bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hydramnios and small for gestational age: prevalence and clinical significance
Authors: FURMAN BORIS , EREZ OFFER , SENIOR LEON , SHOHAM‐VARDI ILANA , BAR‐DAVID JURY , MAYMON ELI , MAZOR MOSHE 
Published: March 2003

Objective. To investigate the clinical significance of combined obstetrical pathology of small for gestational age and hydramnios as a predictor of peripartum complications, intrapartum morbidity and poor neonatal outcome.Methods. The study population consisted of 152 small for gestational age neonates with hydramnios out of 67,806 singleton deliveries during the study period (0.22%). We compared the 152 small for gestational age neonates with hydramnios (hydramnios/small for gestational age) to a sample of 1% of the appropriate for gestational age neonates with normal amniotic fluid (normal amniotic fluid/appropriate for gestational age) (582 cases). Analyses were conducted for the entire cohort as well as for the cohort in which all cases with congenital malformations were excluded.Results. There was a significantly higher rate of congenital anomalies in the hydramnios/small for gestational age group compared with the normal amniotic fluid/appropriate for gestational age group (25% vs. 2.4%, p<0.001). There were significantly more previous perinatal deaths, infertility treatments and diabetes type B‐R among the hydramnios/small for gestational age group. These findings remained significant after exclusion of the neonates with congenital malformations. The rates of labor dystocia, placental abruptio, abnormal presentations, prolapse of cord and cesarean sections were significantly higher in the hydramnios/small for gestational age group compared with normal amniotic fluid/appropriate for gestational age group (5.9/2.4%, p<0.05; 5.9/0.7%, p<0.001; 14.5/3.2%, p<0.001; 2/0.2%, p<0.01; 24.3/8.2%, p<0.001; respectively). Rates of ante partum death and post partum death as well as low 1 and 5 minute Apgar scores were significantly higher in the hydramnios/small for gestational age group (9.9/0.3%; 14.5/0.3%; 12.8/2.1%; 11.7/0.6%, p<0.001, respectively).Conclusions. The combination of small for gestational age and hydramnios is a risk factor for peripartum complications and perinatal mortality even in the absence of congenital malformations.
Addition of gonadotrophin‐releasing hormone agonist and/or two inseminations with husband's sperm do not improve the pregnancy rate in superovulated cycles
Authors: KARLSTRÖM PER‐OLOF , BERGH TORBJÖRN , LUNDKVIST ÖRJAN 
Published: March 2003

Background. A prospective randomized study was performed to evaluate the addition of a gonadotropin releasing hormone agonist (GnRH‐a) during treatment with human menopausal gonadotropins (hMG) in cycles with artificial inseminations with husband's washed sperm (AIH). We also compared the pregnancy rate per cycle after one versus two AIHs.Methods. We designed a 22 factorial trial. A total of 172 couples with unexplained infertility (n=88), endometriosis (n=39), or cervical (n=24) or male (n=21) factors were included, of whom 161 fulfilled the inclusion criteria and treatment. Eighty‐one women were treated with GnRH‐a/hMG and another 80 with hMG only, respectively.Results. The pregnancy rates did not differ between the two stimulation protocols (12% for GnRH‐a/hMG and 9% for hMG). With GnRH‐a/hMG more follicles >15 mm (3.4 and 2.4, respectively; p<0.01) and a higher multiple pregnancy rate after 20 weeks of gestation were observed (55% vs. 0%; p<0.05). Eighty‐seven women were treated with one AIH, whereas 65 women received two AIHs on two consecutive days. The pregnancy rates were similar in these two groups (11% and 9% respectively; n.s.)Conclusion. It is concluded that neither addition of GnRH‐a before and during controlled ovarian hyperstimulation nor two AIHs compared with one single AIH per cycle has a beneficial effect on the pregnancy rate. However, GnRH‐a increases the risk for multiple pregnancies.
Attitudes among health care professionals on the ethics of assisted reproductive technologies and legal abortion
Authors: DE LA FUENTE FONNEST ISABEL , SØNDERGAARD FINN , FONNEST GERT , VEDSTED‐JACOBSEN AGNETE 
Published: March 2003

