Intrapartum cardiotocography -- the dilemma of interpretational variation.

Objective: To evaluate and compare interobserver variation in interpretation of intrapartum cardiotocograms.

Subjects: Fifteen senior (experience >4 years) and 16 junior (experience < or =4 years) obstetricians from 10 delivery units.

Design: Thirty-one obstetricians interpreted intrapartum cardiotocographic (CTG) readings from 22 parturients.

Feminine life-course of Estonian women born in 1937-47: a questionnaire survey.

Background: This study describes reproductive health, use of contraception, age at menopause, the prevalence of climacteric complaints, and hormone replacement therapy among Estonian women born in 1937-47.

Methods: A sample of 800 Estonian women born in 1937-47 was composed at random from the Estonian population registry in 1997. A postal questionnaire was sent to all participants.

A double blind, randomized trial on augmentation of labour with a combination of intravenous propranolol and oxytocin versus oxytocin only.

Objective: To compare the combination of intravenous propranolol and oxytocin with oxytocin only in augmentation of labour.

Study Design: A prospective randomized double-blind study in an obstetric department of a large university hospital in Finland. A total of 107 parturients with arrested first stage of labour owing to inadequate uterine contractility were randomized to receive intravenously once or twice a 2 mg dose of propranolol or placebo combined with oxytocin infusion.

Good perinatal outcome in selective vaginal breech delivery at term.

Background And Aim: To compare perinatal outcome in groups of planned vaginal breech delivery, elective cesarean section with the fetus in breech presentation, and planned vaginal delivery with the fetus in cephalic presentation in a university hospital with a tradition of managing breech deliveries by the vaginal route.

Methods: A cohort study from a 7-year period 1995-2002, including 590 planned vaginal deliveries with a term (> 37 weeks) singleton fetus in breech presentation, 396 elective cesarean sections with a term singleton fetus in breech presentation, and 590 control women intending vaginal delivery with a singleton term fetus in cephalic presentation.

Results: The Apgar scores were lower in the group of planned vaginal breech delivery, but in other outcome measures there were no significant intergroup differences.

Effects of ospemifene and raloxifene on hormonal status, lipids, genital tract, and tolerability in postmenopausal women.

Objective: To compare ospemifene and raloxifene regarding their effects on hormones, lipids, genital tract, and tolerability in postmenopausal women.

Design: A randomized, double-blind study in which 118 healthy postmenopausal women received 30 (n = 29), 60 (n = 30), or 90 mg (n = 30) of ospemifene or 60 mg (n = 29) of raloxifene for 3 months.

Results: There were no significant differences in the baseline characteristics between study groups.

Blinding decreased recruitment in a prevention trial of postmenopausal hormone therapy.

Purpose: To compare the effect of blind design (active drug and placebo) and nonblind design (active drug and no treatment) on recruitment.

Setting: A primary prevention trial with postmenopausal hormone therapy in Estonia.

Methods: Women who were eligible and willing to participate on the basis of the questionnaire survey were randomized into blind and nonblind groups.

Skin contamination by oestradiol gel--a remarkable source of error in plasma oestradiol measurements during percutaneous hormone replacement therapy.

Objectives: To study the consequence of skin contamination by oestradiol gel on circulating plasma oestradiol levels.

Methods: We studied ten healthy, hysterectomized postmenopausal women who had used percutaneous oestradiol gel for at least 2 years. After wash-out period percutaneous dose of 1.

Oral ascorbic acid increases plasma oestradiol during postmenopausal hormone replacement therapy.

Objectives: To study the possible interaction between ascorbic acid (AA) and oestradiol (E2) in postmenopausal women on hormone replacement therapy (HRT).

Methods: We studied 25 healthy postmenopausal women who had used percutaneous E2 gel at same dose for 10-12 months, at which time the plasma E2 concentrations were stabilized. The subjects were treated with 1000 mg of AA daily for 3 months and blood samples for assay of AA and E2 were taken at 0, 1 and 3 months.

