bluuebunny/crossref_metadata_2025_split huggingface dataset:
Very and moderate preterm births: are the risk factors different?
Authors: Ancel Pierre‐Yves , Saurel‐Cubizolles Marie‐Josèphe , Carlo Di Renzo Gian , Papiernik Emile , Bréart Gérard ,   A complete list of members of the Europop Group may be found on page 1169
Published: August 2005

Objective
To describe the risk factors for very pretenn births and to compare the strengths of the associations between these risk factors and very and moderate preterm births.Design
A case‐control study.Setting
Fifteen European countries.Methods
Between 1994 and 1997, 1675 very preterm births, 3652 moderate preterm births and an unmatched control group of 7965 births at term were included. Odds ratios for very and moderate preterm births (related to socioeconomic status, behavioural factors, maternal age, body mass index and obstetric history) were estimated and compared using polytomous logistic regression.Results
Underprivileged social situation, older maternal age and adverse previous pregnancy outcomes were significantly related to very and moderate preterm births. However, these factors were more strongly associated with very preterm births than with moderate preterm births, for both spontaneous and induced deliveries. Smoking during pregnancy, young maternal age and low body mass index were significantly related to very and moderate spontaneous preterm births, but no significant difference in odds ratios was observed between the two outcomes.Conclusion
These results suggest that risk factors for very and moderate preterm births are similar, but the strength of the associations differ, especially for social factors and obstetric history.
Intracranial haemorrhage as a cause of maternal mortality during 1991–1992 in Japan: a report of the Confidential Inquiry into Maternal Deaths Research Group in Japan
Authors: Sameshima Hiroshi , Nagaya Ken ,   A complete list of individuals in the research group can be found on page 1176
Published: August 2005

Objective
To determine the causes of maternal deaths by intracranial haemorrhage in Japan.Design
Retrospective analysis of records relating to maternal deaths in 1991 and 1992.Samples
Two hundred and thirty maternal deaths, including 25 cases of primary intracranial haemorrhage and two cases with secondary bleeding.Methods
Attending doctors were interviewed and completed a 600‐item data collection instrument for each maternal death. An expert committee reviewed the data for each death to determine whether the maternal deaths could have been prevented.Main outcome measures
Preventability of maternal death from intracranial haemorrhage treated in obstetric and emergency services in Japan.Results
Half of the primary intracranial haemorrhages occurred during pregnancy, 20% during labour, and 30% in the postnatal period. Neurosurgeons considered that there were only three women in whom surgical drainage was indicated. The committee determined that there was only one maternal death which had a 2 70% of being prevented. After detailed discussion of each case, 60% of the women (15/25) may have been saved by earlier and more intensive medical intervention.Conclusions
These findings suggest that detailed history taking and early diagnosis of intracranial haemorrhage would be helpful. Regionalisation of obstetric emergency systems are necessary to reduce maternal deaths in Japan due to intracranial haemorrhage.
The role of observer error in antenatal dipstick proteinuria analysis
Authors: Bell Stephen C. , Halligan Aidan W. F. , Martin Allison , Ashmore Jill , Shennan Andrew H. , Lambert Paul C. , Taylor David J. 
Published: August 2005

Objective
To determine the role of inter–observer error and the influence of training upon dipstick urine analysis.Design
A two phase observational and training studyMethods
Five standard solutions of serum albumin were used to test the accuracy of midwives and nursing auxiliaries involved in dipstick urine analysis at a maternity hospital. The standard solutions were chosen such that they should have resulted in negative (n= 2) and positive (n= 3) dipstick test results, respectively.Setting
A teaching maternity hospital and academic department of obstetrics and gynaecology.Participants
Twenty midwives, 20 nursing auxiliaries and nine laboratory technicians.Results
For the two nonproteinuric solutions, a higher false positive rate was observed for nursing auxiliaries(40% and 55%), compared with midwives (5% and 30%) (P= 0.020 and P= 0.20, respectively). Before training, laboratory technicians recorded high false positive rates (67% and 89%), but after training these were reduced to 0% and 22% (P= 0.25 and P= 0.023, respectively). Both nursing auxiliaries and midwives recorded false negative rates of between 10% and 45% for the three proteinuric solutions.Conclusions
Observer error may be reduced by assigning midwives to urine dipstick analysis or by the implementation of directed training. Classification of pre‐eclampsia or other hypertensive diseases of pregnancy on the basis of the presence and degree of proteinuria should be confirmed with a 24–hour quantitative protein collection.
Differences in umbilical cord serum lipid levels with mode of delivery
Authors: Yoshimitsu Nobuyuki , Douchi Tsutomu , Yamasaki Hideki , Nagata Yukihiro , Andoh Tetsuo , Hatano Hiromichi 
Published: August 2005

