bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expectant management of early pregnancies of unknown location: a prospective evaluation of methods to predict spontaneous resolution of pregnancy
Authors: Banerjee Saikat , Aslam Naaila , Woelfer Brigitte , Lawrence Alexandra , Elson Janine , Jurkovic Davor 
Published: December 2003

Objective To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan.Design Prospective observational study.Setting Dedicated early pregnancy unit in an inner city teaching hospital.Population Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications.Methods A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta‐human chorionic gonadotrophin (β‐hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non‐declining β‐hCG levels.Main outcome measures Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum β‐hCG level to < 20 iu/L) without need for any active intervention.Results Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values ≥ 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L.Conclusion Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.
Fetal and maternal lactate increase during active second stage of labour
Authors: Nordström Lennart , Achanna Siva , Naka Keiichi , Arulkumaran Sabaratnam 
Published: December 2003

Objective
To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour.Design
Prospective, observational study of randomly selected labours.Setting
Labour ward, Sultanah Aminah General Hospital, Johore Bahru, Malaysia.Main outcome measures
Fetal scalp and maternal venous blood lactate, umbilical arterial and vein lactate and acid–base balance at delivery.Results
Sixty‐nine women and their infants were monitored in the second stage of labour. Mean maternal venous lactate by the end of the first stage was 2.6 ± 1.0 (±S.D.) mmol/L and increased to 3.6 ±1.4, 4.2 ±1.7, 4.8 ±1.6, 5.4 ±2.1 and 4.3±0.9 mmol/L, respectively, for every 15 minute of bearing down. Corresponding values for fetal scalp blood lactate were 2.4 ±1.1, 3.1 ±1.6, 3.2 ±1.8, 4.2 ±2.4, 4.9 ±2.8 and 5.8±1.9 mmol/L. The mean slope of maternal lactate increase was 0.070 mmol/L per minute (95% CI 0.050, 0.090) and for fetal lactate increase 0.032 mmol/L per minute (95% C.I.: 0.018, 0.045). The duration of active second stage was significantly associated with fetal lactate (P<0.001) and maternal lactate (P=0.03) at the time of crowning of the fetal head, and lactate in umbilical arterial and vein blood at delivery (P<0.001). Expulsion time ≥ 45 minutes, compared with shorter active second stage, and acidaemia at birth implied larger arterial‐venous lactate differences (P<0.001). Fetal lactate at crowning was also significantly associated with the umbilical arterial‐veonus lactate difference (P=0.03).Conclusions
Maternal and fetal lactate concentrations increase significantly with duration of the active second stage of labour, more rapidly in the mother. It is likely that fetal anaerobic metabolism is the main source for the fetal lactate increase.
Female genital mutilation: analysis of the first twelve months of a southeast London specialist clinic
Authors: Momoh Comfort , Ladhani Shamez , Lochrie Denise P. , Rymer Janice 
Published: December 2003

Objectives To analyse the sources and reasons for referral of women who have undergone genital mutilation to a recently established specialist clinic, and to determine the consequences of the genital mutilation procedure.Design Retrospective descriptive case series.Setting The maternity units of Guy's and St. Thomas's Hospital, London.Population One hundred and sixteen women attending the clinic over a one‐year period.Main outcome measures (1) sources and reasons for referral to the specialist clinic; (2) characteristics of the women attending the clinic; (3) acute and chronic complications of the genital mutilation procedure; (4) attitudes towards female genital mutilation.Results Complete case records were available for 108 women. Of the 86 women who could remember the procedure, 78% were performed by a medically unqualified person, usually at home (71%), at a median age of seven years. Acute and chronic complications were each present in 86% of women with Type III genital mutilation. Most women (82%) were referred by their midwife because they were pregnant, of whom 48% were primigravid. Eighteen non‐pregnant women also attended the clinic to request either defibulation or for advice. None of the 89 pregnant women requested re‐infibulation after delivery, but almost 6% were seriously considering having their daughter undergo genital mutilation outside the United Kingdom. In addition, fewer than 10% of the women refused to continue the tradition of female genital mutilation.Conclusions During its first year, the recently established African Well Woman Clinic has provided specialist care for 116 women with genital mutilation. Such women may attend with a variety of common medical or psychiatric conditions and often do not volunteer that they have undergone the procedure. Doctors and midwives in particular, should enquire specifically about genital mutilation when caring for women from high risk countries, and offer the services of specialist clinics for female genital mutilation.
Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss
Authors: Hurskainen Ritva , Aalto Anna‐Mari , Teperi Juha , Grenman Seija , Kivela¨ Aarre , Kujansuu Erkki , Vuorma Sirkku , Yliskoski Merja , Paavonen Jorma 
Published: December 2003

