bluuebunny/crossref_metadata_2025_split huggingface dataset:
The long‐term outcome of retropubic urethrocystopexy (sutures and fibrin sealant) and pubococcygeal repair
Authors: LALOS OTHON , BERGLUND ANNA‐LENA , BJERLE PER 
Published: March 2003

Background. To evaluate the results of retropubic urethrocystopexy (with sutures and fibrin sealant) and pubococcygeal repair five to seven years postoperatively.Material and methods. Thirty women with genuine stress urinary incontinence were subjected to retropubic urethrocystopexy (n=30) and 15 women to pubococcygeal repair (n=15). The preoperative assessment included both subjective and objective methods. The results evaluated three months, one year and five to seven years after the surgical treatment.Results. One year after surgery 71% of the women in the urethrocystopexy group reported that they were continent, compared with only 43% five to seven years after surgery. In the pubococcygeal repair group 80% were continent at one‐year follow‐up, compared with 60% at the long‐term follow‐up. According to pad test 79% of the women in the urethrocystopexy group had ceased leaking urine at minimal activity and 64% at maximal activity five to seven years after surgery. However, in the pubococcygeal repair group the corresponding percentage was 71% under both conditions. Intravesical pressure and Body Mass Index increased significantly in the whole group but urethra conductance and maximal urine flow decreased only in the urethrocystopexy group five to seven years after the surgical treatment.Conclusions. Accurate assessment of the results of any surgical treatment of stress urinary incontinence is difficult. During long term follow‐up period significant changes may occur among the women, e.g. menopause and increase of Body Mass Index both predisposing to urinary incontinence.
Increased risk of preterm delivery with elevated maternal alpha‐fetoprotein and plasma zinc levels in African‐American women
Authors: NEGGERS YASMIN H. , GOLDENBERG ROBERT L. , DUBARD MARY B. , CLIVER SUZANNE P. 
Published: March 2003

Background. This study evaluated the relationship of maternal serum alpha‐fetoprotein (MSAFP) and plasma zinc levels (PZn) to pregnancy outcome.Methods. The subjects for this investigation consisted of 917 African‐American women, who on registration for prenatal care between 7–22 weeks gestational age (GA), had PZn levels determined and also had MSAFP recorded in their charts.Results. MSAFP levels greater than the 90th percentile significantly increased the risk of PTD (adjusted odds ratio or AOR=2.5, 95% C.I.=1.5−4.2) but not of IUGR. There was no significant relationship between maternal PZn level and PTD or IUGR. When subjects were stratified by MSAFP levels, in women with MSAFP greater than the 90th percentile, the AOR for PTD was 4.0 (95% C.I.=1.2−13.5) for women with PZn levels greater than the median vs. those with PZn equal to or less than the median. In women with MSAFP equal to or less than the 90th percentile, there was no such difference. Multiple regression analyses, using GA at birth as the dependent variable, indicated an interaction between MSAFP and PZn levels.Conclusion. In this population, the adverse pregnancy outcome associated with elevated MSAFP was seen only in women with PZn levels greater than the median. The reason for this association is not currently apparent.
The prevalence of anemia in pregnant Nepali women – a study in Kathmandu
Authors: BONDEVIK GUNNAR T. , ULSTEIN MAGNAR , LIE ROLV T. , RANA GEETHA , KVÅLE GUNNAR 
Published: March 2003

Background. Anemia in pregnancy is associated with maternal and perinatal morbidity and mortality. The World Health Organization has suggested that where up‐to‐date information is not available, prevalence studies should be undertaken.Methods. The distribution of hematocrit in 2280 pregnant women attending Patan Hospital, Kathmandu, for their first antenatal visit in a twelve month period, 1994–95, was studied. Anemia was defined as a hematocrit value ≤34% in the first and third trimesters, or ≤33% in the second trimester. Severe anemia was defined as a hematocrit value ≤24%. The prevalence of anemia and severe anemia, and associations with socio‐demographic (age, ethnic group, living area, maternal and paternal education and occupation) and biological (height, body mass index, parity, gestation) variables were investigated.Results. The hematocrit values ranged from 11–49% with a mean value of 32.6% (s.d. 3.9). The prevalences of anemia and severe anemia were 62.2% and 3.6%, respectively. High prevalence of anemia was observed among teenagers, farmers, women of short height, the ethnic groups Lama/Sherpa/Tamang, and women married to industrial workers or illiterate men. Also, the risk of anemia increased with gestation. Work within the service professions, higher education and high body mass index, were associated with a lower risk of anemia.Conclusions. A high prevalence of anemia among pregnant women in Kathmandu was observed. The hematocrit values were related to socio‐demographic and biological factors. In order to plan focused and effective intervention, studies on the etiology of anemia among pregnant women in rural and urban areas of Nepal need to be carried out.
Adequate timing of fetal ultrasound to guide metabolic therapy in mild gestational diabetes mellitus
Authors: ROSSI GABRIELE , SOMIGLIANA EDGARDO , MOSCHETTA MARTA , BOTTANI BARBARA , BARBIERI MAURIZIO , VIGNALI MARIO 
Published: March 2003

