bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors and clinical manifestations of pre‐eclampsia
Authors: Ødegård Rønnaug A. , Vatten Lars J. , Nilsen Stein Tore , Salvesen Kjell Å. , Austgulen Rigmor 
Published: August 2005

Objective
To study associations between established risk factors for pre‐eclampsia and different clinical manifestations of the disease.Design
A population‐based, nested case‐control study.Setting
Information from 12,804 consecutive deliveries that took place over three years at a birth clinic, which alone serves a population of nearly 240,000 in Rogaland county, Norway.Subjects
Cases of pre‐eclampsia (n= 323) and healthy controls (n= 650) were selected. Pre‐eclampsia was defined as increase in diastolic blood pressure (≥ 25 mmHg to ≥ 90 mmHg) and proteinuria (≥ 1+ by dipstick testing) after 20 weeks of pregnancy.Main study measures
Parity, previous pre‐eclampsia, blood pressure, maternal weight, and maternal smoking were included as study varstudy variables. Women with pre‐eclampsia were grouped according to clinical manifestations of the disease (i.e. severity [mild, moderate or severe]) and time of onset (early or late gestation). Associations with the study factors were estimated as relative risks (odds ratio, OR).Results
Both nulliparity and hypertension increased pre‐eclampsia risk, with no clear preference for any clinical subtype. High maternal weight was related to a higher risk of mild and moderate, but not severe, pre‐eclampsia. Previous pre‐eclampsia strongly increased the risk for pre‐eclampsia in the current pregnancy, and the risk of early onset disease was especially high (OR 42.4; 95% CI 11.9–151.6). Overall, smoking was associated with a reduced risk for pre‐eclampsia (OR 0.6; 95% CI 0.4–0.9). However, no effect of smoking was observed in the early onset disease group and among women with repeated pre‐eclampsia.Conclusion
Nulliparity and hypertension increased the risk for each subgroup of pre‐eclampsia, but high maternal weight, previous pre‐eclampsia and smoking were not consistently associated with each clinical subtype. This observation may suggest that heterogeneous clinical manifestations of pre‐eclampsia may be preceded by different pathological mechanisms.
Can glucose tolerance test predict fetal hyperinsulinism?
Authors: Weiss Peter A. M. , Haeusler Martin , Tamussino Karl , Haas Josef 
Published: August 2005

Objective
To establish cut off levels for oral glucose tolerance test in pregnancy using fetal hyperinsulinism as a clinical endpoint.Design
Capillary blood glucose levels at 0, 1, and 2 hours after the ingestion of either 1 g/kg or 75 g glucose, at 28 (SD 5) weeks of gestation were analysed in 220 women with elevated amniotic fluid insulin levels [≥ 42 pmol/L (≥ 7 μU/mL)] after a mean (SD) of 31 weeks (3) and in 220 nondiabetic controls.Results
In women with elevated amniotic fluid insulin levels the mean (SD) capillary blood glucose values at 0, 1, and 2 hours were 5.2 mmol/L (1.0) [94 mg/dL (18)], 10.5 mmol/L (1.4) [189 mg/dL (25)] and 8.2 mmol/L (2.0) [147 mg/dL (36)], respectively. The one‐hour value had the highest sensitivity to predict elevated amniotic fluid insulin levels. The 5th centile of the one‐hour blood glucose levels representing a detection rate of 95% was 8.9 mmol/L (160 mg/dL).Conclusion
Glucose cut off levels in most established oral glucose tolerance test criteria are too high, to accurately predict amniotic fluid hyperinsulinism. A one‐hour test may be sufficient for detecting amniotic fluid hyperinsulinism. Since different loads (1 g/kg, 75 g or 100 g) and blood fractions (venous plasma or capillary blood) have minimal impact on oral glucose tolerance test results, a single one‐hour cut off of 8.9 mmol/L (160 mg/dL), independent of the sampling method, may be appropriate for the diagnosis of gestational diabetes mellitus severe enough to cause amniotic fluid hyperinsulinism.
Hormonal regulation of neonatal weight: placental leptin and leptin receptors
Authors: Schulz Solveig , Häckel Carsten , Weise Wolfgang 
Published: August 2005

