bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of heart disease diagnosed de novo in pregnancy in a West London population
Authors: Tan Jackie , de Swiet Michael
Published: August 2005

Objectives
To determine the prevalence of heart disease diagnosed de novo in pregnancy in a West London population and to re‐examine the current role of routine cardiovascular examination in antenatal care in the UK.

Design
Retrospective study.

Setting
Obstetric medical clinics at Queen Charlotte's and Chelsea Hospital, University College Hospital and Northwick Park Hospital.

Population
Three hundred and twenty women referred for cardiac evaluation during pregnancy.

Results
The majority of the 139 women referred specifically for evaluation of murmurs during pregnancy were found to have physiological murmurs (97%). Only four women (3%) were found to have significant cardiac lesions de novo in their pregnancy. Three of these four women were immigrants who had no previous history of heart disease. The only woman from the UK was already known to have a murmur from childhood.

Conclusions
Our study shows that heart disease diagnosed de novo in pregnancy in a West London population is an uncommon problem with low prevalence. It also appears to be a problem seen mainly in the immigrant population. The results emphasise the importance of taking a thorough medical history in all pregnant women. However, our results if they are confirmed, would suggest that only immigrants and those with significant symptoms or a known history of heart murmur or heart disease need undergo cardiovascular examination during pregnancy. These findings need to be confirmed in a larger group in other parts of the UK before further recommendations on selective cardiovascular examination can be made. This will have significant implications for midwifery‐led care.
A randomised placebo‐controlled trial of ursodeoxycholic acid and S‐adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy
Authors: Nicastri P. L. , Diaferia A. , Tartagni M. , Loizzi P. , Fanelli M.
Published: August 2005

A randomised placebo controlled study was performed in 32 women with intrdhepatic cholestasis of pregnancy. The population was divided into four groups: for 20 days each group was treated only with ursodeoxycholic acid, or S‐adenosylmethionine, or a combination of both drugs, or a placebo (vitamin). Itching, standard liver function tests and serum total bile acids were measured before, during, and after treatment. Itching improved in all the women as well as the biochemical abnormalities. No side‐effects in the mother or in the infant were recorded during and after therapy. A combination of ursodeoxycholic acid and S‐adenosylmethionine is more effective than placebo and than either drug alone.
Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy
Authors: Hope Peter , Breslin Sue , Lamont Linda , Lucas Alexandra , Martin Denis , Moore Isabella , Pearson James , Saunders Dawn , Settatree Ralph
Published: August 2005

Objective
To use information collected by the Confidential Enquiry into Stillbirths and Deaths in Infancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia.

Design
Review of casenotes by a multidisciplinary focus group.

Sample
All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia.

Main outcome measures
Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate.

Results
Maternal obesity and big babies were over‐represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered.

Conclusions Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome.
A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care
Authors: Slade P. , Heke S. , Fletcher J. , Stewart P.
Published: August 2005

Objective
To investigate whether women having medical or surgical terminations of pregnancy differ in their emotional distress before or after the procedure. To evaluate whether choice of procedure occurs, the factors influencing type of procedure and the effect of choice on emotional responses and satisfaction with care.

Design
A prospective comparative study.

Setting
A termination of pregnancy unit in a University Teaching Hospital.

Participants
Two hundred and seventy‐five women attending for medical or surgical first trimester termination of pregnancy.

Methods
Interviews concerning choice and measures of emotional status were completed prior to terminations. Four weeks after termination emotional functioning was reassessed together with satisfaction with care.

Results
Women having a surgical termination waited longer for the procedure and were at more advanced gestation than those having the medical termination. There were no differences in emotional responses related to type of procedure or gestation. One‐quarter remained highly anxious at four weeks. Medical and surgical groups did not differ in emotional status prior to termination. Those having the medical procedure rated it as marginally more stressful and experienced more post‐termination physical problems and disruption to life. Seeing the fetus was associated with more intrusive events (nightmares, flashbacks, unwanted thoughts related to the experience). One‐quarter of the medical and 67% of the surgical group reported having no choice in type of procedure. Only 53% of the medical group would choose the same procedure again compared with 77% of the surgical group.

Conclusions
Termination method did not influence emotional adjustment. Many women were not offered genuine choice of procedure. Having choice was considered very important but was unrelated to emotional distress or satisfaction with care.
Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence?
Authors: King Jennifer K. , Freeman Robert M.
Published: August 2005

Objective
To assess the contribution of constitutional factors, as demonstrated by antenatal bladder neck mobility, in the development of postpartum urinary stress incontinence.

Design
A prospective investigational study.

Setting
General district hospital.

Population
One hundred and three primigravid women with no pre‐existing urinary incontinence or neurological disorder.

Methods
Antenatal and postnatal measurement of bladder neck mobility using perineal ultrasound.

Main outcome measure
Urinary stress incontinence at 10–14 weeks postpartum.

Results
Women with postpartum urinary stress incontinence have significantly greater antenatal bladder neck mobility than those women continent postpartum. There were no significant differences in any labour or delivery variables, including mode of delivery, between the postpartum continent and incontinent women.

