bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaginal delivery after previous caesarean section for failure of second stage of labour
Authors: Jongen V. H. W. M. , Halfwerk M. G. C. , Brouwer W. K. 
Published: August 2005

Objective
To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery.Design
Retrospective follow up study.Setting Medical
Centre Leeuwarden, The Netherlands.Participants
All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 1986–1998.Methods
Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour.Results
Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour.Conclusions
In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.
Treatment with a gonadotrophin releasing hormone agonist before hysterectomy for leiomyomas: results of a multicentre, randomised controlled trial
Authors: Vercellini Paolo , Giorgio Crosignani Pier , Mangioni Costantino , Imparato Emilio , Ferrari Augusto , De Giorgi Olga 
Published: August 2005

Objectives
To ascertain whether uterine shrinkage induced by a gonadotrophin releasing hormone agonist before hysterectomy for fibroids increases the possibility of a vaginal procedure.Design
A multicentre, prospective, randomised, controlled study.Participants
One hundred and twenty‐seven premenopausal women with a uterine volume of 12 to 16 gestational weeks.Interventions
Twelve weeks of triptorelin depot treatment before hysterectomy or immediate surgery.Main outcome measures
Number of vaginal and abdominal hysterectomies, operating time, blood loss, degree of difficulty of the procedure, perioperative serum haemoglobin and haematocrit levels, hospital stay, and patients' overall satisfaction with treatment.Results
After randomisation, four women withdrew from the study, leaving 60 women in the triptorelin arm and 63 in the immediate surgery arm. At baseline evaluation a vaginal hysterectomy was indicated in seven women allocated to pre‐operative medical therapy (12%), and in 10 of those allocated to immediate surgery (16%). Clinical assessment after the 12–week GnRH agonist course showed that abdominal hysterectomy was no longer indicated in 25/53 women (47%) as a vaginal procedure appeared appropriate. Thus the overall rate of indication for a vaginal procedure in the pre‐operative medical treatment arm was 32/60 cases (53%), with a between‐group difference of 37% (95% CI, 26% to 51%; χ21= 19.18, P < 0.0001; OR 6.06; 95% CI, 2.60 to 14.10). Pre‐ and post‐operative serum haemoglobin and haematocrit levels were significantly higher in the GnRH agonist than in the immediate surgery arm. No appreciable difference was observed between the groups in the other intra‐ and post‐operative variables, including patients' satisfaction.Conclusions
Pre‐operative GnRH agonist therapy increased the rate of vaginal hysterectomy in selected women with fibroids and uterine volume of 12 to 16 gestational weeks.
Changing childbirth: lessons from an Australian survey of 1336 women
Authors: Brown Stephanie , Lumley Judith 
Published: August 2005

Objective
To investigate the views and experiences of care in labour and birth of a representative sampleDesign
Cross‐sectional survey mailed to women 6–7 months after giving birth.Population
All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death.Results
After adjusting for parity, the risk status of the pregnancy, and social and obstetric factors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhelpful (midwives: adjusted OR 12.03 [95% CI 7–8–1 8.1, doctors: adjusted OR 6.76 [95% CI 4.–10.31); and having an active say in decisions only sometimes, rarely or not at all (adjusted OR 8.0 [95% CI 4.–16–11). In a separate regression analysis including parity, risk status, obstetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included participation in a shared antenatal care programme (adjusted OR 1.9 [95% CI 1.–3.1) and being of nonEnglish speaking background (adjusted OR 1.0 [95% CI 1.–2.1). The following factors lowered the odds of dissatisfaction: attending a birth centre (adjusted OR 0.34 [95% CI 0.–1.]) and knowing the midwives before going into labour (adjusted OR 0.8 [95% CI 0.–0.]).Conclusion
The survey demonstrates the potential for ‘new’ models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal care taking into account women's views is a prerequisite for improvements in maternity care. of women who gave birth in Victoria, Australia in 1993.
Maternal health after childbirth: results of an Australian population based survey
Authors: Brown Stephanie , Lumley Judith 
Published: August 2005

Objective
To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.Design
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.Participants
All women who gave birth in a two‐week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.Results
The response rate was 62.5% (n= 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under‐represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (435%), sexual problems (26.%), haemorrhoids (24.%) and perineal pain (21%); 16.% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.9 [95% CI 3.–6.]), sexual problems (OR 2.6 [95% CI 1.–3.]), and urinary incontinence (OR 1.81 [95% CI 1.–2.1). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.Conclusion
Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.
Effects of early augmentation of labour with amniotomy and oxytocin in nulliparous women: a meta‐analysis
Authors: Fraser William , Vendittelli Françoise , Krauss Isabelle , Bréart †Gérard 
Published: August 2005

