bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity is a risk factor for early pregnancy loss after IVF or ICSI
Authors: FEDORCSÁK PÉTER , STORENG RITSA , DALE PER OLAV , TANBO TOM , ÅBYHOLM THOMAS 
Published: March 2003

Background. Experience with polycystic ovary syndrome shows that insulin resistance is related to early pregnancy loss. This association was examined by comparing pregnancy outcome in obese and lean women.Methods. A cohort of 383 patients conceiving after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was studied. Ovarian stimulation was achieved by GnRHa and FSH or hMG (n=362), by FSH or hMG alone (n=16), or by clomiphene citrate and FSH or hMG (n=5). Luteal phase was supported with progesterone. Pregnancies were defined by >10 IU/l plasma ß‐hCG on day 14. Ultrasound scan on week 6 and week 12 confirmed fetal viability.Results. Lean group (body mass index [BMI]<25 kg/m2; n=304) and obese group (BMI ≥25 kg/m2; n=79) were established. Obese patients had fewer oocytes collected (median: 8 vs 10 p=0.03), they had higher abortion rate during the first 6 weeks (22% vs 12%; p=0.03) and lower live‐birth rate (63% vs 75%; p=0.04). The relative risk of abortion before week 6 was 1.77 (95% CI: 1.05 to 2.97). Multivariate logistic regression analysis revealed that obesity and low oocyte count were independently associated with spontaneous abortion. In the obese group, low oocyte number was associated with a more profound increase in the risk of abortion than among lean patients. The effect of age, history of past pregnancies, or infertility diagnosis on the probability of miscarriage were not significant.Conclusions. Obesity is an independent risk factor for early pregnancy loss. This risk is, in part, related to the lower number of collected oocytes in obese women.
Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps
Authors: KAMEL HASSAN S. , DARWISH ATEF M. , ABDEL‐RADY MOHAMED SAFWAT 
Published: March 2003

Background. The diagnostic accuracy of transvaginal ultrasonography and vaginal sonohysterography in detecting endometrial polyps in women suffering abnormal uterine bleeding are compared.Methods. One hundred and six patients suffering from menometrorrhagia were studied. To detect whether there was endometrial polyp or not, these patients were subjected to transvaginal ultrasonographic examination as well as to sonohysterography. The final diagnosis was established by diagnostic hysteroscopy and its guided biopsy.Results. Transvaginal ultrasonography resulted in false positive and false negative rates of 25% and 36.2% respectively while the figures with sonohysterography were 5.4% and 8% respectively. Combining both techniques further improved such rates to 2.9% and 2.8% respectively but not significantly (p>0.1). The sensitivity and specificity were 64.5%, 75.5% for transvaginal ultrasonography, and 93.1%, 93.9% for sonohysterography (significantly higher: p<0.001).Conclusions. Sonohysterography is significantly more accurate than transvaginal ultrasonography in the detection of endometrial polyps in cases with abnormal uterine bleeding. Combining both techniques did not significantly improve the diagnostic accuracy. Sonohysterography is an accurate and cost effective method which requires a little skill.
Umbilical cord knots
Authors: SØRNES TORGRIM 
Published: March 2003

Background. Umbilical cord knots may represent a hazard to the fetus, particularly as regards intrauterine death and fetal distress or asphyxia in labor. The object of this study was to analyze the impact of associated umbilical cord encirclements and cord length on fetal outcome and fetal weight deviation.Methods. Among 22,012 births occurring in Akershus Central Hospital, there were 216 instances of umbilical cord knots. Fetal outcome, fetal weight deviation, associated umbilical cord encirclements and cord length were assessed.Results. Neonates with a knotted cord are more often large‐for‐gestational age compared to other babies, and have longer umbilical cords. There is a 10 times higher chance of intrauterine fetal death with a knotted cord, but if this does not occur then there is no increased risk of obstetrical intervention and Apgar scores are the same as in other babies and other fetuses.Conclusion. There is an association between umbilical cord knots and umbilical cord encirclements. Knotting of the cord is not by itself lethal. Pregnancies with knotted cords have characteristics different from those with ordinary umbilical cord encirclements.
Fetal oxygen saturation during epidural and paracervical analgesia
Authors: KAITA TANJA MARJUT , NIKKOLA EEVA MARIA , RANTALA MIKA ILARI , EKBLAD URPU ULLA , SALONEN MARKKU ARVI OLAVI 
Published: March 2003