Conclusions
There is evidence for a constitutional risk factor (eg. defective pelvic floor connective tissue in the development of postpartum stress incontinence).
Immediate and long term outcome of human parvovirus B19 infection in pregnancy
Authors: Miller Elizabeth , Fairley Christopher K. , Cohen Bernard J. , Seng Claude
Published: August 2005

Objective
To estimate more precisely the risk of fetal loss and congenital abnormalities after maternal parvovirus B19 infection, and to assess the long term outcome for surviving infants.

Design
Prospective cohort study of pregnant women with confirmed B19 infection with follow up of the surviving infants. The rate of fetal loss in the study cohort was compared with that in pregnant women with varicella.

Setting
Cases reported by laboratories in England and Wales between 1985‐1988 and 1992–1995.

Sample
Four hundred and twenty‐seven pregnant women with B19 infection and 367 surviving infants of whom 129 were followed up at 7–10 years of age.

Methods
Questionnaires to obstetricians and general practitioners on outcome of pregnancy and health of surviving infants. Maternal infection confirmed by B19‐specific IgM assay and/or IgG seroconversion.

Results
The excess rate of fetal loss in women with B19 infection was confined to the first 20 weeks of gestation and averaged 9%. Seven cases of fetal hydrops followed maternal infections between 9 and 20 weeks of gestation (observed risk 2.9%, 95% CI 1.2–5.9). No abnormalities attributable to B19 infection were found at birth in surviving infants (observed risk 0%, upper 95% CI 0.86%). No late effects were found at 7–10 years.

Conclusions
Around 1 in 10 women infected before 20 weeks of gestation will suffer a fetal loss due to B19. The risk of an adverse outcome of pregnancy after this stage is remote. Infected women can be reassured that the maximum possible risk of a congenital abnormality due to B19 is under 1% and that long term development will be normal.
Ultrasound detection of vault haematoma following vaginal hysterectomy
Authors: Thomson A.J.M. , Sproston A.R.M. , Farquharson R.G.
Published: August 2005

Objective
To assess whether ultrasound detection of vault haematoma can be used as a predictor of post‐ooperative morbidity following vaginal hysterectomy.

Design
Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994.

Sample
Two hundred and twenty‐three women having undergone vaginal hysterectomy.

Methods
All women hadtransvaginal ultrasound examination by an independent observer on the third post‐operative day. Routine observations and clinical assessments were made by establishedmanagement protocol, by staff blinded to the ultrasound findings.

Main out come measures
Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re‐admission rate and length of stay.

Results
Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31%vs7%), post‐operative haemoglobin drop (2–5 g/dL vs1.6 g/dL), need for blood transfusion (145%vs1.2%), representation to hospital (25.5%vs5.4%)and length of hospital stay (8.87 days vs6.25 days) wereseen in the haematoma group.

Conclusion
Ultrasound detection of vault haematoma following vaginal hysterectomy is a commonfinding associated with increased febrile morbidity, need for blood transfusion, longer hospital stayand higher re‐admission rate. In view of increasing demand for early discharge, driven by purchasersand patients, post‐operative ultrasound identifies a high risk population and is both convenient andnoninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trialof prophylactic antibiotics in this identified subset.
Transcatheter uterine artery embolisation to treat large uterine fibroids
Authors: Bradley E. A. , Reidy J. F. , Forman R. G. , Jarosz J. , Braude P. R.
Published: August 2005

Bilateral uterine artery embolisation was performed to treat eight women with symptomatic large fibroids requiring treatment. Uterine volume was quantitatively assessed by magnetic resonance imaging. Both uterine arteries were occluded effectively in all women, and the procedure was well tolerated, with a 24–36 hour admission for pain relief. The level of pain experienced was variable, but well controlled. Some women experienced intermittent vaginal discharge and pain following the procedure. Improvement of symptoms occurred in six of the seven women and the eighth woman conceived. There were no significant complications. At three months four women had a uterine volume of < 350 cm3. Embolisation appears to be a good alternative to surgery, but longer follow up is required to evaluate the long term effects and to determine those patients for whom the procedure is suitable.
Power Doppler enhancement of the placenta by dehydroepiandrosterone sulphate in term pregnancy
Authors: Hata Toshiyuki , Manabe Atsushi , Yonehara Toshie , Aoki Showa , Miyazaki Kohji
Published: August 2005

We studied the effect of dehydroepiandrosterone sulphate (DHAS) on placental blood flow in 11 women with an uncomplicated pregnancy between 37 and 39 weeks of gestation. Power Doppler enhancement of the placenta was performed before and 60 minutes after the administration of a 200 mg intravenous dose of DHAS dissolved in 20 mL of 5% dextrose. Increased power Doppler enhancements of the placenta after DHAS injection were evident in each case studied. The power Doppler enhancement returned to the baseline imaging within 60 minutes. This DHAS loading test, assessed by means of power Doppler imaging, may be a useful echnique when attempting to assess fetoplacental unction in normal and high risk pregnancies.
Low sodium diet and pregnancy‐induced hypertension: a multi‐centre randomised controlled trial
Authors: Knuist Marianne , Bonsel Gouke J , Zondervan Hans A , Treffers Pieter E
Published: August 2005

Objective
To examine the effectiveness of the standard policy in the Netherlands to prescribe a sodium restricted diet to prevent or to treat mild pregnancy‐induced hypertension.

