bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitric oxide donors induce ripening of the human uterine cervix: a randomised controlled trial
Authors: Thomson Andrew J. , Lunan C. Burnett , Cameron Alan D. , Cameron Iain T. , Greer Ian A. , Norman Jane E.
Published: August 2005

Objective
To determine whether nitric oxide donors can induce cervical ripening before surgical termination of pregnancy in the first trimester.

Design
Prospective, randomised controlled trial.

Setting
Department of Obstetrics and Gynaecology, Royal Infirmary, Glasgow.

Participants
Forty‐eight primigravid women undergoing surgical termination of pregnancy before 12 weeks of gestation.

Methods
The women were randomised to receive per vaginam before surgery either the nitric oxide donor isosorbide mononitrate, the nitric oxide donor glyceryl trinitrate, the prostaglandin analogue gemeprost, or no treatment.

Main outcome measures
The cumulative force required to dilate the cervix to 8 mm was measured objectively and the cervical diameter before surgical dilatation was recorded.

Results
Following isosorbide mononitrate or gemeprost, a lower cumulative force was required to dilate the cervix to 8 mm and a higher cervical diameter before dilatation was recorded. Pretreatment with glyceryl trinitrate reduced the cumulative force required to dilate the cervix but had no effect on cervical diameter.

Conclusions
Like the prostaglandin analogue gemeprost, the nitric oxide donors isosorbide mononitrate and glyceryl trinitrate can effect cervical ripening. Nitric oxide donors may provide an alternative to prostaglandins for cervical ripening before surgical procedures in the first trimester.
Amniotic membrane collagen content and type distribution in women with preterm premature rupture of the membranes in pregnancy
Authors: Hampson Victoria , Liu David , Billett Ellen , Kirk Sandra
Published: August 2005

Amniotic membrane samples were taken following preterm delivery from 15 women with preterm prelabour rupture of the membranes (PPROM) and 14 with unrelated reasons, and from 25 delivering at term. Fibrillar collagens were extracted and analysed by interrupted gel electrophoresis. Collagens were decreased in PPROM relative to controls, but showed similar sub‐type distribution, with one exception. In this case an increased ratio of Type I to Type III collagen was observed, with normal collagen content. In conclusion, PPROM is accompanied by generalised reduction in amnion collagen content, involving all fibrillar sub‐types monitored. This may reflect general changes in protease activity or in collagen expression in affected membranes.
Effect of location of the sensor on reflectance pulse oximetry
Authors: Dassel A. C. M. , Graaff R. , Aardema M. , Zijlstra W. G. , Aarnoudse J. G.
Published: August 2005

Objective
The influence of the location of the sensor on reflectance pulse oximetry during fetal monitoring in labour was investigated using the newborn infant as a model.

Methods
Seven healthy infants were studied between 19 and 48 hours after term delivery. Recordings of reflectance pulse oximetry were obtained from eight different sites on the infant's head. The relative changes in red to infrared light (R/IR) were determined. In pulse oximetry R/IR values are converted to arterial oxygen values by means of an empirically derived calibration curve.

Results
Significantly lower R/IR values were found at the forehead compared with the fontanelle, the parietal and occipital position, and the temporal area. Conversion to oxygen saturation values revealed a difference of up to 13.4% in oxygen saturation between the forehead and the occipital area.

Conclusion
Assuming that the arterial blood oxygen saturation did not change substantially, our findings indicate that in reflectance pulse oximetry there is no unique relation between R/IR and arterial oxygen saturation. The differences in reflectance pulse oximetry at the various sites are explained by differences in optical properties (scattering and absorption) of the tissue underneath the sensor. These will affect the red and infrared light reaching the detectors in a different way, and consequently R/IR changes. Because during intrapartum monitoring exact positioning of the sensor on the fetal head is usually impossible, the accuracy of fetal reflectance pulse oximetry is impaired.
Menstrual characteristics associated with endometriosis
Authors: Arumugam Kulenthran , Lim Jason M. H.
Published: August 2005

This case‐controlled study investigates whether the presence of menstrual characteristics, which may increase the exposure of the peritoneal cavity to retrograde menstruation, increases the risk of developing endometriosis. The menstrual characteristics considered were 1. age at menarche of less than 12 years, 2. duration of menstrual flow greater than five days and 3. menstrual cycle lengths of < 28 days. The frequency with which these menstrual characteristics occurred in 305 women with proven endometriosis was compared with their frequency in 305 age‐matched women without endometriosis. Adjusting for the confounding factors of parity, age at first childbirth and social class, the only menstrual characteristic that was significantly associated with endometriosis was menstrual cycle lengths of less than 28 days (odds ratio 1.83; 95% confidence intervals 1.60–2.55). There was insufficient evidence to conclude that the presence of menstrual characteristics which may increase the exposure of the peritoneal cavity to retrograde menstruation, increase a woman's risk of developing endometriosis. The association of short menstrual cycle lengths with endometriosis may have been consequential rather than causal.
Uterine exteriorisation at caesarean section: influence on maternal morbidity
Authors: Edi‐Osagie Edmond C. O. , Hopkins Ronald E. , Ogbo Victor , Lockhat‐Clegg Farhana , Ayeko Michael , Akpala William O. , Mayers Frederick N.
Published: August 2005

Objective
To compare the influence on caesarean section morbidity of uterine exteriorisation or in

Design
Randomised controlled trial.

