bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia
Authors: Moodley J. , Jjuuko G. , Rout C. 
Published: December 2003

Objective
To compare retrospectively the outcome of caesarean section under epidural anaesthesia with that of general anaesthesia in “stable” women with eclampsia.Design
Retrospective review.Method
Over the five–year study period, there were 533 women with eclampsia and of these 66 women (12.4%), fulfilled the criteria of being ‘stable’. Of the 66 women, 37 received epidural, 27 general, and 2 spinal anaesthesia.Results
There were no major complications with either general or epidural anaesthesia. Epidural anaesthesia was associated with higher one–minute Apgar scores.Conclusion
This study indicates that both maternal and neonatal outcomes are not affected adversely by the use of epidural anaesthesia in selected cases of eclampsia.
Effects of gynaecological education on interpersonal communication skills
Authors: van Dulmen A.M. , van Weert J.C.M. 
Published: December 2003

Objective
To investigate the effects of an experimental communication course on how gynaecologists handle psychosocial issues in gynaecological consultation.Design
Pre‐post testing. Multilevel analysis was used to take into account the similarity among encounters with the same gynaecologist.Sample
Eighteen gynaecologists (13 consultants and 5 junior doctors) from five different hospitals participated. All gynaecologists videotaped consecutive outpatient encounters before and after attending an intensive training course.Main
outcome measures The communicative performance of the gynaecologists at pre‐and post measurement.Results
The gynaecologists recorded a total of 526 outpatient encounters, 272 before and 254 after the training. As a result of the training, gynaecologists’ sensitivity to psychosocial aspects of their patients increased. At post measurement, the gynaecologists gave more signs of agreement, became less directive, asked fewer medical questions and more psychosocial questions. No difference was found in the duration of the outpatient visits. With the trained gynaecologists, patients asked more questions and provided more psychosocial information.Conclusions
Junior doctors and clinically experienced gynaecologists can be taught to handle psychosocial issues without lengthening the visit.
Induced myeloperoxidase activity and related superoxide inhibition during hormone replacement therapy
Authors: Békési Gabor , Kakucs Reka , Varbiro Szabolcs , Feher Janos , Pazmany Tamas , Magyar Zoltan , Sprintz Detlef , Szekacs Bela 
Published: December 2003

Objective
To test whether the menopause entails any changes in the myeloperoxidase activity of neutrophil granulocytes. The effects of hormone replacement therapy on myeloperoxidase activity and related changes in free radical production were also investigated.Design
Laboratory investigation of the effect of oestrogen on intracellular myeloperoxidase activity and release from human neutrophil granulocytes. Analysis of related changes in superoxide anion generation.Setting
2nd Department of Medicine and 1st Department of Obstetrics and Gynaecology, Semmelweis University, Budapest.Samples
Intracellular myeloperoxidase activity (mean peroxidase index) was measured automatically in blood samples obtained for general laboratory work‐up from 135 randomly selected patients in our department. Blood samples from 11 postmenopausal women were analysed before and during hormone replacement therapy. Blood samples from 20 healthy volunteers were obtained and neutrophil granulocytes separated for in vitro measurement of superoxide anion production after adding myeloperoxidase to the incubation media.Methods
The mean peroxidase index was measured using a Technicon H‐3 instrument. myeloperoxidase release from neutrophils was quantified by ELISA technique. Superoxide production of isolated neutrophil granulocytes was measured by photometry.Main
outcome measures Intracellular activity of myeloperoxidase, concentration of myeloperoxidase‐protein in supernatant of neutrophils, release of superoxide anion from neutrophil granulocytes.Results
1. Intracellular myeloperoxidase activity in neutrophils was lower in postmenopausal women, than in females with regular cycles (‐1.84 ±3.06 versus 1.59 ±3.55, P<0,001). 2. In postmenopausal women intracellular myeloperoxidase activity and myeloperoxidase release increased during hormone replacement therapy (‐5.54 ±6.63 versus ‐0.2 ±6.05; P<0.001 and 52.74 mU/ml ±25.73 versus 251.4 ±234.1 mU/ml; P<0.05). 3. Adding myeloperoxidase to neutrophil granulocyte suspensions, the production of superoxide anion fell (e.g. adding 280 ng/ml myeloperoxidase: 77.9 ±14.04 % of control production, P<0.001).Conclusion
Hormone replacement restores the reduced myeloperoxidase activity in menopausal women. Adding myeloperoxidase to neutrophil granulocytes, the production of free radicals decreases.
Contribution of cervical smooth muscle activity to the duration of latent and active phases of labour
Authors: Pajntar Marjan , Leskošek Branimir , Rudel Drago , Verdenik Ivan 
Published: December 2003

