bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of intrapartum defibulation in women with female genital mutilation
Authors: Rouzi Abdulrahim A. , Aljhadali Etedal A. , Amarin Zouhair O. , Abduljabbar Hassan S. 
Published: December 2003

Objective
To assess the use of intrapartum defibulation for women who have had female genital mutilation.Design
A retrospective case analysis.Setting
King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia.Sample
Two hundred and thirty‐three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999.Methods
The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation.Results
One hundred and fifty‐eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred.Conclusions
Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.
Modelling the potential impact of population‐wide periconceptional folate/multivitamin supplementation on multiple births
Authors: Lumley Judith , Watson Lyndsey , Watson Max , Bower Carol 
Published: December 2003

Objective
To develop a model of the impact of population‐wide periconceptional folate supplementation on neural tube defects and twin births.Design
A hypothetical cohort of 100,000 pregnancies ≥20 weeks, plus terminations of pregnancy after prenatal diagnosis before 20 weeks.Methods
Application of pooled data on the relative risks for neural tube defects and twins following periconceptional folate from meta‐analysis of the randomised trials.Main outcome measures
1. Pregnancies with a neural tube defect (i.e. terminations of pregnancy, perinatal deaths, and surviving infants); 2. twin births (i.e. preterm births, perinatal deaths, postneonatal deaths, birth defects, cerebral palsy); 3. numbers needed to treat.Results
The change in neural tube defects would be 75 fewer terminations (95% CI ‐47, ‐90), 30 fewer perinatal deaths (95% CI 18, ‐35), and 13 fewer surviving infants with a neural tube defect (95% CI –8, ‐16). The change in twinning would be an additional 572 twin confinements (95% CI –100, +1587), among whom there would be 63 very preterm twin confinements (95% CI –11, +174), 54 perinatal and postneonatal deaths (95% CI –9, +149), 48 surviving twins with a birth defect (95% CI –8, +133), and nine with cerebral palsy (95% CI –2, +26). The numbers needed to treat for the prevention of one pregnancy with a neural tube defect is 847, for the birth of one additional set of twins is 175, for the birth of one additional set of very preterm twins is 1587, and for the birth of an additional twin with any of the following outcomes (perinatal death, postneonatal death, survival with a birth defect, or survival with cerebral palsy) is 901.Conclusions
Monitoring rates of neural tube defects and twinning is essential as supplementation or fortification with folate is implemented.
Does deep endometriosis infiltrating the uterosacral ligaments present an asymmetric lateral distribution?
Authors: Chapron Charles , Fauconnier Arnaud , Dubuisson Jean‐Bernard , Vieira Marco , Bonte Hélène , Vacher‐Lavenu Marie‐Cécile 
Published: December 2003

Objective
To investigate whether deeply infiltrating endometriosis occurs with equal frequency between left and right uterosacral ligaments.Design
Retrospective analysis of consecutive cases.Setting
Department of gynaecological surgery in a tertiary care university hospital in Paris, France.Population
One hundred and thirty consecutive women with laparoscopic resection of histologically proven deep endometriosis infiltrating the uterosacral ligaments.Methods
Laterality, intraoperative aspect of the uterosacral ligaments, and associated endometriosis were recorded during laparoscopy. Deep endometriosis infiltrating the uterosacral ligaments was considered as histologically proven in the presence of endometrial glands and stroma.Main
outcome measure Frequency of left‐ and right‐sided deep endometriosis infiltrating the uterosacral ligaments.Results
The left uterosacral ligament alone was involved in 69 cases; the right uterosacral ligament alone was involved in 38 cases; both were involved in 23 cases. For patients with unilateral deep endometriosis infiltrating the uterosacral ligaments the observed proportion of endometriosis involving the left uterosacral ligament (69/107, 64.5%) was significantly different from the expected proportion of 50% (χ2=8.98; P < 0.01).Conclusion
Anatomical differences between left and right hemipelvis and differences in the frequency of ovulation between right and left ovary could explain these results.
Follow up after LLETZ: could schedules be modified according to risk of recurrence?
Authors: Flannelly G. , Bolger B. , Fawzi H. , De Barros Lopes A. , Monaghan J.M. 
Published: December 2003