Setting
Princess Anne Maternity Unit of the Royal Bolton Hospital, UK.

Population
One hundred and ninety‐four women undergoing delivery by caesarean section.

Methods
Two intra‐operative readings of arterial pulse rate, mean arterial blood pressure, and arterial haemoglobin oxygen saturation were obtained. Pre‐operative and day‐3 haemoglobin concentrations were determined. Intra‐ and post‐operative complications, puerperal pain scores, and febrile and infectious morbidity were assessed. A postal questionnaire was used to assess morbidity six weeks after delivery.

Main outcome measures
Intra‐operative changes in pulse rate, mean arterial blood pressure and oxygen saturation; peri‐operative changes in haemoglobin concentration; incidence of intraoperative vomiting, pain, intra‐ and post‐operative complications, and febrile and infectious morbidity; immediate and late puerperal pain scores; satisfaction with the operation.

Results
No clinically significant differences between uterine exteriorisation and in situ repair were found in pulse rate, mean arterial pressure, oxygen saturation and haemoglobin changes. Likewise, the incidence of vomiting and pain was similar. Vomiting occurred in 10% of all the women, and 57% of all pain complaints occurred at the initial skin incision. There was a trend towards higher immediate and late pain scores in the exteriorisation group, reaching statistical significance on day 3. Overall, pain scores averaged 6/10 on day 1 despite patient‐controlled analgesia, and three‐quarters of all women reported persisting pain on day 42. Intra‐ and postoperative complications, febrile and infectious morbidity, and duration of hospital stay were similar in both groups.

Conclusions
We have demonstrated that uterine exteriorisation and in situ repair have similar effects on peri‐operative caesarean section morbidity. Intra‐operative pain reflected adequacy of anaesthesia, while vomiting reflected adequacy of pre‐operative preparation of patients. Exteriorising the uterus at caesarean section is a valid option.
Vaginal delivery after previous caesarean section for failure of second stage of labour
Authors: Jongen V. H. W. M. , Halfwerk M. G. C. , Brouwer W. K.
Published: August 2005

Objective
To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery.

Design
Retrospective follow up study.

Setting Medical
Centre Leeuwarden, The Netherlands.

Participants
All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 1986–1998.

Methods
Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour.

Results
Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour.

Conclusions
In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.
Treatment with a gonadotrophin releasing hormone agonist before hysterectomy for leiomyomas: results of a multicentre, randomised controlled trial
Authors: Vercellini Paolo , Giorgio Crosignani Pier , Mangioni Costantino , Imparato Emilio , Ferrari Augusto , De Giorgi Olga
Published: August 2005

Objectives
To ascertain whether uterine shrinkage induced by a gonadotrophin releasing hormone agonist before hysterectomy for fibroids increases the possibility of a vaginal procedure.

Design
A multicentre, prospective, randomised, controlled study.

Participants
One hundred and twenty‐seven premenopausal women with a uterine volume of 12 to 16 gestational weeks.

Interventions
Twelve weeks of triptorelin depot treatment before hysterectomy or immediate surgery.

Main outcome measures
Number of vaginal and abdominal hysterectomies, operating time, blood loss, degree of difficulty of the procedure, perioperative serum haemoglobin and haematocrit levels, hospital stay, and patients' overall satisfaction with treatment.

Results
After randomisation, four women withdrew from the study, leaving 60 women in the triptorelin arm and 63 in the immediate surgery arm. At baseline evaluation a vaginal hysterectomy was indicated in seven women allocated to pre‐operative medical therapy (12%), and in 10 of those allocated to immediate surgery (16%). Clinical assessment after the 12–week GnRH agonist course showed that abdominal hysterectomy was no longer indicated in 25/53 women (47%) as a vaginal procedure appeared appropriate. Thus the overall rate of indication for a vaginal procedure in the pre‐operative medical treatment arm was 32/60 cases (53%), with a between‐group difference of 37% (95% CI, 26% to 51%; χ21= 19.18, P < 0.0001; OR 6.06; 95% CI, 2.60 to 14.10). Pre‐ and post‐operative serum haemoglobin and haematocrit levels were significantly higher in the GnRH agonist than in the immediate surgery arm. No appreciable difference was observed between the groups in the other intra‐ and post‐operative variables, including patients' satisfaction.

