bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maintained bone density at advanced ages after long term treatment with low dose oestradiol implants
Authors: Naessén Tord , Persson Ingemar , Thor Leif , Mallmin Hans , Ljunghall Sverker , Bergström Reinhold 
Published: August 2005

ABSTRACTObjective
To investigate whether the bone preserving effect of low dose oestrogen replacement therapy (20 mg oestradiol implanted subcutaneously every six months) persists during continuous long term treatment through advanced ages.Design
Cross sectional clinical study of postmenopausal women treated with oestradiol implants as compared with nonusers matched for age.Setting
Outpatient research unit at a university hospital.Subjects
Thirty‐five women with a mean age of 67 years (range 47–83 years) at the time of investigation who, after a prior hysterectomy, had been treated with oestradiol implants for climacteric symptoms for a mean period of 16 years (range 5.5–31 years). The results were compared with those in women matched for age and without any diseases or medications known to affect the bone metabolism.Main outcome measures
Bone mineral densities (BMD) in the distal forearm, vertebrae and hip analysed by study group, age and duration of treatment.Results
Implant users had a median serum oestradiol concentration in the luteal range, 313 (range 126–1711) pmol/1, and premenopausal levels of follicle stimulating hormone (FSH). All women except one who were given the standard dose at the standard intervals had serum oestradiol levels below 650 pmol/1. Compared with nonusers, women treated with oestradiol implants had 20 to 25% higher BMD at all measurement sites: distal radius (P<0.0001), lumbar vertebrae (P<0.0002) and femoral neck (P<0.0001). These differences also remained after adjustment for potential confounders (height, age at menarche, parity, smoking habits, physical exercise and education) (P<0.01 at all sites). In a multiple regression analysis the negative effect of advancing age was more than compensated by the positive effect of increasing treatment duration with a higher BMD at all measurement sites in women with a longer as compared with shorter, duration of treatment; the regression coefficients were significant (P<0.05) in the spine and hip measurements.Conclusions
Continuous long term treatment with low dose oestradiol implants yielding physiological levels of serum oestradiol preserves both compact and cancellous bone and the effect seems to persist into advanced ages without any inevitable age related bone loss.
Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years' experience with a see‐and‐treat policy
Authors: Loobuyck Henk A. , Duncan Ian D. 
Published: August 2005

ABSTRACTObjective
To assess the efficacy of the Semm Cold Coagulator (100°C) for CIN 1 and 2 applying a ‘see and treat’ policy.Design
Retrospective review of women with CIN 1 and 2 seen and treated at their first visit when specific criteria were satisfied.Setting
Colposcopy Clinic, Ninewells Hospital, Dundee.Subjects
485 women with CIN 1 and 680 women with CIN 2 confirmed by colposcopically directed biopsy and treated between 1 January, 1978 and 31 December, 1990.Results
Overall, a 96.7% primary success rate with a single treatment (97.1% for CIN 1, 96.5% for CIN 2) and 99% overall success rate after one or more treatments with the cold coagulator. None of the women developed micro‐invasive or invasive cancer and only 1.1% developed CIN 3. In 98.3% treatment was undertaken at their first and only colposcopy clinic attendance. Heavy vaginal bleeding occurred in 1.5% after treatment and 0.6% complained of a heavy vaginal discharge. One woman developed cervical stenosis which required dilatation because of dysmenorrhoea.Conclusion
Cold coagulation at 100°C of CIN 1 and 2 proven by colposcopically directed biopsy using a ‘see and treat’ policy subject to specific conditions is a safe, cost effective, practical approach. It is more likely to return the cervix to sustained normality than withholding treatment and simply maintaining cytological surveillance, and it should prevent some of the invasive cancers that have been described in reports of management by cytological surveillance.
Plasma prostaglandin metabolite concentrations in normal and dysfunctional labour
Authors: Johnston Tracey A. , Greer Ian A. , Kelly Rodney W. , Calder Andrew A. 
Published: August 2005