Objectives
To document the pattern of recurrence of disease following large loop excision of the transformation zone (LLETZ) to identify a low risk group of women who might benefit from less intensive cytological surveillance.Design
Analysis of prospectively collected information with retrospective review of follow up smears.Population
Three thousand, five hundred and sixty women who underwent LLETZ (median age 31 years; IQR 12 years).Setting
Colposcopy clinic at Northern Gynaecological Oncology Centre, Gateshead.Methods
Women treated with LLETZ from 1988 to 1995 were reviewed. Information on the pathology from LLETZ was collected prospectively and information on the subsequent smears was obtained from the family health authorities.Results
Invasive cancer was detected on the original LLETZ in 134 women who were excluded from the study. Of the remaining 3426 women, histology of LLETZ showed high grade CIN (II and III) in 2371 (69%). At least one follow up smear was undertaken in 3385 women (99%). This constituted 9765 women years of follow up with a mean duration of 35 months. Four hundred and seventeen women (12.2%) had a dyskaryotic follow up smear. Incomplete excision of the lesion and an age of ≥ 50 years at the time of the LLETZ were associated with an increased risk of recurrent CIN. Based on these risk factors the study group was divided into three risk groups: 1. women aged < 50 with no disease at the margins (n=1680); 2. women aged ≥ 50 with disease at the margins (n=93); and 3. women aged < 50 with positive margins, or aged ≥ 50 with negative margins (n=1653). The cumulative survival without recurrent CIN at five years for these groups were 92%, 57% and 86%, respectively.Conclusion
Women aged ≥ 50 with CIN at the margins of excision constituted a small minority high risk group (3%). Consideration should be given to repeat treatment of these women rather than surveillance. Women aged < 50 with complete excision of low grade CIN comprised 51% of the study group. These women were at low risk of recurrent CIN and might benefit from less intensive cytological surveillance following LLETZ.
A new condition‐specific health‐related quality of life questionnaire for the assessment of women with anal incontinence
Authors: Bugg G.J. , Kiff E.S. , Hosker G. 
Published: December 2003

Objective
To design and validate a condition‐specific health‐related quality of life questionnaire for the assessment of women with anal incontinence.Design
A psychometric study by postal survey.Setting
South Manchester University Hospital, UK.Sample
Two hundred and twenty women with known anal incontinence.Method
The questionnaire was adapted from the King's Health Questionnaire, a condition‐specific health‐related quality of life questionnaire for the assessment of women with urinary incontinence. The questionnaire was then tested for acceptability, reliability and validity by postal survey.Results
The Manchester Health Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test–retest reliability, criterion and construct validity.Conclusion
The questionnaire is both a valid and reliable instrument for the assessment of health‐related quality of life among women with anal incontinence. It will be useful in many different clinical settings and be of practical use in the evaluation of women after childbirth. As the good response rates show it could be a successful part of a postal survey.
Risk factors predisposing to fetal loss following a second trimester amniocentesis
Authors: Papantoniou Nikolaos E. , Daskalakis George J. , Tziotis John G. , Kitmirides Stylianos J. , Mesogitis Spyros A. , Antsaklis Aris J. 
Published: December 2003

