bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous fetal reduction in multiple gestations assessed by transvaginal ultrasound
Authors: BLUMENFELD ZEEV , DIRNFELD MARTHA , ABRAMOVICI HAIM , AMIT AMNON , BRONSHTEIN MOSHE , BRANDES JOSEPH M. 
Published: August 2005

ABSTRACTObjective
To assess the occurrence of disappearance of one or more of the fetuses in pregnancies which start as multiple gestation.Design
Observational study.Setting
Infertility section, Rambam Hospital, Haifa.Subjects
88 women with multiple gestations, established after ovulation induction (54 twin, 26 triplet, five quadruplet, and three quintuplet) and diagnosed by trans‐vaginal ultrasound at 5–6 weeks, in all of whom absorption of at least one gestation sac was detected at follow‐up ultrasound scan.Interventions
Follow‐up by serial transvaginal and later abdominal ultrasound scan throughout pregnancy.Results
Of the 54 twin gestations, 51 ended in the birth of a singleton and three in miscarriage. Of the 26 pregnancies starting as triplets, 12 ended in singleton births, 12 in twins and two miscarried. The five quadruplet gestations resulted in one singleton birth, one set of twins, two triplets, and one ended in late miscarriage. Of the three quintuplet pregnancies, two resulted in the birth of triplets, one of them after spontaneous, the other after iatrogenic fetal reduction. In the third quintuplet pregnancy, one fetus vanished spontaneously and another was subject to iatrogenic reduction, two fetuses survived and were liveborn. Of the 221 fetuses identified 107 (48%) vanished spontaneously.Conclusion
Iatrogenic fetal reduction should be delayed until 12 weeks gestation in quadruplet or higher multiple gestations, but is probably not indicated in twin and triplet gestations.
Fetal breathing movements in oligohydramnios are not increased by amnioinfusion
Authors: FISK NICHOLAS M. , TALBERT DAVID G. , NICOLINI UMBERTO , VAUGHAN JANET , RODECK CHARLES H. 
Published: August 2005

ABSTRACTObjective
To determine whether fetal breathing movements (FBM) in pregnancies with oligohydramnios change with restoration of amniotic fluid volume.Design
A prospective experimental study.Setting
Fetal Medicine Unit, tertiary referral hospital.Subjects
16 women with singleton pregnancies complicated by severe oligohydramnios.Interventions: Restoration of amniotic fluid volume by transabdominal amnioinfusion. Controls comprised pregnancies in which infused fluid leaked vaginally, so that oligohydramnios was not corrected.Main outcome measures
Change in total breathing movements, change in FBM incidence derived from 40 min recordings immediately before and after amnioinfusion.Results
There was no significant difference in the change in total breathing movements or in the change in incidence of FBM between the 10 pregnancies in which amniotic fluid volume was restored, and the other six in which fluid leaked after infusion and volume was not restored. In both groups, there was no significant change with infusion in number of FBM (mean change −12, 95% CI −218 to +74 in the fluid‐retained group and −64, 95% CI −273 to +145 in the fluid‐leaked group) and incidence of FBM (median change −2–5%, range −27 to +10 in the fluid retained group and −4–5%, range −34 to +15 in the fluid‐leaked group).Conclusions
This study suggests that restitution of amniotic fluid volume in human pregnancies complicated by severe oligohydramnios does not acutely alter the incidence of FBM. These data support an increasing literature suggesting that impairment of fetal breathing is not the mechanism for oligohydramnios‐related pulmonary hypoplasia.
Lung volume measured by functional residual capacity in infants following first trimester amniocentesis or chorion villus sampling
Authors: THOMPSON PETER J. , GREENOUGH ANNE , NICOLAIDES KYPROS H. 
Published: August 2005

