bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial
Authors: Langer Ana , Campero Lourdes , Garcia Cecilia , Reynoso Sofia 
Published: August 2005

Object
To evaluate the effects of psychosocial support during labour, delivery and the immediate postpartum period provided by a female companion (doula).Design
The effects of the intervention were assessed by means of a randomised clinical trial. Social support by a doula was provided to women in the intervention group, while women in the control arm received routine care.Setting
A large social security hospital in Mexico City.Participants
Seven hundred and twenty‐four women with a single fetus, no previous vaginal delivery, < 6 cm of cervical dilatation, and no indications for an elective caesarean section were randomly assigned to be accompanied by a doula, or to receive routine care.Outcome measures
Breastfeeding practices, duration of labour, medical interventions, mother's emotional conditions, and newborn's health.Methods
Blinded interviewers obtained data from the clinical records, during encounters with women in the immediate postpartum period, and at their homes 40 days after birth. Relative risks and confidence intervals were estimated for all relevant outcomes.Results
The frequency of exclusive breastfeeding one month after birth was significantly higher in the intervention group (RR 1.64; I‐C: 1.01–2.64), as were the behaviours that promote breastfeeding. However, the programme did not achieve a significant effect on full breastfeeding. More women in the intervention group perceived a high degree of control over the delivery experience, and the duration of labour was shorter than in the control group (4.56 hours vs 5.58 hours; RR 1.07 CI (95%) =−1.52 to −0.51). There were no effects either on medical interventions, mothers' anxiety, self‐esteem, perception of pain and satisfaction, or in newborns' conditions.Conclusions
Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions, perhaps because of the strict routine in hospital procedures, the cultural background of the women, the short duration of the intervention, and the profile of the doulas. It is important to include psychosocial support as a component of breastfeeding promotion strategies.
Association of circulating endothelin and noradrenaline with increased calcium‐channel binding sites in the placental bed in pre‐eclampsia
Authors: Ferreira‐de‐Almeida José A. , Amenta Francesco , Cardoso Filomena , Polónia Jorge J. 
Published: August 2005

Objective
To evaluate factors contributing to both placental hypoperfusion and maternal vasoconstriction in pre‐eclampsia.Design
Single centre, comparative study of calcium‐channel density and affinity in the placental bed of pregnant women with normotension and pre‐eclampsia.Setting
Teaching hospital.Participants
Twenty‐two primigravidae in the third trimester of pregnancy: 10 with pre‐eclampsia and 12 normotensive.Methods Plasma levels of endothelin‐1 (by RIA) and noradrenaline (by HPLC‐ED) were measured. Both pharmacological characterisation and anatomical localisation of dihydropyridine‐sensitive binding sites (using radioligand‐binding studies and autorradiographic techniques) were determined with 3H‐isradipine in placental bed tissues to determine both the density (Bmax) and the affinity (Kd) of receptor sites.Results
Higher plasma levels of endothelin‐1 and noradrenalin were found in women with pre‐eclampsia compared with normotensive women. Placental bed tissues bound 3H‐isradipine in a saturable, reversible time and temperature‐dependent manner with very low Kd values. Study of the 3H‐isradipine specificity binding included the use of several dihydropyridine displacers. In the group with pre‐eclampsia the Scatchard analysis of the results showed a significant increase (P < 0.001) both in the affinity [Kd = 0.23 nmol (0.04) vs 0.45 nmol (0.03), pre‐eclampsia vs norrnotensive] and in the density of calcium‐channel binding sites [Brnax = 77.70 frnol/rng (1.30) vs 64.30 fmourng (1.80) tissue, pre‐eclampsia vs normotensive]. Autoradiography confirmed that in the placental bed tissue of those with pre‐eclampsia there was a much higher silver grain density in the arteries walls, compared with norrnotensive women.Conclusions
In pre‐eclampsia there is an increase in the maternal circulation of two strong vasoconstrictor factors (endothelin‐1 and noradrenalin) and a sharp increase both in the density and the affinity of calcium‐channel binding sites in placental bed central area. The latter may strongly contribute to the perpetuation of the uteroplacental hypoperfusion either by itself or by amplifying the local actions of circulating factors, such as endothelin‐1 and noradrenalin.
Does gestational hypertension become pre‐eclampsia?
Authors: Saudan Patrick , Brown Mark A. , Buddle Megan L. , Jones Michael 
Published: August 2005

