bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cost effectiveness analysis of goserelin compared with danazol as endometrial thinning agents
Authors: Sculpher Mark , Thompson Elizabeth , Brown Jim , Garry Ray 
Published: August 2005

Objective
To analyse the cost, effectiveness and cost effectiveness of two endometrial thinning agents prior to laser ablation for dysfunctional uterine bleeding: danazol and goserelin.Setting
A district general hospital.Design
A retrospective cost effectiveness analysis, from the perspective of the health service, based on data from an open, randomised, parallel group comparative study of 160 pre‐menopausal women with dysfunctional uterine bleeding.Methods
Within the trial, length of operation and duration of hospital stay was recorded for each woman. Resource use due to complications of surgery and adverse drug events was evaluated by one of the authors (R.G.). Additional surgery after completion of the study was collected using a postal questionnaire which was distributed to every woman who had undergone surgery. Resource use was costed using detailed unit costs from a specific NHS trust and from published sources. A cost effectiveness analysis was undertaken relating differential cost to differential rates of amenorrhoea at women's last point of follow up.Results
Information on amenorrhoea was available from 138 women, of whom 111 had completed the questionnaire to indicate longer term follow up. Women who did not complete the clinical trial were not included in this economic evaluation. On average, women randomised to goserelin spent less time in theatre and on the ward. Based on longer term follow up, rates of retreatment were similar in the two groups. The mean (SD) health service cost of women in the goserelin group was £323.84 (£309.94), compared with £243.45 (£265.23) in the danazol group; median (range) costs were £220.29 (£191–£2127) and £159.76 (£140–£1426) in the two groups, respectively. These costs were significantly higher for goserelin (P= 0.0001). The goserelin group also had a higher rate of amenorrhoea (38.8%vs 28.6%, P= 0.23). Based on mean differences in cost, the incremental cost of goserelin per additional woman with amenorrhoea was £788; based on median differences in cost the ratio was £590.Conclusions
The shorter duration in theatre and stay in hospital provided a modest offset of the higher acquisition cost of goserelin, but the overall cost of management remained significantly higher than managing women with danazol. The rates of amenorrhoea indicated that goserelin was more effective at 24 weeks and approximately two years after surgery, although statistical significance was only achieved at 24 weeks. The economic impact of women withdrawn from treatment was not considered, but sensitivity analysis indicates that these women may have had a large effect on the overall result of this study. Purchasers will need to decide whether the additional cost of management with goserelin is justified by the increased rates of amenorrhoea and the reduced withdrawals from treatment.
Trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996
Authors: Rajkhowa M. , Glass M. R. , Rutherford A. J. , Balen A. H. , Sharma V. , Cuckle H. S. 
Published: August 2005

Objective
To examine the incidence of ectopic pregnancy over the period 1966 to 1996.Setting
England and Wales.Design
Use of official statistics on hospital discharges, maternities, legal abortions and estimated populations of women aged 15–44 years.Main outcome measures
Incidence rates of ectopic pregnancies.Results
Between 1966 to 1970 and 1994 to 1996 the recorded incidence increased 4.5‐fold from 3.45 to 15.5 per 1000 maternities, 3.8‐fold from 3.25 to 12.4 per 1000 pregnancies and 3.1‐fold from 30.2 to 94.8 per 100,000 women aged 15–44. The rate of increase was not uniform. Incidence approximately doubled between 1966 and 1985, when the official data collection system changed. By 1989, when data from the new system became available, there had been a further almost doubling of recorded incidence. Subsequently, the upward trend appears to have continued until 1991 to 1992 and has remained stable in the last four years of the study. The trends were similar in each of three 10‐year age groups.Conclusions
The recorded incidence of ectopic pregnancy has increased markedly over the last three decades. This may be partly due to artefacts of data recording and more sensitive diagnostic tests, but it is likely that the actual incidence has increased, probably due to a sexually transmitted agent.
Genetic influence on birthweight and gestational length determined by studies in offspring of twins
Authors: Clausson Britt , Lichtenstein Paul , Cnattingius Sven 
Published: August 2005