Objective
To examine whether umbilical and maternal leptin levels correlate with birthweight, placental weight, and maternal weight; and to detect membrane‐bound leptin receptors in placental tissue as well as soluble leptin receptors in umbilical and maternal blood.Design
Prospective observational study.Setting
University teaching hospital.Methods
Serum levels of leptin and soluble leptin receptors were analysed in 31 randomly selected mother/newborn pairs at delivery. In addition, placental tissue was assayed for leptin receptors using immunocytochemistry and Western blot.Results
The mean [SD] leptin level in umbilical cord venous blood (7.1 ng/mL [4.0]) was significantly lower (P < 0.001) than in maternal blood (22.5 ng/mL [10.8]). Umbilical cord leptin concentrations correlated significantly with birthweight (P < 0.001), placental weight (P < 0.005) but not with maternal leptin. Maternal leptin concentrations correlated only with maternal weight (P < 0.001). In chorionic villous tissue, trophoblasts stained strongly positive for leptin receptor‐like immunoreactivity. Two membrane‐bound isoforms of the leptin receptor were also detected in placental tissue. In both umbilical and maternal serum, a soluble leptin receptor was found migrating as broad band at Mr 97,000 D.Conclusion
The present data strongly reinforce the idea that circulating leptin levels may provide a growth‐promoting signal for fetal development during late pregnancy. While membrane‐bound leptin receptors may be involved in autocrine regulation of placental leptin production, the soluble receptor form may serve as a transport vehicle for leptin to fetal tissues.
Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden
Authors: Essén Birgitta , Johnsdotter Sara , Hovelius Birgitta , Gudmundsson Saemundur , Sjöberg N.‐O. , Friedman Jonathan , Östergren P.‐O. 
Published: August 2005

Objective
To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome.Methods
Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth.Participants
Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden.Results
The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance.Conclusions
Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as ‘survival behaviours’ related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance.
Gynaecological presentation of retroperitoneal tumours
Authors: Spillane Andrew J. , Thomas J. Meirion 
Published: August 2005

Objective
To illustrate the problems associated with mistaken pre‐operative diagnosis following gynaecological presentation of patients with retroperitoneal tumours.Design
A case series of five referrals.Results
Non‐gynaecological tumours were not suspected in each case and hence there was a failure to undertake further pre‐operative investigation and referral to a specialised soft tissue sarcoma service. This resulted in four of the patients having an unnecessary laparotomy with an inappropriate transperitoneal biopsy undertaken when the retroperitoneal tumour was discovered. The mistaken diagnosis of ovarian malignancy lead to increased morbidity, compromise of potential for a long disease free interval and/or possibly lessened the chance of cure in each case.Conclusions
Misinterpretation of clinical signs and an over‐reliance on ultrasound diagnosis were the commonest causes of inappropriate management of these patients. Gynaecologists should consider more frequently the other, less common differential diagnoses of a pelvic mass. This is especially true in circumstances with a predominantly solid tumour, where there are clinical signs of vascular or rectal displacement, or where there is ultrasound evidence of ureteric obstruction. The more frequent utilisation of a computerised tomography scan with intravenous and oral contrast with referral before inappropriate transperitoneal biopsy are recommended as complete en bloc surgical excision at the first laparotomy is the treatment of choice in virtually all primary retroperitoneal tumours.
Births in Finland and Estonia from 1992 to 1996: convergent differences?
Authors: Gissler Mika , Karro Helle , Tellmann Alvi , Hemminki Elina 
Published: August 2005

Objective
To describe the differences in childbearing, in prenatal and obstetrical practices, and in perinatal health outcome in Finland and Estonia.Design
Registry study using the data from the Finnish and Estonian medical birth registries for years 1992 to 1996 (in total 324,021 and 74,297 newborns, respectively).Results
In 1992 the birth rates were 51 per 1000 women aged 15 to 49 in Finland and 48 per 1000 in Estonia. The birth rate declined in the study period in both countries, but the decline was more rapid in Estonia (−26%) than in Finland (−6%). In the same period the rates of induced abortion declined in both countries (−34% and −6%, respectively), but the rate in 1996 was still much higher in Estonia (46/1000) than in Finland (8/1000). Compared with Finnish mothers, Estonian mothers were younger, had fewer multiple births, less prenatal care and fewer interventions during pregnancy and delivery. The intervention rates increased in both countries during the study period, but this increase was more rapid in Estonia. The infant outcomes were poorer in Estonia, but the differences between Estonia and Finland decreased during the 1990's.Conclusions
The differences in prenatal and maternal care and in induced abortion rates have decreased between Estonia and Finland. Changes in maternal backgrounds, improved referral system for complicated pregnancies, improvements in prenatal care and in availability of appropriate equipment and technology may have caused improved maternal and infant health in Estonia, but this should be further investigated.
Introduction of the Misgav Ladach caesarean section at an African tertiary centre: a randomised controlled trial
Authors: Björklund Kenneth , Kimaro Melkizedeki , Urassa Ernest , Lindmark Gunilla 
Published: August 2005

ObjectiveTo determine whether the Misgav Ladach caesarean section technique can offer benefits compared with conventional caesarean section technique in the prevailing conditions of a busy African tertiary centre.DesignA randomised controlled trial.SettingA tertiary African obstetric unit with 18,000 deliveries annually.ParticipantsThree hundred and thirty‐nine women undergoing caesarean section.MethodsEight residents and registrars were instructed in the Misgav Ladach technique for caesarean section during one week, after which the study commenced. The course participants instructed their colleagues; in total, 16 doctors participated. Women requiring caesarean section were randomised to Misgav Ladach or to the conventional lower midline incision procedure, excluding those with a previous scar.ResultsDuring 11 weeks 339 randomised procedures (328 of which were emergency procedures) were carried out. Mean operating time was 25.3 minutes for Misgav Ladach and 32.6 minutes for the lower midline incision procedure (95% CI −8.3; −6.3). Mean blood loss was 354 mL and 447 mL (−133; −53), and the number of sutures 3.1 and 6.1 (−3.1; −2.9), respectively. No significant difference was found in Apgar scores. Mobilisation was earlier with the Misgav Ladach procedure. No difference was found in overall post‐operative infection rates i.e. wound infection or febrile illness, but the combination of wound infection and fever was more common in the Misgav Ladach group.ConclusionThe Misgav Ladach caesarean section confers benefits such as reduced blood loss, conservation of time and suture material, and rapid mobilisation, but more studies are needed to explore modifications aimed at reducing post‐operative infections in settings with limited resources.
Early pregnancy predictors of preterm birth: the role of a prolonged menstruation‐conception interval
Authors: Gardosi Jason , Francis Andre 
Published: August 2005