Objective
To identify the effect of cervical muscle activity as an additional factor influencing the duration of the latent and active phase of labour.Design
Prospective observational study.Setting
The Ljubljana Maternity Hospital.Participants
Fifty healthy nulliparous women requiring induction of labour having relatively unripe cervices.Methods
At the onset of labour an open‐ended catheter was inserted to measure intrauterine pressure during the latent and active phase of labour. Electromyographic activity of the cervix was registered by two bipolar spiral needle electrodes placed in the transverse direction on the proximal part of the cervix in the vagina. The mean intensity of distinctive peaks in an electromyographic spectrogram were calculated in the time/frequency domain. Multiple linear regression was used to find factors affecting the duration of the latent and active phase of labour.Main outcome measures
Duration of the latent and active phase of labour.Results
Eleven independent variables explained 64% of the variance of the latent phase duration, the most important being the effacement and consistency of the cervix, and intensity of electromyographic signals. For the duration of the active phase the same variables explained 36% of the variance; the most important variables were mean duration of uterine contractions, mean maximum intensity of uterine contractions and the newborn's head circumference.Conclusions
The cervical smooth muscle activity, expressed as an electromyographic signal, contributes to the duration of the latent phase but not to the duration of the active phase. However, frequent cervical contractions are not associated with a longer latent phase.
Rate of rise in maternal plasma corticotrophin‐releasing hormone and its relation to gestational length
Authors: Leung T.N. , Chung T.K.H. , Madsen Gemma , Lam Peggo K.W. , Sahota Daljit , Smith Roger 
Published: December 2003

Objective
To assess the relationship between rate of increase in maternal plasma corticotrophin‐releasing hormone and gestational length.Design
A prospective observational study.Setting
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.Methods
Serial venous samples taken at four to six week intervals from 81 pregnant Chinese subjects were assayed for corticotrophin‐releasing hormone concentrations. The investigators responsible for the laboratory assay were blinded to the obstetric outcome.Results
A total of 380 blood samples were taken. Each subject provided three to seven samples (median =5). Seven of the 81 subjects had preterm delivery. Maternal corticotrophin‐releasing hormone levels increased exponentially as gestation advanced. A negative correlation between the rate of rise of logarithmic equivalence of corticotrophin‐releasing hormone concentrations (Ln‐corticotrophin releasing hormone) per week and the gestational age at delivery was demonstrated (r =−0.45, P<0.001). The rate of increase of Ln‐corticotrophin releasing hormone concentrations per week was also significantly greater for those who delivered preterm before 37 weeks compared with those with uncomplicated term deliveries (0.27 Vs 0.22, P= 0.018).Conclusions
The rate of increase in maternal plasma corticotrophin‐releasing hormone is inversely proportional to gestational length. Results in a Chinese population confirm and extend results from previous caucasian populations. This study provides another piece of evidence on the close link between maternal plasma corticotrophin‐releasing hormone and the timing of human parturition. As the hormone is synthesized by the placenta, it supports the suggestion that the human placenta has an important role in determining gestational length.
Vaginal microbiological flora, and behavioural and clinical findings in women with vulvar pain
Authors: Tchoudomirova Krasimira , Mårdh Per‐Anders , Hellberg Dan 
Published: December 2003

