bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia
Authors: Dwyer Nuala , Hutton John , Stirrat Gordon M. 
Published: August 2005

ABSTRACTObjective
To evaluate the effectiveness of endometrial resection as a surgical treatment for menorrhagia.Design
Randomised controlled trial.Setting
Gynaecology department at a teaching hospital.Subjects
Two hundred women needing surgical treatment for menorrhagia between January 1990 and May 1991. After withdrawal of four women 97 underwent hysterectomy and 99 underwent endometrial resection.Main outcome measures
Patient satisfaction 4 months after surgery; post‐operative complications; length of hospital stay; duration of time before return to work, normal daily activities and sexual intercourse; change in premenstrual symptoms.Results
The difference in patient satisfaction between endometrial resection (84 out of 99) and abdominal hysterectomy (89 out of 95) just reached statistical significance in favour of abdominal hysterectomy at 4 months after surgery (difference = 9%, 95% confidence intervals (CI) 1.1%–17.5%). Post‐operative morbidity, length of hospital stay and time taken to return to work, normal daily activities and sexual intercourse were significantly less in the endometrial resection group. However, the premenstrual symptoms of dysmenorrhoea, bloating and breast tenderness were less frequent after hysterectomy.Conclusion
In the short term, endometrial resection was almost as satisfactory as abdominal hysterectomy for the surgical treatment of menorrhagia, and was associated with less morbidity. However, even at 4 months after surgery, there was a failure rate of at least 10% in those in whom endometrial resection appeared complete. Longer term comparative studies are necessary before the widespread introduction of endometrial resection as an alternative to abdominal hysterectomy for the surgical treatment of menorrhagia.
The effect of early labour, maternal analgesia and fetal acidosis on fetal plasma oxytocin concentrations
Authors: Thornton S. , Charlton L. , Murray B. J. , Davison J. M. , Baylis P. H. 
Published: August 2005

ABSTRACTObjective
To determine the effect of early labour, maternal analgesia and fetal hypoxia on circulating fetal oxytocin concentrations.Design
Prospective observational study.Setting
Delivery suite in a District General Hospital.Subjects
Fifty women at term who did not require oxytocin administration or more than one form of analgesia. Study groups: vaginal delivery with (1) no analgesia, (2) pethidine, or (3) epidural analgesia. Caesarean section under regional analgesia (4) prior to, and (5) after the onset of labour.Interventions
Samples of blood were collected from the umbilical artery (UA) and umbilical vein (UV) immediately after fetal delivery prior to placental separation or oxytocic administration.Main outcome measures
Plasma oxytocin (OT) concentration, umbilical vein pH, cystine aminopeptidase activity.Results
The geometric mean UA–OT was significantly greater than UV–OT in all groups and was not altered by pethidine; however, epidural administration increased the UA–UV difference. The UA–UV difference at caesarean section was not significantly altered by the onset of labour. There was no correlation between UV pH and UA–UV plasma oxytocin. Cystine aminopeptidase activity was not detectable in UA and UV plasma.Conclusions
Fetal OT production is increased by epidural but not by pethidine analgesia. It is not influenced by the onset of labour or fetal hypoxia.
Levels of insulin‐like growth factor‐I and insulin‐like growth factor‐binding protein‐1 in pregnancy with preterm delivery
Authors: Wang Hsin‐Shih , Lee Cheng L. , Chard Tim 
Published: August 2005

ABSTRACTObjective
To investigate the relationship between preterm delivery and maternal serum insulin‐like growth factor‐I (IGF‐I) and insulin‐like growth factor‐binding protein‐1 (IGFBP‐1) levels.Design
A study over a 12 month period in which all samples were collected according to a pre‐set protocol.Setting
St. Bartholomew's Hospital, London.Subjects
Thirty‐eight nonpregnant adult females, 456 pregnant women at various gestational ages, 84 women with average‐for‐gestational‐age babies at term delivery, and 49 pregnant women with preterm delivery (44 with singleton pregnancy and five with twin pregnancy).Main outcome measures
Serum IGF‐I and IGFBP‐1 levels were determined by radioimmunoassay.Results
Serum IGF‐I concentrations increased as pregnancy progressed. In the third trimester, serum IGF‐I levels in singleton preterm deliveries were lower than those in normal pregnancies, and IGFBP‐1 concentrations were higher than those in normal pregnancies. This phenomenon was not obvious in the second trimester. Maternal circulating IGFBP‐1 levels were correlated inversely with birthweight in women with singleton preterm delivery.Conclusions
Neither IGF‐I nor IGFBP‐1 appears to play a significant role in preterm delivery since maternal serum IGF‐I and IGFBP‐1 levels are similar in preterm and term deliveries.
The incidence of vaginal bleeding with tibolone treatment
Authors: Rsymer J. , Fooelman I. , Chapman M. G. 
Published: August 2005

