bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for the prevention of pre‐eclampsia and its complications
Authors: Rotchell Y. E. , Cruickshank J. K. , Phillips Gay M. , Griffiths J. , Stewart A. , Farrell B. , Ayers S. , Hennis A. , Grant A. , Duley L. , Collins R. 
Published: August 2005

Objective
To determine whether prophylactic, low dose controlled‐release aspirin improves outcome for pregnant women and their babies in Barbados.Design
Randomised placebo‐controlled trial.Setting
The Queen Elizabeth Hospital, Barbados.Population
All women attending antenatal clinics between 12 and 32 weeks of gestation were eligible, if without specific contraindications to aspirin and unlikely to deliver immediately.Methods
Randomisation was computer‐generated in the antenatal clinic; 1822 women were allocated to receive 75 mg controlled‐release aspirin and 1825 matching placebo.Main outcome measures
Proteinuric pre‐eclampsia, other pregnancy‐induced hypertension, pregnancy duration, birthweight, stillbirths and neonatal deaths, major neonatal events.Results
All but three women from each group were followed up successfully. Forty‐four percent were primigravid, and 8% had previous obstetric complications. There were no significant differences between the allocated treatment groups in the incidence of proteinuric pre‐eclampsia (40 [2.2%] of those allocated aspirin, compared with 46 [2.5%] allocated placebo), of preterm delivery (255 [14.0%] vs 270 [14.8%]), of birthweight < 1500 g (32 [1.7%] vs 33 [1.8%]) or of stillbirth and neonatal death (44 [2.4%] vs 38 [2.1%]). Aspirin was not associated with excess risk of maternal orfetal bleeding.Conclusions The results of this study in Barbados do not support the routine use of low dose aspirin for prevention of pre‐eclampsia or its complications, confirming results of previous large trials in other settings.
A randomised controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe pre‐eclampsia
Authors: Coetzee E. J. , Dommisse J. , Anthony J. 
Published: August 2005

Objective
To determine whether the administration of prophylactic intravenous magnesium sulphate reduces the occurrence of eclempsia in women with severe pre‐eclampsia.Design
Randomised controlled trial.Setting
A tertiary referral obstetric unit.Population
Eight hundred and twenty‐two women with severe pre‐eclampsia requiring termination of pregnancy by induction of labour or caesarean section.Methods
The women were randomised to receive either placebo (saline) or magnesium sulphate intravenously. The investigators were blinded to the contents of the pre‐mixed solutions.Main outcome measure
The occurrence of eclampsia in the two groups.Results
The data of 699 women were evaluated. Fourteen were withdrawn after randomisation. The overall incidence of eclampsia was 1.8%. Of 345 women who received magnesium sulphate, one developed eclampsia (0.3%); in the placebo group, 11/340 women (3.2%) developed eclampsia (relative risk 0.09; 95% confidence interval 0.01–0.69; P= 0.003).Conclusion
The use of intravenous magnesium sulphate in the management of women with severe pre‐eclampsia significantly reduced the development of eclampsia.
Increase in incidence of gastroschisis in the South West of England in 1995
Authors: Penman David G. , Fisher Ross M. , Noblett Helen R. , Soothill Peter W. 
Published: August 2005

Objective
To describe the incidence of gastroschisis and to identify possible aetiological factors.Design
A retrospective case review study.Setting
The South West Region of England.Population
All known cases of gastroschisis were identified from the regional fetal medicine, ultrasound, pathology and neonatal surgery databases. Datasets to be collected were agreed prospectively and included demographic, past medical, family and obstetric information for all pregnancies conceived between January 1987 and December 1995.Results
In the first eight years the incidence was 1.61 10,000 but in 1995 a highly statistically significant rise to 4.4/ 10,000 was found (P= 0.0009). The increased incidence was not associated with changes in maternal age, proportion of primigravidae, use of tobacco or illicit drugs, conception while taking the oral contraceptive pill, or an increase in the number of teenage pregnancies. The median maternal age at last menstrual period for pregnancies with gastroschisis was 20.4 years which was much younger than the national average of 28 years. Thirty‐seven percent of these conceptions occurred during the first quarter of the year compared with the expected 25%.Conclusions
The incidence of gastroschisis has risen to a higher level than previously reported which, despite a marked association with young maternal age at conception, is not due to an increase in the teenage pregnancy rate. As the average length of inpatient stay in the neonatal intensive care unit for cases with this malformation is approximately four weeks, the rise has considerable cost implications. The increasing incidence may also offer opportunities to determine the cause of gastroschisis.
Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women
Authors: Cardozo Linda , Benness Christopher , Abbott Denise 
Published: August 2005

