Biomedical subjects

G Csemiczky

Publications and source records attributed to G Csemiczky.

At least 19 recordsLinked to original sources

PubMed2002

Delivery rates following IVF treatment, using two recombinant FSH preparations for ovarian stimulation.

BACKGROUND: A prospective, semi-randomized, open, clinical study was conducted to compare ovarian response, pregnancy outcome and delivery rates using two recombinant FSH preparations (Gonal-F and Puregon) for IVF. METHODS: We analysed stimulation parameters and outcome data in 812 initiated treatment cycles where 292 women used Gonal-F and 200 used Puregon. Embryo transfer was carried out in 676 cycles. In the two preparation groups we also compared 170 women previously treated with FSH for IVF with 266 previously untreated. RESULTS: The pregnancy rate with Gonal-F was 26% and with Puregon 28%. Delivery rates were identical, 22%. Clinical pregnancy and delivery rates per cycle with embryo transfer in earlier untreated women were 29.0 and 24.0%, whereas in previously treated women they were 23.5 and 18.8% respectively. After repeated cycles, delivery frequencies consecutively decreased, independent of the FSH preparation used. CONCLUSION: Gonal-F and Puregon seem to be equally potent in achieving follicular development and equally effective, in terms of delivery rates, for use in an IVF programme. Repeated cycles resulted in equally large consecutive decreases in delivery rates, regardless of preparation choice, but were considered worthwhile for up to three stimulation cycles in selected patients.

Adult↗

PubMed2001

Effects of oral contraceptives on breast epithelial proliferation.

The association between oral contraceptive (OC) use and breast cancer is not fully understood. Estrogen is a known mitogen to breast epithelial cells, but there is still a controversy about the effect of added progestogens. Fine needle aspiration (FNA) biopsies were used to assess epithelial proliferation in normal breast tissue from 106 healthy premenopausal women with and without oral contraceptives. In 26 women biopsies were performed before and after 2 months of OC use. Proliferation, expressed as percentage of Ki-67/MIB-1 positive cells, was correlated to endogenous progesterone, androgenic/anabolic compounds and exogenous progestogen. We found a higher proliferation (p = 0.03) in OC users compared to non users, with mean values of 4.8% and 2.2%, respectively. There was a positive correlation between proliferation and progesterone levels in non-users and with serum levonorgestrel concentrations in women using OCs containing this progestogen (rs = 0.43, p = 0.02). Women using OCs had significantly lower serum androgen levels compared to naturally cycling women and free testosterone levels displayed an inverse relation to breast epithelial proliferation. There was a marked variation in the response to exogenous sex steroids. In certain women after 2 months of OC use, the percentage of MIB-1 positive cells was as high as 40-50%. The results add to the growing evidence that progestogens may be mitogenic in breast tissue. Increased proliferation during hormonal contraception should be regarded as an unwanted and potentially hazardous side effect. Efforts should be made to define hormonal contraceptive regimens which minimize breast epithelial proliferation and to identify those women with the most pronounced proliferative response.

Adolescent↗

PubMed2000

The influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF-treatment.

BACKGROUND: Comparing stress levels in women entering IVF treatment with those of fertile controls as well as relating these levels to the outcome of IVF. METHODS: State anxiety and personality profiles as well as stress hormones were studied in 22 normally menstruating women entering IVF treatment for tubal infertility. Their personality profiles as well as state anxiety scores measured before entering IVF treatment were related to the outcome of treatment. Twenty-two fertile women served as controls. Stress markers were serum prolactin and cortisol. These were estimated by radioimmunoassay. The psychological evaluation included the Karolinska Scales of Personality (KSP) and state anxiety as measured by the STAI questionnaire. Basal FSH on cycle day 3 and E2 and P4 AUC during the luteal phase were evaluated as hormonal predictors for the outcome of IVF treatment. RESULTS: Comparison of the personality profiles of the two groups, showed that infertile women had significantly higher scores of suspicion (p>0.05), guilt (p>0.05), and hostility (p>0.01), but lower somatic anxiety (0.05) and indirect aggression (0.05) than fertile controls. The infertile women also had significantly higher levels of prolactin and cortisol throughout the menstrual cycle. Serum cortisol, prolactin and FSH levels on cycle day 3 did not differ between the women who conceived after IVF treatment and those who did not conceive. However, significant differences were found in E2 and P4 AUC (p>0.01) in the luteal phase between those women who became pregnant and those who failed. There was a trend (p<0.06) toward higher state anxiety levels among the women who did not succeed in becoming pregnant after IVF treatment. CONCLUSIONS: The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.