ABSTRACTObjective
To determine the concentrations of the metabolites of prostaglandin E2 (PGEM) and of prosta‐glandin F2α (PGFM) prior to the onset of labour and during spontaneous labour, and to correlate the changes in concentrations of these metabolites with labour outcome.Design
Longitudinal study throughout labour.Setting
Labour ward of a large maternity unit.Subjects
Seven primigravid and 11 parous women in the late third trimester with no signs of labour, and 17 primigravid and 11 parous women in spontaneous labour.Interventions
Six of the primigravid women required augmentation with oxytocin because of dysfunctional labour.Results
Before labour, parous women had significantly higher concentrations of both PGEM (P<0.007) and PGFM (P<0.006) compared with primigravid women. During labour, PGFM concentrations were significantly higher in both primigravid (P<0.0002) and parous (P<0.0001) women compared with the concentrations of these metabolites in women not in labour; the same was true for PGEM in primigravid (P<0.003) but not in parous (P= 0.1) women. There was a small but significant increase (P<0.02) in PGEM as labour progressed in both the normal groups. Amniotomy was associated with a significant increase in PGFM in primigravid and parous women (P<0.002 and P<0.009, respectively). The concentration of PGFM one hour following amniotomy correlated inversely with the amniotomy to delivery interval in both the normal primigravid (r=−0.624; P= 0.04) and the parous (r= 0.745; P= 0.021) groups. Women with dysfunctional labour showed no significant rise in PGEM or PGFM. Their PGFM concentrations were significantly lower than those seen in normal labour (P<0.05). The concentration of PGFM in cord blood was significantly higher (P<0.0001) in the parous women who laboured than in women delivered by elective caesarean section. There was no difference in the corresponding concentrations of PGEM (P= 0.9).Conclusions
These data show that spontaneous labour is associated with increased concentrations of prostaglandin metabolites in the maternal plasma, and are consistent with PGF2α being an important stimulator of uterine contractility, with a relative deficiency of PGF2α being associated with dysfunctional labour.
The use of free β‐hCG in antenatal screening for Down's syndrome
Authors: Wald Nicholas , Densem James , Stone Rossana , Cheng Raymond 
Published: August 2005

ABSTRACTObjective
To investigate the value of the measurement of free β human chorionic gonadotrophin (hCG) as a serum marker of Down's syndrome in the second trimester of pregnancy.Design
A prospective observational study using stored antenatal serum samples.Setting
Serum samples collected from women receiving routine antenatal care in Oxford.Subjects
Seventy‐five singleton pregnancies with fetal Down's syndrome and 367 unaffected singleton pregnancies. Each affected pregnancy was matched with five control pregnancies for maternal age, gestational age, and duration of storage of the serum sample. None of the pregnancies were associated with neural tube defects.Main study measures
Maternal serum free β‐hCG levels. These were compared with total hCG levels in the same pregnancies. The performance of screening using free β‐hCG was compared with that using the principal markers, namely alpha‐fetoprotein (AFP), unconjugated oestriol (uE3), and total hCG together with maternal age.Results
The median free β‐hCG level in the affected pregnancies was 2.22 multiples of the normal median (MoM), significantly higher than in the unaffected pregnancies (95% confidence interval, 1.84–2.68 MoM). The discriminatory performances of free β‐hCG and total hCG, each considered separately, were similar; with a cut‐off level of 2.5 MoM the detection rate was 43% and 5.7% of unaffected pregnancies had raised free β‐hCG levels (likelihood ratio of 7.5 (43/5.7)), somewhat better discrimination than the 32% and 4.6% respectively using total hCG (likelihood ratio of 7.0 (32/4.6)). With a higher cut‐off level of 3.5 MoM, the rates were 19% and 2.7% respectively (likelihood ratio of 7.0), using free β‐hCG, worse than the 19% and 1.4% using total hCG (likelihood ratio of 13.6). Screening using maternal age, AFP, uE3 and free β‐hCG (instead of total hCG) yielded a detection rate of 62% (instead of 58%) at a screening risk cut‐off level corresponding to a 5% false‐positive rated).Conclusion
The main advantage in using free β‐hCG instead of total hCG is that there is a small increase in the detection rate (4%) for a given false‐positive rate when used with maternal age, AFP and uE3. The main disadvantage is that there is less practical experience with free β‐hCG measurement and insufficient data to screen in certain categories of pregnancy (e.g., twins). The best practical advice is to use total hCG for the present but consider changing to free β‐hCG either (i) after further data are available that will permit the interpretation of screening results in the same way as is currently available with total hCG, or (ii) if its use with another marker confers a worthwhile increase in the detection rate for a given false–positive rate.
The value of cytology and colposcopy in the follow up of cervical intraepithelial neoplasia after treatment by laser excision
Authors: Mahadevan N. , Horwell D. H. 
Published: August 2005