Conclusions
Pre‐operative GnRH agonist therapy increased the rate of vaginal hysterectomy in selected women with fibroids and uterine volume of 12 to 16 gestational weeks.
Changing childbirth: lessons from an Australian survey of 1336 women
Authors: Brown Stephanie , Lumley Judith
Published: August 2005

Objective
To investigate the views and experiences of care in labour and birth of a representative sample

Design
Cross‐sectional survey mailed to women 6–7 months after giving birth.

Population
All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death.

Results
After adjusting for parity, the risk status of the pregnancy, and social and obstetric factors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhelpful (midwives: adjusted OR 12.03 [95% CI 7–8–1 8.1, doctors: adjusted OR 6.76 [95% CI 4.–10.31); and having an active say in decisions only sometimes, rarely or not at all (adjusted OR 8.0 [95% CI 4.–16–11). In a separate regression analysis including parity, risk status, obstetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included participation in a shared antenatal care programme (adjusted OR 1.9 [95% CI 1.–3.1) and being of nonEnglish speaking background (adjusted OR 1.0 [95% CI 1.–2.1). The following factors lowered the odds of dissatisfaction: attending a birth centre (adjusted OR 0.34 [95% CI 0.–1.]) and knowing the midwives before going into labour (adjusted OR 0.8 [95% CI 0.–0.]).

Conclusion
The survey demonstrates the potential for ‘new’ models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal care taking into account women's views is a prerequisite for improvements in maternity care. of women who gave birth in Victoria, Australia in 1993.
Maternal health after childbirth: results of an Australian population based survey
Authors: Brown Stephanie , Lumley Judith
Published: August 2005

Objective
To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.

Design
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.

Participants
All women who gave birth in a two‐week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.

Results
The response rate was 62.5% (n= 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under‐represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (435%), sexual problems (26.%), haemorrhoids (24.%) and perineal pain (21%); 16.% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.9 [95% CI 3.–6.]), sexual problems (OR 2.6 [95% CI 1.–3.]), and urinary incontinence (OR 1.81 [95% CI 1.–2.1). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.

Conclusion
Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.
Effects of early augmentation of labour with amniotomy and oxytocin in nulliparous women: a meta‐analysis
Authors: Fraser William , Vendittelli Françoise , Krauss Isabelle , Bréart †Gérard
Published: August 2005

Objectives
To estimate the effects among nulliparae of early augmentation with amniotomy and oxytocin on caesarean delivery, and on other indicators of maternal and neonatal morbidity including transfusion, Apgar score < 7 at 5 minutes, and admission to the special care nursery.

Design
Meta‐analysis.

Methods Published studies were identified through manual and computerised searches. Two unpublished studies were identified through direct communication with the investigators. Twelve trials were identified which compared a policy of early labour augmentation including amniotomy followed by oxytocin with a less active form of management. Two methodologically unacceptable studies were excluded. Studies were grouped according to whether they admitted only women with abnormal progress (therapy trials: n= 3) or accepted women with normal labour (prevention trials: n= 7).

Results
Unstratified analysis did not provide support for the hypothesis that early augmentation reduces the risk of caesarean section (typical odds ratio [OR] 0.9; 95% CI 0.7–1.1). The typical odds ratio for prevention trials was similar to that obtained in the unstratified analysis (typical OR 0.9, 95% CI 0.7–1.2). Although only a small number of women have been randomised in therapy trials, a trend toward a reduction in the rate of caesarean section with early intervention was seen in this group (typical OR 0.6,95% CI 0.2–1.4).

Conclusions
Early augmentation does not appear to provide benefit over a more conservative form of management in the context of care of nulliparous women with mild delays in the progress of labour. In the context of established delay in labour, an active policy of augmentation may reduce the risk of caesarean section. However, only three small trials have been performed in this context, and they do not have adequate power to allow firm conclusions to be drawn.
The validity of continuous automated fluid monitoring during endometrial surgery: luxury or necessity?
Authors: Hawe Jeremy A. , Chien Patrick F. W. , Martin Doreen , Graham Phillips A. , Garry Ray
Published: August 2005

Thirty‐four consecutive women undergoing endometrial laser ablation, as a treatment of menorrhagia, were recruited to assess the validity of fluid absorption monitoring by a new continuous automated system (AquaSens). The same group of women also had monitoring of fluid absorption carried out by our standard technique of weighing. The intra‐class correlation coefficient for the fluid deficit estimated by AquaSens compared to our standard technique of manually weighing the irrigation bags was 0.98 (95% CI 0.96–0.99). Aquasens therefore provides a valid and non‐invasive method of continuously monitoring fluid deficit amongst patients undergoing operative hysteroscopy procedures, thereby reducing the risk of unexpected fluid absorption and its potentially fatal sequelae.
The effect of pregnancy on survival in women infected with HIV a systematic review of the literature and meta‐analysis
Authors: French Rebecca , Brocklehurst Peter
Published: August 2005

Objective
To investigate the effect of pregnancy on disease progression and survival i? women infected with HIV by a systematic review of the literature and meta‐analysis.