Objectives
To estimate the effects among nulliparae of early augmentation with amniotomy and oxytocin on caesarean delivery, and on other indicators of maternal and neonatal morbidity including transfusion, Apgar score < 7 at 5 minutes, and admission to the special care nursery.Design
Meta‐analysis.Methods Published studies were identified through manual and computerised searches. Two unpublished studies were identified through direct communication with the investigators. Twelve trials were identified which compared a policy of early labour augmentation including amniotomy followed by oxytocin with a less active form of management. Two methodologically unacceptable studies were excluded. Studies were grouped according to whether they admitted only women with abnormal progress (therapy trials: n= 3) or accepted women with normal labour (prevention trials: n= 7).Results
Unstratified analysis did not provide support for the hypothesis that early augmentation reduces the risk of caesarean section (typical odds ratio [OR] 0.9; 95% CI 0.7–1.1). The typical odds ratio for prevention trials was similar to that obtained in the unstratified analysis (typical OR 0.9, 95% CI 0.7–1.2). Although only a small number of women have been randomised in therapy trials, a trend toward a reduction in the rate of caesarean section with early intervention was seen in this group (typical OR 0.6,95% CI 0.2–1.4).Conclusions
Early augmentation does not appear to provide benefit over a more conservative form of management in the context of care of nulliparous women with mild delays in the progress of labour. In the context of established delay in labour, an active policy of augmentation may reduce the risk of caesarean section. However, only three small trials have been performed in this context, and they do not have adequate power to allow firm conclusions to be drawn.
The effect of pregnancy on survival in women infected with HIV a systematic review of the literature and meta‐analysis
Authors: French Rebecca , Brocklehurst Peter 
Published: August 2005

Objective
To investigate the effect of pregnancy on disease progression and survival i? women infected with HIV by a systematic review of the literature and meta‐analysis.Methods
Appropriate publications were identified using electronic and hand searching of relevant journals from 1983 to 1996. Studies were included in the review if they were cohort studies, either prospective or retrospective, or case‐control studies which investigated disease progression of pregnant women infected with HIV and included a control group of non‐pregnant women infected with HIV for comparison. Methodological quality was assessed for each study. Data were extracted for predetermined outcome measures. Sensitivity analyses were performed to explore the association between pregnancy and disease progression for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies had controlled for potential confounding.Results
Seven studies, all prospective cohorts, were eligible to be included in the rediew. The summary odds ratio for the risk of an adverse maternal outcome related to HIV infection and pregnancy were as follows: death 1.8 (85% CI 0.99–3.3); HIV disease progression 1.41 (95% C1 0.85–2.33); progression to an AIDS‐defining illness 1.63 (95% CI 1.00–2.67) and fall of CD4 cell count to below 200×106/L 0.73 (95% CI 0.17–3.06). Sensitivity analyses showed that HIV progression in pregnancy was significantly more common in a developing country setting (odds ratio 3.71, 95% CI 1.82–7.75) than in developed countries (odds ratio 0.55, 95% 0.27–1.11) and also significantly more common in high quality studies when compared to low quality ones, odds ratios 3.71 (95% CI 1.82–7.57) and 0.55 (95% CI 0.27–1.11), respectively. However, there appears to be less progression of HIV disease and progression to AIDS when studies attempted to control for confounding by matching or restriction techniques, although this was not statistically significant in either case.Conclusions
The findings of this review have implications for women infected with HIV who are pregnant or are considering a pregnancy. There does appear to be an association between adverse maternal outcomes and pregnancy in women infected with HIV, although this association is not strong. The relation may be due to the result of bias including residual confounding. Further large scale observational studies with long term follow up are required before this issue can be fully resolved.
Women's knowledge and attitudes, and the acceptability of voluntary antenatal HIV testing
Authors: Duffy T. A. , Wolfe C. D. A. , Varden C. , Kennedy J. , Chrystie I. L. 
Published: August 2005