Objective
To study early pregnancy characteristics as possible risk factors associated with preterm birth.Design
Retrospective analysis of prospectively collected maternity data.Population
21,069 singleton deliveries with record of a specified last menstrual period and a midtrimester dating scan.Setting
Catchment area of tertiary centre serving a general maternity population.Methods
Univariate and multivariate analysis. Variables included: maternal age; height; weight at first visit; parity; ethnic group; cigarette smoking and alcohol consumption recorded in early pregnancy; history of abortion; history of preterm birth; and discrepancy between menstrual dates and ultrasound dates.Main outcome measures
Adjusted odds ratios for factors associated with preterm birth, stratified according to parity (nulliparae vs multiparae) and gestational age (early preterm, 24–33 weeks; late preterm, 34–36 weeks; all preterm, < 37 weeks). Population attributable risk (aetiologic fraction) of the significant variables for preterm birth.Results
The overall preterm (< 37 weeks) delivery rate according to scan dates was 7.0%. Preterm birth was associated with young (< 20 years), short (≤ 155 cm) and underweight (≤ 52 kg) mothers, non‐Europeans, cigarette smokers, previous abortion or previous preterm delivery, and a prolonged menstruation‐conception interval. Preterm births which followed the spontaneous onset of labour (72%) had results which were similar to the overall group, while there were too few iatrogenic preterm deliveries for separate analysis. Logistic regression showed that associations varied in different parity and gestational age groups. For nulliparae, smoking was not associated with preterm birth, but it was strongly associated with multiparous women (adjusted OR 1.8, 95% CI 1.6–2.1). A past history of premature delivery had the highest risk for birth before 34 weeks in the index pregnancy (adjusted OR 5.1, 95% CI 3.4–7.6). A discrepancy between menstrual and scan dates of greater than +7 days, suggestive of a prolonged interval between last menstruation and conception, was present in 23.3% of all pregnancies, and was associated with an increased risk of preterm delivery in all gestational age categories for nulliparae (adjusted OR 1.5, 95% CI 1.3–1.8) and multiparae (adjusted OR 1.9, 95% CI 1.6–2.2). Because of its high prevalence, this variable constituted a relatively high population‐attributable risk for premature birth for both nulliparae (10.7%) and multiparae (16.6%).Conclusions
A discrepancy of more than +7 days between menstrual and scan dates, indicating a prolonged interval between last menstruation and conception, is a significant predictor of preterm birth. This effect is independent of other factors such as maternal age, height, weight and smoking which are also associated with prematurity. In a maternity population with ultrasound scan dates and recorded last menstrual period, this variable can be easily calculated and used as a marker for increased surveillance.
The outcome of 72 pregnancies in 55 women with cystic fibrosis in the United Kingdom 1977–1996
Authors: Edenborough F. P. , Mackenzie W. E. , Stableforth D. E. 
Published: August 2005

Objective
To identify pregnancies in women with cystic fibrosis and describe obstetric, infant and maternal medical outcomes in relation to the severity of maternal disease.Design
Retrospective study, based on casenotes.Setting
Eleven cystic fibrosis centres in the United Kingdom.Population
Pregnant women with cystic fibrosis.Methods
Single observer medical and obstetric casenote review categorising maternal cystic fibrosis (e.g. genotype, pancreatic, hepatic and diabetic status) and pre‐pregnant severity (e.g. weight and lung function) and noting fetal outcome and maternal morbidity.Main outcome measures
Completed pregnancies and pregnancy losses, fetal outcome and complications, maternal morbidity, such as changes in weight, lung function, pulmonary infections during and after pregnancy. Relation of outcomes to severity of maternal cystic fibrosis.Results
From 72 pregnancies identified, the outcomes were known for 69; there were 48 live births (70%) of which 22 were premature (46%); 14 therapeutic abortions (20%); and 7 miscarriages (10%). There were no stillbirths, neonatal or early maternal deaths. Three major fetal anomalies were seen, but no infant had cystic fibrosis. At the conclusion of our study three pregnancies were still continuing. Prematurity with increased fetal complications and maternal morbidity with infection, declining lung function and poor weight gain were associated with poor pre‐partum lung function.Conclusion
Pregnancy occurs in women with cystic fibrosis of all degrees of severity. Outcomes for the infant are generally good but are variable for the mother. Predicting outcome on the basis of maternal severity is difficult but lung function appears to be the most significant determining factor. Pregnancy may be normal in women with normal lung function (forced expiratory volume > 80%). However, it may adversely affect mild and moderate lung disease due to cystic fibrosis and should be avoided in pulmonary hypertension, cor pulmonale and when forced expiratory volume < 50% predicted. Ideally, all pregnancies should be planned with prior counselling and monitored by dedicated cystic fibrosis teams, including obstetricians who are experienced in managing high risk pregnancies.
Effectiveness of prenatal chromosomal analysis using multicolour fluorescent in situ hybridisation
Authors: Thilaganathan Baskaran , Sairam Shanthi , Ballard Terence , Peterson Caroline , Meredith Rodney 
Published: August 2005

