bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial haemorrhage in Shizuoka prefecture
Authors: Nishiguchi Tomizo , Saga Kozue , Sumimoto Kazuhiro , Okada Kazuchika , Terao Toshihiko 
Published: August 2005

Objective
To compare three methods of vitamin K prophylaxis for neonatal vitamin K deficient intracranial haemorrhage.Design
We designed three strategies for vitamin K prophylaxis: 1. therapeutic administration of vitamin K in a mass screening system using the hepaplastin test; 2. routine oral administration of vitamin K to newborn infants; and 3. administration of vitamin K to lactating mothers during the late neonatal period in addition to the routine method. We evaluated the efficacy of these methods by determining hepaplastin test values at the first month of age.Population
66,076 full term healthy newborn infants without any complications.Results
Of 55,513 infants in the mass screening system, 3068 infants received vitamin K therapeutically. At the first month of age, in the group where vitamin K was administered therapeutically, 56 infants (1.83%) exhibited low hepaplastin test values (< 40%) despite vitamin K administration. But extremely low values (< 20%), indicating a very high risk of neonatal intracranial haemorrhage, were observed in 34 (0.06%) of 52,445 infants who did not receive vitamin K. In the routine administration system, oral administration of vitamin K twice within the first week of life showed a lower incidence (0.19%) of low level cases than a single administration (1.56%). An additional administration of vitamin K to lactating mothers throughout the late neonatal period showed an effective result.Conclusions
These findings suggest that vitamin K prophylaxis might reduce the risk of developing neonatal intracranial haemorrhage, but a complete prevention of this disease could not be achieved by oral administration of vitamin K. The transmission of vitamin K through breast milk would be a suitable method of vitamin K prophylaxis.
Emergency contraception: a survey of women's knowledge and attitudes
Authors: Smith Blair H. , Gurney Elaine M. , Aboulela Leila , Templeton Allan 
Published: August 2005

Objective
To assess women's knowledge and attitudes in relation to emergency contraception and to identify ways in which these might be improved.Design
Postal survey: questionnaire seeking level of knowledge of emergency contraception, and attitudes to use, publicity and availability.Population
A stratified random sample of 2000 Grampian women aged 18 to 47. Women were identified through the Community Health Index.Results
Most women (94%) were aware of emergency contraception and identified an appropriate source. Fewer (39%) knew the correct timing for its use. These figures were generally higher among younger, single women. The popular media represented the commonest source of information, and GPs and Family Planning Clinics were cited rarely. Increased advertising was considered desirable by 71% (mainly older women); only 36% (mainly younger, single women) considered over‐the‐counter availability desirable. Reasons for these responses and factors influencing them were explored.Conclusions
Knowledge of emergency contraception is greatest among those most likely to use it, but deficient mainly in relation to the correct timing for its use and to intrauterine methods. Publicity should concentrate on the timing of its use. The popular media are an important publicity vehicle, but health professionals appear to be under‐used. Many women hold opinions on advertising and over‐the‐counter availability of emergency contraception which will have to be considered if deregulation proceeds.
Using a logistic model to identify women with first‐trimester spontaneous abortion suitable for expectant management
Authors: Nielsen Sven , Hahlin Mats , Odén Anders 
Published: August 2005

Objective
To design a method to identify women with first trimester spontaneous abortion suitable for expectant management.Design
A stepwise logistic regression analysis based on retrospective analysis of clinical and biochemical variables.Setting
Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden.Participants
One hundred and three women with inevitable or incomplete spontaneous abortion at < 13 weeks of gestation were chosen for expectant management. Eighty‐one women with complete spontaneous abortion (i.e. complete expulsion and/or resolution of pregnancy products within three days of expectant management) were compared with those (n= 22) who underwent surgical evacuation of the uterus, most commonly owing to retained products of conception after three days.Results
Employing a stepwise logistic regression procedure, five diagnostic variables possessing prognostic power were identified: serum progesterone, daily serum hCG change, serum CA125, serum alpha fetoprotein and intrauterine diameter. The logistic regression analysis was also applied to three diagnostic variables chosen for routine clinical use: serum progesterone, serum hCG and intrauterine diameter. The probability of complete spontaneous abortion within three days of expectant management in each woman could be calculated.Conclusion
We have used a logistic model to calculate the probability of complete spontaneous abortion within three days in women with first trimester miscarriages. Such information may be of clinical use in caring for women, as well as for development of management guidelines for those with miscarriages.
Fetal pathology in intrauterine death due to parvovirus B19 infection
Authors: Wright C. , Hinchliffe S. A. , Taylor C. 
Published: August 2005