Objective
To study genital symptoms and signs in women with vulvar pain, and the association with potential risk factors such as microbiological agents, sexual behaviour and genital hygiene.Design
Prospective cohort study of apparently healthy women attending for contraceptive advice.Setting
Two family planning clinics and one youth clinic in Sweden.Population
Out of 996 women recruited, 79 women (7.9%) had, on request, complaints of current burning and smarting vulvar pain and/or superficial dyspareunia (our definition of vulvar pain) while 917 women without such symptoms served as controls.Results
Complaints of dysmenorrhoea, vaginal discharge, genito‐anal pruritus, dysuria, and abdominal pain were more frequent in the study group, than in the control group. In the women with vulvar pain, erythemas, superficial ulcerations, and fissures were found significantly more frequently. Vaginal candidosis was the only current genital infection that occurred more often in the study group, than among the controls. There were no differences in the history of gonorrhoea, genital chlamydial infection, genital herpes, genital warts, and candidosis between the two groups. The sexual debut of the women with vulvar pain occurred later in life, compared with the control group. Control subjects were more likely to use tampons for menstrual sanitation, than the women with vulvar pain.Conclusions
Neither infectious conditions caused by current known agents, with the exception of candidosis in some cases, nor behavioural factors, such as sexual behaviour and genital hygiene habits could in this study explain vulvar pain.
Screening with a uterine Doppler in low risk pregnant women followed by low dose aspirin in women with abnormal results: a multicenter randomised controlled trial
Authors: Goffinet François , Aboulker Danielle , Paris‐Llado Josefa , Bucourt Martine , Uzan Michèle , Papiernik Emile , Bréart Gérard ,   Collaborators and participating centres of the French Doppler study group are listed on page 517.
Published: December 2003

Objectives
To assess whether systematic screening with an uterine artery Doppler in low risk pregnant women followed by the prescription of low dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction and pre‐eclampsia.Design
A multicentre randomised trial.Population
3317 low risk pregnant women. In the Doppler group, the uterine artery Doppler was performed between 20 and 24 weeks. Women with abnormal results received 100 mg of aspirin daily until the 35th week.Main
outcome measures Intrauterine growth restriction was defined as birthweight below the tenth and the third centile according to gestational age. Pre‐eclampsia was defined as hypertension associated with proteinuria > 0.5g/L.Results
Intrauterine growth restriction, whether defined by the third or tenth centile, did not differ significantly between the two groups (RR = 1.22 [0.73 ‐ 2.04] and 1.18 [0.93 ‐ 1.51] respectively). Screening with uterine artery Doppler did not affect birthweight or any of the criteria of perinatal morbidity. There was no effect on the incidence of pre‐eclampsia (RR = 1.99 [0.97 ‐ 4.09]) or hypertensive disorders. These results were the same for nulliparae and multiparae.Conclusions
There is no justification for screening with uterine artery Doppler in a low risk population, even if abnormal results are followed by aspirin treatment and increased prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of pre‐eclampsia and intrauterine growth restriction. Only when all of these conditions are fulfilled, aspirin or other treatments may prove its efficacy.
Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial
Authors: Creinin Mitchell D. , Schwartz Jill L. , Pymar Helen C. , Fink Wendy 
Published: December 2003

