bluuebunny/crossref_metadata_2025_split huggingface dataset:
The importance of chlamydial infections in obstetrics and gynaecology: An update
Authors: CURRIE Marian J. , BOWDEN Francis J. 
Published: January 2007

AbstractChlamydia is now the most common notifiable infectious disease in many countries, a fact that has serious ramifications for the reproductive health of women. This review highlights the epidemiology, pathophysiology, clinical features and reproductive sequelae of the infection. Current screening and management methods are outlined. Obstetricians and gynaecologists are ideally placed to play a major role in the primary prevention of this significant sexually transmitted infection.
Proteomic analysis and characterisation of human cervico‐vaginal fluid proteins
Authors: DI QUINZIO Megan K. W. , OLIVA Karen , HOLDSWORTH Sarah J. , AYHAN Mustafa , WALKER Susan P. , RICE Gregory E. , GEORGIOU Harry M. , PERMEZEL Michael 
Published: January 2007

AbstractAim:  Cervico‐vaginal fluid (CVF) may provide insight into the biochemical pathways of human reproduction and parturition. The aim of this study was to establish a 2‐D electrophoretic map of human CVF in healthy, pregnant women at term.Methods:  CVF was collected, concentrated and processed by routine 2‐D polyacrylamide gel electrophoresis using pH 4–7‐immobilised pH gradient strips and 8–16% gradient polyacrylamide gels. Imaged gels were analysed, yielding more than 400 proteins. A total of 157 proteins were common to all gels with a subgroup of the most abundant proteins being excised and characterised either by MALDI or by electrospray ion‐trap mass spectrometry.Results:  Twenty‐one proteins were successfully identified, yielding 15 different proteins. These included blood transport proteins (albumin and transthyretin); a structural protein (β‐actin); proteins involved in fatty acid metabolism (fatty acid‐binding protein and acetyl‐CoA‐binding protein); a calcium‐binding protein (annexin III); an anti‐inflammatory cytokine (interleukin‐1 receptor antagonist); proteinase inhibitors (α‐1‐antitrypsin, monocyte/neutrophil elastase inhibitor, squamous cell carcinoma antigen‐1 and cystatin A); and enzymes involved in oxidative stress defence (thioredoxin, peroxiredoxin 2, glutathione S‐transferase P and copper,zinc superoxide dismutase).Conclusion:  CVF is a complex body fluid consisting of both endogenous and environmental proteins. The putative role of some of these proteins in the human reproductive tract is discussed.
Sleep duration and quality in healthy nulliparous and multiparous women across pregnancy and post‐partum
Authors: SIGNAL T. Leigh , GANDER Philippa H. , SANGALLI Michel R. , TRAVIER Noémie , FIRESTONE Ridvan T. , TUOHY Jeremy F. 
Published: January 2007

AbstractBackground:  Longitudinal studies of sleep during normal pregnancy and post‐partum are rare, and interpretation of the findings is often hampered by methodological issues. Consequentially, there is still limited information on what constitutes normal sleep quality and quantity across pregnancy and early post‐partum, for both nulliparous and multiparous women.Aims:  To quantify the change and variability in sleep duration and quality across pregnancy and post‐partum for healthy nulliparous and multiparous women.Methods:  Nineteen women (eight nulliparous and 11 multiparous) wore an actigraph and completed a sleep diary to objectively measure sleep for seven nights during the second trimester, one week prior to delivery, and at one and six weeks post‐partum. Mixed model analysis of variance and logistic regression were used to investigate changes in sleep across this timeframe.Results:  The largest changes in sleep occurred in the first week post‐partum (1.5 h less sleep than during pregnancy, three times more sleep episodes in 24 h, 70% of women regularly napping during the day, and greatest day‐to‐day variability in sleep). Compared to multiparas, nulliparas generally had less efficient sleep, spent more time in bed and had greater wake after sleep onset in the second trimester, and spent less time in bed and had fewer sleep episodes a day at one week post‐partum.Conclusions:  These changes should be used to inform women about the extent of change in sleep, particularly early post‐partum, and to help health‐care providers identify women experiencing severe sleep loss and disruption and discuss possible coping strategies with them.
Misoprostol for termination of mid‐trimester post‐Caesarean pregnancy
Authors: BHATTACHARJEE Nabendu , GANGULY Rajendra Prasad , SAHA Shyama Prasad 
Published: January 2007