Methods
Appropriate publications were identified using electronic and hand searching of relevant journals from 1983 to 1996. Studies were included in the review if they were cohort studies, either prospective or retrospective, or case‐control studies which investigated disease progression of pregnant women infected with HIV and included a control group of non‐pregnant women infected with HIV for comparison. Methodological quality was assessed for each study. Data were extracted for predetermined outcome measures. Sensitivity analyses were performed to explore the association between pregnancy and disease progression for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies had controlled for potential confounding.

Results
Seven studies, all prospective cohorts, were eligible to be included in the rediew. The summary odds ratio for the risk of an adverse maternal outcome related to HIV infection and pregnancy were as follows: death 1.8 (85% CI 0.99–3.3); HIV disease progression 1.41 (95% C1 0.85–2.33); progression to an AIDS‐defining illness 1.63 (95% CI 1.00–2.67) and fall of CD4 cell count to below 200×106/L 0.73 (95% CI 0.17–3.06). Sensitivity analyses showed that HIV progression in pregnancy was significantly more common in a developing country setting (odds ratio 3.71, 95% CI 1.82–7.75) than in developed countries (odds ratio 0.55, 95% 0.27–1.11) and also significantly more common in high quality studies when compared to low quality ones, odds ratios 3.71 (95% CI 1.82–7.57) and 0.55 (95% CI 0.27–1.11), respectively. However, there appears to be less progression of HIV disease and progression to AIDS when studies attempted to control for confounding by matching or restriction techniques, although this was not statistically significant in either case.

Conclusions
The findings of this review have implications for women infected with HIV who are pregnant or are considering a pregnancy. There does appear to be an association between adverse maternal outcomes and pregnancy in women infected with HIV, although this association is not strong. The relation may be due to the result of bias including residual confounding. Further large scale observational studies with long term follow up are required before this issue can be fully resolved.
Women's knowledge and attitudes, and the acceptability of voluntary antenatal HIV testing
Authors: Duffy T. A. , Wolfe C. D. A. , Varden C. , Kennedy J. , Chrystie I. L.
Published: August 2005

Objective
To assess pregnant women's knowledge of, and attitudes towards, antenatal HIV testing, and its acceptability to them.

Setting
Antenatal clinic at Guy's Hospital, London, six community antenatal clinics and a midwifery group practice.

Population
Eight hundred and forty‐three women attending the antenatal clinics.

Method
The women received a leaflet explaining HIV testing, and completed a questionnaire before and after their booking appointment. This included an assessment of their knowledge of, and attitudes towards HIV testing, and its acceptability.

Results
Seven hundred and eighty‐nine women (94%) completed questionnaires. Fifty‐one percent (n= 405) were Caucasian, 25% (n= 195) African, 11% (n= 86) West Indian and 13% (n= 100) were from other ethnic groups. Fifty‐eight percent received the HIV information leaflet, of whom 86% had read it. Knowledge relating to HIV was good, the median knowledge score being 6 out of a possible 8, but it was less in non‐Caucasian women and those with lower educational qualifications. Knowledge was not related to uptake of testing. Thirty‐five percent of women accepted the offer of an HIV test, rates being higher in hospital clinics (41%) than in the midwifery group practice (10%) and the community clinics (30%). Women more likely to accept the offer of an HIV test were non‐Caucasian (P = 0.0443), those who had thought about the HIV test before this pregnancy (P= 0.0298) and those seeing one particular midwife (P= 0.0003). Most women (67%) thought that all pregnant women should be offered the HIV test and then make their own decision. Overall, 64% women did not change their original pre‐discussion decision on testing for HIV. Thirty‐six percent of women changed their decision from ‘yes’ to ‘no’ or ‘don't know’ after seeing the midwife. Women attending the community clinics (P= 0.003) and those who had been tested before (P= 0.0451) were more likely to change their decision.

Conclusion
This study, in a multiethnic population, has shown that knowledge regarding HIV is good but does not increase the uptake of testing. Women prefer to be offered the HIV test and make their own choice regarding whether to accept it.
The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England
Authors: Wilton L. V. , Pearce G. L. , Martin R. M. , Mackay F. J. , Mann R. D.
Published: August 2005

Objective
To determine the proportion and nature of congenital anomalies in babies born to women exposed to newly marketed drugs during the first trimester.

Design
Non‐interventional observational cohort studies.

Methods
The women were identified in confidence by the Prescription Pricing Authority. The doctor was sent a questionnaire to determine clinical events, including pregnancy, occurring after the drug was dispensed. A supplementary questionnaire determined the outcome of each reported pregnancy.

Setting
General medical practice in England.

Population
Women exposed to newly marketed drugs in whom pregnancy was recorded.

Main outcome measures
Outcomes of pregnancies, the proportion and nature of congenital anomalies in the babies born.

Results
2511 pregnancies were reported. In 831 of these pregnancies a newly marketed drug had been taken during the first trimester and in 74 during the secondkhird trimester. The outcome was ascertained for 780 (94%) of these 831 pregnancies: 547 (66%) births; 10 (1%) ectopic pregnancies; 94 (11%) spontaneous miscarriages; 5 (< 1%) missed abortions; 120 (14%0) legal abortions; and 4 (C 1%) intrauterine deaths. 557 infants were born, of whom 14 (2.5%) had congenital anomalies.

Conclusions
The proportion of live infants with a congenital abnormality born to mothers exposed to newly marketed drugs in the first trimester was similar to the percentage of congenital anomalies estimated by the Ofice for National Statistics. These data add valuable information to the safety database of these drugs.
Partogram action line study: a randomised trial
Authors: Lavender Tina , Alfirevic Zarko , Walkinshaw Stephen
Published: August 2005

Objective
To assess the effect of three different partograms on caesarean section and maternal satisfaction.

Design
Prospective randomised clinical trial.

Setting
Regional teaching hospital in North West of England.

Participants
Nine hundred and twenty‐eight primigravid women with uncomplicated pregnancies who presented in spontaneous labour at term.

Interventions
The women were randomised to have their progress of labour recorded on a partogram with an action line 2, 3 or 4 hours to the right of the alert line. If the progress reached the action line, a diagnosis of prolonged labour was made. Prolonged labour was managed according to the standard ward protocol.

Main outcome measures
Primary: Caesarean section rate and maternal satisfaction; secondary: need for augmentation, duration of labour, analgesia, cord blood gas analysis, postpartum haemorrhage, number of vaginal examinations, Apgar score and admission to special care baby unit.

Results
Caesarean section rate was lowest when labour was managed using a partogram with a 4‐hour action line. The difference between the 3‐ and 4‐hour partograms was statistically significant (OR 1.8,95% CI 1.1.3.2), but the difference between 2 and 4 hours was not (OR 1.4, 95% CI 0.8‐2.4). The women in the 2‐hour arm were more satisfied with their labour when compared to the women in the 3‐hour (P < 0.0001) and 4‐hour (P < 0.0001) arm.

Conclusion
Our data suggest that women prefer active management of labour. It is possible that partograms which favour earlier intervention are associated with higher caesarean section rate. As the evidence on which to base the choice of partograms remains inconclusive further satisfaction. research is required.
Neonatal mortality amongst Scottish preterm singleton births (1985–1994)
Authors: Magowan B. A. , Bain M. , Juszczak E. , McInneny K.
Published: August 2005

Objective
To provide a valid estimate of singleton neonatal mortality based on birthweight and gestational age at delivery.

Design
Record linkage of maternity data and neonatal mortality data.

Setting
Scotland, UK.

Population
All singleton preterm deliveries from 24 to 36 weeks inclusive between 1985 and 1994.

Main outcome measure
Neonatal death.

Results
There were 625,646 liveborn singleton deliveries over the study period, of which 33,912 were preterm (5.4%). The overall neonatal mortality in the preterm group was 41/1000 and the data have been presented by both gestational age and birthweight. The neonatal mortality rate fell with advancing gestation from 795/1000 live births at 24 weeks to 9/1000 live births at 36 weeks and was higher at the extremes of birthweight for a given gestational age. There was a significant increase in the proportion of babies delivered iatrogenically over the study period (χ test for trend P < 0.001).

Conclusion
This is the largest recent series to consider neonatal mortality using both birthweight and gestational age. These figures will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.
Preterm and term births of small for gestational age infants: a population‐based study of risk factors among nulliparous women
Authors: Clausson Britt , Cnattingius Sven , Axelsson Ove
Published: August 2005

Objective
To study risk factors for small for gestational age (SGA) infants by gestational age among nulliparous women and to estimate mortality rates among SGA and appropriate‐for‐gestational‐age (AGA) infants by gestational age.

Design
A population‐based study from the Swedish Medical Birth Register.

Setting
Sweden 1992–1993.

Population
Liveborn singleton infants to nulliparous women (n= 96,662).

Main outcome measures
Crude and adjusted odds ratios of risk factors for SGA by gestational age. Rates of neonatal and postneonatal mortality.

Results
Older maternal age (≥ 30 years) was foremost associated with increased risks of very and moderately preterm SGA (≥ 32 weeks and 33–36 weeks, respectively), but also with term SGA (≥ 37 weeks). Risks of SGA increased with decreasing maternal height at all gestational ages. Smoking increased the risks of moderately preterm and term SGA. Short maternal education increased the risk of preterm SGA and low pre‐pregnancy body mass index slightly increased the risk of term SGA. Pre‐eclampsia and essential hypertension foremost increased the risk of very preterm SGA (OR = 40.5 and 32.4, respectively) and moderately preterm SGA (OR = 17.4 and 10.6, respectively), but also increased the risk of term SGA. Neonatal and postneonatal mortality rates of SGA infants were substantially influenced by gestational age, and mortality rates were consistently higher among preterm SGA infants compared with AGA infants.