Objective
To assess pregnant women's knowledge of, and attitudes towards, antenatal HIV testing, and its acceptability to them.Setting
Antenatal clinic at Guy's Hospital, London, six community antenatal clinics and a midwifery group practice.Population
Eight hundred and forty‐three women attending the antenatal clinics.Method
The women received a leaflet explaining HIV testing, and completed a questionnaire before and after their booking appointment. This included an assessment of their knowledge of, and attitudes towards HIV testing, and its acceptability.Results
Seven hundred and eighty‐nine women (94%) completed questionnaires. Fifty‐one percent (n= 405) were Caucasian, 25% (n= 195) African, 11% (n= 86) West Indian and 13% (n= 100) were from other ethnic groups. Fifty‐eight percent received the HIV information leaflet, of whom 86% had read it. Knowledge relating to HIV was good, the median knowledge score being 6 out of a possible 8, but it was less in non‐Caucasian women and those with lower educational qualifications. Knowledge was not related to uptake of testing. Thirty‐five percent of women accepted the offer of an HIV test, rates being higher in hospital clinics (41%) than in the midwifery group practice (10%) and the community clinics (30%). Women more likely to accept the offer of an HIV test were non‐Caucasian (P = 0.0443), those who had thought about the HIV test before this pregnancy (P= 0.0298) and those seeing one particular midwife (P= 0.0003). Most women (67%) thought that all pregnant women should be offered the HIV test and then make their own decision. Overall, 64% women did not change their original pre‐discussion decision on testing for HIV. Thirty‐six percent of women changed their decision from ‘yes’ to ‘no’ or ‘don't know’ after seeing the midwife. Women attending the community clinics (P= 0.003) and those who had been tested before (P= 0.0451) were more likely to change their decision.Conclusion
This study, in a multiethnic population, has shown that knowledge regarding HIV is good but does not increase the uptake of testing. Women prefer to be offered the HIV test and make their own choice regarding whether to accept it.
The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England
Authors: Wilton L. V. , Pearce G. L. , Martin R. M. , Mackay F. J. , Mann R. D. 
Published: August 2005

Objective
To determine the proportion and nature of congenital anomalies in babies born to women exposed to newly marketed drugs during the first trimester.Design
Non‐interventional observational cohort studies.Methods
The women were identified in confidence by the Prescription Pricing Authority. The doctor was sent a questionnaire to determine clinical events, including pregnancy, occurring after the drug was dispensed. A supplementary questionnaire determined the outcome of each reported pregnancy.Setting
General medical practice in England.Population
Women exposed to newly marketed drugs in whom pregnancy was recorded.Main outcome measures
Outcomes of pregnancies, the proportion and nature of congenital anomalies in the babies born.Results
2511 pregnancies were reported. In 831 of these pregnancies a newly marketed drug had been taken during the first trimester and in 74 during the secondkhird trimester. The outcome was ascertained for 780 (94%) of these 831 pregnancies: 547 (66%) births; 10 (1%) ectopic pregnancies; 94 (11%) spontaneous miscarriages; 5 (< 1%) missed abortions; 120 (14%0) legal abortions; and 4 (C 1%) intrauterine deaths. 557 infants were born, of whom 14 (2.5%) had congenital anomalies.Conclusions
The proportion of live infants with a congenital abnormality born to mothers exposed to newly marketed drugs in the first trimester was similar to the percentage of congenital anomalies estimated by the Ofice for National Statistics. These data add valuable information to the safety database of these drugs.
Partogram action line study: a randomised trial
Authors: Lavender Tina , Alfirevic Zarko , Walkinshaw Stephen 
Published: August 2005

Objective
To assess the effect of three different partograms on caesarean section and maternal satisfaction.Design
Prospective randomised clinical trial.Setting
Regional teaching hospital in North West of England.Participants
Nine hundred and twenty‐eight primigravid women with uncomplicated pregnancies who presented in spontaneous labour at term.Interventions
The women were randomised to have their progress of labour recorded on a partogram with an action line 2, 3 or 4 hours to the right of the alert line. If the progress reached the action line, a diagnosis of prolonged labour was made. Prolonged labour was managed according to the standard ward protocol.Main outcome measures
Primary: Caesarean section rate and maternal satisfaction; secondary: need for augmentation, duration of labour, analgesia, cord blood gas analysis, postpartum haemorrhage, number of vaginal examinations, Apgar score and admission to special care baby unit.Results
Caesarean section rate was lowest when labour was managed using a partogram with a 4‐hour action line. The difference between the 3‐ and 4‐hour partograms was statistically significant (OR 1.8,95% CI 1.1.3.2), but the difference between 2 and 4 hours was not (OR 1.4, 95% CI 0.8‐2.4). The women in the 2‐hour arm were more satisfied with their labour when compared to the women in the 3‐hour (P < 0.0001) and 4‐hour (P < 0.0001) arm.Conclusion
Our data suggest that women prefer active management of labour. It is possible that partograms which favour earlier intervention are associated with higher caesarean section rate. As the evidence on which to base the choice of partograms remains inconclusive further satisfaction. research is required.
Neonatal mortality amongst Scottish preterm singleton births (1985–1994)
Authors: Magowan B. A. , Bain M. , Juszczak E. , McInneny K. 
Published: August 2005