Adult↗

PubMed2000

Recombinant follicle stimulating hormone in in-vitro fertilization treatment-clinical experience with follitropin alpha and follitropin beta.

The objective of this prospective study was to compare the outcome of ovarian hyperstimulation for in-vitro fertilization (IVF) using two different preparations of recombinant follicle stimulating hormone (FSH). The study was based on 296 consecutive IVF cycles in 1997, 199 performed using follitropin alpha (Gonal-F) and 97 performed using follitropin beta (Puregon). Outcome was compared regarding pregnancy rate, oestradiol and progesterone response, endometrial thickness, follicle number, number of retrieved oocytes, fertilized oocytes, sperm count and sperm motility. There was no significant difference in outcome of stimulation. Clinical pregnancy rate was similar, 29.1% for Gonal-F and 28.1% for Puregon. There was no difference in endometrial response, oestradiol response, number of smaller (12-15 mm) or larger (>15 mm) follicles, number of oocytes retrieved, fertilized, divided and replaced, in sperm counts or in sperm progressive motility. There was a lower follicle number in the Puregon group, but not statistically significant. The serum progesterone concentrations on the day of oocyte retrieval, however, were significantly lower in the Puregon group. In conclusion, it was not possible to find significant differences in the IVF programme with regard to stimulation outcome between Gonal-F and Puregon. The results of this study indicate that Gonal-F and Puregon may be equally suitable for use in ovarian stimulation for IVF.

Adult↗

PubMed1999

Endometrial evaluation is not predictive for in vitro fertilization treatment.

PURPOSE: The main purpose of this study was to evaluate ovarian function by clomiphene citrate (CC) challenge test in a group of tubal infertile women and to study endometrial morphological maturation in the early luteal phase of CC-stimulated cycles as compared to in vitro fertilization (IVF) treatment outcome. METHODS AND RESULTS: Four women presented with strongly retarded, proliferative endometrium in the luteal phase. Of these, three presented with impaired ovarian function, high basal follicle-stimulating hormone, and high follicle-stimulating hormone levels after clomiphene stimulation on cycle day 10. In the remaining 30 women, showing an in-phase endometrium after CC stimulation, a comparison of six morphological characteristics did not reveal any significant differences between the 14 women who did become pregnant and the 16 who did not. No significant differences in endometrial thickness were observed between the groups. Significant differences were found when comparing estradiol and progesterone area under the curve during the luteal phase (P < 0.001 and P < 0.01, respectively) between those who did and those who did not become pregnant. CONCLUSIONS: Luteal endometrium morphology was not a sharp instrument to detect differences between women who did and women who did not become pregnant following IVF treatment, while ovarian function, as measured by hormonal markers, seemed to be a more reliable prognostic factor for IVF treatment outcome.

Area Under Curve↗

PubMed1999

A randomized trial on effects of hormone therapy on ambulatory blood pressure and lipoprotein levels in women with coronary artery disease.

OBJECTIVE: To investigate 1-year effects of hormone replacement therapy (HRT) on ambulatory blood pressure (ABP) and lipoprotein levels in postmenopausal women with coronary artery disease (CAD). METHODS: Sixty patients at a mean age (+/- SD) of 59 +/- 7 years were randomized into three groups: conjugated equine oestrogens (CEE) 0.625 mg daily (n = 20), 50 microg 17beta-oestradiol transdermally (TTSE) per 24 h (n = 20) or placebo (n = 20) for 18 days, then combined with medroxyprogesterone acetate 5 mg for 10 days. Each cycle of 28 days was repeated for one year. RESULTS: Night-time systolic ABP had decreased by 9.6% (P= 0.0075) in 15 of 18 women in the CEE group and by 22% in 12 of 13 women (P = 0.0034) in the placebo group after 1 year. In the CEE group, a 4.6% rise in daytime systolic ABP (P< 0.05) and a 4.2% rise in night-time systolic ABP (P< 0.05) appeared from baseline to 6 months in 13 of 18 women. In the CEE group (14 women analysed), high-density lipoprotein levels showed a 15.8% increase (P= 0.0018) in 13 women, low-density lipoprotein levels a 15.2% decrease (P= 0.0129) in 12 women and total cholesterol levels a 7.5% decrease (P = 0.057) in 11 women after 1 year. Triglyceride levels showed no changes. In the TTSE group and in the placebo group, with 12 and 13 women analysed respectively, no significant changes appeared. CONCLUSIONS: One year of HRT in patients with CAD does not influence ABP. Oral HRT induces beneficial effects on lipoprotein levels.

