/45 (31.1%), and 8/10 (80.0%), respectively. The rate of common iliac/paraaortic node metastasis according to the DTM index = 0, 1, and 2 was 1/48 (2.1%), 2/45 (4.4%), and 3/10 (30.0%), respectively. By logistic regression analysis, it was shown that the DTM index and tumor diameter were independently related to lymph node metastasis. Using multivariate Cox regression analysis including singly determined serum SCC and CA125 levels, clinical stage (IB/IIA vs. IIB), tumor diameter (≤ 2 vs. 2–4 vs. > 4 cm), parametrial invasion, lymph node metastasis, and the DTM index, the DTM index was found to be the most important prognostic factor (p = 0.0005). However, when the sites of positive nodes were included in the multivariate analysis, only the sites of positive nodes (p = 0.0008) and parametrial invasion (p = 0.041) showed independent prognostic significance.Conclusion.  Combination assay of pretreatment serum SCC and CA125 levels seems to be useful in estimating lymph node status and the prognosis for patients with cervical SCC in a preoperative setting.