Awareness of breast cancer incidence and risk factors among healthy women.

The efficacy of early breast cancer detection programmes seems to be mainly influenced by the awareness of breast cancer in general among healthy women. This study aimed to provide information about women's understanding of breast cancer incidence and risk of disease. Based on a newly developed questionnaire 2108 healthy women were asked about their knowledge and perceptions in relation to breast cancer incidence, risk factors, risk perception and level of concern. Of these women 78.8% were well aware of breast cancer in general terms. However, there were major aspects such as incidence or risk factors that were poorly understood. Only one-third correctly estimated the incidence of breast cancer; 95% understood breast cancer in the familial history as a risk factor, but only 57% understood the age risk; 37.1% of women perceived hormonal contraceptives and 35.9% hormonal replacement therapy as risk factors of breast cancer. The latter estimation was significantly higher in women above 40 years. Recommendations for the improvement of cancer prevention programmes include targeting understanding of lifetime risk of breast cancer, age as a risk factor, survival from breast cancer or hormonal factors. There is a need to separately address the perceptions of women depending on age, social status and educational levels.

Impact of three-dimensionally measured endometrial volume on the pregnancy rate after intrauterine insemination.

OBJECTIVE: The success of artificial reproductive techniques not only depends on the quality of oocytes and spermatozoa but also on the receptivity of the endometrium. The aim of this study was to assess the role of endometrial volume measurement by three-dimensional ultrasound in predicting the pregnancy rate (PR) in women receiving controlled ovarian hyperstimulation followed by intrauterine insemination. MATERIAL AND METHODS: 104 patients having intrauterine insemination (IUI) were included in this prospective trial. Ovarian hyperstimulation was performed with gonadotropins in 73 % of patients and with clomiphene citrate (CC) in 27 % of patients. Endometrial thickness, pattern and three-dimensional volume were measured immediately before insemination. RESULTS: In 104 IUI cycles a total of 14 clinical pregnancies were recorded (PR=13.5 %). The endometrial volume was 3.5 ml and was not significantly different in pregnant (4.0 +/- 1.5 ml) from non-pregnant women (3.4 +/- 1.9 ml). In the subgroup of women with an endometrial volume > or = 2 ml and trilaminar endometrium the pregnancy rate was 22 %, significantly higher than that in women without these two criteria (PR 6 %, p < 0.05). The negative predictive value of an endometrial volume < 2 ml for a clinical pregnancy after IUI was 96 %. Endometrial volume and thickness were significantly higher after ovarian hyperstimulation with gonadotropins (3.7 ml and 11.0 mm) than with CC (2.8 ml and 9.5 mm; p < 0.05). CONCLUSIONS: An endometrial volume < 2 ml at the day of insemination is associated with a poor likelihood of pregnancy. Endometrial volume measured by 3D ultrasound is a new objective parameter to predict endometrial receptivity.

[Fetal complications after failed pregnancy termination in the first trimester]. / Fetale Komplikationen nach misslungenem Schwangerschaftsabbruch im ersten Trimester.

BACKGROUND: Two different methods are in use for induction of abortion: either dilation and curettage (D & C) or medical termination with antigestagens and/or prostaglandins. The risk of continuing pregnancy after D & C ranges from 0.023 to 1% and is inversely correlated with gestational age. METHODS AND RESULTS: Several authors reported fetal anomalies (limb and oro-facial defects) in such cases. For the medical induction of abortion a combination of Mifepristone and Misoprostole is the treatment of choice in order to reduce the risk of ongoing pregnancy. Using single drug therapy carries an increased risk of failure and of subsequent fetal anomaly. There seems to be an increased incidence of limb defects and Möbius' syndrome in fetuses born after failed termination of pregnancy, but normal fetal development is entirely possible. CONCLUSION/DISCUSSION: The patients concerned must be informed in detail of the risks and probable consequences which must be included in the counselling concept of the treating gynaecologist.

Transvaginal volumetry of first trimester gestational sac: a comparison of conventional with three-dimensional ultrasound.

The aim of this study was to determine whether three-dimensional (3D) ultrasound is superior to two-dimensional (2D) ultrasound in evaluating first trimester gestational sac volume (GSV). 130 mainly low risk pregnancies between 5 and 12 weeks gestation were prospectively investigated. The 2D volumetry of GSV was performed using the ellipsoid formula; the 3D volumetry was carried out in all three planes using the contour mode and the volume from the measured circumferences and the distances between them were computed by a software. The data were analysed by variance and regression. The mean GSV increased from 1.5 +/- 2 ml with 5 weeks to 127 +/- 27 ml with 12 weeks (3D, longitudinal plane). The standard deviation of measured GSV increased with gestational age (GA) and GSV, and was more evident using 2D than 3D volumetry. GSV of pregnancies with similar GA differed considerably and viable pregnancies followed by miscarriage did not show different GSV. We conclude, that 3D volumetry of first trimester GSV is superior to 2D volumetry in its estimation, but seems to be without a prognostic significance for gestational outcome.

Fetal lung volumetry by three-dimensional ultrasound.

The aim of this study was to establish a method for determination of fetal lung volume by three-dimensional ultrasound. The thoraces of a total of 113 fetuses (singleton pregnancies, 11-41 weeks of gestation without any signs of malformation or oligohydramnios) were examined by three-dimensional ultrasound. Volumetric evaluation of each lung was performed in each of three perpendicular planes (six measurements in total). There were significant differences in all three measurements between the left and right lungs. Especially in the second and third trimesters, measurement of the frontal and the sagittal planes was sometimes prevented by poor imaging conditions. The scan volume was always too small for fetuses above 34 weeks. With these problems considered, nomograms of fetal lung volume for the left and the right lung were calculated. Lung volumes in the present study showed good correlation with published autopsy findings. Three-dimensional ultrasonographic volumetry is a useful method for determining fetal lung volume and may have a role to play in the detection of pulmonary hypoplasia.