Background. The purpose of the present study was to study the attitudes among Danish health care professionals likely to encounter ethical controversies of ART and related subjects.Methods. Anonymous questionnaire study design. A total number of 993 were asked to participate from May‐July 1994.Results. There was a tendency towards a more liberal attitude among gynecologists than among nurses. There was a majority for legal abortion (before 12 weeks of gestation), for selective reduction in multiple pregnancies, and for donor anonymity. There was a majority against sex selection, artificial reproduction as to single women and lesbians, and against adoption by homosexuals. The multivariate analysis showed a strong correlation between attitude and background variables, especially as to religion and profession.Conclusion. Religion and profession are determinants for the attitude towards several of the ethical controversies of ART and related subjects asked for in this study. We found a discrepancy between recommendations by the Ethical Council of Denmark and the attitudes among health care professionals.
Perioperative morbidity of gynecological laparoscopy
Authors: LEONARD FRANCK , LECURU FABRICE , RIZK ELIE , CHASSET SOPHIE , ROBIN FRANÇOIS , TAURELLE ROLAND 
Published: March 2003

Background. To study the morbidity rate of gynecological laparoscopy and to the most influential variables.Methods. We conducted a prospective observational study from January 1st 1992 to December 31st 1998 in a single tertiary care center. It concerned patients who underwent gynecological laparoscopic surgery performed by seniors and residents. We have prospectively recorded patients characteristics, indications for laparoscopy, leading diagnosis, main operative procedures, post‐operative course, surgical and anesthetic incidents and accidents. Complications were defined as any event that would modify the usual course of laparoscopy or of the post‐operative period.Results. One thousand and thirty‐three laparoscopies were included. 80.1% of the procedures were major or advanced laparoscopies. The overall complication rate was 3%, with a laparotomy rate of 1.2%. About half of those complications (54.8%) occurred during the installation of laparoscopy. Veress needle and first trocar insertion accounted for 23.5% of those accidents (0.3% of the procedures) and suprapubic trocar insertion for 76.5%. Hemorrhages constituted almost all of the complications occurring during the operative stage (80%). The risk increased with the level of surgery and decreased with surgeon's experience. Prior abdominal surgery had no significant effect on the overall morbidity rate. Post‐operative and anesthetic complications were rare. The overall complication rate as well as the laparotomy rate were stable all along the course of the study.Conclusions. Complication rate of gynecological laparoscopy is not negligible. Efforts should be made to lower the complications induced by the installation of laparoscopy, especially for secondary trocars.
Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: A prospective, double‐blinded, placebo‐controlled, multicenter study
Authors: LARSSON PER‐GÖRAN , PLATZ‐CHRISTENSEN JENS‐JÖRGEN , DALAKER KNUT , ERIKSSON KATARINA , FÅHRAEUS LARS , IRMINGER KRISTINE , JERVE FRITJOF , STRAY‐PEDERSEN BABILL , WÖLNER‐HANSSEN PÅL 
Published: March 2003

Background. Bacterial vaginosis (BV) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy. Vaginal application of 2% clindamycin cream is an efficacious treatment for BV, but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy.Aim. To evaluate whether preoperative treatment with clindamycin cream might reduce the signs of post‐abortion infection after legal abortion.Design. Prospective, double‐blinded, placebo‐controlled, multicenter study.Material and methods. Consecutive women attending for surgical termination prior to 11+4 gestational weeks were approached. We randomized participants to preoperative vaginal treatment with 2% clindamycin cream or placebo cream in a double‐blinded fashion. At all visits vaginal smears were air dried on microscopy slides to be stored. The rate of postoperative pelvic infection according to our definition was the main outcome variable, the cure rates of BV and of intermediate flora were secondary outcome variables.Results. Of 1655 enrolled women, 1102 were evaluable for analyses. Fifty‐eight women developed signs of post‐abortion infection. Preoperative treatment with clindamycin cream significantly (RR: 4.2, 95% C.I. 1.2–15.9) reduced the risk of post‐abortion infection among women with abnormal vaginal flora (BV and intermediate flora). Treatment with clindamycin cream in women with normal lactobacilli flora did not demonstrate any difference compared to the non‐treatment group.Conclusion. Preoperative treatment for at least three days with clindamycin cream significantly reduced the risk for developing signs of post‐abortion infection only among women with preoperative abnormal vaginal flora (BV and intermediate flora).
Microlaparoscopy: a new approach to the reassessment of ovarian cancer patients
Authors: FRANCHI MASSIMO , GHEZZI FABIO , BERETTA PAOLO , DONADELLO NICOLETTA , MIGLIERINA MASSIMILIANO , ZANABONI FLAVIA 
Published: March 2003