Background. We wanted to assess changes in fetal oxygenation during maternal epidural or paracervical analgesia in labor.Methods. A prospective, open and non‐randomized study. Twenty healthy parturients were enrolled before they asked for pain relief. Informed consent was obtained. Fetal and maternal oxygen saturations were measured before and up to 1 h after the initiation of analgesia. Fetal oximetry was performed with the Nellcor N‐400 oximeter+FS‐14B fetal oxygen sensor (Nellcor Puritan Bennett, Pleasanton, California, USA). Maternal oximetry was done with Datex Satlite portable monitor (Datex, Finland). Visual analog scale was used for assessing pain relief. Two‐way analysis of variance and students t‐test were used for statistical analyses.Results. Fetal oxygenation initially improved in both groups. The saturation then returned to baseline in both groups. In the epidural group, the values remained at baseline or slightly below, while in the paracervical group the saturation remained a little higher than baseline (p=0.009). No change was seen in maternal oxygenation or heart rate. No change in fetal heart rate was found either. Epidural block was superior to paracervical block with respect to pain relief (p=0.002).Conclusions. There was a small but significant difference in fetal oxygenation between epidural and paracervical groups during the observation period. The magnitude of the difference is hardly clinically significant. A larger, randomized study is needed to elucidate the mechanisms behind this finding.
Diabetic retinopathy in pregnancy during tight metabolic control
Authors: LAUSZUS FINN , KLEBE JOACHIM G. , BEK TOKE 
Published: March 2003

Background. The relation between retinopathy and the parameters: 24‐h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studied before, during, and after pregnancy in women with insulin‐dependent diabetes mellitus on tight metabolic control during pregnancy.Methods. Prospective study of 112 pregnant women with insulin‐dependent diabetes mellitus followed with fundus photography at the Department of Ophthalmology, Århus University Hospital. Changes in retinopathy were related to 24‐h blood pressure, blood glucose, albuminuria, and adverse perinatal outcome.Results. There was an association between grade of retinopathy and HbA1c before (Spearman's rho=0.49, p<0.04) and after pregnancy (Spearman's rho=0.42, p<0.02), but no such correlation was found at any examination during pregnancy where glycemia was kept tight. Those women who had progression of retinopathy during or after pregnancy had significantly earlier onset of diabetes mellitus (14±8 years, range 1–27) than those women with improvement or no progression of retinopathy (19±8 years, range 1–36, p<0.04). No association was found between progression of retinopathy and HbA1c, blood pressure, adverse perinatal outcome or any of the other variables studied.Conclusions. Tight glycemic control during pregnancy is recommendable to avoid progression of retinopathy. Attention should be given to the period after delivery where the tight regulation may be difficult to achieve. IDDM women should be encouraged to plan pregnancies early in life.
Pregnancy complications and delivery practice in women with connective tissue disease and inflammatory rheumatic disease in Norway
Authors: SKOMSVOLL JOHAN FREDRIK , ØSTENSEN MONIKA , IRGENS LORENTZ M. , BASTE VALBORG 
Published: March 2003

Objective. To assess possible associations between inflammatory rheumatic disease and pregnancy complications/delivery practice.Methods. In a population based study proportions were compared of obstetrical complications and interventions at delivery notified to the Medical Birth Registry of Norway during the years 1967–95 in women with (3,403) and without (671,221) rheumatic disease.Results. Women with rheumatic disease had significantly higher rates of preeclampsia and cesarean section. The relative risk of preeclampsia was particularly high in women with connective tissue disease in the years 1977–86. In women with inflammatory arthritides, the relative risk of preeclampsia was particularly high during 1987–95. The relative risk of cesarean section was high in all patient groups throughout the observation period and particularly in women with connective tissue disease.Conclusion. High rates of preeclampsia and cesarean section in connective tissue disease pregnancies documented in a population based study emphasize the importance of monitoring and obstetrical interventions.
Erythrocyte zinc protoporphyrin testing in pregnancy
Authors: HARTHOORN‐LASTHUIZEN ELSE J. , LINDEMANS JAN , LANGENHUIJSEN MART M. A. C. 
Published: March 2003