AbstractObjective:  To evaluate the efficacy and safety of PGE1 analogue, misoprostol, for inducing abortion or labour during mid‐trimester in women who have had a prior Caesarean section (one or more).Study design:  Women who had to undergo termination of pregnancy between 13 and 26 weeks of gestation for various indications and who had at least one previous Caesarean section were studied over a period of two and a half years. The standard regimen for misoprostol in all the cases was 400 µg up to 20 weeks of gestation and 200 µg for pregnancies longer than 20 weeks, either vaginally or sublingually every six hours (up to maximum 24 h). A contemporaneous cohort of women undergoing the same procedure for similar indications but without scarred uteri served as control.Results:  Eighty women in the study group underwent termination procedures for unwanted pregnancy, missed abortion, fetal anomaly or fetal death. The median induction–abortion interval was 16.4 h (10–21 h) and did not differ much from that in women without previous Caesarean delivery (median: 15.6 h; range 9.6–20 h), P > 0.05. Misoprostol was found to be safe in our cohort of post‐Caesarean women and there was no case of scar rupture or dehiscence. No significant differences in rates of incomplete abortions, blood loss or sepsis were detected in the study group compared to the control group.Conclusion:  The use of misoprostol for mid‐trimester pregnancy termination is not contraindicated in women with Caesarean scar and is effective and comparable with those in women without scarred uteri.
The effects of acupuncture during labour on nulliparous women: A randomised controlled trial
Authors: HANTOUSHZADEH Sedigheh , ALHUSSEINI Navid , LEBASCHI Amir Hussein 
Published: January 2007

AbstractBackground:  Acupuncture is as an ancient system of diagnosis and treatment. It is regarded as a complementary tool for pain management.Aims:  To assess the effects of acupuncture on nulliparous women during labour with respect to pain, labour duration and maternal acceptability.Methods:  One hundred and forty‐four healthy nulliparous women in active phase were randomised into the study and control group, receiving real and minimal acupuncture, respectively. Visual analogue scale was used to assess pain. Objectives were to evaluate acupuncture effect on pain and labour duration and patients’ willingness to receive acupuncture for subsequent pregnancies.Results:  Visual analogue scale pain score in the study group was lower after two hours. Active phase duration and the oxytocin units administered were lower in the study group. Study group patients had greater willingness to receive acupuncture again. No adverse effects were detected.Conclusions:  Acupuncture could reduce pain experience, active phase duration and oxytocin units. Patients were satisfied and no adverse effects were noted.
Labour and perinatal outcome in women at term with one previous lower‐segment Caesarean: A review of 1000 consecutive cases
Authors: TAN Peng Chiong , SUBRAMANIAM Revathy Nadesan , OMAR Siti Zawiah 
Published: January 2007

AbstractObjective:  To compare the outcome in 1000 women at term with one lower transverse Caesarean that was suitable for a trial of labour.Methods:  One thousand consecutive women with one previous scar suitable for a trial of labour delivering in our centre from June 2002 to December 2005 were identified from the labour ward register. Data were retrieved from patients’ charts, and neonatal admissions were determined.Results:  In the study, 76.8% of women underwent a trial of labour, with a 71.2% vaginal birth rate. Hospital stay was shorter with a trial of labour. The three perinatal deaths (0.4%; P = 1.0) occurred in the trial of labour group. Compared to elective repeat Caesareans, successful vaginal births after trial of labour were associated with less neonatal admission, reduced blood transfusion requirement and shorter hospital stay; emergency Caesarean deliveries after a trial of labour were associated with more neonatal admissions and operative complications.Conclusions:  Trial of labour was associated with a shorter hospital stay. A successful trial of labour after one Caesarean was associated with the best outcome underscoring the importance of patient selection for a trial of labour.
Women with gestational diabetes mellitus in the ACHOIS trial: Risk factors for shoulder dystocia
Authors: ATHUKORALA Chaturica , CROWTHER Caroline A. , WILLSON Kristyn ,   Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group
Published: January 2007