Background. The purpose of the work was to determine the feasibility and accuracy of microlaparoscopy as diagnostic method for the reassessment of ovarian cancer patients.Methods. Eight patients scheduled for second‐look laparoscopy who had undergone primary surgery for ovarian cancer followed by 6 cycles of chemotherapy were included in the study. Microlaparoscopy was performed using a 2.8 mm laparoscope followed by conventional 10‐mm laparoscopy. Three additional 5‐mm ancillary trocars were inserted to perform intra‐abdominal biopsies. Pelvic washings were performed in all cases.Results. Microlaparoscopy was feasible in all cases and as accurate as conventional laparoscopy in seven cases. In one case the procedure was terminated before conventional laparoscopy because of positive biopsies at frozen section examination. There were no intra‐operative complications related to microlaparoscopy. The median time from skin incision to the removal of the microlaparoscope was 47 minutes (range 30–70).Conclusion. Microlaparoscopy seems to be a safe, accurate, minimally invasive method and therefore we suggest its use as primary approach to the reassessment of ovarian cancer patients.
Birthweight percentiles by gestational age in multiple births
Authors: GLINIANAIA SVETLANA V. , SKJÆRVEN ROLV , MAGNUS PER 
Published: March 2003

Objective. To assess secular trends for birthweight by gestational age in twins in Norway and to develop current national birthweight standards by gestational age for twin and triplet births using population‐based data.Material and methods. The analysis of secular trends for birthweight and gestational age in twins was based on 32,379 twin livebirths (1967–95). Taking into account the observed secular trends in birthweight for 35–40 weeks of gestation, data on twins born during 1987–95 only were included in the calculation of birthweight percentiles for 35–40 weeks, while for lower and upper weeks, data on twins born during 1967–95 were used. The construction of birthweight‐for‐gestation curves for triplets was based on the data on 690 triplets.Results. Whereas the overall mean birthweight and gestational age decreased in 1987–95 compared with the previous years, the mean birthweights by gestational age for the 35–40 weeks of gestation was significantly higher in 1987–95. Male twins weighed more than female twins throughout the gestation with consistent and significant differences from 27 to 42 weeks of gestation. Smoothed curves for birthweight‐by‐gestational‐age percentiles of male and female twins are plotted. The birthweight‐by‐gestational‐age curves of triplets were almost identical with twin curves before 30 weeks of gestation, starting to diverge from them progressively thereafter. The intrauterine growth of twin births also starts to differ markedly from singletons at approximately 30 weeks of gestation.Conclusion. This study shows that plurality‐specific birthweight‐by‐gestation standards should be used for assessment of fetal growth in multiple births rather than singleton standards.
Significance of endovaginal ultrasonography in assessing tamoxifen‐associated changes of the endometrium
Authors: STRAUSS HANS‐GEORG , WOLTERS MATTHIAS , METHFESSEL GISELA , BUCHMANN JUERGEN , KOELBL HEINZ 
Published: March 2003

Background. A prospective study was conducted investigating the value of endovaginal ultrasound in the assessment of tamoxifen‐associated changes of the endometrium in patients with breast cancer.Methods. Seventy postmenopausal patients with breast cancer treated with anti‐estrogens for at least 6 months were entered. Those with bleeding disorders and/or an endometrial thickness of ≥10 mm found on ultrasonography underwent hysteroscopy and dilatation and curettage (D&C) for further histological evaluation. In 22 patients, positive ultrasound findings could be compared with histopathology.Results. 82% of the 22 patients with positive sonographic findings had a glandular‐cystic hyperplasia or a glandular‐cystic polyp. No adenomatous hyperplasia or endometrial cancer was observed in our series.Conclusion. Vaginal ultrasound represents a useful diagnostic tool to detect tamoxifen‐associated changes of the endometrium. A threshold of 10 mm endometrial thickness appears suitable to identify endometrial abnormalities while reducing the rate of false‐positive findings to an acceptable level. However, the role of vaginal ultrasound in screening for endometrial cancer or premalignant lesions remains uncertain.
Upregulation of interleukin‐8 and polarized epithelial expression of interleukin‐8 receptor A in ovarian carcinomas
Authors: IVARSSON KARIN , EKERYDH ANNE , FYHR ING‐MARIE , JANSON PER OLOF , BRÄNNSTRÖM MATS 
Published: March 2003