Objective
To evaluate the clinical effectiveness of multicolour fluorescent in situ hybridisation (FISH) analysis in routine prenatal diagnosis.Design
Prospective study.Sample
3203 amniotic fluid samples.Methods
Unique DNA (chromosomes 13 and 21) and α satellite centromeric‐specific (chromosomes X, Y and 18) probes were used in two mixes to permit the simultaneous analysis of several chromosomes. The performance of multicolour FISH and conventional cytogenetic analysis was compared.Results
Conventional cytogenetic analysis identified 111 chromosomal abnormalities, of which 94 were potentially detectable by the FISH technique and 97 would be typically associated with neonatal phenotypic abnormalities. Multicolour FISH analysis detected 84% (93/111) of all chromosome abnormalities and 99% (93/94) of abnormalities where there was a specific probe. The sensitivity of multicolour FISH analysis was 95% (92/97) for chromosomal abnormalities likely to result in an abnormal postnatal outcome. Multiple ultrasound abnormalities were detected in all five cases of clinically relevant chromosomal abnormalities missed by multicolour FISH. FISH results were available within 48 hours and the sample failure rate was 0.1% (3/3202).Conclusion
Multicolour FISH analysis is a sensitive and reliable technique for the rapid prenatal diagnosis of chromosomal abnormalities. Examining only five chromosomes allowed 95% of clinically relevant chromosomal abnormalities to be diagnosed correctly. As routine antenatal screening is targeted at the major autosomal trisomies and sex chromosome aneuploidies, multicolour FISH analysis may potentially replace conventional cytogenetic analysis in routine prenatal diagnosis.
Ambulatory urodynamics: do they help clinical management?
Authors: Gorton Emma , Stanton Stuart 
Published: August 2005

Objective
To assess the contribution of ambulatory urodynamics to the treatment of women with urinary incontinence.Design
A retrospective casenote review of all women referred from the urogynaecology clinic for ambulatory urodynamic monitoring from 1 April 1994 to 31 December 1997.Setting
A teaching hospital tertiary referral centre urodynamic laboratory.Participants
Notes were retrieved of 71 women, 80% of whom had had the investigation because the conventional cystometrogram had been normal.Results
Technical difficulties occurred in 30 traces, two of which were not interpretable. Detrusor instability was diagnosed in 32 women, including three women who also had stress incontinence (42% of interpretable traces). Of these, 20 women were treated with anticholinergics compared with nine of 37 women where detrusor instability was not diagnosed. None of the women with detrusor instability were offered anti‐incontinence surgery, compared with five of those where the bladder remained stable. Less than half the women who were treated with anticholinergic medication improved, but none were considered suitable for more aggressive treatment.Conclusions
Although the diagnosis of detrusor instability may be increased by ambulatory urodynamics, this does not always translate into more effective treatment. Ambulatory urodynamic testing does not yet result in clinical improvements in diagnosis and treatment.
A double‐blind randomised trial of leuprorelin acetate prior to hysterectomy for dysfunctional uterine bleeding
Authors: Weeks Andrew D. , Duffy Sean R. G. , Walker James J. 
Published: August 2005

Objective
To evaluate the use of pre‐operative leuprorelin acetate for reducing the morbidity from hysterectomy for nonfibroid menorrhagia.Design
A double‐blind, randomised, placebo‐controlled trial.Setting
Gynaecology department in a large university teaching hospital.Sample
Fifty‐one women without uterine fibroids awaiting abdominal or vaginal hysterectomy for dysfunctional uterine bleeding.Methods
Participants received leuprorelin acetate or placebo for eight weeks prior to hysterectomy.Main outcome measures
Operative blood loss, operative difficulty, first day morphine use, speed of return to ‘normal health’.Results
The study and control groups were similar as regards prognostic factors. Two women in the study group withdrew because of side‐effects. Although a 34% reduction in uterine volume was seen in those treated with leuprorelin, there were no significant differences in operative blood loss (183 mL in the study group vs 285 mL in controls, P= 0.27), operation time (39 vs 49 min, P= 0.64) or operative difficulty (visual analogue scale 3.0 vs 4.0, P= 0.09). Furthermore, there was no difference between the groups in post‐operative morbidity or rate of recovery.Conclusions
Treating women with leuprorelin acetate for 8 weeks prior to surgery for nonfibroid menorrhagia has no significant operative or post‐operative benefits.