bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human papillomavirus vulvitis: a new disease or an unfortunate mistake?
Authors: Dennerstein Graeme J. , Scurry James P. , Garland Suzanne M. , Brenan John A. , Fortune Denys W. , Sfameni Salvatore F. , O'Keefe Rodney J. , Tabrizi Sepehr N. 
Published: August 2005

ABSTRACTObjective
To determine whether human papillomavirus (HPV) was responsible for symptoms in women with vulvar pruritus, pain and superficial dyspareunia who had been referred with a diagnosis of HPV vulvar disease made on clinical and/or colposcopic and/or histological grounds.Design
In addition to standard clinical and laboratory investigations of the whole population, a sample of 15 test cases from the population of 71 women referred with a clinicopathological diagnosis of HPV vulvar disease, and two positive and 21 negative controls were assayed for HPV DNA. Polymerase chain reaction assays using L1 consensus primers were performed blinded to the clinicopathological diagnosis.Setting
Dermogynaecology Clinic at Mercy Hospital for Women.Subjects
Seventy‐one women referred with a diagnosis of HPV vulvar disease.Results
Thirteen cases which could be tested for HPV DNA were negative. Diagnoses other than HPV were found for the women's presentation in all cases.Conclusions
In the population studied, our investigations indicated that the clinicopathological diagnosis of HPV infection was incorrect and that HPV was not a cause of vulvar symptoms. We believe that the term HPV vulvitis is unfortunate as it has invited destructive treatments and drawn attention away from more likely causes of this difficult group of vulvar conditions.
Charts of fetal size: 3. Abdominal measurements
Authors: Chitty Lyn S. , Altman Douglas G. , Henderson Annabel , Campbell Sruart 
Published: August 2005

ABSTRACTObjective
To construct new size charts for fetal abdominal circumference and area.Design
A prospective, cross sectional study.Setting
The routine ultrasound department of a London teaching hospital.Subject
The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days.Methods
Fetuses were scanned once only for the purpose of the study at gestations between 12 and 42 weeks, when up to 20 dimensions were measured. Separate regression models were fitted to estimate the mean and standard deviation as functions of gestational age. Gentiles were derived by combining these two regression models, assuming that the measurements have a Normal distribution at each gestation.Results
A total of 610 fetuses had their abdominal circumference measured directly. Abdominal diameters were recorded for 425 fetuses and the circumference was also derived from these, as was the abdominal area. New charts for abdominal circumference (directly measured and derived from diameters) are presented. The directly measured circumferences were consistently (by about 3.5 %) greater than those derived from measurement of the abdominal diameters. The new charts are compared with previously published charts that are in wide use. A chart for abdominal area is also presented.Conclusions
We have constructed new size charts for the fetal abdominal circumference, both measured directly and derived from abdominal diameters. We have demonstrated the difference between the size charts constructed from these two sets of values and hence the importance of using the appropriately derived chart when assessing the abdominal circumference. The differences between the new charts and previous ones may be largely due to methodological differences.
Age related changes in the female reproductive cycle
Authors: Fitzgerald C. T. , Seif M. W. , Killick S. R. , Bennett D. A. 
Published: August 2005