Background. The chemokine interleukin‐8 is present in a variety of tumor types with suggested effects on proliferation, migration, and angiogenesis. Elevated levels of interleukin‐8 are present in cyst fluids from malignant ovarian tumors. The origin and potential targets for this chemokine in ovarian tumors were investigated in this study.Methods. Interleukin‐8 and its receptors were analyzed in 26 ovarian samples, including both normal and neoplastic tissue, with immunohistochemistry, Western blotting, and in situ hybridization.Results. The mRNA for IL‐8 was detected in higher amounts in the epithelial compartments compared to stromal areas, while the IL‐8 protein was present in both epithelial and stromal areas, and in cystic formations of the tumors. The tissue levels of IL‐8 protein increased with lower differentiation of the tumors. Both types of IL‐8 receptors were detected in most specimens. A typical expression pattern for IL‐8 receptor A was detected, with expression only on the luminal side of the epithelial tumor cells, while IL‐8 receptor B was more evenly distributed in the tissue.Conclusions. An increased synthesis of IL‐8 during dedifferentiation of the tumor, and a typical expression pattern of the IL‐8 receptor A were detected, indicating a function for IL‐8 in biology of epithelial ovarian cancer.
Prevalence of nocturnal hypoglycemia in first trimester of pregnancy in patients with insulin treated diabetes mellitus
Authors: HELLMUTH ELLINOR , DAMM PETER , MØLSTED‐PEDERSEN LARS , BENDTSON INGER 
Published: March 2003

Background. Excellent metabolic control before conception and during diabetic pregnancies is the aim in order to avoid malformations and perinatal morbidity. Since an inverse correlation between median blood glucose concentration (BG) and hypoglycemia as well as a high prevalence of nocturnal hypoglycemia have been described, we investigated the frequency of nocturnal hypoglycemia and the predictive value of bedtime blood glucose concentration for development of this condition in insulin treated diabetic patients.Methods. During hospitalization, with no other changes in the patients' normal schedules, hourly blood samples were drawn from an iv‐cannula from 22.00 h to 07.00 h for one night. BG (venous whole blood) and hemoglobin A1c were determined the following day.Results. Fifty‐three patients participated; subsequently ten were excluded due to discontinuation of blood sampling during the night, caused by either discomfort or cannula problems. Of the remaining 43 patients, 16 (37%) had at least one blood glucose <3.0 mmol/l. The duration of hypoglycemia was 2.4 (1–7) h with the highest prevalence at 05 h. Only one patient felt hypoglycemic during the night. Hemoglobin A1c was similar in patients with (7.1±1.2%, mean±s.d.) and without (6.8±0.8%) nocturnal hypoglycemia. Women with nocturnal hypoglycemia had significantly lower BG before bedtime compared to patients without hypoglycemia, 6.4±3.6 mmol/l vs. 7.9±2.4 mmol/l, p<0.05. The best predictive value for nocturnal hypoglycemia was a BG below 6.0 mmol/l at 23.00, which resulted in a risk of nocturnal hypoglycemia of 71%. Conversely, if the BG was ≥6.0 mmol/l, the chance of avoiding nocturnal hypoglycemia was 83%.Conclusion. Nocturnal hypoglycemia was seen with a prevalence of 37% during a night in the first trimester of pregnancy in insulin treated patients. Only one patient registered the hypoglycemia. Nocturnal hypoglycemia could be predicted in the majority of patients by measurements of BG before bedtime.
Antenatal, neonatal and post neonatal deaths evaluated by medical audit
Authors: DAHL LAURITZ BREDRUP , BERGE LILLIAN NORDBØ , DRAMSDAHL HARALD , VERMEER ADRI , HUURNINK AART , KAARESEN PER IVAR , ØIAN PÅL 
Published: March 2003

