bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of a UK multicentre trial
Authors: GAMSU H. R. , DONNAI P. , MULLINGER B. M. , DASH C. H. 
Published: August 2005

SummaryIn a prospective, randomized, double‐blind, multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome (RDS) in preterm infants. The dose of betamethasone was 4 mg every 8 h for six doses, unless delivery occurred. The 251 women who were enrolled gave birth to 262 liveborn infants, 130 in the betamethasone and 132 in the placebo group; the two groups were evenly matched in most respects. The diagnosis of RDS in the newborn was confirmed by two independent assessors. Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo group developed RDS. In infants whose mothers had received at least three injections, RDS was also less frequent in the steroid group than in the placebo group (3/104 and 10/104 respectively; P<0·05). There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial (0/30 and 8/45 respectively; P<0·05). The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation, within 8 days of trial entry, and whose mothers had received at least three injections (0/27 steroid group and 7/32 placebo group; P=0·03), and there were also significantly fewer neonatal deaths (2/27 and 13/32, respectively; P<0·01) in this subgroup. Betamethasone did not provoke earlier delivery. Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids: there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group. Neonatal jaundice was significantly less frequent in the steroid (55/129) than in the placebo group (81/127; P<0·01) but not in the subgroups born before 34 completed weeks gestation.
A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion
Authors: FARQUHAR C. M. , ROGERS V. , FRANKS S. , BEARD R. W. , WADSWORTH J. , PEARCE S. 
Published: August 2005

SummaryThe value of medroxyprogesterone acetate (MPA) and of psychotherapy in the treatment of lower abdominal pain due to pelvic congestion was assessed in a randomized controlled trial. Eighty‐four women with abnormal pelvic venography were assigned to one of four treatment groups: MPA alone, MPA plus psychotherapy, placebo alone, and placebo plus psychotherapy. Women were treated for 4 months and thereafter followed up regularly for 9 months with pain assessments, pelvic ultrasound scanning, and hormone measurements. During treatment, MPA showed a significant benefit in terms of a reduction in visual analogue scale pain score, with 73% of women reporting at least 50% improvement compared with 33% of those treated with placebo. At 9 months after the end of therapy there was no overall significant effect of MPA or psychotherapy, but there was an interaction between MPA and psychotherapy, with 71 % of the women in this group showing a ≥50% reduction in pain score. Therapy with MPA is a useful first‐line therapy for women with pain associated with demonstrable pelvic congestion.
A comparison of three methods of assessing inter‐observer variation applied to ultrasonic fetal measurement in the third trimester
Authors: SARMANDAL PURNIMA , BAILEY SUSAN M. , GRANT JOHN M. 
Published: August 2005

SummaryThe inter‐observer variation of fetal biparietal diameter, head circumference, abdominal circumference, and femoral length measured in the third trimester by ultrasound was studied by three different methods—coefficient of variation, correlation coefficient, and the 95% limits of agreement. The coefficients of variation were 1·6 to 3·7%, the correlation coefficients were 0·89 to 0·98 with P values of <0·001, yet the limits of agreement when applied to centile charts were found to be too wide to separate reliably small fetuses from those that were not small. We conclude that the limits of agreement is the preferred method of assessing inter‐observer variation, and we suggest that future research into growth retardation move away from ultrasonic measurements of the fetus.
The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials
Authors: GRANT ADRIAN 
Published: August 2005