Objective
To investigate whether umbilical cord serum lipid levels differ with mode of delivery.Design
Retrospective observation study.Population
Two hundred and ninety mothers aged 29.1 years (SD 4.7) who had vaginal delivery, and 44 mothers aged 30.4 years (SD 4.7) who had elective caesarean section were enrolled.Main outcome measures
Maternal and umbilical cord blood were obtained immediately after delivery. Serum lipid levels including total cholesterol, high density lipoprotein cholesterol, saturated fatty acid, mono‐unsaturated fatty acid and polyunsaturated fatty acid were measured. Obstetric variables and serum lipid levels were compared between the two groups. In each group the correlations of fetal serum lipid levels with maternal serum lipid levels were investigated.Results
There were no significant differences in maternal age, neonatal weight, gestational duration, placental weight and neonatal gender distribution between the two groups. Only the two fetal serum lipid levels (including total cholesterol and non‐high density lipoprotein cholesterol) showed a correlation with maternal fetal lipid levels with correlation coefficients > 0.3 in the caesarean section group. However, saturated fatty acid, mono‐unsaturated fatty acid and total fatty acid levels in the non‐high density lipoprotein low density lipoprotein, very low density lipoprotein, intermediate density lipoprotein and free fatty acid fraction in the umbilical cord serum were significantly higher in the vaginal delivery cases (P < 0.01).Conclusions
Umbilical cord serum levels of saturated and mono‐unsaturated fatty acids increase during vaginal delivery.
A three‐year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence
Authors: Ulmsten Ulf , Johnson Per , Rezapour Masoumeh 
Published: August 2005

Objective
To study the long term results of tension‐free vaginal tape, a new ambulatory surgical procedure for treatment of female stress urinary incontinence.Study design
A prospective open study using a standardised protocol for pre‐ and post‐operative evaluation.Participants
Fifty consecutive women participated in the study. All suffered from genuine stress incontinence. The mean age was 57 years (SD 11), 42 women (84%) were multiparous, 8 (16%) nulliparous.Surgical method
Tension‐free vaginal tape implies the implantation of a prolene tape around mid‐urethra via a minimal vaginal incision. The procedure is carried out under local anaesthesia, allowing the surgeon to check intra‐operatively that continence has been obtained.Results
All the women except one could be operated on an ambulatory basis under local anaesthesia. Mean operation time was 29 minutes (range 16–47). Ninety percent of the women were able to micturate spontaneously within 24 hours with insignificant residual volumes. In another 10% of the women an in‐dwelling catheter had to be used temporarily. There was no need for long term post‐operative catheterisation (> 14 days). Post‐operative evaluation was carried out after 2 to 6, 12, 24 and 6 months. According to the protocol, 86% of the women were completely cured and another 11% were significantly improved. No signs of deterioration of the results over time were observed. No defect in healing or rejection of the tape occurred.Conclusion
We consider the tension‐free vaginal tape operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. The technique can be considered as an ambulatory procedure performed under local anaesthesia, allowing the majority of the women to be discharged from the clinic the same day or the day after the procedure.
Transvaginal ultrasonography and endometrial histology in peri‐ and postmenopausal women on hormone replacement therapy
Authors: Lindgren R. , Mattsson L.‐Å. , Andersson K. , Lagrelius A. , Sandin K. , Karlsson K. , Risberg B. 
Published: August 2005