Design
Multi‐centre randomised controlled trial between April 1992 and April 1994.

Setting
Seven practices of independent midwives and one university hospital.

Participants
The experimental group comprised 184 women given a low sodium diet (≤ 50 mmol sodium/day) and a control group of 177 women given a normal diet. Eligible women for inclusion had had a rise of blood pressure, or excessive weight gain or oedema during the antenatal period. The 361 women in the trial were recruited from 2020 nulliparae, of whom 1512 (75%) gave informed consent at the beginning of their pregnancy to participate in the study.

Main outcome measures
The difference between highest diastolic blood pressure after randomization and diastolic blood pressure at the moment of randomisation; referral and admission to hospital for hypertension.

Results
There was no difference in increase of diastolic blood pressure after randomisation, the percentage of referral and admission to hospital for hypertension, or in obstetric outcome between the two groups. Urinary sodium excretion after randomisation in the normal diet group was significantly higher than in the low sodium group.

Conclusion
Prescribing a sodium‐restricted diet to prevent or to treat mild pregnancy‐induced hypertension is not effective. Therefore there is no need to introduce a salt restricted diet in prenatal care, although increasing evidence shows that a low sodium diet prevents hypertension in non pregnant individuals.
The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair
Authors: Mackrodt Carolyn , Gordon Beverley , Fern Elizabeth , Ayers Sarah , Truesdale Ann , Grant Adrian
Published: August 2005

Objective
To compare polyglactin 910 sutures with chromic catgut sutures for postpartum perineal repair.

Design
A stratified randomised controlled trial, using a 2 × 2 factorial design.

Setting
The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.

Sample
1780 women who had sustained an episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery.

Methods
Policies of repair with polyglactin 910 or chromic catgut were compared. Both groups were assessed by a research midwife completing questionnaires at 24 to 48 hours and at ten days postpartum, and by self‐completed questionnaires at three months after birth.

Main outcome measures
1. 24 to 48 hours postpartum: perineal pain, healing; 2. ten days postpartum: perineal pain, healing and removal of sutures; 3. three months postpartum: perineal pain, removal of sutures, resuturing, dyspareunia, and failure to resume pain‐free intercourse.

Results
Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. The two groups were similar at trial entry. Significantly fewer women allocated to the polyglactin 910 reported pain in the previous 24 hours at both 24 to 48 hours (59%vs 67%; RR 0.89, 95% CI 0.83–0.95; 2P < 0.01), and ten days (24%vs 29%; RR 0.81, 95% CI 0.69–0.95; 2P = 0.01). At three months postpartum there was no clear difference between the groups in terms of perineal pain, dyspareunia or failure to resume pain‐free intercourse. More women in the polyglactin 910 group reported that some suture material had been removed (12%vs 7%; RR 1.62,95% CI 1.19–2.21; 2P < 0.01). Three women in the polyglactin 910 group had required resuturing compared with ten in the chromic catgut group (RR 0.30; 95% CI 0.08–1.09; 2P=0.1).

Conclusions
Using polyglactin 910 rather than chromic catgut for perineal repair leads to about one fewer women among every 20 having perineal pain and using analgesia ten days postpartum. Its only apparent disadvantage is that more women, again estimated as 1 in 20, report having material removed during healing. Data from this and other trials suggest that for every 100 women repaired with a polyglycolic acid‐based material, about one fewer will require resuturing.
Variation in biochemical screening for Down's syndrome in the United Kingdom
Authors: Macintosh M. , Ellis A. , Cuckle H. , Seth J.
Published: August 2005

A questionnaire survey was undertaken of all 73 laboratories performing Down's syndrome screening in 1995. An estimated 352,000 tests were performed representing 47% of maternities. Three‐quarters of these tests have ultrasound dating information at the time of testing. The majority of laboratories (70%) commenced screening at 15 weeks of gestation or later, and there was considerable variation in the upper limit of screening (17 to 24 weeks). Eighty‐six percent of laboratories screened all women regardless of age. The reported Down's syndrome risk was based on term in 85% of laboratories. There was an inconsistent approach to determining and reporting high risk for trisomy 18 (Edwards’ syndrome): 5% reported risks on report forms and 42% notified the clinicians if the risk was considered to be raised.
Analysis of birthweight and gestational age in antepartum stillbirths
Authors: Gardosi Jason , Mul Theo , Mongelli Max , Fagan David
Published: August 2005

Objective
To study the characteristics of birthweight and gestational age of third trimester fetal deaths which occurred before the onset of labour.

Design
Review of computerised confidential perinatal mortality records. Data originated from the 1992 Trent Region Perinatal Mortality Survey.

Sample
One hundred and forty‐nine antepartum stillbirths of at least 24 weeks of gestation confirmed by early ultrasound scan. Congenital abnormalities and multiple pregnancies were excluded.

Main outcome measures
Reported causes of stillbirth, weight‐for‐gestational age centiles based on a standard derived from normal pregnancies; pregnancy characteristics compared with the local maternity population.

