bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo‐oophorectomy
Authors: Raju Kankipati S. , Auld Barry J. 
Published: August 2005

ABSTRACTObjective
To identify differences in the peri‐operative outcome of women undergoing hysterectomy with bilateral salpingo‐oophorectomy performed either by abdominal hysterectomy and bilateral salpingo‐oophorectomy or by laparoscopic‐assisted salpingo‐oophorectomy and vaginal hysterectomy. To identify any potential management implications, including financial differences, between these two forms of operations.Subjects and methods
Eighty women undergoing hysterectomy and bilateral salpingo‐oophorectomy for benign gynaecological conditions were prospectively randomised to have the procedure by laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy or total abdominal hysterectomy and bilateral salpingo‐oophorectomy. The peri‐operative and post‐operative courses of both groups were compared.Results
Although laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy took longer (100 (SD 5.6) versus 57 (SD 4.7) min, P < 0.0001), the women undergoing this procedure had a shorter time in hospital (3.5 versus six days, P < 0.0001) quicker recovery (three versus six weeks, P < 0.0001) and returned to work earlier. There were minimal complications in both groups and they were not significantly different. The cost of the laparoscopic‐assisted procedure was greater during the operation with longer operating time and cost of disposable instruments. However, the total cost of treatment was less in this group because of shortened post‐operative stay.Conclusion
The study shows laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy is a safe and cost‐effective procedure for women requiring a hysterectomy and bilateral salpingo‐oophorectomy.
Expression of transforming growth factor‐α in the normal cervix and in benign and malignant lesions of the uterine cervix
Authors: Konishi Ikuo , Ishikawa Yukiyoshi , Wang Shu‐yu , Wang Da‐peng , Koshiyama Masafumi , Mandai Masaki , Komatsu Takayuki , Yamamoto Shinichi , Mori Takahide 
Published: August 2005

ABSTRACTObjective
To investigate the expression and distribution of transforming growth factor‐α (TGF‐α) in the normal cervix and in benign and malignant lesions of the uterine cervix.Subjects and methods
Immuno‐histochemical reactivity with a monoclonal antibody against TGF‐α was examined in tissue specimens from 15 normal cervices, six cervical polyps, four cervical condylomata acuminata, 34 cervical intra‐epithelial neoplasias, 35 invasive squamous cell carcinomas, five adenocarcinomas, and three mixed adenosquamous carcinomas.Results
Normal squamous cells of the exocervix were found to be negative for TGF‐α immuno‐reactivity, whereas reserve cells and metaplastic squamous cells in the transformation zone were positive for TGF‐α. Although TGF‐α immuno‐reactivity was variable in the cervical condylomas, most cases of cervical intra‐epithelial neoplasia with or without koilocytotic atypia were negative for TGF‐α. In the invasive carcinomas, however, TGF‐α immunoreactivity was observed in 17 out of the 35 cases of squamous carcinoma, and in all cases of adeno‐ and adenosquamous carcinomas. In addition, intense TGF‐α immuno‐reactivity was found in clinically advanced tumours.Conclusion
These results suggest that the expression of TGF‐α is associated with squamous metaplasia in the normal cervix, and that TGF‐α may play an important role in cervical carcinogenesis, especially in its progression.
The definition of pre‐eclampsia
Authors: Perry Ivan J. , Beevers D. G. 
Published: August 2005