Objective
To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia.Design
sectional comparative study of women referred for menorrhagia.Setting
Gynaecology departments of all five university teaching hospitals in Finland.Sample
Two hundred and twenty‐six women aged 35‐49 years complaining of menorrhagia.Main outcome measures
Several psychosocial factors, seeking medical attention, menstrual blood loss.Results
Twenty‐nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss <60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained significant variables by multivariate analysis.Conclusions
A significant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia.
Bladder neck mobility in continent nulliparous women
Authors: Peschers Ursula M. , Fanger Gabi , Schaer Gabriel N. , Vodusek David B. , DeLancey John O.L. , Schuessler Bernhard 
Published: December 2003

Objective
To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied.Design
Clinical observational study.Setting
Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland.Population
Thirty‐nine nulliparous volunteers.Methods
Vesical neck motion was assessed with perineal ultrasound. Intra–abdominal pressure was controlled for with an intrarectal probe. Intra‐rater reliability was evaluated.Results
Vesical neck mobility was significantly lower during coughing (8 mm, SD 4 mm) than during valsalva (15 mm, SD 10 mm) (P < 0.005). Between individuals mobility varied from 4 mm to 32 mm during coughing and from 2 mm to 31 mm during valsalva. Test‐retest‐studies showed a maximum difference between to tests during coughing of 4 mm and during valsalva of 5 mm.Conclusion
The bladder neck is mobile in normal continent women and bladder neck mobility is lower during coughing than during Valsalva.
Biochemical markers of maternal bone turnover are elevated in pre‐eclampsia
Authors: Anim‐Nyame Nick , Sooranna Suren R. , Jones Julia , Alaghband‐Zadeh Jamie , Steer Philip J. , Johnson Mark R. 
Published: December 2003

Objectives
To investigate the hypothesis that bone turnover is reduced in pre‐eclampsia compared with normal pregnancy.Design
A prospective sectional study.Setting
Obstetric unit at the Chelsea and Westminster Hospital, London.Methods
Third trimester maternal plasma levels of the linked carboxyl‐terminal telo‐peptide of type I collagen (ICTP), (a marker of bone resorption) and the carboxyl terminal pro‐peptide of type I pro‐collagen (PICP), (a marker of bone formation) were compared in 25 women with pre‐eclampsia and in 24 normal pregnant controls. The subjects were matched for maternal age, booking body mass index and gestational age. PICP and ICTP levels were measured by radio‐immunoassay.Results
ICTP and PICP levels were significantly increased in women with pre‐eclampsia compared with the normal pregnant controls (P= 0.0001 and P= 0.004, for ICTP and PICP respectively, Wilcoxon signed ranked test). There was no significant correlation between either of the markers and booking body mass index, blood pressure, serum uric acid levels or platelet count.Conclusions
These data suggest that bone turnover is increased in established pre‐eclampsia compared with normal pregnancy. Further studies are required to investigate whether this precedes the onset of the disease.
Inadequate repeatability of the one‐hour pad test: the need for a new incontinence outcome measure
Authors: Simons A.M. , Yoong W.C. , Buckland S. , Moore K.H. 
Published: December 2003

Objective
To assess the reproducibility of two one‐hour pad tests performed within one week using serial ultrasound scanning to obtain identical bladder volumes, and to measure the effect of patient anxiety upon test reproducibility.Design
Prospective observational study.Setting
Tertiary urogynaecological unit.Sample
Fifty‐six incontinent women undergoing 112 pad tests.Method
Two one‐hour pad tests were performed with natural diuresis one week apart prior to treatment. At the second test, serial ultrasound scans were performed until bladder volume reached that of the first test, followed by identical provocation.Main outcome measures
One‐hour pad loss, bladder volumes (Vol1, Vol2), anxiety VAS questionnaire.Results
Despite serial scanning, bladder volumes differed significantly. Median volume before second pad test was 541 mL, compared with 433 mls before first test (P<0.001). The second pad test was also significantly larger than first (median 16g vs 4g, P=0.017), and 13/56 (23%) women were dry on the first test but incontinent on the second. In 26 women (46%) both bladder volumes were similar, but the second pad loss was still significantly greater (median 14g vs 4g, P=0.037). The mean difference between tests was 10g and the limits of agreement were wide (ranging from –44 to +66 g difference for the test result). Women were more anxious about leaking during the first test (Median VAS during the first test was 2.8cm, compared with 0.6cm during the second test, P=0.008). 42.5% found the second test to be more typical.Conclusion
In women with similar bladder volumes, the test–retest reliability of the one‐hour pad test was judged to be clinically inadequate, as the first and second pad test could differ by –44 to +66g. Lower anxiety levels at the second test may account for this finding. The one‐hour pad test is a useful baseline measure of incontinence, but the poor repeatability suggests that is not an optimal measure of post‐treatment change.
Exploration of cyclical changes in memory and mood in postmenopausal women taking sequential combined oestrogen and progestogen preparations
Authors: Natale Vincenzo , Albertazzi Paola , Zini Monica , Di Micco Raffaele 
Published: December 2003

Objective
To investigate the effect of progesterone on cognitive function, mood, sleep quality and libido when added to oestrogen in sequential combined hormonal replacement therapy regimens.Design
Observational study over three hormonal replacement therapy cycles.Setting
Menopause Centre of Ospedale Maternità, Bologna, Italy.Population
Twenty‐three postmenopausal women with an average of 70 months of amenorrhoea (range 12 to 234 months) on different sequential combined hormonal replacement therapy regimen for an average of 15 months (range 3–48) months.Methods
Psychological testing for memory, mood, sleep quality and libido during the oestrogen only part of the cycle compared with the oestrogen‐progestogen part of the cycle.Results
Twenty women completed the six visits of the trial. The addition of progestogens to oestrogen appeared to benefit memory (P<0.01) but worsened mood (P<0.005). There was no evidence of change in other parameters such as sleep quality or libido.Conclusion
The addition of progestogens improved memory above what was obtained with oestrogen alone. This effect did not depend on an improvement of mood since the latter worsened during the progestogenic phase of an hormonal replacement therapy cycle. Progestogen added to oestrogen did not significantly influence sleep or libido.
Maternal plasma glucose at high altitude
Authors: Krampl Elisabeth , Kametas Nikos A. , Zegarra Ana Maria Cacho , Roden Michael , Nicolaides Kypros H. 
Published: December 2003

Objective
To compare plasma glucose in pregnant women living at very high altitude; pregnant women living at sea level; non‐pregnant women living at very high altitude; and non‐pregnant women living at sea level.Design
sectional study.Participants
Ninety‐four pregnant women attending for routine antenatal care at 8–42 weeks of gestation in Cerro de Pasco, Peru which is situated 4370 m above sea level; 122 pregnant women in Lima, which is at sea level; 22 non‐pregnant women in Cerro de Pasco; and 31 non‐pregnant women in Lima.Methods
Plasma glucose concentrations were measured in samples obtained from the antecubital vein between 8 am and 10 am after an overnight period of fasting for at least 10 hours.Results
Fasting plasma glucose was lower in women at high altitude than in those at sea level, and in both groups the level was lower in pregnant women than in non‐pregnant controls. The body mass index was not significantly different between all four groups, and it did not have a significant independent contribution in explaining the variance in fasting plasma glucose.Conclusion
Women native at high altitude have lower plasma glucose concentrations before and during pregnancy than those at sea level.
A comparison of oral and vaginal misoprostol tablets in induction of labour at term
Authors: Shetty Ashalatha , Danielian Peter , Templeton Allan 
Published: December 2003