Conclusions
Risk factors for SGA and mortality rates among SGA infants vary by gestational age. A subdivision of risk factors by gestational age adds knowledge, particularly about risks of preterm SGA, where the highest rates of mortality were observed.
Leptin concentrations in maternal serum and cord blood: relationship to maternal anthropometry and fetal growth
Authors: Geary Michael , Pringle P. Jane , Persaud Marcia , Wilshin Jean , Hindmarsh Peter C. , Rodeck Charles H. , Brook Charles G. D.
Published: August 2005

Objective
To determine 1. the relationship between maternal serum leptin concentrations and maternal anthropometry and 2. the relationship between cord serum leptin concentrations at birth and neonatal anthropometry.

Design
Prospective cohort study of fetal growth in low–risk pregnancies.

Setting
University teaching hospital.

Sample
Thirty–nine women and their babies taking part in a fetal growth study.

Methods
Blood was taken from the women between 10–20 weeks of gestation and from the umbilical cord of their babies at delivery. Serum leptin was measured by radio–immunoassay. Maternal anthro–pometric measurements were recorded at booking. Neonatal anthropometric measurements were recorded within 48 hours after delivery. Linear regression analysis was used to explore the relationship between serum leptin concentrations and anthropometric measures and multiple regression analysis then applied to determine which variables remained independently associated with leptin.

Results
The median (range) leptin concentration in maternal serum was 11.8 ng/mL (1.7–39.7) and in cord blood was 4.2 ng/mL (0.6–21.4). Maternal leptin levels correlated with maternal weight, body mass index, midarm circumference and skinfold thickness, but not with birthweight, placental weight or maternal height. Body mass index and midarm circumference remained significant after multiple regression analysis. Cord leptin levels correlated with birthweight, birthlength, placental weight and skinfold thickness but not with ponderal index. Birthweight and subscapular skinfold thickness remained significant after multiple regression analysis. Cord leptin concentrations did not correlate with maternal leptin concentrations.

Conclusions
We suggest that there are very strong associations between maternal leptin and maternal adiposity in pregnancy, and between cord leptin at delivery and birthweight, as well as other anthropometric markers of fetal growth.
Very and moderate preterm births: are the risk factors different?
Authors: Ancel Pierre‐Yves , Saurel‐Cubizolles Marie‐Josèphe , Carlo Di Renzo Gian , Papiernik Emile , Bréart Gérard ,   A complete list of members of the Europop Group may be found on page 1169
Published: August 2005

Objective
To describe the risk factors for very pretenn births and to compare the strengths of the associations between these risk factors and very and moderate preterm births.

Design
A case‐control study.

Setting
Fifteen European countries.

Methods
Between 1994 and 1997, 1675 very preterm births, 3652 moderate preterm births and an unmatched control group of 7965 births at term were included. Odds ratios for very and moderate preterm births (related to socioeconomic status, behavioural factors, maternal age, body mass index and obstetric history) were estimated and compared using polytomous logistic regression.

Results
Underprivileged social situation, older maternal age and adverse previous pregnancy outcomes were significantly related to very and moderate preterm births. However, these factors were more strongly associated with very preterm births than with moderate preterm births, for both spontaneous and induced deliveries. Smoking during pregnancy, young maternal age and low body mass index were significantly related to very and moderate spontaneous preterm births, but no significant difference in odds ratios was observed between the two outcomes.

Conclusion
These results suggest that risk factors for very and moderate preterm births are similar, but the strength of the associations differ, especially for social factors and obstetric history.
Intracranial haemorrhage as a cause of maternal mortality during 1991–1992 in Japan: a report of the Confidential Inquiry into Maternal Deaths Research Group in Japan
Authors: Sameshima Hiroshi , Nagaya Ken ,   A complete list of individuals in the research group can be found on page 1176
Published: August 2005

Objective
To determine the causes of maternal deaths by intracranial haemorrhage in Japan.

Design
Retrospective analysis of records relating to maternal deaths in 1991 and 1992.

Samples
Two hundred and thirty maternal deaths, including 25 cases of primary intracranial haemorrhage and two cases with secondary bleeding.

Methods
Attending doctors were interviewed and completed a 600‐item data collection instrument for each maternal death. An expert committee reviewed the data for each death to determine whether the maternal deaths could have been prevented.

Main outcome measures
Preventability of maternal death from intracranial haemorrhage treated in obstetric and emergency services in Japan.

Results
Half of the primary intracranial haemorrhages occurred during pregnancy, 20% during labour, and 30% in the postnatal period. Neurosurgeons considered that there were only three women in whom surgical drainage was indicated. The committee determined that there was only one maternal death which had a 2 70% of being prevented. After detailed discussion of each case, 60% of the women (15/25) may have been saved by earlier and more intensive medical intervention.