ABSTRACTBackground
Redman and Jefferies have proposed a revised definition of pre‐eclampsia which is based on absolute blood pressure levels and an increment from the baseline in the first half of pregnancy. There is no requirement for proteinuria. This definition should facilitate the distinction between nonproteinuric pre‐eclampsia and other causes of nonproteinuric gestational hypertension, such as chronic essential hypertension.Objectives
1. To determine whether the blood pressure criteria of Redman and Jefferies can select women with characteristics of pre‐eclampsia from the group of women with gestational hypertension by the current criteria of the International Society for the Study of Hypertension in Pregnancy (ISSHP). 2. To determine the level of agreement between the classification system proposed by Redman and Jefferies and that of the ISSHP.Design
A prospective study.Setting
Obstetric unit, Dudley Road Hospital, Birmingham, UK.Subjects
Six hundred and ninety‐two healthy nulliparous women and 11 women with chronic hypertension antedating pregnancy.Main outcome measures
1. Differences in maternal characteristics and obstetric outcome among women with gestational (nonproteinuric) hypertension by the ISSHP criteria, meeting (and failing to meet) the Redman and Jefferies' blood pressure criteria. 2. The proportion of women classified as normal, proteinuric pre‐eclampsia, and chronic hypertension on the basis of both Redman and Jefferies' criteria and the current ISSHP criteria.Results
There were 55 women with gestational hypertension alone by the ISSHP criteria, of whom 33 met Redman and Jefferies' blood pressure criteria for pre‐eclampsia. This group of 33 women had characteristics of nonproteinuric pre‐eclampsia, compared with the remaining 22 women in the ISSHP gestational hypertension category who had characteristics of chronic hypertension. The group of 33 were significantly younger and less obese, had significantly lower blood pressure at their first antenatal visit and their obstetric outcome was poorer. The Redman and Jefferies' blood pressure criteria identified as normal 99.5% (95% CI, 98.6% to 99.9%) of women who were also characterised as normal on the basis of the ISSHP criteria (622/625). There were 12 women with proteinuric pre‐eclampsia by the ISSHP criteria of whom 11 (92%; 95% CI, 62% to 99.8%) met Redman and Jefferies' blood pressure criteria for pre‐eclampsia. None of the 11 women with chronic hypertension antedating pregnancy met these criteria.Conclusions
In this population the blood pressure criteria for pre‐eclampsia proposed by Redman and Jefferies select women with features of pre‐eclampsia (i.e., proteinuria and relatively poor outcome) and, in particular, they enable a distinction to be made between nonproteinuric pre‐eclampsia and other causes of gestational hypertension.
Oligohydramnios sequence: the spectrum of renal malformations
Authors: Newbould M. J. , Lendon M. , Barson A. J. 
Published: August 2005

ABSTRACTObjective
To assess the value of the autopsy findings on a series of infants dying with features of the oligohydramnios sequence, with particular reference to anomalies of the renal tract.Design
Retrospective review.Setting
Pathology departments serving three maternity units in Manchester.Subjects
Eighty‐nine infants having an autopsy examination between 1976 and 1990.Results
Thirty‐two (34%) infants had bilateral renal agenesis, 30 (34%) had bilateral cystic dysplasia, eight (9%) had unilateral agenesis with unilateral cystic dysplasia, four (4%) had renal histology characteristic of a recessively inherited disorder (two cases of renal tubular dysgenesis and two cases of autosomal recessive (infantile) polycystic disease), nine (10%) had minor urinary tract anomalies, and three (3%) had morphologically normal renal tracts. Forty‐eight (54%) infants had congenital abnormalities other than those resulting from oligohydramnios sequence; most commonly, these were anomalies of the sporadic VATER association, but in four infants the extra renal anomalies present allowed recognition of a recessively inherited syndrome (Meckel's in three cases, Smith‐Lemli‐Opitz in one).Conclusions
A detailed autopsy is vital in assessment of infants with oligohydramnios sequence resulting from a congenital abnormality of the kidneys or urinary tract. This applies equally to second trimester fetuses following miscarriage or therapeutic abortion, to stillborn infants, or to neonatal deaths.
The effects of 3g eicosapentaenoic acid daily on recurrence of intrauterine growth retardation and pregnancy induced hypertension
Authors: Bulstra‐Ramakers M. T. E. W. , Huisjes H. J. , Visser G. H. A. 
Published: August 2005

ABSTRACTObjective To study the effects of addition of 3 g eicosapentaenoic acid daily to the diet, on recurrence rate of intrauterine growth retardation and pregnancy induced hypertension in a high risk population.Design Prospective, double blind, randomised multicentre study. Eicosapentaenoic acid or placebo were given from 12 to 14 weeks of gestation onwards.Setting University Hospital and regional hospitals in the north of the Netherlands.Subjects Sixty‐three women with a history of intrauterine growth retardation (birthweight < 10th centile) with or without pregnancy induced hypertension in the previous pregnancy.Main outcome measures Birthweight centiles and signs of pregnancy induced hypertension in current pregnancy.Results One‐third of the women developed pregnancy induced hypertension and one‐third of the infants had a birthweight below the 10th centile. There were no differences between eicosapentaenoic acid and placebo group.Conclusion Addition of 3 g eicosapentaenoic acid daily does not prevent recurrence of intrauterine growth retardation or pregnancy induced hypertension in a high risk population.
Longitudinal study of fetal middle cerebral artery flow velocity waveforms preceding fetal death
Authors: Rowlands David J. , Vyas Sanjay K. 
Published: August 2005