Objective
To determine the association between endometrial thickness and endometrial histology in a large sample of women using HRT.Design
Results from three multi‐centre studies were combined.Participants
Five hundred and sixty‐four climacteric women were treated with either sequential, continuous combined or long‐cycle therapy.Main outcome measures
The women underwent 717 examinations with both transvaginal ultrasonography and histological examination of the endometrium. Endometrial thickness was measured and associated with the histological findings.Results
Eight cases of endometrial hyperplasia were diagnosed. All the hyperplasias were simple without atypia. Two cases had an endometrial thickness < 4 mm and two a thickness > 8 mm. The > 4 mm threshold for abnormal endometrium had a sensitivity of 75%, a specificity of 47%. a positive predictive value of 2% and a negative predictive value of 99%.Conclusion
No association could be found between the endometrial thickness measured by transvaginal ultrasonography and endometrial pathology. In six out of eight women with simple hyperplasia the endometrium measured > 4 mm.
Active contractions of the cervix in the latent phase of labour
Authors: Rudel Drago , Pajntar Marjan 
Published: August 2005

Objective
To study the activity of the human uterine cervix at the onset of labour and further characterise cervical asynchronous electromyographic (EMG) activity in the latent phase.Design
Prospective observational study.Setting
Clinical hospital in Ljubljana.Participants
Forty‐seven healthy nulliparous women with relatively unripe cervices requiring induction of labour.Methods
Simultaneous registration of a cervical EMG and of the intrauterine pressure at the very early stage of labour; subsequent EMG signal processing to determine its time, amplitude and frequency parameters.Main outcome measures
Simultaneous comparison of the cervical EMG and the mechanical activity of the uterine corpus to deduce electrical properties of the cervical smooth muscle tissue and its activity.Results
EMG bursts, asynchronous with the contractions of the uterine corpus, were registered in 20 out of 47 women. In 14 women bursts appeared independent of uterine corpus contractions and in six they followed the peak of contractions. The bursts had low average median frequency (0.3 Hz). In seven women bursts were superimposed onto a background EMG (median frcquency = 1–2 Hz).Conclusions
Bursts in the cervical EMG may appear asynchronously with the uterine contractions. Bursts not related to contractions suggest active and independent cervical muscle activity. The bursts which follow contractions may be an active response of the cervical musculature to passive stretching during a contraction. The EMG frequency content suggests two different contraction mechanisms or a different origin of the EMG in the cervix.
Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses
Authors: Morgante Giuseppe , la Marca Antonio , Ditto Antonino , De Leo Vincenzo 
Published: August 2005

Objective
To evaluate the ability of two malignancy risk indices (RMI 1 and Rh4I 2) incorporating menopausal status, serum CA125 level and ultrasound findings, to discriminate a benign from a malignant pelvic mass.Design
A retrospective study.Setting
Department of Obstetrics and Gynaecology, University of Siena, Italy.Population
One hundred and twenty‐four women over 30 years of age admitted consecutively between January 1995 and December 1997 for surgical excision of ovarian masses.Main outcome measures
The sensitivity, specificity, and positive predictive value of serum CA125, ultrasound findings and menopausal status, separately and combined into the RMI 1 and RMI 2, to diagnose ovarian cancer.Results
The RMI 1 and RMI 2 were more accurate than menopausal status, ultrasound findings, and CA125 separately in diagnosing cancer. For all cut off values between 80 and 250, RMI 2 performed better than RMI 1. The RMI 2 at a cut off level of 125 gave a sensitivity of 81%, specificity of 90%, and positive predictive value of 74%.Conclusions
We found that RMI 2 was more reliable in discriminating benign and malignant ovarian disease than RMI 1. RMI is a simple method which can be used in gynaecology clinics and less specialised centres.
Maternal and child health after assisted vaginal delivery: five‐year follow up of a randomised controlled study comparing forceps and ventouse
Authors: Johanson R. B. , Heycock E. , Carter J. , Sultan A. H. , Walklate K. , Jones P. W. 
Published: August 2005