Objective
To study the pathological features of fetuses dying because of parvovirus B19 infection, with particular reference to the presence of hydrops; to assess the usefulness of immunochemistry as a screening method for the detection of parvovirus infection at post‐mortem examination.Design
Review of clinical, sonographic, serological and pathological data; immunohistochemical staining of post‐mortem tissue.Sample
Cases of intrauterine fetal death occurring during the 18‐month period January 1993 to June 1994 inclusive, referred for post‐mortem examination to the Pathology Department, Royal Victoria Infirmary, Newcastle upon Tyne.Results
Eleven cases of fetal death due to parvovirus infection were identified. Seven fetuses were less than 18‐week size. Three fetuses showed conspicuous hydropic change. One of the 11 cases was detected for the first time by retrospective immunochemical screening. Of cases originating from the Newcastle district, parvovirus infection was responsible for about 10YO of all non‐malformed fetal deaths occurring between 10 and 24 weeks of gestation referred for pathological examination.Conclusions
During the period of study, parvovirus infection was a relatively common cause of mid‐trimester fetal death. Many fetuses dying because of this infection are not noticeably hydropic, and the possibility of parvovirus infection should be considered in any case of intrauterine fetal death. Immunochemistry can be used to confirm the histopathological diagnosis, and may be of particular help where there is advanced autolysis; immunohistochemical screening may detect occasional cases not initially identified by examination of routinely stained tissue sections.
Randomised trial comparing hysterectomy and transcervical endometrial resection: effect on health related quality of life and costs two years after surgery
Authors: Sculpher Mark J. , Dwyer Nuala , Byford Sarah , Stirrat Gordon M. 
Published: August 2005

Objective
To compare the impact of endometrial resection and abdominal hysterectomy on a range of health outcomes and health service costs, based on longer term follow up of patients randomised to a clinical trial.Design
A parallel group randomised control trial.Setting
The gynaecology department of a teaching hospital.Participants
196 women requiring surgical treatment for menorrhagia were randomised and received surgery (88 underwent resection and 97 hysterectomy). Longer term follow up was undertaken using a postal questionnaire sent to all 196 women.Main outcome measures
Longer term assessment was on the basis of menstrual symptoms, health related quality of life using the Short Form 36 (SF36) and the EuroQo1 visual analogue scale, patient satisfaction and health service resource cost.Results
Of 196 women who were sent a questionnaire, 155 (79%) responded at an average interval of 2.8 years after initial surgery. All aspects of health outcomes were as good or better in patients randomised to hysterectomy. Among patients randomised to resection, 57% had experienced no improvement in premenstrual symptoms following surgery and 23% had taken time off work due to menstrual problems; among hysterectomy patients, these rates were 23% and YO, respectively. Women randomised to hysterectomy had better mean scores on seven of the eight dimensions of the SF36 health related quality of life instrument, with the greatest difference being on the pain dimension (P= 0.01). Women randomised to hysterectomy were generally more satisfied with treatment (P= 0.002). By two years after initial surgery, women randomised to resection had a 12% probability of having had a repeat resection and a 16% chance of having had a hysterectomy. As a percentage of the mean total cost associated with women randomised to hysterectomy, the mean total cost of resection was 53% based on four months follow up; this proportion had increased to 71 YO, based on an average overall follow up of 2.2 years.Conclusions
These results show that, at an average follow up of 28 years among responders to a questionnaire, women randomised to hysterectomy experienced more of an improvement in menstrual symptoms and higher rates of satisfaction with treatment. There is also some evidence of superior health related quality of life amongst hysterectomy patients. However, the health service cost of endometrial resection remains lower than that of hysterectomy. An assessment of the relative cost effectiveness of the two procedures awaits further research.
Velamentous umbilical cord insertion may be suspected from maternal serum α‐fetoprotein and hCG
Authors: Heinonen Seppo , Ryynänen Markku , Kirkinen Pertti , Saarikoski Seppo 
Published: August 2005