ABSTRACTObjective
To assess longitudinally fetal cerebral vasodilatation in small‐for‐gestational age fetuses to investigate whether intrauterine death might be predictable.Design
Prospective observational study.Setting
Ultrasound department in a university hospital.Subjects
Five pregnancies with ultrasonographically confirmed small fetuses (abdominal circumference less than the 3rd centile) monitored longitudinally until time of intrauterine death.Main outcome measure
Time between last ultrasound examination and diagnosis of intrauterine death, and variation in middle cerebral artery pulsitility index prior to death.Results
Two of the five fetuses showed a reversal of adaptation (as indicated by an elevation of the middle cerebral artery pulsitility index) within 48 hours of intrauterine death. The other three had their final ultrasound examination 3 to 7 days before death and showed no such reversal of adaptation.Conclusion
Reversal of adaptation in fetal hypoxaemia as indicated by a rise in the middle cerebral artery pulsitility index may be a predictor of intrauterine death within 48 hours. Whether delivery after reversal of adaptation would result in salvage of neurologically intact babies needs to be investigated.
The value of fetal arterial, cardiac and venous flows in predicting pH and blood gases measured in umbilical blood at cordocentesis in growth retarded fetuses
Authors: Rizzo Giuseppe , Capponi Alessandra , Arduini Domenico , Romanini Carlo 
Published: August 2005

ABSTRACTObjective
To assess the value of Doppler indices, calculated from fetal arterial peripheral vessels, cardiac outflow tracts and venous vessels, in the identification of acidaemia, hypercapnia and hypoxaemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth retarded fetuses.Design
Doppler measurements were taken from umbilical artery, thoracic descending aorta, renal artery, middle cerebral artery, cardiac outflow tracts, inferior vena cava and ductus venoms immediately before cordocentesis. Logistic regression and receiver‐operator characteristic curve analysis were performed to examine the relation between Doppler indices and acid‐base status.Setting
Tertiary centre for fetal medicine.Subjects
Forty‐eight growth retarded fetuses fulfilling these criteria for inclusion: 1. absence of chromosomal and structural anomalies; 2. an abdominal circumference or ultrasonographic estimated fetal weight less than the 5th centile; 3. presence of abnormal velocity waveforms in umbilical artery; and 4. postnatal confirmation of a birthweight below the 5th centile and absence of structural anomalies.Results
The percentage of reverse flow in inferior vena cava was a more closely related variable for acidaemia (x2= 29.69; P≤ 0.001) and hypercapnia (x2= 12.86; P≤ 0.001) than the other Doppler indices. Hypoxaemia was better predicted by the pulsatility index from middle cerebral artery (χ2= 15.31; P ≤ 0.001).Conclusion
The analysis of velocity waveforms from inferior vena cava and middle cerebral artery can be used to predict acid‐base status in growth retarded fetuses secondary to placental insufficiency. This may lead to a more accurate antepartum monitoring of such fetuses.
Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics
Authors: Brosens J. , de Souza Nandita M. , Barker Fred G. , Paraschos Thanos , Winston Robert M. L. 
Published: August 2005

ABSTRACTObjective
To evaluate prospectively the role of endovaginal ultrasonography in the diagnosis of adenomyosis and to identify predictive characteristics.Setting
In Vitro Fertilisation Unit, Hammersmith Hospital.Subjects
Fifty‐six women with menorrhagia and dysmenorrhea.Design
Endovaginal sonography was performed and uterine body morphometry and myometrial echogenicity were assessed. The sonographic suspicion of adenomyosis was scored high or low depending on the degree of uterine enlargement, uterine asymmetry not due to fibroids and heterogenicity of myometrial echoes. The sonographic diagnosis was compared either with the histological findings after hysterectomy (n= 34) or to the appearances on magnetic resonance imaging (n= 22).Results
Adenomyosis was diagnosed in 28 patients: 15 by histology and 13 by magnetic resonance imaging. Endovaginal ultrasound demonstrated a sensitivity of 86%, a specificity of 50%, a positive predictive value of 86%, and a negative predictive value of 77%. Uterine morphometry alone did not predict adenomyosis: although the mean length of the longitudinal, antero‐posterior and transverse axis was larger in uteri with, compared with those without, adenomyosis, this did not reach statistical significance. The uterine asymmetry ratio was 1.43 (SD 0.6) and 1.34 (SD 0.4) (P= 0.26) in uteri with and without adenomyosis, respectively, but in the presence of adenomyosis the mean posterior wall was significantly thicker than the mean anterior wall: 25.6 (SD 66) mm compared with 21.8 (SD 5.0) mm, P= 0.02. Therefore, adenomyosis was best predicted on the basis of ill‐defined myometrial heterogeneity. However, leiomyomas and various echogenic shadows and artefacts often complicate subjective assessment of the myometrial echogenicity.Conclusion Endovaginal sonography in symptomatic patients can be a sensitive but not a specific procedure for the diagnosis of adenomyosis.
Effects of gemeprost and mifepristone on the mechanical properties of the cervix prior to first trimester termination of pregnancy
Authors: Carbonne B. , Brennand J. E. , Maria B. , Cabrol D. , Calder A. A. 
Published: August 2005