ABSTRACTObjective
To determine the incidence of breakthrough bleeding and its significance in recently postmenopausal women who take tibolone (Livial‐Organon).Design
A two year comparative nonrandomised prospective study of women taking tibolone (2–5 mg) and control subjects not on medication.Setting
Teaching hospital menopause and well women clinic.Subjects
One hundred women who were recently menopausal (between 6 and 36 months since last menstrual period). Fifty were commenced on tibolone and 50 received no medication.Main outcome measures Episodes of bleeding throughout the two year study period were recorded. Oestradiol levels were measured at baseline and at six, 12 and 24 months. The age of menopause and time since last menstrual period (LMP) were noted.Results
Twenty percent (12/59) (95% CI 11.0% to 32.8%) of women in the tibolone group had breakthrough bleeding compared with 9.4% (5/23) (95% CI 3.1% to 20.7%) in the control group. Of the women who bled in the tibolone group, 50% had LMP between six and 12 months prior to entering the study, and 83% were younger than the average age of menopause. Sixty‐seven percent had detectable oestradiol levels on at least one occasion over the two years (five women had detectable oestradiol levels and did not bleed). None had evidence of endometrial stimulation at dilatation and curettage. Eighty percent of women who bled in the control group were between six and 12 months since LMP on entry into the study, and 80% had detectable oestradiol levels during the study. At dilatation and curettage there was no evidence of endometrial stimulation.Conclusions
A minority of women will bleed on tibolone therapy. Women who are likely to bleed are younger, are recently menopausal, and may have remaining endogenous oestrogen production.
Taking account of vaginal bleeding in screening for Down's syndrome
Authors: Cuckle H. , Van Oudgaarden E. D. , Mason G. , Holding S. 
Published: August 2005

ABSTRACTObjective
To derive a method for revising the risk of Down's syndrome in maternal serum marker screening when there is vaginal bleeding. The effect on screening performance of routinely allowing for the presence or absence of bleeding in all women is also assessed.Design
Overview of published studies on the rate of reported vaginal bleeding in pregnancies with Down's syndrome, on the rate according to maternal age and on the association of bleeding with alpha‐fetoprotein (AFP) level. The publications are supplemented with data on unconjugated oestriol (uE3), human chorionic gonadotrophin (hCG) and AFP levels in a consecutive series of screened women.Setting
Routine Down's syndrome screening tests carried out on women having antenatal care at the St James's University Hospital, Leeds.Subject
Eight hundred and nine screened women.Results
In five studies the rate of vaginal bleeding in Down's syndrome pregnancies was 1.7 times that in unaffected pregnancies on average. In three studies, the vaginal bleeding rate increased proportionally by 2.2 % on average for each year of maternal age. Three studies and our own data were consistent with a 10% increase in the mean AFP level associated with vaginal bleeding, but it did not appear to materially alter uE3 and hCG levels or the standard deviations and correlation coefficients for any of the three analytes. An individual woman's risk was calculated by multiplying her age‐specific odds of Down's syndrome by two likelihood ratios, one relating to the vaginal bleeding itself and one from the marker levels. Routine allowance for the presence or absence of vaginal bleeding was estimated to increase the detection rate by less than 1%.Conclusion
Our method is of clinical value in revising the risk when there is concern that vaginal bleeding might be responsible for a negative maternal serum Down's syndrome screening result. A policy of routinely incorporating information on vaginal bleeding in risk estimation for all women would have too small an effect on overall screening performance to recommend it.
The cell adhesion molecule, VCAM‐1, is selectively elevated in serum in pre‐eclampsia: does this indicate the mechanism of leucocyte activation?
Authors: Lyall Fiona , Greer Ian A. , Boswell Fiona , Macara Lena M. , Walker James J. , Kingdom John C. P. 
Published: August 2005

ABSTRACTObjectiveTo determine whether circulating levels of cell adhesion molecules, markers of endothelial damage and leucocyte activation, were increased in pre‐eclampsia.DesignSerum was prepared from peripheral venous blood and stored at –70°C. The cell adhesion molecules, VCAM‐1, E‐Selectin and ICAM‐1, were measured by ELISA.SettingDepartment of Obstetrics and Gynaecology, Royal Infirmary, Glasgow.SubjectsSixteen primigravid women with pre‐eclampsia were recruited for the study. The pre‐eclampsia group were compared with 18 healthy primigravid women with uncomplicated pregnancies.ResultsThe pre‐eclamptic group had significantly higher serum levels of the cell adhesion molecule VCAM‐1 (t= 3.673;P< 0.001). There were no significant differences in the adhesion molecules ICAM‐1 or E‐Selectin.ConclusionsEndothelial damage and dysfunction are common to all the pathological features of pre‐eclampsia. This study shows that concentrations of cell adhesion molecules, which indicate leucocyte‐endothelial attachment and activation, are elevated in the serum of patients with pre‐eclampsia. Such increases in soluble circulating cell adhesion molecules may reflect increased expression of these molecules on the endothelium and thereby explain the mechanism for leucocyte activation in pre‐eclampsia.
Planned vaginal delivery after two previous caesarean sections
Authors: Chattopadhyay Sisir K. , Sherbeeni Mariam M. , Anokute Charles C. 
Published: August 2005