Adult↗

PubMed1998

Importance of endometrial quality in women with tubal infertility during a natural menstrual cycle for the outcome of IVF treatment.

PURPOSE: The importance of endometrial maturation at estimated time of implantation for the outcome of IVF treatment in regularly menstruating women with tubal infertility was evaluated. METHODS: FSH was measured on cycle day 3, on days 10-15 urine and blood were collected to estimate the day of the LH peak, and E2 and P4 were measured during the luteal phase, on cycle days 19-26. An endometrial biopsy was obtained on days LH + 3 to LH + 6. RESULTS: The number of subjects with delayed endometrial maturation was larger in the group of infertile women who did not become pregnant compared to pregnant women and controls. Those infertile women who did not become pregnant after IVF treatment also presented with a higher basal FSH on cycle day 3 and lower E2 and P4 AUC in the luteal phase. Six infertile women and two controls presented with mid- and late-proliferative endometrium in the luteal phase on cycle days LH + 3 to LH + 6, in the presence of adequate E2 and P4 secretion. Six morphological characteristics were compared in the three groups: (1) 17 infertile women who became pregnant, (2) 18 who did not become pregnant, and (3) 28 controls. The pregnant infertile women did not differ from the controls. The numbers of glandular and stromal mitoses were significantly higher in those women who did not become pregnant (P < 0.01) compared with those who became pregnant. Endometrial biopsies obtained on cycle days LH + 5 and LH + 6 showed significant differences in glandular epithelial height (P < 0.05) and number of vacuolated cells among the nonpregnant women (P < 0.01), the pregnant women (P < 0.05), and controls. CONCLUSIONS: A higher frequency of retarded endometrial development in women who did not become pregnant following IVF treatment was found. In some cases, endometrial insensitivity could most likely cause retarded endometrial development and failure of implantation after IVF treatment, which could not be overcome by routine luteal-phase support. However, our results do not allow conclusions concerning its relative importance compared to preembryo quality; this has to be investigated further.

Adult↗

PubMed1998

Zona pellucida thickness variation and occurrence of visible mononucleated blastomers in preembryos are associated with a high pregnancy rate in IVF treatment.

PURPOSE: The ability of six morphological criteria (embryo development rate, fragmentation, regularity of blastomere shape, equality of blastomere size, zona pellucida thickness variation [ZPTV], and visible mononucleated blastomeres [VMBs]) to predict pregnancy in IVF treatment cycles was evaluated. METHODS: In order to select a homogeneous study group, 85 consecutive nulliparous couples with single tubal infertility undergoing their first IVF treatment and receiving three preembryos at embryo replacement 2 days after ovum pickup were included. RESULTS: A total of 255 preembryos was replaced two days after ovum pickup and resulted in 34 clinical pregnancies (40%). By logistic regression analysis, ZPTV and VMBs showed highly significant and strong predictive values, whereas none of the other parameters was a significant predictor of pregnancy. In the treatments in which all replaced preembryos had a ZPTV of less than 15%, the pregnancy rate was extremely low (1/22). If the maximum ZPTV of any of the replaced preembryos was in the interval between 15 and 20%, the pregnancy rate was 24.1% (7129). In the treatments in which at least one preembryo had a ZPTV of more than 20%, the pregnancy rate was 76.5% (26/34). When VMBs were added to the results of the ZPTV analysis, the pregnancy rate was as high as 92.3% (24/26). CONCLUSIONS: ZPTV and VMBs seem to be strong predictors of pregnancy in IVF treatment and thus important indicators of good embryo quality.

Adult↗

PubMed1998

Female patients with cystic fibrosis suffer from reproductive endocrinological disorders despite good clinical status.

