摘要:

Background.We have reviewed the literature concerning vaginal recurrence in endometrial cancer with emphasis on prognostics and therapeutic results. Compared to the overall outcome of recurrences (11‐17 per cent survive more than 3‐19 years) the survival rate of strictly vaginal recurrence appears significantly higher (up to 60‐70 per cent survive more than 5 years). However, the prognosis deteriorates significantly in cases where recurrences prove to be more widespread. Other factors towards predicting a poor outcome are high age, high stage, high grade, detection of papillary carcinoma, rapid recurrence, location to the lower part of vagina, large tumorsize, and previous radiation.Methods.Different methods of initial treatment and cross‐relations between most prognostic factors renders any ranking of prognostic factors almost impossible.Results.Standard treatment of vaginal recurrence including combined external and intra vaginal radiation used for decades have been unable to improve survival rate.Conclusion.We suggest a more individualized treatment based on exact delineation of the

ISSN:0001-6349    

DOI:10.3109/00016349609033275

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.The aim of this work was to analyse the fertility prognosis after conservative or radical surgery for tubal pregnancy.Data sources.Index Medicus was searched for all attainable literature on the subject. Methods of study selection. A total of 40 scientific publications through the latest 40 years were selected. For fulfilling the selection criterias the study design should appear clearly. Furthermore the rate of women obtaining intrauterine pregnancy and the rate of repeat ectopic pregnancy following radical or conservative tubal surgery was to be compared using 95% confidence limits. The results from each report were compared in four groups according to study design i.e. retrospective non‐comparing materials, retrospective comparing studies, prospective selected treatment series or prospective randomized comparing investigations. Data extraction and synthesis. Pooling the results from the retrospective noncomparing materials revealed that there was no significant difference in intrauterine pregnancy rates, i.e. 46% following conservative tubal surgery and 44% after radical surgery. The repeat ectopic pregnancy rate was 10% following conservative surgery and 15% after radical surgery. In the group of restrospective comparing studies only one of 15 materials could document a significant better intrauterine pregnancy rate after conservative tubal surgery than following radical treatment for tubal pregnancy. There were no differences either in this group in repeat ectopic pregnancy rates. Prospective investigations were almost exclusively represented by selected conservative treatment series. In these series the average intrauterine pregnancy rate was 57% and the repeat ectopic pregnancy rate was 13%.Conclusions.In studies on fertility after radical or conservative surgical treatment for tubal pregnancy no significant difference in intrauterine pregnancy rates or repeat ectopic pregnancy rates were found. Prospective selected treatment series demonstrated higher intrauterine pregnancy rates than retrospective studies. The repeat ectopic pregnancy rate was not raised in prospective series. No prospective randomised trial was foun

ISSN:0001-6349    

DOI:10.3109/00016349609033276

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.To investigate the effects of estradiol (E2) alone and in combination with progesterone or oxytocin on contractile activity of term human myometriumin vitro.Methods.Myometrial specimens were obtained from 24 term pregnant women not in labor who underwent elective cesarean. Biopsies were kept in ice‐cold and oxygenated Hepes buffer and buffer containing different hormonal solutions. The biopsies were dissected and mounted in tissue baths at 37d`C and isometric tension was recorded.Results.(1) Estradiol at 0.1 and 1 μg/mL increased the contractile frequency (p<0.01 for each), decreased the tonus (p<0.05 andp<0.01) and suppressed the activity area of contractions (p<0.05 andp<0.01) as compared to control. (2) No significant differences in frequency and activity area of contractions between strips superfused with E2 plus progesterone and progesterone alone were recorded. Myometrial tonus was decreased by 0.1 μg/mL or 1 μg/mL E2 plus progesterone as compared to progesterone alone (p<0.05 andp<0.01). (3) There were no significant differences in frequency between strips superfused with E2 plus oxytocin and oxytocin alone. Myometrial tonus was decreased by 0.1 μg/mL or 1 μg/mL E2 plus oxytocin as compared with oxytocin alone (p<0.05 andp<0.01). Estradiol at 0.1 μg/mL or 1 μg/mL plus oxytocin reduced the activity area of contractions compared to oxytocin (p<0.05 andp<0.01).Conclusions.These data suggest that E2 had both stimulatory and inhibitory effects on term human myometrial contractility and that E2 altered the myometrial response to progesterone and oxytocin mainly by decreasi