Objective
To examine the influence of possible risk factors on fetal loss rate following amniocentesis.Design
Retrospective analysis of case records between 1993 and 1998.Setting
Fetal medicine unit of a large teaching hospital.Population
One thousand and six women with singleton pregnancies formed the study group. Seven hundred and eight of them had bleeding during the current pregnancy before the procedure, while 298 had a history of three or more first trimester abortions and/or a second trimester miscarriage or termination of pregnancy. Four thousand and twenty‐four women who had amniocentesis and had no risk factors served as controls. Both groups were also classified according to maternal age. Group 1: 1610 women aged 20–34 years; Group 2: 2850 women aged 35–39 years; Group 3; 570 women > 40 years.Methods
Women of both groups underwent a second trimester amniocentesis between 16 and 21 weeks of gestation. Fetal losses following amniocentesis were examined in three time intervals: 1. in the first two weeks after the procedure; 2. up to the 28th week; 3. from the 28th week to term.Results
There was a statistically significant difference in the fetal loss rate between women aged 20–34 years (2.54%) and those > 40 years (5.1%). Women with a history of vaginal bleeding during the current pregnancy had a higher fetal loss rate compared with controls (6.5%vs 2.8%), which corresponds to an odds ratio of 2.4 (95% CI 1.69–3.42). A similar difference was found between the group of women with a history of previous abortions/terminations and the controls (8%vs 2.8%): OR 3.03 (95% CI 1.92–4.79).Conclusions
There is a higher risk of fetal loss following amniocentesis in women > 40 years of age compared with those aged 20–34 years. Bleeding in the current pregnancy, a history of three or more first trimester abortions, a second trimester miscarriage or termination of pregnancy seem to be significant predisposing factors for fetal loss after an amniocentesis.
Comparison of cervical vacuum cup cannula with metal cannula for hysterosalpingography
Authors: Cohen Shlomo B. , Wattiez Arnaud , Seidman Daniel S. , Lidor Arie L. , Hendler Israel , Rabinovichi Jaron , Goldenberg Mordechai 
Published: December 2003

Objective
The aim of this study was to compare the use of a cervical vacuum cap cannula with the traditional metal cannula.Design
A prospective, randomised, single‐blinded comparative study.Sample
Fifty consecutive infertile women undergoing hysterosalpingography for evaluation of infertilityMethods
Hysterosalpingography was performed either with the traditional metal cannula (n=25) or a cervical vacuum cap cannula (n=25).Main outcome measures
Length of procedure, fluoroscopic time, amount of contrast medium, pain to the patient while applying the cannula and injecting the contrast medium, level of difficulty to the performer, the need to reapply the cannula, complications, and results of the hysterosalpingography.Results
Using the cervical vacuum cap cannula, compared with the metal cannula, the duration of the procedure was significantly shorter (5.3 vs 9.3 minutes; P<0.001), less fluoroscopic time was needed (0.9 vs 1.8 minutes; P<0.001), a smaller amount of contrast medium was used (4.6 vs 15.7 mL; P<0.001), the procedure caused less pain to the patient (3.2 vs 6.8, respectively; on a scale of 1–10; P<0.001), and was easier for the physician to perform (1.4 vs 3.4; on a scale of 1–10; P<0.001). No significant differences were encountered between the two groups in the need to reapply the cannula, in the rate of complications or in the results of the hysterosalpingography.Conclusions
The cervical cap cannula appears to be superior to the traditional metal cannula for performing hysterosalpingography.
Long term outcome following laparoscopic supracervical hysterectomy
Authors: Okaro Emeka O. , Jones Kevin D. , Sutton Christopher 
Published: December 2003

Objectives
To assess the long term outcome of laparoscopic supracervical hysterectomy.Design
Retrospective study.Setting
Minimal Access Surgical Unit, Department of Gynaecology, Royal Surrey County Hospital, Surrey.Methods
Analysis of patient case records.Population
Seventy consecutive women who had a laparoscopic supracervical hysterectomy.Outcome
measures Symptoms related to the cervical stump and the need for further surgery.Results
The mean time of patient follow up was 66 months (range 52–84). The mean time from initial procedure to second treatment was 14 months (range 3–53). Seventeen women (24.3%) reported symptoms related to the cervical stump, and all required further surgery. The cervical stump was removed in 16 (22.8%). One patient had laparoscopic adhesiolysis only and two had a laparotomy and trachelectomy because the bowel was adherent to the cervical stump. Nine had a laparoscopically assisted cervical trachelectomy as the sole procedure. Five had laser treatment to endometriotic deposits, and laparoscopically assisted cervical trachelectomy. Histological analysis showed normal cervical tissue in six (35.3%). Endometriosis was detected in four cervical stumps (23.5 %), residual endometrium in another four (23.5 %) cases, and chronic cervicitis, mild CIN and a mucocoele in a further three patients. Of the 17 women who reported cervical stump symptoms, 14 (82.3%) had been treated for endometriosis in the past, compared with 17/53 (32%) who did not have symptoms (P<0.0002, χ2 test).Conclusions
Symptoms related to the cervical stump requiring further surgery frequently occur following a laparoscopic supracervical hysterectomy.
Levels of cord blood thyroid stimulating hormone after external cephalic version
Authors: Yik‐Si Chan Louis , Kin Lau Tze , Yu Chiu Pui , Wing‐KinWong Gary , Leung Tse Ngong 
Published: December 2003