ABSTRACTObjective
To determine the incidence of respiratory problems and lung volume abnormalities in babies bom after first trimester amniocentesis or chorion villus sampling.Design
A prospective randomized study.Setting
Harris Birthright Research Centre for Fetal Medicine, Paediatric Respiratory Laboratory, King's College Hospital.Subjects
Babies of mothers who had undergone first trimester amniocentesis (n= 74) or chorion villus sampling (CVS) (n= 86) for fetal karyotyping because of advanced maternal age, parental anxiety or family history of chromosomal abnormal ‐ity in the absence of parental chromosome re‐arrangement.Main outcomes
Respiratory distress in the neonatal period and lung volume as assessed by measurement of functional residual capacity (FRC).Results
CVS was associated with a significantly higher incidence of neonatal respiratory distress, six infants in the CVS group but none in the amniocentesis group required admission to the special care baby unit because of respiratory distress (P <0–05). Although there was no significant difference in the mean FRC between the two groups (amniocentesis 29–7 ml/kg vs CVS 29–6 ml/kg) the overall incidence of FRC values <2–5th centile of the normal range was 9%.Conclusion
Both amniocentesis and CVS performed in the first trimester of preg‐nancy may impair antenatal lung growth.
The cytological detection of persistent cervical intraepithelial neoplasia after local ablative treatment: a comparison of sampling devices
Authors: HUGHES R. G. , HADDAD N. G. , SMART G. E. , COLQUHOUN M. , McGOOGAN E. , MACINTYRE C. C. A. , PRESCOTT R. J. 
Published: August 2005

ABSTRACTObjective
To determine whether the cytological detection of persistent cervical intraepithelial neoplasia (CIN) after local ablative treatment is improved by the use of sampling devices other than the Ayre's spatula.Design
A randomized controlled study.Setting
Lothian Area Colposcopy Clinic.Subjects
856 patients who had received local therapy (CO2 laser or cold coagulation) for CIN II or III between 9 and 30 months earlier.Intervention
Each patient had three consecutive cervical smears taken, one with the Ayre's spatula, one with either the Aylesbury, the Rocket or the Multispatula device, and finally one with the Cytobrush. The allocation of which spatula and the order of the first two was randomized. Each patient had a colposcopic examination immediately after the smears were taken.Main outcome measures
A comparison of the detection of histologically proven persistent CIN by the Ayre's spatula with the detection of persistent disease by alternative sampling devices.Results
Of the 856 patients 130 had histologically proven persistent CIN. Another 98 had suspicious findings on colposcopy but punch biopsies reported as histologically normal. Of the remaining patients with normal colposcopy 130 were randomly selected to form a control group. The cervical smears from these 358 women were reported. Significantly fewer Ayre’ s samples contained endocervical cells than Aylesbury samples (47%vs 59%, difference 12%; 95% CI 3%‐21%; P<0.1), Rocket samples (47%vs 67%; difference 20%, 95% CI; 12%‐32%; P<0.001) or Multispatula samples (47%vs 76%; difference 29%, 95% CI 19–38%; P<0.001). When punch biopsies contained CIN, dyskaryotic cells were seen in 10% of Ayre's samples, 4.3% of Aylesbury samples, 8.3% of Rocket samples, and in no smear taken with the Multispatula. Obtaining a third smear with the Cytobrush did not substantially improve the detection rate of dyskaryosis. Neither the order of use of the spatulas, the form of initial treatment nor the size of the transformation zone had any apparent effect on the cytological detection of persistent CIN.Conclusions
We recommend that surveillance of patients who have received local ablative therapy for CIN should be by both cytology and colposcopy, and that cytological samples should be obtained using the Ayre's spatula.
Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean
Authors: DULEY LELIA 
Published: August 2005

ABSTRACTObjective
To present estimates of maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean, and to discuss strategies to prevent these deathsDesign
Retrospective review of all available data.Setting
Database of the World Health Organization's Maternal Health and Safe Motherhood Programme.Main outcome measures
Estimates of the total maternal mortality and the proportions of deaths associated with hypertensive disorders of pregnancy.Results
Estimates of mortality associated with hypertensive disorders of pregnancy were similar in Africa, Latin America and the Caribbean, despite considerably higher total mortality in Africa. Variations in both overall mortality and that associated with hypertensive disorders of pregnancy were greatest in Asia. Despite their limitations, these data suggest that between 10–15% of maternal deaths are associated with hypertensive disorders of pregnancy, and that 10% are associated with eclampsia.Conclusions
Where maternal mortality is relatively high, the excess is likely to be due to a high mortality associated with haemorrhage and infection and reductions are most likely to come from reductions in these deaths. Evidence from both developed and developing countries suggests that deaths associated with hypertensive disorders of pregnancy are the most difficult to prevent. More rigorous assessment of interventions designed to prevent these deaths is urgently required.
Management of severe pre‐eclampsia and eclampsia by UK consultants
Authors: HUTTON J. D. , JAMES D. K. , STIRRAT G. M. , DOUGLAS K. A. , REDMAN C. W. G. 
Published: August 2005

