bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of cerebral hemodynamics during roll over test in healthy pregnant women and those with pre‐eclampsia
Authors: Zatik János , Major Tamás , Aranyosi János , Molnár Csilla , Limburg Martien , Fülesdi Béla 
Published: December 2003

Objective
To compare cerebral autoregulatory responses obtained during roll over tests in healthy pregnant women and those with pre‐eclampsia in order to assess the middle cerebral artery velocity changes in relation to the roll over test in normotensive and pre‐eclamptic women.Participants
Twenty‐two healthy pregnant women and 26 with pre‐eclampsia underwent transcranial Doppler measurements of the middle cerebral artery.Methods
Systolic, mean and diastolic blood flow velocities and mean arterial blood pressures were recorded in the left lateral position and five minutes after turning to the supine position. Absolute values of mean blood flow velocities, mean arterial blood pressure values and calculated cerebral blood flow indices as well as cerebrovascular resistance area products were compared at different positions among the groups.Results
Mean arterial blood pressure increased in both groups while turning from the left lateral to the supine position. In women with pre‐eclampsia both mean arterial blood pressure and absolute values of mean blood flow velocity values were higher in both positions, compared with healthy pregnant women. In both groups, changing the position resulted in a decrease of absolute values of mean blood flow velocities. Calculated cerebral blood flow indices did not change, while cerebrovascular resistance area products increased significantly in the groups during roll over testing. In women with pre‐eclampsia, the increase of cerebrovascular resistance area products was more pronounced as compared with healthy pregnant women.Conclusions
In women with pre‐eclampsia roll over test results in an increase of the mean arterial blood pressure, which is accompanied by a decreased mean blood flow velocity in the middle cerebral artery. Further studies are needed to clarify the pathophysiological background of cerebral haemodynamic changes in pre‐eclampsia.
Cardiovascular function in pregnancy: effects of posture
Authors: Del Bene Riccarda , Barletta Giuseppe , Mello Giorgio , Lazzeri Chiara , Mecacci Federico , Parretti Elena , Martini Elisabetta , Vecchiarino Sabrina , Franchi Franco , La Villa Giorgio 
Published: December 2003

Objective
To evaluate the cardiovascular response to active postural changes in pregnancy.Design
Prospective study.Setting
Outpatient Clinic, Fetal Maternity Unit.Participants
Sixteen healthy women referred prior to pregnancy.Methods
Heart rate, arterial pressure, echocardiographic end–diastolic and end–systolic left ventricular volumes (Teichholz's formula) were measured in the three months before pregnancy, at the end of the first and second trimester, at mid third trimester, and six months after delivery in the supine and standing position, in thirteen women (mean age 33, range 25–38 years).Results
Cardiac output (supine position) significantly increased (28%): it reached its maximum at the second trimester, remained steadily elevated in the mid third trimester, and returned to baseline after delivery. Cardiac output increased during pregnancy also in the active orthostatic position, the percentage increase being greater (70%) since the standing pre–conception value was lower. The postural stress induced similar changes in heart rate, arterial pressure and left ventricular ejection fraction before, during and after pregnancy. However, the reduction in cardiac output associated with early standing attenuated significantly at the second trimester and it was absent at mid third trimester (F = 3.13, P= 0.021). This was due to the interplay between the significantly lesser increase in systemic vascular resistance, occurring since the first trimester, and the significantly lesser decrease in left ventricular end–diastolic volume which was observed in the mid third trimester.Conclusion
These data indicate that the elevated cardiac output is adequately maintained in pregnancy during the postural challenge, due to optimisation of the responses of preload and afterload.
Vulvar vestibulitis: a multi‐factorial condition
Authors: Danielsson Ingela , Eisemann Martin , Sjöberg Inga , Wikman Marianne 
Published: December 2003