Objective
To investigate the relationship between breech presentation, external cephalic version and levels of cord blood thyroid stimulating hormone.Design
Case–control study.Setting
University teaching hospital.Population
The study group consisted of 289 consecutive singleton deliveries at term over a four‐year period, all of whom had an attempt at external cephalic version performed near term for breech presentation. The control group included 23,001 singleton term deliveries during the same four‐year period.Methods
Between group differences were compared with the Mann‐Whitney U test or χ2 test when appropriate.Main outcome measures
Levels of cord blood thyroid stimulating hormone and the incidence of false positive screening results for congenital hypothyroidism.Results
Babies who were born vaginally after prior successful external cephalic version had significantly higher median levels of cord blood thyroid stimulating hormone (6.4 vs 6.0mIU/L, P=0.034) and the incidence of false positive screening for thyroid stimulating hormone (12.9%vs 7.2%, P=0.016, OR 1.9) compared with babies with spontaneous cephalic presentation. In babies with a breech presentation born by elective caesarean section, previous attempts at external cephalic version had no effect on cord blood thyroid stimulating hormone levels. There was also no difference in the levels of cord blood thyroid stimulating hormone between cephalic and breech‐presenting fetuses born by elective caesarean section. However, breech‐presenting babies born by emergency caesarean section after onset of labour had higher median levels of cord thyroid stimulating hormone than those with cephalic presentation (5.1 vs 4.5 mIU/L, P=0.008).Conclusion
Levels of cord blood thyroid stimulating hormone are elevated in babies born vaginally after a successful external cephalic version. This finding may represent a biological difference in fetal response to the stress of labour in breech‐presenting fetuses, which is not correctable by a successful external cephalic version.
Induction of labour with a viable infant: a randomised clinical trial comparing intravaginal misoprostol and intravaginal dinoprostone
Authors: Rozenberg Patrick , Chevret Sylvie , Goffinet Franc¸ois , Durand‐Zaleski Isabelle , Ville Y. , Vayssie`re Christophe , Roberto Aline , Lahna Zouhair , Nisand Israel , Fisch Caroline , Chaumet‐Riffaud Philippe , Chastang Claude 
Published: December 2003

Objective
To compare the efficacy and safety of vaginal misoprostol (50μg) with vaginal dinoprostone.Design
Double‐blind randomised trial.Setting
Obstetrics Department, Poissy Hospital, France.Participants
370 patients with medical indications for induction of labour.Outcome measures
Vaginal deliveries within 24 hours, as well as time to vaginal deliveries, caesarean rates, costs, and fetal, neonatal and maternal condition.Results
Compared with vaginal dinoprostone, vaginal misoprostol resulted in greater efficacy in several areas: vaginal delivery within 24 hours; time to vaginal delivery; and vaginal delivery within 12 hours. There was a non‐significant increase in the caesarean section rate for fetal distress in the misoprostol group, but fewer caesarean sections for failed induction. Fetal tolerance was similar in the two groups, although significantly more neonates had a cord pH <7.20 and (non‐significantly) none had meconium stained amniotic fluid in the misoprostol group. The incidence of poor neonatal outcome was similar in both groups. Subgroup analysis by indication for induction showed that the higher rates of arterial cord pH <7.20 and of meconium‐stained amniotic fluid with misoprostol persisted only in possible fetal compromise. Poor neonatal outcome was less frequent in the misoprostol group in cases of induction for non‐fetal indications.Conclusions
Vaginal misoprostol resulted in successful and earlier induction of labour more often than dinoprostone, but the safety of misoprostol raises some concern in potentially compromised infants. Misoprostol should be preferred to dinoprostone in cases of induction for non‐fetal indications.
The relationships between leptin and inflammatory cytokines in women with pre‐eclampsia
Authors: Bartha Jose L. , Romero‐Carmona Raquel , Escobar‐Llompart Miguel , Comino‐Delgado Rafael 
Published: December 2003