ABSTRACTObjective
To investigate the effect of age on the control of the reproductive cycle in regularly menstruating women.Design
In this prospective study all women were seen regularly during both the follicular and luteal phases. Ultrasound scanning was used to confirm ovulation and measurements were taken to assess follicular development and endometrial thickness. Serum gonadotrophin levels on day 4 of the cycle, the maximum periovulatory oestradiol and progesterone on the seventh day after ovulation were measured and compared in different age groups.Subjects & Setting
Fifty‐six healthy, regularly menstruating women were recruited from volunteers amongst staff of the University Hospital of South Manchester.Results
Ovulation occurred later in the cycle for older women, with mean follicular phase length increasing from 13.9 days (in group 21–25 years) to 15–9 days (in group 37–45 years (P < 0.05). The mean of the maximum follicular diameter prior to rupture was significantly smaller in the older women: 16.7 mm in the 37 to 45 years old group compared with 19.6 mm, 21.6 mm and 21.3 mm in the 21 to 25, 26 to 31 and 32 to 36 years old age groups, respectively (P < 0.001). The maximum thickness of the endometrium in the luteal phase was greatest for older women: 15.9 mm in the age group 37 to 45 years compared with 12.1 mm in the age group 21 to 25 years (P < 0.001). Serum gonadotrophin concentrations during menses were higher with increased age; mean follicle stimulating hormone was 4.8 iu/l in the age group 21 to 25 years, and 8.5 iu/l in the age group 37 to 45 years (P < 0.001). Mean luteinising hormone was 4.5 iu/l in age group 21 to 25 years and 7.21 iu/l in age group 37 to 45 years (P < 0.001). Mean ovarian steroid concentrations were no different.Conclusions
These data illustrate significant age related differences in the pituitary‐ovarian axis and endometrial thickness. This has implications for the management of older women in assisted reproduction and fertility control programmes.
Digital imaging colposcopy, image analysis and quantification of the colposcopic image
Authors: Shafi M. I. , Dunn J. A. , Chenoy R. , Buxton E. J. , Williams C. , Luesley D. M. 
Published: August 2005

ABSTRACTObjective
To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone.Design
Prospective programme study of all patients undergoing colposcopy for cytological abnormalities.Setting
Dudley Road Hospital, Birmingham.Subject
Fifty consecutive patients having cytological and colposcopic abnormality treated with large loop excision of transformation zone formed the study group.Main outcome measures
Pretreatment and colposcopic features correlated with histological diagnosis of excised transformation zone.Results
Index cytology and current smoking status are the most important variables for prediction of histological diagnosis. Other important variables are focality of lesion, surface pattern, intercapillary distance and degree of acetowhiteness.Conclusion
Digital imaging colposcopy allows image capture, processing and objective analysis. This methodology holds advantages for basic and clinical research, teaching, diagnostics and clinical audit. The system can act as a quality control tool for colposcopy units. This system should prove invaluable for further quantitative studies, for natural history studies and for those patients with deferred treatment of their cytological and colposcopic abnormalities. The statistical models described may be incorporated into the system and can aid the colposcopist in management of the woman with abnormal cervical cytology and colposcopic abnormality.
Retraction: Doppler ultrasound of the uteroplacental circulation in the prediction of pregnancy outcome in women with raised maternal serum alpha‐fetoprotein
Authors: Robson M. , Hamid R. , McParland P. , Pearce J. M. 
Published: August 2005

ABSTRACTObjective
To determine whether Doppler waveforms from the uteroplacental circulation could improve the prediction of pregnancy outcome in women with raised maternal serum alpha‐fetoprotein and a structurally normal fetus. The study further attempts to determine whether the presence of an early diastolic notch would constitute a better screening test than waveform patterns.Design
An observational study.Setting
A tertiary referral obstetric service.Subjects
All women referred to St George's Hospital with a raised maternal serum alpha‐fetoprotein had waveform measurements from the uteroplacental circulation after exclusion of fetal abnormalities. Pregnancy outcome was determined by questionnaire sent to the referring clinicians.Main outcome measures
Adverse perinatal outcome in the form of preterm labour, low birthweight and perinatal mortality.Results
Data from 332 cases were available for analysis. Women with a normal pattern of uteroplacental waveforms had a perinatal mortality of 9.6/1000. Women with a uniform high resistance pattern had a perinatal mortality of 846/1000, and those with a mixed resistance pattern had a perinatal mortality of 268/1000. Overall there were 27 cases of placental abruption which accounted for eight of the 50 perinatal deaths. The remainder were due to prematurity or low birthweight or both. The presence of the early diastolic notch did not improve on the waveform patterns in the prediction of perinatal death.Conclusion
Women with raised maternal serum alpha‐fetoprotein and normal Doppler waveform patterns from the uteroplacental circulation can be reassured, but mixed or uniform high resistance patterns should encourage increased surveillance and a search for intervention therapies.
Haemostatic, fibrinolytic and endothelial variables in normal pregnancies and pre‐eclampsia
Authors: Halligan Aidan , Bonnar John , Sheppard Brian , Darling Michael , Walshe Joseph 
Published: August 2005