Objective
To assess the efficacy of oral oestriol in the prevention of recurrent Urinary tract infections in elderly women.Design
Double‐blind, randomised, parallel group, placebo controlled trialSetting
Urogynaecology Unit at King's College Hospital with some women recruited from the geriatric units of St. Pancras Hospital and Dulwich Hospital, London (UK).Participants
Seventy‐two postmenopausal women older than 60 years of age (mean 73.2 years) suffering from recurrent urinary tract infections.Intervention
Oral oestriol (3 mg per day) or placebo for six months.Main outcome measures
Urinary tract infection rates.Results
The study was difficult to conduct because of its design and the age of the participants. Oral oestriol (3 mg per day) was not shown to be superior to placebo in the prevention of recurrent urinary tract infections, but both oestriol and placebo improved urinary symptoms during the trial.Conclusion
The power of the study might have been too low to detect a significant difference between the groups, or oral oestriol(3 mg per day) may have been either the wrong dose or the wrong route of administration for this indication.
Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population
Authors: de Jong Catharina L. D. , Gardosi Jason , Dekker Gustaaf A. , Colenbrander Gerard J. , van Geijn Herman P. 
Published: August 2005

Objective
Physiological as well as pathological variables influence birthweight. The aim of the present study was to examine perinatal outcome in relation to birthweight centiles applying a customised birthweight standard.Methods
Two hundred and seventeen babies from high risk pregnancies were evaluated and classified as small or not small for gestational age according to two standards: 1. conventional Dutch birthweight centiles and 2. customised centiles which adjust individually for physiological variables like maternal booking weight, height and ethnic origin.Results
Customisation of the weight standards resulted in identification of an additional group of infants who were small for gestational age, but not by the Dutch standards. These babies were associated with significantly more adverse perinatal events than those who were not small for gestational age as defined by a customised standard.Conclusions
Adjustment of birthweight centiles for physiological variables significantly improves the identification of infants who have failed to reach the expected birthweight and who are at increased risk for adverse perinatal events.
Lipid peroxidation in cord blood at birth: the effect of labour
Authors: Rogers M. S. , Mongelli J. M. , Tsang K. H. , Wang C. C. , Law K. P. 
Published: August 2005

Objective
To determine the effect of labour on free oxygen radical activity in the fetus, as reflected by lipid peroxide levels in umbilical cord arterial blood.Design
Prospective, observational study.Setting
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong.Methods
Umbilical cord arterial and venous blood samples were collected from singleton term infants delivered by elective caesarean section. Base excess, PO2, pCO2, and pH were measured in both samples and compared to identify double venous samples. Cord arterial acid‐base balance and concentrations of organic hydroperoxides and malondialdehyde were compared with those obtained from normal vaginal deliveries.Results
Cord arterial blood samples, obtained from cases of uncomplicated labour followed by spontaneous vaginal delivery, had significantly higher lipid peroxide concentrations than those delivered following elective caesarean section. This was most marked for malondialdehyde with a median value increased by 105%, whilst organic hydroperoxide was increased by only 27%. Of the acid‐base parameters, base excess was increased by 78%, with only minimal changes in pH, PCO2, and PO2. These differences remained highly significant after including other pregnancy characteristics in multivariate analysis.Conclusion
The findings indicate that high levels of free oxygen radical activity in the fetus are a function of the labour process, as are changes in acid‐base balance.
Development and validation of the menorrhagia outcomes questionnaire
Authors: Lamping Donna L. , Rowe Pamela , Clarke Aileen , Black Nick , Lessof Leila 
Published: August 2005

Objective
To develop and evaluate the acceptability, reliability and validity of a short, patient‐based questionnaire for assessing the outcomes of surgical treatment for menorrhagia due to benign disease.Design
A psychometric study by postal survey.Setting
Five hospitals in southeast England.Sample
One hundred and eleven women undergoing hysterectomy for menorrhagia due to benign disease.Methods
Data from a long research questionnaire used in the North West Thames Hysterectomy Study were analysed using standard psychometric methods to identify the subset of items which were the most scientifically sound indicators of outcome. The Menorrhagia Outcomes questionnaire is a 26–item questionnaire which covers symptoms, post‐operative complications, quality of life, and women's satisfaction with outcome. The questionnaire was field tested for acceptability, reliability and validity by postal survey.Results
The Menorrhagia Outcomes Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test‐retest reliability, criterion and construct validity.Conclusion
The Menorrhagia Outcomes Questionnaire is a practical and scientifically sound measure of outcome from the woman's perspective following surgical treatment for menorrhagia due to benign disease. It takes less than five minutes to complete, is appropriate for use with different surgical treatments for menorrhagia (eg. hysterectomy, endometrial resection, laser ablation) and is feasible for routine monitoring of large numbers of women by postal survey. Most importantly, this questionnaire has been shown to perform well from a scientific point view, having met standard psychometric criteria for reliability and validity.
Sonographic prediction of malignancy in adnexal masses using an artificial neural network
Authors: Tailor Anil , Jurkovic Davor , Bourne Thomas H. , Collins William P. , Campbell Stuart 
Published: August 2005

