bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relation between fetal abdominal circumference and birthweight: findings in 3512 pregnancies
Authors: Smith G. C. S. , Smith M. F. S. , McNay M. B. , Fleming J. E. E. 
Published: August 2005

Objectives
To establish the relation between fetal abdominal circumference and birthweight in a large population of fetuses; to identify whether the error in estimating birthweight by abdominal circumference varied with the magnitude of abdominal circumference; and to establish whether adding femur length to abdominal circumference caused a clinically important reduction of error in predicting birthweight.Design
A retrospective study.Setting
The ultrasound department of a teaching maternity hospital offering a tertiary referral service.Sample
From 3512 nondiabetic women with a normally formed singleton fetus, an abdominal circumference measurement of the infant was made within seven days of delivery; of these, 1213 had a femur length measurement performed at the same time.Results
There was a linear relation between abdominal circumference and birthweight. There was a strong inverse correlation between the proportional error in predicting birthweight from the abdominal circumference and the magnitude of the abdominal circumference. Both the Campbell and Wilkin equation (abdominal circumference alone) and the Hadlock equation (abdominal circumference and femur length) were associated with systematic errors, especially with larger birthweight infants. The median absolute errors for the two equations were not significantly different overall (6.98% and 6.86% respectively), although the Hadlock equation was significantly more accurate in predicting birthweight in infants weighing greater than 4500 g. However, no threshold value of abdominal circumference or of estimated fetal weight using the Hadlock equation had a positive predictive value in estimating infants of > 4500 g of greater than 35%.Conclusions
Prediction of birthweight should be by abdominal circumference alone. Table 1 presents robust estimates of the error of predicting birthweight using fetal abdominal circumference.

The relation between fetal abdominal circumference (AC) and birthweight (BW).

AC (mm)
n
Median BW(g)
10th‐90th centile BW (g)
Range BW(g)

200‐209
13
900
750‐1030
740‐1040

210‐219
20
1040
830‐1370
780‐1400

220–229
20
1060
750‐1410
650‐1460

230‐239
28
1255
980‐1470
900‐1860

240‐249
36
1435
1200‐1790
1080‐1950

250‐259
37
1580
1290‐1925
1180‐2260

260‐269
56
1835
1490‐2190
1340‐2400

270‐279
89
2000
1640‐2320
1390‐2620

280‐289
134
2265
1920‐2660
1530‐2910

290‐299
219
2530
2130‐2900
1820‐3100

300‐309
350
2685
2340‐3080
2010‐3420

310‐319
387
2850
2470‐3290
2110‐3650

320‐329
484
3060
2700‐3470
2350‐3770

330‐339
439
3260
2880‐3700
2570‐3980

340‐349
423
3380
3040‐3860
2670‐4240

350‐359
314
3615
3240‐4040
2890‐4460

360‐369
245
3750
3330‐1190
3020‐4610

370‐379
117
3840
3480‐4360
3180‐4790

380‐389
66
4140
3660‐4640
3470‐4820

390‐399
35
4290
3665‐4675
3640‐5000
An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy
Authors: Macklon Nicholas S. , Greer Ian A. , Bowman Adrian W. 
Published: August 2005

Objective
To investigate gestational and postural changes in diameter and blood flow in the proximal deep leg veins during pregnancy.Design
A longitudinal, prospective observational study.Setting
The ultrasound department of a teaching maternity hospital.Population
Twenty‐four healthy women with uncomplicated singleton pregnancies.Methods
Real‐time and duplex Doppler ultrasound assessments of the vessel diameter, flow velocity and respiratory flow fluctuation in the proximal deep leg veins of women serially measured from the first trimester of pregnancy to six weeks postnatally.Main outcome measures
The effects of increasing gestation and the adoption of the left lateral position on the above parameters.Results
An increase in vessel diameter and a fall in flow velocity with increasing gestation was observed. However, no change in venous flow variation was observed. Delivery had reverse effects. Flow velocity was slower in the left than the right legs, but on adoption of the left lateral position an increase in flow velocity and venous flow variation was observed in both legs during pregnancy.Conclusions
These data are consistent with the observed increase in incidence and pattern of deep venous thrombosis in pregnancy and may aid interpretation of duplex Doppler ultrasound examinations for deep venous thrombosis in pregnancy. Postural changes should be part of this evaluation. The gravid uterus may not be the sole cause for postural changes in deep venous flow velocity.
A randomised comparison between amniotic fluid index and maximum pool depth in the monitoring of post‐term pregnancy
Authors: Alfirevic Zarko , Luckas Murray , Walkinshaw Steve A. , McFarlane Maureen , Curran Rosemary 
Published: August 2005

Objective
To compare the impact of two different ultrasound methods for assessing amniotic fluid volume on the incidence of obstetric interventions in post‐term pregnancies.Design
A prospective randomised controlled trial.Setting
Liverpool Women's Hospital.Participants
Five hundred women with singleton, uncomplicated pregnancies with gestational age 290 days.Interventions
Random allocation to fetal monitoring by either: 1. amniotic fluid index and computerised cardiotocography, or 2. maximum pool depth and computerised cardiotocography.Main outcome measures
Primary: caesarean section. Secondary: the number of abnormal monitoring tests, induction of labour, intrapartum management and neonatal outcome.Results
The number of abnormal amniotic fluid indices was significantly higher than the number of abnormal maximum pool depths (10%vs 2.4%; OR 4.51, 95% CI 1.82–11.21; P= 0.0008) which resulted in more inductions for abnormal post‐term monitoring in the amniotic fluid index group (14.8%vs 8.4%; OR 1.89; 95% CI 1.07–3.33; P= 0.0362) and more intrapartum electronic fetal monitoring (94.4%vs 88.4%; OR 2.21; 95% CI 1.13–4.29; P= 0.0255). There were no other statistically significant differences in outcomes related to labour and delivery, but there was a trend towards more caesarean sections in the amniotic fluid index group (18.8%vs 13.2%), in particular caesarean sections for fetal distress (8%vs 4%). There were no perinatal deaths and no statistically significant differences in perinatal outcome between the two groups.Conclusions
Published reference ranges for amniotic fluid index overestimate the number of abnormal results in post‐term pregnancies. Their use, when compared with maximum pool depth, is likely to increase the number of obstetric interventions with, as yet, an uncertain impact on perinatal mortality and morbidity. It is possible that antepartum fetal assessment in pregnancies where the risk of adverse perinatal outcome is very low may cause, rather than prevent morbidity.
Is loop excision adequate primary management of adenocarcinoma in situ of the cervix?
Authors: Houghton S. J. , Shafi M. I. , Rollason T. P. , Luesley D. M. 
Published: August 2005

Objective
To assess the efficacy of cervical loop excision as primary management of adenocarcinoma in situ.Design
A two‐centre retrospective study.Setting
Birmingham and Midlands Hospital for Women and City Hospital NHS Trust.Population
Nineteen women with a histological diagnosis of adenocarcinoma in situ (high grade CIGN) of the cervix made on diathermy loop excision.Main outcome measures
Presence or absence of adenocarcinoma in situ at loop specimen margins, results of cervical cytological examinations following loop excision, results of histopathological assessment of any surgical specimens taken after initial loop excision.Results
Of the 19 women with confirmed adenocarcinoma in situ on loop excision, the median age was 31, and 8 (42%) were nulliparous. The median follow up of these women was 19 months. Eleven women were treated by loop excision alone and have had normal follow up to 18 months. Five women have undergone further surgical procedures, four had a hysterectomy and one had a repeat loop excision. No residual disease was found in any of these surgical specimens, confirming that loop excision was adequate primary management of the disease. Three women have had abnormal endocervical follow up cytology suggestive of residual disease. One of these three women may represent a case of residual endocervical disease. Excision margins of the loop specimen were not involved by adenocarcinoma in situ in 11 women. However, excision margin status of the loop specimen did not appear to be predictive of residual disease.Conclusions
Our small retrospective study suggests that diathermy loop excision of the cervix is adequate primary management of adenocarcinoma in situ of the cervix. Cytological and colposcopic follow up, including cytobrush endocervical cytological sampling and long term follow up, is recommended in these women.
Maternal fever in term labour in relation to fetal tachycardia, cord artery acidaemia and neonatal infection
Authors: Herbst Andreas , Wolner‐Hanssen Pål , Ingemarsson Ingemar 
Published: August 2005