Objective
To compare the efficacy of equivalent doses of orally administered with vaginally administered misoprostol in induction of labour at term.Design
A non‐blinded randomised controlled trial.Setting
Induction and labour wards of a UK teaching hospital.Participants
Two hundred and forty‐five pregnant women at term, with medical or obstetric indications for labour induction and unfavourable cervices.Methods
The women were randomly assigned to receive 50μgm of misoprostol orally or vaginally four hourly to a maximum of five doses.Main
outcome measures Interval from induction to vaginal delivery, mode of delivery, oxytocic and analgesic requirements in labour, neonatal outcome, patient satisfaction and acceptability.Results
The mean induction to vaginal delivery interval was significantly shorter in the vaginal group compared with the oral group (17.8h vs 27.9h: mean difference 10.1hrs, 95% CI 5.8–14.4). More women were delivered within 24 hours (80%vs 46.3%; RR 1.7, 95% CI 1.3–2.1) and fewer women needed oxytocin augmentation (39%vs 58.2%; RR 0.67, 95% CI 0.5‐0.9) in the vaginal group. There was no difference in the mode of delivery, analgesic requirements or neonatal outcomes in the two groups. There was a higher incidence of uterine hyperstimulation in the vaginal group (4.9%vs 0.8%, RR 6, 95% CI 0.07–48.7) and more caesarean sections were performed for fetal distress in this group (13%Vs 2.4%, RR 5.3, 95% CI 1.6–17.7), although the overall operative delivery rate was similar in the two groups.Conclusion
Misoprostol effectively induces labour, with the vaginal route of administration having a faster action than the oral route in equivalent doses. However, the more frequent occurrence of hyperstimulation and the higher intervention rate for fetal distress in the vaginal group could mean that the preferred route might be oral. More trials are needed to find the right oral dosage that combines efficacy with safety.
The effect of stopping smoking on cervical Langerhans'cells and lymphocytes
Authors: Szarewski Anne , Maddox Peter , Royston Patrick , Jarvis Martin , Anderson Malcolm , Guillebaud John , Cuzick Jack 
Published: December 2003

Objective
To investigate the effects of stopping smoking on cervical Langerhans’ cells and lymphocytes.Design
Prospective intervention study.Setting
A large family planning clinic in central London.Population
Women volunteers prepared to attempt to give up smoking for six months. Their most recent cervical smear showed no abnormality greater than mild dyskaryosis.Methods
The women were seen at three‐month intervals for six months. Reduction in smoking was assessed by self‐reporting and validated by salivary cotinine concentrations. Colposcopy and a biopsy of a normal area were performed at the first and last visits. Any area of abnormality was also biopsied at the final visit. Langerhans’ cells and lymphocytes were counted.Main
outcome measures Proportional changes in counts of Langerhans’ cells and lymphocytes with reduction in smoking.Results
Reduction in smoking by 20 to 40 cigarettes per day was significantly associated with a reduction of between 6% and 16% in counts of Langerhans cells, CD8 and total lymphocytes. Heavy smoking was significantly associated (P= 0.02) with an increased chance of persistent human papillomavirus infection. The presence of candida was associated with significantly higher counts of between 41% and 47% in total lymphocytes and CD8 lymphocytes. In contrast, the presence of anaerobic vaginosis was associated with significantly lower counts of between 16% and 30% in Langerhans cells, CD4 and CD8 lymphocytes.Conclusions
This large intervention study has demonstrated a clear relationship between reduction in smoking and changes in cervical immune cell counts. Future studies need to take into account cytokine interactions, which recent studies suggest may be significant in the immune response to both human papillomavirus and cervical intraepithelial neoplasia and the ever‐increasing complexity of the cell‐mediated immune system of the cervix.
Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial
Authors: Crowley Tessa , Low Nicola , Turner Andrew , Harvey Ian , Bidgood Ken , Horner Patrick 
Published: December 2003

