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  • 1
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. The short-term reproductive prognosis of recurrent miscarriage for which no cause was found has been evaluated in 95 couples investigated between 1980 and 1986 at the First Obstetric and Gynaecological Clinic of the University of Milan. The actuarial overall 3-year livebirth delivery rate was 64%, increasing constantly with time. The reproductive success rate decreased with the number of previous miscarriages from 80% in women with two, to 60% with three and 46% with four or more miscarriages. No effect of age and socio-economic status emerged. There was a positive association between the number of previous miscarriages and the risk of miscarriage in the next pregnancy. Compared with women with two miscarriages the relative risk of another miscarriage was 2·3 for those with three previous miscarriages and 5·0 for those with four or more (χ21 for trend adjusted for age = 5·2, P= 0·02).
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 107 (2000), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The safety of use of the calcium channel blocker nifedipine in pregnancy as it affects child development has not been well evaluated. We report the results, with regard to the safety for children of use of nifedipine in pregnancy, on children followed up at 18 months of age born from women recruited in a study comparing routine treatment with nifedipine compared with no treatment1.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective During the pilot phase of a trial to evaluate the effectiveness of caesarean section delivery compared with vaginal delivery in reducing mother-to-child transmission of human immunodeficiency virus (HIV) infection, the feasibility of randomisation to mode of delivery was assessed.Design At 36 weeks of pregnancy, women infected with HIV were randomly allocated to either caesarean section delivery at 38 weeks or vaginal delivery. Information was also collected on the reasons why women were not enrolled, either because they refused or had a contraindication.Setting Fifty-one centres in six European countries. Population Pregnant women with confirmed HIV1 infection Main outcome measures Randomisation.Results Three-hundred and thirty-nine women had been randomised by the end of 1996, the large majority from Italy (n= 250) and France (n= 54), with 22 from South Africa, three from Sweden, nine from Barcelona and one from London. A further 150 women were eligible but had not been randomised. Forty-eight women (14%) were not delivered according to the arm to which they were randomised; the majority (n= 44) were changed from vaginal to caesarean section delivery. There is wide variation between European countries in the acceptability and adherence to the mode of delivery trial.Conclusion The pilot phase of this trial has shown that in some settings randomisation to mode of delivery is feasible and acceptable, but that in other setttings clinicians and pregnant women are more reluctant to be randomised. Pending further information on transmission rates and accrual, enrollment into the trial continues.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 91 (1984), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients (P〈O.001). The prognostic relevance of the clinical stage decreased after adjustment for lymph–node involvement, but the statistical significance of lymph–node involvement was unaffected when stage was allowed for. In the present series, the estimated 10–year disease–free survival was 80% in patients treated by radical hysterectomy compared with 62% in the group treated by total hysterectomy (stage IB to IV patients only); this difference, however, was not statistically significant when the data were adjusted for clinical stage (P=O.10). None of the 20 patients with recurrent disease could be managed successfully.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. On the basis of the numbers of single and multiple births routinely collected by the Central Institute of Statistics, trends in multiple births in Italy over the period 1955–1983 were analyzed. Between 1955 and 1983 the frequency of multiple births declined by about 25% (from 12–6/1000 deliveries to 9-6/1000 deliveries). The downward trend was constant until the early 1970s when rates tended to level off and increase slightly. This finding was largely attributable to trends in dizygotic rates, monozygotic births being approximately constant over the period considered. Multiple birth rates rose till age 35–39, being more than two times higher in this age group than in teenagers, but flattened off in the subsequent strata of age: this finding was constant over the period considered. Despite the general decreasing trend, the regional differences persisted largely unchanged, multiple birth rates being about 30% higher in Southern (and less developed areas) of the country than in the North of Italy. Geographic differences were limited to dizygotic pregnancies, monozygotic rates being constant (about 4/1000 pregnancies) in various areas.