bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discordant birthweight and late fetal death in like‐sexed and unlike‐sexed twin pairs: a population‐based study
Authors: Rydhström Håkan 
Published: August 2005

ABSTRACTObjective
To study the relation between pregnancy loss (one or two fetal deaths in a pair) in twin pregnancy and gender (like‐sexed and unlike‐sexed pairs), discordant birthweight, and placentation.Design
The type of placentation for gestations with pregnancy loss was studied, based on material retrieved from the original medical records, for a defined region comprising 20.0% of the total twin population.Subjects and setting
Four thousand one hundred and ninety‐one unlike‐sexed and 10875 like‐sexed twin pairs born in Sweden between 1973 and 1989, in most cases with a gestational duration 28 or more completed weeks.Results
The relative risk (RR) for pregnancy loss in like‐sexed pairs, compared with unlike‐sexed ones, was 2.3 and the 95% confidence limits (CL) 1.7–3.1. Not until discordance exceeded 999 g did the pregnancy loss rate for unlike‐sexed pairs increase significantly, compared with the (first) stratum with discordance less than 250 g (RR = 6.3; CL 3.5–11.3). For like‐sexed twin pairs a higher pregnancy loss rate, compared with the first stratum, was seen already in the stratum with discordance 250–499 g (RR = 1.3; CL 1.0–1.8); a significant increase in pregnancy loss rate was found in all the three strata 500–749 g (RR = 2.1; CL 1.5–3.0), 750–999 g (RR = 3.5; CL 2.3–3.0), and 1000 g or more (RR=10.9; CL 8.4–14.2), respectively. When calculating the discordance as a percentage of the weight of the larger twin, unlike‐sexed pairs experienced a significant increase in pregnancy loss when discordance exceeded 40 to 50%. For like‐sexed ones, the corresponding figures were 20 to 30%. In the 47 unlike‐sexed pregnancies complicated by pregnancy loss, both twins died in two pregnancies (4.3%), whereas for like‐sexed pairs the corresponding figures were 65/279 (23.3%). Of 47 gestations with pregnancy loss in a defined region, 32 were monochorionic (monozygous), nine were like‐sexed dichorionic (monozygous or dizygous), and six were unlike‐sexed (dizygous).Conclusions
Pregnancy loss was twice as high in like‐sexed compared with unlike‐sexed pairs, and only in like‐sexed pairs was pregnancy loss strongly correlated to birthweight discordance. In twin pregnancies with one fetal death the risk for the surviving twin to succumb is five to six times higher in like‐sexed compared with unlike‐sexed pairs and is most probably related to monochorionicity.
Charts of fetal size: 2. Head measurements*
Authors: Chitty Lyn S. , Altman Douglas G. , Henderson Annabel , Campbell Stuart 
Published: August 2005

ABSTRACTObjective
To construct new size charts for fetal head circumference, biparietal diameter and other head dimensions.Design
A prospective, cross sectional study.Setting
The routine ultrasound department of a London teaching hospital.Subjects
The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days.Methods
Fetuses were scanned once only for the purpose of the study at gestations between 12 and 42 weeks, when up to 20 dimensions were measured. For each measurement separate regression models were fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived by combining these two regression models, assuming that the measurements have a normal distribution at each gestational age.Results
A total of 594 fetuses had their biparietal diameter measured and their head circumference measured directly. Both head diameters were recorded for 587 fetuses and the circumference was also derived from these, as was the cephalic area. New charts are presented for biparietal diameter (both outer–outer and outer–inner), head circumference (directly measured and derived from diameters). The directly measured head circumferences were consistently (by about 1%) greater than those derived from measurement of the head diameters. The new charts are compared with previously published charts that are in wide use. Charts for occipitofrontal diameter, cephalic index and cephalic area are also presented.Conclusions
We have constructed new size charts for the fetal biparietal diameter and for head circumference, both measured directly and derived from head diameters. We have demonstrated the difference between the size charts constructed from these two sets of values and hence the importance of using the appropriately derived chart when assessing the head circumference. The differences between the new charts for biparietal diameter and head circumference and previous ones may be largely due to methodological differences.
First trimester maternal serum pregnancy‐associated plasma protein A and pregnancy‐specific βl‐glycoprotein in fetal trisomies
Authors: Bhrsinger N. A. , Brizot M. L. , Johnson A. , Snijders R. J. M. , Abbott J. , Schneider H. , Nicolaides K. H. 
Published: August 2005