Objective
To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis.Design
Randomised double‐blind placebo‐controlled trial.Setting
Two teaching hospitals and one district general hospital.Sample
Two hundred and seventy‐three women with bacterial vaginosis undergoing termination of pregnancy.Methods
Women with bacterial vaginosis, diagnosed using modified Spiegel's criteria, were individually randomised to receive either a 2 g metronidazole suppository or identical placebo per‐operatively. Participants, doctors and investigators were blinded to treatment allocation. Participants were asked to complete a questionnaire about post‐operative symptoms, visits to the general practitioner, antibiotic treatment, readmission to hospital, contraception and emotional response after one month.Results
The prevalence of bacterial vaginosis was 29.3% (326/1111). Intention‐to‐treat analysis showed that post‐operative upper genital tract infection developed in 12/142 (8.5%) women allocated to metronidazole and 21/131 (16.0%) women randomised to placebo, a difference of 7.6% (95% confidence intervals –15.4 to +0.2%; relative risk 0.53, 0.27 to 1.03, P= 0.055). The effect of prophylaxis was similar when the analysis was restricted to women receiving the allocated treatment and with complete follow up. There was no difference in the risk of readmission to hospital and the frequencies of self reported symptoms in the two groups were similar.Conclusion
This randomised placebo‐controlled trial among women with bacterial vaginosis provides weak evidence that metronidazole decreases the risk of upper genital tract infection after first trimester suction termination of pregnancy but a chance finding could not confidently be excluded. Large well‐conducted randomised trials with long term outcome measures are now needed to determine the most effective antibiotic combinations and strategy for prevention of post‐abortal pelvic infection.
Circulatory responses to maternal hyperoxaemia and hypoxaemia assessed non‐invasively in fetal sheep at 0.3–0.5 gestation in acute experiments
Authors: Kiserud Torvid , Jauniaux Eric , West Daniel , Ozturk Ozkan , Hanson Mark A. 
Published: December 2003

Objectives
To determine fetal haemodynamic responses to hyperoxaemia and hypoxaemia in early pregnancy.Design
Repeated measurements in acute experiments.Setting
Experimental physiology laboratory.Methods
Non‐invasive Doppler ultrasound of the umbilical vein, ductus venosus, umbilical and common carotid arteries of 12 fetal lambs (0.27–0.56 gestation) during maternal hyperoxaemia and hypoxaemia under ketamine anaesthesia. The effect of gestational age, hyperoxaemia, and hypoxaemia were assessed based on analysis of variance for dependent measurements and P≤ 0.05 was considered significant. Differences between groups were considered significant if the 95% confidence interval did not include zero.Results
Gestational age had a significant effect on the blood velocity in the umbilical vein and ductus venosus. There were no circulatory changes during hyperoxaemia, but a simultaneous increase of pCO2 was an important confounder. However, hypoxaemia caused significantly reduced heart rate, reduced maximum and weighted mean blood velocity, and augmented pulsation in the umbilical vein. Hypoxaemia also caused reduced velocities in the ductus venosus (peak velocity during systole and minimum during diastole, and time‐averaged velocity) and augmented pulsation of the flow velocity. Additionally, the pulsatility of blood flow increased in the umbilical artery and was reduced in the common carotid artery.Conclusions
Maternal hypoxaemia in early pregnancy causes similar fetal circulatory responses to those in late pregnancy: bradycardia, reduced venous flow velocities, augmented pulsatility in veins and a redistributional flow velocity pattern of the umbilical and common carotid arteries.