bluuebunny/crossref_metadata_2025_split huggingface dataset:
The contribution of assisted conception, chorionicity and other risk factors to very low birthweight in a twin cohort
Authors: Lynch Anne , McDuffie Robert , Stephens Janet , Murphy James , Faber Kenneth , Orleans Miriam 
Published: December 2003

Objectives
To investigate the contribution of assisted conception (assisted reproductive technology and ovulation induction), chorionicity and selected maternal risk factors for very low birthweight.Design
Retrospective twin cohort study.Setting
Staff model Colorado Health Maintenance Organization.Sample
Five hundred and sixty‐two twin gestations [assisted = 193 (34%); unassisted = 369 (66%)].Methods
Data were collected from a perinatal database and medical record review. Data were analysed using univariate and multivariable logistic regression analysis.Main outcome measure
Very low birthweight.Results
Women with assisted twin gestation were more likely to be older, nulliparous, non‐smokers, married, have a prior history of a miscarriage and a dichorionic placentation. There was no difference in the distribution of low and very low birthweight, discordant growth or preterm delivery between assisted and unassisted twin gestations. Significant risk factors for very low birthweight were: a prior preterm birth (odds ratio, OR, 3.8, 95% confidence interval, CI, 2, 7), monochorionicity (OR 3, 95% CI 2, 4.7), nulliparity (OR 2, 95% CI 1.3, 3), cigarette smoking (OR 1.8, 95% CI 1, 3) and prior miscarriage (OR 1.6, 95% CI 1, 2). Monochorionicity was significantly associated with adverse perinatal outcomes.Conclusion
Assisted conception did not play a significant role in the occurrence of very low birthweight in this cohort. A history of preterm birth and a monochorionic twin gestation were the leading risk factors for very low birthweight. Associated risk factors for very low birthweight were nulliparity, cigarette smoking and a prior miscarriage.
Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?
Authors: Leung W.C. , Lam H.S.W. , Lam K.W. , To M. , Lee C.P. 
Published: December 2003

Objective
The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia.Design
A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12‐month period (13 March 2000 to 12 March 2001).Setting
A local teaching hospital.Sample
Six hundred and seventy deliveries.Methods
A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery.Main outcome measures
Birth trauma and birth asphyxia.Results
There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre‐study period (1998 and 1999) (RR 0.27, 95% CI 0.11–0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88–1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82–0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period.Conclusions
Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period.
The pre‐operative assessment of the adnexal mass: the accuracy of clinical estimates versus clinical prediction rules
Authors: Boll Dorry , Geomini Peggy M.A.J. , Brölmann Hans A.M. , Sijmons Edith A. , Heintz Peter M. , Mol Ben W.J. 
Published: December 2003

Objective
To evaluate the reproducibility of the clinical judgement of gynaecologists, gynaecologists in training and gynaecologic oncologists and to compare the predictive performance of the offhand assessment with the predictive performance of existing mathematical models for the pre‐operative assessment of the adnexal mass.Design
Questionnaire with paper cases of women operated on for an adnexal mass.Setting
Gynaecological unit in a teaching hospital in the South of The Netherlands.Population
Women who underwent surgery for adnexal mass between January 1991 and December 1998.Methods
We offered 45 gynaecologists five different sets of 34 cases, with data on female age and menopausal status, a written description of the sonography, Doppler flow measurement and serum CA125 measurement. Nine observers for every set were asked to estimate the probability of malignancy.Main outcome measures
The reproducibility of the risk estimates as made by the participants was expressed with an intraclass correlation coefficients. The accuracy of the judgement of the clinicians and the result of mathematical models in the prediction of malignancy were expressed with sensitivity, specificity, and receiver‐operating characteristic curves.Results
Neither clinically relevant nor statistically significant differences could be found between the accuracy of the risk assessments made by the clinicians and the accuracy of the risk assessments made by prediction models.Conclusion
This study demonstrates that at this moment there is no need to introduce complicated predictive scoring systems such as neural networks or logistic regression models for the pre‐operative assessment of the adnexal masses.
Factor V Leiden in pregnancies complicated by placental abruption
Authors: Procházka Martin , Happach Catharina , Maršál Karel , Dahlbäck Björn , Lindqvist Pelle G. 
Published: December 2003

