bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low dose acetylsalicylic acid in prevention of pregnancy‐induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches
Authors: Vainio Merja , Kujansuu Erkki , Iso‐Mustajärvi Marja , Mäenpää Juhani 
Published: December 2003

Objective
To evaluate the efficacy of low‐dose acetylsalicylic acid in the prevention of pregnancy‐induced hypertension and intrauterine growth retardation in high‐risk pregnancies as determined by transvaginal Doppler ultrasound study of the uterine arteries at 12 to 14 weeks of gestation.Design
Randomised, double blind and placebo‐controlled trial.Setting
The Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland.Population
One hundred and twenty pregnant women considered to be at high risk of pre‐eclampsia or intrauterine growth retardation were screened by transvaginal Doppler ultrasound at 12 to 14 weeks of gestation.Methods
Ninety pregnant women with bilateral notches in the uterine arteries were randomised to receive acetylsalicyclic acid 0.5mg/kg/day (n= 45) or placebo (n= 45) from 12 to 14 weeks of gestation.Main outcome measures
Hypertensive disorders of pregnancy and intrauterine growth retardation.Results
Forty‐three women on acetylsalicyclic acid and 43 on placebo were successfully followed up. The use of acetylsalicyclic acid was associated with a statistically significant reduction in the incidence of pregnancy‐induced hypertension (11.6%vs 37.2%, RR = 0.31, 95% CI 0.13–0.78) and pre‐eclampsia (4.7%vs 23.3%, RR = 0.2, 95% CI 0.05–0.86). The incidence of hypertension before 37 weeks of pregnancy was also significantly reduced (2.3%vs 20.9%, RR = 0.22, 95% CI 0.05–0.97). The reduction in the incidence of intrauterine growth retardation (2.3%vs 7%) was not statistically significant. Acetylsalicyclic acid was not associated with excess risk of maternal or fetal bleeding.Conclusion
In women rated in Doppler velocimetry waveform analysis to be at high risk of pre‐eclampsia, low‐dose acetylsalicyclic acid reduces the incidence of pregnancy‐induced hypertension and especially proteinuric pre‐eclampsia.
The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence
Authors: Jackson Simon , James Mark , Abrams Paul 
Published: December 2003

Objective
To determine whether oestrogen replacement will produce an improvement in the quantity, or quality, of pelvic collagen in postmenopausal women.Design
A prospective double‐blind placebo controlled trial of oestrogen therapy.Setting
Southmead Hospital, Bristol, UK.Population
Fifty‐five postmenopausal women with a urodynamic diagnosis of genuine urinary stress incontinence.Methods
Randomisation to a six‐month, double‐blind, placebo‐controlled, trial of oestradiol valerate 2mg once daily. A 10mg–30mg periurethral biopsy was taken from the vaginal epithelium before and after treatment. Tissue was analysed for total collagen content, intermolecular cross‐links, advanced glycation end‐products, collagen type ratios and matrix metalloproteinase (MMP) activity.Results
Forty‐nine women completed the trial of whom 26 received oestrogen and 23 received placebo. When compared with placebo, oestrogen treatment resulted in significant decreases in total collagen (P= 0.0054), the mature cross‐link HHL (P= 0.0009) and the advanced glycation end‐product NFC‐1 (P= 0.0009). There was a significant rise in the immature cross‐link HLKNL (P= 0.0191). Oestrogen produced a significant increase in MMP‐2 expression (Pro MMP‐2, P= 0.0017).Conclusions
Six months treatment with oestrogen has profound effects upon pelvic collagen metabolism, stimulating collagen degradation via increased proteinase activity. While aged collagen is being lost, new collagen is synthesised as witnessed by the increase in the immature cross‐links and the decrease in both mature cross‐links and advanced glycation end‐products. Collagen loss contradicts previous reports; perhaps aged collagen degradation is merely an early response to oestrogen stimulation. We have evidence of new collagen synthesis, and it may be that a longer treatment interval would show total collagen content increasing. Further studies within this field are warranted.
Grandmultiparae in a modern setting
Authors: Bugg G.J. , Atwal G.S. , Maresh M. 
Published: December 2003