ABSTRACTObjective
To study the effects of oral mifepristone and vaginal gemeprost on the mechanical properties of the cervix prior to first trimester termination of pregnancy by vacuum aspiration.Design
A comparative study. Each patient served as her own control.Setting
The Royal Infirmary of Edinburgh, Scotland, UK.Subjects
Forty nulliparous women at six to twelve weeks of pregnancy.Interventions
The women received either gemeprost (1 mg) 3 h prior to termination of pregnancy or mifepristone (200 mg) 48 h before operation.Main outcome measures
Two different objective methods of assessment of the mechanical properties of the cervix, one measuring the distensibility of the cervix before drug administration and immediately before the operation, and the other measuring the force necessary to dilate the cervix; incidence of new symptoms following drug intake; immediate complications and estimated blood loss.Results
Both treatments significantly increased cervical distensibility. Baseline dilatation was greater in the mifepristone group. The force required to dilate the cervix was significantly reduced in mifepristone‐treated patients, There was a good correlation between the two different methods of assessment of the mechanical properties of the cervix only in the gemeprost group.Conclusion
Cervagem and mifepristone can be used to increase cervical distensibility. Cervical dilatation is easier with a 48 h regimen of mifepristone than with gemeprost.
Application of ultrasonic transit time flowmetry to the measurement of umbilical vein blood flow at caesarean section
Authors: Konje Justin C. , Taylor David J. , Rennie Michael J. 
Published: August 2005

Objective
To determine the applicability of ultrasonic transit time flowmetry to the measurement at caesarean section of umbilical vein blood flow rate and to examine the relationship between flow rates and birthweight for gestational age.Design
Umbilical vein blood flow was measured at caesarean section using a transonic time flow probe on a loop of the umbilical cord in 33 appropriate and 21 small for gestational age fetuses.Results
The mean (SD) umbilical vein blood flow in the 54 fetuses was 78.4 (23.1) ml kg−1 min−1. There was a linear relation between umbilical vein blood flow measured by ultrasonic transit time flowmetry and birthweight (r= 0.63, P < 0.0001). The mean umbilical vein blood flow in appropriate for gestational age fetuses [90 (18) ml kg−1 min−1] was greater than that in the small for gestational age group [66 (23) ml kg−1 min−1]; P < 0.04).Conclusions
Umbilical vein blood flow measurements obtained by the ultrasonic transit time flowmetry technique are simple to perform and compare well with reported values obtained by the Doppler ultrasound technique (when vessel diameter is greater than 4 mm). Umbilical venous blood flow rate is significantly lower in small for gestational age fetuses.
Persistent ectopic pregnancy following conservative surgery for tubal pregnancy
Authors: Dwarakanath L. S. , Mascarenhas L. , Penketh R. J. A. , Newton J. R. 
Published: August 2005

Objective
To audit the incidence and management of persistent ectopic pregnancy following conservative tubal surgery performed at laparotomy and via the laparoscope.Design
A retrospective analysis of the case records. Setting The Birmingham and Midland Hospital for Women.Participants
Two hundred and fourteen women who received surgical treatment for ectopic pregnancy between October 1991 and December 1994.Results
Of the 85 women who underwent conservative tubal surgery, nine were diagnosed as having persistent ectopic pregnancy on the basis of hCG values. The incidence after laparoscopy was no higher than after laparotomy. A second surgical procedure was indicated in only four cases.Conclusions
Post‐operative surveillance of serum hCG remains mandatory. Patients who remain symptom free may be managed conservatively The threshold for a second‐look laparoscopy should be relatively high and be based on the presence of symptoms rather than changes in hCG values.
A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum haemorrhage
Authors: Soriano David , Dulitzki Mordechai , Schiff Eyal , Barkai Gad , Mashiach Shlomo , Seidman Daniel S. 
Published: August 2005