Objective
To determine the relative importance of genetic effects on birthweight, gestational length and small for gestational age.Design
A cohort study, using individual record linkage between the population‐based Swedish Twin and Birth Registers to estimate twin similarities in twins with known zygosity.Population
Included were 868 monozygotic and 1141 dizygotic female twin pairs, born in Sweden before 1959, who both delivered single births from 1973–1993.Methods
Quantitative genetic methods, offspring birthweight, gestational length and small for gestational age birth in twin sisters.Main outcome measures
Twin similarities measured as probandwise concordance rates and intra‐class correlations for birthweight, gestational length and small for gestational age births.Results
Concordance rates and intra‐class correlations for birthweight, gestational length and small for gestational age were consistently higher in monozygotic compared with dizygotic twins. Model fitting suggested heritability estimates in the range from 25% to 40%.Conclusions
This study suggests genetic effects not only for birthweight and fetal growth, but also for gestational length. The mediation of these genetic effects may partly be due to similarities in maternal antropometric measures, lifestyle and medical complications during pregnancy. The study does not distinguish between fetal and maternal genetic effects.
A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage
Authors: Giacalone Pierre Ludovic , Vignal Jacques , Daures Jean Pierre , Boulot Pierre , Hedon Bernard , Laffargue François 
Published: August 2005

Objective
To determine whether early placental drainage plus cord traction reduces the incidences of manual removal and blood loss, and to determine the risk factors associated with blood loss after delivery.Design
Prospective randomised study.Setting
University teaching hospital, Montpellier, France.Methods
A randomised study compared 239 women who had placental cord drainage plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery were assessed. The duration of the third stage of labour and the time between birth and the beginning of perineal suturing were measured. Statistical analysis used the paired t test for continuous variables, the Kruskal‐Wallis test for nonparametric data and χ2 test for categoric variables. Stepwise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable.Results
No significant difference was found in the two groups with regard to the incidence of manual removal of retained complete or incomplete placenta or postpartum haemorrhage. The median values of the duration of the third stage of labour, birth‐to‐perineal suture time and drop in haemoglobin were significantly lower in the cord drainage group than in the control group. After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin.Conclusion
Cord drainage decreases the duration of the third stage of labour and reduces blood loss but not the incidence of manual removal of the placenta.
Anaemia in pregnancy in southern Malawi: prevalence and risk factors
Authors: van den Broek N. R. , Rogerson S. J. , Mhango C. G. , Kambala B. , White S. A. , Molyneux M. E. 
Published: August 2005

Objective
To determine prevalence of anaemia in pregnancy in southern Malawi, and to establish if an ‘at risk’ group can be identified for targeted intervention.Design
Prospective cross‐sectional study.Setting
A semi‐urban hospital and a rural health clinic in southern Malawi.Population
Pregnant women attending the antenatal clinic for their booking visit.Methods
Haemoglobin concentration (g/dL) measured from a capillary blood sample (fingerprick) by battery operated HemoCue machine.Results
In urban Blantyre 57% of women were anaemic by WHO standards (haemoglobin < 11.0 g/dL) and 3.6% were severely anaemic (haemoglobin < 7.0 g/dL). The prevalence was higher in the rural area; 72% and 4.0%, respectively. Primiparae were at slightly increased risk for overall anaemia and severe anaemia but the effect of targeting this group alone for interventions would mean at least 65% of anaemic women and over half of the women with severe anaemia would be excluded. When the effect of age was examined separate from gravidity, adolescents were not found to be at increased risk of anaemia. Anaemia was more prevalent in the wet season and in women who booked late for antenatal care.Conclusion
The prevalence of anaemia in pregnancy in our population is unacceptably high and deserves more attention. Prophylaxis of all women rather than an ‘at risk’ group based on age or gravidity is recommended.
The influence of bowel atresia in gastroschisis on fetal growth, cardiotocograph abnormalities and amniotic fluid staining
Authors: Dixon James C. , Penman David M. , Soothill Peter W. 
Published: August 2005