Background. To compare the usefulness of serum ferritin, hemoglobin and erythrocyte zinc protoporphyrin estimations as indicators of the need of iron supplementation in pregnancy.Methods. In 97 healthy pregnant women serum ferritin, hemoglobin and erythrocyte zinc protoporphyrin concentrations were measured at each trimester period. Iron supplementation was prescribed at hemoglobin values below 113 g/L.Results. Neither in the first nor in the second trimester differences in serum ferritin and erythrocyte zinc protoporphyrin values have been found between women who got iron therapy prescribed and women who did not get iron therapy, whereas already in the first trimester hemoglobin values were lower in the group that got iron therapy. These results indicate that hemodilution rather than iron deficiency determined which women got iron therapy. In the third trimester 14 out of 80 women without iron supplementation had depleted iron stores and a significant erythrocyte zinc protoporphyrin increase, indicating evolving iron deficiency anemia. However, only five of them showed hemoglobin levels below 113 g/L and got iron therapy. Low serum ferritin levels were found in 23% of the women at booking and in 92% in the third trimester. Serum ferritin levels neither predicted the development of iron deficient erythropoiesis nor of anemia.Conclusions. Iron deficiency can neither be diagnosed nor predicted by serum ferritin or hemoglobin measurements at booking or later on in pregnancy. Erythrocyte zinc protoporphyrin measurements can be of help in determining which women have iron deficient erythropoiesis and may benefit by iron therapy.
Sex hormone‐binding globulin in gestational diabetes
Authors: BARTHA JOSE L. , COMINO‐DELGADO RAFAEL , ROMERO‐CARMONA RAQUEL , DEL CARMEN GOMEZ‐JAEN MARIA 
Published: March 2003

Background. Insulin is an important regulator of serum sex hormone‐binding globulin ( SHBG) concentration which works by inhibiting its production in hepatocytes. Low SHBG level is associated with increased insulin resistance and hyperinsulinemia. Our purpose was to compare maternal serum SHBG level between normal and gestational diabetic pregnant women and to study the relationships between SHBG, SHBG/insulin and SHBG/glucose ratio and several endocrine, metabolic and clinical parameters.Methods. Serum SHBG concentrations were measured in 34 women with gestational diabetes and in 32 matched controls. Glucose, insulin, C‐peptide, fructosamine, β‐ HCG, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, total and free T4, total and free estriol, T3 and IGF‐1 were measured. Insulin sensitivity was estimated using the short insulin tolerance test.Results. SHBG,
SHBG/insulinemia ratio and
SHBG/glucose ratio were significantly lower in the diabetic group (309.54±112.22 vs 460.54±144.54, p=0.00001), (33.55±16.62 vs 72.56±66.50, p=0.0006 using log‐transformed values), (5.88±1.87 vs 3.39±1.23, p<0.00001).
SHBG was negatively correlated with insulinemia (r=−0.40, p=0.001), C‐peptide (r=−0.41, p=0.001), glycemia (r=−0.27, p=0.02), diastolic blood pressure (r=−0.41, p=0.001) and β‐
HCG (r=−0.41, p=0.001) and positively correlated with LDL‐c (r=0.25, p=0.04) and apolipoprotein B (r=0.33, p=0.007).Conclusions. SHBG concentrations are lower in gestational diabetic pregnant women and are related to insulin levels but not to peripheral insulin sensitivity. Since insulinemia was similar in normal and gestational diabetic pregnant women, we speculate that gestational diabetes is characterized by a higher peripheral insulin resistance, a fasting normal insulinemia and a higher hepatic insulin sensitivity, at least in other actions than on carbohydrate metabolism. The role of sex steroids, T4 and IGF‐1 in regulating SHBG appears to be limited during pregnancy.
Effects of prandial glycemic changes on objective fetal heart rate parameters
Authors: SERRA‐SERRA VICENTE , CAMARA ROSA , SARRIÓN PASCUALA , JAREÑO MILAGROS , CERVERA JESÚS , BELLVER JOSÉ , PERALES ALFREDO 
Published: March 2003