Objective
Patients with unexplained elevations in second trimester maternal serum α‐fetoprotein or human chorionic gonadotrophin (hCG) concentrations are at increased risk as regards a variety of pregnancy complications and adverse perinatal outcomes. Evidence suggests that elevated α‐fetoprotein and hCG concentrations may, in some case, be sensitive indicators of underlying placental pathology, either vascular or inflammatory in nature. The present study was carried out to compare these biochemical markers in pregnancies complicated by velamentous umbilical cord insertion (VCI) with normal pregnancies.Design
An observational study.Participants
Maternal serum hCG and α‐fetoprotein concentrations were measured in samples from 76 singleton pregnancies complicated by VCI and from 5200 chromosomally normal controls at 15 weeks of gestation.Results
Maternal serum hCG concentrations were elevated (mean 1·47 multiples of median (MOM)) in affected pregnancies, whereas α‐fetoprotein levels were lower (mean 0·88 MOM) in the subjects than in the controls. In relation to Down's syndrome risk assessment, the pattern of the two markers indicated high risk more often in VCI than in pregnancies with normal umbilical insertion. Accordingly, the increased false positive rate (26·3% compared with 6·6%) resulted in a higher rate of invasive techniques for fetal karyotyping in these pregnancies.Conclusions
In obstetric practice, elevated maternal serum hCG concentrations may in some cases be explained as being solely the result of abnormal insertion, which provides a link between unexplained hCG elevation and adverse pregnancy outcome. We suggest colour flow Doppler imaging of cord insertion in pregnancies followed because of unexplained hCG elevation or a false positive result in Down's syndrome screening.
Very preterm birth–a regional study. Part 2: The very preterm infant
Authors: Hagan R. , Benninger H. , Chiffings D. , Evans S. , French N. 
Published: August 2005

Objective
To ascertain the growth characteristics, delivery room management and hospital mortality of very preterm live born infants (< 33 weeks of gestation) and to identify differences between infants associated with the aetiological factor related to their very preterm delivery.Design
Cohort analytical study.Setting
King Edward Memorial Hospital for Women, Western Australia.Main variables examined
Gestational age, birthweight, birthweight ratio, condition at birth and mortality.Results
Six hundred and ninety‐three live born very preterm infants were born to 608 mothers between 1.1.90 and 31.12.91. This was 1.37% of all live borns in Western Australia. Three hundred and eighty‐five (55.6%) were male. Growth characteristics (birthweight, birthweight ratio and proportion small for gestational age) differed between infants depending on the primary obstetric complication associated with the very preterm delivery. Overall 217 (31%) infants were small for gestational age, 34 (4.9%) had a congenital anomaly, and 102 (14.7%) died. Corrected mortality, excluding major fatal congenital anomaly, was 86 (12.7%). The majority of infants died on the first day (n= 59 (57.8%). The only factors associated with an increased or decreased mortality were decreasing gestation (adjusted odds ratio (AOR) 1.7, 95% CI 1.50–1.93), decreasing birthweight ratio (small for gestational age) (AOR 1.3, 95% CI 1.08–1.53), antepartum haemorrhage as primary complication (AOR 3.1, 95% CI 1.25–7.69) and any antenatal steroids (AOR 0.26, 95% CI 0.14–0.51). In comparison with other studies, survival in the extremely preterm group, defined as a gestational age of less than 28 weeks, is improving.Conclusions
Very preterm infants account for a large proportion of perinatal mortality. Further studies are required to explore the differences between infants on the basis of the primary obstetric complication and to ensure that increased survival is not associated with an increase in disabilities.
Vaginal hysterectomy for the large uterus
Authors: Magos Adam , Bournas Nikolaos , Sinha Rakesh , Richardson Robert E. , O'Connor Hugh 
Published: August 2005

Objective
To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size.Design
A prospective observational study.Setting
The Royal Free Hospital, London.Participants
Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size.Interventions
Vaginal hysterectomy with or without bilateral salpingo‐oophorectomy or oophorectomy.Main outcome measures
Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra‐and post‐operative complications, duration of hospitalisation.Results
The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (n= 6) and superficial vaginal grazes (n= 5). One of the women required a blood transfusion. The mean post‐operative hospital stay was 3.7 days (range 2 to 9 days).Conclusion
Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.
The Burch colposuspension for women with and without detrusor overactivity
Authors: Colombo Mario , Zanetta Gerardo , Vitobello Domenico , Milani Rodolfo 
Published: August 2005

Objective
To compare the results of the Burch colposuspension in women with stress urinary incontinence and detrusor overactivity with those obtained in women with stress incontinence and stable bladders. Additionally, to analyse the value of two detrusor instability indexes and of standard cystometric parameters in predicting the surgical outcome.Design
Retrospective cohort study.Setting
Secondary referral centre Urodynamics Unit, San Gerardo Hospital, Monza.Sample
Forty‐four women with detrusor overactivity (21 with low compliance bladder and 23 with detrusor instability) and 44 with stable bladders. They were matched for age, parity, dystocia, menopause, body mass index, previous vaginal surgery, heavy work, urethral functional length and maximum urethral closure pressure.Results
At two years follow up, the cure rate of stress incontinence was 95% in the control group (patients with stable bladders) and 75% in detrusor overactivity group (odds ratio 0.1, 95% confidence interval 0.01–0.9, P= 0.02). No significant differences were observed between cured and failed patients according to both detrusor instability indexes. Likewise, mean pre‐operative standard cystometric values of cured and failed patients showed no differences.Conclusions
Although results were better in women with stable bladders, we believe that the success of the Burch colposuspension in cases with mixed incontinence should be considered satisfactory. No pre‐operative cystometric parameter consistently predicting the surgical outcome on stress incontinence was identified.
Umbilical artery pulsatility index in early pregnancies with chromosome anomalies
Authors: M. Martinez J. , Comas C. , Ojuel J. , Puerto B. , Borrell A. , Fortuny A. 
Published: August 2005

