bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient falloposcopy; intra‐luminal imaging of the fallopian tube by trans‐uterine fibre‐optic endoscopy as an outpatient procedure
Authors: SCUDAMORE IAN W. , DUNPHY BRUCE C. , COOKE IAN D. 
Published: August 2005

ABSTRACTObjective
To develop trans‐uterine falloposcopy using the linear eversion tech‐nique in outpatients.Design
A prospective, descriptive study of the introduction and application of this new technique.Setting
A tertiary referral University Research Clinic independent of operating theatres and inpatient admission.Subjects
Twenty‐one infertile women with previous evidence of fallopian tube disease.Main outcome measures
Rate of successful tubal cannulation and procedure completion, tubal section visualized, condition of the tubal epithelium, subsequent treatment plan.Results
A bilateral examination was attempted in 19/21 patients and completed in 18. Two early falloposcopies with inadequate analgesia were aborted due to pain after only one tube had been examined without an attempt to identify or cannulate the contralateral tubal ostium. In one patient, neither ostium was identified or can‐nulated. After ostial localization, 37/37 tubes were cannulated. If the ostium was not localized but ‘blind’ cannulation attempted, 1/3 were cannulated successfully. Epithelium characteristic of the ampulla was seen in 31/38 (82%) tubes, and of the proximal tube only in 3/38 (8%). Successful bilateral assessment noted complete bilateral proximal obstruction in 2/18 patients, non‐obstructive bilateral endotubal damage in 7/18, unilateral damage in 3/18 and bilateral healthy tubes in 6/18. Unilateral examination in two patients found minimal evidence of damage in one and severe intra‐tubal adhesions in the other. After falloposcopy, 11/21 patients elected for 1VF, 9/21 tubal surgery and 1/21 for IVF whilst awaiting surgery.Conclusion
Falloposcopy is a technique which can be performed in an outpatient clinic. It is well tolerated, and high rates of luminal cannulation and visualization are possible. Atraumatic access to the tube and visualization of its lumen offer excit‐ing opportunities for diagnosis and treatment of tubal conditions.
Breech delivery and epidural analgesia
Authors: CHADHA YOGESH C. , MAHMOOD TAHIR A. , DICK MICHAEL J. , SMITH NORMAN C. , CAMPBELL DORIS M. , TEMPLETON ALLAN 
Published: August 2005

ABSTRACTObjective
To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (3=37 weeks).Design
A retrospective study.Setting
Data Bank, Aberdeen Maternity Hospital.Subjects
643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term.Outcome measures
Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates.Results
Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P<0.001) and longer duration of labour (P<0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI0.88–3.63) or multiparae (odds ratio 0.97; 95% CI 0.48–1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46–11.95) and multiparae (odds ratio 5.37; 95% CI 2.07–13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (<3 cm or ≥3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was <3 cm (odds ratio 3.65; 95% CI 1.14–11.65).Conclusion
Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.
Survey of colposcopy service provided by genito‐urinary medicine in England and Wales
Authors: WILLIAMS OLWEN , BODHA MARGARET , HICKS D. , ALAWATTEGAMA A. B. 
Published: August 2005

ABSTRACTObjective
To investigate the expansion of colposcopy services within genitourinary medicine (GUM) in England and Wales since 1985.Design
Data collected by postal and verbal communication from 189 genitourinary medicine clinics in England and Wales in January 1990.Subjects
Consultant and junior genito‐urinary physicians practising colposcopy.Main outcome measures
Number of clinics providing colposcopy service; indication for colposcopy, treatment facilities available, waiting lists and training opportunities, compared with that in 1985.Results
Of the 189 genito‐urinary medicine clinics contacted, 60 provided a colposcopy service and 55 of these returned completed questionnaires. There has been a 67% increase in the number of colposcopes in use and over 50% of clinics have the facilities to treat cervical pathology. Waiting lists were minimal for both examination and treatment. Both men and women are examined with the colposcope for a variety of indications. At present, 52% of career grade GUM physicians practise colposcopy compared to 24% in 1985 and 94% of senior registrars compared with 42% in 198.5 were in training or trained in colposcopy.
Gynaecologists' abortion practice
Authors: FRANCOME COLIN , SAVAGE WENDY D. 
Published: August 2005