ISSN:0001-6349    

DOI:10.3109/00016349609033277

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Purposes. The aims of this study were: first, to ascertain the characteristics of younger and older mothers in the Finnish population; second, to assess the health conditions pertaining to births and newborns according to maternal age groups.Methods. The data, 26 373 primiparous and 38 895 multiparous women, came from the 1991 nationwide Finnish birth register, and was completed using death and education registers. The younger (<18 and 18‐19 year olds) and older (35‐39 and 40 and over) mothers were compared to 20‐34 year olds. Infant outcomes were studied by adjusting for mothers' social and obstetric background characteristics by using stepwise logistic regression.Results. Births were rare among women younger than 18 years or 40 years or older. Younger primiparous mothers (less than 20 years) were less often married, more often had a lower social class background, and tended to live in Northern Finland and used antenatal care somewhat less. Their pregnancies, giving birth and infant outcomes were similar to those of 20‐34 years old mothers. Most older mothers were women having their families late, rather than having big families. Older primiparas (35 years or older) were less likely to be married, were more often highly educated and lived in urban areas and in the most southern county. Older mothers had more problems during pregnancy and labor, and their infant outcomes were worse.Conclusions. Our study supports the notion that for young mothers giving birth is a social rather than a medical problem, whereas the reverse is true for older mothers. However, perinatal results for most older mothers a

ISSN:0001-6349    

DOI:10.3109/00016349609033278

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To assess a technique for forward extrapolation of ultrasound‐estimated fetal weight to the time of delivery.Methods.A total of 276 women who delivered within 35 days of ultrasound examination were studied. Fetal weight was estimated according to either Hadlock's formula for the biparietal diameter, abdominal circumference and femur length or Campbell's formula for the abdominal circumference. The extrapolation technique is based on the hypothesis that the fetal weight: median weight ratio remains constant in the third trimester. The weight estimates were either left unchanged or extrapolated to the time of delivery according to this method and compared with a technique described by Spinnato and colleagues (7, 8). The accuracy of the method was assessed by analysing the weight predictions in relation to the birth weights, using non‐parametric tests.Results.The mean systematic error using our extrapolation method with Hadlock's weight formula was 5.9%. which was significantly better than using Spinnato's method (8.8%) or making no adjustment at all (—6.5%). The random errors were also significantly reduced (11.2% versus 12.3% and 12.3%.p<0.0005). With Campbell's formula, the mean systematic error from our method was 3.8%. whereas the unadjusted formula would have yielded an error of −8.5% (p<0.001). The absolute errors with our technique were also significantly lower than those of the other methods.Conclusions.In the prediction of birth weight, an antenatal ultrasound estimation of fetal weight needs to be projected to the expected time of birth and for this it must take the time lapse to delivery into consideration. The method presented is able to accomplish this with simplicity and a

ISSN:0001-6349    

DOI:10.3109/00016349609033279

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.Fetal growth may be determined by genetic as well as environmental factors. Whether psychological distress during pregnancy influences fetal growth is a matter of debate.Material and methods.A prospective population‐based study with repeated measures of psychological distress (General Health Questionnaire) during pregnancy, based on the use of questionnaires. Danish speaking women with singleton pregnancies attending antenatal care between August 1, 1989 and September 30, 1991 were eligible to the study (n= 8719). Of these women 5868 women (67%) completed all questionnaires. The main outcome measure was fetal growth (assessed as birth weight for gestational age (continuous)) and birth weight below the 10th percentile of birth weight for gestational age (light for gestational age (LGA) (dichotonmus). Gestational age was calculated primarily from an early ultrasound scan. Confounders were controlled using multivariate statistical methods.Results.Birth weight for gestational age and risk of delivering a LGA baby were not associated with psychological distress, neither distress in 16th week nor in 30th week of pregnancy.Conclusion.To the extent that fetal growth can be explored at birth, the results indicate that psychological distress does not influence fetal growt

ISSN:0001-6349    

DOI:10.3109/00016349609033280

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.One of the possible mechanisms responsible for pre‐eclampsia is a loss of efficiency of the L‐arginine‐nitric oxide pathway with subsequent inactivation of the guanylyl cyclases of the vascular smooth muscle cells. As a result there should be a decrease in plasma cyclic 3′‐5′ guanosine monophosphate (cGMP) concentrations in pre‐eclampsia. We assessed the behavior of this nucleotid in the plasma of pre‐eclamptic women.Subjects and methods.Sixteen pre‐eclamptic women, 16 normotensive pregnant women matched for gestational age and six nonpregnant controls were investigated. Arterial blood pressure was recorded at inclusion time and then once a‐day until the fourth day after delivery concomitantly with the collection of blood samples for determining plasma cGMP, atrial natriuretic peptides (ANP). creatinine, uric acid and platelet counts. Also 24 h urines were simultaneously collected to calculate renal clearance of cGMP.Results.Before the initiation of antihypertensive treatment, plasma cGMP levels were significantly higher (p<0.01) in pre‐eclampsia women as compared both to pregnant normotensive controls and nonpregnant women (7.02±0.9 versus 4.8±0.76 versus 1.93±0.15 pmol‐ml−1, p<0.01). Under antihypertensive treatment, cGMP levels decreased significantly (p<0.05) to 5.48±0.9 pmol‐ml−1. The increase of plasma cGMP was associated with high ANP levels; the likelihood that a renal impairment could account for an increase in plasma cGMP was ruled out because the clearance of creatinine was not impaired. Similarly the possibility of a significant linear correlation between cGMP levels and blood pressure values or biological data was excluded in these women.Conclusion.Plasma cGMP concentrations are increased in pre‐eclampsia. They decrease to control values when blood pressure returns to normal values; they indicate enhanced guanylyl cyclase activation by ANP and additional factors, but cannot be considered as a direct ind