Objective
To determine 1. whether maternal fever during term labour is associated with acidaemia at birth and neonatal infection and 2. whether fetal tachycardia precedes maternal fever and is associated with neonatal infection.Design
Retrospective matched‐pair case‐control study.Subjects
Two hundred and forty‐eight newborn infants whose mothers developed fever during term labour (cases) and 248 control infants. The women were matched for parity and duration of labour.Main outcome measures
Cord artery acid‐base status, Apgar scores, neonatal infections, and fetal heart rate before maternal fever.Results
Mean pH, as well as the rate of cord artery acidaemia at birth (pH < 7.10) was equal in cases and controls (in both groups 7.24% and 6%, respectively). Signs of septicaemia and/or pneumonia were identified in 17 case newborns (7%) and in one control (0.4%; OR 17.0, P < 0.001). Of 212 pairs with complete heart rate data, fetal tachycardia preceded maternal fever in 39 cases (18%) and in 16 controls (8%) (OR 2.6, P= 0.003). Tachycardia before maternal fever was not associated with increased neonatal infectious morbidity.Conclusions
Maternal fever during term labour was associated with perinatal infection, but not with acidaemia at birth. Elevated fetal heart rate preceded maternal fever in a minority of cases and was not associated with perinatal infection.
Maternal serum inhibin‐A and free β‐hCG concentrations in trisomy 21 pregnancies at 10 to 14 weeks of gestation
Authors: Noble P. L. , Wallace E. M. , Snijders R. J. M. , Groome N. P. , Nicolaides K. H. 
Published: August 2005

Objective
To determine the relation between maternal serum inhibin‐A and free β‐hCG concentrations in chromosomally normal pregnancies and to compare the two biochemical markers for their sensitivity in identifying trisomy 21 pregnancies.Sample
Inhibin‐A and free β‐hCG were measured in maternal serum samples from 800 chromosomally normal singleton pregnancies at 10 to 14 weeks of gestation and 76 singleton pregnancies with fetal trisomy 21.Results
In the normal group maternal serum inhibin‐A was significantly associated with both maternal weight and gestational age (F= 11.2, P < 0.0001). In pregnancies with trisomy 21 the maternal serum inhibin‐A and free β‐hCG concentrations were significantly increased (mean difference inhibin = 0.51 SD, F= 18, P < 0.0001 and mean difference free β‐hCG = 1.13 SD, F= 80, P < 0.0001). For a 5% false positive rate, the sensitivity of maternal serum free β‐hCG in identifying pregnancies with trisomy 21 was 28.9% compared with 12.8% for maternal serum inhibin‐A. Delta inhibin‐A was significantly associated with delta‐free β‐hCG (r= 0.345, P < 0.01) and the deviation from the normal mean for free β‐hCG was significantly greater than the deviation for inhibin‐A (t= 4.0, P < 0.0001). For a 5% false positive rate, the sensitivity achieved by combining information from delta inhibin‐A and delta free β‐hCG was similar to the sensitivity of free β‐hCG alone (30.3% compared with 28.9%)Conclusion
At 10 to 14 weeks of gestation fetal trisomy 21 is associated with increased maternal serum inhibin‐A and free β‐hCG levels. However, the degree of elevation of inhibin‐A is less than that of free β‐hCG, and there is a significant association between levels of the two proteins. The sensitivity for trisomy 21 achieved with the combination of maternal serum inhibin‐A and free β‐hCG is not significantly different from that achieved with maternal serum free β‐hCG alone.
Late termination of pregnancy in North Holland
Authors: Bosnia Jacqueline M. , van der Wal Gerrit , Hosman‐Benjaminse Sylvia L. 
Published: August 2005

