bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diet in late pregnancy and glucose‐insulin metabolism of the offspring 40 years later
Authors: Shiell A. W. , Campbell D. M. , Hall M. H. , Barker D. J. P. 
Published: August 2005

Objective
To determine how diets of women in pregnancy influence the glucose‐insulin metabolism of their offspring in adult life.Design
A follow up study of men and women born during 1948–1954 whose mothers had taken part in a survey of diet in late pregnancy.Setting
Aberdeen, Scotland.Population
One hundred and sixty‐eight men and women born in the Aberdeen Maternity Hospital.Main outcome measure
Plasma glucose and insulin concentrations, fasting and after a standard oral glucose challenge.Results
The offspring of women who had high intakes of fat and protein in late pregnancy had a reduced plasma insulin increment between fasting and 30 min with a 7.0% decrease in increment (P= 0.007) per 10 g increase in protein intake and a 4.9% decrease (P= 0.002) per 10 g increase in fat intake. This was independent of the mother's body mass index or weight gain in pregnancy. A low maternal body mass index in early or late pregnancy was associated with a raised fasting plasma insulin concentration with a decrease of 2.4% (P= 0.05) per 1 kg/m2 increase of maternal body mass.Conclusion
High intakes of protein and fat during pregnancy may impair development of the fetal pancreatic beta cells and lead to insulin deficiency in the offspring. The offspring of thin mothers tend to be insulin resistant.
Umbilical artery Doppler studies in small for gestational age babies reflect disease severity
Authors: McCowan Lesley M. E. , Harding Jane E. , Stewart Alistair W. 
Published: August 2005

Objectives
To determine: 1. whether abnormal umbilical artery Doppler studies were independently associated with newborn morbidity; and 2. whether small for gestational age babies with normal umbilical artery Doppler studies had small mothers and a low rate of newborn malnutrition and morbidity.Design
Prospective observational study.Setting
National Women's Hospital, a tertiary referral centre, Auckland, New Zealand.Population
One hundred eighty‐six women and their small for gestational age babies (birthweight < 10th%) who had been participants in one of two randomised controlled trials of small for gestational age pregnancies between 1993 and 1997.Methods
Newborn morbidity and morphometry were compared between small for gestational age babies with normal and abnormal umbilical artery Doppler studies (resistance index > 95th%). Maternal demographic characteristics and morbidity were also compared.Results
Compared with small for gestational age babies with normal umbilical artery Doppler studies (n= 109), small for gestational age babies with abnormal umbilical artery Doppler studies (n= 77) were diagnosed earlier in pregnancy as being small for gestational age (30.3 vs 32.9 weeks, P < 0.001), were smaller in all body proportions at birth (median Z score birthweight −1.82 vs−1.70, P= 0.004, Z score length −1.86 vs−1.36, P < 0.0001, Z score head circumference −1.31 vs−0.89, P < 0.0001) and were more likely to experience newborn morbidity. When birthweight and gestation were entered into a logistic regression model, an abnormal umbilical artery Doppler study was not an independent predictor of prolonged newborn nursery admission or hypoglycaemia. Of small for gestational age babies with normal umbilical artery Doppler studies, 53 (49%) had low ponderal indices, 26/98 (26%) were hypoglycaemic and 38 (35%) required admission to the newborn nursery. There was no difference in maternal height, weight and ethnicity between the abnormal and normal umbilical artery Doppler groups.Conclusions
Abnormal umbilical artery Doppler studies reflect earlier onset and more severe growth restriction and are not independently associated with newborn morbidity. Small for gestational age babies with normal Doppler studies have a high rate of newborn nursery admission and malnutrition at birth and are not all just normal small babies.
Serum inhibin, activin and follistatin in postmenopausal women with epithelial ovarian carcinoma
Authors: Menon Usha , Riley Simon C. , Thomas Janice , Bose Chinmoy , Dawnay Anne , Evans Lee W. , Groome Nigel P. , Jacobs Ian J. 
Published: August 2005