Objective
To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study.Design
Follow up of a randomised controlled trial.Setting
District general hospital in the West Midlands.Population
Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty‐eight women responded (74.5%) and all were included in the study; forceps (n= 115) and vacuum extractor (n= 113).Main outcome measures
Bowel and urinary dysfunction, child vision assessment, and child development.Results
Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control ‘sometimes’ or ‘frequently’ by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97,95% CI 0.38–2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups.Conclusions
There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.
Serial colour flow duplex scanning of the veins of the lower limb throughout pregnancy
Authors: Sparey Colette , Sissons Guy , Haddad Nabil , Rosser Saskia , de Cossart Linda 
Published: August 2005

Objective
To examine changes in diameter and reflux in normal veins of the lower limb throughout pregnancy.Methods
Fifty‐seven women were recruited into the study and 43 completed the full assessment to six weeks postpartum. Thirteen had pre‐existing venous disease and are reported elsewhere. The veins were assessed in both lower limbs using colour flow duplex scanning. This was performed at a 75° tilt measuring vein diameter and the presence or absence of reflux. Measurements were made at 12, 20, 26, 34, 38 weeks of gestation and 6 weeks postpartum.Results
No new reflux developed in any of the veins studied. In the superficial system the maximum change was seen in the long saphenous vein at 34 weeks, on the left side the vein diameter failed to return to baseline size. Significant change also occurred in the superficial femoral vein. Dilatation of the deep veins of the calf was observed being greater in the left posterior tibia1 and the left peroneal at the mid‐calf point.Conclusion
Colour flow duplex scanning is an acceptable method of assessing the lower limb veins in pregnancy. Maximum diameter changes were seen in the long saphenous vein and in the deep veins at mid‐calf. No new reflux developed during the gestation period in veins which were previously normal.
Nonsurgical mid‐trimester termination of pregnancy: a review of 500 consecutive cases
Authors: Ashok Premila W. , Templeton Allan 
Published: August 2005

Objective
To assess the effectiveness of a regimen comprising mifepristone followed by a combination of the vaginal and oral administration of misoprostol for mid‐trimester medical termination of pregnancy.Design
Retrospective analysis of prospectively collected data in women undergoing mid‐trimester medical termination of pregnancy.Setting
Aberdeen Royal Infirmary, Scotland.Sample
A consecutive series of 500 women with pregnancies of 13–21 weeks of amenorrhea undergoing legally induced abortion in one Scottish NHS hospital.Methods
Each woman received a single oral dose of mifepristone 200 mg and 36–48 h later vaginal misoprosto1800 pg. Three hours following the first dose of misoprostol, 400 yg doses were administered orally at three hourly intervals, to a maximum of four doses. Success was defined as abortion occurring with five doses of prostaglandin, or within 15 h of administration of the first dose of prostaglandin.Results
Ninety‐seven percent aborted successfully. The median dose of misoprostol required was 1200 yg and the median induction‐toabortion interval after first prostaglandin administration was 6.5 h. The median number of doses of misoprostol required to induce abortion, and the induction‐toabortion interval, was statistically significantly higher among women at gestations 17–21 weeks than among those at 13–16 weeks (P= 0–0001). A total of 9.4% required surgical evacuation of the uterus under general anaesthesia and 66.4% of the women were managed as day cases.Conclusions
The combination of oral mifepristone 200 mg followed by vaginally and orally administered misoprostol provides a noninvasive and effective regimen for second trimester termination of pregnancy.
The effect of oestrogen supplementation on post‐menopausal urinary stress incontinence: a double‐blind placebo‐controlled trial
Authors: Jackson Simon , Shepherd Angela , Brookes Sara , Abrams Paul 
Published: August 2005