Results
Of 149 stillbirths, 83 (56%) were preterm and 66 were at term, and the majority (126; 85%) occurred from 31 weeks. Most of the deaths (97; 65%) were reported as ‘unexplained’ even though post‐mortems had been carried out in 60% of all cases. Using a gestational age‐specific fetal weight standard derived from normal, term live births, 41% of all cases of stillborn infants were small‐for‐ gestational age (< 10th centile; OR 6.2; 95% CI 3.3–11.5); 39% of which had been classified as unexplained were small for gestational age (OR 5.6; 2.6–12.0). This excess of small stillbirths was most pronounced between 31 and 33 weeks, where the weights of 63% of all stillbirths and 72% of unexplained fetal deaths were < 10th centile. Overall, a higher proportion of preterm (< 37 weeks) than term stillbirths were small for gestational age: 53%vs 26% (OR 3.3; 1.6–6.5). However, at term there were also more subtle differences in weight deficit, with more fetuses with a weight between the 10th and 50th centiles than between 50th and 90th (36 vs 11; OR 3.3; 1.4–7.8). Mothers of pregnancies ending in stillbirth were similar in age, size, parity and ethnic group to mothers of live born babies, but were more likely to be smokers (37 vs 27%, OR 1.6; 1.2–2.3).

Conclusions
Many stillborn babies are small for gestational age. In the absence of significant differences in physiological pregnancy characteristics, this is unlikely to be a constitutional smallness, but represents a preponderance of intrauterine growth restriction. For a full appreciation of the strength of this association, appropriate weight standards and classifications need to be applied in perinatal mortality surveys. Many antepartum stillbirths which are currently designated as unexplained may be avoidable if slow fetal growth could be recognised as a warning sign.
Antenatal corticosteroid therapy and risk of osteoporosis
Authors: Ogueh Onome , Khastgir Gautam , Studd John W. W. , Jones Julia , Alaghband‐Zadeh Jamshid , Johnson Mark Richard
Published: August 2005

Objective
To assess the risk of maternal osteoporosis associated with antenatal corticosterioid administration for neonatal respiratory distress syndrome prophylaxis.

Design
Prospective longitudinal study.

Setting
Maternity unit of Chelsea and Westminster Hospital, London.

Population
Fourteen pregnant women who received dexamethasone therapy for fetal lung maturation in anticipation of delivery before 34 completed weeks of gestation.

Methods
Blood samples were collected before dexamethasone administration, 24 hours and 48 hours after the course of dexamethasone, and within 24 hours of delivery. Serum levels of carboxy terminal pro‐peptide of type I pro‐collagen (PICP) were measured to monitor the rate of bone formation, and serum levels of cross‐linked carboxy terminal telopeptide (ICTP) were measured as a marker of bone resorption.

Main outcome measures
Changes in the markers of bone turnover following dexamethasone administration.

Results
Serum PICP levels dropped 24 hours after dexamethasone therapy (P= 0.001), but partially recovered by 48 hours (P= 0.014) to reach higher than pre‐therapy levels at delivery (P= 0.044). Although there were no corresponding changes in the serum levels of ICTP after 24 and 48 hours of therapy, levels increased from pretherapy to delivery (P= 0.006).

Conclusion
Antenatal corticosteroid therapy leads to a transient suppression of, followed by an increase in, bone formation without any significant alteration in the pattern of bone resorption expected during pregnancy.
Randomised comparative trial of the intrauterine system and norethisterone levonor gestrel for treatment of idiopathic menorrhagia
Authors: Irvine G. A. , Campbell‐Brown M. B. , Lumsden M. A. , Heikkilä A. , Walker J. J. , Cameron I. T.
Published: August 2005

Objective
To compare the efficacy and acceptability of the levonorgestrel intrauterine system and norethisterone for the treatment of idiopathic menorrhagia.

Design
A randomised comparative parallel group study.

Setting
Gynaecology outpatient clinic in a teaching hospital.

Participants
Forty‐four women with heavy regular periods and a measured menstrual blood loss exceeding 80 ml.

Methods
Twenty‐two women had a levonorgestrel intrauterine system inserted within the first seven days of menses, and 22 women received norethisterone (5 mg three times daily) from day 5 to day 26 of the cycle for three cycles.

Main outcome measures
The main outcome measure was the change in objectively assessed menstrual blood loss after three months of treatment.

Results
When menstrual blood loss at three months was expressed as a percentage of the control, the levonorgestrel intrauterine system reduced menstrual blood loss by 94% (median reduction 103 ml; range 70 to 733 ml), and oral norethisterone by 87% (median reduction 95 ml; range 56 to 212 ml). After three cycles of treatment 76% of the women in the levonorgestrel intrauterine system group wished to continue with the treatment, compared with only 22% of the norethisterone group.

Conclusions
Both the levonorgestrel intrauterine system and oral norethisterone in this regimen provided an effective treatment for menorrhagia in terms of reducing menstrual blood loss to within normal limits. The levonorgestrel intrauterine system was associated with higher rates of satisfaction and continuation with treatment, and thus offers an effective alternative to currently available medical and surgical treatments for menorrhagia. norethisterone for the treatment of idiopathic menorrhagia.
Effective analgesia following perineal injury during childbirth: a placebo controlled trial of prophylactic rectal diclofenac
Authors: Searles Jayne A. , Pring David W.
Published: August 2005

Objective
To determine if diclofenac suppositories administered prophylactically produce effective.