Objective
To compare maternal serum leptin concentration in women with pre‐eclampsia and women with normal pregnancy, and to evaluate the relationships between leptin and several inflammatory cytokines.Design
Prospective clinical study.Setting
University Hospital of Puerto Real, Cadiz, Spain.Sample
Twenty‐seven women with pre‐eclampsia and 25 normotensive pregnant women.Methods
Maternal serum levels of TNF‐α, TGF‐β1, interleukin 6, and leptin were measured using a commercially available immunoassay.Main
outcome measures Maternal serum levels of leptin and its relationship to levels of TNF‐α, TGF‐β1 and interleukin 6.Results
Maternal serum leptin levels were higher in women with pre‐eclampsia, but this difference was of borderline statistical significance (median 15.9ng/mL; interquartile range (5.4–31.9) vs 30.5ng/mL (13.9–64) (P=0.05). The concentration of maternal serum leptin was correlated with pre‐gestational and gestational body mass index (r=0.45, P=0.03; r=0.44, P=0.04), TNF‐α concentration (r=0.57, P=0.002) and interleukin‐6 level (r=0.46, P=0.02) in women with normal pregnancy. In women with pre‐eclampsia, only a significant correlation between maternal serum leptin level and TNF‐α concentration (0.47, P=0.01) was found.Conclusions
The level of maternal serum leptin is increased and correlates positively with the level of TNF‐α in women with pre‐eclampsia. In women with a normal pregnancy leptin levels not only correlate with TNF‐α, but also with IL‐6 and body mass index.
Body composition and energy metabolism in normotensive and hypertensive pregnancy
Authors: Martin Allison , O'Sullivan Anthony J. , Brown Mark A. 
Published: December 2003

Objective
To determine whether the insulin resistance syndrome and altered body composition are features of hypertensive pregnancy.Design
Women were recruited in the third trimester of pregnancy from the antenatal clinic, day assessment unit, and maternity ward of St George Hospital, Sydney.Population
Women with pre‐eclampsia (n=12), gestational hypertension (n=12), essential hypertension in pregnancy (n=11), and normotensive pregnancy (n=10).Methods
Energy metabolism was assessed by indirect calorimetry to measure basal metabolic rate and diet‐induced thermogenesis. Body composition was measured as lean body mass, total body water and fat mass by bio‐electrical impedance. Blood was collected for measurement of glucose, insulin and lipid profiles. Insulin resistance was indirectly assessed by the insulin and glucose concentrations and diet‐induced thermogenesis.Results
Women with essential hypertension and gestational hypertension were heavier than women with normotensive pregnancies both pre‐pregnancy and in the third trimester, whereas women with pre‐eclampsia were similar to those with normotensive pregnancy. Women with essential hypertension were otherwise similar to normotensive pregnancy but women with gestational hypertension had a reduced diet‐induced thermogenesis and almost double insulin levels. Women with pre‐eclampsia had a similar body composition and insulin levels but reduced basal metabolic rate, diet‐induced thermogenesis and glucose levels compared with normotensive pregnancy.Conclusions
Women who develop gestational hypertension, but not pre‐eclampsia, are more likely to be overweight. Women with essential hypertension are similar to women with normotensive pregnancy throughout pregnancy. Both gestational hypertension and pre‐eclampsia appear to be associated with some degree of insulin resistance, greater than that occurring in normal pregnancy.