Objective
The aim of our study was to obtain measurements of the umbilical artery pulsatility index in pregnancies before invasive procedures for prenatal diagnosis, to investigate its potential prognostic value in predicting chromosomal abnormalities.Design
A prospective study.Participants
Nine hundred and twenty‐four consecutive women with singleton pregnancies between 10 and 18 weeks of gestation who underwent chorionic villus sampling (n= 385) or genetic amniocentesis (n= 539). All Doppler measurements were obtained by a single investigator before the invasive procedure. Pregnancies where structural malformations were detected by ultrasound were excluded.Results
Twenty‐six fetuses with chromosomal anomaly, including 12 with trisomy 21, were diagnosed. Using the 90th centile in umbilical artery pulsatility index values as a cut‐off for trisomy 21 the detection rate was 66.6%, with a specificity of 90.4% and a positive predictive value (defined as the proportion of unaffected individuals with positive results, 1‐specificity) of 8.8%. However, with this cut‐off the false positive rate was 9.6%. All 19 chromosomally normal pregnancies in which a fetal loss occurred after the procedure had a normal umbilical artery pulsatility index before it was carried out.Conclusions
These preliminary data suggest that trisomic fetuses have an abnormally increased umbilical artery pulsatility index in early pregnancy. Because the number of cases is too small to draw any firm conclusions, the use of a single measurement for screening purposes needs to be confirmed by further investigation and the clinical significance of reference curves of normal values in the detection of pathological conditions has still to be determined. The potential of umbilical artery pulsatility index as an additional parameter along with others previously established for Down's syndrome screening, such as nuchal oedema, needs to be explored further.
A comparison of goserelin and danazol as endometrial thinning agents prior to endometrial laser ablation
Authors: Garry Ray , Khair Anu , Mooney Paul , Stuart Mary 
Published: August 2005

Objective
To compare the effectiveness of goserelin and danazol prior to endometrial laser ablation and assess different dosage regimens.Design
A prospective open randomised trial.Setting
Specialist unit in minimal access gynaecological surgery in a district general hospital.Participants
One hundred and sixty premenopausal women with dysfunctional uterine bleeding.Interventions
Randomisation into four groups receiving either one or two injections of goserelin acetate (3.6 mg subcutaneously) or 28 or 56 days of danazol (four 200 mg tablets daily), followed by endometrial laser ablation.Main outcome measures
Endometrial thickness pretreatment and, immediately prior to endometrial laser ablation, assessed by vaginal ultrasound and full thickness endometrial biopsy; appearance of the endometrium at surgery; duration of the operation; the amount of fluid absorbed during surgery; and the clinical outcome at 24 weeks after surgery.Results
The two drugs were equally effective in thinning the endometrium. Compared with danazol, goserelin was better tolerated and resulted in a more satisfactory endometrial appearance at hysteroscopy, a greater reduction in cavity length (0.5 cm compared with 0.3 cm, P < 0.002), a shorter operation (16.4 min compared with 21.6 min, P < 0.00l), less fluid absorption (0 ml compared with 200 ml, P= 0.001), and a higher rate of amenorrhoea or oligoamenorrhoea (77% compared with 54%, P < 0.001) at the six month check. The administration of goserelin for 8 weeks compared with 4 weeks produced greater thinning of the endometrium on ultrasound and on histological examination, a greater reduction in cavity length on ultrasound and an increase in reported vasomotor symptoms. In both treatment regimens, 95 % of women reported a satisfactory reduction in menstrual flow at the six month check.Conclusions
Goserelin appears to be more effective and better tolerated than danazol for treatment prior to endometrial laser ablation. Eight weeks treatment with goserelin resulted in better operating conditions and more vasomotor side effect, compared with four weeks treatment, although there was no difference in clinical outcome.
The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy
Authors: Chenoy R. , Billingham L. , Irani S. , Rollason T. P. , Luesley D. M. , Jordan J. A. 
Published: August 2005

Objective
To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones.Design
A prospective randomised clinical trial.Setting
Academic Unit colposcopy clinics in Birmingham.Participants
One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis.Methods
Three‐way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra‐epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy.Results
No significant difference in change in lesion size (P= 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy.Conclusions
The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re‐epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.