AbstractBackground:  Gestational diabetes mellitus (GDM) is associated with increased risk of fetal macrosomia and shoulder dystocia. However, not all women with GDM and fetal macrosomia have shoulder dystocia.Aims:  To identify the risk factors for shoulder dystocia in women with gestational diabetes using data from women recruited into the routine care group of the ACHOIS trial.Methods:  A secondary analysis was performed on data collected from women enrolled in the ACHOIS trial. Bivariate analyses were performed using the Fisher exact test. Variables found to be significantly associated with shoulder dystocia and previously identified risk factors were used as explanatory variables in multivariate analyses.Results:  A positive relationship was found between the severity of maternal fasting hyperglycaemia and the risk of shoulder dystocia, with a 1 mmol increase in fasting oral glucose‐tolerance test leading to a relative risk (RR) of 2.09 (95% CI 1.03–4.25). Shoulder dystocia occurred more often in births requiring operative vaginal delivery (RR 9.58, 95% CI 3.70–24.81, P < 0.001). Macrosomic and large‐for‐gestational‐age infants were more likely to have births complicated by shoulder dystocia (RR 6.27, 95% CI 2.33–16.88, P < 0.001 and RR 4.57, 95% CI 1.74–12.01, P < 0.005, respectively). Fetal macrosomia was the only variable to maintain its significance in all multivariate analyses.Conclusions:  Fetal macrosomia is the strongest independent risk factor for shoulder dystocia. Effective preventative strategies are needed.
Patterns of antenatal corticosteroid prescribing 1998–2004
Authors: POLYAKOV Alex , COHEN Saul , BAUM Marita , TRICKEY Donna , JOLLEY Damien , WALLACE Euan M. 
Published: January 2007

AbstractBackground:  The administration of antenatal corticosteroids to women at risk of preterm birth is an important component of care for such women. However, inevitably, attempts to maximise the number of women who receive corticosteroids ahead of preterm birth will also expose women perceived at risk who subsequently deliver at term. These women have not been previously quantified.Aims:  To describe antenatal corticosteroid prescribing practices at a single institution over a seven‐year period.Methods:  Interrogation of an electronic birthing outcome system supplemented by hand‐searching of medical records, recording all women birthing before 34 weeks and all women with a hospital admission before 34 weeks but birthing after 34 weeks. The number of women receiving antenatal corticosteroids in each of these groups was recorded, and trends between groups and over time were analysed using logistic regression.Results:  While the total number of women receiving antenatal corticosteroids in our institution has risen over the last seven years, the proportion of women receiving antenatal corticosteroids who deliver between 24 and 35 weeks has increased inconsistently and modestly (average increase 12% per year (95% CI: 6–19%, P < 0.001). In contrast, the number of women receiving antenatal corticosteroids who subsequently deliver after 34 weeks has increased consistently, with an average increase rate of 21% per year (95% CI: 16–25%, P < 0.001).Conclusions:  Increasing numbers of women birthing after 34 weeks in our hospital are receiving antenatal corticosteroids before 34 weeks. The long‐term implications of this are not currently clear.
Clinical and histological significance of atypical glandular cell on Pap smear
Authors: BEHTASH Nadereh , NAZARI Zeinab , FAKHREJAHANI Farhad , KHAFAF Alireza , AZAR Elham Ghayouri 
Published: January 2007