Design
A randomised double blind placebo controlled trial.

Setting
York District Hospital.

Population
One hundred women sustaining objective perineal injury (second degree tear or episiotomy) during spontaneous vaginal delivery at term.

Methods
Suppositories were administered at the time of repair and approximately 12 hours later. The suppositories were randomised prior to issue by the pharmacy department and contained either 100 mg diclofenac or placebo.

Main outcome measures
Pain scores assessed at 12, 24, 48 and 72 hours after delivery using a six point numerical scoring system and the use of additional analgesia and local treatments to the perineum.

Results
The mean pain score was significantly reduced in the diclofenac group at 24, 48 and 72 hours after delivery (0.86, 0.7 and 0.59, respectively) compared with the control group (1.64, 1.31 and 1.5; P < 0.005). In addition there was less supplementary analgesia required (eight women only at 72 hours compared with 15 in the control group) and this was limited to paracetamol or topical treatments to the perineum.

Conclusion
Prophylactic rectal diclofenac provides effective analgesia after perineal repair and its effect appears to be maintained into the second and third postpartum days. and lasting analgesia following perineal injury.
Placental hormones during induced hypoglycaemia in pregnant women with insulin‐dependent diabetes mellitus: evidence of an active role for placenta in hormonal counter‐regulation
Authors: Björklund A. O. , Adamson U. K. C. , Carlström K. A. M. , Hennen G. , Igout A. , Lins P.‐E.S. , Westgren L. M. R.
Published: August 2005

Objective
To study the effect of induced hypoglycaemia on serum levels of the placental hormones oestriol, human placental lactogen, placental growth hormone and progesterone in the third trimester of pregnancy.

Design
A prospective experimental investigation.

Setting
High risk pregnancy unit and diabetes research unit at Karolinska Institutet Danderyd Hospital, a university hospital.

Participants
Ten women with insulin‐dependent diabetes mellitus in the third trimester of pregnancy.

Methods
Venous blood samples were collected every 15 minutes for analyses of oestriol, progesterone, human placental lactogen and placental growth hormone, during the 150 min of a hyperinsulinaemic hypoglycaemic clamp, which maintained arterial blood‐glucose level of about 2–2 mmol/l.

Main outcome measures
Levels of analysed placental hormones during hypoglycaemia.

Results
A statistically significant increase was observed in placental growth hormone during hypoglycaemia (P < 0.0001), whereas the placental hormones progesterone, human placental lactogen and oestriol did not show changes of clinical significance.

Conclusions
The increase in placental growth hormone indicates that the placenta is an endocrine organ which may take an active part in acute metabolic processes, such as here in the hormonal counterregulation of hypoglycaemia.
Biochemical modifications of human whole saliva induced by pregnancy
Authors: Salvolini E. , Di Giorgio R. , Curatola A. , Mazzanti L. , Fratto G.
Published: August 2005

Objective
To assess human unstimulated whole saliva components during pregnancy, to determine the relation, if any, between pregnancy and oral health, particularly total protein concentration, α‐amylase activity, sialic acid content and calcium and phosphate concentrations were evaluated.

Design
Cross‐sectional study.

Participants
Forty‐five healthy primigravid women; 15 nonpregnant women acted as controls.

Results
1. A higher total protein content at 10 and 21 weeks of gestation with respect to the controls and to pregnant women at 40 weeks; 2. a higher α‐amylase activity at 10 and 21 weeks of gestation compared with the controls and to pregnant women at 40 weeks; 3. an increased sialic acid content at 21 and 40 weeks; 4. decreased calcium and phosphorus concentrations at 21 and 40 weeks of gestation.

Conclusions
Pregnancy modifies saliva composition. This could play a pivotal role in the incidence of pregnancy‐induced dental caries.
Does antenatal care influence postpartum health behaviour? Evidence from a community based crosssectional study in rural Tamil Nadu, South India
Authors: Bruun Nielsen Birgitte , Hedegaard Morten , Haraksingh Thilsted Shakuntala , Joseph Abraham , Liljestrand Jerker
Published: August 2005

Objective
To study the association between attendance to antenatal care and postpartum health behaviour among women in rural Tamil Nadu, South India.

Design
Community based, cross‐sectional questionnaire study of 30 randomly selected areas served by health subcentres.

Setting
Rural parts of Salem District, Tamil Nadu, South India.

Population
1321 women who were delivered in the six months before the questionnaire‐based interview.

Main outcome measures
Feeding of colostrum, time of initiation of breastfeeding and maternal dietary habits during the first month postpartum.

Results
The median number of antenatal visits was four (range 0‐51; lower quartile 3, upper quartile 7)., The fifth month of pregnancy was the median time for the initiation of antenatal care. Pregnant women 1. who had a large number of antenatal care visits, 2. who initiated antenatal care in the first trimester or 3. who reported having received information about breastfeeding were more likely to feed colostrum (odds ratio 1.48; 95% CI 1.06 to 2.07), (odds ratio 1.40; 95% CI 1.06 to 1.85), (odds ratio 1.66; 95% CI 1.29 to 2.14, respectively). Only women who reported having received information about breastfeeding were more likely to initiate early breastfeeding (odds ratio 1.81; 95% CI 1.34 to 2.43). Use of antenatal care facilities was not associated with maternal postpartum dietary habits.

Conclusions
A large number of women attended antenatal care in the study area, but antenatal care had a limited effect on postpartum health behaviour. As antenatal care is considered an essential part of primary health care and takes up considerable resources, we recommend further research to explain the gap between the intentions of antenatal care and the actual outcome of such care.
Therapeutic and other interventions to reduce the risk of mother‐to‐child transmission of HIV‐1 in Europe
Authors:   The European Collaborative Study
Published: August 2005

Objectives
To document policies regarding the use of interventions to reduce risk of vertical transmission of human immunodeficiency virus (HIV) and assess the extent of changes since 1994.

Design
A postal questionnaire survey and data from the European Collaborative Study (ECS), a prospective multi‐centre cohort study.

Setting
Fifty‐four obstetric centres in 16 European countries.

Sample
A questionnaire response from 54 obstetricians; 669 deliveries to HIV‐infected women enrolled in the ECS from 1994 to 1997.

Main outcome measures
Use of zidovudine during pregnancy, at delivery and to the neonate; caesarean section delivery rates; vaginal lavage; avoidance of breastfeeding; vertical transmission rate.

Results
Zidovudine therapy to reduce vertical transmission is now widespread in Europe and routine in all but one centre surveyed, although regimens vary. In 11 (26%) centres elective caesarean section is offered to all HIV‐infected women and a further nine (21%) have a policy of routine vaginal lavage. In all centres HIV‐infected women are advised to avoid breastfeeding. In the ECS there has been a significant temporal decline in the vertical transmission rate with an increase in zidovudine use. More than 90% of women in the ECS who were delivered in 1997 received one or more components of zidovudine therapy; the rate of vertical transmission is 9% where zidovudine has been used, compared with 15% without use of zidovudine.

Conclusions
Although the use of zidovudine to reduce vertical transmission is increasing in Europe and, with the avoidance of breastfeeding, is associated with a decline in vertical transmission, the success of these interventions will be limited by the uptake of antenatal screening.
Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations
Authors: Irion Olivier , Hirsbrunner Almagbaly Pascale , Morabia Alfredo
Published: August 2005

Objective
To compare neonatal mortality and neonatal and maternal morbidity in planned vaginal delivery versus elective caesarean section for breech presentation at term. To identify factors associated with the risk of caesarean section during labour.

Design
Cohort study.

Setting
University Hospital of Geneva.

Population
Seven hundred and five consecutive singleton term breech presentations: 385 planned vaginal deliveries and 320 elective caesarean sections.

Methods
Relative risk and risk difference with their 95% confidence intervals (95% CI) were calculated for neonatal and maternal morbidity. Prognostic factors for the risk of intrapartum caesarean section were analysed by multiple logistic regression.

Main outcome measures
1. Neonatal mortality 2. Neonatal morbidity (eg. fracture, haematoma with hyperbilirubinemia, paresis, paralysis, visceral trauma, respiratory distress, umbilical cord arterial pH < 7.0 with 5 minute Apgar score < 7), corrected neonatal morbidity was defined as morbidity after exclusion of major malformations. 3. Maternal morbidity (eg. endometritis, urinary infection, pulmonary infection, surgical complications, hysterectomy, anaemia, pulmonary embolism, cardio‐respiratory arrest).

Results
There were significantly fewer maternal complications in the planned vaginal delivery group than in the elective caesarean section group (risk difference 10.5%, 95% CI 3.9 to 17.0). Five neonates with major malformations died. There was no difference in corrected neonatal morbidity between the planned vaginal delivery and the elective caesarean section groups (risk difference 1.9%, 95% CI ‐1.0 to 4.9). Nulliparity, maternal age > 30 years and a higher body mass index were independently associated with the risk (30%) of intrapartum caesarean section, but it was not possible to construct a predictive model useful for clinical practice.

Conclusions
There is no firm evidence to recommend systematic elective caesarean section for breech presentation at term. Large unbiased studies are needed to determine whether a potential benefit for the newborns outweighs the increased risk for the mothers associated with elective caesarean section.
Nifedipine versus expectant management in mild to moderate hypertension in pregnancy
Authors:   Gruppo di Studio Ipertensione in Gravidanza
Published: August 2005

Objective
To compare the effect of routine treatment with the calcium channel blocker nifedipine in mild to moderate hypertension in pregnancy.

Design
Randomised clinical trial.

Setting
General and University hospitals.

Participants
Pregnant women, between 12 and 34 weeks of gestation, with chronic, pregnancy‐induced or unclassifiable hypertension and diastolic pressure between 90 and 110 mmHg.

Methods
Eligible women were randomly assigned treatment with slow‐release nifedipine, 10 mg twice daily until delivery, or no treatment. In the no treatment group nifedipine was given if the diastolic pressure exceeded 110 mmHg. A total of 145 women were assigned nifedipine and 138 no treatment.