ISSN:0001-6349    

DOI:10.3109/00016349609033281

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.Prostaglandin E2for local application has been widely used for preinduction cervical ripening in cases presenting with an unfavorable cervical state. The optimal way of administering prostaglandin E2, however, remains unclear. The aim of this study was to compare the effect of multiple application of 0.5 mg Minprostin® intracervical Gel to the effect of 3 mg Minprostin® vaginal tablets in priming the uterine cervix and inducing labor in an open, prospective, randomised study.Methods.PGE2was applied up to three times a day for two days until ripening was obtained or labor induced. In case no progress took place amniotomy was performed and i.v. oxytocin stimulation one hour later if necessary. A total of 208 pregnant women, consecutively admitted for induction of delivery, with Bishop Scores 0‐5, were included.Results.Minprostin® gel (group I) and Minprostin® tablets (group II) were equally effective in ripening the cervix. Delivery within 48 hours was achieved in 59% and 63% respectively. The mean number of applications was 2.6 (s.d. 1.6) and 2.7 (s.d. 1.3) respectively. In case more than four doses were required no further effect was seen on delivery rates. Rates of cesarean section (performed in 15% and 18% respectively), labor induction (3%/1%), drop outs (14%/12%) and failed inductions (10%/5%) were comparable. Patients in group I had a significantly lower demand for analgesia. A significantly shorter induction‐delivery interval in group II was seen in patients with preinduction Bishop scores 3‐5 compared to patients with Bishop scores 0‐2. Side effects were few. Both procedures appear safe. Conclusions. Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets in cases presenting with an unfavorable cervical state is equall

ISSN:0001-6349    

DOI:10.3109/00016349609033282

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To compare maternal and neonatal outcomes after 12 or 24 hours of expectant management in healthy nulliparous women with a ripe cervix and PROM at term.Design.A prospective, randomized study.Location.Karolinska Hospital, Stockholm. Sweden.Subjects.Two hundred and five healthy nulliparous women with singleton pregnancies, cephalic presentation, gestational duration 36 to 42 weeks, randomized to 12 or 24 hours of expectant management after evaluation of the cervical score (>5). If spontaneous labor did not occur, induction was performed with oxytocin after 12 or 24 hours, respectively. Main parameters. Maternal early morbidity and neonatal infections, obstetric intervention rate (cesarean section or instrumental delivery).Results.The cesarean section rate was 4% in each group. The vacuum extraction rate was 21% in each group. Induction of labor was performed in 47% of the women allocated to 12 hours of expectant management vs 17% of the women allocated to 24 hours of expectant management (p<0.05). The maternal morbidity rate was almost negligible. Only a few fetal infections occurred and no difference was noted between the groups.Conclusions.In healthy nulliparous women at term with a ripe cervix, expectant management over 24 hours vs 12 hours resulted in fewer inductions of labor and no increase in instrumental deliveries, without any increase in neonatal or maternal morbidity.

ISSN:0001-6349    

DOI:10.3109/00016349609033283

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To determine the effect of vaginal misoprostol application for cervical dilatation and to determine the lime taken for pregnancy interruption.Methods.200 μg misoprostol and gyno‐flor vaginal tablet, employed to create acidic milieu, were applied into the posterior fornix of 40 women with gestational age of 5 to 10 weeks. Placebo was applied vaginally to 20 women who made up the control group. All cases were examined 5 hours later. The cervical dilatation, presence of fetoplacental material in the vagina, extrauterine cervical bleeding and the time necessary for dilatation and suction curettage were investigated.Results.In 33 (82.5%) of the cases cervical bleeding, in 21 (52.5 %) of the cases fetoplacental material on the cervix and or in the vagina were detected in women of misoprostol group, while neither cervical bleeding nor fetoplacental material on the cervix and/or in the vagina was detected in the placebo group. In the misoprostol group the time taken for the operation was significantly (p<0.005) shorter than that of the control group.Conclusion.Vaginal application of misoprostol shortens the time needed for the termination of the gestation by its facilitating effect on cervical dilatati

ISSN:0001-6349    

DOI:10.3109/00016349609033284

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY