bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital diaphragmatic hernia: prenatal diagnosis, outcome and continuing morbidity in survivors
Authors: Huddy Charlotte L. J. , Boyd Patricia A. , Wilkinson Andrew R. , Chamberlain Paul 
Published: August 2005

Objective
To improve counselling by investigating the prenatal diagnosis, outcome and morbidity in survivors of congenital diaphragmatic hernia.Setting
Prenatal Diagnosis Unit, Oxford Radcliffe Women's Centre, Oxford.Design
Cohort study.Sample
Babies with congenital diaphragmatic hernia diagnosed postnatally and born to women scanned prenatally identified between January 1991 and December 1996.Methods
Associated anomalies, outcome of pregnancy and final diagnoses were determined from hospital records. A report from the general practitioner and paediatrician recorded health and development information.Main outcome measures
Accuracy of prenatal diagnosis, survival of cases of congenital diaphragmatic hernia and presence of ongoing morbidity in survivors.Results
There were 35 pregnancies with congenital diaphragmatic hernia, nine of which were not diagnosed prenatally. In 22 pregnancies with isolated congenital diaphragmatic hernia, four were terminated, there were six perinatal deaths and two later deaths. Thirteen of 35 cases (37%) with congenital diaphragmatic hernia were associated with other abnormalities: four with abnormal karyotype and nine with other structural anomalies. Five of these women continued with their pregnancy; there were two neonatal deaths and three survivors. Thirteen of 35 infants (37%) survived, eight with chronic disorders requiring specialist intervention including respiratory problems (n= 6); developmental delay (n= 4); poor growth (n= 5); artificial feeding (n= 3); gastro‐oesophageal reflux (n= 3); recurrent hospital admissions (n= 6); and further surgery (n= 4).Conclusions
The survival for infants born alive with congenital diaphragmatic hernia was 56% (13/23), 61% of whom have persistent disorders. Despite advances in neonatology there is a high mortality and morbidity with congenital diaphragmatic hernia. Prenatal counselling should reflect this.
Changed pattern in the use of episiotomy in Sweden
Authors: Röckner G. , Fianu‐Jonasson A. 
Published: August 2005

Objective
To study changes in the use of episiotomy since 1989, controlling for variables such as severe tears, epidural anaesthesia, duration of the second stage of labour, instrumental deliveries, birthweight and maternal position at delivery.Design
Retrospective study. Data were obtained from original birth records and questionnaires.Setting
Huddinge University Hospital and all labour wards (n= 62) in Sweden.Population
10,661 women who were delivered vaginally (4575 nulliparae, 6086 multiparae) between 1992 and 1994, and 3366 nulliparae delivered in all Swedish hospitals during the month of March 1995.Main outcome measures
Episiotomy rates, severe tears and instrumental deliveries.Results
The rate of episiotomy was 1 % and of severe tears 0.6% among multiparae delivered vaginally (including instrumental deliveries) at Huddinge University Hospital between 1992 and 1994. The rate of episiotomy was 6.6% and of severe tears 2.3% among nulliparae. Vacuum extraction and epidural anaesthesia were more commonly associated with episiotomy. Factors significantly associated with severe tears were infant birthweight ≥ 4000 g, vacuum extraction and episiotomy. In all Swedish labour wards in 1995 the mean incidence of episiotomy in nulliparae was 24.5%, a significant decrease from 33.7% in 1989. Wide variations occurred between hospitals (4%‐50%).Conclusion
The use of episiotomy was much reduced at Huddinge University Hospital, with a consistently low rate of severe tears. This supports the growing evidence for individualised and restrictive use of episiotomy at childbirth.
The effect of ovariectomy and oestrogen replacement on small artery biomechanics in the rat
Authors: Acs Nandor , Széksics Béla , Nádasy György L. , Várbíró Szaboles , Kakucs Réka , Monos Emil 
Published: August 2005

Objective
To determine the effects of oestrogen deficiency and hormone replacement therapy on the biomechanical properties of a small artery.Sample
Thirty non‐pregnant female Sprague‐Dawley rats.Methods
Twenty animals were pharmacologically ovariectomised by triptorelin and received either oestradiol propionate or its vehicle. Ten other animals received only the vehicle for the same period of time (control group). After 12 weeks of treatment, cylindrical segments of the saphenous artery were isolated and cannulated at both ends. Pressure‐diameter curves were recorded from segments in normal Krebs‐Ringer, using norepinephrine, and then with papaverine. The vessel segment close to the examined one was histologically evaluated. Serum levels of oestradiol and cortisol were determined.Main outcome measures
Biomechanical parameters based on the pressure‐diameter curves.Results
Pharmacological ovariectomy decreased the passive diameter of the arteries and oestrogen replacement therapy prevented this. Decreased reactivity to norepinephrine was also restored by oestrogen treatment. Pressure induced myogenic tone was decreased significantly by oophorectomy and increased after oestradiol treatment. No significant changes were found in wall thickness, distensibility, elastic modulus or tangential stress. No significant histological alterations were seen in the vessel wall. Oestradiol levels were significantly decreased in the castrated animals compared with the other two groups.Conclusions
These results suggest that oestrogen deficiency decreases and oestrogen replacement increases the passive diameter of small peripheral arteries, and that oestrogen enhances the reactivity of vascular smooth muscle. These responses may provide the background mechanisms for the increased incidence of arterial hypertension and hot flushes during the menopause and the ability of oestrogen substitution to prevent them.
Modified Joel‐Cohen technique for caesarean delivery
Authors: Wallin Gunnar , Fall Ole 
Published: August 2005

Objective
To investigate whether a series of changes in the current caesarean section operative routine, based on new knowledge, would be beneficial.Design
A prospective controlled trial.Setting
Labour ward with approximately 3000 deliveries annually in a suburban area of Gothenburg, Sweden.Participants
Seventy‐two pregnant women scheduled for delivery by caesarean section were randomised to either modified Joel‐Cohen technique (n= 36) or Pfannenstiel technique (n= 36).Main outcome measures
Blood loss during surgery and operating time.Results
based on new knowledge, would be beneficial. The median estimated intra‐operative blood loss was 250 mL in the modified Joel‐Cohen group and 400 mL in the Pfannenstiel group (P= 0.026). The proportion of women with 2 300 mL was 16/36 in the modified Joel‐Cohen group vs 28/36 in the Pfannenstiel group (OR 0.229,95% CI 0.082–0.637). Median operating time was 20 min in the modified Joel‐Cohen group compared with 28 min in the Pfannenstiel group (P < 0.001). The proportion of women with 2 25 min was 1/36 in the modified Joel‐Cohen group vs 33/36 in the Pfannenstiel group (OR 0.003, 95% CI Conclusions We conclude that the modified Joel‐Cohen technique of caesarean delivery reduced intra 0.000–0.026).Conclusions
We conclude that the modified Joel‐Cohen technique of caesarean delivery reduced intra‐operative blood loss and operating time compared with the Pfannenstiel technique.
Changes in anal anatomy following vaginal delivery revealed by anal endosonography
Authors: Frudinger Andrea , Halligan Steve , Bartram Clive I. , Spencer John A. D. , Kamm Michael A. 
Published: August 2005

Objective
To investigate changes in anal canal anatomy following vaginal delivery in women without apparent sphincter injury.Design
Prospective controlled observational study.Setting
District general hospital.Population
Consecutive parous and nulliparous women attending a gynaecology outpatient clinic.Methods
All women were examined using anal endosonography, and parous subjects without apparent sphincter injury compared with age‐matched nulliparous controls to determine any differences in general anal canal morphology.Main outcome measures
Individual anal canal components were measured at defined levels and subjects compared with controls.Results
Twenty‐one of 54 parous women had no anal sphincter scar. Compared with nulliparous women, they had significant anterior sphincter thinning (mean 3.7 mm vs 4.6 mm, P < 0.01) in association with lateral external sphincter thickening (mean 7.0 mm vs 4.4 mm, P < 0.01), and longitudinal muscle thickening (mean 2.8 mm vs 2.1 mm, P < 0.01).Conclusions
Specific changes in anal morphology have been demonstrated following vaginal delivery in women without apparent sphincter injury.
Epidemiological characteristics of women with high grade CIN who do and do not have human papillomavirus
Authors: Tabrizi Sepehr N. , Fairley Christopher K. , Chen Shujun , Borg Anthony J. , Baghurst Peter , Quit Michael A. , Garland Suzanne M. 
Published: August 2005

Objective
Human papillomavirus infection is an important aetiological agent associated with the devel‐ opment of cervical neoplasia. However, even with the most sensitive methods of detection, human papillomavirus DNA has been detected in only 90% of cases of cervical cancer and between 80%‐90% of cases of dysplasia. This study aimed to determine if there are epidemiological differences between women who are positive or negative for human papillomavirus. with high grade cervical intraepithelial neoplasia (CIN).Design
Four hundred and sixty women with CIN 11 and 111 lesions were studied. To ensure optimal detection of human papillomavirus DNA, two specimens (i.e. tampon and cervical biopsy) were collected from each woman and tested by three techniques: L1 ‐polymerase chain reaction, E6–PCR and low stringency Southern blotting. A detailed questionnaire was completed and blood sample collected for determination of serum levels of beta‐carotene, vitamin A and E from each patient. Human leucocyte antigen (HLA)‐DQB 1 alleles were also compared between the groups of women who were positive or negative for human papillomavirus.Results
Overall, human papillomavirus DNA analysis was positive in 411 women (89%). Age, number of sexual partners in the last 12 months, past pregnancy and marital status werc associated with human papillomavirus detection in the crude analysis. However, in the adjusted analysis no cpidemi‐ ological features remained significantly differcnt between the human papillomavirus positive and negative patients. Moreover, examination of vitamin A, E and beta‐carotene levels did not show a significant difference between the two groups of patients. However, in the HLA‐DQBI allele profile a significantly higher proportion of women who were negative for human papillomavirus had DQB1 *0201, *0603 and *0604 (P= 0.05.0.001,0.03, respectively).Conclusion
We did not find a significant differcnce in epidemiological factors between women with human papillomavirus positive and negative high grade CIN. However differences between the frequency of thrcc HLA DQB1 alleles suggest that women with these allele profiles have a higher chance of clearing human papillomavirus, without affecting their chance of developing dysplasia.
Colposuspension after previous failed incontinence surgery: a prospective observational study
Authors: Cardozo Linda , Hextall Andrew , Bailey Jane , Boos Kelvin 
Published: August 2005

Objective
To evaluate the outcome of colposuspension for genuine stress incontinence in women who had previously undergone bladder neck surgery.Design
Prospective observational study.Setting
Tertiary referral urogynaecology unit.Participants
Fifty‐two consecutive women with recurrent genuine stress incontinence operated on one surgeon.Main outcome measures
Subjective and objective cure of stress incontinence. Complications one surgeon.Results
The mean age of the women was 51 years (range 28–72) and weight 72.7 kg (range 53–112). Sixty‐five continence procedures had been performed previously, with 13 women (25%) having had more than one operation. Nine months post‐operatively the subjective cure rate was 80% and objective cure rate 78%. Intraoperative complications were few but included two bladder injuries and one rectus muscle tear which required repair. Seven women (13%) developed voiding difficulties which required clean intermittent self‐catheterisation, but only one needed to continue this for six months. None of the women developed detrusor instability.Conclusions
In this setting colposuspension after previous bladder neck surgery offers a high rate of success. However, long term follow up is needed to see if this effect is maintained.
Follow up of women with simple ovarian cysts detected by transvaginal sonography in the Tokyo metropolitan area
Authors: Sasaki H. , Oda M. , Ohmura M. , Akiyama M. , Liu C. , Tsugane S. , Terashima Y. , Tanaka T. 
Published: August 2005

Objective
To investigate the management of women with asymptomatic ovarian masses, to determine the appropriate duration of follow up, and to identify diagnostic indicators of growing cysts.Design
Review of women's hospital records.Setting
Tokyo Metropolitan Cancer Detection Center, Japan.Population
Two hundred and twenty‐five pre‐ and postmenopausal women with a diagnosis of ovarian cyst ≥6 cm in diameter and normal serum level of CA125, diagnosed between 1 October 1990 and 25 December 1991.Main outcome measure
Change in size of cyst as shown by ultrasound.Results
Seventy‐five months after initial diagnosis, 29 (13%) of the masses had progressed, 31 (14%) had persisted, and 165 (73%) had regressed. One hundred and nine masses (48%) had regressed within six months of the initial diagnosis. In univariate analysis transvaginal ultrasonographic assessment of morphology findings, cyst diameter, carcinoembyronic antigen (CEA) and CA 19.9 were associated with the prognosis of the cyst. Multivariate regression analysis demonstrated that only the initial serum CA19‐9 level and serum CEA level were significant predictors of ovarian masses that regressed (P for trend = 0.004 and 0.02, respectively).Conclusion
Simple ovarian cysts in patients with a normal level of CA125 have a low risk for ovarian cancer. Vaginal ultrasound at six months will identify regression of most simple cysts. CA19‐9 and CEA at the initial diagnosis are useful parameters to predict future regression of ovarian cysts.
The white coat effect in hypertensive pregnancy: much ado about nothing?
Authors: Brown Mark A. , Robinson Arlene , Jones Mike 
Published: August 2005

Objectives
To determine the prevalence of white coat hypertension and white coat effect among hypertensive pregnant women and to assess whether the presence of a significant white coat effect was associated with adverse pregnancy outcome when clinical management was based upon standard sphygmomanometric blood pressure recordings.Design
Prospective blinded studies assessing the presence of a white coat effect.Setting
Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia.Population
One hundred and twenty‐one hypertensive pregnant women in the second half of their pregnancy admitted to hospital or the day assessment unit for management of their hypertensive disorders.Methods
Routine sphygmomanometric blood pressures were recorded by midwives in the ward or day assessment unit and awake blood pressure recordings were averaged. These blood pressures were compared with average awake blood pressures recorded by ambulatory blood pressure monitor (ABPM) (Spacelabs 90207, Seattle, Washington, USA). White coat hypertension was defined as an average sphygmomanometer blood pressure ≥ 140 mmHg systolic and/or ≥ 90 mmHg diastolic with awake ABPM average blood pressure within the normal range for ABPM‐derived blood pressures in pregnancy, according to gestation. White coat effect was the difference between average sphygmomanometer blood pressure and average awake ABPM‐derived blood pressure. All clinical management was based upon routine sphygmomanometer recordings and clinicians were blinded to ABPM data.Main outcome measures
Prevalence of white coat hypertension and white coat effect; maternal and fetal outcomes in those with and without a white coat effect of ≥ 20 mmHg systolic and/or ≥ 10 mmHg diastolic.Results
Systolic and diastolic white coat hypertension were present in only 3.2% and 4.2% of the group, respectively. A systolic white coat effect ≥ 20 mmHg was found in only 4.2% but 20.2% (26% for day assessment unit patients vs 15% for inpatients; P= 0.17) had a diastolic white coat effect 10 mmHg. There was no difference in maternal or fetal outcomes between women with and with out a white coat effect.Conclusions
White coat hypertension is an infrequent occurrence in mildly hypertensive pregnant women. Although a white coat effect is present more often, this is associated with clinical outcomes similar to women who do not exhibit this phenomenon. Using ABPM to identify a white coat effect in women presenting with hypertension in the second half of their pregnancy does not appear to be clinically useful.
Medical termination of pregnancy at 63 to 83 days gestation
Authors: Gouk Elaine V. , Lincoln Karen , Khair Anu , Haslock Joanne , Knight June , Cruickshank Derek J. 
Published: August 2005

Objective
To assess the efficacy of a medical regimen for the termination of pregnancy within the gestational age range of 63 to 83 days.Design
Prospective observational study.Setting
Gynaecology department within a district general hospital.Population
Women attending t0068e pregnancy advisory clinic between June 1996 and December 1997.Methods
The medical regimen used was mifepristone 200 mg orally followed after 36 to 48 h by misoprostol 800 μg administered vaginally.Main outcome measures
The success rate of the medical termination of pregnancy regimen, where success was defined as achieving complete abortion without the need for secondary intervention by either surgical or repeat medical means.Results
Primary medical termination of pregnancy was chosen by 253 (80.8%) of the 313 women and was successful in 239 (94.5%). Repeat medical treatment achieved completion of the abortion in a further three women (1.2%) and surgical evacuation of the uterus was required in 10 (4.0%). One woman declined further intervention after failed medical treatment but subsequently miscarried.Conclusions
The combination of mifepristone and misoprostol is effective for the termination of pregnancy for gestations of 63 to 83 days.
The effect of compression therapy on venous haemodynamics in pregnant women
Authors: Büchtemann Alexandra S. , Steins Anke , Volkert Birgit , Hahn Martin , Klyscz Thomas , Jünger Michael 
Published: August 2005