ABSTRACTObjective
To determine the outcome of trial of labour after two caesarean sections.Design
Prospective observational study.Setting
Maternity and Children's Hospital, Riyadh, Saudi Arabia.Subjects
Women with two previous caesarean sections considered suitable for a trial of vaginal delivery.Main outcome measures
The rates of vaginal delivery, scar dehiscence, uterine rupture and associated complications among 115 women with two previous sections who underwent trial of labour were compared with 1006 women with two previous sections who did not have a trial of labour.Results
Trial of vaginal delivery was requested by 230 out of 1136 women (20%) who had two previous caesarean sections. Of the 115 women accepted for the trial, 103 (89%) were delivered vaginally. Labour started spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin (PGE2) in the remaining 37. Augmentation of labour with oxytocin was required in 32 (28%) of the trial labour group. There were no scar dehiscences among the women delivered vaginally. There was one scar dehiscence and one woman required hysterectomy after failed trial of labour, a frequency comparable to the occurrence of these complications in women who did not have a trial of labour.Conclusion
A trial of labour in selected patients with two previous caesarean sections appears a reasonable option.
Fetal fibronectin detection for prediction of preterm birth in low risk women
Authors: Hellemans P. , Gerris J. , Verdonk P. 
Published: August 2005

ABSTRACTObjective To evaluate the clinical value of cervical fetal fibronectin detection by a quantitative enzyme‐linked immunosorbent assay (ELISA) (PTDcheck®, Adeza Biomedical, Sunnyvale, California, USA) as a screening tool for the prediction of preterm contractions and preterm delivery in an unselected population of pregnant women globally considered to be at low risk for preterm delivery (n = 133).Design A prospective study in which cervical fetal fibronectin samples were collected at two‐week intervals between 26 and 36 weeks of gestation.Setting A regional training hospital.Subjects One hundred and thirty‐three singleton pregnancies presenting consecutively at an antenatal clinic.Main outcome measure Occurrence of preterm contractions and preterm delivery (delivery at < 37 weeks of gestation).Results Twenty‐four (18 %) patients were considered positive for the presence of fetal fibronectin. Overall 15 patients (11%) developed preterm contractions and, despite therapeutic intervention, 10 patients (8 %) were delivered preterm. As a predictor for preterm contractions, cervical fetal fibronectin detection had a sensitivity of 47%, a specificity of 86%, a positive predictive value of 29% and a negative predictive value of 93%. As a predictor for preterm delivery, cervical fetal fibronectin detection had a sensitivity of 60%, a specificity of 85Y0, a positive predictive value of 25% and a negative predictive value of 96%.Conclusions Cervical fetal fibronectin determinations at a two‐week sampling frequency for prediction of preterm birth in a general obstetric population at low risk for preterm birth has limited clinical value as a routinely performed screening procedure.
Measurement of creatine kinase activity and diagnosis of ectopic pregnancy
Authors: Duncan W. C. , Sweeting V. M. , Cawood P. , Illingworth P. J. 
Published: August 2005

ABSTRACTObjective To investigate whether the measurement of maternal plasma creatine kinase concentration is of clinical value in the diagnosis of tubal ectopic pregnancy.Design A retrospective observational study covering a three month period.Setting The gynaecological emergency service of a UK teaching hospital.Subjects One hundred and twenty women presenting with clinical suspicion of an ectopic pregnancy such that plasma human chorionic gonadotrophin (hCG) concentration was measured.Main outcome measures Plasma hCG and creatine kinase concentrations were measured. Pregnancies were classified as ectopic pregnancy, complete miscarriage, incomplete miscarriage or ongoing pregnancy. Pregnancies were further classified as uncertain diagnosis if the diagnosis was not clear after initial investigation.Results Twenty‐one of the patients had an ectopic pregnancy. Diagnosis was classified as uncertain in 48 % of pregnancies studied and in 54% of ectopic pregnancies during the study period. The mean plasma creatine kinase was higher in ectopic pregnancies than other pregnancies in the study group (P < 0.01) and remained higher in the subgroup of patients with uncertain diagnosis (P < 0.05) but there were significant overlaps in creatine kinase concentrations in all four clinical groups. When a cut‐off point of 45 iu/l is used, the measurement of plasma creatine kinase activity has a sensitivity of 0‐57 and a specificity of 0.67 for the diagnosis of ectopic pregnancy.Conclusions The plasma concentration of creatine kinase is not sufficiently discriminative to be of clinical value in the diagnosis of tubal ectopic pregnancy.
Initial experience with laparoscopic‐assisted Doderlein hysterectomy
Authors: Garry Ray , Hercz Peter 
Published: August 2005