Objectives
To investigate the relationship between intestinal atresia and fetal growth, intrapartum cardiotocograph abnormalities and staining of the amniotic fluid in gastroschisis pregnancies.Design
Observational study of 115 gastroschisis pregnancies conceived between 1980 and 1996.Setting
South West Region of England.Main outcome measures
Birthweight, intrapartum cardiotocograph abnormality, staining of amniotic fluid and Apgar score.Results
There was no statistically significant difference between the Apgar scores or the frequency of amniotic fluid staining of gastroschisis cases with or without atresia. Patent bowel gastroschisis was associated significantly with more cardiotocograph abnormalities (61%vs 26%, P= 0.026) and reduced growth (P= 0.02), when compared with cases with intestinal atresia.Conclusions
Bile vomiting may be an important cause of amniotic fluid staining. Bowel atresia protects against the increased incidence of cardiotocograph and growth abnormality found in cases of gastroschisis which may reflect their aetiology.
Parvovirus B19 infection: association with third‐trimester intrauterine fetal death
Authors: Skjöldebrand‐Sparre Lottie , Tolfvenstam Thomas , Papadogiannakis Nikos , Wahren Britta , Broliden Kristina , Nyman Margareta 
Published: August 2005

Objective
To identify the presence of parvovirus B19 infection as a possible cause of fetal loss in the third trimester.Design
Prospective study of women experiencing third‐trimester intrauterine fetal death (IUFD).Setting
All cases of IUFD at Danderyd Hospital from 1992 to 1998.Population
Ninety‐three women with IUFD in 33,759 deliveries (0.3%).Methods
Detection of B19 DNA by polymerase chain reaction (PCR) in placental and fetal tissue. Placental pathology and B19‐specific immunohistochemistry. Maternal serology in consecutive samples.Results
Among 93 cases of IUFD, seven (7.5%) had detectable B19 DNA in freshly‐frozen placental tissue. The detection of B19 DNA in these tissues was confirmed by detection of B19 DNA in six separately stored paraffin‐embedded placental tissues. No other explanations for the fetal deaths were found. None of the women had experienced any clinical signs of infection prior to fetal demise. None of the seven fetuses were hydropic. Histopathologic examination of the placentas revealed only minor abnormalities. Serology on maternal samples at birth revealed delayed or absent B19 IgG responses in five of seven cases. Two women were B19 IgG seropositive at the time of delivery but had unusual infection patterns; persistent viraemia for at least five months before birth in one case and likely persistence or re‐infection by B19 in the other.Conclusion
In our study, 7.5% of IUFDs in the third trimester may have been caused by parvovirus B19 infection, without signs of fetal hydrops. This finding indicates that B19 PCR should be included in the routine investigation of IUFD.
Guidelines in gynaecology: evaluation in menorrhagia and in urinary incontinence
Authors: Chadha Yogesh , Mollison Jill , Howie Fiona , Grimshaw Jeremy , Hall Marion , Russell Ian 
Published: August 2005

Objective
To evaluate the effectiveness of national guidelines and local protocols in improving hospital care (process and outcome) for women with menorrhagia and for women with urinary incontinence.Design
2×2 balanced incomplete block controlled before and after study.Setting
Gynaecology units in four district general hospitals across Scotland.Intervention
National guidelines were adapted locally to protocols, which were disseminated at specific local educational meetings and implemented by placing a copy of the appropriate protocol in women's hospital casenotes prior to consultation.Population
Four hundred and ninety‐seven women with menorrhagia and 449 women with urinary incontinence.Main outcome measures
Process of care within six key areas of clinical practice: initial hospital assessment; appropriate use of hospital investigations; inappropriate use of hospital investigations; appropriate first line treatments; appropriate pre‐surgery assessment; and use of surgical treatments. Outcome of care using condition‐specific outcome measures and four domains of SF‐36 at zero, six and twelve months following intervention.Results
There were significant improvements with the introduction of guidelines and protocols in two (initial hospital assessment and appropriate pre‐surgery assessment) of the six key areas of clinical practice assessed. In the other areas there were no significant improvements or deteriorations observed. There was no evidence of effect of guidelines and protocols on the condition‐specific outcome measures or on the four domains of the SF‐36.Conclusions
There were only very modest benefits observed from the introduction of guidelines and protocols on the hospital management of the two conditions. The reasons for this lack of impact of the guidelines is unclear. Experience of this study raises important methodological issues for future research in this area.
Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse
Authors: Colombo Mario , Vitobello Domenico , Proietti Fabio , Milani Rodolfo 
Published: August 2005