Objective
To investigate the role of serum inhibin A, inhibin pro‐αC immunoreactivity, activin A, and follistatin in postmenopausal women with epithelial ovarian cancer.Design
Case‐control study.Sample
Serum samples from 27 postmenopausal women with epithelial ovarian cancer and 54 controls from the general population participating in an ovarian cancer screening trial.Results
Women with epithelial ovarian cancer had significantly higher serum levels of pro‐αC immunoreactivity (P= 0.03), activin A (P= 0.004) and follistatin (P= 0.04), but not inhibin A (P= 0.13). Using the 90th centile in the control group as the cut off, pro‐αC levels were elevated in 41% of women with epithelial ovarian cancer, while inhibin A was elevated in only 15%. Using the 95th centile as the cut off, serum pro‐αC was elevated in only 11% of women with epithelial ovarian cancer (3/27), while activin A was elevated in 48% (11/23). Follicle stimulating hormone levels were significantly lower in women with epithelial ovarian cancer (P= 0.01). Although, inhibin‐related peptides can modulate follicle stimulating hormone levels, there was no correlation between inhibin A, pro‐αC immunoreactivity, activin A or follistatin and follicle stimulating hormone.Conclusion
These data demonstrate that though there is preferential secretion of precursor forms of the α subunit rather than dimeric inhibin A by epithelial ovarian cancer, pro‐αC is unlikely to be a useful tumour marker. Activin A is more commonly elevated in postmenopausal women with epithelial ovarian cancer and its role as a tumour marker in the diagnosis and screening of epithelial ovarian cancer warrants further evaluation.
Ultrasonographic measurement of endometrial changes following discontinuation of tamoxifen treatment in postmenopausal breast cancer patients
Authors: Cohen Ilan , Beyth Yoram , Azaria Ron , Flex Dov , Figer Arie , Tepper Ron 
Published: August 2005

Objective
To assess whether there is a decrease in endometrial thickness following discontinuation of tamoxifen treatment as measured by ultrasound.Design
Prospective study.Setting
Department of Obstetrics and Gynaecology, Sapir Medical Centre, Kfar‐Saba, Israel.Population
Fifty‐eight postmenopausal women with breast cancer who were treated with tamoxifen.Methods
Transvaginal ultrasonographic measurements of endometrial thickness.Main outcome measures
Evaluation of the changes of endometrial thickness and the frequency the endometrium reached a thickness of ≤ 5 mm at different time intervals after stopping tamoxifen treatment.Results
There was a significant decrease in median thickness of the endometrium, within six months after stopping tamoxifen, from 7.75 mm measured at the last ultrasonographic study performed before tamoxifen discontinuation down to 5.2 mm (P= 0.002). There were no further reductions in endometrial thickness, and it remained constantly low in subsequent ultrasonographic studies which were performed at various times up to 30 months following the discontinuation of tamoxifen treatment. While taking tamoxifen, only 25.9% of the women had an endometrial thickness of ≤ 5 mm. This proportion doubled in their first six months after stopping.Conclusions
Median thickness of endometrial thickness significantly reduced within six months following tamoxifen discontinuation, and remained constantly low thereafter. This finding may support use of ultrasonographic imaging for the measurement of tamoxifen's effect on the endometrium of postmenopausal breast cancer patients.
The misoprostol third stage of labour study: a randomised controlled comparison between orally administered misoprostol and standard management
Authors: El‐Refaey Hazem , Nooh Randa , O'Brien Pat , Abdalla Mona , Geary Michael , Walder Jane , Rodeck Charles 
Published: August 2005

Objective
To compare misoprostol with standard oxytocic regimens in the prevention of postpartum haemorrhage.Design
Randomised controlled trial.Setting
Obstetric unit in a large teaching hospital.Methods
One thousand women randomised to 500 μg misoprostol given orally or to standard oxytocic regimens of oxytocin, oxytocin with ergometrine, or ergometrine.Main outcome measures
Incidence of postpartum haemorrhage and the incidence and severity of side effects.Results
Postpartum haemorrhage occurred in 12% of women given misoprostol and in 11% of women given standard oxytocic drugs (relative risk (RR) 1.10, 95% confidence interval (CI) 0.79, 1.55). Blood loss of 1000 mL or more occurred in 2% of women in each group. Nausea, headache, dizziness and tiredness were less frequent with misoprostol (RR (95% CI) 0.71 (0.59, 0.84); 0.53 (0.38, 0.74); 0.73 (0.61, 0.87) and 0.88 (0.83, 0.94) respectively). The main side effects of misoprostol were shivering (RR 1.95, 95% CI 1.69, 2.25) and a rise in temperature (difference in mean rise 0.34°C, 95% CI 0.26, 0.42).Conclusion
Oral misoprostol for the prevention of postpartum haemorrhage was comparable to standard oxytocics. Many side effects were less common with misoprostol but shivering and pyrexia were more common. Larger randomised trials are needed before establishing the equivalence between misoprostol and standard oxytocic drugs in the prevention of postpartum haemorrhage.
Antenatal use of enoxaparin for prevention and treatment of thromboembolism in pregnancy
Authors: Ellison Joanne , Walker Isobel D. , Greer Ian A. 
Published: August 2005