ABSTRACTObjective
To examine the potential value of maternal serum levels of pregnancy‐associated plasma protein A (PAPP‐A) and pregnancy‐specific βl‐glycoprotein (SP1) in the detection of fetal trisomy.Design
Cross‐sectional study.Setting
The Harris Birthright Research Centre For Fetal Medicine, King's College Hospital Medical School, London, UK and Division of Maternal‐Fetal Medicine, Jefferson Medical College, Philadelphia, USA. Subjects and methods Maternal serum PAPP‐A and SP1 concentrations were measured at 10 to 13 weeks gestation in samples from 42 pregnancies with fetal trisomy (trisomy 21, n= 29; trisomy 18, n= 9; trisomy 13, n= 4) and in samples from 210 matched controls.Results
In controls, both maternal serum PAPP‐A and SP1 increased significantly with gestation and in trisomic fetuses levels of both hormones were reduced. However, discriminant analysis demonstrated that SP1 did not contribute significantly in the distinction between trisomic and control pregnancies. Although levels of PAPP‐A were reduced throughout the gestational range examined (10 to 13 weeks), especially in cases with fetal trisomy 21, the deviation was more pronounced at 10 to 11 weeks than at 12 to 13 weeks gestation. In 45% of pregnancies with fetal trisomy 21 and 70% of pregnancies with trisomies 18 or 13 maternal serum PAPP‐A levels at 10 to 11 weeks gestation were below the 5th centile of the normal range.Conclusion
Maternal serum PAPP‐A concentration in the first trimester of pregnancy may prove to be useful in the prediction of risk for fetal trisomies.
Risk of preterm delivery in pregnant women with group B streptococcal urinary infections or urinary antibodies to group B streptococcal and E. coli antigens
Authors: McKenzie H. , Donnet M. Louise , Howie P. W. , Patel N. B. , Benvie Dawn T. 
Published: August 2005

ABSTRACTObjective
To establish whether there is an association between preterm delivery and either group B streptococcal urinary infection or the presence of urinary antibodies to group B streptococcal or E. coli antigens.Design
A prospective study with urine culture and antibody measurement performed at the first antenatal visit and at 28 weeks gestation.Setting
Ninewells Hospital, Dundee.Subject
Two thousand and forty‐three women registering consecutively at an antenatal clinic.Main outcome measure
Delivery at less than 37 weeks gestation.Results
No increase in preterm delivery was observed in women with positive urine cultures for group B streptococci either at booking or at 28 weeks, even when confirmed by positive repeat cultures. Preterm delivery was more common in women with elevated urinary antibodies to E. coli antigens at booking (relative risk 1.81, 95% CI 1.22–2.68, P= 0.005) and at 28 weeks (relative risk 2.36, 95% CI 1.60–3.48, P < 0.0001) and to group B streptococcal antigens at 28 weeks (relative risk 2.24, 95% CI 1.46–3.43, P= 0.0003).Conclusions
These data do not support previous reports that positive urine cultures for group B streptococci are associated with an increased risk of preterm delivery. Our report of an association between elevated levels of urinary antibodies and preterm delivery is a new finding consistent with the possibility that a local inflammatory response to uro‐genital infection may be important in stimulating the onset of preterm labour. The results suggest that screening for urinary antibodies at 28 weeks gestation might help to identify a group of women at increased risk of prematurity.
Retraction: Low dose aspirin in women with raised maternal serum alpha‐fetoprotein and abnormal Doppler waveform patterns from the uteroplacental circulation
Authors: Hamid R. , Robson M. , Pearce J. M. 
Published: August 2005