Background. Ultrasound assessment of abdominal circumference early in the third trimester had been proposed to introduce insulin therapy in order to prevent fetal overgrowth in women with mild gestational diabetes mellitus. The purpose of this study was to investigate adequate weeks gestation timing for testing this parameter.Methods. One hundred and forty‐one women were included in a randomized trial. Seventy‐three women were evaluated at both 28 and 32 weeks gestation whereas 68 women were investigated only at 32 weeks gestation. In both groups, insulin therapy was promptly started when abdominal circumference exceeded the 75th percentile. Macrosomic rates were compared using the Fisher's exact test.Results. Twenty‐nine women whose fetal abdominal circumference exceeded the 75th percentile were considered eligible for insulin therapy. In this group, we observed a statistically significant increase in the percentage of macrosomic infants born from women whose ultrasound abdominal circumference assessment was performed only at 32 weeks gestation when compared to women evaluated at both 28 and 32 weeks gestation (71.43% vs 33.33%, p<0.05).Conclusions. Our results support the need for fetal ultrasound at 28 weeks gestation to direct metabolic therapy since insulin administration introduced after 32 weeks gestation has a poor effect on fetal growth.
Management of pregnancies with suspected intrauterine growth retardation in Sweden
Authors: BRODSZKI JANA , MARŠÁL KAREL 
Published: March 2003

Background. Diagnosis and management of intrauterine growth retardation during pregnancy remain a major challenge in obstetric care. The objective of this survey was to evaluate the routine clinical management of pregnancies with suspected intrauterine growth retardation at obstetric departments in Sweden.Methods. In 1997, a questionnaire was sent to all 59 obstetric departments in Sweden. Forty‐two departments, caring for 83% of all deliveries in Sweden, replied. Four major topics were addressed: definition and diagnosis of intrauterine growth retardation; magnitude of the problem; clinical management; use of Doppler ultrasound in clinical decision‐making.Results. Intrauterine growth retardation is diagnosed by a combination of serial fundal height measurements and ultrasonic fetal biometry at 40 departments, two departments perform routine fetal biometry at 32 weeks. The diagnosis is most often made at 32–36 gestational weeks. Five departments use 1.5 s.d. below the mean as cut‐off point for diagnosis of small for gestational age fetuses; 35 departments use mean – 2 s.d. and two departments mean – 2.5 s.d. Intrauterine growth retardation is suspected in 1.6–6.3% pregnancies. About 19% of patients with suspected intrauterine growth retardation are hospitalized. On average, 63% of all small‐for‐gestational age babies are diagnosed prenatally. Thirty‐nine out of 42 obstetric departments use formalized management protocols. All departments use cardiotocography, repeat ultrasound scans and Doppler ultrasound for antenatal surveillance.Conclusions. In Swedish obstetric units, the diagnostic procedures and methods of fetal surveillance in pregnancies suspected of intrauterine growth retardation are more or less uniform. Doppler examination of umbilical artery is used at all responding departments and is considered a valuable asset in clinical decision‐making.
Influence of chorioamnionitis on survival and morbidity in singletons live‐born at <32 weeks of gestation
Authors: KOSUGE SHUICHI , OHKUCHI AKIHIDE , MINAKAMI HISANORI , MATSUBARA SHIGEKI , UCHIDA AKIRA , EGUCHI YUKARI , HONMA YOKO , SATO IKUO 
Published: March 2003