Objective
To compare the Burch colposuspension and the anterior colporrhaphy in women with both stress urinary incontinence and advanced anterior vaginal wall prolapse (cystocele).Design
Prospective randomised study.Setting
Secondary referral centre, Urogynaecology Unit, San Gerardo Hospital, Monza, Italy.Sample
Seventy‐one women undergoing surgery for primary genuine stress incontinence and concurrent grade 2 or 3 cystocele (descending at or outside the vaginal introitus).Methods
Full urodynamic investigation performed pre‐operatively and repeated six months after surgery. Clinical follow up continued for 8 to 17 years.Main outcome measures
Subjective (patient history) and objective (negative stress test result) cure of stress incontinence. Assessment of cystocele recurrence.Results
Thirty (86%) of the 35 evaluable women who had the Burch colposuspension and 17 (52%) of the 33 evaluable women who had the anterior colporrhaphy were subjectively cured (OR 5.6, 95% CI 1.6 to 21.6; P= 0.005). Objective cure rates were 74% (26 of 35) and 42% (14 of 33), respectively (OR 3.9, 95% CI 1.3 to 12.5; P= 0.02). A recurrent cystocele of grade 2 or 3 with or without prolapse at other vaginal sites was recorded in 34% (12 of 35) and 3% (1 of 33) of women, respectively (OR 16.7, 95% CI 2.0 to 368.1; P= 0.003).Conclusions
The Burch colposuspension was better in controlling stress incontinence but it lead to an unacceptable high rate of prolapse recurrence. The anterior colporrhaphy was more effective in restoring vaginal anatomy but it was accompanied by an unacceptable low cure rate of stress incontinence. Neither of the two operations is recommended for women who are suffering from a combination of stress incontinence and advanced cystocele.
An audit of the management of uterine malignancy within the West Midlands
Authors: Redman C. W. E. 
Published: August 2005

Objective
To audit the management of uterine malignancy.Design
Retrospective casenote analysis.Setting
Cancer units/centres within the West Midlands.Sample
The last 10 cases managed by each hospital in 1997.Results
Ninety‐six cases of uterine malignancy from ten hospitals were analysed. Only six hospitals were able to provide a complete data set. Eighty‐eight cases (92%) presented with abnormal, usually postmenopausal, vaginal bleeding. Over 90% of the cases were primary endometrial carcinomas. Of the 15 standards audited, 11 were met by at least one hospital. No hospital met all the standards, although every hospital was able to meet at least one. Standards concerned with initial referral and diagnostic intervals were universally failed. Outpatient diagnosis was made in only 30%. The availability of Rapid Access Clinics neither promoted outpatient diagnosis nor sped up diagnosis. Once the diagnosis had been made, surgery was usually performed within six weeks.Conclusions
This audit has provided valuable baseline data for future activity. Serious attention must be given to improvement in clinical cancer data collection. Referral pathways for women with suspected uterine cancer, and endometrial cancer in particular, need improvement. It is recommended that the current standards remain unaltered, and after the West Midlands Gynaecological Oncology Group had the opportunity to consider and implement the necessary changes, the audit be repeated.
High risk human papillomavirus in women with normal cervical cytology prior to the development of abnormal cytology and colposcopy
Authors: Hopman E. H. , Rozendaal L. , Voorhorst F. J. , Walboomers J. M. M. , Kenemans P. , Helmerhorst Th. J. M. 
Published: August 2005