ABSTRACTObjective
To ascertain the relation between gynaecologists' opinions on the provision of abortion and the service provided by the Health Service in their district and to investigate the methods used for second trimester abortion.Design and Setting
A postal questionnaire sent three times to a 50% random sample of gynaecologists practising in the National Health Service (NHS) in 1989 in Great Britain.Subjects
343 of 396 practising gynaecologists, 87% of those selected.Main outcome measures
Proportion of gynaecologists holding views or reporting practice.Results
Although only 11% actually performed abortions beyond 20 weeks, 57% approved later operations in cases of rape and 85% for a threat to the woman's health; only 47% approved late abortion for schoolgirls under 16 years. Dilatation and evacuation was used by only 1% of NHS gynaecologists even though from 13 to 16 weeks it is a safe and efficient method. Although Government statistics report that vacuum aspiration is used in over one third of second trimester abortions, this is technically unlikely and was not confirmed by this study. Less than 50% of abortions in England and Wales are performed in the NHS yet fewer than 40% of gynaecologists reported problems in providing an abortion service. Overall 21% thought they were providing abortions for over 90% of the women resident in their districts, whereas only 2% of districts achieve this proportion in their home regional health authority. Overall 60% supported separating abortion work from general gynaecology, and 45% would like regional abortion units. Only 27% supported fertility control acquiring the status of a subspecialty.Conclusions
Accepting these suggestions would improve the service, reduce regional variations in provision, provide opportunities for research and could have an important effect in helping slow the world population increase.
Which hormone tests for the diagnosis of polycystic ovary syndrome?
Authors: ROBINSON S. , RODIN D. A. , DEACON A. , WHEELER M. J. , CLAYTON R. N. 
Published: August 2005

ABSTRACTObjective
To assess the frequency of abnormal values for hormone measurements commonly used in the biochemical diagnosis of polycystic ovary syndrome (PCOS).Design
Hormone measurements in 63 unselecled women with clinical and ultrasound diagnosis of PCOS attending gynaecological and general endocrine clinics in a District General Hospital were compared with those from a group of 20 normal ovula‐tory controls in the early follicular phase of their cycles.Measurements
Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratio, total testosterone, derived free testosterone, sex hormone binding globulin, androstenedione, and dehydroepiandrosterone (DHEA) were measured by radioimmunoassays. LH and FSH measured by two different assays.Results
The mean serum LH and LH/FSH ratio were significantly (P<0.01) higher in the women with PCOS compared with the normal group, but these two measurements were in the abnormal range for only 35% and 41–44%, respectively. Absolute gonadotrophin values were significantly different using the two assay methods, which employed the same reference preparation as standard. Mean serum total testosterone concentration was significantly higher in the PCOS group and was the most frequently (70%) abnormal biochemical marker for PCOS. Sex hormone binding globulin (SHBG) did not differ significantly between the two groups but showed a negative correlation with body mass index in women with PCOS. The combination of SHBG and testosterone to derive a free testosterone value did not further aid the biochemical diagnosis of PCOS. Androstenedione was significantly higher in the PCOS group than in the control group, with a frequency of 53%. There was no significant difference in DHEA‐S between the two groups.Conclusion
When typical ovarian ultrasound appearances plus the clinical features of oligomenorrhoea and/or hirsuitism were used to define PCOS total testosterone was the best single hormonal marker of the condition. Testosterone, androstenedione or LH, either alone or in combination, were raised in 86% of women with PCOS and these should be the definitive hormonal tests. Using LH/FSH ratio as a biochemical criterion for diagnosis of PCOS should be abandoned because of its low sensitivity. To be of value the normal range for all hormones should be precisely defined in a group of regularly ovulating women in the early follicular phase of the cycle for the assay used in each laboratory.
Contact factor mediated fibrinolysis is increased by the combined oral contraceptive pill
Authors: Campbell S. J. , Mackie I. J. , Robinson G. E. , Machin S. J. 
Published: August 2005

ABSTRACTObjective
To study the fibrinolytic pathways and their relationship with the contact system in women using combined oral contraceptives (COCs).Design
Serial plasma samples were collected from 18 women before treatment with COCs containing 30 μg oestrogen during treatment cycles 3 and 6, and 2 weeks after stopping treatment. Fibrinolysis was measured before and after dextran sulphate mediated contact activation using fibrin plates.Results
Fibrinolysis increased significantly during cycles 3 and 6 (from 77% to 100% and 113%, respectively, P<0.01) and showed a further increase after dextran sulphate activation (from 134% to 158% and 167%, respectively, P<0.01). Tissue‐plasminogen activator, urokinase‐plasminogen activator and plasminogen activator inhibitor did not change significantly. There were significant elevations of Factor XII (from 0.92 μ/ml to 1.43 u/ml, P<0.01) and prekallikrein (0.94 u/ml to 1.10 u/ml, P<0.05) in cycle 3, which both remained high at cycle 6 (P<0.01) and decreased after stopping the COC. Alpha‐2‐macroglobulin and C1‐esterase inhibitor showed no significant change, but alpha‐1‐antitrypsin increased from 0.85 u/ml to 1.11 u/ml by cycle 3 (P<0.01), and returned to near normal levels after stopping the COC.Conclusions
The increase in fibrinolysis may be due to increased levels of Factor XII and prekallikrein without a corresponding increase in their natural inhibitors (C1‐esterase inhibitor and alpha‐2‐macroglobulin). A parallel increase in the intrinsic pathway of coagulation may be limited by elevated alpha‐1‐antitrypsin at the level of activated Factor XI. The increase in fibrinolysis caused by oral contraceptives may balance any potential thrombotic risk due to increased fibrinogen or vitamin K dependent coagulation factors.
Fractured clavicle of the newborn in a population with a high prevalence of grand‐multiparity: analysis of 78 consecutive cases
Authors: Turnpenny P. D. , Nimmo A. 
Published: August 2005