Objective
To determine the safety and efficacy of intramuscular oxytocin plus ergometrine compared to intravenous oxytocin for prevention of postpartum haemorrhage, and the significance of administration at the end of the second stage of labour compared with that after the third stage.Design
A prospective cohort study.Setting
A university affiliated tertiary medical centre.Participants
Two thousand one hundred and eighty–nine women delivering singletons during 40 consecutive weeks.Main outcome measures
Postpartum haemorrhage (> 500 ml), prolonged third stage (> 30 min), retained placenta (>60min), elevated blood pressure (systolic > 150 mmHg, diastolic > 100 mmHg).Results
The rate of postpartum haemorrhage was not significantly different for oxytocinergometrine compared with oxytocin, when administered at the end of the second stage of labour (odds ratio 1.10, 95% confidence interval (CI) 0.75–1.61) or after the third stage (odds ratio 0.95, 95% CI 0.68–1.34). The patients receiving oxytocics at the end of the second stage of labour had significantly lower rates of postparturn haemorrhage, for both oxytocinergometrine (odds ratio 0.69, 95% CI 0.49–0.98) and oxytocin (odds ratio 0.60, 95% CI 0.41–0.87), compared with those treated after the third stage.Conclusion
Administration of oxytocin alone is as effective as the use of oxytocin plus ergometrine in the prevention of postpartum haemorrhage, but associated with a significantly lower rate of unpleasant maternal side effects. Oxytocics administered after delivery of the fetal head compared with after the placental expulsion are associated with a significantly lower rate of postpartum haemorrhage.
Oral misoprostol versus mifepristone for cervical dilatation before vacuum aspiration in first trimester nulliparous pregnancy: a double blind prospective randomised study
Authors: Ngai Suk Wai , Au Yeuug Kam Chuen , Lao Terence , Ho Pak Chung 
Published: August 2005

Objective
To compare the effectiveness of oral misoprostol and mifepristone for cervical priming before first trimester termination of nulliparous pregnancy.Design
Prospective double blind randomised study.Setting
Department of Obstetrics and Gynaecology, University of Hong Kong.Participants
One hundred nulliparous women undergoing termination of pregnancy between 8 and 12 weeks of gestation were recruited for this prospective randomised trial. The women were allocated to either the oral misoprostol or mifepristone group. Subjects in misoprostol group were given placebo and misoprosto1 400 pg 36 h and 12 h respectively before vacuum aspiration. Subjects in mifepristone group were given 200 mg mifepristone and placebo 36 h and 12 h respectively prior to operation.Main outcome measures
Baseline pre‐operative cervical dilatation, the incidence of side‐effects, the amount of blood loss and duration of procedure.Results
There were no significant differences in the baseline cervical dilatation, incidence of side‐effects, amount of blood loss and duration of procedure.Conclusions
Misoprostol and mifepristone are of similar effectiveness for cervical priming prior to vacuum aspiration in nulliparous women. Misoprostol has additional advantages of being widely available and inexpensive.
Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials
Authors: Grant Adrian , Penn Zoe J. , Steer Philip J. 
Published: August 2005

Objective
To compare a policy of elective caesarean delivery with a policy of selective caesarean delivery for women in spontaneous preterm labour.Design
Systematic review of relevant randomised controlled trials.Participants
One hundred and twenty‐two women from six trials.Interventions
Random allocation to ‘intention to deliver by caesarean section’ (elective caesarean policy), compared with ‘intention to deliver vaginally’ (selective caesarean policy).Main outcome measures
Actual use of caesarean delivery, low Apgar score, neonatal intubation, intracranial pathology, perinatal death, and major maternal complications.Results
One in six women in both groups were not delivered as allocated. Typical odds ratios for all adverse neonatal outcomes tended to favour the elective group, but for all outcomes studied the confidence intervals were wide and did not exclude clinically important hazards of the policy. The odds of serious maternal morbidity were increased in the caesarean section group (OR 6–2; 95% CI 1.3–30.1).Conclusion
A policy of elective caesarean delivery increases the risks of maternal morbidity, but it remains unclear whether these are offset by benefits for the infant.