Background. Chorioamnionitis (CAM) may accelerate lung maturation in fetuses. It is possible that CAM prevents infant death after live birth.Methods. A retrospective study of live‐born singletons at <32 weeks of gestation between 1993 and 1997. Perinatal risk factors for adverse outcomes were analyzed using a logistic regression model, with special reference to the presence of histologically confirmed CAM. Adverse outcomes included infant death before 1 year of age, and survival with cerebral palsy and/or mental retardation.Results. A total of 81 infants, weighing 1181±426 g, were born at 28.1±2.3 weeks of gestation. Of those, 15 (19%) died before 1 year of age, while 16 (20%) infants developed major handicaps by 1.5 years of age (six with cerebral palsy, eight with mental retardation, and two with both cerebral palsy and mental retardation). CAM, present in 44 women, was significantly associated with a reduced risk of death after live birth, with an odds ratio of 0.11 (p=0.01). Only the presence of such intracranial lesions as periventricular leukomalacia and intraventricular hemorrhage were significantly associated with an increased risk of major handicaps (odds ratio of 11.0, p=0.04). Adverse outcomes occurred in a similar proportion of infants in groups without CAM (14/37) and with CAM (17/44). However, among infants with adverse outcomes, the number of deaths was significantly higher in the group without CAM (10/14) vs. with CAM (5/12) (p<0.05).Conclusions. The presence of CAM may somehow prevent infant death after live birth. Larger studies are required to confirm this phenomenon.
Socio‐economic, demographic and obstetric risk factors for late fetal death of unknown etiology in Lithuania:
Authors: Maleckiene Laima , Nadisauskiene Ruta , Bergström Staffan 
Published: March 2003

Background. The purpose of this study was to evaluate the association between third trimester unexplained prelabor fetal deaths and various socio‐economic, demographic and obstetric factors in Lithuania.Methods. A case–referent study on 58 women with third trimester fetal death and 116 women with live fetus at term was carried out. Inclusion criteria for women in the first group (cases) were: prelabor fetal death of unknown etiology, singleton pregnancy >26 weeks of gestation and intact fetal membranes. For each case two referent women were recruited, admitted during the same period in active phase of labor at term (>37 weeks of gestation) with intact fetal membranes and fetus alive. Data were obtained by interview, anthropometry and by reviewing the medical records. Several potential socio‐economic, demographic and obstetrical risk factors for unexplained fetal death were investigated.Results. Univariate analyses determined several factors that were associated with fetal death of unknown etiology: low educational level, single marital status, low income, etc. After secondary logistic regression analysis only three independent variables remained significantly associated with otherwise unexplained stillbirth: small for gestational age fetus (OR 29.6; 95% CI 6.2–141.6), low income (OR 7.4; 95% CI 3.1–17.6), and maternal white blood cell count more than 16,000/mm3 (OR 5.4; 95% CI 1.4–21.6). Body mass index, smoking, occupation of women and other evaluated parameters were not confirmed to be significant risk factors.Conclusion. Small for gestational age fetus, low income and elevated maternal white blood cell count are factors significantly associated with late prelabor fetal death in Lithuania.
Tumor cell spillage to the vaginal cavity and vaginal stump during the surgery of endometrial carcinoma
Authors: Ryo Eiji , Yorinaga Yasuko , Nagasaka Tsuneki , Yoshikawa Hiroyuki , Taketani Yuji 
Published: March 2003

Background. Our purpose was to investigate the spillage of the endometrial carcinoma cells to the vaginal cavity and vaginal stump during the surgery.Methods. Cytologic examination of specimens obtained from the vaginal cavity and vaginal stump during surgery performed on 15 patients with endometrial carcinoma. And the risk factors of carcinoma cell spillage to the vaginal cavity were investigated.Results. Carcinoma cells from the vaginal cavity were negative for nine patients and positive for six patients. Those from the vaginal stump were negative for l4 patients and positive for one patient. In one patient, both were positive. Total abdominal hysterectomy might be one risk of carcinoma cell spillage to the vaginal cavity compared with modified radical hysterectomy and radical hysterectomy.Conclusions. Endometrial carcinoma cells were spilled into the vaginal cavity in not a few cases and their spillage from there to the vaginal stump could follow during the surgery.
Influences of perinatal factors on cord blood thyroid‐stimulating hormone level
Authors: Chan Louis Yik‐Si , Leung Tse Ngong , Lau Tze Kin 
Published: March 2003