ABSTRACTObjective
To perform a clinical analysis of newborn babies with a fractured clavicle and investigate the possible role of relative calcium deficiency in the aetiology.Design
Prospective descriptive study (clinical aspects); case controlled study (calcium, phosphate, alkaline phosphatase).Setting
The Nazareth Hospital, Israel.Subjects
All babies with a fractured clavicle detected in the newborn period and their mothers delivered between 23 August 1987 and 22 June 1989. The majority of the population were Arab.Interventions
Serum calcium, phosphate and alkaline phosphatase were measured on the third postpartum day in 42 affected babies (with uncomplicated deliveries), their mothers, and a matched group of babies and mothers as controls.Main outcome measures
Clinical associations of fractured clavicle of the newborn; statistical comparison of affected group with controls (calcium study).Results
The incidence of fractured clavicle was 18.7 per 1000 singleton vaginal births; 38 in the posterior clavicle at delivery, 27 in the anterior, position unascertained in nine. Four (5.2%) occurred in instrumental deliveries, three (3.9%) in assisted breech delivery; shoulder dystocia was noted in 13. The male to female ratio of 51:26 was significantly different but not due to birth weight. Affected babies were significantly heavier than the unaffected population. The incidence was higher in parous mothers older than 25 years of age but there was no evidence of increased incidence with increasing parity. No significant results were obtained in the calcium study between affected babies and their mothers, when compared with controls.Conclusions
Fractured clavicle of the newborn is a benign form of birth trauma from which heavier babies are at greater risk. It occurs in 1 to 2% of deliveries, most of these being uncomplicated vaginal births, and is often undetected. There is no evidence for relative calcium deficiency.
Whole blood platelet aggregation in moderate and severe pre‐eclampsia
Authors: Norris Lucy A. , Gleeson Noreen , Sheppard Brian L. , Bonnar John 
Published: August 2005

ABSTRACTObjective
To compare whole blood platelet aggregation in moderate and severe pre‐eclampsia with normal pregnancy.Design
Whole blood platelet aggregation in response to collagen, ADP, PAF, adrenalin and arachidonic acid was measured in the pre‐eclampsia group at 36 weeks gestation and at 1, 24 and 48 h and at five days and six weeks post delivery. The normal pregnancy group were studied serially at 12, 20, 28, 32, and 36 weeks gestation and at 1, 24, 48 h and six weeks post delivery.Setting
Trinity College Medical School, St James's Hospital, Dublin.Subjects
Thirty women with diagnosed pre‐eclampsia were recruited for the study. Fifteen of these women had severe pre‐eclampsia and the remaining 15 had moderate disease. The pre‐eclampsia group were compared with 20 healthy primigravid women with uncomplicated pregnancies and deliveries.Results
In women with severe pre‐eclampsia, platelet aggregation in response to collagen, ADP, adrenalin and arachidonic acid was significantly lower at 36 weeks gestation compared with normal pregnancy. Lower levels of collagen induced aggregation were also found at 1 h post delivery when compared with normal pregnancy. Women with moderate pre‐eclampsia showed a decreased response to aggregating agents at 36 weeks gestation but this was not significant. ADP, collagen and PAF induced aggregation was higher in women with moderate pre‐eclampsia at 36 weeks gestation and during the early puerperium compared with severe pre‐eclampsia.Conclusions
The clinical signs of pre‐eclampsia are accompanied by a reduction in platelet responsiveness, the extent of which is related to the severity of the disease. This suggests that an abnormal platelet activation occurs early in pregnancies destined to be complicated by pre‐eclampsia. This activation may be involved in the pathogenesis of pre‐eclampsia since its inhibition using low dose aspirin has been shown to modify the disease in high risk pregnancies.
Prediction of morbidity in small and normally grown fetuses by fetal heart rate variability, biophysical profile score and umbilical artery Doppler studies
Authors: Soothill P. W. , Ajayi R. A. , Campbell S. , Nicolaides K. H. 
Published: August 2005

ABSTRACTObjective
To assess the ability of noninvasive tests of fetal wellbeing to predict hypoxic morbidity independent of fetal size.Design
A prospectively planned, longitudinal, observational study.Setting
Fetal Surveillance Unit, King's College Hospital, London.Subjects
One hundred and ninety‐one pregnant women with singleton pregnancies who were delivered after 32 weeks' gestation who were seen in the Fetal Surveillance Unit within seven days of delivery.Interventions
Fetal surveillance by fetal abdominal circumference, heart rate variability (mean range), biophysical profile score and umbilical artery pulsatility index measurements.Main outcome measures
Birthweight was classified as < or ≤2.5th centile (AGA or SGA) for gestational age and sex. Morbidity was defined as at least one of the following at birth: delivery by emergency caesarean section for fetal distress, umbilical venous blood pH less than 7.15, 5 min Apgar score less than 7 or admission to the Special Care Baby Unit (SCBU).Results
Fetal abdominal circumference was the best indicator of which fetuses (n = 30) would be SGA. Fourteen of the 30 (47%) SGA fetuses had morbidity at birth and abnormal umbilical Doppler studies significantly predicted this (χ2= 2.93, P= 0.003). By contrast, fetal heart rate variability and the biophysical profile score did not. Twenty‐seven of the 161 (17%) AGA fetuses had morbidity at birth, but this was not significantly predicted by heart rate variability, biophysical profile score or umbilical Doppler studies.Conclusions
None of the antenatal testing techniques studied predicted morbidity in normally grown fetuses but Doppler studies indicated whether a small fetus was ‘sick small’ or ‘normal small’.
Denervation and re‐innervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study
Authors: Barnick C. G. W. , Cardozo L. D. 
Published: August 2005

ABSTRACTObjective
To investigate the role of altered innervation of the urethral sphincter in the genesis of genuine stress incontinence.Design
Prospective observational study.Setting
Tertiary referral centre urodynamics unit.Subjects
Sixty‐eight women, 33 with urodynamically proven pure genuine stress incontinence and 35 controls without urinary symptoms.Interventions
Concentric needle electromyography of the urethral striated sphincter.Main outcome measures
The means of motor unit potential duration, number of changes in polarity and the amplitude of individual motor unit potentials were compared between the two groups.Results
There was no statistically significant difference in motor unit potential duration (P= 0.87) or in the number of changes in polarity (P= 0.85). There was a trend towards a higher amplitude of motor unit potentials in the control group (P= 0.07).Conclusions
Our findings suggest that denervation and re‐innervation of the striated urethral sphincter following trauma to the pelvic floor, such as that occurring during childbirth, is not a major aetiological factor in the development of genuine stress incontinence.
Reagent strip testing of antenatal urine specimens for infection
Authors: Etherington I. J. , James D. K. 
Published: August 2005

ABSTRACTObjective
To compare reagent strip testing (RST) with microscopy and culture in identifying significant bacteriuria, and secondly, to consider potential cost savings if RST screening proved to be reliable.Design
Prospective descriptive study.Setting
Antenatal Clinic, Bristol Maternity Hospital.Subjects
Eight hundred and ninety‐eight women having urine testing in pregnancy for microscopy and culture either routinely or because of a clinical indication.Interventions
The midstream specimens of urine had RST examination using Ames Multistix 8SG prior to being sent to the laboratory.Main outcome measure
Significant culture (>105 colonies/ml) of a single organism in culture.Results
The highest predictive value for a negative result of the urine culture (99.7%) was obtained when using four RSTs in combination. The RST for nitrite had a high predictive value for a positive urine culture (90%). The samples which gave a false negative result with RST screening were mainly infected with low grade urinary pathogens or genital tract contaminants.Conclusion
RST screening for bacteriuria provides a reliable and cheap alternative to culture of all urine specimens.
Plasma protein levels in normal human fetuses: 13 to 41 weeks' gestation
Authors: Fryer A. A. , Jones P. , Strange R. , Hume R. , Bell J. E. 
Published: August 2005

ABSTRACTObjective
To establish reference ranges for the levels of alpha‐fetoprotein, albumin, prealbumin (transthyretin) alpha‐1‐antitrypsin, transferrin, ceruloplasmin and total protein in the plasma of normal human fetuses and newborn babies.Design
Prospective study of individual normal cases to fulfil objectives.Setting
Pathology laboratories of the University of Edinburgh and the biochemistry laboratories of the University of Keele.Subjects
Twenty‐two normal fetuses 13 to 22 weeks of gestation and 66 babies born between 24 and 41 weeks gestation.Results
Albumin is the predominant plasma protein throughout gestation. The levels of alpha‐fetoprotein and prealbumin fell significantly with increasing gestation, whereas the concentrations of the other proteins studied increased. The ratios of individual proteins to total protein demonstrated similar trends.Conclusions
This study provides developmental profiles of normal human fetal plasma proteins to serve as possible reference data for abnormal fetuses. Declining levels of prealbumin (transthyretin) were unexpected and suggest a functional role for this protein in early pregnancy.