Objective
To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among women who had previously delivered five or more times (grandmultiparous) with that of age‐matched control women who had previously delivered two or three times (multiparous).Design
A matched cohort study.Setting
An inner city university maternity hospital in the United Kingdom.Sample
Three hundred and ninety‐seven grandmultiparous women were compared with three hundred and ninety‐seven age‐matched multiparous women.Methods
Data on the subjects were obtained from a computerised maternity information system (SMMIS). Characteristics and complications occurring in the two groups were compared. Data validation was performed with a 10% randomised sample of the casenotes in both groups. Nineteen relevant data fields were abstracted and compared with the matched SMMIS record.Results
The overall incidence of intrapartum complications for grandmultiparous women was 16% compared with 18% in the control multiparous women (odds ratio 0.9, 95% CI 0.6–1.3). Grand multiparity was associated with a significantly higher body mass index at booking (P <0.01) and the last antenatal clinic (P < 0.05), an increased incidence of antenatal anaemia (22%vs 16%, odds ratio 1.8, 95% CI 1.2–2.8) and a decreased incidence of elective caesarean section (6%vs 11%, odds ratio 0.5, 95% CI 0.3–0.9). Agreement was greater than 95% in all the data fields reviewed except three. In the 14 categorical variables reviewed the Cohen's kappa results were in excess of 0.6.Conclusion
This study suggests that in a developed country with satisfactory health care conditions, grandmultiparity should not be considered dangerous, and risk assessment should be based on past and present history and not simply on the basis of parity.
Violent deaths: the hidden face of maternal mortality
Authors: Granja Ana Carla , Zacarias Eugenio , Bergström Staffan 
Published: December 2003

Objective
To review pregnancy‐related deaths due to injuries, to identify the characteristics of these women and to compare the magnitude of injury‐related maternal deaths to that of other causes of maternal deathDesign
A retrospective study was performed during a five‐year period (1991–1995), covering deaths from injuries, including suicide, homicide and accidents in Maputo, MozambiqueSetting
Department of Forensic Medicine at the Maputo Central Hospital, MozambiquePopulation
The pregnant or recently pregnant (post‐abortion and postpartum) population of Maputo city, the national capital of Mozambique. Twenty‐seven cases of pregnancy‐related deaths caused by injuries were identifiedMain outcome measures
Proportion of deaths due to homicide, suicide, and accidents in pregnant women or within 42 days after termination of pregnancyResults
Ten cases were due to alleged homicide, nine to alleged suicide and six to alleged accident. Fifty‐nine percent (16/27) of women suffering an injury‐related maternal death were younger than 25 years of age. Eighty‐five percent of pregnancies were less than 28 weeks of gestational age. The magnitude of the problem of violence‐related maternal deaths compares with the magnitude of pregnancy‐induced hypertension as the fourth cause of maternal death at Maputo Central HospitalConclusion
The contribution of violence‐related deaths to maternal mortality is significant and must not be neglected.
Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review
Authors: Clark T. Justin , Mann Christopher H. , Shah Neil , Khan Khalid S. , Song Fujian , Gupta Janesh K. 
Published: December 2003

Objective
To determine the accuracy of outpatient endometrial biopsy in diagnosing endometrial cancer in women with abnormal uterine bleeding.Design
A systematic quantitative review of published research.Methods
Studies were selected if accuracy of outpatient endometrial biopsy was estimated compared with a reference standard. Diagnostic accuracy was determined by pooled likelihood ratios for positive and negative test results. There were 1013 subjects in 13 diagnostic evaluations reported in 11 primary studies.Results
A positive test result on outpatient biopsy diagnosed endometrial cancer with a pooled likelihood ratio of 66.48 (95% CI 30.04–147.13) while a negative test result had a pooled likelihood ratio of 0.14 (95% CI 0.08–0.27). The post test probability of endometrial cancer was 81.7% (95% CI 59.7%–92.9%) for a positive test and 0.9% (95% CI 0.4%–2.4%) for a negative test.Conclusion
Outpatient endometrial biopsy has a high overall accuracy in diagnosing endometrial cancer when an adequate specimen is obtained. A positive test result is more accurate for ruling in disease than a negative test result is for ruling it out. Therefore, in cases of abnormal uterine bleeding where symptoms persist despite negative biopsy, further evaluation will be warranted.
Levels of C‐reactive protein in pregnant women who subsequently develop pre‐eclampsia
Authors: Savvidou Makrina D. , Lees Christoph C. , Parra Mauro , Hingorani Aroon D. , Nicolaides Kypros H. 
Published: December 2003