Background. There is confusion in the literature about the potential effect of maternal glucose levels on the fetal heart rate (FHR) cardiotocographic interpretation.Methods. Study design: prospective clinical descriptive study. Subjects: 21 pregnant women with diabetes mellitus, 23 women with gestational diabetes and 18 healthy non‐diabetic pregnant volunteers (control group). Treatment: maternal capillary glucose measurement and objective FHR analysis (Oxford System 8002) pre‐ and 1 h post‐meal. Statistical analysis: descriptive statistics, Student t‐tests and Pearson correlation studies.Results. Maternal capillary glucose levels ranged between 2.7–10.5 mmol/l pre‐meal and 4.2–14.8 mmol/l post‐meal. The differences between objective FHR parameters pre‐ and post‐meal were not significant in any of the groups of women studied. No correlation was found between prandial glycemic and FHR changes. Women with optimal and suboptimal glycemic control exhibited similar objective FHR parameters pre‐ and post‐meal. Women with gestational diabetes showed similar prandial cardiotocographic changes irrespective of whether they were on insulin therapy or on hypoglycemic diet only.Conclusions. Objective FHR parameters are unaffected by prandial glycemic changes over a wide range of maternal glucose levels. Timing the non‐stress test in relation to the meals seems irrelevant in clinical practice.
Relationships between serum leptin level and regional bone mineral density, bone metabolic markers in healthy women
Authors: IWAMOTO ICHIRO , DOUCHI TSUTOMU , KOSHA SHOICHIRO , MURAKAMI MASATO , FUJINO TOSHINORI , NAGATA YUKIHIRO 
Published: March 2003

Background. Leptin might affect bone metabolism. This study was performed to investigate the relationship of leptin to bone metabolism in detail in premenopausal and postmenopausal healthy women.Methods. The relationships between serum leptin level and bone mineral density of several regional sites of the body as well as whole body, along with bone metabolic markers, were examined in 47 premenopausal and 29 postmenopausal healthy women.Results. Serum leptin level was weakly correlated with bone mineral density of pelvis (Pearson's correlation coefficient r=0.39, p<0.05) and left leg (r=0.41, p<0.01) in the premenopausal women, although the correlation decreased after adjustment for
BMI. There was no significant relationship between serum leptin level and whole body bone mineral density both in the premenopausal and postmenopausal women. Serum leptin level was correlated with serum alkaline phosphatase (r=0.56, p<0.001) and urinary deoxypyridinoline/cr (r=−0.32, p<0.05) by Pearson's correlation test in the premenopausal women; the relationships were maintained even after adjustment for BMI (r=0.50 and −0.48, respectively).Conclusions. Leptin is not a key regulator of bone metabolism, although it may have some effects on bone metabolic markers and BMD regionally in premenopausal women.
Transvaginal color Doppler study of uterine blood flow in primary dysmenorrhea
Authors: DMITROVIĆ ROMANA 
Published: March 2003

Background. The pain in primary dysmenorrhea is caused by excessive prostaglandin production that leads to vasoconstriction and uterine ischemia. Changes in uterine blood flow are important factors in pathophysiology of primary dysmenorrhea. The aim of the study was to determine if vasoconstriction of the uterine vessels in patients with primary dysmenorrhea is detectable by transvaginal color Doppler ultrasound.Methods. Forty‐two women with primary dysmenorrhea and fifty healthy controls were included in this prospective study. Women were examined with transvaginal color Doppler ultrasound on first day of the cycle, once in the follicular and once in the luteal phase. Measurements of pulsatility index in uterine, arcuate, radial and spiral arteries were performed. Student's t‐test was used to establish statistical significance between groups.Results. Women in dysmenorrhea group had significantly higher uterine blood flow indices than healthy controls in all three measurements periods. This includes all vessels studied on the first day of the cycle, the radial and spiral arteries during the follicular phase and the arcuate, radial and spiral arteries during the luteal phase.Conclusions. We found that women with primary dysmenorrhea have elevated Doppler indices in uterine arteries not only on first day of the cycle but throughout the whole cycle. Therefore we postulated that primary dysmenorrhea is not only the disorder of menstruation but also a disease of a menstrual cycle as a whole.
Long‐term follow‐up of 246 hyperprolactinemic patients
Authors: Touraine Philippe , Plu‐Bureau Geneviève , Beji Claudine , Mauvais‐Jarvis Pierre , Kuttenn Frédérique 
Published: March 2003