ABSTRACTObjective
To determine the behaviour of the coagulation variables antithrombin III (ATIII), protein C, thrombin/antithrombin III (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t‐PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre‐eclamptic pregnancies.Design
Longitudinal and cross‐sectional observational study.Setting
Antenatal clinic and maternity hospital.Subjects
Thirty‐six primigravid normotensive Caucasian patients, four of whom subsequently developed pre‐eclampsia, and 12 patients with established pre‐eclampsia.Main outcome measures
Plasma levels of PAI‐1, PAI‐2 and t‐PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques.Results
PAI‐1 and PAI‐2 antigen levels rose progressively throughout normal pregnancy. Among the established pre‐eclamptic group compared with matched normal pregnancies, the PAI‐2 antigen level was significantly lower (48.5±22.8 versus 183.5±37.4; P < 0.001), the PAI‐1 antigen level was significantly higher (122.34±4 versus 79.2±19.7; P < 0.001), ATIII activity was significantly lower (87.8±27.1 versus 110.9±19.3; P < 0.001) and TATIII complex levels were significantly higher (16.9±6.4 versus 10.2±5.9; P < 0.001). Among the four initially normotensive patients who subsequently developed pre‐eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation.Conclusion
Significantly elevated levels of PAI‐1 and fibronectin occurring early in pregnancies that subsequently develop pre‐eclampsia suggest that these variables may have predictive values. PAI‐2 would seem to be a marker of placental function in pre‐eclampsia while increased t‐PA and TATIII complex levels reflect the severity of the condition.
A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre‐eclamptic pregnancies
Authors: Meekins J. W. , Pijnenborg R. , Hanssens M. , MCFadyen I. R. , van Asshe A. 
Published: August 2005

ABSTRACTObjective
To investigate trophoblast invasion and vascular changes in placental bed spiral arteries in normal and severe pre‐eclamptic pregnancies.Design
A histological and immunohistochemical study of placental bed biopsies containing spiral arteries.Setting
The University Hospital, Leuven, Belgium.Subjects
Twenty‐one placental bed biopsies from 21 normal pregnancies and 24 placental bed biopsies from 24 severe pre‐eclamptic pregnancies, taken at caesarean section.Observations
Histological and immunohistochemical appearance of spiral arteries (stained with haematoxylin and eosin), periodic acid schiff, and a monoclonal antibody to low molecular weight cytokeratin.Results
One hundred and twenty‐seven spiral arteries were studied. In the 21 biopsies from clinically normal pregnancies at term, 100% of the decidual spiral arteries and 76% of the myometrial arteries showed trophoblast invasion. In the 24 biopsies from women with severe pre‐eclampsia, trophoblast invasion was seen in 44 % and 18 % of the decidual and myometrial segments, respectively. Endovascular trophoblast invasion was complete, partial or isolated. A variety of morphological features was present not only in different spiral arteries from the same biopsy but also in different segments of the same artery. The vascular change most commonly associated with normal pregnancies was physiological change and subintimal thickening of both segments of the spiral arteries. In pre‐eclampsia medial disorganisation and hyperplasia in the myometrial arteries and acute atherosis in decidual arteries were common.Conclusion
Endovascular trophoblast did not show an all or none invasive phenomenon in normal and pre‐eclamptic pregnancies. More decidual than myometrial arteries were invaded in both groups of patients, and there was a gradient in the percentage of decidual and myometrial arteries invaded from normal pregnancy to pre‐eclampsia. Morphological features in one spiral artery may not necessarily be representative of all of those in a placental bed.
Umbilical cord blood gas analysis at delivery: a time for quality data
Authors: Westgate Jennifer , Garibaldi Jonathan M. , Greene Keith R. 
Published: August 2005