Objectives
To estimate the extent to which late termination of pregnancy (gestational period > 24 weeks) is practised, to find out what fetal diseases and abnormalities lead to termination and to obtain insight into the clinical judgement and decision‐making process by gynaecologists with regard to termination.Design
A retrospective study.Place
Province of North Holland, The Netherlands.Methods
An anonymous printed questionnaire, was sent to all associations or departments of gynaecology in the 21 hospitals in North Holland. The period of study covered the years 1990 to 1994.Results
Completed questionnaires were received from 19 associations or departments in the 21 hospitals (90% response). In the five‐year period under study in 14 of these hospitals had terminated 103 pregnancies beyond the 24th week of gestation. Antenatal sonography had been performed on all these pregnancies. Anencephaly was diagnosed before termination in 21% and severe chromosomal defects in a further 21%. Other severe abnormalities were neural groove defects, such as hydrocephaly and/or spina bifida (16%), no renal function (12%) and skeletal abnormalities (11%). In 87% the antenatal diagnosis was verified postnatally; in 78% this was done by autopsy. The diagnosis was confirmed in all these cases (‘almost confirmed’ in two cases). In every case the pregnant woman herself had asked for her pregnancy to be terminated. In 78% the prognosis was discussed with other medical specialists and the professionals concerned with management; there was a consultation about the termination in 91% of the cases. A report was always compiled for the medical records.Conclusion
Late termination of pregnancy is practised on a substantial scale in North Holland. The reasons for termination were severe structural abnormalities which, in most cases, were not compatible with survival. The gynaecologists in North Holland dealt prudently and responsibly with late termination of pregnancy, although they did not always adhere to the guidelines set out in the 1994 report of the Netherlands Association for Obstetrics and Gynaecology.
Early amniotomy increases the frequency of fetal heart rate abnormalities
Authors: Goffinct François , Fraser William , Marcoux Sylvie , Bréart Gérard , Moutquin Jean‐Marie , Daris Marlene ,   the Amniotomy Study Group
Published: August 2005

Objective
To determine whether early amniotomy, when practised as an isolated intervention, increases the hourly rate of fetal heart rate record abnormalities.Design
This is a secondary analysis of the results of a multicentre randomised trial of early versus late amniotomy in labour.Setting
Secondary and tertiary level teaching hospitals.Intervention
Early amniotomy versus an attempt to conserve the amniotic membranes.Main outcome measures
The hourly rates of early, mild variable, severe variable and late decelerations; caesarean section rates.Results
Severe variable decelerations, when classified as categorical events ( 1/h to 2/h, 2/h to < 4/h, 4/h), were more frequent in the amniotomy group (χ2 for trend = 5.7, P= 0.017). The mean hourly rates of severe variable and late fetal heart rate decelerations were increased in the amniotomy group (severe variable: amniotomy group 1.4/h, control 0.7/h, P= 0.021; late: amniotomy group 3.3/h, control 2.3/h, P= 0.011). Although the overall rate of caesarean was similar in the two groups (OR 1.2; 95% CI 0.8–1.8), there was an increase in caesarean section for fetal distress (OR 2.3; 95% CI 1.1–4.5) associated with amniotomy.Conclusion
Our data suggest that early amniotomy increases the hourly rate of severe variable fetal heart rate decelerations without evidence of an adverse effect on neonatal outcome. In settings where the diagnosis of fetal compromise is based primarily on electronic monitoring, caesarean section for fetal distress may be increased by early amniotomy.
Influence of hypertensive disorders and cigarette smoking on placental abruption and uterine bleeding during pregnancy
Authors: Ananth Cande V. , Savitz David A. , Bowes Watson A. , Luther Edwin R. 
Published: August 2005

Objective
To assess the influence of hypertensive disorders in pregnancy on the subsequent risk of placental abruption and uterine bleeding of unknown aetiology, and to examine the combined effects of hypertensive disorders and cigarette smoking during pregnancy on the risk of uteroplacental bleeding disorders.Design
Retrospective cohort study.Setting
Data for this study were derived from the Nova Scotia Atlee Perinatal database, Canada, comprising of women who were delivered in the province between 1980 and 1993.Population
120,666 pregnancies resulting in singleton births, of which 13,360 pregnancies were complicated by pre‐eclampsia and/or chronic hypertension.Main outcome measures
Risks and relative risks of placental abruption and uterine bleeding of unknown aetiology in pregnancies complicated by chronic hypertension, mild and severe pre‐eclampsia, and chronic hypertension with superimposed pre‐eclampsia, each compared with normotensive patients. Adjusted relative risks were obtained through the fit of multivariable logistic regression models based on the method of generalised estimating equations.Results
Chronically hypertensive women had no increased risk of abruption (RR 1.4; 95% CI 0.5–3.6), while women whose pregnancies were complicated by severe pre‐eclampsia (RR 3.8; 95% CI 2.1–6.9), and chronic hypertension with superimposed pre‐eclampsia (RR 2.8; 95% CI 1.2–6.3) showed strong associations with placental abruption. However, none of the hypertensive disorders were associated with uterine bleeding of unknown aetiology. The association between placental abruption and hypertensive disorders varied by parity. Parous women with chronic hypertension and superimposed pre‐eclampsia were at greater risk of placental abruption (aRR 3.8; 95% CI 1.9–7.8) than nulliparous women with chronic hypertension and superimposed pre‐eclampsia (aRR 1.6; 95% CI 0.5–4.9). The joint effects of smoking and hypertension had a greater effect on the risk of placental abruption than would have been expected based on their individual effects.Conclusions
The pattern of association between placental abruption and hypertension varied in relation to the specific type of hypertensive disorder. However, uterine bleeding of unknown aetiology was not associated with hypertension. Findings from this study suggest that placental abruption and uterine bleeding of unknown origin are aetiologically distinct obstetric complications with respect to hypertensive disorders during pregnancy.
The metabolic consequences of treating postmenopausal women with non‐oral hormone replacement therapy
Authors: Crook D. 
Published: August 2005

Objective
To define the metabolic profile of postmenopausal hormone replacement therapies when delivered through gels, patches, implants or other non‐oral routes. Such information may be useful in the absence of reliable clinical data on the effects of these therapies on the risk of cardiovascular disease.Design and methods
Selective literature review.Patients
Postmenopausal women.Results
Non‐oral oestrogen therapies fail to invoke the hepatic response associated with oral therapy. Changes in hepatic protein synthesis are minimal and so plasma levels of binding globulins and other proteins tend to be normal. Many of the perturbations of the haemostatic system seen with oral therapy are avoided. In the absence of hepatic over‐synthesis of apolipoproteins, plasma lipoprotein levels are unchanged or reduced. The direct effects of oestrogen on vascular function are apparent when the hormone is administered non‐orally.Conclusions
The net effect of non‐oral oestrogen therapies on the risk of cardiovascular disease is difficult to predict on the basis of current data. Some changes in plasma lipoprotein levels, such as the reduced fasting levels of triglycerides, would be considered desirable, but the cardioprotective increase in levels of high‐density lipoproteins is absent. The differential effect on haemostasis markers is promising, but preliminary data relating to transdermal patches fail to support the idea that non‐oral therapies will avoid the increased risk of venous thromboembolism associated with oral therapy. The ability of non‐oral therapies to improve vascular function implies that they will offer postmenopausal women at least some of the cardiovascular protection seen with oral therapy.
Metabolic changes induced by peroral oestrogen and transdermal oestradiol gel therapy
Authors: Karjalainen A. , Heikkinen J. , Savolainen M. J. , Bäckström A‐C. , Salinto M. , Kesäniemi Y. A. 
Published: August 2005

Objective
To investigate changes in plasma lipid and lipoprotein levels induced by peroral oestrogen replacement and transdermal oestradiol gel therapy.Design
The effects of peroral oestradiol valerate tablets (2 mg) and placebo gel were compared with 1g transdermal oestradiol gel (1mg oestradiol) and placebo tablets in a randomised, double‐blind, double‐dummy study for 6 months.Setting
Department of Internal Medicine, University of Oulu and Oulu Deaconess Institute, Oulu, Finland.Population
Seventy‐nine hysterectomised, postmenopausal women, 39 women in the peroral oestrogen group and 40 in the gel group.Main outcome measures
Cholesterol and triglycerides in total plasma and in various lipoprotein fractions, and sex hormones.Results
In the peroral oestrogen group total and LDL cholesterol were decreased and HDL cholesterol and triglycerides were increased. In the oestradiol gel group plasma total, LDL and VLDL cholesterol and the ratio of LDL/HDL cholesterol were significantly decreased, but no change in HDL cholesterol and triglycerides was observed. Overall the decrease in LDL levels was correlated with the increase in oestrogen levels.Conclusions
Both peroral and transdermal replacement therapy had beneficial effects on plasma lipids by lowering total and LDL cholesterol and LDL/HDL cholesterol ratio. These changes seem to be associated with changes in oestrogen levels.