Results
In the nifedipine group 45.0% of women were delivered before term, compared with 37.0% in the no treatment group; the difference was not significant. In all, 56.3% of women allocated nifedipine and 62.1% allocated no treatment underwent caesarean section; the difference was not statistically different (OR 0.7,95% CI 041.1). There was no significant difference between the two groups in the percentage of babies weighing less than the 10th centile (OR 0.8; 95% CI 0.4–1.4) or in the mean birthweight. The frequency of admission of infants to the neonatal intensive care unit was not affected by treatment.

Conclusions
This trial found no benefit on pregnancy outcome of routine treatment with nifedipine. In clinical practice, the treatment of hypertension in pregnancy may be delayed until the hypertension becomes severe.
Effect of routine screening for Down's syndrome on the significance of isolated fetal hydronephrosis
Authors: Oluleye Thompson M. , Thilaganathan Baskaran
Published: August 2005

Objective
To determine the risk of Down's syndrome in fetuses with isolated hydronephrosis at 18–23 weeks in an unselected general population after routine screening for Down's syndrome, using first trimester nuchal translucency measurement and second trimester maternal serum biochemistry.

Population
All pregnant women undergoing a routine 18–23 week ultrasound scan, from a population who had been offered screening for Down's syndrome.

Setting
A district general hospital serving a low risk obstetric population.

Methods
Prospective study of all routine 18–23 weeks ultrasound scans. The prevalence of isolated hydronephrosis and Down's syndrome was determined and the relative risk for Down's syndrome was calculated for different ultrasound findings.

Results
10,971 women were scanned at 18–23 weeks during the study period. Down's syndrome was diagnosed in 14 of 20 cases before this stage using first trimester nuchal translucency measurement and second trimester maternal serum biochemistry. Isolated fetal hydronephrosis was diagnosed in 423 pregnancies (3.9%); none of these pregnancies were affected by Down's syndrome. The relative risk for Down's syndrome was 0.18 (95% CI 0.06–0.53) for women with a normal scan (n= 9983). When multiple ultrasound markers were found (n= 565), the relative risk for Down's syndrome was 2.00 (95% CI 0.18–22‐10) and 9.00 (95% CI 1.14–71.30) for all other aneuploidies.

Conclusion
The finding of isolated fetal hydronephrosis does not significantly increase the age‐related risk for Down's syndrome. The presence of multiple ultrasound markers is associated with an increased risk of aneuploidies other than Down's syndlome. These findings are explained by the reduced prevalence of Down's syndrome as a result of prior screening and diagnosis of this condition.
The impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella‐related terminations of pregnancy in South Australia
Authors: Cheffins Tracy , Chan Annabelle , Keane Rosemary J , Haan Eric A. , Hall Robert
Published: August 2005

Objectives
To describe the impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella‐related terminations of pregnancy in South Australia, and to identify factors associated with a re‐emerging problem.

Design and Methods
A population‐based descriptive study using data from South Australian notifications of disease, births and terminations of pregnancy, the rubella immunisation programme, antenatal rubella antibody screening and paediatric hospital case records.

Setting
South Australia (population 1.48 million people; 20,000 births per year).

Main outcome measures
Incidence of rubella (age‐sex specific), congenital rubella syndrome and rubella‐related terminations of pregnancy; antenatal rubella sero‐positive rates; rubella immunisation uptake rates.

Results
Rubella notification rates in 1990–1996 were significantly higher for males than females for ages 15–34 years. There were five cases of congenital rubella syndrome notified in 1980–1996 compared with at least 20 confirmed or compatible cases in 1965–1979. Rubella‐related terminations of pregnancy are now rare, with the last termination for maternal rubella being in 1993. The antenatal rubella sero‐positive rate in 1995 was 96.7%, but was significantly lower among Asian women born overseas (78.6% among those 30 years or older). Vaccination uptake rates in schoolgirls decreased between 1990 and 1994 (91.2% to 86.9%).

Conclusions
Since the introduction of rubella immunisation, the incidence of rubella infection among women of reproductive age, and of rubella‐related terminations, has fallen. Congenital rubella syndrome has not been notified since 1990 but its risk persists with a recent increase in rubella notifications, a fall in school immunisation rates, a relatively low antenatal sero‐positive rate among older Asian women born overseas and the trend towards giving birth at older ages. Effective immunisation programmes must be maintained, particularly in schools and for young children and migrant women.
Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome
Authors: Woolas Robert P. , Bower Mark , Newlands Edward S. , Seckl Michael , Short Dee , Holden Lydia
Published: August 2005

The aim of this study was to determine the influence of cytotoxic chemotherapy on subsequent reproductive performance. Details of post‐treatment reproductive intent and outcome were requested from 1211 survivors registered at The Charing Cross Hospital gestational trophoblastic disease centre; a response rate of 96% was achieved. Seven hundred and twenty‐eight women had tried to become pregnant; 607 reported at least one live birth, 73 conceived but had not registered a live birth, and 48 did not conceive. No differences were apparent between the 392 women who received methotrexate as single agent chemotherapy and the 336 treated with multi‐agent chemotherapy. Women who had registered a live birth were younger (P < 0.0001) and the duration of follow up was significantly less among those who did not achieve pregnancy at all (P < 0.0003). A higher than expected rate of caesarean section and stillbirth was recorded. The chemotherapy protocols used by this unit have minimal impact on the subsequent ability to reproduce.
An immunoscintigraphic evaluation of the engineered human monoclonal antibody (hCTMO1) for use in the treatment of ovarian carcinoma
Authors: Davies Q , Perkins A. C. , Roos J. C. , Molthoff C. F. M. , Verheijen R. H. M. , Frier M. , Kenemans P. , Broadhead T. , Sopwith M. , Symonds E. M.
Published: August 2005

Objective
To assess the safety and targeting ability of the engineered human antibody (hCTMO1) in women with ovarian carcinoma.