Objective
To study the influence of compression on the haemodynamics o the deep venous system in pregnancy.Design
A prospective, observational studySetting
The phlebological unit of the department of dermatology at a university hospital.Population
Fifteen pregnant women with no previous signs of chronic venous insufficiency.Methods
Parameters of the venous pump function were assessed by strain‐gauge plethysmography. Blood flow velocity, flow volume and vessel diameter in the superficial femoral vein were measured by duplex sonography. All examinations were performed with and without applied compression stockings (25–32 mmHg) at two different stages of gestation and after delivery. In addition, subjective symptoms were graded.Results
Venous pump function improved and refilling time lengthened significantly when compression was used during gestation and postnatally. Duplex sonography showed an increase in blood flow velocity and flow volume in the superficial femoral vein with applied compression; the vessel diameter increased slightly. Subjective symptoms of the leg, graded on an arbitrary scale, were reduced by regular compression therapy.Conclusion
Our results indicate that compression improves the clinical symptoms of venous congestion and the venous haemodynamics of the legs during pregnancy and in the postpartum period. Thus, the regular use of compression during pregnancy and the puerperium may reduce the incidence of thromboembolic events.
Maternal peripheral blood leukocytes in normal and pre‐eclamptic pregnancies
Authors: von Dadelszen Peter , Wilkins Thurl , Redman Christopher W. G. 
Published: August 2005

Objective
To analyse activation of maternal peripheral blood leukocytes by flow cytometric measurements of intracellular free‐ionised calcium of lymphocytes, granulocytes, and monocytes, separately.Design
Case‐control study.Setting
High risk pregnancy service in a regional centre.Material
Samples from 10 women with Pre‐eclampsia, 10 appropriately‐matched women with normal pregnancy, nine multigravid normal women at mid‐gestation selected as being least likely to demonstrate any tendencies towards Pre‐eclampsia, and 11 healthy nonpregnant women of reproductive age were studied.Methods
Using flow cytometry, intracellular free ionised calcium ([Ca2+]i) was estimated by loading the cells with Fluo‐3 and measuring the changes in fluorescence intensity induced by free ionised calcium. After the basal levels were measured, the response of phagocytes to stimulation with n‐formylmethionyl‐leucyl‐phenylalanine (fMLP) was determined.Main outcome measures
Basal [Ca2+]i of peripheral blood leukocytes.Results
Median basal [Ca2+]i was significantly increased in all three subsets of leukocytes—lymphocytes, granulocytes and monocytes in Pre‐eclampsia—compared with the three control groups. Samples from both groups of women with normal pregnancy did not differ from those from nonpregnant women. The peak responses of monocytes to stimulation with 10 nmol fMLP were greater in samples from pre‐eclamptic women, giving evidence of priming.Conclusions
Peripheral blood leukocytes are activated in Pre‐eclampsia in terms of basal changes in the intracellular second messenger—free ionised calcium. Peripheral blood monocytes are primed to give greater responses after stimulation with fMLP.
Administration of low‐dose aspirin to mothers with small for gestational age fetuses and abnormal umbilical Doppler studies to increase birthweight: a randomised double‐blind controlled trial
Authors: McCowan Lesley M. E. , Harding Jane , Roberts Alistair , Barker Sarah , Ford Cassandra , Stewart Alistair 
Published: August 2005

Objective
To determine whether antenatal treatment (for ≥= 14 days) with 100 mg aspirin daily, given to mothers with small for gestational age fetuses and abnormal umbilical Doppler, will increase birthweight.Design
Randomised, double‐blind placebo controlled trial.Setting
A tertiary referral centre.Participants
Ninety‐nine women, of whom 65 were treated for ≥= 14 days (32 with aspirin and 33 with placebo) and comprised the study group. The entry criteria were: singleton pregnancy with ultrasound evidence of a small for gestational age fetus (abdominal circumference < 10%); previous anatomy scan <20 weeks and no evidence of fetal abnormality; gestation between 24 and 36 weeks; umbilical artery Doppler resistance index > 95% for gestation; no previous aspirin treatment in pregnancy; and no contra‐indication to aspirin treatment.Results
The mean duration of treatment was 30 days for aspirin treated, and 29 for placebo. No difference was found in birthweight or other measures of fetal growth or newborn morbidity between those treated with aspirin or placebo. Compliance, assessed by thromboxane B2 analysis, showed almost complete suppression of thromboxane B, in aspirin treated women.Conclusion
Low‐dose aspirin did not increase birthweight in pregnancies where the fetus has abnormal umbilical Doppler and is thought to be small for gestational age.