Conclusions
These findings suggest that detailed history taking and early diagnosis of intracranial haemorrhage would be helpful. Regionalisation of obstetric emergency systems are necessary to reduce maternal deaths in Japan due to intracranial haemorrhage.
The role of observer error in antenatal dipstick proteinuria analysis
Authors: Bell Stephen C. , Halligan Aidan W. F. , Martin Allison , Ashmore Jill , Shennan Andrew H. , Lambert Paul C. , Taylor David J.
Published: August 2005

Objective
To determine the role of inter–observer error and the influence of training upon dipstick urine analysis.

Design
A two phase observational and training study

Methods
Five standard solutions of serum albumin were used to test the accuracy of midwives and nursing auxiliaries involved in dipstick urine analysis at a maternity hospital. The standard solutions were chosen such that they should have resulted in negative (n= 2) and positive (n= 3) dipstick test results, respectively.

Setting
A teaching maternity hospital and academic department of obstetrics and gynaecology.

Participants
Twenty midwives, 20 nursing auxiliaries and nine laboratory technicians.

Results
For the two nonproteinuric solutions, a higher false positive rate was observed for nursing auxiliaries(40% and 55%), compared with midwives (5% and 30%) (P= 0.020 and P= 0.20, respectively). Before training, laboratory technicians recorded high false positive rates (67% and 89%), but after training these were reduced to 0% and 22% (P= 0.25 and P= 0.023, respectively). Both nursing auxiliaries and midwives recorded false negative rates of between 10% and 45% for the three proteinuric solutions.

Conclusions
Observer error may be reduced by assigning midwives to urine dipstick analysis or by the implementation of directed training. Classification of pre‐eclampsia or other hypertensive diseases of pregnancy on the basis of the presence and degree of proteinuria should be confirmed with a 24–hour quantitative protein collection.
Differences in umbilical cord serum lipid levels with mode of delivery
Authors: Yoshimitsu Nobuyuki , Douchi Tsutomu , Yamasaki Hideki , Nagata Yukihiro , Andoh Tetsuo , Hatano Hiromichi
Published: August 2005

Objective
To investigate whether umbilical cord serum lipid levels differ with mode of delivery.

Design
Retrospective observation study.

Population
Two hundred and ninety mothers aged 29.1 years (SD 4.7) who had vaginal delivery, and 44 mothers aged 30.4 years (SD 4.7) who had elective caesarean section were enrolled.

Main outcome measures
Maternal and umbilical cord blood were obtained immediately after delivery. Serum lipid levels including total cholesterol, high density lipoprotein cholesterol, saturated fatty acid, mono‐unsaturated fatty acid and polyunsaturated fatty acid were measured. Obstetric variables and serum lipid levels were compared between the two groups. In each group the correlations of fetal serum lipid levels with maternal serum lipid levels were investigated.

Results
There were no significant differences in maternal age, neonatal weight, gestational duration, placental weight and neonatal gender distribution between the two groups. Only the two fetal serum lipid levels (including total cholesterol and non‐high density lipoprotein cholesterol) showed a correlation with maternal fetal lipid levels with correlation coefficients > 0.3 in the caesarean section group. However, saturated fatty acid, mono‐unsaturated fatty acid and total fatty acid levels in the non‐high density lipoprotein low density lipoprotein, very low density lipoprotein, intermediate density lipoprotein and free fatty acid fraction in the umbilical cord serum were significantly higher in the vaginal delivery cases (P < 0.01).

Conclusions
Umbilical cord serum levels of saturated and mono‐unsaturated fatty acids increase during vaginal delivery.
A three‐year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence
Authors: Ulmsten Ulf , Johnson Per , Rezapour Masoumeh
Published: August 2005

Objective
To study the long term results of tension‐free vaginal tape, a new ambulatory surgical procedure for treatment of female stress urinary incontinence.

Study design
A prospective open study using a standardised protocol for pre‐ and post‐operative evaluation.

Participants
Fifty consecutive women participated in the study. All suffered from genuine stress incontinence. The mean age was 57 years (SD 11), 42 women (84%) were multiparous, 8 (16%) nulliparous.

Surgical method
Tension‐free vaginal tape implies the implantation of a prolene tape around mid‐urethra via a minimal vaginal incision. The procedure is carried out under local anaesthesia, allowing the surgeon to check intra‐operatively that continence has been obtained.

Results
All the women except one could be operated on an ambulatory basis under local anaesthesia. Mean operation time was 29 minutes (range 16–47). Ninety percent of the women were able to micturate spontaneously within 24 hours with insignificant residual volumes. In another 10% of the women an in‐dwelling catheter had to be used temporarily. There was no need for long term post‐operative catheterisation (> 14 days). Post‐operative evaluation was carried out after 2 to 6, 12, 24 and 6 months. According to the protocol, 86% of the women were completely cured and another 11% were significantly improved. No signs of deterioration of the results over time were observed. No defect in healing or rejection of the tape occurred.