Objective
Recent studies suggest an increased prevalence of obstetric complications in female carriers of hereditary or acquired thrombophilias. The aim of the study was to determine if carriership of the factor V (FV) Leiden mutation (activated protein C [APC] resistance) is higher in women who have had of placental abruption during pregnancy.Design
A retrospective case–control study.Setting
University Hospital MAS, Malmö, Sweden.Methods
A comparison of 102 women with placental abruption with 2371 prospectively collected controls. Carriership of FV Leiden was determined and the women were interviewed.Main outcome measures
Proportion of FV Leiden carriership, first degree heritage of thrombosis and previous placental abruption in cases and controls.Results
Carriage of FV Leiden was found in 15.7% of women who have had placental abruption as compared with 10.8% of controls (P= 0.12, odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.9–2.7). Around 20% of women with placental abruption reported first degree heritage for venous thrombosis, as compared with 6.7% of controls (P≤ 0.001).Conclusions
FV Leiden carriership was not significantly different in women with placental abruption. However, there was an increased prevalence of first degree heritage for venous thrombosis in women with placental abruption, indicating a higher prevalence of thrombophilia among women with placental abruption.
Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy
Authors: Sebire N.J. , Fisher R.A. , Foskett M. , Rees H. , Seckl M.J. , Newlands E.S. 
Published: December 2003

Objective
To determine pregnancy outcome, including the rate of repeat molar pregnancy, following histologically confirmed complete or partial hydatidiform mole.Design
Retrospective review of a large supraregional database of registrations for gestational trophoblastic disease.Setting
Supraregional Trophoblastic Disease Unit, London.Sample
Women with pregnancies affected by complete or partial hydatidiform mole registered between 1992 and 1998.Methods
All patients with a diagnosis of histologically confirmed complete or partial hydatidiform mole were identified and data on subsequent pregnancies compared between groups using comparison of proportion test.Main outcome measures
Pregnancy outcome by partial or complete mole subtype, with particular regard to risk of subsequent molar pregnancy.Results
Of 2578 complete moles, the subsequent pregnancy was affected by hydatidiform mole in 27 (1.9%) cases, including 22 (81%) complete moles and 5 (19%) partial moles. Of 2627 partial moles, the subsequent pregnancy was also molar in 25 (1.7%) cases, including 17 (68%) partial moles and 8 (32%) complete moles. Overall recurrence risk for molar pregnancy was 1.8% (1 in 55), or a 20‐fold increase compared with the background risk. Of 27 cases with repeat complete moles, three had further complete moles, suggesting the recurrence risk following two previous complete moles is approximately 10%. There were no other significant differences in pregnancy outcome between cases with previous complete or partial hydatidiform mole and that expected in an unselected obstetric population.Conclusions
Women having a pregnancy affected by a histologically confirmed complete or partial hydatidiform mole may be counselled that the risk of repeat mole in a subsequent pregnancy is about 1 in 60 and if this were to occur, the majority of cases will be of the same type of mole as the preceding pregnancy. However, >98% of women who become pregnant following a molar conception will not have a further hydatidiform mole and these pregnancies are at no increased risk of other obstetric complications.
Choices about abortion method: assessing the quality of patient information leaflets in England and Wales
Authors: Wong Sandra S.M. , Bekker Hilary L. , Thornton Jim G. , Gbolade Babatunde A. 
Published: December 2003

ObjectiveTo assess the quality of patient leaflets regarding the choice between medical and surgical abortions.DesignCross sectional survey.SettingNHS and private providers of abortion services in England and Wales.SampleLeaflets from three private providers, all teaching hospitals (n= 14) and a representative sample of NHS district hospitals (n= 27), accessed by approximately 100,000 women per year.MethodsOn telephoning the above abortion services, the leaflets provided to women choosing to have medical or surgical abortions were requested. Content analysis of leaflets included: application of a coding frame assessing adequacy of information about options, risks and procedures; the Flesch Readability Ease scale.Main outcome measuresProvision of leaflet, adequacy of information and ease of readability.ResultsSeventy‐three percent (44/60) of contacted providers offered women a leaflet. Of these 44 leaflets, one mentioned medical and 15 surgical abortion methods only. Adequacy of information provision was low, with on average 10/23 points covered about the surgical method, 12/21 points about the medical method and 7/11 points about aftercare. Readability scores were poor with 24/44 (55%) rated as ‘difficult’ or ‘fairly difficult’. Among NHS providers, scores were slightly higher in the teaching than in the district hospitals.ConclusionsOn average, leaflets provided half the information possible about the risks and procedures of medical and surgical methods. In addition, readability was rated as difficult in over half the leaflets. It seems unlikely that these leaflets enable women to make informed choices between abortion methods and, therefore, do not meet the requirements of current guidelines.
Do bladder neck position and amount of elevation influence the outcome of colposuspension?
Authors: Bombieri L. , Freeman R.M. 
Published: December 2003