ABSTRACTObjectives
To address the practical problems of routine umbilical cord blood sampling, to determine the ranges for pH, pCO2 and base deficit and to examine the relationships of these parameters between cord vessels.Design
An observational study of umbilical cord artery and vein blood gas results.Setting
A large district general hospital in the UK.Subject
One thousand nine hundred and forty‐two cord results from 2013 consecutive pregnancies of 34 weeks or more gestation, monitored by fetal scalp electrode during labour.Results
Only 1448 (74.6%) of the 1942 supposedly paired samples had validated pH and pCO2data both from an artery and the vein; 54 (2.8%) had only one blood sample available, 90 (4.6%) had an error in the pH or pCO2 of one vessel and in 350 (18%) pairs the differences between vessels indicated that they were not sampled from artery and vein as intended. Only 60% of the cases with an arterial pH less than 7.05 had evidence of a metabolic acidosis (base deficit in the extracellular fluid 10 mmol/1 or more). Of all the cases, 2.5% had a venous‐arterial pH difference greater than 0.22 units.Conclusions
Both artery and vein cord samples must be taken and the results screened to ensure separate vessels have been sampled. Interpretation of the results requires the examination of pCO2 and base deficit of the extracellular fluid from each vessel as well as the pH. Confusion about the value of cord gas measurements may be due to the use of erroneous data and inadequate definitions of acidosis which do not differentiate between respiratory and metabolic components.
Clinical value of amniotic fluid interleukin‐6 determinations in the management of preterm labour
Authors: Dudley Donald J. , Hunter Cheri , Mitchell Murray D. , Varner Michael W. 
Published: August 2005

ABSTRACTObjective
To ascertain whether the determination of amniotic fluid interleukin‐6 (IL‐6) concentrations would be a useful clinical test in the management of women with preterm contractions.Setting
The labour and delivery unit and the Fetal Diagnostic Centre at the University of Utah.Subjects
Pregnant women at various stages of gestation in the third trimester.Design
Amniotic fluid samples were collected from women experiencing one of four clinical scenarios: 1. term pregnancy, not in labour with no evidence of intrauterine infection; 2. normal term labour with no evidence of infection; 3. preterm labour with no evidence of infection and undelivered within one week of sampling; and 4. preterm labour and delivered within seven days of sample collection. Amniotic fluid was obtained by amniocentesis or at the time of amniotomy or hysterotomy. IL‐6 in each specimen was determined by a specific rapid ELISA.Results
Amniotic fluid IL‐6 levels, given as mean (SEM) in the four groups of women listed were: 1. term pregnancy, not in labour: 20.9 (7.2) pg/ml (n= 60); 2. normal term labour with no infection: 554 (90.7) pg/ml (n= 46); 3. preterm labour with no evidence of infection, undelivered: 47.0 (17.2) pg/ml (n= 35); and 4. preterm labour, delivered: 456.7 (101.7) pg/ml (n= 40). There was no significant difference in the means of amniotic fluid IL‐6 for the term labour and preterm labour delivered groups. In general, amniotic fluid IL‐6 levels during term labour increased with advancing cervical dilation. There was no correlation of cervical dilation and amniotic fluid IL‐6 levels in women having preterm delivery. Receiver‐operator curves revealed optimal IL‐6 levels for discrimination of labour at term to be 50 pg/ml and for preterm delivery to be 200 pg/ml.Conclusions
IL‐6 can readily be detected in the amniotic fluid of most women who are in active labour, regardless of gestational age. Our data suggest that amniotic fluid IL‐6 determinations may be clinically useful in the management of preterm labour.
Endometrial ablation in the treatment of menorrhagia
Authors: Erian J. 
Published: August 2005