Assessment of the metabolic tolerance in postmenopausal women over a 1-year period of two hormone replacement therapies containing estradiol in combination with either norgestrel or trimegestone.

This double-blind, randomized, multi-center study compared the metabolic tolerance of a combined formulation containing estradiol (E2) and trimegestone (TMG) with a standard hormone replacement therapy (HRT) containing estradiol valerate (EV) and norgestrel (NG). Blood lipids, glucose and fibrinogen concentrations were measured in the study which was conducted over 13 cycles, each of 28 days, and included 634 subjects in two randomized groups. A total of 481 subjects completed the study.

Self-adjusted postmenopausal hormone replacement therapy: effects on the biological and immunological profile of FSH and correlation to climacteric symptoms.

Objective: The purpose of the present study was to evaluate the hormonal profile of patients of postmenopausal age during estrogen replacement therapy (ERT) with special reference to the serum levels of biologically active FSH (B-FSH) in a self-adjusted ERT model.

Design: The hormonal values found have been correlated to climateric symptoms reported by the patients (scored by the Kupperman menopausal index (KI)).

Methods: B-FSH was measured using an assay based on a cell system transfected permanently with FSH receptor cDNA.

A 1-year comparison of the efficacy and clinical tolerance in postmenopausal women of two hormone replacement therapies containing estradiol in combination with either norgestrel or trimegestone.

This double-blind, randomized, multi-center study compared the efficacy and clinical tolerance of a combined formulation containing 2 mg estradiol (E2) and 0.5 mg trimegestone (TMG) with a standard hormone replacement therapy containing estradiol valerate (E2V) and norgestrel (NG) in the treatment of climacteric symptoms. The study was conducted over 13 cycles, each of 28 days, and involved 634 subjects, of whom 481 completed the study.

Neurologic sequelae after caesarean section.

Background: Because pregnancy increases the sensitivity of nervous tissue to local anaesthetics, pregnant patients may be at higher risk of developing neurologic deficits after spinal block than non-pregnant patients. Therefore, we evaluated prospectively the incidence and type of neurologic symptoms after spinal anaesthesia with hyperbaric bupivacaine for caesarean section.

Methods: In this prospective follow-up study we recorded neurologic complications during anaesthesia and postoperatively until discharge from the hospital of 219 patients, who underwent caesarean section under spinal anaesthesia with hyperbaric bupivacaine (5 mg/ml, mean 13 mg).

Factors underlying changes in bone mineral during postpartum amenorrhea and lactation.

To determine the physiologic and habitual factors that may modulate changes in bone mineral density (BMD) postpartum, dual-energy X-ray absorptiometry was performed at the lumbar spine, right femoral neck and dominant distal radius immediately after delivery, after resumption of menses, and 1 year thereafter in a cohort of 41 healthy postpartum Finnish women aged 31.5 (SD 4.6) years.

Why do postmenopausal women discontinue hormone replacement therapy?

Objectives: To study the prevalence and acceptance of hormone replacement therapy (HRT) in the Finnish population and to ascertain the factors leading to premature discontinuation of HRT.

Methods: A questionnaire survey was conducted among all women aged 50-60 selected from the age-sex register, 1065 women were identified and 884 (response rate 84%) agreed to participate.

Results: 111 women were premenopausal and 773 postmenopausal; 302 (39%) were current HRT users, 126 (16%) previous users and 345 (45%) non-users.

GnRH analogues and uterine leiomyomas. Effect of hormone replacement therapy on cell proliferation.

Cell proliferation in uterine leiomyomas treated preoperatively with either nafarelin (400 microg/day) for 3 months (7 patients) or nafarelin plus hormone (oestradiol + norethisterone) add-back therapy (6 patients) was investigated by automatic image analysis of frozen tissue sections using immunohistochemistry with anti-proliferating cell nuclear antigen antibody. GnRHa therapy decreased cell proliferation in leiomyomas to a level corresponding to the situation previously seen in postmenopausal leiomyomas. However, there was no consistent correlation between cell proliferation and shrinkage of leiomyomal size.