Objective
To generate a neural network algorithm which computes a probability of malignancy score for pre‐operative discrimination between malignant and benign adnexal tumours.Design
A retrospective analysis of previously collected data. Information from 75% of the study group was used to train an artificial neural network and the remainder was used for validation.Setting
The Gynaecological Ultrasound Research Unit at King's College Hospital, London.Population
Sixty‐seven women with known adnexal mass who had been examined using transvaginal B‐mode ultrasonography and colour Doppler imaging with pulse spectral analysis immediately before surgery. The excised masses were classified histologically as benign (n= 52) or malignant (n= 19, of which three were borderline.Methods
The variables that were put into the artificial neural network were: age, menopausal status, maximum tumour diameter, tumour volume, locularity, the presence of papillary projections, the presence of random echogenecity, the presence of analysable blood flow velocity waveforms, the peak systolic velocity, time‐averaged maximum velocity, the pulsatility index, and resistance index. Histological classification, categorised as benign or malignant, was the output result.Results
A variant of the back propagation method was selected to train the network. The overall architecture of the network with the best performance contained an input layer with four variables (age, time‐averaged maximum velocity, papillary projection score and maximum tumour diameter), a hidden layer with three units and an output layer with one. The sensitivity and specificity at the optimum diagnostic decision value for the artificial neural network output (0.45) were 100% (95% CI 78.2%–100%) and 98.1% (95% CI 89.5%–100%), respectively. These values were significantly better than those obtained from the independent use of the resistance index, pulsatility index, time‐averaged maximum velocity or peak systolic velocity at their optimum decision values (P < 0.01).Conclusion
Artificial neural networks may be used on clinical and ultrasound derived end‐points to accurately predict ovarian malignancy. There is a need for a prospective evaluation of this technique using a larger number of patients.
Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali
Authors: Etard Jean‐François , Kodio Belco , Traoré Sidy 
Published: August 2005

Objective
Few prospective studies have been undertaken of maternal mortality in sub‐Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako.Design
Prospective cohort study.Setting
Bankoni (population 59,000), a district of Bamako (population 700,000).Population
5782 pregnant women identified during quarterly household visits.Methods
After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital.Main outcome measures
Maternal mortality ratio, late maternal mortality, likely cause of death.Results
Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery.Conclusions
This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality.
Amniotic fluid concentrations of Interleukin‐1β, Interleukin‐6 and TNF‐α in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome
Authors: Baud Olivier , Emilie Dominique , Pelletier Eric , Lacaze‐Masmonteil Thierry , Zupan Véronique , Fernandez Hervé , Dehan Michel , Frydman René , Ville Yves 
Published: August 2005

Objectives
To test the association between cytokine levels in the amniotic fluid and (i) the vascular invasion phase of intrauterine infection, (ii) the occurrence of periventricular leukomalacia; to assess the correlation between C‐reactive protein levels, a recognised biological marker of inflammation in maternal serum and cytokine levels in the amniotic fluid.Design
Prospective clinical study.Setting
Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France.Sample
Thirty‐one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation.Methods
Interleukin 1‐β, Interleukin 6 and TNF‐α prospectively measured in the amniotic fluid. Histological examination of the placenta. Ultrasound examination and magnetic resonance imaging of the brains of the newborn infants performed within the first week of life.Main outcome measures
The occurrence of periventricular leukomalacia was assessed by trans fontanellar ultrasound and magnetic resonance imaging.Results
There was a significant positive correlation between the occurrence of histological chorioamnionitis, vascular extension of infection of the membranes, maternal inflammatory syndrome and neonatal sepsis. A strong association was found between maternal serum C‐reactive protein concentrations and cytokine levels in the amniotic fluid. Interleukin‐1β was the best predictor of vascular extension of chorioamnionitis, and TNF‐α was the best predictor of the development of severe early neonatal infection. There was no association betwecn the amniotic fluid levels of cytokines and the development of periventricular leukomalacia.Conclusions
These data suggest that IL‐1β, IL‐6 and TNF‐α are produced in relation to intrauterine inflammation and infection, but cannot be directly implicated in the development of fetal cerebral white matter lesions.
Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: response to sex steroid replacement
Authors: Bath Louise E. , Critchley Hilary O. D. , Chambers Sarah E. , Anderson Richard A. , Kelnar Christopher J. H. , Wallace W. Hamish B. 
Published: August 2005