Objective
To investigate whether a maternal inflammatory response precedes the development of pre‐eclampsia.Design
Cross‐sectional study.Setting
Antenatal clinic in an inner city teaching hospital.Population
Two groups of women were examined at 23–25 weeks of gestation. The first group (45 women) had normal uterine artery Doppler waveforms and subsequently had a normal pregnancy outcome. The second group (45 women) had Doppler evidence of impaired placental perfusion and 21 (47%) of them had normal outcome, 14 (31%) developed intrauterine growth restriction and 10 (22%) developed pre‐eclampsia, with or without intrauterine growth restriction.Methods
C‐reactive protein, an acute‐phase reactant, was measured in maternal serum using a highly sensitive method with a detection limit of 0.05mg/L.Main Outcome Measures
Development of pre‐eclampsia, as defined by the International Society for the Study of Hypertension in Pregnancy. Intrauterine growth restriction was defined as birthweight <5th centile for gestation and sex of the neonate.Results
The serum C‐reactive protein concentration in women who subsequently developed pre‐eclampsia (median 1.56, range 0.55–3.12mg/L) or delivered a baby with birthweight <5th centile (median 0.74, range 0.64–1.58mg/L) was not significantly different from that in women with uncomplicated pregnancies (median 1.28, range 0.75–2.08mg/L; P= 0.95 and P= 0.62, respectively).Conclusion
These findings suggest that the onset of clinical signs of pre‐eclampsia may not be preceded by a maternal inflammatory response, as assessed by measurement of C‐reactive protein.
The role of arginine vasopressin in human labour: functional studies, fetal production and localisation of V1a receptor mRNA
Authors: Thornton S. , Baldwin P.J. , Harris P.A. , Harding F. , Davison J.M. , Baylis P.H. , Timmons P.M. , Wathes D.C. 
Published: December 2003

Objective
To investigate labour‐associated changes in: 1. the myometrial contractile response to arginine vasopressin compared with oxytocin in vitro 2. fetal production of arginine vasopressin and 3. myometrial vasopressin V1a receptor mRNA.Design
The contractile response to vasopressin (compared with oxytocin) was investigated in paired myometrial strips in vitro. Blood was taken from the umbilical artery and vein at delivery and arginine vasopressin measured by radio‐immunoassay. V1a receptor mRNA was determined by in situ hybridisation.Results
Myometrium was more sensitive to arginine vasopressin than oxytocin (P <0.05 for frequency, amplitude and activity integral in paired strips) after, but not before labour. There was a marked umbilical arteriovenous difference in arginine vasopressin concentration at delivery suggesting fetal production which was not influenced by labour. Myometrial vasopressin V1a receptor mRNA was not increased after the onset of labour.Conclusions
The human uterus is extremely sensitive to arginine vasopressin in vitro. Arginine vasopressin is produced by the fetus but fetal formation is not increased during labour.
A deficient maternal calcium intake during pregnancy increases blood pressure of the offspring in adult rats
Authors: Bergel Eduardo , Belizán José M. 
Published: December 2003

Objective
To assess in an animal model the effect of maternal dietary calcium intake during pregnancy on the blood pressure of offspring.Design
Randomised controlled trial.Sample
Ninety‐eight 20‐week‐old female Wistar–Kyoto rats, giving birth to a total of 119 pups that were included in the follow up study.Methods
Rats were randomised to a calcium deficient diet, a diet with the recommended calcium levels, or a diet with calcium content much higher than the recommended levels. After one month on the experimental diet they were bred. After birth, systolic blood pressure in the offspring was measured monthly till 52 weeks of age.Main outcome measures
Blood pressure of the offspring.Results
The difference in blood pressure of the offspring between the normal and low maternal calcium group increased 0.49 mmHg per month (95% CI 0.18 to 0.84), 0.38 (0.07 to 0.68) between the low and high calcium group, and 0.12 (−0.20 to 0.43) between the normal and high calcium group. At the end of the follow up (52 weeks of age) blood pressure of the offspring in the deficient calcium group was 12.1 mmHg (95% CI 8.8 to 15.4, P < 0.0001) higher than in the normal calcium group and 7.5 mmHg (95% CI 4.4 to 10.5, P < 0.001) higher than the high calcium group. Blood pressure of the offspring in the high calcium group was 4.3 mmHg (95% CI 1.0 to 7.5, P= 0.0l) higher than in the normal calcium group. In a multiple regression model maternal calcium intake during pregnancy was the strongest predictor of blood pressure of the offspring during adulthood.Conclusions
This experiment supports previous studies in humans suggesting a link between calcium intake during pregnancy and blood pressure in the offspring, and provides an animal model to explore the mechanisms involved in such association.
The impact of subcutaneous oestradiol implants on biochemical markers of bone turnover and bone mineral density in postmenopausal women
Authors: Pereda C.A. , Hannon R.A. , Naylor K.E. , Eastell R. 
Published: December 2003