Objective
To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non‐symptomatic control group.Design
A case–control study conducted in 1998.Setting
Two clinics in northern Sweden.Sample
Thirty‐eight women, 18–25 years of age, suffering from vulvar vestibulitis, and 70 healthy controls.Methods
The women completed two questionnaires: the temperament and character inventory to study personality aspects, and the Giessen subjective complaints list, which is a checklist of subjective bodily complaints.Results
Regarding personality aspects the women with vulvar vestibulitis scored significantly higher than the control group, on exclusively one out of seven subscales of the temperament and character inventory (i.e. harm avoidance). This trait is considered to be partly inherited and stable throughout life, and to give the person a tendency to react to problems with pessimistic thoughts, increased anxiety and fatigue. On the Giessen subjective complaints list the women with vestibulitis reported a significantly higher number of somatic complaints in several areas.Conclusions
The findings that women suffering from vulvar vestibulitis have more bodily complaints than the controls is interpreted as an indication of a psychosomatic element in their illness, which could be primary or secondary. Furthermore, these women are characterised by a particular personality trait, and it is suggested that this trait might influence their experience and management of pain and stress. A multi‐factorial origin of vulvar vestibulitis is advocated and a multimodal interdisciplinary treatment approach is suggested. To elucidate further the mechanisms behind this health problem, prospective controlled studies are urgently needed.
Ultrafast magnetic resonance imaging of central nervous system abnormalities in utero in the second and third trimester of pregnancy: comparison with ultrasound
Authors: Whitby Elspeth , Paley Martyn N. , Davies Norman , Sprigg Alan , Griffiths Paul D. 
Published: December 2003

Objective
To assess the ability of ultrafast magnetic resonance imaging to visualise abnormalities in the central nervous system of third trimester fetuses in utero and to compare the results with the current ‘reference standard’ of ultrasound and postnatal imaging or post‐mortem data.Design
A prospective, observational study comparing the diagnostic accuracy of two imaging methods: antenatal ultrasound and antenatal magnetic resonance with each other and postnatal or post mortem data.Population
Twenty‐one pregnant women of 19–36 weeks of gestation whose fetus were thought to have a central nervous system abnormality on the basis of antenatal ultrasound. The women had either not been offered or had refused a termination and were willing to have a magnetic resonance scan.Methods
A 1.5T magnetic resonance scanner used a single shot fast spin echo sequence, in three image planes. The results were compared with the ultrasound results obtained by an experienced investigator independently. A series of 21 patients, with a range of pathologies of central nervous system, were imaged. Postnatal ultrasound and/or magnetic resonance imaging, or post‐mortem data were used for additional confirmation of the pathology in all cases.Results
The magnetic resonance report was different to the ultrasound in 10/21 (47.6%), magnetic resonance provided information additional to the ultrasound in 5/21 (23.8%), ultrasound and magnetic resonance results agreed in 6/21 cases (28.6%).Conclusion
Magnetic resonance in the third trimester provides a useful adjuvant to ultrasound imaging of the fetus when assessing abnormalities of the central nervous system after 19 weeks of gestation particularly if the abnormality involves the posterior fossa.
Declining trend in major gynaecological surgery in The Netherlands during 1991–1998. Is there an impact on surgical skills and innovative ability?
Authors: Brölmann Hans A.M. , Vervest Harry A.M. , Heineman Maas J. 
Published: December 2003

Objectives
To assess the number of major surgical procedures in gynaecology over a period of eight years in The Netherlands and to detect possible trends. Relevance of the trends and the possible impact on surgical skills and on innovative ability are discussed.Design
Observational study.Setting
Hospital care in The Netherlands.Sample
Data from a national hospital discharge database, from all 119 hospitals in The Netherlands.Methods
When a patient is discharged from the hospital, data on the diagnosis and treatment are registered by local medical officers and administrators. Registration of surgical procedures is based on the International Classification of Procedures in Medicine (ICPM, WHO 1978), the so‐called WCC‐standard. All hospitals but one (a cancer centre) in The Netherlands participate in this registration, resulting in 99.3 % of all admissions. Data on gynaecological manpower were obtained from the Dutch College of Obstetricians and Gynaecologists. In order to standardise the frequency numbers per 1000 women, yearly data of the female population according to age were obtained from the Central Office for Population Statistics.Results
The female population aged 20 years of age and older increased 3% between 1991 and 1998, from 5.8 million to 6.0 million. In the same period the number of gynaecologists grew from 604 to 625, also an increase of 3%. The total number of hysterectomies dropped from 21,433 in 1991 to 16,320 (‐24 %) in 1998 (χ2 for trend 1245.1, P< 0.001) Surgery of the uterine cavity, either performed hysteroscopically or blind, increased from 311 to 1,958 (+ 625 %) cases per year (χ2 for trend 2459.2, P<0.001). No trend has been detected in the numbers of adnexal operations, including surgical treatment of tubal pregnancy (tubotomy or tubectomy). In 1998, 12% of all ovarian surgery and 28% of all surgery for ectopic pregnancies was performed laparoscopically. Surgery for female urinary incontinence experienced a strong decline of 46% in the studied period. The frequency of vaginal repair decreased with 1354 (‐16 %) cases. The abdominal prolapse surgery (abdominal sacral colpopexy, obliteration of the Douglas pouch) is steadily increasing, although the absolute numbers are small. In 1998 seven hundred and forty‐three women underwent an abdominal approach of their prolapse repair, compared with 7239 that had the vaginal repair.Conclusions
The declining trend of major gynaecological surgery in combination with the increasing number of gynaecologists will result in more difficulty for gynaecologists to acquire and maintain surgical skills and may therefore affect their ability to innovate within the surgical profession.
Anatomical and functional changes in the lower urinary tract during pregnancy
Authors: Wijma Jacobus , Potters Annemarie E. Weis , de Wolf Ben T.H.M. , Tinga Dick J. , Aarnoudse Jan G. 
Published: December 2003

Objective
To assess the prevalence and the development of urinary incontinence in nulliparous pregnant women, both subjectively and objectively, and to investigate the relation of incontinence with the mobility of the urethro‐vesical junction measured by perineal ultrasound.Design
A prospective longitudinal study.Setting
University Hospital and Martini Hospital Groningen, the Netherlands.Population
A cohort of 117 nulliparous pregnant women and 27 nulliparous non‐pregnant controls.Methods
Urinary incontinence was measured by a questionnaire and by a 24‐hour pad test. The position of the urethro‐vesical junction and its mobility were measured by perineal ultrasound.Main outcome measure
Prevalence of urinary incontinence; mobility of the urethro‐vesical junction, indicated by the displacement/pressure coefficient.Results
Up to 35% of the women reported urinary incontinence in pregnancy, and 20% of the women had a positive pad test. The angle of the urethro‐vesical junction angle at rest and the displacement/pressure coefficient during coughing showed a significant increasing trend during pregnancy, but no changes were seen during the Valsalva manoeuvre. No relationship was found between subjective and objective incontinence data and the position and mobility of the urethro‐vesical junction.Conclusion
The prevalence of incontinence in nulliparous women as found by the pad test was significantly higher in pregnancy (20%) than in the non‐pregnant control group (4%). Perineal ultrasound of the urethro‐vesical junction showed lowering of the pelvic floor occurring as early as 12‐16 weeks of pregnancy. Serial measurements of the displacement/pressure coefficient suggest that the dynamic characteristics of the connective tissues of the pelvic floor remain unaltered, whereas a significant decrease in pelvic floor muscle contraction occurs. Since no relation was found between measurements of the urethro‐vesical junction and incontinence, urinary incontinence in pregnancy is most likely explained by other factors.
Leucocyte intracellular pH and Na+/H+ exchanger isoform‐1 activity in postpartum women with pre‐eclampsia
Authors: Lee Virginia M. , Halligan Aidan W.F. , Ng Leong L. 
Published: December 2003

Objective
To investigate leucocyte Na+/H+ exchanger isoform 1 activity in postpartum pre‐eclamptics.Design
Exchanger isoform‐1 activity and intracellular resting pH were established in leucocytes isolated from two study groups.Sample
Leucocytes isolated from 10 women who had had pre‐eclamptic pregnancies more than five months postpartum, and from 10 age‐matched normotensive women who were more than five months postpartum.Setting
Hypertension Clinic, Antenatal Assessment Area, Leicester Royal Infirmary.Methods
A well validated technique involving flurometry using a pH sensitive dye (BCECF‐AM) was performed to determine exchanger isoform‐1 activity and intracellular pH. Determination of exchanger isoform‐1 protein abundance was performed by western blotting. Exchanger isoform‐3 protein abundance was examined to rule out the possibility of activity due to this particular isoform.Results
Intracellular pH was significantly lower in the postpartum pre‐eclamptic group (7.11 +/‐ 0.02), compared with the postpartum normotensive controls (7.33 +/‐ 0.04; P<0.001). Exchanger isoform‐1 efflux rate (in mmol/L/minute) was significantly higher in the postpartum pre‐eclamptic group (35.91 +/‐ 3.1), compared with the postpartum normotensives (23.94 +/‐ 2.0; P= 0.005). Exchanger isoform‐1 protein density was established to be similar among the two subject groups. No exchanger isoform‐3 protein was identified by western blotting.Conclusion
Our results suggest that elevated exchanger isoform‐1 activity is an important finding in women who have suffered from pre‐eclampsia. This increased activity is not due to an increase in exchanger isoform‐1 protein abundance or the presence of exchanger isoform‐3.
Sacrohysteropexy with synthetic mesh for the management of uterovaginal prolapse
Authors: Leron Elad , Stanton Stuart L. 
Published: December 2003

Objective
To study the ongoing results of sacrohysteropexy with Teflon mesh for treatment of uterovaginal prolapse in women who desire to preserve their uterus.Design
Prospective observational study.Setting
Tertiary referral urogynaecology unit.Participants
Thirteen consecutive women with uterovaginal prolapse wishing to retain their uterus operated on by one surgeon.Surgical
method Sacrohysteropexy with Teflon mesh attached to the uterine isthmus and to the anterior longitudinal ligament of the first or second sacral vertebra in a tension‐free fashion.Main
outcome measures Subjective and objective cure of uterine prolapse and operative and post‐operative complications.Results
The mean age of the women was 38 years (range 27–60). Eight women were multiparous. Twelve women had second degree uterine prolapse and one woman had third degree of uterine prolapse. Mesh was extended to correct a cystocele in one woman and a rectocele in three women. In four women colposuspension was performed at the same time. There were no intra‐ and post‐operative complications. The mean follow up time was 16 months (range 4–49). At follow up only one woman had a first degree uterine prolapse. A total of seven women (53.8%) reported constipation which had been experienced pre‐operatively by four women (30.8%).Conclusions
We consider the sacrohysteropexy with Teflon mesh a safe, effective and durable surgical procedure for the management of uterovaginal prolapse in young women and those who desire to retain their uterus.
Are there common triggers of preterm deliveries?
Authors: Petridou E. , Salvanos H. , Skalkidou A. , Dessypris N. , Moustaki M. , Trichopoulos D. 
Published: December 2003

Objective
To assess the effect(s) of transient events which are perceived as stressful on the inseption of preterm delivery.Design
A case–control study, with immature infants as cases and borderline term babies as controls.Setting
A teaching maternity hospital in Athens.Population
All infants born at less than 37 weeks of gestation, during a twelve‐month period.Methods
Information was collected about maternal socio‐demographic and lifestyle characteristics, clinical variables and stressful events occurring within two weeks prior to delivery.Main
outcome measures Factors affecting the risk of preterm delivery.Results
Extreme prematurity (<33 weeks) is more common among younger (<25 years of age) and older (>29 years of age) women and is positively associated with parity, body mass index and smoking, whereas it is inversely associated with educational level, regular physical exercise and serious nausea/vomiting. After controlling for these factors, however, only coitus during the last weeks of pregnancy had a significant triggering effect on prematurity (P= 0.004, odds ratio 3.21, 95% CI 1.45 to 7.09 for very immature babies, and P= 0.04, OR=2.20, 95% CI 1.03 to 4.70 for immature babies). On the contrary, several events perceived as stressful, such as illness of relatives or friends, husband's departure, loss of employment, were unrelated to the onset of premature labour.Conclusions
Coitus during the last few weeks of pregnancy appears to increase the risk of preterm delivery, while a possible detrimental effect of physical exertion seems more limited. Stressful events should not receive undue attention as possible causes of preterm delivery.
Factors associated with nucleic acids related to human immunodeficiency virus type 1 in cervico‐vaginal secretions
Authors: Spinillo Arsenio , Debiaggi Maurizia , Zara Francesca , Maserati Renato , Polatti Franco , De Santolo Antonella 
Published: December 2003