Objective
To determine whether the amount of bladder neck elevation and the position of the bladder neck after surgery influence the cure rate after colposuspension.Design
Prospective, observational study.Setting
Urogynaecology unit, district general hospital.Population
Seventy‐seven women undergoing colposuspension for urodynamic stress incontinence.Methods
The bladder neck was imaged pre‐operatively and one week after surgery using magnetic resonance imaging. The position of the bladder neck after surgery and the amount of elevation were correlated to continence outcome one year after surgery (subjective and objective evidence of stress incontinence).Main outcome measures
Subjective and urodynamic stress incontinence one year after surgery.Results
At one year the subjective and objective failure rates were 11.6% and 10.5%, respectively. Measures using magnetic resonance imaging were obtained in 73 women. No association was found between continence outcome and post‐operative bladder neck position and elevation.Conclusion
The post‐operative position of the bladder neck and the amount of elevation do not influence continence outcome. Post‐operative morbidity (voiding dysfunction and detrusor instability) might be preventable by avoiding excessive bladder neck elevation and compression, without compromising the success of the procedure.
Increased vaginal bleeding and psychological distress: a longitudinal study of their relationship in the community
Authors: Shapley Mark , Jordan Kelvin , Croft Peter R. 
Published: December 2003

Objective
To explore the temporal relationship between the development of self‐reported symptoms of vaginal bleeding and the development of psychological distress among women in the community.Design
Prospective cohort study using postal surveys at baseline and at 6 and 12 months.Setting
An urban four‐partner general practice with 10,000 registered patients.Population
All women aged 18–54 years on the practice age–sex register.Methods
Baseline postal questionnaire with follow up questionnaires sent at 6 and 12 months.Main outcome measures
The associations between the development of heavy periods and psychological distress.Results
Two thousand and four hundred and thirty‐five baseline questionnaires were sent out with an initial response rate of 76%. One thousand and five hundred and thirteen women (62%) responded to all three questionnaires. Women with psychological distress at baseline were more likely to develop heavy periods 6 months later than women without distress (adjusted odds ratio 1.87, 95% CI 1.15, 3.02). Women with heavy periods at baseline were no more likely to develop psychological distress 6 months later than women with non‐heavy periods (adjusted odds ratio 1.09, 95% CI 0.73, 1.63). Similar findings existed with respect to intermenstrual bleeding and postcoital bleeding. Results of the 12‐month analysis were similar.Conclusion
In the community, psychological distress appears to influence the future self‐reporting of heavy periods and other symptoms of vaginal bleeding.
Management of incomplete abortion in South African public hospitals
Authors: Brown H.C. , Jewkes R. , Levin J. , Dickson‐Tetteh K. , Rees H. 
Published: December 2003

Objective
To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate.Design
A multicentre, prospective descriptive study.Setting
South African public hospitals that manage gynaecological emergencies.Sample
Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included.Methods
A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaestetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation.Main outcome measures
Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients.Results
There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation.Conclusions
The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post‐abortion care programmes.
Inter‐observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts
Authors: Blix Ellen , Sviggum Oddvar , Koss Karen Sofie , Øian Pål 
Published: December 2003