Objective
To provide a valid estimate of singleton neonatal mortality based on birthweight and gestational age at delivery.Design
Record linkage of maternity data and neonatal mortality data.Setting
Scotland, UK.Population
All singleton preterm deliveries from 24 to 36 weeks inclusive between 1985 and 1994.Main outcome measure
Neonatal death.Results
There were 625,646 liveborn singleton deliveries over the study period, of which 33,912 were preterm (5.4%). The overall neonatal mortality in the preterm group was 41/1000 and the data have been presented by both gestational age and birthweight. The neonatal mortality rate fell with advancing gestation from 795/1000 live births at 24 weeks to 9/1000 live births at 36 weeks and was higher at the extremes of birthweight for a given gestational age. There was a significant increase in the proportion of babies delivered iatrogenically over the study period (χ test for trend P < 0.001).Conclusion
This is the largest recent series to consider neonatal mortality using both birthweight and gestational age. These figures will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.
Preterm and term births of small for gestational age infants: a population‐based study of risk factors among nulliparous women
Authors: Clausson Britt , Cnattingius Sven , Axelsson Ove 
Published: August 2005

Objective
To study risk factors for small for gestational age (SGA) infants by gestational age among nulliparous women and to estimate mortality rates among SGA and appropriate‐for‐gestational‐age (AGA) infants by gestational age.Design
A population‐based study from the Swedish Medical Birth Register.Setting
Sweden 1992–1993.Population
Liveborn singleton infants to nulliparous women (n= 96,662).Main outcome measures
Crude and adjusted odds ratios of risk factors for SGA by gestational age. Rates of neonatal and postneonatal mortality.Results
Older maternal age (≥ 30 years) was foremost associated with increased risks of very and moderately preterm SGA (≥ 32 weeks and 33–36 weeks, respectively), but also with term SGA (≥ 37 weeks). Risks of SGA increased with decreasing maternal height at all gestational ages. Smoking increased the risks of moderately preterm and term SGA. Short maternal education increased the risk of preterm SGA and low pre‐pregnancy body mass index slightly increased the risk of term SGA. Pre‐eclampsia and essential hypertension foremost increased the risk of very preterm SGA (OR = 40.5 and 32.4, respectively) and moderately preterm SGA (OR = 17.4 and 10.6, respectively), but also increased the risk of term SGA. Neonatal and postneonatal mortality rates of SGA infants were substantially influenced by gestational age, and mortality rates were consistently higher among preterm SGA infants compared with AGA infants.Conclusions
Risk factors for SGA and mortality rates among SGA infants vary by gestational age. A subdivision of risk factors by gestational age adds knowledge, particularly about risks of preterm SGA, where the highest rates of mortality were observed.
Leptin concentrations in maternal serum and cord blood: relationship to maternal anthropometry and fetal growth
Authors: Geary Michael , Pringle P. Jane , Persaud Marcia , Wilshin Jean , Hindmarsh Peter C. , Rodeck Charles H. , Brook Charles G. D. 
Published: August 2005

Objective
To determine 1. the relationship between maternal serum leptin concentrations and maternal anthropometry and 2. the relationship between cord serum leptin concentrations at birth and neonatal anthropometry.Design
Prospective cohort study of fetal growth in low–risk pregnancies.Setting
University teaching hospital.Sample
Thirty–nine women and their babies taking part in a fetal growth study.Methods
Blood was taken from the women between 10–20 weeks of gestation and from the umbilical cord of their babies at delivery. Serum leptin was measured by radio–immunoassay. Maternal anthro–pometric measurements were recorded at booking. Neonatal anthropometric measurements were recorded within 48 hours after delivery. Linear regression analysis was used to explore the relationship between serum leptin concentrations and anthropometric measures and multiple regression analysis then applied to determine which variables remained independently associated with leptin.Results
The median (range) leptin concentration in maternal serum was 11.8 ng/mL (1.7–39.7) and in cord blood was 4.2 ng/mL (0.6–21.4). Maternal leptin levels correlated with maternal weight, body mass index, midarm circumference and skinfold thickness, but not with birthweight, placental weight or maternal height. Body mass index and midarm circumference remained significant after multiple regression analysis. Cord leptin levels correlated with birthweight, birthlength, placental weight and skinfold thickness but not with ponderal index. Birthweight and subscapular skinfold thickness remained significant after multiple regression analysis. Cord leptin concentrations did not correlate with maternal leptin concentrations.Conclusions
We suggest that there are very strong associations between maternal leptin and maternal adiposity in pregnancy, and between cord leptin at delivery and birthweight, as well as other anthropometric markers of fetal growth.