ABSTRACTObjective
To determine the current management of severe pre‐eclampsia and eclampsia in the United Kingdom.Design
One‐page postal survey to all (1007) UK consultant obstetricians with questions about use of antihypertensive and anticonvulsant drugs in severe pre‐eclampsia and eclampsia, other management strategies, definition of factors determining severity, protocol development and regional review.Results
688 replies (69.6% response rate). The antihypertensive drugs used were mainly oral labetalol (35%), oral methyl dopa (23%) and parenteral hydralazine (29%); diuretics were not used. Diazepam was the preferred drug in eclampsia. Very few consultants used magnesium sulphate (2%). Anticonvulsants were also prescribed by 85% of consultants to prevent fits; the drugs then preferred were diazepam (41%), phenytoin (30%) and chlormethiazole (24%). Two‐thirds of consultants felt there was a need for trials to study the effectiveness of antihypertensive and anticonvulsant drugs. In a woman with proteinuric hypertension, 15% of consultants did not regard the development of headache as indicating severe pre‐eclampsia. Consistent management practices were not associated with agreement about protocols. Regional review does not appear to have occurred.Conclusion
Antihypertensive and anticonvulsant therapies are widely used but trials are considered necessary. Improvements in the management of women with severe pre‐eclampsia or eclampsia might occur if UK obstetricians sought more collective opinion and undertook regional audit of protocols.
Placental bed biopsies in placental abruption
Authors: DOMMISSE J. , TILTMAN A. J. 
Published: August 2005

ABSTRACTObjective
To investigate structural changes in the uteroplacental blood vessels in association with placental abruption.Design
Prospective descriptive study.Subjects
18 women with clinical evidence of severe placental abruption delivered by caesarean section.Interventions
Placental bed biopsies were obtained at caesarean section and studied histologically.Results
Six specimens did not include trophoblast in the myometrium and were therefore not representative of the placental bed. Of the 12 representative specimens, seven demonstrated absence of physiological transformation of the utero‐placental arteries (four of these were from hypertensive patients). Four biopsies showed abnormal vascular structures deep in the myometrium. One of these abnormal vessels included a fresh plug and extensive surrounding intramyometrial haemorrhage.Conclusions
Vascular malformations in association with placental abruption may be the result of trophoblastic invasion and could be the site of vessel rupture. Further descriptive and comparative studies are needed.
25 mg oestradiol implants—the dosage of first choice for subcutaneous oestrogen replacement therapy?
Authors: OWEN E. J. , SIDDLE N. C. , MCGARRIGLE H. T. , PUGH M. A. 
Published: August 2005

ABSTRACTObjective
To assess the oestrogen concentrations and symptom relief obtained with 25 mg oestradiol implants.Design
Open, observational study.Subjects
Twelve symptomatic, post‐menopausal women seen in a designated menopause clinic.Intervention
A 25 mg oestradiol pellet was inserted subcutaneously, blood samples were obtained before implantation and at regular intervals (2–4 weeks) until symptoms refused as hypoestrogenaemia developed.Main outcome measures
Change in symptom score following implant treatment. Concentrations of oestrogens and their metabolites before and during low dose subcutaneous oestradiol therapy.Results
Ten of the 12 women had excellent symptom relief, associated with oestradiol concentrations in the follicular range for between 28 and 35 weeks. The ratio of circulating oestrogen metabolites remained physiological, despite the oestradiol concentrations being substantially higher on treatment.Conclusions
We suggest that 25 mg pellets should be used as the initial dose for subcutaneous oestrogen treatment, and a combination of return of symptoms and weeks since insertion used to judge the timing of reimplantation.
Endometrial responses in artificial cycles: A prospective study comparing four different oestrogen dosages
Authors: LI T. C. , COOKE I. D. , WARREN M. A. , GOOLAMALLEE M. , GRAHAM R. A. , APLIN J. D. 
Published: August 2005