Objective
To examine the clinical efficacy of mifepristone 600 mg followed on the same day or two days later by misoprostol 400μg orally in women undergoing medical termination of pregnancy whose pregnancies have a gestational age up to 49 days.Design
Prospective, randomised trial.Setting
Clinical research office.Participants
Eighty‐six women, requesting elective termination of a pregnancy which has a gestational age of ≤ 49 days.Methods
After administration of mifepristone 600 mg, participants were randomised to take misoprostol six to eight hours later (Group 1) or 48 hours later (Group 2). Women returned for a follow up evaluation 24±1 hours after taking the misoprostol. Participants in Group 1 who had not aborted received a second dose of misoprostol to take 48 hours after the mifepristone. All women returned approximately two weeks after receiving mifepristone. If termination of pregnancy had still not occurred and the pregnancy was non‐viable, the woman returned again in three weeks.Main
outcome measures Rate of complete abortion 24 hours after administration of misoprostol.Results
At 24 hours after receiving misoprostol, 21/42 (50%, 95% CI 35%, 65%) women in Group 1 and 40/44 (91%, 95% CI 82%, 99%) women in Group 2 had complete abortions. By follow up two weeks later after the administration of mifepristone, 40/42 (95%, 95% CI 89%, 100%) women in Group 1 and 43/44 (98%, 95% CI 93%, 99%) women in Group 2 were known to have complete abortions. Nausea, vomiting or diarrhoea in women using the standard regimen (Group 2) occurred in 68%, 36%, and 20%, respectively.Conclusions
After treatment with mifepristone 600 mg, administration of misoprostol 400 μg orally on the same day is not as effective at causing abortion within the first 24 hours compared with the standard time interval of 48 hours between medications.
Wide scope prenatal diagnosis at Kuopio University Hospital 1997‐1998: integration of gene tests and fetal karyotyping
Authors: Kallinen Juuso , Marin Katja , Heinonen Seppo , Mannermaa Arto , Palotie Aarno , Ryynänen Markku 
Published: December 2003

Objective
To investigate the applicability of carrier screening in women undergoing invasive prenatal diagnosis.Design
Prospective study.Setting
University‐based clinic.Participants
Two hundred and fifty‐six pregnant women.Methods
Gene tests were offered for fragile X syndrome, aspartylglycosaminuria and infantile neuronal ceroid lipofuscinosis at the time of invasive prenatal testing.Results
The overall uptake of the tests was 92%. Previously unrecognised carriership was found in 10 women: aspartylglycosaminuria (7); infantile neuronal ceroid lipofuscinosis (2) and fragile X (1). Fetal genotyping was carried out in one carrier of aspartylglycosaminuria whose partner was also a carrier, and in one woman who was found to have fragile X premutation. Both fetuses were unaffected.Conclusion
Carrier screening for single‐gene disorders is feasible and well accepted among pregnant women undergoing invasive prenatal testing. The major benefit is that there is no need to consider extra invasive tests when carriership is detected. Incorporation of genetic testing into fetal karyotyping gives more security to future parents.
Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information
Authors: Freeman‐Wang Theresa , Walker Patrick , Linehan John , Coffey Claire , Glasser Brian , Sherr Lorraine 
Published: December 2003

Objective
To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics.Design
An observational study followed by a randomised trial.Setting
Colposcopy Clinic, Royal Free Hospital, London.Participants
Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis.Main outcome measure
The level of anxiety measured by the Spielberger State Anxiety Inventory.Conclusion
Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one‐stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.
Impact of pneumoperitoneum on visceral metastasis rate and survival. Results in two ovarian cancer models in rats
Authors: Lécuru Fabrice , Agostini Aubert , Camatte Sophie , Robin François , Aggerbeck Martine , Jaïs Jean‐Philippe , Vildé Françoise , Taurelle Roland 
Published: December 2003