Ten women with cystic fibrosis (CF) were evaluated with regard to hormonal profiles during a natural and a clomiphene citrate (CC) stimulated cycle. Five of the women were found to be anovulatory during a natural cycle. All women except one did respond with ovulation to CC stimulation indicating adequate ovarian response. Neither did they show increased follicle-stimulating hormone (FSH) concentrations on day 10 after CC treatment confirming normal ovarian reserve. Clinically the anovulatory women differed from the ovulating in two aspects: more profound essential fatty acid deficiency (EFAD) and higher peak/basal insulin response during an oral glucose tolerance test. The anovulatory women had significantly lower luteal oestradiol and progesterone but higher total testosterone concentrations when compared to healthy controls and the ovulatory CF women. The pathological insulin response and high testosterone concentrations resemble those seen in women with polycystic ovarian (PCO) syndrome. However, the CF patients in our study had normal ovaries, as deduced from ultrasound examination and normal luteinizing hormone (LH)/FSH ratio. It is suggested that EFAD as well as hypersecretion of insulin may be of importance for the observed ovarian dysfunction. Further studies are needed to evaluate the relation between ovulatory mechanisms and EFAD in CF women as well as studies to compare anovulatory CF women with women with PCO syndrome.

Adult↗

PubMed1996

Risk for ovulation in women taking a low-dose oral contraceptive (Microgynon) when receiving antibacterial treatment with a fluoroquinolone (ofloxacin).

The possibility of escape ovulation in women using a fluoroquinolone ofloxacin for antibacterial treatment at a dose of 200 mg twice daily for 7 days when taking a combined oral contraceptive (Microgynon, 150 micrograms levonorgestrel and 30 micrograms ethinyl estradiol) was studied in 20 women. By using a placebo-controlled, randomized, cross-over design 6 contraceptive pill cycles were followed. Follicle-stimulating hormone and estradiol concentrations were measured on tablet days 5-8, 19-21; progesterone was assayed on days 19-21 during treatment with ofloxacin or placebo. Ultrasonographical investigations for measurements of the number and diameter of ovarian follicles were performed on one of days 5-10, 11-17, 18-24, 25-28. No indications of ovulation during ofloxacin medication were detected. It is concluded that alternative contraceptive precautions should not be needed when ofloxacin is prescribed for patients taking oral contraceptives.

Adult↗

PubMed1996

The pharmacodynamic effects of an oral contraceptive containing 3 mg micronized 17 beta-estradiol and 0.150 mg desogestrel for 21 days, followed by 0.030 mg desogestrel only for 7 days.

During oral treatment with 3 mg micronized 17 beta-estradiol and 0.150 mg desogestrel for 21 days followed by 0.030 mg (A) desogestrel (15 women) or placebo (B) (14 women) for 7 days, ovarian function, bleeding pattern and estradiol levels were evaluated. The study was performed in a group-comparative, double-blind fashion. During a pre-treatment control cycle, using ultrasound scan, follicular diameter was measured on cycle days 10-16 and endometrial thickness on one of cycle days 22-26. Estradiol was measured at the time of ultrasound scan and progesterone three times in the luteal phase. During three treatment cycles, follicular diameter and endometrial thickness were monitored three times weekly and at the same time, estradiol and progesterone were measured. Treatment resulted in anovulation in all women. Maximum and mean estradiol levels were approximately 900 pmol/l and 550 pmol/l during treatment, respectively, and approximately 200 pmol/l during the estradiol-free weeks in both groups. Ten women showed ovarian activity (follicle size > or = 15 mm) during treatment, seven in group A and three in group B. Endometrial thickness decreased approximately 3 mm during treatment in both groups. The incidence of breakthrough bleeding and spotting was higher in group A when compared to group B. The study indicates that the combination of 3.0 mg micronized estradiol and 0.150 mg desogestrel is an effective and safe contraceptive, offering an acceptable cycle control. The addition of a low dose of desogestrel during the pill-free period did not further suppress ovarian activity nor improve the bleeding pattern. The results of this study should be interpreted with great care, since the number of women studied is relatively small.

Adult↗

PubMed1996

Controlled ovarian stimulation using highly purified FSH results in a lower serum oestradiol profile in the follicular phase as compared with HMG.