ABSTRACTA prospective 5‐year multicentre study, involving three UK gynaecology centres with a special interest in endoscopic laser surgery, was set up to determine the safety, acceptability, clinical effectiveness and complications of neodymium yttrium‐aluminium‐garnet laser ablation of the endometrium in the treatment of menorrhagia. A total of 2342 women with disabling menorrhagia that was unresponsive to medical therapy were involved. The main outcome measures were: preoperative endometrial preparation, duration of laser ablation, intra‐ and postoperative complications, amenorrhoea rate, oligomenorrhoea rate, and the women's subjective assessment of treatment. No major complications occurred in the 2342 treatments. Nine (0.4%) cases of transient fluid overload, 11 (0.5%) of infection and five (0.2%) of uterine perforation occurred. None of the women required a laparotomy. The mean duration of the laser ablation was 24 min. The post‐surgery amenorrhoea rate was higher in women pretreated with danazol. Of the 1866 women followed up for at least 1 year after treatment, 1043 (56%) developed complete amenorrhoea, 701 (38%) reported continuing but satisfactorily reduced menstruation, and 122 (7 %) patients failed to improve with the first treatment (57 of these 122 women responded to a second laser ablation). Overall, 1744 (93%) had a satisfactory response to laser ablation and only 33 (1.8%) required subsequent hysterectomy. In conclusion, this study showed that hysteroscopic endometrial laser ablation is an acceptable alternative to hysterectomy for the treatment of menorrhagia.
Blood pressure changes during labour and whilst ambulating with combined spinal epidural analgesia
Authors: Shennan Andrew , Cooke Vicky , Lloyd‐Jones Fiona , Morgan Barbara , De Swiet Michael 
Published: August 2005

ABSTRACTObjective To determine the influence of combined spinal epidural analgesia with fentanyl and low dose bupivacaine on maternal blood pressure and pulse rate in labour. Also, to evaluate the maternal cardiovascular response to mobilising with this form of analgesia in labour. Finally, to define the changes that occur in blood pressure and pulse rate during the second stage of labour and immediately postpartum when using combined spinal epidural analgesia.Design A prospective observational study.Subjects and methods Blood pressure and pulse measurements were made at least every 10 minutes, using the Space Labs 90207 ambulatory blood pressure monitor, on 62 women in labour with combined spinal epidural analgesia.Results A significant fall in systolic blood pressure (> 20%) occurred in eight women (12%), all within 30 minutes of the spinal injection. Fifty‐two women subsequently received an epidural dose (mean interval 90 minutes after spinal) and none of these women had a fall in systolic blood pressure of greater than 20%. No women had symptoms related to hypotension. Thirty‐five women ambulated for more than 10 minutes on 65 occasions. Average blood pressure remained unchanged while ambulating (126/79 versus 126/79), but pulse rate was significantly increased (85 to 90, P≤ 0.001). The mean blood pressure in the second stage of labour (n= 41) did not rise with pushing (134/83 versus 134/83), but the pulse rate increased significantly (94 to 108, P≤ 0.001). Blood pressure remained unchanged immediately postpartum (n= 33) (134/83 versus 134/81) following ergometrine administration.Conclusion The combined spinal epidural analgesia will only result in significant falls in systolic blood pressure within 30 minutes of the spinal injection. No further important changes in blood pressure occur when mobilising or with epidural top‐ups. The combined spinal epidural analgesia may modify the normal compensatory mechanisms of blood pressure control, but does not cause significant maternal hypotension once the spinal injection has been given.
Planned abdominal compared with planned vaginal birth in triplet pregnancies
Authors: Wildschut H. I. J. , Van Roosmalen J. , Van Leeuwen E. , Keirse M. J. N. C. 
Published: August 2005

ABSTRACTObjective To compare a policy of planned abdominal delivery with a policy of planned vaginal delivery in triplet pregnancies.Design Retrospective study.Setting Two Dutch university hospitals, each having a different approach to the planned mode of delivery in triplet gestations.Subjects Thirty women giving birth to triplets in the hospital in Leiden, who favoured planned abdominal delivery, compared with 39 from the Medical Centre in Amsterdam who favoured vaginal delivery.Main outcome measures Perinatal mortality and early neonatal complications.Results Both centres were equally successful in achieving their planned policies: in Leiden 80% of women were delivered by caesarean section but in Amsterdam 87% of women were delivered vaginally. Compared with vaginal delivery, planned abdominal delivery was associated with a significantly hgher perinatal mortality rate (P= 0.02), primarily due to respiratory distress syndrome, and a higher recorded neonatal complication rate (P= 0.03), especially sepsis, respiratory distress syndrome, and necrotising enterocolitis.Conclusions A policy of planned abdominal delivery in triplets is not superior to a policy of planned vaginal delivery in terms of fetal and early neonatal outcome.