SummaryA systematic review of the 14 relevant controlled trials was conducted because there is no agreement about the choice of material and technique for repair of perineal trauma sustained during childbirth. Derivatives of polyglycolic acid (marketed as Dexon and Vicryl) appear to be the absorbable material of choice for both deep and skin closure. Compared with catgut their use is associated with about a 40% reduction in short‐term pain and need for analgesia. The main drawback is that some material often needs removal during the puerperium. Glycerol‐impregnated catgut is ruled out because of its link with longterm dyspareunia. Compared with the non‐absorbable materials (silk and nylon) polyglycolic acid skin sutures were associated with less shortterm perineal pain, and had no clear disadvantages. Continuous, subcuticular stitching appears preferable to interrupted, transcutaneous suturing, particularly in terms of perineal pain in the early puerperium.
Idiopathic thrombocytopenic purpura in pregnancy: A randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count
Authors: Christiaens G. C. M. L. , NIEUWENHUIS H. K. , VON DEM BORNE A. E. G. Kr. , OUWEHAND W. H. , HELMERHORST F. M. , VAN DALEN C. M. , VAN DER TWEEL I. 
Published: August 2005

Abstract Objective–To determine the efficacy of antenatal low dose oral betamethasone in preventing neonatal thrombocytopenia and/or bleeding in infants of mothers with idiopathic thrombocytopenic purpura (ITP). Setting–Hospital department of obstetrics and gynaecology, referral centre. Patients–41 pregnancies in 38 women were randomized. The results of 13 pregnancies were considered non‐assessable. The final analysis involved 14 in the betamethasone group and 14 in the non‐treatment group. All fulfilled the criteria for ITP. Interventions–The treated group received 1.5 mg betamethasone orally per day, from day 259 till day 273 and 1 mg from day 273 till delivery. Main outcome measures–Effects of treatment were assessed in terms of maternal platelet counts after the first trimester and neonatal platelet counts at birth and the first week of life and neonatal bleeding episodes. Results–There were no significant differences in neonatal platelet counts at birth. Two infants in the belamethasone group and one in the untreated group had a severe thrombocytopenia either at birth or during the first week of life (<50 × 109/1). Seven infants in the betamethasone group and six in the nontreatment group had a mild thrombocytopenia. The overall frequency of neonatal thrombocytopenia was similar: 64% in the betamethasone group and 57% in the untreated group (95% CI of the true difference: –43.5% to +29.5%). There was also no significant difference in neonatal bleeding episodes. Conclusions–Low‐dose betamethasone in pregnant women with TTP does not prevent thrombocytopenia or bleeding in their newborn infants.
Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies
Authors: TYRRELL S. N. , LILFORD R. J. , MACDONALD H. N. , NELSON E. J. , PORTER J. , GUPTA J. K. 
Published: August 2005

AbstractObjective–To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy. Design–A pragmatic randomized trial. Setting–St James's University Hospital, Leeds. Subjects–500 pregnant women at high risk of intrauterine growth retardation or still birth. Interventions–Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians. Main outcome measures–Gestational age al delivery, obstetric intervention rates and short‐term neonatal morbidity. Results–Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end‐diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end‐diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5‐min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group. Conclusions–The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end‐diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.
The efficacy and tolerance of mifepristone and prostaglandin in first trimester termination of pregnancy
Authors:   UK MULTICENTRE TRIAL
Published: August 2005

AbstractObjective— To investigate the use of oral mifepristone (RU 486) and vaginal gemeprost for the induction of legal first trimester abortion.Design— An uncontrolled multicentre observational study.Setting— 13 Hospital gynaecological units in Scotland and England.Subjects— 588 Pregnant women with up to nine weeks amenorrhoea having legal abortions.Interventions— Oral mifepristone 600 mg followed 48 h later by vaginal gemeprost 1 mg. Women stayed in the hospital for a minimum of 4 h on each occasion.Main outcome measures— Frequency of complete abortion and the need for subsequent surgical evacuation, analgcsia and blood transfusion.Results— There was complete abortion in 94% (95% C192–96%). None of the 46 women at <43 days gestation needed surgical evacuation. This was performed in 6.5% of the remainder but among these the rate did not increase with gestation. Five women (four from one centre) required both curettagc and blood transfusion. A fall in haemoglobin concentration of 2–4 g/dl occurred in only 1%. Narcotic analgesia was required after gemeprost by 37% of nullipara and 13% of multipara. Overall 26% had vomiting and 13% diarrhoea.Conclusion— The sequential use of oral mifepristone and vaginal gemeprost is effective in inducing abortion up to the 63rd day of pregnancy. Efficient management of pain and bleeding is easier if women are in a hospital for some hours after the gemeprost.
A randomized comparison of oxytocin, sulprostone and placebo in the management of the third stage of labour
Authors: POESCHMANN R. P. , DOESBURG W. H. , ESKES T. K. A. B. 
Published: August 2005