We have examined the efficacy of highly purified follicle stimulating hormone (FSH-HP) for controlled ovarian stimulation in our in-vitro fertilization (IVF) programme, and compared the results obtained with this preparation with those using human menopausal gonadotrophin (HMG) in 15 patients who had received treatment with both FSH-HP and HMG in consecutive cycles (n = 39). No differences were found in the duration of stimulation, which was 13.9 days (HMG) as compared with 14.3 days (FSH-HP). However, in the FSH-HP-treated cycles we found a striking difference in the rise of serum oestradiol, which was significantly lower than in HMG-treated cycles (2953 +/- 938 pmol/l as compared with 6349 +/- 3683 pmol/l on the day before ovum retrieval). Number and size of follicles were similar in the two groups, as were oocyte characteristics. Increase in endometrial thickness at two days prior to ovum retrieval was slightly higher after HMG. The results indicate that in combination with a long gonadotrophin-releasing hormone agonist (GnRHa) protocol, pure FSH is sufficient for adequate follicle recruitment and growth. However, since FSH-HP resulted in markedly reduced concentrations of serum oestradiol as compared to HMG cycles, IVF programmes using repeated oestradiol measurements to decide the day of ovum retrieval must take this into consideration in order not to prolong the stimulation unnecessarily.

Adult↗

PubMed1996

Luteal phase oestradiol and progesterone levels are stronger predictors than follicular phase follicle stimulating hormone for the outcome of in-vitro fertilization treatment in women with tubal infertility.

Basal follicle stimulating hormone (FSH) in a natural cycle, FSH on cycle days 3 and 10 in a clomiphene citrate-stimulated cycle and oestradiol and progesterone area under the curve (AUC) in the luteal phase of the clomiphene citrate-stimulated cycle were evaluated as hormonal predictors for the outcome of IVF treatment in 53 normally cycling women with tubal infertility. The pregnant women had significantly fewer treatment cycles (P < 0.001) and needed fewer ampoules of gonadotrophins (P < 0.001). They also had more oocyte retrievals (P < 0.001), more oocytes per retrieval (P < 0.01), higher fertilization rate (P < 0.001) and more replaced pre-embryos per replacement (P < 0.01) as compared with non-pregnant women. Significant differences were found in FSH concentrations on cycle days 3 (P < 0.05) and 10 (P < 0.001) after clomiphene citrate stimulation and for oestradiol and progesterone AUC in the luteal phase (P < 0.001) between those women who became pregnant and those who did not become pregnant after IVF treatment. Luteal oestradiol and progesterone had considerably stronger predictive value for the outcome of IVF treatment as compared to basal FSH and clomiphene citrate challenge test.

Adult↗

PubMed1996

High tubal damage grade is associated with low pregnancy rate in women undergoing in-vitro fertilization treatment.

In order to analyse the relationship between grade of tubal damage and pregnancy rate following in-vitro fertilization (IVF) treatment, 50 consecutive couples with isolated tubal infertility who underwent IVF without previous reconstructive surgery were studied. The couples had tried to conceive for 2.5-5.6 years (mean 3.9 years) and had gone through a complete investigation for infertility. All women fulfilled the standard criteria for normal ovulatory cycles. All males had normal spermiograms. Tubal function was in each case evaluated by hysterosalpingography and laparoscopy. Grade of tubal damage was classified on a scale of I-IV. Patients with milder tubal damage (groups I-II) showed considerably higher take-home baby rate per started cycle (48%) than patients with severe tubal damage (group IV; 6%) (P < 0.001) even though patients in group IV underwent more treatment cycles than patients in groups I-II (2.7 versus 1.8; P < 0.01). In the first treatment cycle nine out of 12 patients in groups I-II became pregnant as compared with only one out of 16 in group IV (P < 0.01). As indicators of lower ovarian response, the women in group IV needed a higher number of gonadotrophin ampoules per cycle (P < 0.001) and exhibited lower pre-ovum retrieval oestradiol concentrations (P < 0.001). Oocyte retrievals per started cycle (I-II: 100%; III: 98%; IV: 84%) did not differ significantly between the groups, neither did pre-embryo replacements (I-II: 95%; III: 80%; IV: 73%) nor pre-embryos per replacement (I-II: 3.0; III: 2.9; IV: 2.8). The present results concerning the role of tubal damage grade for the outcome of IVF treatment should be considered in patient counselling. Further studies are needed to elucidate the mechanisms by which the extent of tubal damage may impair ovarian function and reduce IVF outcome.