Objective
To determine the likelihood of progression from gestational hypertension (GH) to pre‐eclampsia (PE) in hypertensive pregnant women and whether this change can be identified in advance by available clinical and laboratory measures.Design
A retrospective analysis and a prospective study.Setting
St George Hospital, Sydney, a teaching hospital of the University of New South Wales delivering 2500 women per year.Population
Eight hundred and forty‐five women with new hypertension in the second half of pregnancy, managed by a uniform protocol (661 in the retrospective analysis, 184 in the prospective study).Methods
Clinical and laboratory data at initial presentation were compared among women with GH who developed PE and those who remained with a diagnosis of GH until delivery. Data predictive for progression from GH to PE were analysed by logistic regression analysis.Main Outcome Measured
Progression from GH to PE.Results
In the retrospective analysis, 416 women initially presented as having GH and 62 (15%) progressed to PE. In the prospective study, 112 women initially presented with GH and 29 (26%) progressed to PE, giving an overall progression of 17%. In both studies, women who developed PE from GH presented earlier than those who remained with GH until delivery. In multiple logistic regression analyses prior miscarriage and early gestation at presentation were associated with increased likelihood of progressing from GH to PE.Conclusion
Approximately 15–25% of women initially diagnosed with GH will develop PE and this is more likely with earlier presentation or if the woman has had a prior miscarriage. Women with gestational hypertension diagnosed after 36 weeks of gestation have only about 10% risk of developing PE. These data should help stratify the risks of mildly hypertensive pregnant women being managed as outpatients in their third trimester.
An immunohistochemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina
Authors: Hodgins Malcolm B. , Spike Rosemary C. , Mackie Rona M. , MacLean Allan B. 
Published: August 2005

Objective
Tomap potential sites of sex steroid action in the human vulva.Methods
Monoclonal antibodies to androgen, oestrogen and progesterone receptors were used to stainfrozen sections of vulval skin, vagina and suprapubic skin. A scoring system was devised to comparereceptor distribution in the epidermis and dermis of skin with vaginal epithelium and stroma.Results
Androgen receptors were seen in epidermal keratinocytes, sebaceous glands, sweat glands, hairfollicles and dermal fibroblasts of skin, and epithelial cells and stromal fibroblasts of the vagina. Androgen receptor scores were significantly higher in the epidermis of labia majora and minora thanin vaginal epithelium. Oestrogen receptors were seen in basal and suprabasal cells of vaginalepithelium and epidermis of labia minora but were restricted to basal keratinocytes in true skin.They were seen in stromal fibroblasts and vaginal smooth muscle, and dermal fibroblasts of theskin. Oestrogen receptors were highest in vaginal epithelium and stroma, and lowest insuprapubic skin. Progesterone receptors were seen in vaginal epithelium, fibroblasts and smoothmuscle but not in the vulva. There was no evidence of significant differences in androgen oroestrogen receptor staining in the vulva of pre‐ or postmenopausal women.Conclusion
The transition from vagina to vulva is marked by an increase in androgen and a decrease inoestrogen and progesterone receptors. This distribution of receptors would indicate a limited role foroestrogen creams on the vulva.
The effects of ovarian hormone deficiency on wound contraction in a rat model
Authors: Calvin M. , Dyson M. , Rymer J. , Young S.R. 
Published: August 2005

Objective
to demonstrate the effect of a deficiency of ovarian hormones on the process of wound contraction, using the oophorectomised rat model of the human menopause.Design
A randomised controlled trial.Population Ninety‐six adult Wistar rats were randomly allocated into either an oophorectomised groupor a sham‐oophorectomised control group.Methods Having confirmed a significant reduction in plasma oestradiol levels in the oophorectomisedrats, full‐thickness excised lesions were made in the flank skin of the adult rats at either two weeks orfour months after oophorectomy, so that the effects of two different durations of hormone deficiencycould be assessed and compared with the sham‐oophorectomised controls. Following wounding, therats were left for 3, 5, 10 or 22 days; wound contraction was assessed from photographs of thewounds taken at these intervals after injury.Results
In the rats wounded four months after oophorectomy there was a slower rate of woundcontraction, resulting in larger wounds at days 3, 5, 10 and 22, compared with control rats. No significant difference was observed in rats wounded two weeks after oophorectomy, indicating that the effects of ovarian hormone deficiency on this process are delayed.Conclusion
Due to the pivotal role of wound contraction in the process of wound healing these findingsmay be of clinical relevance and could have an important impact on the administration of hormonereplacement therapy.
A randomised trial of low dose aspirin for primiparae in pregnancy
Authors: Golding J. ,   on behalf of The Jamaica Low Dose Aspirin Study Group
Published: August 2005