AbstractObjective— To compare the effect on post partum bloodloss of the postpartum prophylactic administration of oxytocin or sulprostone in low risk women having an expectant management of the third stage.Design— Randomized, placebo controlled, double‐blind trial.Setting— Radboud University Hospital, Nijmegen (67 women) and Lievensberg Hospital, Bergen op Zoom (10 women).Participants— 77 women entered the trial (three were excluded).Interventions— The intramuscular injection, immediately after the birth of the baby, of either oxytocin 5 IU, sulprostone 500 ng or 0.9% saline.Main outcome measures— Quantitative postpartum blood loss and length of third stage.Results— Postpartum blood loss was reduced almost equally, by about 35%, by oxytocin (P = 0.02), or sulprostone (P = 0.05). The mean length of the third stage was shorter in both groups receiving the active treatment, this effect was significant in the sulprostone group (P = 0.01).Conclusion— Prophylactic administration of oxytocin or sulprostone directly after delivery followed by expectant management of the third stage reduces post partum blood loss and shortens the third stage.
The obstetric and neonatal outcome of pregnancy in women with a previous history of infertility: a prospective study
Authors: LI T. C. , MACLEOD I. , SINGHAL V. , DUNCAND S. L. B. 
Published: August 2005

AbstractObjective— To compare the frequency of common antenatal problems, the amount of antenatal surveillance and the obstetric and neonatal outcome in women with and without a history of infertility.Design— A prospective cohort study with age and parity matched controls.Setting— A single consultant unit at the Jessop Hospital for Women, Sheffield, over a 22‐month period.Subjects— 114 women with a history of infertility who reached 16 weeks gestation with a singleton live fetus and 114 control women matched for age and parity.Main outcome measures— Frequency of antepartum, complications, amount of antepartum surveillance, obstetric and neonatal outcome.Results— Common antenatal complications were not increased. In the infertility compared with the control group, the relative risk of requiring an emergency caesarean section was 2.43 (95% CI 1.05–5.63). There was no difference in birthweight.Conclusion— Many of the previously observed differences in outcome of pregnancy in women after infertility compared with those without are associated with age and parity but these characteristics do not explain the increased frequency of emergency caesarean section.
The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy for dysfunctional uterine bleeding
Authors: THOMAS E. J. , OKUDA K. J. , THOMAS N. M. 
Published: August 2005

AbstractObjective— To observe if a combination of a depot GnRH agonist and cyclical hormone replacement therapy decreases menstrual b od loss.Design— open, observational study comparing the objective assessment of menstrual blood loss before, during and after 3 months treatment.Subjects— 20 women with a subjective complaint of heavy menstrual loss in whom no cause could be discovered.Interventions— Each woman received 3 months of depot goserelin (Zoladex) combined with cyclical hormone replacement therapy (Cyclo‐Progynova, 1 mg). Menstrual loss and symptoms were assessed before, throughout and after the study.Main outcome measures— Changes in objective and subjective assessments of menstrual blood loss and the acceptability of the treatment.Results— The median pretreatment menstrual loss was 68 ml (range 23–397). Only 8 (40%) of the patients had a loss exceeding 80 ml per period. The median blood loss was 30 ml, 16 ml, and 17 ml in the three treatment cycles (P < 0.001 Wilcoxon rank sum for the third cycle). There was a significant decrease in the median length of menstruation (P < 0.001) and the number of towels or tampons (P < 0.01) used per period in the third treatment cycle. There was a significant decrease (P < 0.005) in the number of women complaining of dysmenorrhoea, premenstrual symptoms, flooding and the passage of clots. Seventeen patients experienced hot flushes. Eighteen of the 20 patients were completely satisfied with the treatment and would have been happy to continue with it for longer than 12 months.Conclusions— The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy is a successful and acceptable treatment of dysfunctional uterine bleeding.
Sensory urgency: how full is your bladder?
Authors: CREIGHTON SARAH M. , PEARCE J. MALCOLM , ROBSON ISABEL , WANG KATHRYN , STANTON STUART L. 
Published: August 2005