Background. Cord blood thyroid‐stimulating hormone level is affected by various perinatal factors. The aim of this study is to investigate the relative impact of these factors on the cord blood thyroid‐stimulating hormone results in singleton pregnancies.Methods. The study group consisted of 20,086 consecutive singleton deliveries over a 3 year period. The effect of mode of delivery, infant sex, gestation at birth, birth weight, and duration of labor on the incidence of false elevation of cord blood thyroid‐stimulating hormone was assessed by univariate analysis and logistic regression.Results. There was an independent positive association between false elevation of cord blood thyroid‐stimulating hormone (≥15.0 mIU/L) and birth weight (p=0.005), male infant sex (p<0.001), and instrumental delivery (p<0.001). Both elective and emergency cesarean section were negatively associated with elevated cord thyroid‐stimulating hormone level (p<0.001). When the cutoff level was raised to 40.0 mIU/L, none of the variables examined were significant. The incidence of false positive tests (≥15.0 mIU/L) was higher in neonates born by cesarean section for failed instrumental delivery and fetal distress than for failure to progress of labor (34.7% vs 4.5% vs 1.3% respectively, p<0.001).Conclusions. While the incidence of false positive screening was significantly affected by various perinatal factors when the thyroid‐stimulating hormone cutoff level is low, it was unaffected at a high cutoff level. The present study also provides further evidence that cord blood thyroid‐stimulating hormone level reflects fetal response to perinatal stress events.
Four years experience of first‐trimester nuchal translucency screening for fetal aneuploidies with increasing regional availability
Authors: Wayda Kornélia , Keresztúri Attila , Orvos Hajnalka , Horváth Emese , PÁl Attila , Kovács LÁszló , Szabó JÁnos 
Published: March 2003

Background. A prospective screening study was carried out at the regional genetic and perinatal center in South Hungary in order to determine the efficiency of first‐trimester nuchal translucency screening for fetal aneuploidies, following augmentation of the availability of nuchal translucency screening in the region by the inclusion of newly‐trained hospital sono‐graphers.Methods. Nuchal translucency thickness was measured by transvaginal sonography in 7,044 women with singleton or multiple pregnancies at weeks 10–12. Fetal karyotyping was performed when the nuchal translucency was ≥2.5 mm, and in women with fetuses at high cytogenetic risk.Results. Follow‐up was performed in 6,841 of the 7,044 screened women. An abnormal karyotype was found in 33 cases (0.48%). The level of increased nuchal translucency was 4.5% at a cutoff of ≥2.5 mm, and 2.8% at a cutoff of ≥3 mm. Seventeen cases of trisomy 21, eight of trisomy 18, four of trisomy 13, one of 45,X, one of triploidy and two cases with other chromosomal abnormalities were detected. In the 33 fetuses with a chromosomal abnormality, the nuchal translucency thickness was <2.5 mm in a case of trisomy 18, ≥2.5 mm in 32 cases and ≥3 mm in 28 cases. With cutoffs of 2.5 mm and 3 mm, the sensitivity was 96.97% and 84.85%, respectively.Conclusions. Application of a nuchal translucency thickness cutoff of 2.5 mm is highly efficient for the screening of fetal aneuploidies at 10–12 weeks. This efficiency can be maintained by increasing the regional availability of nuchal translucency screening through the inclusion of newly‐trained hospital sonographers.
Is 24‐h sperm motility a useful IVF measure when male infertility is not apparent?
Authors: Eskandar Mamdoh 
Published: March 2003