Changes in bone mineral density during pregnancy and postpartum: prospective data on five women.

Areal bone mineral density (BMD, g/cm(2)) of five healthy women (aged 26-30 years) was measured at the lumbar spine, right femoral neck and dominant distal radius with dual-energy X-ray absorptiometry before pregnancy, immediately after delivery, 1 month after the resumption of menses and 1 year thereafter. Because of the small number of subjects, only individual changes in BMD that were greater than 2 radical2 times the short-term in vivo precision were considered as significant changes. To obtain a further perspective, the reproduction-related BMD changes were compared with twice the standard deviation (SD) of the BMD changes in healthy premenopausal women (about +/- 5%), and with the SD of the BMD in a cross-sectional sample of young healthy women.

In the dose range of 0.5-2.0 mg/kg, acetylsalicylic acid does not affect prostacyclin production in hypertensive pregnancies.

Objective: To determine the dose of acetylsalicylic acid (ASA), that inhibits the production of the vasoconstrictive, aggregatory thromboxane A2 while sparing the production of the vasodilatory antiaggregatory prostacyclin.

Design: A controlled study comparing the effects of three doses of ASA on the production of thromboxane A2 and prostacyclin.

Methods: Seven pregnant hypertensive patients and five non-pregnant healthy women received 0.

Peripherally administered sufentanil inhibits pain perception after postpartum tubal ligation.

The clinical effectiveness of locally administered opioids is still under discussion; in particular, the potency of morphine in settings other than intra-articular arthroscopy has been questioned. We developed another pain model, postpartum resection of the fallopian tubes for sterilisation, in which each patient serves as her own control when one side is infiltrated with the active drug (in this study sufentanil 5 mg) and the contralateral side with normal saline. In the control group both sides are infiltrated with plain saline.

Antibodies against copper-oxidised and malondialdehyde-modified low density lipoproteins in pre-eclampsia pregnancies.

Objective: To measure auto-antibodies against oxidatively modified low density lipoprotein (LDL) in pre-eclamptic pregnancies using two different techniques.

Design: Clinical study comparing pre-eclamptic and normal pregnancies.

Setting: Tampere University Hospital, Finland.

CYP1A1 activity in renal cell carcinoma and in adjacent normal renal tissue.

Cytochrome P450-isoenzyme, CYP1A1, is responsible for the metabolic activation of several precarcinogenic environmental chemicals to their carcinogenic intermediates. Microsomal CYP1A1 activity in renal cell carcinoma (RCC) and in normal renal tissue was determined by measuring spectrofluorometrically the hydroxylation rate of benzo[a]pyrene. The study included 50 patients who underwent nephrectomy for RCC.

Activin B: detection by an immunoenzymometric assay in human serum during ovarian stimulation and late pregnancy.

A recently developed immunoenzymometric assay for activin B has been characterized further by measurement during ovarian stimulation and pregnancy. The assay is based on a monoclonal anti-peptide antibody, anti-betaB(101-115). In addition to quantitative analyses, the antibody has been used for immunohistochemical localization of the activin betaB-subunit in human term placenta.

Can climacteric women self-adjust therapeutic estrogen doses using symptoms as markers?

Objectives: To investigate if disappearance of climacteric symptoms during hormone replacement therapy (HRT) also means good therapeutic level of serum estradiol. The study group comprised of 32 postmenopausal women who had frequent climacteric symptoms.

Methods: The women increased the daily treatment doses of percutaneous estradiol every 2 weeks until they felt comfortable with it.

Patient managed clinical trial.

We describe a trial design of postmenopausal hormone therapy. Our goal was to design a trial that allows more patient management than usual, would include placebo effect in the therapy, would imitate the normal practices of health care as much as possible, and would be based on ordinary health services. We gave women a randomized recommendation to use or not use hormone therapy, invited them to two discussion groups, and sent them two questionnaires.