ABSTRACTObjective
To investigate the use of low dose aspirin in the reduction of perinatal morbidity and mortality in women with unexplained raised maternal serum alpha‐fetoprotein and abnormal uteroplacental Doppler waveform patterns.Design
Prospective randomised controlled trial.Setting
A tertiary referral obstetric service.Subjects
One hundred and sixty‐four women referred to our unit with raised maternal serum alpha‐fetoprotein and a structurally normal fetus had abnormal uteroplacental Doppler waveform patterns at 24 weeks of gestation.Intervention
Women were randomly allocated to two groups, receiving either low dose aspirin 75 mg (n= 76) or placebo (n= 88) daily until delivery.Main outcome measures
Preterm labour, low birthweight, the occurrence of placental abruptions and perinatal mortality.Results
The frequency of severely small for gestational age infants (birthweight < 5th centile) was reduced in the aspirin treated group to 16% compared with 25% in the placebo group (95% CI –21% to 13%). The frequency of delivery before 34 weeks of gestation was 26% in the aspirin group and 42% in the placebo group (95% CI–30% to 1%). The perinatal mortality was 240/1000 in the aspirin group and 320/1000 in the placebo group (95% CI–22% to 6%). None of these reductions was statistically significant. Although the frequency of placental abruptions was similar in the two groups, significantly more babies died from abruption in the aspirin treated group (91%versus 30%, 95% CI 28% to 94%). Low dose aspirin did cause a significant reduction (P= 0.008) in deaths from causes other than placental abruption.Conclusion
This trial revealed a benefit of low dose aspirin therapy in women with raised maternal serum alpha‐fetoprotein and abnormal uteroplacental Doppler waveform patterns, but the effect was smaller than expected. Although a reduction in deaths from small preterm babies was observed, there was an increase in the number of deaths following placental abruption without a significant increase in the number of abruptions. We recommend that this should be considered before giving aspirin to these high risk women and that other investigators should specifically look for this effect.
Serum CA 125 levels and sonography in the pre‐operative assessment of myometrial invasion of endometrial cancer
Authors: Lehtovirta Pentti , Cacciatore Bruno , Ylostalo Pekka 
Published: August 2005

ABSTRACTObjective
To assess the value of elevated serum CA 125 levels and ultrasonography in predicting deep myometrial invasion of endometrial cancer.Design
We assessed pre‐operatively serum CA 125 levels and myometrial invasion by ultrasonography in women undergoing laparotomy because of endometrial cancer. The results were compared with histological determination of myometrial invasion of endometrial cancer. Invasion was classified as superficial (less than one‐half of myometrium involved) or deep (more than one‐half of myometrium involved).Setting
University hospital.Subjects
Seventy‐eight women with a histologically proved endometrial carcinoma confined to the uterus: nine had Stage IA disease, 45 Stage IB, five Stage 1C, one Stage IIA, four Stage IIB and 14 Stage IIIA. The myometrial invasion was found to be superficial in 57 (73%) patients and deep (more than half) in 21 (27%), respectively.Results
CA 125 levels were above 35 iu/1 in 17 (21.8 %) of 78 patients: nine (42.8 %) of 21 with deep myometrial invasion and eight (14%) of 57 with superficial invasion (P < 0.01). The positive predictive value of an elevated CA 125 level for deep myometrial invasion was 52.9% and the negative predictive value 80.3 %. Sonography correctly estimated invasion in 69 cases (88.5%). Deep invasion was assessed by ultrasound with a significantly (P < 0.01) higher sensitivity than CA 125 (95.2% vs. 42.8). Positive and negative predictive values for deep myometrial invasion of sonography were 71.4% and 98%, respectively.Conclusion
Ultrasonography was more accurate than serum CA 125 levels in predicting myometrial invasion of endometrial carcinoma.
Variation in obstetric care within and between hospital levels in Finland
Authors: Hemminki Elina , Gissler Mika 
Published: August 2005