AbstractObjective— To investigate whether women with sensory urgency have an abnormal perception of bladder fullness.Design— Prospective observational study.Setting— Urodynamic Unit, St George's Hospital, London.Subjects— 15 women with sensory urgency, 15 women with idiopathic detrusor instability and 15 without symptoms of frequency or urgency (control group).Interventions— All the women attended for cystometry. Each was asked to complete a visual analogue score of how full she perceived her bladder to be on a scale from 1 to 10. This was done before filling cystometry and at three times during bladder filling. At each time actual filled volume was noted.Main outcome measures— Maximum bladder capacity and individual perception of bladder fullness.Results— Women with sensory urgency and detrusor instability had similar maximum bladder capacity although values in both groups were significantly lower than in the control group; thus percentage of maximum bladder capacity was used for analysis. Linear regression was performed for each group of patients and a predicted visual analogue score at 25, 50 and 75% of capacity calculated. These were compared between groups by rank analysis of variance. There was no significant difference between sensory urgency and detrusor instability. However, at 25, 50 and 75% of capacity, both groups had a significantly higher score than the control group.Conclusions— This abnormal perception would explain symptoms of frequency and urgency in these two groups. These results also confirm the similarity between detrusor instability and sensory urgency.
Alpha thalassaemia hydrops fetalis in the UK: the importance of screening pregnant women of Chinese, other South East Asian and Mediterranean extraction for alpha thalassaemia trait
Authors: PETROU M. , BRUGIATELLI M. , OLD J. , HURLEY P. , WARD R. H. T. , WONG KWAI PENG , RODECK C. , MODELL B. 
Published: August 2005

ABSTRACTObjective
Alpha zero (α° or α‐1) thalassaemia is an important genetic risk for women originating from Hong Kong, Singapore, Vietnam, Thailand, the Philippines or South China. Cypriots are also at risk. Carriers of α° thalassaemia trait can be detected by routine haemoglobinopathy screening. When a couple are both carriers, in each pregnancy there is a 25% risk that the fetus will have α thalassaemia hydrops fetalis; this is fatal for the fetus and carries serious obstetric and psychological risks for the mother. Most informed couples at risk request prenatal diagnosis and selective abortion. This study investigates the effectiveness of screening, counselling and prenatal diagnosis for α thalassaemia hydrops fetalis in the UK.Design
Retrospective analysis of the notes.Subjects
18 couples attending University College Hospital London for prenatal diagnosis of α thalassaemia hydrops fetalis since 1982.Results
The study shows underdiagnosis of both α° thalassaemia trait and α thalassaemia hydrops fetalis leading to avoidable stillbirths and complications in pregnancy.Conclusion
We recommend early screening for α° thalassaemia trait for all women of Southeast Asian or eastern Mediterranean origin and the offer of prenatal diagnosis when indicated. The diagnosis of α thalassaemia hydrops fetalis should be considered in women of the relevant ethnic origin who have a stillbirth, neonatal death, abnormal ultrasound findings at fetal anomaly scanning (especially a large placenta), or who develop pre‐eclampsia.
A prospective, randomised, cross‐over study comparing the effects of clomiphene citrate and cyclofenil on endometrial morphology in the luteal phase of normal, fertile women
Authors: LI T. C. , WARREN M. A. , MURPHY C. , SARGEANT S. , COOKE I. D. 
Published: August 2005