AbstractBackground:  Atypical glandular cell (AGC) on Pap smear is uncommon but may represent a variety of benign and malignant lesions.Aim:  The aim of this study was to evaluate the association between AGC on Pap smear and significant pathological finding to tailor management protocols.Methods:  Between 2002 and 2005, 60 women with AGC on Pap smears were referred to our colposcopy clinic. Forty‐one women underwent colposcopy‐directed biopsy, endocervical curettage, endometrial sampling and cervical conisation to determine the cytological and histological correlations of AGC on Pap smears.Results:  The mean age of the patients was 46.9 ± 11.5 years (range, 23–80 years). Of these patients 13 patients (31.7%) were postmenopause and 28 patients (68.2%) were in reproductive age. We found eight (19.5%) significant pathological findings including four (9.7%) high‐grade squamous intraepithelial lesion, one (2.4%) adenocarcinoma of uterus, one (2.4%) adenocarcinoma of cervix, one (2.4%) squamous cell carcinoma of cervix and one (2.4%) papillary serous tumour of ovary.Conclusion:  AGC on Pap smear was associated with a clinically significant diagnosis in approximately 20% of our cases. The women with a diagnosis of AGC on cervicovaginal smear are needed to be evaluated at least with colposcopy, endocervical and endometrial curettage. Clinicians should be careful about the significance of AGC on Pap smears.
Endometrial cells as a predictor of uterine cancer
Authors: HEARD Adrian R. , RODER David M. , SHORNE Lesley , KENNY Bernadette , PRIEST Kevin R. 
Published: January 2007

AbstractBackground:  With the recent cervix screening national guidelines recommending against reporting of benign endometrial cells, we examined South Australian data to see what impact this would have on detecting uterine cancers.Aims:  To test whether benign endometrial cells detected in cervical cytology testing confer an increased risk of uterine cancer, and to ascertain what percentage of uterine cancers will be missed in cervical screening programs if these cells are not reported.Methods:  The study was a retrospective cohort design of 1585 women with shed endometrial cells, each matched with three women without shed cells. All were linked with cancer registry data to check for uterine cancer diagnosis. Cox proportional hazards regression was used to check for any increase in cancer risk with shed endometrial cells. Using the calculated relative risks for uterine cancer diagnosis, we estimated the number of uterine cancers in South Australia associated with benign endometrial cells.Results:  The presence of benign endometrial cells in a cervical cytology test increases the risk of uterine cancer sixfold. However, screening women with benign cells would involve a major increase in pathology work for only an 18% increase in uterine cancers detected.Conclusions:  Until cytology systems have a higher sensitivity in detecting which benign endometrial cells are associated with uterine cancer, pathology laboratories are unlikely to be required to report these cells on tests. Inability to adjust for symptomatic status may have reduced the relevance of the results in this study.
Alternative cervical cancer prevention in low‐resource settings: Experiences of visual inspection by acetic acid with single‐visit approach in the first five provinces of Thailand
Authors: PALANUWONG Buncha 
Published: January 2007

AbstractBackground:  After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single‐visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low‐resource settings such a high coverage is still hard to attain by the conventional Pap smear approach.Aims:  To evaluate whether VIA/SVA can increase women's access to the prevention services in low‐resource provinces of Thailand.Methods:  A cross‐sectional study was conducted by analysing electronic screening records of the provinces. A χ2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998–2005.Results:  This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362 300 (66.8%) in the first year.Conclusion:  VIA/SVA has provided good screening coverage and lowered the financial burden in five low‐resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low‐resource areas.
Achieving quality assurance standards in colposcopy practice: A teaching hospital experience
Authors: NOOH Ahmed , BABBURI Padma , HOWELL Robert 
Published: January 2007

AbstractObjective:  To assess the performance of the colposcopy service of the teaching hospitals of Cardiff and Vale Trust, University of Wales, Cardiff, South Wales, UK by determining if patients attending colposcopy clinic had been managed in accordance with the local departmental, regional and national (National Health Service Cervical Screening Programme) guidelines with the ultimate purpose of identifying areas for improvement in patients’ care.Methods:  We retrospectively analysed the case notes of 426 women who attended the colposcopy clinic over a three‐month period in 2005.Results:  This study has shown that five of the national standards have been achieved. These relate to availability of cytology report at the time of colposcopic assessment, recording of colposcopist's impression as to the nature of the cervical lesion, suitability of biopsy samples for histological analysis, primary haemorrhage as a complication of large loop excision of transformation zone treatment and inpatient admission following this treatment. However, other five unmet standards relate to recording of visibility of squamocolumnar junction, predictability of high‐grade lesion, taking a biopsy from a high‐grade lesion as suggested by smear, recording consent of treatment, and number of treatments performed as an outpatient.Conclusion:  Our findings should lead to changes in the structure and functioning of the colposcopy clinic that would improve the detection of significant disease and the timeliness of diagnosis and the speed with which results are communicated.
Total laparoscopic hysterectomy: The Brisbane learning curve
Authors: GARRETT Andrea J. , NASCIMENTO Marcelo Carraro , NICKLIN James L. , PERRIN Lewis C. , OBERMAIR Andreas 
Published: January 2007