ABSTRACTObjective
In obstetrics, both area and hospital variation has previously been documented for operative procedures, but not for other treatments or diagnostic procedures. This study investigated the extent of variation in care during pregnancy, at birth and after birth.Design and methods
The variation was studied by hospitals (n= 52) by hospital level. To account for differences in women's background characteristics, logistic regression analyses were done. The data came from the 1991 Finnish Birth Register which records data on all births (n= 64 171).Results
All interventions and care practices studied varied notably from one hospital to another, with the variation usually being greater within hospitals of the same level than between hospitals of different levels. Each of the seven non‐operative interventions showed a larger variation than did each of the four operative interventions. Standardisation for mothers’ background characteristics did not eliminate this variation. Some interventions, but not all, were clustered in the same hospitals.Conclusions
Such large variation indicates a need for further studies on the benefits of obstetric interventions and of care practices, and on better application of research results to obstetric care.
A survey of views on hormone replacement therapy
Authors: Norman S. G. , Studd J. W. W. 
Published: August 2005

ABSTRACTObjective
To investigate the attitude of consultant gynaecologists and general practitioners to various aspects of hormone replacement therapy and to compare the findings in these two groups.Design
Anonymous postal survey of 589 general practitioners and 998 consultant gynaecologists; 373 (63%) and 655 (66%) valid replies, respectively, were received.Main outcome measures
Views on universal treatment of eligible women, indications for hormone replacement therapy, prescribing practice, pretreatment investigation, monitoring, and contraindications to treatment.Results
More consultants (64%) than general practitioners (56%) thought hormone replacement therapy should be offered to all eligible women, with a significant trend against treatment amongst more senior consultants. Most practitioners were prepared to offer treatment before the cessation of menstruation, but only 27% of consultants and 11% of general practitioners recommended indefinite treatment. Most limited treatment to less than 10 years. Menopausal symptoms, premature natural and surgical menopause, and a family history of osteoporosis were regarded as indications for treatment, but less than half felt established osteoporosis an indication. Hormone replacement therapy was judged to reduce the risk of ischaemic heart disease and osteoporosis by both groups but there was less consensus on the prevention of cerebrovascular accident. In general, consultants had more faith in hormone replacement therapy as prophylaxis. One‐quarter of consultants said that hormone replacement therapy should be initiated by consultants. Only 4% of general practitioners shared this view. About 30% of both groups required mammography, but less than 10% required sophisticated tests. A range of common cardiovascular conditions were regarded as contraindications, although general practitioners were more likely to regard thrombosis and cerebrovascular accident as contraindications. Breast cancer and a family history of breast cancer were regarded with suspicion by both groups.Conclusions
Practitioners were positively inclined to hormone replacement therapy, but many were unconvinced of its chronic use and use in those with cardiovascular conditions. There were differences in views as to who should initiate therapy.
Endometrial resection follow up: late onset of pain and the effect of depot medroxyprogesterone acetate
Authors: Jacobs Susan A. , Blumenthal Norman J. 
Published: August 2005

ABSTRACTObjective
To observe longer term (9 to 18 months) follow up of women after a transcervical resection of the endometrium (TCRE) and the effect of post‐operative medroxyprogesterone acetate on the results.Design
An observational study.Setting
A district public hospital and a nearby private hospital in Sydney, Australia.Subjects
Sixty‐one women who underwent TCRE from January to December 1991 were contacted 9 to 18 months after the procedure. They were questioned about symptoms and levels of satisfaction at six months, 12 months and at the time of interview, 9–18 months after the procedure. The 27 women treated from 1 January to 31 August 1991 were given medroxyprogesterone acetate 150mg at the time of surgery. From 1 September to 31 December 1991 no medroxyprogesterone acetate was given (32 women). Two women underwent immediate hysterectomy, and are included as unsuccessful TCREs but are excluded from description of effects of medroxyprogesterone acetate on the results of TCRE.Results
Late onset, defined as after 12 months, of pain with or without bleeding occurred in 7 out of 52 women (13.5%). Overall, 49 out of 61 women (80.3%) were satisfied with the operation at the time of interview, 9 to 18 months post‐operatively. Success rates, measured by satisfaction, were 89% (24/27) in the medroxyprogesterone acetate group and 75% (24/32) in the no medroxyprogesterone acetate group.Conclusion
Follow up after endometrial resection revealed that a definite subgroup of women develop late onset of pain with or without bleeding. Results at four to six months do not necessarily correlate with longer term outcomes. This needs to be investigated with larger, long term follow up studies, as does the apparently beneficial effects of medroxyprogesterone acetate on the long term results of TCRE.
Assessment of medical treatments for menorrhagia
Authors: Shaw R. W. 
Published: August 2005