ABSTRACTObjective
To examine the effect of two anti‐oestrogens, clomiphene citrate and cyclofenil, on endometrial morphology in the luteal phase.Design
A prospective, randomised, cross‐over study.Setting
Jessop Hospital for Women, Sheffield, UK.Subjects
10 women who were previously fertile and regularly cycling.Intervention
The administration of clomiphene citrate or cyclofenil in the treatment cycles. A LH timed endometrial biopsy was taken on day LH + 6.Main outcome measures
Histological dating and morphometric analysis of the endometrial sample.Results
Only one out of 10 subjects had abnormal endometrium. There was no difference in the results between cycles treated with clomiphene citrate and cyclofenil.Conclusions
Clomiphene citrate or cyclofenil does not have a major adverse effect on endometrial morphology in the luteal phase of normal fertile subjects. The possible adverse effects of anti‐oestrogens on endometrium may have been previously overestimated.
Serum relaxin as a potential marker for preterm labour
Authors: PETERSEN LONE KJELD , SKAJAA KRISTJAR , ULDBJERG NIELS 
Published: August 2005

ABSTRACTObjective
To determine whether high serum relaxin concentrations in the 30th week of pregnancy were associated with preterm labour.Design
Case‐control study.Setting
Two antenal clinics of the Department of Obstetrics and Gynecology University Hospital of Aarhus.Subjects
A cohort of 991 women (82% of 1203 eligible) in the 30th week of pregnancy attending one of the two antenatal clinics. The cases comprised 23 (2.4%) women without pre‐eclampsia or small for gestational age babies, who were delivered spontaneously before 37 completed weeks gestation. The control group of 46 women was randomly selected from the rest of the cohort, all of them were delivered at term.Interventions
Blood samples were collected at 30 weeks gestation and stored for analysis.Main outcome measures
Serum relaxin concentrations estimated by ELISA technique, length of gestation at delivery.Results
The mean serum relaxin concentrations in the 30th week of pregnancy was 455 (SD 169) pg/ml and 327 (SD 139) pg/ml in the cases and controls, respectively (P = 0003, t test). In women with preterm delivery a negative correlation was found between relaxin concentration in the 30th week of pregnancy and the gestational age at parturition (r=−0.53, P= 0.02).Conclusion
High relaxin concentrations may be associated with preterm delivery but the present results need confirmation in large scale studies.
A randomized controlled trial to compare three types of fetal scalp electrode
Authors: NEEDS LINDA , GRANT ADRIAN , SLEEP JENNIFER , AYERS SARAH , HENSON GAYE 
Published: August 2005

ABSTRACTObjectives
To compare three scalp electrodes in respect of need for reapplication, trace quality and scalp trauma.Design
Randomized controlled trial.Setting
Maternity Unit, Royal Berkshire Hospital, Reading.Participants
780 women in labour at term, with cephalic fetal presentation, deemed to require electronic fetal heart rate monitoring using a scalp electrode.Interventions
Three types of fetal scalp electrode: Rocket‐Rolon (double‐helix spiral); Hewlett‐Packard (double‐helix spiral); and Surgicraft‐Copeland (clip).Main outcome measures
Need for more than one electrode; reason for replacement; trace quality; scalp trauma; direct financial costs.Results
Reapplication was significantly least likely in the Surgicraft‐Copeland group (odds ratio vs Hewlett‐Packard = 0.61, 95% CI 0.41–0.90; odds ratio vs Rocket‐Rolon = 0.43, 95% CI = 0.29.0.62). This reflected a much lower rate of replacement because of detachment. The Hewlett‐Packard was, however, least likely to be replaced because of poor trace quality. Interpretable traces were equally common, but trace quality tended to be superior in the Hewlett‐Packard group. There was no serious scalp trauma. Difficulty removing the electrode was least often reported in the Hewlett‐Packard group, and a mark on the scalp persisted least often in the Rocket‐Rolon group.Conclusions
The Surgicraft‐Copeland performed the best overall, and particularly in respect of attachment to the scalp. It appears to be the electrode of choice of the three tested.