Objective
To assess the safety and efficacy of enoxaparin use for thromboprophylaxis or treatment of venous thromboembolism during pregnancy.Design
Retrospective review of casenotes of women who received enoxaparin during pregnancy.Setting
Obstetric Medicine Unit at Glasgow Royal Maternity Hospital.Sample
Data were obtained on 57 pregnancies in 50 women over six years.Methods
Information was obtained from case records in relation to outcome measures, the presence of underlying thrombophilia and indication for anticoagulation.Main outcome measures
Incidences of venous thromboembolism, haemorrhage, thrombocytopenia, peak plasma anti‐factor Xa levels and symptomatic osteoporosis.Results
There were no thromboembolic events in the thromboprophylaxis group. There were no incidences of heparin‐induced thrombocytopenia. Twenty‐two women had spinal or epidural anaesthesia and no complications were encountered. There was one instance of antepartum haemorrhage following attempted amniotomy in a woman with previously unknown vasa praevia. Two women sustained postpartum haemorrhage, both secondary to vaginal lacerations, resulting in blood loss > 1000 mL. Blood loss following caesarean section was not excessive. No instances of vertebral or hip fracture were encountered. The median peak plasma anti‐factor Xa level on a dose of 40 mg once daily was 0.235 U/mL; peak plasma anti‐factor Xa levels were not affected by gestational age.Conclusions
The use of enoxaparin in pregnancy is associated with a low incidence of complications and a dose of 40 mg once daily throughout pregnancy provides satisfactory anti‐factor Xa levels and appears effective in preventing venous thromboembolism.
The development and validation of an algorithm for real‐time computerised fetal heart rate monitoring in labour
Authors: Taylor Graham M. , Mires Gary J. , Abel Eric W. , Tsantis Stavros , Farrell Tom , Chien Patrick F. W. , Liu Ying 
Published: August 2005

Objective
To develop and validate a computerised algorithm for the interpretation of the characteristics of fetal heart rate monitoring in labour.Design
Prospective observational study.Setting
Labour ward in a tertiary hospital.Sample
Intrapartum cardiotocograms from 24 pregnancies.Methods
A computerised algorithm was developed to assess the fetal heart baseline rate, variability, the number of accelerations and the number of decelerations. Twenty five minute segments of cardiotocograms were interpreted by the algorithm and also by seven expert reviewers independently. The reviewers were unaware of the outcome of labour. The reliability of the characteristics of car‐diotocography and the validity of the computerised algorithm were assessed using the intraclass correlation coefficient and weighted kappa statistic for continuous and ordinal variables respectively.Results
The inter rater reliability of the baseline fetal heart rate and the number and type of decelerations was good (intraclass correlation coefficient 0.93, 0.93 and 0.79, respectively). The reliability of baseline variability (kappa = 0.27) and accelerations (intraclass correlation coefficient = 0.27) was poor. The computerised algorithm had good agreement with the reviewers for the baseline fetal heart rate (intraclass correlation coefficient 0.91 to 0.98) and the number of decelerations (intraclass correlation coefficient 0.82 to 0.91), but was less valid as regards the number of late decelerations (intraclass correlation coefficient 0.68 to 0.85) and the number of accelerations (intraclass correlation coefficient 0.06 to 0.80), and was invalid as regards baseline variability (kappa 0.00 to 0.34).Conclusions
The high level of validity of the computerised algorithm for the estimation of the baseline fetal heart rate and the number of decelerations justifies its further technical development.
The relationship between increased folate catabolism and the increased requirement for folate in pregnancy
Authors: Higgins John R. , Quinlivan Eoin P. , McPartlin Joseph , Scott John M. , Weir Donald G. , Darling Michael R. N. 
Published: August 2005