ABSTRACTObjective
To examine the endometrial response to four different regimens of oestrogen.Design
A prospective, randomized cross‐over study.Setting
Jessop Hospital for Women, Sheffield.Subjects
Twenty one women with premature ovarian failure divided into three equal groups.Interventions
Four different regimens of hormone replacement therapy: variable, fixed 1 mg, fixed 2 mg and fixed 4 mg oestrogen dosages. Each woman received the variable dosage regimen in one cycle and crossed over to receive one of the three fixed dose regimens (1 mg, Group 1; 2 mg, Group 2; 4 mg Group 3) in another cycle.Main outcome measure
Ultrasonographic measurement of endometrial thickness and outpatient endometrial biopsy on day 19 of the artificial cycle; analysis of endometrial specimens by three separate methods: traditional histological criteria, morphometry and immunohistochemistry.Results
The endometrial response was similar in those treated with the variable and the fixed 2 mg or 4 mg dosage regimens. The response was suboptimal in those treated with the fixed 1 mg dosage regimen.Conclusions
Normal endometrial development requires adequate priming of the endometrium by oestrogen, which may be administered in a sequential, variable dosage fashion, or simply by a fixed daily dosage regimen. However, the minimum daily dose required is likely to be 2 mg of oestradiol valerate. No adverse effect on the endometrium was observed at a daily dose of 4 mg oestradiol valerate, which produced plasma levels of oestradiol above the reference ranges of the natural cycle.
Fetal urine biochemistry: an index of renal maturation and dysfunction
Authors: NICOLINI UMBERTO , FISK NICHOLAS M. , RODECK CHARLES H. , BEACHAM JEREMY 
Published: August 2005

ABSTRACTObjective
To construct a reference range for fetal urinary sodium, potassium, urea, creatinine, calcium and phosphate with gestation and to assess to what extent these biochemical indices are modified in fetuses with lower urinary tract obstruction.Design
Prospective descriptive study.Setting
Royal Postgraduate Medical School London.Subjects
24 women between 17 and 35 weeks gestation with an ultrasound diagnosis of fetal lower urinary tract obstruction, with or without renal dysplasia and a control group of 26 women between 16 and 33 weeks gestation with normal amniotic fluid volume and fetal anatomy.Interventions
Fetal urine samples (1–100 ml) were aspirated from the control fetuses either before termination of pregnancy(n = 9) or at the time of intrauterine transfusion for Rh alloimmunization (n = 17). The fetuses with obstructive uropathy had urine samples aspirated on one occasion (n = 14) or serially (n = 10).Main outcome measures
Relation between urine biochemistry and renal damage ascertained clinically or at postmortem.Results
In the control group, urinary sodium and phosphate decreased and creatinine increased significantly with gestational age, consistent with increasing fetal glomerular filtration rate and progressive maturation of tubular function. Urinary sodium and calcium were significantly higher in fetuses with renal dysplasia compared with those with lower urinary tract obstruction but normal renal histology or normal clinical outcome. Serial urinary samples from fetuses with obstructive uropathy showed more pronounced deviation from the normal with increasing gestation in all fetuses with renal dysplasia. The highest sensitivity in the detection of renal dysplasia was shown by urinary calcium (100%) whereas urinary sodium showed the best specificity (80%).Conclusion
Renal damage is the direct effect of urinary obstruction, rather than an association so that treatment should start as soon as possible. Urine biochemistry may be helpful in the management of these patients.
Maternal serum unconjugated oestriol and human chorionic gonadotrophin levels in pregnancies with insulin‐dependent diabetes: implications for screening for Down's syndrome
Authors: WALD NICHOLAS J. , CUCKLE HOWARD S. , DENSEM JAMES W. , STONE ROSSANAB. 
Published: August 2005

ABSTRACTObjective
To investigate maternal serum unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) levels in pregnant women with insulin‐dependent diabetes mellitus and to consider the implications of the results for antenatal screening for Down's syndrome.Design
Descriptive study using stored antenatal serum samples.Setting
Stored serum samples collected from women receiving routine antenatal care in Oxford.Subjects
126 singleton pregnancies in 92 women with insulin‐dependent diabetes mellitus and for each pregnancy, two pregnancies without diabetes matched for gestational age and duration of storage of the serum sample. None of the pregnancies was associated with fetal neural tube defect or Down's syndrome.Main study measures
Maternal serum uE3 and hCG levels at 15–22 weeks gestation. Alpha‐fetoprotein (AFP) levels were also measured for comparison.Results
The median uE3 level in the diabetic pregnancies was 0.92 multiples of the median (MoM) for pregnancies without diabetes at the same gestational age (P<0.05); and the hCG level was 0.95 MoM (P=0.48). The median AFP level was also reduced to 0.77 MoM (P<0.001).Conclusion
The reduction in uE3 and AFP levels in insulin‐dependent diabetic pregnancies is sufficiently great to be taken into account in maternal serum screening programmes for Down's syndrome. Dividing the uE3 and AFP levels in such pregnancies by the corresponding median for insulin‐dependent diabetic pregnancies will yield a similar false‐positive rate in pregnancies with and without insulin‐dependent diabetes mellitus.
Is Stage I epithelial ovarian cancer overtreated both surgically and systemically? Results of a five‐year cancer registry review
Authors: FINN CATHERINE B. , LUESLEY D. M. , BUXTON E. J. , BLACKLEDGE G. R. , KELLY K. , DUNN J. A. , WILSON S. 
Published: August 2005