Objective
To study the significance of the presence of high risk human papillomavirus (HPV) in women with initially normal cervical cytology for the development of abnormal cytology and an abnormal colposcopic impression.Design
Prospective, observational studyParticipants and methods
Sixty‐eight women with cytomorphologically normal smears and at least one positive HPV test result were evaluated every six months by cytology, colposcopy and HPV testing. The endpoint of the study was abnormal cervical cytology.Results
The median time of follow up from the first positive HPV test was 34 months. A total of 17 women developed abnormal cytology, of whom 16 (94%) had persistence of a high risk HPV infection. Women with persistent high risk HPV were more likely to develop abnormal cervical cytology than women without high risk HPV (hazard ratio 28.2, 95% CI 3.72–215.2); they also had an increased risk of developing an abnormal colposcopic impression (hazard ratio 4.4, 95% CI 1.69–11.7). Among the 17 women with abnormal cytology, high grade dysplasia was histopathologically demonstrated in eight women.Conclusion
Persistent presence of high risk HPV in normal cervical smears is associated with a significantly increased risk of developing abnormal cytology and to a lesser degree with developing an abnormal colposcopic impression.
A randomised double‐blind placebo‐controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy
Authors: Lau W. C. , Tam W. H. , Lo W. K. , Yuen P. M. 
Published: August 2005

Objective
To assess whether transcervical intrauterine instillation of local anaesthetic agent reduces pain during diagnostic outpatient hysteroscopy and endometrial biopsy.Design
Prospective, randomised, double blind, placebo‐controlled trial.Setting
Outpatient hysteroscopy clinic in a university teaching hospital.Population
Ninety women undergoing outpatient diagnostic hysteroscopy with or without endometrial biopsy.Methods
Transcervical intrauterine instillation of 5 mL of 2% lignocaine into the uterine cavity before performing the procedure.Main outcome measures
Evaluation of pain at different stages of the procedure using a visual analogue scale and changes in blood pressure and heart rate.Results
The use of local anaesthetic did not alleviate pain experienced during hysteroscopy and endometrial biopsy. It did not prevent the occurrence of vaso‐vagal reactions; however the incidence of these was low.Conclusions
Transcervical instillation of local anaesthesia neither reduced pain nor prevented vasovagal reaction during hysteroscopy and endometrial biopsy.
Effect of SR49059, an orally active V1a vasopressin receptor antagonist, in the prevention of dysmenorrhoea
Authors: Brouard R. , Bossmar T. , Fournié‐Lloret D. , Chassard D. , Åkerlund M. 
Published: August 2005

Objective
To investigate the clinical effect of SR49059 when given shortly before the onset of menstruation as a preventative treatment of dysmenorrhoea.Design
A double‐blind, randomised, placebo‐controlled, cross‐over trial in complete block design (three periods, three treatments).Setting
A clinical research organisation in Paris, France.Participants
Women aged 18–35 years suffering from primary dysmenorrhoea.Interventions
In each of three menstrual cycles, women reported to the study centre and were given a daily dose of either placebo, 100 mg or 300 mg SR49059 from a minimum of 4 hours up to a maximum of three days before the onset of bleeding and/or menstrual pain. If this did not control the pain, women were allowed once a day to take a second dose of study treatment providing that at least 4 hours had passed since the first drug intake.Main outcome measures
Intensity of menstrual pain recorded by means of a visual analogue scale. Rating of symptoms of dysmenorrhoea (mainly back and pelvic pain) in relation to functional capacity (Sultan score). Self‐assessment of menstrual blood loss in a menstrual diary record.Results
Analysis of intensity of menstrual pain, as recorded by visual analogue scale and Sultan pain score (back and pelvic pain) during the first 24 hours of dysmenorrhoea, showed a dose‐related effect of SR49059. The 300 mg dose of SR49059 was significantly more effective than placebo. Similarly, a dose‐related effect of SR49059 was shown on total Sultan score. SR49059 was well tolerated and no significant effect on the bleeding pattern was noted.Conclusions
This study showed for the first time a therapeutic effect of an orally active vasopressin V1a receptor antagonist in the prevention of dysmenorrhoea. Further studies are required to examine effect mechanisms and determine effective doses.