Objectives
To estimate the rate of folate catabolism in pregnant and nonpregnant women and to derive the recommended dietary allowance for folate.Design
Prospective, observational study.Setting
Rotunda Hospital, Dublin.Women
Twenty‐four healthy gravid women were studied once during each trimester and postpartum. Twenty‐five nonpregnant controls were assessed before and after folic acid supplementation.Interventions
Women provided 24‐hour urine collections while adhering to a strict dietary regimen containing no exogenous folate catabolites.Main outcome measures
Urinary levels of p‐acetamidobenzoylglutamate and p‐aminobenzoylglutamate were measured by high pressure liquid chromatography.Results
The 24‐hour excretion of folate catabolites, expressed as mean [95% CI] folate equivalents in μg) progressively increased during pregnancy. A peak was reached in the third trimester (349.1 μg [308.1 to 390.1]) where the rate was more than twice the rate in the nonpregnant control group (136.4 μg [112.4 to 160.4]) (P < 0.001). Based on our results the recommended dietary allowance for folate in nonpregnant women should be 250 μg and this should rise during pregnancy to 430 μg in the second trimester and 540 μg in the third trimester.Conclusions
The rate of folate catabolism progressively increases during pregnancy reaching a peak in the third trimester at the time of maximal fetal growth. The increased demand for folate during pregnancy appears to be due to the accelerated breakdown of the vitamin because of its participation in cellular biosynthesis. These results provide a quantitative basis for the current debate on the appropriate recommended dietary allowance for folate in both pregnant and nonpregnant women.
The long learning curve of gynaecological cancer surgery: an argument for centralisation
Authors: Trimbos J. Baptist , Hellebrekers Bart W. J. , Kenter Gemma G. , Peters Lex A. W. , Zwinderman Koos H. 
Published: August 2005

ObjectiveTo study the development of surgical performance of an unchanging surgical team over 13 years.DesignProspective, observational study.SettingA university hospital, The Netherlands.ParticipantsThree hundred and eight women who underwent surgical treatment for early cervical cancer.InterventionsRadical hysterectomy and pelvic lymphadenectomy between 1 January 1984 and 31 December 1996.ResultsThe surgical procedure and indication for treatment remained unchanged during the study period. This applied also to the surgical team. The women's age increased significantly during the study years, as was the case with the number of nodes removed. The depth of infiltration by the tumour increased steadily throughout the study, but this failed to reach statistical significance. The distribution of FIGO stages, percentage of positive lymph nodes, radicality of the surgical margins and post‐operative morbidity remained the same. Overall, the five year survival rate was 83%; for women with negative nodes 91%, and for women with positive nodes 53%. Survival tended to improve during the course of the study, but this was not statistically significant. Blood loss during surgery decreased consistently during the whole study period, from a mean of 1515 mL at the beginning of the study to a mean of 1071 mL at the end (P< 0.0001). The operating time also diminished significantly by 8 minutes per year (P< 0.0001). In 1985 the average operating time was 270 minutes, compared with 187 minutes in 1996.ConclusionsThese findings indicate that it takes a long time to acquire skill in the surgical treatment of early cervical cancer. Centralisation of relatively infrequent operations for cancer should be encouraged.
The role of laparoscopic surgery in the management of endometrial cancer
Authors: Lim B. K. , Lavie Ofer , Bolger B. , Lopes Tito , Monaghan J. M. 
Published: August 2005

Objective
To assess the place of laparoscopically assisted vaginal hysterectomy in the treatment of endometrial cancer.Design
A retrospective uncontrolled case series.Setting
Gynaecological Oncology Department, Queen Elizabeth Hospital, Gateshead.Population
Women with endometrial cancer referred to this centre from August 1992 to August 1997.Main outcome measures
Success of laparoscopically assisted vaginal hysterectomy, operative morbidity, and the length of hospital stay.Results
Laparoscopically assisted vaginal hysterectomy was successful in 35 of 40 women (88%). Five women required laparotomy. Two women sustained injury to the inferior epigastric vessels. One sustained injury to the small intestine requiring later laparotomy and three women required a blood transfusion. The mean hospital stay was 3.3 days (SD 1.5). Three women died of the disease within one year of their operation.Conclusion
Laparoscopically assisted vaginal hysterectomy is a feasible treatment for endometrial cancer. It can be performed successfully in high risk population who are medically unfit and overweight. However, a larger randomised study is required to assess the morbidity compared with the traditional open approach.
Risk factors for pre‐eclampsia in a large cohort of Latin American and Caribbean women
Authors: Conde‐Agudelo Agustin , Belizán José M. 
Published: August 2005