ABSTRACTObjectiveTo review the incidence of Stage I epithelial ovarian carcinoma in the West Midlands region and to identify prognostic factors that have a significant effect on survival.DesignA retrospective review of all Stage I ovarian cancer patients registered from 1.1.80 to 31.12.84.SettingWest Midlands Regional Cancer Registry.Population457 patients with Stage I ovarian cancer—373 with epithelial ovarian carcinoma.Main outcome measuresSurvival at censor date of 30.6.89.Results28% developed recurrent disease, and the overall 50‐year survival of the group was 70%. Univariate analysis of all possible prognostic factors showed that stage, adjuvant chemotherapy, histological grade and type, surgical rupture of the tumour, intact capsule histologically, clinical finding of ascites and the performance of peritoneal washings were significantly associated with survival. Adequate surgical staging as defined by FIGO was not significantly associated with survival. A multivariate analysis based on the Cox proportional hazard model identified histological grade, adjuvant chemotherapy, patient age and peritoneal washings as having independent prognostic effects. Surprisingly adjuvant chemotherapy and peritoneal washings had negative effects on survival.ConclusionsAlthough a retrospective review has limitations, it would appear that adequate surgical staging and adjuvant chemotherapy confer no benefit in terms of survival in Stage I disease.
Antenatal cardiotocogram quality and interpretation using computers
Authors: DAWES G. S. , LOBB M. , MOULDEN M. , REDMAN C. W. G. , WHEELER T. 
Published: August 2005

ABSTRACTObjective
To test the application in practice of computerized fetal heart rate (FHR) analysis in pregnancy.Design
Randomized distribution of subjects with computerized analysis automatically revealed or concealed.Setting
A district general hospital and a teaching hospital outside London.Subjects
2869 pregnant women studied within a year.Outcome measures
Quality and duration of the cardiotocogram; quantitative measurement of FHR variation; number of stillbirths.Results
With interactive advice to the operator, records were of improved quality (up to 28% without signal loss) with potentially much reduced recording time. The short‐term FHR variation measured in the last records before intervention is reported for the first time.Conclusion
The benefits of using the computers include improvement in record quality and saving of time. In addition, where interpretation depended on estimation of FHR variation there was prima facie evidence of observer misinterpretation; visual analysis was unreliable. A larger trial is now required with more rigorous constraints on intervention.
Spontaneous resolution of pre‐eclampsia‐related thrombocytopenia
Authors: CHANDRAN RAVI , SERRA‐SERRA VICENTE , REDMAN CHRISTOPHER W. G. 
Published: August 2005

ABSTRACTObjective
To observe the spontaneous resolution of pre‐eclampsia‐related thrombocytopenia.Design
A retrospective study.Setting
High Risk Pregnancy Unit, John Radcliffe Maternity Hospital, Oxford.Subjects
Thirty women with pre‐eclampsia complicated by the HELLP/ELLP syndrome who did not receive any specific treatment for their thrombocytopenia.Intervention
Serial platelet counts throughout labour and the puerperium until the platelet counts returned to levels above 100 × 109/l.Main outcome measures
Time taken from delivery and platelet nadir for platelet counts to return to levels above 100 × 109/1. The rate of recovery from the platelet nadir was measured by the slope of the serial platelet counts plotted against time.Results
The mean time until platelet count exceeded 100 × 109/l was 67 h (SD 25) after delivery and 44 h (SD 17) from the platelet nadir. All women had counts above 100 × 109/1 by 111 h after delivery, and by 88 h after the platelet nadir. Although the time to recovery appeared to depend on the degree of thrombocytopenia, the rate of resolution did not.Conclusion
These data can be used as a guide by clinicians as to the expected time course for postpartum resolution of pre‐eclampsia‐related thrombocytopenia.