Objective
To assess HIV‐related nucleic acids in cervico‐vaginal secretions and the factors associated with them.Design
Observational study.Setting
Department of Obstetrics and Gynaecology, University of Pavia, Italy.Population
HIV‐positive patients attending a cytology service.Methods
Paired blood and cervico‐vaginal lavage samples were obtained from 122 known HIV‐seropositive patients during periodic visits for cytologic screening for lower genital tract neoplasia. Vaginal specimens for the diagnosis of bacterial vaginosis, trichomonas vaginalis and candida infection were also obtained. HIV‐1‐RNA in plasma, proviral HIV‐1‐DNA, cell associated and cell‐free HIV‐1 RNA in cervico‐vaginal secretions were quantitatively evaluated by competitive polymerase chain reaction (c‐PCR) and reverse transcriptase PCR (cRT‐PCR).Main
outcome measure Prevalences of HIV related nucleic acids in cervico‐vaginal secretions and their univariate and multivariate associations with clinical variables.Results
Proviral HIV‐1 DNA, cell‐associated and cell‐free HIV‐1 RNA were detected in 50% (61/122), 37.7% (46/122) and 32.8% (40/122) of the patients, respectively. In logistic regression analysis, the presence of HIV‐1 RNA in blood was the factor which correlated best with the detection of HIV‐1 DNA (OR = 5.48, 95% CI=2.28‐13.20), cell‐associated (OR = 4.85; 95% CI = 1.89–12.45) and cell‐free HIV‐1 RNA (OR = 4.63, 95% CI = 1.74–12.33) in cervico‐vaginal samples. However, between 20% and to 35% of patients who tested negative for blood HIV‐1 RNA were positive for either HIV‐1 DNA or HIV‐1 RNA detection in cervico‐vaginal lavages. Bacterial vaginosis was associated with an increased prevalence of cell‐associated (OR=3.58, 95% CI = 1.22–10.54) and cell‐free HIV‐1 RNA (OR = 2.94, 95% CI = 1.0–8.7) detection in cervico‐vaginal secretions. Additional factors associated with increased prevalence of HIV‐1 RNA detection were advanced stage of HIV disease and vulvovaginal candidiasis.Conclusions
Although the presence of HIV‐1 RNA in blood is the factor which correlates best with the detection of HIV‐related nucleic acids in cervico‐vaginal secretions, the shedding of HIV in the genital tract can occur in 20‐30% of non‐viremic subjects. Bacterial vaginosis and candida infection could have a facilitating role in local HIV viral replication and shedding.
Microvascular vasodilator response to acetylcholine is increased in women with pre‐eclampsia
Authors: Davis Karl R. , Ponnampalam Janani , Hayman Richard , Baker Philip N. , Arulkumaran Sabaratnam , Donnelly Richard 
Published: December 2003

Objectives
To evaluate in vivo microvascular responses to incremental doses of the endothelial‐dependent vasodilator, acetylcholine, and the endothelial‐independent vasodilator, sodium nitroprusside, in women with pre‐eclampsia and gestation‐matched normotensive pregnant controls.Design
Prospective clinical study.Setting
Southern Derbyshire Acute Hospitals Trust, and University of Nottingham Division of Vascular Medicine.Population
Thirteen women with pre‐eclampsia and 16 normotensive pregnant controls.Methods
Cutaneous microvascular vasodilator responses to iontophoretic administration of incremental doses of acetylcholine and sodium nitroprusside (25‐100μC) were evaluated under temperature‐controlled conditions using laser Doppler fluximetry.Results
Resting skin temperature and blood flow were similar among 13 women with pre‐eclampsia [mean blood pressure 151/93 mmHg (4/3); mean gestation 35.6 weeks (1.0); and mean proteinuria 1.1 g/24h (0.2)] and 16 normotensive pregnant controls [mean blood pressure 111/63 mmHg (2/2); mean gestation 34.3 weeks (0.9)]. Peak vasodilator responses to acetylcholine were increased in women with pre‐eclampsia (median flux ratio 15.1 [IQR 12.3‐17.6] vs 11.7 [IQR 8.4‐12.6], P<0.05), whereas sodium nitroprusside responses were not different between the two groups: 11.4 [IQR 8.6‐13.4] vs 9.5 [IQR 8.0‐12.3].Conclusion
In vivo microvascular vasodilator responses to acetylcholine are increased in women with pre‐eclampsia, while endothelial‐independent vasodilation is unchanged. Although the mechanism of acetylcholine induced vasodilation in small vessels is unclear, this study confirms previous animal data and provides in vivo evidence of altered microvascular endothelial cell function in pre‐eclampsia.