ABSTRACTObjective
To determine the value of colposcopic assessment in the follow up of cervical intraepithelial neoplasia (CIN) treated by laser excision.Design
Retrospective analysis of case records of women with CIN treated by laser excision over the period 1986 to 1990.Setting
A colposcopy clinic in a district general hospital.Subjects
Five hundred‐forty consecutive patients with either CIN or microinvasion diagnosed on laser excision specimens.Results
Of 452 patients followed up for 10 months, 14 were diagnosed as having persistent CIN. Eleven of these were detected at the first follow up visit at four months using both colposcopic and cytological assessment. Elimination of colposcopic assessment in follow up would have reduced the number detected to five patients.Conclusion
For patients undergoing laser excision for CIN involving the endocervical canal, a normal initial, post‐treatment colposcopy is necessary before surveillance may be reduced to cytology alone.
The effect of the oxytocin antagonists, CAP 476 and F327, on calcium mobilisation in single cultured human myometrial cells
Authors: Thornton S. , Gillespie J. I. , Anson L. C. , Greenwell J. R. , Melin P. , Dunlop W. 
Published: August 2005

ABSTRACTObjective
To investigate the mechanism of action of the oxytocin (OT) antagonists, CAP 476 and F327.Design
A prospective descriptional study.Subjects
Women undergoing caesarean section at term or hysterectomy.Interventions
Myometrial cells were cultured from uterine biopsies.Main outcome measures
Intracellular calcium ([Ca2+]i), determined in single cells.Results
Application of OT caused a transient increase in [Ca2+]i. CAP 476 abolished and F327 reduced the response to OT but neither reduced the [Ca2+]i transient induced by cell depolarisation with 120 mmol K+. CAP 476 did not reduce transients caused by prostaglandin E2. F327 reduced the frequency of repetitive [Ca2+]i transients occurring during continuous application of OT.Conclusions
The results demonstrate that the antagonists reduce the effect of OT and that their action is relatively specific. Their mechanism of action as clinical tocolytic agents is discussed.
Ampicillin and metronidazole treatment in preterm labour: a multicentre, randomised controlled trial
Authors: Norman K. , Pattinson R. C. , de Souza J. , de Jong P. , Moller G. , Kirsten G. 
Published: August 2005

ABSTRACTObjective
To ascertain whether adjuvant ampicillin and metronidazole given to women in preterm labour with intact membranes would prolong pregnancy and decrease the perinatal mortality and morbidity.Design
A multicentre, prospective, randomised controlled trial.Setting
Three perinatal centres serving an indigent population.Subjects
Eighty‐one women in active preterm labour with otherwise uncomplicated singleton pregnancies between 26 and 34 weeks gestation or an ultrasound fetal weight estimate of 800 g to 1500g.Interventions
The study group received ampicillin and metronidazole for five days. The control group received no antibiotics. In all women contractions were suppressed with hexoprenaline and indomethacin for 24 h, and betamethasone was given for fetal lung maturity.Main outcome measures
Days gained and perinatal mortality and morbidity.Results
The study (n= 43) and control groups (n= 38) were comparable at entry. In those receiving ampicillin and metronidazole the pregnancy was significantly prolonged (median 15 days versus 2.5 days, P= 0.04) with significantly more women still pregnant after seven days (63%versus 37%, P= 0.03, OR 0.34 95% CI 0.13–0.94). Significantly more infants in the control group developed necrotising enterocolitis than in the study group (5 versus 0, P= 0.02).Conclusion
Adjuvant ampicillin and metronidazole in the management of women in preterm labour with intact membranes significantly prolonged the pregnancy and decreased neonatal morbidity.
Behavioural state dependency of renal artery and descending aorta velocimetry and micturition in the normal term fetus
Authors: de Koekkoek‐Doll Petra K. , Stijnen Theo , Wladimiroff Juriy W. 
Published: August 2005