Objective
To compare the impact of CO2 laparoscopy, gasless laparoscopy, and midline laparotomy on the development of distant metastases and on survival in two ovarian carcinoma models.Design
A prospective randomised study in rats.Material
and methods Two ovarian cancer xenografts were obtained by intraperitoneal injection of IGR–OV1 or NIH–OVCAR‐3 cells. Experimental surgical procedures were performed on day 7 (IGR–OV1 model) or day 14 (NIH: OVCAR‐3 model) after intraperitoneal injection: CO2 laparoscopy (pneumoperitoneum (PNP) with unheated CO2 at a pressure of 8 mmHg for 1 hour); gasless laparoscopy (consisting in abdominal wall expansion by a balloon for 1 hour); midline laparoscopy (consisting in bowel exteriorisation on a mesh for one hour following xyphopubic laparotomy). The control group underwent general anaesthesia alone. The animals were killed by CO2 inhalation as soon as they became moribund.Main
outcome measures Pathological examination was carried out on the liver, lungs and pleura as well as the retroperitoneal nodes. Survival was determined from the time of surgery to the sacrifice of the animal. Statistical analysis used ANOVA, Fisher exact test, Bonferonni method and the log‐rank test.Results
In the IGR–OV1 model, distant metastases were rare, and were not promoted by CO2 laparoscopy. With the NIH: OVCAR‐3 model, pleural, pulmonary and para‐aortic metastases were not enhanced by CO2 PNP when compared with other approaches. Conversely, midline laparotomy and laparoscopy significantly increased liver involvement when compared with gasless laparoscopy (P= 0.04 and P= 0.008). Survival was comparable no matter what kind of surgery had been performed in the IGR–OV1 model (P= 0.7) or in the NIH: OVCAR‐3 model (P= 0.5).Conclusions
CO2 laparoscopy had a minor impact on distant and nodal metastases in the two models. Similarly, survival was similar for all surgical groups.
False positive serum biochemical screening and subsequent fetal loss in women less than 35 years of age
Authors: Antsaklis Aris J. , Papantoniou Nikolaos E. , Daskalakis George J. , Mesogitis Spyros A. , Kitmirides Stylianos J. , Michalas Stylianos S. 
Published: December 2003

Objective
To examine the fetal loss rate in women younger than 35 years of age following a false positive serum biochemical screening.Design
Retrospective analysis of case records between 1991 and 1998.Setting
Fetal medicine unit of a large teaching hospital.Population
Four hundred and fifty‐six women with singleton pregnancies and false positive serum biochemical screening for Down's Syndrome (study group). Nine hundred and twelve matched controls with true negative serum biochemical screening (control group).Methods
Women of both groups had a second trimester serum screening for Down's Syndrome using alpha fetoprotein, human chorionic gonadotrophin (hCG) and unconjugated oestriol (uE3); and they also underwent genetic amniocentesis.Results
The overall fetal loss rate in the study group was 5.3% (24/456), compared with 1.65% (15/912) in the control group RR 3.2, 95% CI 1.7‐5.99; P<0.001). The majority of fetal losses in the study group occurred after 28 weeks, while in the controls this happened between 24 and 28 weeks of gestation.Conclusions
A false positive serum biochemical screening in women under 35 years of age is associated with a threefold increased risk of subsequent fetal loss. However, most of fetal losses in this group occurred after 28 weeks, indicating that intensive antepartum fetal surveillance could improve the perinatal outcome.
The accuracy of lamellar body count and lecithin/sphingomyelin ratio in the prediction of neonatal respiratory distress syndrome: a meta‐analysis
Authors: Wijnberger L.D.E. , Huisjes A.J.M. , Voorbij H.A.M. , Franx A. , Bruinse H.W. , Mol B.W.J. 
Published: December 2003

Objective
To compare the performance of the lecithin/sphingomyelin ratio and the lamellar body count in the prediction of neonatal respiratory distress syndrome.Design
Meta‐analysis.Sample
Six studies reporting on the performance of both the lecithin/sphingomyelin ratio and the lamellar body count published between January 1966 and August 1999.Methods
We performed a computerised MEDLINE search to identify articles published on the subject. For the six selected studies, prevalence of respiratory distress syndrome and sensitivity and specificity of the tests in the prediction of respiratory distress syndrome were calculated, and overall performance was assessed by constructing summary receiver–operating characteristic curves.Results
The constructed summary receiver–operating characteristic curves showed the lamellar body count to perform slightly better than the lecithin/sphingomyelin ratio in the prediction of respiratory distress syndrome (P= 0.13).Conclusions
Since the lamellar body count can be performed quickly and since it is less expensive than the lecithin/sphingomyelin ratio, we recommend the former as the test of first choice in the assessment of fetal lung maturity.