Adult↗

PubMed1995

Ovarian function in relation to the outcome of in vitro fertilization (IVF) treatment in regularly menstruating women with tubal infertility.

STUDY DESIGN: Ovarian endocrine function was evaluated in 53 regularly menstruating women, 27 to 38 years of age, who failed to conceive at least 2 years following reconstructive surgery for tubal infertility. Thirty apparently healthy women, 24 to 40 years of age with proven fertility, served as controls. Blood samples were obtained daily on cycle days 2-4 and 22-26 to assess FSH, E2, and P4 results. RESULTS: There was a tendency for women with more advanced tubal damage to be subjected to more extensive surgery. Based on extent of reconstructive surgery, the patients were divided into three groups. Group A (n = 29) had less extensive surgery, limited to the fallopian tubes, group B (n = 14) included patients with extended adhesiolysis, and group C (n = 10) comprised patients that had the most extensive reconstructive procedures involving ovarian surgery. Significantly highest FSH levels were found in group C (P < 0.001) compared to groups A and B in the early follicular phase. During the luteal phase, E2 levels were lower in groups B (P < 0.01) and C (P < 0.001) compared to group A. P4 levels were lower in group C compared to groups A and B. CONCLUSION: When the patients underwent IVF treatment higher grades of tubal damage, more extensive surgery and hormonal signs of ovarian insufficiency were highly related to treatment failure.

Adult↗

PubMed1994

Selection of ovarian stimulation protocol is related to IVF treatment outcome in women 35 years of age and older.

PURPOSE: The aim of this study was to assess if the woman's age influenced IVF treatment outcome when a long GnRHa-hMG or a CC-hMG ovarian stimulation protocol was used. Two hundred women were included in the study, 100 women under the age of 35 and 100 women 35 years of age and older (mean 31.8 years and 36.7 years respectively). In the younger group as well as in the older group 50 women were stimulated according to a GnRHa-hMG protocol and 50 women received a CC-hMG regimen. RESULTS: Significant differences between stimulation protocols were found in the older group for the mean numbers of oocytes recovered (4.7 vs 3.0), preembryos obtained (3.2 vs 2.0) and replaced (2.3 vs 1.7), as well as pregnancy (30% vs 10%) and delivery (24% vs 4%) rates per replacement. CONCLUSION: It is concluded that women over 35 years of age seem to have a more favorable outcome of IVF treatment when using a long GnRHa-hMG protocol compared with CC-hMG, while this difference was not as obvious and lacking statistical significance under the age of 35.

Adult↗

PubMed1991

The effect of follicular growth and luteal function of "missing the pill". A comparison between a monophasic and a triphasic combined oral contraceptive.

The effects of follicular growth and hormonal indices of the deliberate omission of two low-dose combined oral contraceptives, a monophasic 130 micrograms ethinylestradiol + 150 micrograms desorgestrel) and a triphasic (30 micrograms ethinylestradiol + 50 micrograms levonorgestrel for 6 days, followed by 40 micrograms ethinylestradiol + 75 micrograms levonorgestrel for 5 days and 30 micrograms ethinylestradiol + 125 micrograms levonorgestrel for 10 days) combination during the first three days of one contraceptive pill cycle was studied in two groups of 10 women each. Follicular growth was followed by ultrasound scanning and plasma levels of estradiol, and progesterone were measured every other day until day 19 of the contraceptive pill cycle. In each group, ovulation occurred in one subject and 4 women reacted with follicular activity only, while 5 women on the monophasic and 3 on the triphasic formulation exhibited complete ovarian suppression. Two subjects on the triphasic preparation showed follicular growth followed by insufficient luteal function. Thus, the risk of escape ovulation when the pill-free interval is prolonged to 10 days in women taking low-dose combined oral contraceptive pills, is low (1/10).

Adult↗

PubMed1986

Comparison between the conventional Malmström extractor and a new extractor with Silastic cup.

One hundred women for whom instrumental delivery had to be performed due to fetal asphyxia or uterine inertia were randomized to a vacuum extraction with the conventional Malmström instrument or the Silastic cup of Kobayashi. With the Silastic cup, extraction time was shorter and injuries to the scalp were less common. On the other hand, extraction with the Silastic cup failed more often, especially in occiput posterior position. There were no differences in Apgar scores between the two groups.

Clinical Trials as Topic↗