Objective
To study risk factors for pre‐eclampsia in a large cohort of Latin American and Caribbean women.Design
Retrospective cross‐sectional study from the Perinatal Information System, the database of the Latin American Center for Perinatology and Human Development, Montevideo, Uruguay.Setting
Latin America and the Caribbean, 1985–1997.Population
878,680 pregnancies at 700 hospitals; of these 42,530 were complicated by pre‐eclampsia and 1872 by eclampsia.Main outcome measures
Crude and adjusted relative risks (RR) of risk factors for pre‐eclampsia. Adjusted relative risks were obtained after adjustment for potential confounding factors through multiple logistic regression models based on the method of generalised estimating equations.Results
The following risk factors were significantly associated with increased risk of pre‐eclampsia: nulliparity (RR 2.38; 95% CI 2.28–2.49); multiple pregnancy (RR 2.10; 95% CI 1.90–2.32); history of chronic hypertension (RR 1.99; 95% CI 1.78–2.22); gestational diabetes mellitus (RR 1.93; 95% CI 1.66–2.25); maternal age ≥ 35 years (RR 1.67; 95% CI 1.58–1.77); fetal malformation (RR 1.26; 95% CI 1.16–1.37); and mother not living with infant's father (RR 1.21; 95% CI 1.15–1.26). Pre‐eclampsia risk increased according to pre‐pregnancy body mass index (BMI). In comparison with women with a normal pre‐pregnancy BMI (19.8 to 26.0), the RR estimates were 1.57 (95% CI 1.49–1.64) and 2.81 95% CI 2.69–2.94), respectively, for overweight women (pre‐pregnancy BMI = 26.1 to 29.0) and obese women (pre‐pregnancy BMI > 29.0). Cigarette smoking during pregnancy and a pre‐pregnancy BMI < 19.8 were significant protective factors against the development of pre‐eclampsia. The pattern of risk factors among nulliparous and multiparous women was quite similar.Conclusions
Risk factors for pre‐eclampsia observed among Latin American and Caribbean women are similar to those found among North American and European women.
Prenatal diagnosis of fetal primary cytomegalovirus infection
Authors: Antsaklis Aris J. , Daskalakis George J. , Mesogitis Spyros A. , Koutra Panagiota T. , Michalas Stylianos S. 
Published: August 2005

Objective
To determine the reliability of prenatal diagnosis for congenital cytomegalovirus in women with primary infection.Design
Retrospective analysis of case records between 1992 and 1997.Setting
Fetal medicine unit of a large teaching hospital.Population
Forty‐two pregnant women with primary cytomegalovirus infection.Methods
Fetal diagnosis was made by amniocentesis for viral culture and amplification of cytomegalovirus DNA by polymerase chain reaction (n= 37), or by cordocentesis for the detection of cytomegalovirus ‐specific IgM antibodies (n= 13). All patients had serial ultrasonographic scans in order to detect those fetuses with abnormalities that could be associated with cytomegalovirus infection.Results
Fourteen pregnancies (33.3%) had evidence of vertical transmission. Nine out of 14 (64.3%) had positive amniotic fluid culture, while 11 (78.6%) had positive polymerase chain reaction results. The combination of both tests allowed antenatal diagnosis in 12 of the 14 infected fetuses (sensitivity 85.7%). All women who underwent cordocentesis for the detection of cytomegalovirus‐specific IgM antibodies had negative results, but in two cases cytomegalovirus infection was detected by amniotic fluid studies. In five of the infected fetuses there were abnormal ultrasonographic findings. All pregnancies with evidence of vertical transmission were terminated and the remainder proceeded normally to term.Conclusions
Our data showed that amniotic fluid studies, preferably polymerase chain reaction amplification of viral DNA, are the best diagnostic tools for the detection of vertical transmission in pregnancies with primary cytomegalovirus infection. For women with positive amniotic fluid studies who elect to continue their pregnancies, cordocentesis and serial ultrasound scans may be useful for assessment of fetal status.