Objective
To investigate whether low dose aspirin medication given to primiparous women provides benefit in preventing pre‐eclampsia or intrauterine growth retardation.Design
Randomised double‐blind controlled trial of low dose aspirin and placebo in pregnancy.Population Residents of the parishes of Kingston and St Andrew, Jamaica; 6275 primiparae enrolled between 12 and 32 weeks of gestation.Main outcome measures
Hypertensive disorders of pregnancy (including pre‐eclampsia and eclampsia), preterm delivery, and low birthweight. In addition, to assess whether enrolment early, rather than late had more beneficial effect. Possible adverse effects on the woman and her infant were monitored.Results
Of enrolled primiparae, 97% were followed throughout pregnancy. There were no differences between those on aspirin and those on placebo in the development of hypertensive disorders (e.g. for a rise in diastolic pressure of 25 mmHg the odds ratio [OR] was 1.02 [95% CI 0.86–1.211; for proteinuric pre‐eclampsia OR 1.15 [95% CI 0.92–1.44]; eclampsia OR 0.82 [95% CI 0.44–1.531); except for oedema which was significantly less prevalent in those on aspirin (OR 0.85 [95% CI 0.75–0.961). Women on aspirin were not significantly less likely to deliver preterm (OR 0.93 [95% CI 0–79‐1.091) or have a larger fetus (mean birthweight difference 18 g [95% CI ‐9 to 451). They were, however, significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum; for postpartum haemorrhage OR 1.40 (95% CI 1.13–1‐73).Conclusions This trial shows that low dose aspirin has no consistent beneficial effect in primiparae.
The Collaborative Randomised Amnioinfusion for Meconium project (CRAMP): 2. Zimbabwe
Authors: Mahomed K. , Mulambo T. , Woelk G. , Hofmeyr G. J. , Gülmezoǧlu A. M. 
Published: August 2005

Objective
To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.Design
Multicentre randomised controlled trial.Setting
A large urban academic hospital. Electronic fetal heart rate monitoring was not used.Participants
Women in labour at term with moderate or thick meconium staining of the amniotic fluid.Interventions
Transcervical amnioinfusion of 500 mL saline over 30 minutes, then 500 mL at 30 drops per minute. The control group received routine care. Blinding of the intervention was not possible.Main outcome measures
Caesarean section, meconium aspiration syndrome and perinatal mortality.Results
There was no difference in risk for caesarean section in the two groups (amnioinfusion 9.5%vs control 12.3%; RR 0.84, 95% CI 0.53–1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1%vs 12.8%; RR 0.24, 95% CI 0.12–0.48), and there was a trend towards fewer perinatal deaths (1.2%vs 3.6%; RR 0.34, 95% CI 0.11–1.06).Conclusions
Amnioinfusion is technically feasible in a developing country situation with limited intrapartum facilities. In this study amnioinfusion for meconium stained amniotic fluid was associated with striking improvements in perinatal outcome.
Pregnancy after heart or heart‐lung transplantation: a series of 10 pregnancies
Authors: Troché V. , Ville Y. , Fernandez H. 
Published: August 2005