ABSTRACTObjective
To examine the behavioural state dependency of renal artery and descending aorta pulsatility index and hourly fetal urinary production rate (HFUPR) in the normal term fetus.Design
An observational study.Subjects
Twenty‐three healthy women with a normal singleton pregnancy between 36 and 40 weeks gestation.Main outcome measures
Renal artery and descending aorta pulsatility indices were established using pulsed Doppler ultrasound. HFUPR (ml) was estimated using real‐time ultrasound. Fetal behavioural states 1F (quiet sleep) and 2F (active sleep) were determined from combined recordings of fetal heart rate, eye movements and body movements.Results
An inverse correlation between pulsatility index and fetal heart pattern was established for both the renal artery (r= 0.60; SD = 0.22; P= 0.0001) and the descending aorta (r= 0.73; SD = 0.16; P= 0.0001). The difference in mean pulsatility index between states IF and 2F adjusted for fetal heart pattern was 0.09 (SD 0.23) for the renal artery (P= 0.02) and 0.26 (SD 0.19) for the descending aorta (P= 0.0001). Mean HFUPR was significantly higher (44.8 %, P= 0.01) in state 1F (96 ml) compared with state 2F (54 ml) During the urinary filling phase, a poor correlation existed between renal artery pulsatility index and HFUPR (r= 0.04) and between descending aorta pulsatility index and HFUPR (r= 0.01).Conclusions
In the normal term fetus renal artery and descending aorta pulsatility indices are reduced during fetal behavioural state 2F, suggesting reduced downstream impedance at the fetal trunk and in particular at renal level. This behavioural state is, however, also associated with reduced micturition. No correlation exists between renal artery and descending aorta pulsatility indices and fetal urinary output.
Platelet activation in normotensive and hypertensive pregnancies complicated by intrauterine growth retardation
Authors: Norris L. A. , Sheppard B. L. , Burke G. , Bonnar J. 
Published: August 2005

ABSTRACTObjective
To study platelet function in normotensive and hypertensive intrauterine growth retardation (IUGR).Design
ADP and collagen induced whole blood platelet aggregation, β‐thromboglobulin release and platelet count were measured in the IUGR groups at a mean gestational age of 36 weeks (28–40), and at 1, 24, 48 h and six weeks post delivery. The normal pregnancy group were studied serially at 12, 20, 28, 32 and 36 weeks of gestation and at 1, 24, 48 h and six weeks post delivery.Setting
Trinity College Medical School, St. James's Hospital, Dublin.Subject
Twenty‐nine women with a fetus with diagnosed IUGR were recruited for the study. Of these, 15 were normotensive throughout their pregnancy and the remaining 14 pregnancies were complicated by both hypertension and proteinuria. Twenty healthy primigravida acted as controls.Results
In the hypertensive IUGR group, levels of collagen and ADP induced aggregation were almost 50% lower before delivery than in normal pregnancy. Platelet count in the hypertensive group was decreased by 30% compared with normal pregnancy. Levels of β‐thromboglobulin were 40 to 50% higher in both the normotensive and hypertensive IUGR groups compared with normal pregnancy. Unlike the hypertensive IUGR group, the normotensive IUGR group showed similar levels of platelet count and ADP and collagen induced aggregation to those found at 36 weeks of normal pregnancy. In the early puerperium of hypertensive pregnancies, the platelet parameters measured returned gradually to normal. The normotensive IUGR group had increased levels of ADP induced aggregation in the first 24 to 48 h post delivery. The platelet count in the normotensive but not the hypertensive group correlated with birthweight.Conclusions
Normotensive and hypertensive IUGR are accompanied by platelet activation. In normotensive IUGR, this activation appears to be confined to the uteroplacental circulation. In hypertensive IUGR, the results suggest that platelet activation also extends into the peripheral circulation resulting in a reduced platelet responsiveness and a lower platelet count. Release of vasoactive amines from activated platelets in the peripheral circulation may be responsible for the clinical syndrome of hypertension and proteinuria present in pregnancies complicated by pre‐eclampsia and IUGR but absent in normotensive IUGR.
Ductus venosus flow velocity waveforms in relation to fetal behavioural states
Authors: Huisman Tjeerd W. A. , Brezinka Christoph , Stewart Patricia A. , Stijnen Theo , Wladimiroff Juriy W. 
Published: August 2005