Objective.  To examine the relationship of 24‐h sperm motility between post insemination and fertilization in vitro, in a population with no apparent semen abnormalities. A retrospective study from July 1998 to June 2000.Material and methods.  Four hundred and seventy‐one consecutive in‐vitro fertilization (IVF) cycles for which the primary diagnosis was not male infertility (total motility count > 40 × 106) were studied. Linear regression was used to examine the general relation between 24‐h sperm motility and IVF. The cohort with 0% 24‐h motility was compared with all other cycles using the t‐test and the χ2‐test. Test quality was assessed using the positive likelihood ratio.Results.  Overall fertilization was 58 ± 16%. There were 45/471 cycles (9.5%) with zero fertilization. Linear regression of percent fertilization vs. 24‐h motility showed no relationship (r = 0.01). The cohort with 0% 24‐h motility had a lower fertilization rate 29 ± 19% (P = 0.05), and had a higher incidence of no fertilization 7/21 (P = 0.01). The positive likelihood ratio was 4.6.Conclusions.  Zero 24‐h motility indicates occult male infertility, and a positive result indicates a fair to good test. Overall there was no relationship between sperm survival at 24 h post insemination and fertilization in vitro. However, 0% 24‐h sperm motility was associated with reduced fertilization
Recurrent cervical cancer: detection and prognosis
Authors: Duyn Annette , Van Eijkeren Marion , Kenter Gemma , Zwinderman Koos , Ansink Anca 
Published: March 2003

Background.  Only a small proportion of cervical cancer recurrences is detected during routine follow‐up. We investigated which percentage of recurrences is detected during follow‐up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB–IVA.Methods.  Characteristics of the primary tumor, characteristics of recurrent disease and follow‐up were collected retrospectively from clinical records of 277 patients who achieved a complete remission of at least 3 months after primary treatment for cervical cancer in 1992, 1993 and 1994 in three university hospitals in the Netherlands.Results.  Of 277 patients, 47 (17%) developed recurrent disease; this was most often detected after self‐referral (45%), and in 32% during routine follow‐up. Survival did not differ significantly between these two groups. The presence of symptoms (87%) was the most important first abnormal test result leading to diagnosis of recurrence. In univariate analysis, disease‐free interval (DFI) and treatment modality were significant prognostic factors for crude survival of recurrence. However, treatment modality varied considerably and the subgroups were small. Therefore, multivariate analysis was not feasible and clinically valid conclusions could not be drawn.Conclusions.  In only 32% of all cases, recurrence was detected during a scheduled follow‐up visit. In the majority of patients, recurrent cervical cancer was detected by symptoms (87%). In recurrent disease, DFI was a prognostic factor for survival.
Accuracy of fetal pulse oximetry
Authors: Luttkus Andreas K. , Lübke Marion , Büscher Ulrich , Porath Martina , Dudenhausen Joachim W. 
Published: March 2003

Background. The goal of this investigation was to evaluate the agreement of fetal pulse oximetry to saturation readings from hemoximetry at low oxygen saturation.Methods. Fetal oxygen saturation measurements obtained by pulse oximetry were compared with those obtained by hemoximetry in fetal scalp blood samplings. The prospective observational trial included fetuses with non‐reassuring fetal heart rate tracings suggestive of hypoxia and requiring fetal scalp blood samplings. Arterial oxygen saturation was determined by a blinded pulse oximeter (N400, FS14; Nellcor Puritan Bennett, Pleasanton, CA, USA) and continuously stored on a notebook computer. Saturation from fetal scalp blood samples was measured by hemoximetry (Bayer Diagnostics 865; ABL 625, Radiometer). Data analysis focussed on the absolute and relative difference between hemoximetry and pulse oximetry of fetuses, showing the most distinct difference in neonatal outcome. Normal outcome was defined as spontaneous delivery and umbilical artery pH ≥ 7.20 + Apgar 5 ≥ 7 (n = 42). In contrast, a group of neonates with combined respiratory and metabolic acidemia at birth was defined by pH ≤ 7.16 and an additional base excess ≤ −9.4 mmol/l in the umbilical artery (n = 18).Results. The correlation coefficient between hemoximetry and pulse oximetry measurements was r = 0.72; p = 0.002 in the acidemic group. The median of absolute differences in saturation was + 5.2% (95%CI 2.5–10.3) saturation. The absolute differences ranged from −21% to + 36% saturation. The median of relative differences amounted to 23% (95%CI 15.1–55.0). The relative differences ranged from −30% to + 217%. Observing the saturation distribution in the two groups (hemoximetry and pulse oximetry, respectively) presented a median hemoximetry pulse oximetry of 38% (42%) in the normal and 26% (39%) in the acidemic group. In this small group of cases, the correlation coefficient between pH and saturation from pulse oximetry in fetal scalp blood from the samplings was r = 0.19.Conclusion. Fetal pulse oximetry tends to overestimate arterial oxygen saturation compared with hemoximeter values.