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 99 (1992), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To analyse the determinants of caesarean section rates in Italy.Design Analysis of information using a standard form on all the deliveries after the 28th week of gestation routinely collected by the Italian Central Institute of Statistics.Setting National data of all Italian deliveries in the periods 1980–1983.Subjects A total of more than 2 400 000 deliveries occurred in Italy in the period and are considered in this analysis.Results The frequency of caesarean section rose from 11.2/100 deliveries in 1980 to 14.5/100 in 1983. Caesarean section rates were lower in the Southern (less rich) areas, and rose steadily with maternal age, being about three times higher in women aged ≥40 years than in teenagers. Maternal education was directly associated with caesarean section rates: compared with women with only primary school education, those with a college education reported an about 40% higher rate of caesarean section, but this difference dropped markedly after allowance for maternal age and birth-weight. The section rate was 13.3/100 deliveries in public hospitals and 11.8/100 in private ones, but this reflected the different utilization of public and private services in various geographical areas. Birthweight and gestational age at delivery were important determinants of caesarean section rates; lowest values were observed for very-low-birthweight and very preterm deliveries and babies weighing 3000–3999 g and term deliveries. Caesarean section rates were about 20% higher in nulliparous than in parous women and the rates increased with number of stillbirths or miscarriages; further, the rate ratio was about double in multiple than in single births.Conclusion Caesarean section rates in Italy in the early 1980s were still lower than in North America, but their determinants share several similarities with those reported in other areas.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. The relation between parental moderate alcohol consumption and the risk of miscarriage was analysed using data from a casecontrol study in Milan between January 1987 and June 1988. Cases were 94 women who had two or more ‘unexplained’ miscarriages (after exclusion of genetic, endocrine and Miillerian factors) and without full-term pregnancies, admitted or referred to the First Obstetric and Gynecologic Clinic of the University of Milan. A total of 176 women admitted for normal delivery on selected days to the same university clinic and without previous miscarriages were chosen as controls. Compared with non-drinkers the risk of recurrent miscarriage was 0·9 for regular drinkers. The point estimates were 0·9 for women reporting one drink per day and 0·8 for those reporting two or more. Compared with non-drinkers, the relative risk estimates for drinking by fathers were slightly above unity, being 1·7 for less than three drinks and 1·4 for three or more drinks per day, but the trend in risk was not statistically significant.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. Between 1970 and 1976, 290 patients with endometrial cancer were treated at the 1st Obstetrics and Gynecology Clinic of the University of Milan. The median age was 62 years. Surgery was completed in 262 (90.3%) patients. Abdominal hysterectomy was used in 158 (70.9%) stage I and 40 (71.4%) stage II/III patients; vaginal hysterectomy in 55 (24.7%) stage I and nine (16.1%) stage II/III patients. Resection of the upper vagina was performed in 168 patients. Postoperative external beam radiotherapy was used in stage II/III patients and in 44 (19.7%) stage I high-risk patients. Ten-year survival, determined by the life-table method, was 84.8% in stage I (223 patients), 53.4% in stage II (37 patients), 64.4% in stage III (19 patients), and 9.1% in stage IV (11 patients). Factors associated with poorer prognosis were: late age at diagnosis (P〈0.001); deep myometrial invasion (P〈0.001); poorly differentiated histological grade (P=0.11); lack of resection of the upper vagina (P= 0.13). The role and importance of surgery is discussed, with special emphasis on the selective use of the vaginal route in aged, obese and medically high-risk patients.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To analyse the relation between induced abortion and risk of subsequent miscarriage.Design Case-control study conducted between February 1990 and May 1995.Participants Case group included 782 women (median age 32 years, range 1446) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (〉 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14–45) were interviewed.Results A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8–1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4–1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage.Conclusions This study did not find any strong association between induced and spontaneous abortion.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To analyse the association between oral contraceptive use and the risk of uterine fibroids.Design Participants We considered data collected in a case-control study on risk factors for uterine fibroids.Participants We studied 843 women with uterine fibroids, whose clinical diagnosis dated back no more than two years. Controls were 1557 non-hysterectomised patients younger than 55 years admitted for acute, non-gynecological, non-hormonal, non-neoplastic conditions.Results A total of 254 cases (30.1 %) and 360 controls (23.1 %) reported ever using oral contraceptives: the odds ratio (OR) for ever vs never users was 1–1 (95% CI 0-8–1.3). The risk in current users was below unity when compared with never users (OR 0.3,95% CI 0.2–0.6), while ex-users had a risk of fibroids comparable with never users (OR 1. I, 95% CI 0.9–1.4). The risk of uterine fibroids decreased with duration of oral contraceptive use: compared with never users, the estimated OR was 0.8 (95% CI 0.5–1.2) in ever users for four to six years and 0.5 (95% CI 0.349) for seven years or more (trend = 4.6, P= 0.03).Conclusions Although the role of selection bias should be carefully evaluated, the present data suggest that uterine fibroids should not be considered a contra-indication for oral contraceptive use.
    Type of Medium: Electronic Resource
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