Objective
To study the effect of total body irradiation (14.4 Gray) in childhood and adolescence on ovarian and uterine characteristics, and to investigate the response to physiological sex steroid serum concentrations.Design
All long term post‐pubertal female survivors of total body irradiation who had been treated in paediatric centres in Scotland were identified. Their ovarian and uterine characteristics were studied.Setting
Recruitment was from follow up oncology clinics.Sample
Nine women were identified, eight of whom were assessed and five progressed to detailed investigation. A control population of 12 women treated for acute leukaemia, but not treated with total body irradiation, and five healthy women with no history of childhood malignancy were recruited as controls.Methods
Ovarian function was determined by measurement of serum gonadotrophins and sex steroids. Uterine response to physiological sex steroid replacement was investigated in women with ovarian failure, and to endogenous sex steroid production in women with ovarian function by ultrasound scan. The physiological sex steroid replacement was achieved with transdermal oestradiol patches and self administered vaginal progesterone pessaries.Main outcome measures
Determination of ovarian function and uterine response to physiological sex steroid serum concentrations.Results
Six of eight women treated with total body irradiation had ovarian failure; preservation of function was seen in two girls treated pre‐pubertally who had biochemical evidence of incipient ovarian failure. Four women with ovarian failure had reduced uterine volume, undetectable blood supply and absent endometrium at baseline assessment; after three months of physiological sex steroid replacement treatment uterine blood supply and endometrial response were not significantly different from controls; uterine volume improved but remained significantly smaller than controls and correlated with age at total body irradiation.Conclusions
Ovarian failure after total body irradiation is common and risk relates to age at treatment. Physiological sex steroid replacement improved uterine measures and these women may benefit from assisted reproductive technology.
Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin
Authors: Backos M. , Rai R. , Baxter N. , Chilcott I. T. , Cohen H. , Regan L. 
Published: August 2005

Objective
To study the obstetric course of women with a history of recurrent miscarriage associated with antiphospholipid antibodies, lupus anticoagulant and anticardiolipin antibodies, treated with low dose aspirin and low dose heparin.Design
Prospective observational study.Setting
University based tertiary referral clinic.Population
One hundred and fifty pregnant women with a history of recurrent miscarriage associated with persistently positive tests for antiphospholipid antibodies.Methods
Lupus anticoagulant was detected using the dilute Russell's viper venom time together with a platelet neutralisation procedure. IgG and IgM anticardiolipin antibodies were detected using a standardised enzyme linked immunosorbent assay. An IgG anticardiolipin level ≥5 per litre units and an IgM anticardiolipin level ≥3 per litre units was considered positive. Aspirin (75 mg daily) was commenced at the time of a positive pregnancy test and heparin (5000 units subcutaneously 12 hourly, or enoxaparin 20 mg daily) was started when fetal heart activity was demonstrated on ultrasound. Treatment was stopped at the time of miscarriage or at 34 weeks of gestation.Results
One hundred and seven pregnancies (71%) resulted in a live birth. Forty‐one pregnancies (27%) miscarried, the majority in the first trimester. One woman had a stillbirth, and one a premature baby who died in the neonatal period. One pregnancy was terminated for a fetal anomaly. Gestational hypertension complicated 17% (18/108) of ongoing pregnancies and antepartum haemorrhage 7% (8/108). Twenty‐six babies (24%) were delivered before 37 weeks of gestation. Fifty women (46%) were delivered by caesarean section. The median birthweight of all live born infants was 3069 g (range 5314300); however 15% (16/108) of the infants were small for gestational age.Conclusion
Combination treatment with aspirin and heparin leads to a high live birth rate among women with recurrent miscarriage and antiphospholipid antibodies. However, successful pregnancies are prone to a high risk of complications during all trimesters. Close antenatal surveillance and planned delivery of these pregnancies in a unit with specialist obstetric and neonatal intensive care facilities are indicated.