Design
The monoclonal antibody labelled with Indium‐1 11 was administered to women with suspected primary or recurrent ovarian carcinoma six days pre‐operatively. The first group of women was given a dose of 0.1 mg per kg body weight of radiolabelled antibody. A second group of women received 1 mg per kg body weight and finally a third group was given 1 mg per kg body weight of unlabelled antibody followed one hour later by 0.1 mg per kg body weight of radiolabelled antibody. All the women were then imaged using a gamma camera one hour and up to 96 hours after injection.

Participants
Fourty‐four women in whom there was a high suspicion of primary ovarian carcinoma on the basis of ultrasound or CT imaging and serum CA125 and those in whom there was a suspicion of recurrent ovarian carcinoma after being treated for histologically confirmed carcinoma.

Setting
The Queen's Medical Centre, Nottingham and University Hospital Vrije Universiteit, Amsterdam, The Netherlands.

Results
At the low dose of antibody the sensitivity for detection of ovarian carcinoma was 70%. After increasing the dose of antibody and also after pre‐dosing with unlabelled antibody the sensitivity increased to 100%, but there was a large number of false positive results at the higher dose, and therefore the specificity was low. The liver and bone marrow were the organs with the highest activities.

Conclusion
The genetically engineered antibody hCTMO1 is safe for use in women. This antibody effectively targets ovarian carcinoma and has greater potential as a vector for therapeutic use than as a diagnostic agent.
Neural networks in the diagnosis of malignant ovarian tumours
Authors: Clayton R. D. , Snowden S. , Weston M. J. , Mogensen O. , Eastaugh J. , Lane G.
Published: August 2005

Objective
To assess the role of neural networks in predicting the likelihood of malignancy in women presenting with ovarian tumours.

Design
Retrospective case study.

Setting
University Department of Obstetrics and Gynaecology, St James's Hospital, Leeds.

Methods
Information from 217 cases with histologically proven benign, borderline or malignant tumours was extracted for study. Four variables (age, ultrasound findings with and without colour Doppler imaging and CA125) were entered in the neural network classifier. The neural network results were compared with logistic regression analysis.

Results
When used in the neural network the variables of age, CA125 and ultrasound score produced the best result with a sensitivity of 95% and a corresponding specificity of 78% in predicting malignancy. Logistic regression gave a sensitivity or 82% for a specificity of 51%.

Conclusion
The neural network is a good method of combining diagnostic variables and may be a useful predictor of malignancy in women presenting with ovarian tumours. A comparison of the performance of the neural network with conventional diagnostic methods would be warranted prior to use in clinical practice.
Laparoscopic‐assisted Doderlein hysterectomy: retrospective analysis of 300 consecutive cases
Authors: Hawe Jeremy A. , Clayton Richard , Phillips Graham , Whittaker Mark , Kucukmetin Ali , Garry Ray
Published: August 2005

Objective
To assess the clinical outcomes of the Doderlein laparoscopic‐assisted hysterectomy.

Design
A retrospective study.

Setting
Women's Endoscopic Laser Foundation at South Cleveland Hospital, Middlesbrough and St James's University Hospital, Leeds.

Population
Three hundred consecutive women who had a laparoscopic‐assisted Doderlein hysterectomy.

Methods
Patients were identified from the laparoscopic hysterectomy theatre log at both sites. Case notes were requested and examined.

Main outcome measures
Operative time, uterine weight, associated pelvic pathology, blood loss, hospital stay, intra‐operative and post‐operative complications.

Results
The operations were performed by eight different surgeons, seven of whom were laparoscopic trainees. The mean operating time was 102 minutes (SD 30). Additional surgery including unilateral or bilateral salpingo‐oophorectomy, was carried out in 247 patients (82%). The mean uterine weight was 140 g (SD 74). One hundred and thirty‐two women (44%) had a normal pelvis at hysterectomy. The mean drop in haemoglobin and haematocrit was 1.46 g (SD 0.95) and 4.4% (SD 24), respectively. The overall complication rate was 18%, of which 6.2% were classed as major. The major complications included four cystotomies, five unscheduled laparotomies, seven post‐operative blood transfusions, one pulmonary embolus and two re‐operations (within six weeks). The mean hospital stay was three days.

Conclusions
Laparoscopic‐assisted Doderlein hysterectomy is an alternative to standard laparoscopic hysterectomy techniques. It has the advantage of being easy to learn and is associated with low complication rates, compared with other laparoscopic and traditional techniques for hysterectomy.