Objective
To assess the inter‐observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non‐clinical setting, the inter‐observer agreement between two experts in the non‐clinical setting and to what degree fetal distress in labour could be predicted by the two experts.Design
Observational study.Setting
The maternity unit of Hammerfest Hospital, Norway.Population
Eight hundred and forty‐five high and low risk women.Method
The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (κw), proportion of agreement (Pa) and predictive values were calculated.Main outcome measures
Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios.Results
Inter‐observer agreement between Expert 1 and Expert 2: κw 0.38 (CI 0.31–0.46), Pa for reactive labour admission test 0.86 (CI 0.83–0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26–0.40). Agreement between Expert 1 and midwives/obstetricians: κw 0.25 (CI 0.15–0.36), Pa for reactive labour admission test 0.89 (CI 0.87–0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11–0.25). Agreement between Expert 2 and midwives/obstetricians: κw 0.28 (CI 0.20–0.37), Pa for reactive labour admission test 0.85 (CI 0.82–0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14–0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83.Conclusion
A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.
Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction
Authors: Konje Justin C. , Howarth Edmund S. , Kaufmann Peter , Taylor David J. 
Published: December 2003

Objective
To quantify and compare longitudinal uterine artery volume flow changes in appropriate for gestational age (AGA) pregnancies and those complicated by intrauterine growth restriction (IUGR).Design
Serial longitudinal study.Setting
Large UK Teaching Hospital Obstetrics and Gynaecology Department and Institute of Anatomy, RWTH Aachen, Germany.Population
Pregnant women with accurately dated singleton pregnancies.Methods
Quantified uterine volume flow was prospectively measured by colour power angiography in (a) 32 women with abnormal uterine artery Doppler velocimetry at 20 and 24 weeks of gestation and with risk factors for IUGR (IUGR group) and (b) 25 women with normal uterine artery Doppler velocimetry and no risk factors for IUGR (AGA group) between 20 and 38 weeks of gestation. Values obtained from each gestation were compared using unpaired t test.Main outcome measures
Gestational age at delivery, birthweight and total quantified volume flow (mL/min) per gestation in IUGR and AGA pregnancies.Results
Twenty of the 32 women recruited into the IUGR group and 18 of the 25 controls fulfilled the criteria for inclusion in the analyses. The mean birthweight [SD] and gestational age [SD] at delivery in the IUGR and AGA groups were 2634 [277] versus 3429 [349] g and 39.5 [1.2] and 41.1 [2.3] weeks, respectively. The diameter of the proximal uterine artery just after it crosses the external iliac artery was smaller in the IUGR group from as early as 20 weeks of gestation but this difference only became statistically significant from 24 weeks of gestation and widened as pregnancy advanced. The quantified volume flow in the IUGR group was significantly less than that in the AGA throughout the study period (287 [117] versus 328 [159] mL/min at 20 weeks (P < 0.05), 334 [169] versus 538 [181] mL/min at 24 weeks [P < 0.004] and 534 [332] versus 830 [284] mL/min at 38 weeks of gestation [P < 0.002]). Volume flow in the IUGR group was 12.5% and 36.7% less than that in the AGA group at 20 and 28 weeks of gestation, respectively.Conclusion
Proximal uterine artery diameter and quantified volume flow change with gestation and show significant differences between AGA pregnancies and those complicated by IUGR. These changes occur early and become more marked as pregnancy advances. Early use of these measurements may identify pregnancies at risk of complications.
The relationship between intraocular pressure and refractive error adjusting for age and central corneal thickness
Authors: Nomura Hideki , Ando Fujiko , Niino Naoakira , Shimokata Hiroshi , Miyake Yozo 
Published: December 2003

AbstractPurpose:  To investigate the relationship between intraocular pressure (IOP) and refractive errors after adjusting for age, central corneal thickness (CCT), and other related factors.Methods:  IOP, CCT and refractive errors were measured in the right eyes of 1855 subjects, aged 40–82 years, in a cross‐sectional study design. Subjects were divided into groups by refractive status: hyperopia, emmetropia, mild myopia, moderate myopia, or high myopia. With adjustments for age, CCT, blood pressure, obesity, education, hypertension, diabetes, and smoking status, IOP was estimated for each refractive status using a general linear model.Results:  IOP increased with advancing degrees of myopia, even after adjustment for age, CCT, and other related factors (p = 0.011). Estimated IOP of moderate myopia was significantly higher than that of emmetropia (p = 0.022).Conclusions:  Our results confirm the positive association between IOP and increasing degrees of myopia. This finding would support the hypothesis that the relationship between glaucoma and myopia might be pressure mediated.