AbstractBackground:  Total laparoscopic hysterectomy (TLH) is becoming more commonly used for gynaecological malignancies.Aims:  To describe our experience with TLH since its introduction to our tertiary referral centre for gynaecological cancer in 2003.Methods:  Retrospective analysis of the first 120 consecutive cases of TLH performed at our gynaecological cancer centre. Patients were divided into the first, second and third group of 40 patients. Operating time, estimated blood loss, hospital stay, conversion to laparotomy and intra‐ and postoperative morbidity were evaluated.Results:  The three groups were similar with regard to baseline characteristics. For the entire group the mean hospital stay was 2.4 ± 1.4 days and eight of 120 patients (6.6%) required conversion to laparotomy. Operating time, estimated blood loss and intraoperative morbidity were similar among the three groups. Postoperative morbidity was highest (25%) in the middle one‐third of the patients (P = 0.022). The percentage of pelvic lymph node dissections increased from 2.5% in the first one‐third of patients to 27.5% in the final one‐third of patients (P = 0.003).Conclusions:  TLH can be established safely in a tertiary gynaecological cancer referral centre.
Morbidity associated with vaginal hysterectomies in Queensland public teaching hospitals
Authors: BECKMANN Michael , NEPPE Cliff 
Published: January 2007

AbstractHysterectomies performed vaginally are associated with less perioperative risk than those performed abdominally but the risk is not negligible. There are little sizable and/or contemporary Australian data of adverse outcomes associated with vaginal hysterectomy available. A retrospective analysis was undertaken in each of five Queensland public teaching hospitals of the last 200 women in each centre who underwent a vaginal hysterectomy for benign reasons. Serious morbidity complicated 14.0% of vaginal hysterectomies, minor morbidity was associated with 24.0% of hysterectomies and, overall, 29.9% suffered any (ie serious or minor) morbidity. Following multivariate analysis there remained an association between serious perioperative morbidity and ASA ≥ 2 (relative risk (RR) 1.89 (1.37–2.61)) and omission of prophylactic antibiotics (RR 2.0 (1.45–2.78)). There also remained an association between any morbidity and use of antidepressants (RR 1.35 (1.07–1.72)), epilepsy (RR 2.00 (136–2.95)), preoperative hypoalbuminaemia (albumin ≤ 35 g/L RR 2.08 (1.33–3.24)) as well as ASA ≥ 2 (RR 1.24 (1.00–1.54)) and omission of prophylactic antibiotics (RR 1.45 (1.18–1.79)).
Is Epilepsy Intractability Predetermined or Acquired?
Authors: Abou-Khalil Bassel W. 
Published: January 2007

How Long Does it Take for Epilepsy to Become Intractable? A Prospective Investigation Berg AT, Vickrey BG, Testa FM, Levy SR, Shinnar S, DiMario F, Smith S. Ann Neurol 2006;60:73–79. Objective To determine prospectively when in the course of epilepsy intractability becomes apparent. Methods Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped as focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (a) two drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (b) failure of two drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis. Results Eighty-three children (13.8%) met the stringent and 142 (23.2%) met the two-drug definition. Intractability depended on syndrome ( p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the two-drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two-drug: 40.3 vs 2.2%, p = 0.0001). Early remission periods preceded delayed intractability in 65.4–74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact. Interpretation Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery.