bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histological impact of medical therapy – clinical implications
Authors: Fedele L. , Bianchi S. , Marchini M. , Di Nola G. 
Published: August 2005

ABSTRACTThe medium‐ and long‐term effects of gestrinone and danazol on the endometrium were examined in 36 patients with endometriosis. Endometrial biopsies were taken from each patient before treatment and after 3 and 6 months of treatment with 600 mg danazol daily (n= 17) or with 2.5 mg gestrinone twice weekly (n= 19). Endometrial samples were analysed by light, scanning and transmission electron microscopy. At 3 months' treatment the endometria of patients treated with danazol appeared more atrophic than those of the women treated with gestrinone; some cell organelle involution was evident in all patients. After 6 months of treatment a marked atrophy was observed in patients of both treatment groups. A complete involution of cytoplasmic organelles with cytoplasmic collapse and a shift of nucleoplasmic ratio in favour of the nucleus occurred in patients treated with danazol; the cytoplasmic organelle involution was less marked in patients treated with gestrinone. Compared with gestrinone, danazol induces more rapid endometrial atrophy, with greater impairment of the cytoplasm and cell secretory activity.
Elaboration of stem villous vessels in growth restricted pregnancies with abnormal umbilical artery Doppler waveforms
Authors: Macara Lena , Kingdom John C. P. , Kohnen Gaby , Bowman Adrian W. , Greer Ian A. , Kaufmann Peter 
Published: August 2005

ABSTRACTObjective
To assess the elaboration of placental stem villous vessels from pregnancies complicated by intrauterine growth restriction (IUGR) with absent end–diastolic flow velocity detected prior to delivery in the umbilical artery.Design
Comparison between IUGR and control groups of the distribution, in 15 pm increments of 600 randomly chosen stem vessel profiles (post‐fixation diameter 10‐160 pm) identified by immunohistochemical localisation of a‐smooth muscle actin in the vessel media.Setting
Clinical teaching hospital and university anatomy department.Subjects
Paraffin‐fixed blocks obtained from placentas of eight pregnancies complicated by IUGR and eight gestational age‐matched controls.Results
The distribution of the stem villous vessels in the IUGR placentas, as assessed by the mean vessel diameter in each case, did not differ from the controls (mean vessel diameter 31.8 μm [SD 2.41 vs 29.6 pm [2.3]; P= 0.13). In five IUGR cases a‐smooth muscle actin positive cells (myofibroblasts) were identified within the stroma of nonmuscularised peripheral (mature intermediate and terminal) villi, but in none of the controls.Conclusions
Our data do not support the theory that IUGR with absent end‐diastolic flow velocity in the umbilical artery is due to a selective loss of small stem villous vessels. The increased impedance in this condition may be conferred more distally within the nonmuscularised capillaries of the peripheral villi.
Sonographic, stereological and Doppler flow velocimetric assessments of placental maturity
Authors: Burton G. J. , Jauniaux E. 
Published: August 2005

ABSTRACTObjective
To determine whether sonographic assessments of increasing placental maturity are associated with changes in the theoretical diffusing capacity of the organ and with changes in vascular resistance.Design
Placental maturity was assessed sonographically in 10 organs: five were classified as completely immature and five as completely mature. Doppler flow velocimetric recordings were obtained shortly before delivery performed by elective caesarean section. Placental biopsies taken immediately after delivery were analysed stereologically.Results
No differences were observed in either placental weight or volume, but the morphometric diffusing capacity of the villous membrane was 40 % higher in the mature than in the immature placentas. Doppler indices did not alter with increasing placental maturity.Conclusions
Normal term placentas differ significantly in their diffusion characteristics, even when organ weight and volume remain constant. Umbilical vascular resistance may be heavily influenced by the number of parallel circulatory units offered by the placental lobules.
The mortality and morbidity associated with umbilical cord prolapse
Authors: Murphy D. J. , MacKenzie I. Z. 
Published: August 2005

ABSTRACTObjective
To examine the management of cord prolapse and its morbidity and mortality.Design
Retrospective study of consecutive babies born after cord prolapse, identified using the Oxford Obstetric Data System, and those with registered handicap, identified by the Oxford Region Register of Early Childhood Impairments.Setting
District maternity hospital managing more than 6000 deliveries annually.Subjects
One hundred and thirty–two babies born after the identification of cord prolapse in the John Radcliffe Hospital between January 1984 and December 1992.Main outcome measures
Survival rates, condition at birth assessed by Apgar scores at 1 and 5 minutes and blood gas values on cord blood samples, and incidence of major handicap at three years of age.Results
The incidence of cord prolapse was 1 in 426 total births. There were six stillbirths and six neonatal deaths. One baby died as a result of birth asphyxia. The uncorrected perinatal mortality rate was 91 per 1000. Of 120 survivors, only one baby was known to suffer a major neurological handicap. Electronic cardiotocographs aided the diagnosis of cord prolapse in 41 % of cases. Apgar scores were better with a shorter diagnosis to delivery interval, but cord gas results did not correlate well with Apgar scores or the diagnosis to delivery interval.Conclusions
Cord prolapse occurs with a relatively stable incidence in this population irrespective of changes in obstetric practices. Despite the high incidence of ominous cardiotocographs, low Apgar scores and acidaemia on blood gas analysis, the fetal outcome is not as poor as might be expected and mortality is predominantly attributable to congenital anomalies and prematurity rather than birth asphyxia.
The effect of social deprivation on birthweight, excluding physiological and pathological effects
Authors: Wilcox Mark A. , Smith Sarah J. , Johnson Ian R. , Maynard Paul V. , Chilvers Clair E. D. 
Published: August 2005

ABSTRACTObjective
To study the effect of social deprivation on birthweight, excluding the effect of known physiological factors and exploring the effect of possible pathological factors.Design
Retrospective analysis of computerised obstetric database.Setting
Two teaching hospitals and an associated district general hospital which provided a defined catchment area in the East Midlands.Subjects
The final analysis included 7493 women with complete datasets and gestations of between 259 and 300 days at delivery, dated by ultrasound scan.Main outcome measures
Smoking habit, alcohol consumption, weight gain during pregnancy, systolic and diastolic blood pressures at booking, bleeding during pregnancy and Jarman score; also, the effect of these variables on birthweight, adjusted for the effects of physiological factors using the individualised birthweight ratio.Results
Smohng during pregnancy reduced birthweight but the effect is not linear, becoming less marked as the number of cigarettes smoked increases. Alcohol intake, diastolic and systolic blood pressures at the booking visit and vaginal bleeding during early pregnancy were not significantly related to birthweight. Pregnancy weight gain was significantly positively related to birthweight especially in the normal weight range (60‐99 kg). A multivariate analysis including physiological and pathological factors found increasing Jarman score to be negatively related to birthweight.Conclusions
In this central British population social deprivation is correlated negatively with birthweight: the most socially deprived mothers have the smallest babies. This association cannot be explained in terms of physiological differences in the population nor in a higher prevalence of known pathological factors.
Pregnancy in sickle cell disease in the UK: results of a multicentre survey of the effect of prophylactic blood transfusion on maternal and fetal outcome
Authors: Howard Richard J. , Tuck Susan M. , Pearson T. C. 
Published: August 2005

ABSTRACTObjective
To determine the outcome of pregnancies complicated by sickle cell disease in the UK during 1991‐1993 and the effect of prophylactic blood transfusion programmes on maternal and fetal outcome.Design
A multicentre study.Subjects
Eighty‐one pregnancies complicated by sickle cell disease and 100 pregnancies from women of black African descent without haemoglobinopathies to act as a comparative group. Pregnancies complicated by sickle cell disease were divided by the type of haemoglobinopathy and also by transfusion regimen.Main outcome measures
Antenatal and postnatal complications of sickle cell disease, proteinuric hypertension, preterm delivery, emergency delivery by caesarean section, fetal distress, birthweight, perinatal and maternal mortality.Results
There were two maternal deaths in the 81 pregnancies and the perinatal mortality rate was 60/1000. Antenatal sickling complications occurred in 46.2% of pregnancies and postnatal sickling complications occurred in 7.7% of pregnancies. Pregnancies complicated by sickle cell disease were significantly more likely to be associated with anaemia, preterm delivery, proteinuric hypertension, birthweight below the 10th centile and caesarean section as an emergency procedure than the comparative group. Severe sickling complications occurred more commonly in the third trimester and there was some evidence that a prophylactic transfusion programme reduced the risk of this. Prophylactic transfusion did not improve obstetric outcome when compared with those pregnancies that were untransfused.Conclusions
Sickle cell disease remains a severe complicating factor to pregnancy and perinatal mortality and maternal mortality rates in the UK have increased since last reported. A policy of exchange transfusing all women with homozygous sickle cell disease (HbSS) from 28 weeks gestation is recommended to reduce the risk of maternal complications in the thrd trimester and puerperium. There remains a role for earlier prophylactic blood transfusion programmes in women with poor obstetric and haematological histories.
Screening for fetal trisomies by maternal age and fetal nuchal translucency thickness at 10 to 14 weeks of gestation
Authors: Pandya Pranav P. , Snijders Roslainde J. M. , Johnson Sarah P. , de Lourdes Brizot Maria , Nicolaids Kypros H. 
Published: August 2005

ABSTRACTObjective
To evaluate screening for chromosomal defects by a combination of fetal nuchal translucency thickness and maternal age.Design
A prospective multicentre screening study where fetal nuchal translucency thickness was measured at 10 to 14 weeks of gestation.Subjects
20,804 women with singleton pregnancies screened at 10 to 14 weeks of gestation from 1 September 1992 to 28 October 1994.Main outcome measures
Trisomy 21 and other chromosomal defects identified by increased nuchal translucency thickness and by a combination of nuchal translucency thickness and maternal age.Results
In normal fetuses nuchal translucency thickness increased significantly with crown‐rump length. The nuchal translucency was above the 95th centile in 77% (66 of 86) of fetuses with trisomy 21 and in 78% (61 of 78) of those with other chromosomal defects. On the basis of the distribution of nuchal translucency measurements in normal fetuses and those with trisomy 21, a new method of screening is proposed which involves assessment of individual risk based on the combination of fetal nuchal translucency, crown rump length and maternal age. The minimum risk was 1/100 in 4.9% of the normal pregnancies, in 80% of those with trisomy 21 and in 77% of those with other chromosomal defects.Conclusion
Screening for fetal trisomy 21 can be carried out effectively during the first trimester of pregnancy.
The effect of topical oestradiol on skin collagen of postmenopausal women
Authors: Varila Eero , Rantala Immo , Oikarinen Aarne , Risteli Juha , Reunala Timo , Oksanen Hanna , Punnonen Reijo 
Published: August 2005

ABSTRACTObjective
To examine the effect of topical oestradiol on skin collagen and elastin.Subjects
Twelve postmenopausal women, aged 52 to 76 years.Interventions
Topical oestradiol treatment on the skin of lower abdomen and the vehicle only on the contralateral site; once a day for three months.Main outcome measures
The content of skin hydroxyproline; the levels of the carboxyterminal propeptide of human type I procollagen (PICP) and of the aminoterminal propetide of human type III procollagen (PIIINP).The number and the quality of collagen and elastic microfibrils.Results
The amount of hydroxyproline in the skin significantly (P= 0.012) increased from 11.8 to 16.3 pgμ(38 %) during oestradiol treatment. After treatment, the PICP level in the blister fluid was significantly (P= 0.024) higher on the treated site than on the control site. Also the level of PIIINP increased, but the change was not statistically significant. Electron microscopy showed morphologic improvement of elastic and collagen fibres, while the number of oxytalan and elaunin fibres was unchanged in light microscopy.Conclusions
Topical oestradiol treatment increases the amount of skin collagen. The increase in the level of PICP and PIIINP in skin blister fluid indicates that oestradiol treatment stimulates collagen synthesis. Furthermore, our results show that topical ostradiol treatment has a greater influence on the amount than on the quality of skin collagen. On the contrary, in elastic tissue the oestradiol treatment will only result in morphologic improvement.
First trimester fetal nuchal translucency: Problems with screening the general population 1.
Authors: Roberts L. J. , Bewley S. , Mackinson A‐M. , Rodeck C. H. 
Published: August 2005

ABSTRACTObjective
To evaluate the feasibility of measuring first trimester nuchal translucency in an unselected population, to assess the relationship with gestation and maternal age and to measure reproducibility.Design
A prospective observational study.Setting
University College Hospital, London.Subjects
One thousand and four women attending for a routine first trimester dating scan between eight and thirteen weeks of gestation. Measurements of nuchal translucency were attempted in 1368 (80.‐3%) and successful in 1127 (82% of attempts).Results
Nuchal translucency is most easily measured at 11 weeks of gestation. If a cut‐off of ≥ 3 mm is used, 6% of unselected fetuses between eight and thirteen weeks of gestation are classified as abnormal. Nuchal translucency increases with gestational but not maternal age. Reproducibility is poor: by repeating measurements with a different operator, the same operator using a different still image, or the same operator using the same still image, 18.8%, 173% or 12.4% of nuchal translucency measurements, respectively, change their classification as normal or abnormal.Conclusions
If nuchal translucency ≥ 3 mm were used as an indication for karyotyping, 6% of the normal pregnant population would be screen positive. However, the percentage will vary greatly depending on the gestational age profile of the screened population. The poor reproducibility of nuchal translucency measurement could diminish its usefulness as a screening test for Down's syndrome.
First trimester fetal nuchal translucency: Problems with screening the general population 2.
Authors: Bewley S. , Roberts L. J. , Mackinson A‐M. , Rodeck C. H. 
Published: August 2005

ABSTRACTObjective
To investigate first trimester nuchal translucency 3 mm as a screening test for aneuploidy in the normal pregnant population.Design
A pilot observational study.Setting
University College Hospital, London.Subjects
One thousand one hundred and twenty‐seven women had measurements of nuchal translucency at the time of their dating scan (8–13 weeks of gestation).Results
Seventy fetuses (6%) had a nuchal translucency ≥ 3 mm. Five karyotypically abnormal fetuses were identified by standard routine techniques (three trisomy 21, two trisomy 18), all in high risk mothers (239 years). Only two had nuchal translucency ≥ 3 mm (one trisomy 21, one trisomy 18).Conclusions
Although nuchal translucency measurement is feasible and promising, there is at present insufficient data to warrant its introduction for screening of the general population, or to replace traditional second trimester screening.
Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia
Authors: Preston J. T. , Cameron I. T. , Adams E. J. , Smith S. K. 
Published: August 2005

ABSTRACTObjective
To compare the efficacy and safety of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia.Design
A randomised, double‐blind, placebo controlled study.Setting
University Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge.Subjects
One hundred and three women complaining of heavy periods with a regular cycle recruited directly from general practitioners within the hospital catchment area and from consultants' gynaecology clinics.Interventions
There were forty‐six women on placebo with confirmed ovulatory menorrhagia, defined as menstrual blood loss greater than 80 ml/cycle and mid‐luteal serum progesterone concentration greater than 9 nmol/l). Twenty‐one received norethisterone (5 mg twice a day on days 19 to 26) and 25 received tranexamic acid (1 g four times daily on days 1 to 4) for two cycles.Main outcome measures
Menstrual blood loss was measured using the alkaline haematin method. Haematological assessments were made both at the beginning and at the end of the study, questionnaires were given to assess subjective endpoints, and patients were asked to report any adverse events during all cycles.Results
Tranexamic acid reduced mean menstrual blood loss by 45%, from 175 ml to 97 ml (95% CI for the difference in menstrual blood loss 52 to 108, P 0.0001), norethisterone increased mean blood loss by 20% from 173 ml to 208 ml (95% CI for the difference in menstrual blood loss −64 to 2, P= 0.26). Fourteen (56%) women who received tranexamic acid achieved a mean menstrual loss of less than 80 ml per cycle during treatment, but only two (9.5%) who received norethisterone achieved this mean menstrual loss. There were no serious adverse events reported for either drug.Conclusions
Tranexamic acid is a safe and effective form of medical therapy in women with menorrhaga and is highly likely to normalise blood loss in women losing 80 to 200 ml prior to treatment. Norethisterone at this dose is not effective therapy for ovulatory menorrhagia.
A randomised comparison over 8 months of 100 μg and 200 μg twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome
Authors: Smith Roger N. J. , Studd John W. W. , Zamblera Dante , Holland E. F. Nigel 
Published: August 2005

ABSTRACTObjective
To determine the efficacy of a 100 μg twice weekly dose of Estraderm TTS compared with a 200 μg dose in the treatment of severe PMS, and to determine the overall acceptability of the treatment. To determine the serum oestradiol levels produced by the two doses of Estraderm and to discover whether the lower dose suppresses ovulation.Design
Main: randomised, prospective, comparative study. Subsidiary: cross‐sectional and prospective.Setting
Premenstrual syndrome clinic in teaching hospital.Subjects
Women with severe PMS confirmed by prospective daily symptom recording.Interventions
Estraderm TTS® at a dose of either 100 or 200 μg twice weekly continuously with either dydrogesterone 10 mg or medroxyprogesterone acetate 5 mg, from day 17 to day 26 of each cycle.Main outcome measures
Main: change in total, exponentially smoothed, average maximum score (total‐ESAmax) of 10 common premenstrual syndrome symptoms derived from Trigg's trend analysis and patient satisfaction. Subsidiary: plasma oestradiol and day 21 progesterone levels.Results
Main: no difference in change in total‐ESAmax between Estraderm 100 μg and 200 μg groups. Greater drop‐out rate and greater incidence of side effects attributed to oestrogen in higher dosage group. Satisfaction rate of 45% to 57% at eight months. Subsidiary: 1. Mean (95% CI) oestradiol level of 300 pmol/l (255 to 345) with Estraderm 100 Fg and 573 (494 to 693) with Estraderm 200 pg; 2. Estraderm 100 μg suppresses mid‐luteal progesterone from a mean (95% CI) of 353 (28.4 to 427) to 3.4 (2.4 to 4.5).Conclusions
Estraderm TTS 100 μg twice weekly is as effective as 200 μg twice weekly in reducing symptom levels in severe premenstrual syndrome but is better tolerated. Estraderm 100 μg suppresses ovulation and results in a mean plasma oestradiol level similar to that observed in a spontaneous cycle.
A randomised controlled trial of simple compared with complex antenatal fetal monitoring after 42 weeks of gestation
Authors: Alfirevic Zarko , Walkinshaw Steve A. 
Published: August 2005

ABSTRACTObjective
To compare the impact on perinatal outcome of two different protocols for antenatal fetal monitoring after 42 weeks gestation.Design
A prospective randomised controlled trial.Setting
Liverpool Maternity Hospital.Subjects
One hundred and forty‐five women with singleton, uncomplicated pregnancies after 42 weeks of gestation.Interventions
Random allocation to fetal monitoring by either: 1. a modified biophysical profile comprising of computerised cardiotocography, amniotic fluid index, and assessment of fetal breathing, tone and gross body movements; or 2. standard cardiotocography and maximum pool depth.Outcome measures
Cord pH at delivery, number of abnormal monitoring tests, intrapartum management, mode of delivery and neonatal outcome.Results
There were significantly more abnormal antenatal monitoring results in the modified biophysical profile group (47.2%vs 20.5%; odds ratio = 3.5, 99% CI = 1.3–9.1). There were no differences in cord blood gases, neonatal outcome, or in outcomes related to labour and delivery between the two groups, but a trend towards more obstetric interventions in the modified biophysical profile group was noted. Amniotic fluid volume after 42 weeks was more likely to be labelled as abnormal with amniotic fluid index than with maximum pool depth (44.4%vs 15.1%; odds ratio = 4.5, 99% CI = 1.6–12.8).Conclusions
The results suggest that after 42 weeks fetal monitoring with the modified biophysical profile does not improve pregnancy outcome as measured by umbilical cord pH, but is more likely to yield an abnormal result. The higher incidence of abnormal monitoring results in the modified biophysical profile group was likely to be caused by different methods of amniotic fluid assessment in the modified biophysical profile group (amniotic fluid index) and simple monitoring group (maximum pool depth). The use of amniotic fluid index as a test of fetal wellbeing in prolonged pregnancy may lead to more obstetric interventions with, as yet, unclear impact on the perinatal outcome.