Objective
To evaluate pregnancy after heart or heart‐lung transplantation in France.Design
A questionnaire survey of all French centres performing heart and heart‐lung transplants provided an exhaustive registry on pregnancy after transplantation.Methods
A questionnaire was sent to 36 centres. Anonymous reports on transplantation and subsequent pregnancies between 1984 and 1996 were analysed.Results
Of 1290 heart and 120 heart‐lung transplantation performed during the study period, 10 pregnancies (seven after heart transplantation and three after heart‐lung transplantation) were reported in nine women who were delivered of 11 infants. High blood pressure complicated nine pregnancies and severe pre‐eclampsia occurred in two. One woman developed Kaposi sarcoma of the cervix. Delivery at 35 weeks gestation (27–39) was by caesarean section in 50% cases. Mean birthweight was 1990 g (700–2880g) and 50% of the infants had a birthweight < tenth centile. One infant developed cardiomyopathy as a condition inherited from her mother, and congenital hepatitis B was diagnosed in another.Conclusions
Pregnancy after heart and heart‐lung transplantation is feasible and can be successful, but this should be planned when cardiac and respiratory functions are stable. Adequate obstetrical and genetic counselling should be provided.
Fetal growth velocity in the prediction of intrauterine growth retardation in a low risk population
Authors: Owen Philip , Khan Khalid S. 
Published: August 2005

Objective
To determine whether fetal growth velocity derived from two antenatal ultrasound measurements in the third trimester, 28 days apart, can identify infants born with anthropometric features of intrauterine growth retardation.Design
Prospective observational study.Setting
Department of obstetric ultrasound, Ninewells Hospital, Dundee.Subjects
Two hundred and seventy four low risk women participating in a longitudinal study of serial fortnightly ultrasound in pregnancy.Methods
Growth velocities of the fetal abdominal area and bi‐parietal diameter were calculated from the third from last and last measurements prior to delivery. Receiver Operator Characteristics curves were employed to determine an optimal cutoff point for velocity to predict intrauterine malnourishment.Main outcome measures
Likelihood ratios for fetal abdominal area and bi‐parietal diameter growth velocity in the prediction of growth retarded infants with skinfold thickness < 10th centile; ponderal index < 25th centile, or mid‐arm circumference to occipito‐frontal circumference ratio (MAC:OFC ratio) of less than ‐1 SD. A likelihood ratio of > 10 generates significant changes in the pre‐test probability of growth retardation, whereas a likelihood ratio of 5 to 10 generates only moderate changes.Results
Fetal abdominal area velocity predicted growth retardation with likelihood ratio 10.4 (95% CI 3.9 to 26) for skinfold thickness; likelihood ratio 9.5 (95% CI 4.6 to 19) for ponderal index; a likelihood ratio 4.7 (2.3 to 8.4) for MAC:OFC. Bi‐parietal diameter velocity predicted growth retardation with likelihood ratio 6.5 (95% CI 1.9 to 20) for skinfold thickness but did not predict low ponderal index or MAC:OFC ratio.Conclusions
Fetal abdominal area velocity is useful in identifying infants with reduced skinfold thickness or low ponderal index. Prospective evaluation of serial ultrasound and velocity calculation in a selected population at increased risk of growth failure and a clearer understanding of the relative significance of the different neonatal anthropometric measures of impaired growth achievement is necessary before the estimation of growth velocity can be recommended in clinical practice.
A multicentre study comparing cervicography and cytology in the detection of cervical intraepithelial neoplasia
Authors: De Sutter Ph. , Coibion M. , Vosse M. , Hertens D. , Huet F. , Wesling F. , Wayembergh M. , Bowlon C. , Autier Ph. 
Published: August 2005

Objective
To evaluate in a multicentre setting the performance of cervicography compared withDesign
Prospective comparative multicentre study.Setting
Three hospitals with outpatient gynaecology clinics and three cancer screening clinics.Participants and methods
Cervical cytology and cervicography were performed on 5724 women. If one or both tests showed an abnormality suggestive of at least a low grade squamous intraepithelial lesion, a colposcopy with directed biopsy was carried out. Cervicograms were evaluated by four experienced ‘senior’ assessors and by ten new ‘junior’ assessors.Results
Results were fully analysed for 5192 women (9l%). A cervical biopsy was carried out on 228 women and this confirmed a true positive lesion in 116 cases (incidence rate: 2.2%). Of these, 72 cases (62.1%) were detected by cervicography and 64 (55.2%) by cytology. This difference was not statistically significant (McNemar: P= 0.475). Only 20 cases of CIN (17%) were concordantly detected by both tests. Senior assessors performed significantly better with a detection capacity of 80.6% compared to a detection capacity of 56.6% for the junior assessors (χ2 test: P= 0.034).Conclusions
Cervicography must be considered as a complementary test to cytology. Overall detection of CIN is improved, but this is mainly due to the detection of more low grade lesions. The lower sensitivity and specificity in high grade lesions compared with cervical cytology is the main limitation of cervicography in screening for CIN. An important finding was that the performance of cervicography was highly dependent on the assessors’ experience.
Bone density in long term users of depot medroxyprogesterone acetate
Authors: Gbolade Babatunde , Ellis Sylvia , Murby Brian , Randall Sarah , Kirkman Rosemary 
Published: August 2005