Conclusion
We consider the tension‐free vaginal tape operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. The technique can be considered as an ambulatory procedure performed under local anaesthesia, allowing the majority of the women to be discharged from the clinic the same day or the day after the procedure.
Transvaginal ultrasonography and endometrial histology in peri‐ and postmenopausal women on hormone replacement therapy
Authors: Lindgren R. , Mattsson L.‐Å. , Andersson K. , Lagrelius A. , Sandin K. , Karlsson K. , Risberg B.
Published: August 2005

Objective
To determine the association between endometrial thickness and endometrial histology in a large sample of women using HRT.

Design
Results from three multi‐centre studies were combined.

Participants
Five hundred and sixty‐four climacteric women were treated with either sequential, continuous combined or long‐cycle therapy.

Main outcome measures
The women underwent 717 examinations with both transvaginal ultrasonography and histological examination of the endometrium. Endometrial thickness was measured and associated with the histological findings.

Results
Eight cases of endometrial hyperplasia were diagnosed. All the hyperplasias were simple without atypia. Two cases had an endometrial thickness < 4 mm and two a thickness > 8 mm. The > 4 mm threshold for abnormal endometrium had a sensitivity of 75%, a specificity of 47%. a positive predictive value of 2% and a negative predictive value of 99%.

Conclusion
No association could be found between the endometrial thickness measured by transvaginal ultrasonography and endometrial pathology. In six out of eight women with simple hyperplasia the endometrium measured > 4 mm.
Active contractions of the cervix in the latent phase of labour
Authors: Rudel Drago , Pajntar Marjan
Published: August 2005

Objective
To study the activity of the human uterine cervix at the onset of labour and further characterise cervical asynchronous electromyographic (EMG) activity in the latent phase.

Design
Prospective observational study.

Setting
Clinical hospital in Ljubljana.

Participants
Forty‐seven healthy nulliparous women with relatively unripe cervices requiring induction of labour.

Methods
Simultaneous registration of a cervical EMG and of the intrauterine pressure at the very early stage of labour; subsequent EMG signal processing to determine its time, amplitude and frequency parameters.

Main outcome measures
Simultaneous comparison of the cervical EMG and the mechanical activity of the uterine corpus to deduce electrical properties of the cervical smooth muscle tissue and its activity.

Results
EMG bursts, asynchronous with the contractions of the uterine corpus, were registered in 20 out of 47 women. In 14 women bursts appeared independent of uterine corpus contractions and in six they followed the peak of contractions. The bursts had low average median frequency (0.3 Hz). In seven women bursts were superimposed onto a background EMG (median frcquency = 1–2 Hz).

Conclusions
Bursts in the cervical EMG may appear asynchronously with the uterine contractions. Bursts not related to contractions suggest active and independent cervical muscle activity. The bursts which follow contractions may be an active response of the cervical musculature to passive stretching during a contraction. The EMG frequency content suggests two different contraction mechanisms or a different origin of the EMG in the cervix.
Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses
Authors: Morgante Giuseppe , la Marca Antonio , Ditto Antonino , De Leo Vincenzo
Published: August 2005

Objective
To evaluate the ability of two malignancy risk indices (RMI 1 and Rh4I 2) incorporating menopausal status, serum CA125 level and ultrasound findings, to discriminate a benign from a malignant pelvic mass.

Design
A retrospective study.

Setting
Department of Obstetrics and Gynaecology, University of Siena, Italy.

Population
One hundred and twenty‐four women over 30 years of age admitted consecutively between January 1995 and December 1997 for surgical excision of ovarian masses.

Main outcome measures
The sensitivity, specificity, and positive predictive value of serum CA125, ultrasound findings and menopausal status, separately and combined into the RMI 1 and RMI 2, to diagnose ovarian cancer.

Results
The RMI 1 and RMI 2 were more accurate than menopausal status, ultrasound findings, and CA125 separately in diagnosing cancer. For all cut off values between 80 and 250, RMI 2 performed better than RMI 1. The RMI 2 at a cut off level of 125 gave a sensitivity of 81%, specificity of 90%, and positive predictive value of 74%.

Conclusions
We found that RMI 2 was more reliable in discriminating benign and malignant ovarian disease than RMI 1. RMI is a simple method which can be used in gynaecology clinics and less specialised centres.
Maternal and child health after assisted vaginal delivery: five‐year follow up of a randomised controlled study comparing forceps and ventouse
Authors: Johanson R. B. , Heycock E. , Carter J. , Sultan A. H. , Walklate K. , Jones P. W.
Published: August 2005

Objective
To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study.

Design
Follow up of a randomised controlled trial.

Setting
District general hospital in the West Midlands.

Population
Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty‐eight women responded (74.5%) and all were included in the study; forceps (n= 115) and vacuum extractor (n= 113).

Main outcome measures
Bowel and urinary dysfunction, child vision assessment, and child development.

Results
Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control ‘sometimes’ or ‘frequently’ by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97,95% CI 0.38–2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups.

Conclusions
There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.