Background. Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997.Subjects and methods. Antenatal, neonatal and post neonatal deaths (n=472) at ≥20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non‐optimal care and avoidable deaths were recorded.Results. The death rate (all deaths per thousand total births) declined from 13.8 (1976–80) to 7.7 (1992–97), (p<0.001), due to a reduced death rate in preterms ≥24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre‐hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non‐optimal care (22.5% of deaths, 2.3‰ of total births), avoidable deaths (13.1% of deaths, 1.3‰ of total births), and maternal neglect (7.5% of cases with non‐optimal care, 0.6‰ of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non‐cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population.Conclusion. The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non‐hospitalized patients is a challenge for antenatal health care providers.
Value of urinary prophylaxis with methenamine in gynecologic surgery
Authors: Schiøtz Hjalmar A. , Guttu Kristian 
Published: March 2003

Background.  There is a high risk of postoperative bacteriuria and urinary tract infection after gynecologic surgery. Postoperative asymptomatic bacteriuria often disappears without treatment, but 15–20% of patients still require treatment for postoperative urinary tract infection. This study was carried out to assess the value of prophylactic treatment with methenamine hippurate after routine gynecologic surgery.Methods.  This was a prospective, randomized, double‐blind, placebo‐controlled clinical trial comprising 145 patients undergoing routine gynecologic laparotomy or vaginal plastic surgery using a Foley catheter for 24 h. Antibiotics were not used. Subjects received 1 g Hiprex or placebo twice daily for 5 days. Urine was cultured preoperatively, at catheter removal, and 2 days later. Patients with positive cultures were not given antibiotics unless they were symptomatic. The follow‐up period was 1 month.Statistics.  The chi‐square test, Fisher exact test, and t‐test were used with level of significance at 0.05, and odds ratios with 95% confidence intervals were calculated.Results.  Asymptomatic bacteriuria was diagnosed in 36 cases (50.0%) in the placebo group and 22 cases (30.1%) in the methenamine group (p = 0.02). Urinary tract infection was diagnosed in 10 cases (13.9%) in the placebo group and two cases (2.7%) in the methenamine group (p = 0.03). There were few adverse events.Conclusions.  Prophylactic treatment with methenamine hippurate significantly reduces the incidence of postoperative bacteriuria and urinary tract infection.
Arterial and ductus venosus Doppler in fetuses with absent or reverse end‐diastolic flow in the umbilical artery: correlation with short‐term perinatal outcome
Authors: Müller Thomas , Nanan Ralph , Rehn Monika , Kristen Peter , Dietl Johannes 
Published: March 2003

Background.  High perinatal morbidity and mortality rates have been reported in association with absent or reverse end‐diastolic flow velocities in the umbilical artery. Doppler of fetal venous blood flow might be a helpful instrument for predicting fetal outcome. However, clinical data addressing this issue are rare. Thus, the aim of this study was to evaluate arterial and ductus venosus blood flow velocities as a predictor of short‐term outcome in fetuses with umbilical absent or reverse end‐diastolic flow velocities .Methods.  Thirty‐five high‐risk single pregnancies complicated by umbilical absent or reverse end‐diastolic flow velocities were monitored by serial measurement of the pulsatility index of the umbilical artery, middle cerebral artery, and ductus venosus waveforms over a period of 1–75 days.Results.  The mean observation period between first detection of an umbilical absent or reverse end‐diastolic flow velocity and delivery was 8.9 days. A significant correlation was found between parameters of short‐term perinatal outcome (art. pH, art. base excess, development of intraventricular hemorrhage, mortality) and end‐diastolic flow velocity waveform or pulsatility index of the ductus venosus waveform, but not with arterial Doppler parameters. Gestational age proved to be the best predictor for duration of assisted ventilation and development of respiratory distress syndrome.Conclusions.  Our results indicate that in high‐risk pregnancies with umbilical absent or reverse end‐diastolic flow velocities, determination of blood flow velocities in the ductus venosus is a useful additional parameter for prediction of fetal outcome and for timing delivery.