ABSTRACTAlthough usually not life‐threatening, dysfunctional uterine bleeding (DUB) can cause discomfort and disruption to life for many women. It has been poorly researched in the past, primarily because of difficulties in trying to accurately measure blood loss and response to treatment. There are several different therapies currently available but, for many, actual evidence of their efficacy is lacking from scientific data. Progestogens are the most frequently prescribed drugs for the treatment of DUB. Data support their use in anovulatory women but a number of comparative trials have shown that an overall reduction in blood loss of only 20% is achieved in ovulatory women. Their use, therefore, must be questioned as the first line of treatment. Combined oral contraceptives were at one time popular but whether the low‐dose, current generation pills are equally effective awaits appropriate trials. Prostaglandin synthetase inhibitors can be useful, with up to a third of women with menorrhagia benefiting from a reduction of between 25 % and 35 % in blood loss. A proportionally greater reduction is seen in women with more excessive bleeding. Antifibrinolytic drugs have been shown to reduce menstrual blood loss in DUB by 50% and would be useful in women in whom oestrogens are contraindicated. Gonadotrophin‐releasing hormone analogues are highly effective because of their ability to induce amenorrhoea, but long‐term use is contraindicated because of their hypo‐oestrogenic effects. One other effective therapy for menorrhagia has been danazol. At a dosage of 200 mg daily, danazol has been shown to be highly effective in several open and randomised comparative trials, with a consistent reduction of blood loss of up to 75 % being achieved with maintenance of a regular menstrual cycle. Reducing the dose to 100 mg daily often results in cycle irregularities, whereas increasing the dose to 400 mg daily induces amenorrhoea. A daily dose of 200 mg of danazol is well tolerated and should be considered as a first‐line option in DUB presenting as menorrhagia requiring medical management.
Vaginal ultrasound studies of bladder neck mobility
Authors: Hol M. , Bolhuis C. Van , Vierhout M. E. 
Published: August 2005

ABSTRACTObjective To introduce a simple, well‐standardised vaginal ultrasound technique and to compare the position and mobility of the bladder neck in continent and stress incontinent women using this technique.Design A single‐centre prospective case‐control study.Setting Ikazia Hospital, Rotterdam, The Netherlands.Subjects One hundred and sixty women; sixty randomly chosen women referred to our outpatient department who volunteered for the study to develop a standardised technique, fifty stress‐incontinent women and fifty controls who volunteered for the study for comparison using the standardised technique.Main outcome measures Standardisation with regard to bladder volume, horizontal axis and Valsalva force. The position of the bladder neck at rest, during straining and during squeezing.Results The probe we use does not alter bladder neck mobility. A standardised bladder volume of 250 ml was used rather than maximum bladder capacity. A Foley catheter introduced into the bladder, with the balloon half‐filled with soapy water and half with air gives an easily recognisable fluid level, which is parallel to the horizontal axis of the patient. A standardised Valsalva force of 30 cm H2O can exclude differences in bladder neck mobility due to spontaneous and uncontrolled abdominal force. Measurements by two independently working investigators showed good conformity. The position of the bladder neck in the stress incontinent women was significantly lower and significantly more posterior at rest, during straining and during squeezing. At the same time in stress incontinent women there was significantly more descent during straining and less elevation during squeezing. However, there was a considerable overlap between the two groups for all parameters.Conclusions This standardised vaginal ultrasound technique is a feasible, acceptable and reproducible technique for the study of female bladder neck mobility. The position and mobility of the bladder neck is significantly different in stress incontinent women as compared to continent controls. The great overlap between the two groups still limits the clinical relevance.