ABSTRACTObjective To assess the outcome of a modified laparoscopic‐assisted Doderlein hysterectomy.Define A prospective clinical study.Setting Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, Cleveland.Subjects Twenty consecutive women with indications for hysterectomy and unsuitable for vaginal approach.Intervention Laparoscopic‐assisted Doderlein hysterectomy with modification to make the technique cost effective.Main outcome measures Operative time, uterine weight, blood loss, hospital stay, intra‐operative complications and post‐operative complications.Results The median operative time was 93 minutes, the uterine weight was 168 g, blood loss minimal. The median hospital stay was three days. There were no intra‐operative complications and minimal post‐operative complications.Conclusions The modified laparoscopic‐assisted Doderlein hysterectomy is a safe, rapid procedure which allows the patient to achieve all the benefits of laparoscopic surgery with simple and inexpensive laparoscopic and vaginal techniques.
The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice
Authors: Brocklehurst P. , Carney O. , Ross E. , Mindel A. 
Published: August 2005

ABSTRACTObjective
To determine clinical practice amongst bstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection.Methods
All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection.Results
There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81)routinely examined the genitals for evidence of a recurrence.When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (χ2= 30.38, P < 0.0001). Five hundred and ninety‐six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture.The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was onsidered an acceptable indication for operative delivery by 745 obstetricians (62%).Conclusions
1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.
Transabdominal cervicoisthmic cerclage in the management of recurrent second trimester miscarriage and preterm delivery
Authors: GIBB DONALD M. F. , SALARIA DABEER A. 
Published: August 2005

ABSTRACTObjective
To evaluate the role of transabdominal cervicoisthmic cerclage (TCC) in the management of recurrent mid‐trimester pregnancy miscarriage and preterm delivery.Design
An observational study of 50 women with history of recurrent second trimester miscarriage and preterm delivery in whom TCC was performed.Setting
A tertiary referral centre for high risk obstetrics.Results
TCC was performed on 51 occasions in 50 women. One had TCC performed in two successive pregnancies. Prior to the procedure, they had experienced 36 first trimester miscarriages and 163 later pregnancy losses. These included 152 midtrimester miscarriages and 11 neonatal deaths after preterm delivery. There had been 4 survivors after preterm delivery. The total number of pregnancies after TCC was 61 with three women losing one pregnancy and subsequently having a successful pregnancy. Of these women 44 now have had a successful outcome. Six have not had a successful outcome. Eight women have had two successful consecutive pregnancies after TCC. The fetal survival was 85.2% post‐procedure.Conclusions
TCC is a procedure that may be used in a highly selected group of women with anatomical defects of the cervix and previous failed transvaginal cerclage resulting in recurrent second trimester pregnancy loss and preterm birth. Strict selection criteria were applied as TCC is an invasive procedure. Although TCC is not widely used our study suggests it may be the procedure to consider in women who have had recurrent second trimester pregnancy losses and preterm births associated with cervical damage.
Labour and delivery of ‘normal’ primiparous women: analysis of routinely collected data
Authors: Middle Claire , Macfarlane Allson 
Published: August 2005

ABSTRACTObjective
To ascertain whether there is variation in obstetric practice within a defined subgroup of primiparous women.Design
Analysis of routinely collected data.Subjects
Ten thousand two hundred and ninety‐five primiparous deliveries defined as ‘normal’ in Scotland during 1990 and 44,820 primiparous deliveries defined as ‘normal’ in England between April 1990 and April 1991.Results
Little variation was found in the distribution of mothers' ages and gestational ages at delivery, and babies' birthweights. In both England and Scotland there was considerable variation between regions in instrumental delivery rates and caesarean section rates. There were many deficiencies in the quality of the data provided by the English Maternity Hospital Episode System.Conclusions
There is regional variation in instrumental delivery rates and caesarean section rates in England and Scotland. The poor quality of data for England makes interpretation of the cause of variation difficult because the extent to which variation may reflect deficiencies in the data, rather than differences in practice, is unknown. Improvements need to be made in Maternity Hospital Episode system data, increasing both coverage and data quality. Nevertheless, similar variations in instrumental delivery and caesarean section rates may be associated with differences in population characteristics not measured in these data sets of differences in obstetric practice.