ABSTRACTObjectives
To establish the reproducibility of flow velocity waveforms in the human ductus venosus and to assess the influence of fetal behavioural states on these waveforms in normal term fetuses.Design
Reproducibility of Doppler waveform recording and analysis was studied in 10 normal pregnancies. The relation between ductus venosus flow velocities and behavioural states was investigated in 19 other term fetuses. Time‐averaged, peak systolic, peak diastolic velocity, peak systolic/diastolic ratio and period time were calculated in both cross sectional studies.Setting
Outpatient clinic, department of obstetrics (prenatal diagnosis section), Academic Hospital, Rotterdam—Dijkzigt.Subject
Twenty‐nine women with normal singleton pregnancies at 36 to 39 weeks of gestation, resulting in uncomplicated births of healthy infants.Results
Within‐patient coefficients of variation, ductus venosus waveform recordings were approximately 8 to 10% except for the peak systolic/diastolic ratio (4.3%). A decrease of approximately 30% was established for peak systolic, peak diastolic velocity and time‐averaged velocity during behavioural state 1F (quiet sleep) as compared with state 2F (active sleep).Conclusions
Flow velocity waveform recording in the ductus venosus demonstrates acceptable reproducibility. Fetal behavioural state‐dependent changes were observed, suggesting a redistribution of umbilical venous blood through the ductus venosus shunt during the quiet sleep state.
Mifepristone for labour induction after previous caesarean section
Authors: Lelaidier C. , Baton C. , Benifla J. L. , Fernandez H. , Bourget PH. , Frydman R. 
Published: August 2005

ABSTRACTObjective
To evaluate the efficacy and tolerance of mifepristone in women undergoing induction of labour at term after previous caesarean section.Design
A prospective double blind placebo controlled trial.Subjects
Thirty‐two women at term (after 37.5 weeks' amenorrhea) who had had a previous caesarean delivery with a low transverse uterine incision. All women had a clear clinical indication for induction of labour with unfavourable cervical conditions (Bishop's score < 4). They were randomised to receive either 200 mg of mifepristone or placebo on days one and two of a four‐day observation period.Results
Thirteen women entered spontaneous labour: 11 were treated with mifepristone and two were in the control group (P < 0.01). Thirteen women, still with an unfavourable cervix on day four needed cervical ripening with vaginal tablets of prostaglandins. Of these, four had received mifepristone and nine the placebo. Mean oxytocin requirements were lower in the mifepristone group (P < 0.01) and the mean time interval between day one and start of labour was also significantly shorter in this group. Mode of delivery and neonatal outcome were similar in both groups.Conclusions
Induction of labour is facilitated in term women with prior caesarean section by the use of mifepristone. This induction agent appears safe and useful with no adverse events on the fetus or mother.
The effect of maternal oxygen administration on human fetal cerebral oxygenation measured during labour by near infrared spectroscopy
Authors: Aldrich C. J. , Wyatt J. S. , Spencer J. A. D. , Reynolds E. O. R. , Delpy D. T. 
Published: August 2005

ABSTRACTObjective
To test the hypothesis that intrapartum maternal oxygen administration increases fetal cerebral oxygenation during normal labour.Design
A prospective study comparing changes in fetal cerebral concentrations of oxyhaemo‐ globin, deoxyhaemoglobin and cerebral blood volume measured by near infrared spectroscopy, before, during and after maternal oxygen administration using a 60% Ventimask.Setting
Teaching hospital obstetric unit.Subjects
Ten term fetuses during uncomplicated labour.Results
Maternal oxygen administration for 15 min resulted in a significant increase in the mean concentration of fetal cerebral oxyhaemoglobin (0.78 μmol (SD 0.42) 100 g‐1 brain tissue, P < 0.001) and a significant decrease in the mean concentration of deoxyhaemoglobin (0.80 μmol (SD 0.51) l00 g‐1, P < 0.00l). These changes were associated with a significant increase in the calculated mean cerebral oxygen saturation from 43.9 % (SD 6.3) to 57.3 % (SD 5.6) (P < 0.001). The maximum rise in cerebral oxyhaemoglobin concentration occurred at a mean of 10.7 min (SD 3.9) following commencement of oxygen administration. On returning to air breathing these changes reversed. There were no changes in cerebral blood volume.Conclusion
Maternal oxygen administration during normal labour leads to a significant rise in fetal cerebral oxygenation.