Objective
To investigate the effect of hormone replacement therapy on post‐menopausal urinary stress incontinence.Design
Double‐blind, placebo‐controlled, randomised trial.Setting
University associated teaching hospital.Population
Post‐menopausal women with genuine stress incontinence, not taking hormone replacement therapy.Methods
Randomisation to six months therapy with oestradiol valerate 2 mg daily or placebo. Assessment prior to treatment and upon study completion with the SF‐36 health status questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, a one week urinary diary, one hour perheal pad test, cystometry and urethral profilometry.Results
Sixty‐seven women consented to participate, 33 were randomised to receive oestradiol. Mean age was 63 years. Five women failed to undergo repeat assessment, three of whom were receiving oestrogen. Six women receiving oestradiol experienced breakthrough bleeding during the six months and were subsequently treated with additional monthly progestogen. No significant effect of oestrogen over placebo was observed for any subjective or objective clinical outcome.Conclusions
This trial is one of the largest controlled studies yet reported, with the longest duration of treatment. No improvement in post‐menopausal stress incontinence was demonstrated after six months therapy with oestradiol. This concurs with another study reported recently; it seems unlikely that oestrogen has a significant role to play in this condition. incontinence.
Investigation of the cause of miscarriage and its influence on women's psychological distress
Authors: Nikcevic Ana V. , Tinkel Sarah A. , Kuczmierczyk Andrzej R. , Nicolaides Kypros H. 
Published: August 2005

Objective
To determine whether knowledge of the possible cause of miscarriage reduces women's long term psychological distress.Design
Prospective longitudinal study.Setting
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London.Methods
In 143 women where a routine ultrasound scan at 10–14 weeks of gestation showed an anembryonic pregnancy or fetal death, investigations were carried out to help ascertain the cause of the pregnancy loss. The participants were divided into two groups according to whether the cause was identified or not, and the psychological conditions of the two groups were compared at four weeks and four months after the diagnosis of fetal loss. term psychological distress.Main outcome measures
Anxiety, depression, grief, self‐blame, worry.Results
The scores for all outcome variables were significantly lower at the four‐month compared with the four‐week post‐miscarriage assessment. A fetal chromosomal abnormality was the most commonly identified cause of miscarriage, and this group reported significantly less self‐blame than women in whom no cause was identified. There were no significant differences between the groups on any other outcome variables.Conclusions
In women with a missed miscarriage, identification of the cause of fetal loss reduces the feelings of self‐blame.
Estimation of fetal weight in twins: a new mathematical model
Authors: Ong Stephen , Smith Anne P. M. , Fitzmaurice Ann , Campbell Doris 
Published: August 2005

Objectives
Evaluation of new mathematical formula (Femur 4) derived from a twin population to estimate fetal weight in twins using ultrasound. Comparison of Femur 4 is with conventional mathematical models.Design
Retrospective analysis of ultrasonic measurements of 297 twin babies from 24 to 40 weeks of gestation who were born within 10 days of ultrasound examination.Setting
Aberdeen Maternity Hospital.Methods
With ultrasonic measurements obtained from twin babies, estimated fetal weight was calculated using the mathematical models of Campbell, Shepard and Hadlock. The calculations were repeated for the model of Femur 4. All models were compared against Femur 4.Results
The coefficient of determination of the linear regression between the actual and predicted weight was highest for Femur 4 (0,852). Femur 4 had the highest proportion of babies with estimated weights within 10% of actual birth weight (71.4%). In babies who weighed between 2000 and 3000 g, Femur 4 had the least systematic and random error of −1.69 and 8.96, respectively. For babies below the 10th centile for weight, Femur 4 had comparable positive and negative predictive values of 76.0% and 92.3%, respectively. Femur 4 was equally poor at predicting growth discordancy with positive and negative predictive values of 70.0% and 86.5% only.Conclusion
Femur 4 requires measurements of femur length and abdominal circumference only, hence avoiding the need to obtain difficult head measurements which is a common problem in twins. It is a good model for estimation of fetal weight in twins. However, prediction of growth discordancy remains problematic.