Background. We wanted to evaluate the very long‐term effects of bromocriptine on prolactin (PRL) levels and pituitary tumor size in a large cohort of hyperprolactinemic patients.Methods. We conducted a retrospective cohort study in the Department of Endocrinology from Necker Hospital in Paris, France. Two hundred and forty‐six patients consulted primarily for menstrual disorders, with diagnosis of hyperprolactinemia. Patients were followed‐up for 99.9±3.6 months. One hundred and ninety‐one were treated with bromocriptine, 32 underwent surgery, and 23 received no treatment.Results. The mean initial plasma PRL level was 135.0±20.2 ng/ml. Presence of an adenoma was detected in 60% of our patients and comprised a microadenoma in 64% of cases. Compared to oligomenorrheic women, amenorrheic patients had significantly higher levels of PRL and larger pituitary tumor size. In the bromocriptine group, PRL levels decreased from 99.6±7.9 to 20.0±1.5 ng/ml (p=0.00001). The medical treatment was associated with disappearance of the adenoma in 45% of the women and with stabilization of pituitary tumor size in 40% of patients. Surgery led to disappearance of the adenoma in almost all cases, but failed to definitively cure hyperprolactinemia.Conclusion. In this large‐scale retrospective study, the medical treatment of mild hyperprolactinemia was shown to be effective and sufficient after 9 years of follow‐up.
A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra‐operative blood loss during cesarean section
Authors: Acharya Ganesh , Al‐Sammarai Mohammad Tawfiq , Patel Nilkanth , Al‐Habib Ansam , Kiserud Torvid 
Published: March 2003

Background. Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section. Misoprostol, a potent uterotonic agent, has been reported to be useful in the prevention and treatment of postpartum hemorrhage by several investigators but its use during cesarean section has not been described. The objective of this study was to randomly compare the effectiveness of oral misoprostol with intravenous syntocinon on blood loss during elective cesarean sections under regional anesthesia.Methods. Sixty pregnant women were randomized either to receive misoprostol 400 micrograms orally or syntocinon 10 IU intravenously during cesarean section. The primary outcome measure was intra‐operative blood loss as estimated by physicians, and by values of preoperative and postoperative hemoglobin concentration and hematocrit. Demographic characteristics of the subjects and outcomes were compared using χ‐square test for categorical and two‐sample t‐test for continuous data.Results. Baseline characteristics in terms of age, body weight, parity, gestational age and indications for cesarean section were similar in both groups. The estimated blood loss was 545 ml (CI 476–614) in misoprostol group and 533 ml (CI 427–639) in syntocinon group (p=0.85). Differences in preoperative and postoperative hemoglobin and hematocrit values were also similar in both groups. Two women in the misoprostol group and three in the syntocinon group (p=0.64) required additional oxytocics. One patient in each group required blood transfusion. No serious side effects were noted in either group.Conclusion. Oral misoprostol appears to be safe and as effective as intravenous syntocinon in reduction of intra‐operative blood loss during elective cesarean section under regional anesthesia and merits further investigation.
Comparison of cervical smears secured with different instruments
Authors: Valenzuela Pedro , Martinez Pilar , Santana Alicia , Garrido Nurin , Cano Ana , Arnanz Fuencisca 
Published: March 2003

Background. In this presentation we have compared the results from cytologic samples obtained with the cervical brush and Ayre‘s wooden spatula, against samples obtained with Acellon Combi.Methods. One thousand cervical smears were collected. This was a cross‐sectional study, where it was decided randomly to use cervical brush for sampling of the endocervix and Ayre‘s wooden spatula for exocervix or Acellon Combi for both.Results. The combination of the cervical brush and the wooden spatula yielded an acceptable quantity of columnar cells in 71.6% of the cases, during both endocervical and exocervical sampling, while the Acellon Combi yielded an acceptable quantity in 61.7% of the cases (p<0.01). The combination of brush/spatula yielded an acceptable quantity of squamous cells from samples of endocervix and exocervix in 87.5% cases, while with the Acellon device amounted to 77.4% (p<0.001). Highly significant differences in the state of cellular preservation of samples from endocervix obtained with cervical brush technique were found upon comparison to Acellon group.Conclusions. Henceforth, we believe that the use of the cervical brush and the Ayre wooden spatula increases the quantity and preservation of the cells retrieved during cervical smears compared to Acellon Combi.