Objective
To identify any adverse effect on bone density in long term users of depot medroxyprogesterone acetate (DMPA) for contraception.Design
Cross‐sectional measurement of bone density in users with amenorrhoea of more than one year or any woman using DMPA for more than five years.Setting
Community Family Planning Clinics in Portsmouth and Manchester.Population
One hundred and eighty‐five women aged 17–52 years (mean 33.3 years) who had used DMPA for between 1 and 16 years and were attending the clinics for further injections, between August 1994 and August 1996.Methods
Dual energy X‐ray measurement of bone density of femoral neck and lumbar spine, and venous blood sample taken just prior to the next injection of DMPA.Main outcome measures
Bone density of femoral neck and lumbar spine and serum oestradiol in relationship to years of DMPA use and duration of amenorrhoea.Results
Most women (n= 153) had serum oestradiol levels < 150 pmol/l. Despite this, the mean bone density of the lumbar spine compared with the population mean for women aged 20–59 years gave a Z score (95% CI) of ‐0.332 (‐0.510 to ‐0.154). There was no significant difference in the mean density of the femoral neck from the normal population mean.Conclusion
Despite amenorrhoea and low serum oestradiol, this sample of long term DMPA users had bone density only minimally below the normal population mean. We therefore found no clinically important adverse effect on bone density and therefore no reason to recommend bone conserving measures, such as add‐back oestrogen.
The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta‐analysis
Authors: Brocklehurst Peter , French Rebecca 
Published: August 2005

Objective
To investigate the association between maternal HIV infection and perinatal outcome 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 prospective cohorts with pregnant women identified as being HIV‐infected with a control group of pregnant women who were not infected with HIV. Methodological quality was assessed for each study. Data were extracted for pre‐determined outcome measures. Sensitivity analyses were performed to explore the association between HIV infection and an adverse perinatal outcome for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies controlled for potential confounding.Results
Thirty‐one studies were eligible to be included in the review. The summary odds ratio of the risk of pre‐defined adverse perinatal outcomes related to maternal HIV infection were as follows: spontaneous abortion 4.05 (95% CI 2.75–5.96); stillbirth 3.91 (95% CI 2.65.5–5.77); fetal abnormality 1.08 (95% CI 0.7–1.66); perinatal mortality 1.79 (95% CI 1.14–24.31); neonatal mortality 1.10 (95% CI 0.63–1.93); infant mortality 3.69 (95% CI 3.03–4.49); intrauterine growth retardation 1.7 (95% CI 1.43–2.02); low birthweight 2.09 (95% CI 1.86–2.35) and pre‐term delivery 1.83 (95% CI 1.63–2.06). Sensitivity analyses showed that the association between infant mortality and maternal HIV infection was stronger in studies conducted in developing countries when compared with developed countries [odds ratios (OR) 3.72 (95% CI 3.05–4.54) and 8.6 (95% CI 0.53–141.05), respectively]; studies of higher methodological quality compared with those of poorer quality [odds ratios 14.57 (95% CI 6.93–30.65) and 3.37 (95% CI 2.74.14), respectively] and studies which had used restriction or matching to control for potential confounding factors compared with those that had not [OR 11.60 (95% CI 5.71–23.58) and 3.35 (95% CI 2.73–4.12), respectively].Conclusions
The findings of this review have implications for women infected with HIV who are planning a pregnancy or who find themselves pregnant. There appears to be an association, although not strong, between maternal HIV infection and an adverse perinatal outcome. This relationship may be due to bias including uncontrolled or residual confounding. There does, however, appear to be a real and large increase in the risk of infant death in developing countries associated with maternal HIV infection, especially so when there has been an attempt to control for confounding.