Objective
To evaluate the anabolic effect of oestrogen on bone by comparing the response of markers of bone formation (and resorption) and bone mineral density (BMD) to subcutaneous oestradiol implants.Design
One year double‐blind placebo controlled randomised study.Setting
Clinical research unit within a teaching hospital.Population
Twenty‐one hysterectomised postmenopausal women were randomised to 25 mg oestradiol implants at baseline and at six months or to have a sham procedure at baseline and six months.Methods
BMD and quantitative ultrasound (QUS) were assessed at baseline and one year. Bone alkaline phosphatase (bone ALP), procollagen type I N‐terminal propeptide (PINP), osteocalcin (OC), free deoxypyridinoline (iFDPD), N‐telopeptide of type I collagen (NTX), serum oestradiol and intact parathyroid hormone (PTH) were measured at baseline, 4, 8, 12 and 24 weeks.Main outcome measures
Percentage change markers of bone turnover and PTH and change in oestradiol levels over first six months and percentage of changes in DXA and QUS over one year.Results
PINP, bone ALP and OC increased by 28%, 7% and 9%, respectively (P < 0.01) during the first four weeks of treatment and then decreased significantly. Lumbar spine (LS) and total hip (TH) BMD increased by 5.4% and 6.0% (P < 0.001), respectively, and femoral neck (FN) BMD by 3.7% (P < 0.05) during the first year of treatment compared with control subjects. The peak serum oestradiol level was achieved four weeks after implant insertion. Mean PTH levels increased significantly in subjects receiving subcutaneous oestradiol.Conclusion
Subcutaneous oestrogen exerted an apparent anabolic effect on bone, which was initially reflected by an increase in bone formation markers and later by a large increase in BMD.
S‐relaxin as a predictor of preterm delivery in women with symptoms of preterm labour
Authors: Vogel Ida , Glavind‐Kristensen Marianne , Thorsen Poul , Armbruster Franz P. , Uldbjerg Niels 
Published: December 2003

Objective
To evaluate whether serum relaxin (S‐relaxin) can predict spontaneous delivery before 34 weeks of gestation in high risk pregnancies.Design
A prospective cohort study.Setting
Calculated sample size was reached over a two‐year period, during which 9507 women gave birth. Of these, 157 healthy women were eligible for the study as they were admitted with symptoms of delivery before 34 weeks of gestation. Ninety‐three women were included. Overall participation rate was 59%.Population
Healthy women with singleton pregnancies with symptoms of delivery before 34 weeks of gestation.Methods
S‐relaxin was measured using a standard sandwich ELISA.Main outcome measures
End points were preterm delivery before 34 weeks of gestation and delivery within three days from initiation of symptoms. The best possible prediction of preterm delivery was established using logistic regression for risk factors individually associated with preterm delivery before 34 weeks of gestation. S‐relaxin was dichotomised to obtain best possible fit and then entered into the model. The same analyses were done for delivery within three days.Results
Median S‐relaxin levels varied significantly in the women with preterm prelabour rupture of membranes (PPROM) (316 pg/mL), contractions (222 pg/mL) or ripe cervices (203 pg/mL) (P < 0.05). S‐relaxin above the 80th centile (≥300 pg/mL) was associated with an increased risk of preterm delivery [crude OR = 4.8; (95% CI: 1.9–12)]. Likelihood ratio of a positive test is 2.6 (1.5–4.9) and S‐relaxin resulted in a post‐test probability of preterm delivery of 0.72, compared with a pre‐test probability of 0.49. S‐relaxin contributed to the identification of delivery within three days [adj. OR = 11 (95% CI: 1.8–64)].Conclusion
S‐relaxin may be a useful predictor in women with symptoms of delivery before 34 weeks of gestation.
Does sweeping of membranes beyond 40 weeks reduce the need for formal induction of labour?
Authors: Wong S.F. , Hui S.K. , Choi H. , Ho L.C. 
Published: December 2003

Objective
To assess the efficacy of sweeping of membranes beyond 40 weeks of gestation in reducing the incidence of induction of labour, when induction was planned at 42 weeks.Design
Prospective randomised controlled trial.Setting
A regional obstetric unit in Hong Kong.Population and methods
A total of 120 women with certain gestational age, determined by early pregnancy ultrasound scan, were recruited from 1st July, 1998 to 31st December, 1999. Sixty women were randomly allocated to sweeping of membranes and the other 60 women acted as control. The satisfaction for women allocated to sweeping of membranes was assessed by a questionnaire after the procedure. The two groups were assessed on intention‐to‐treat basis.Main outcome measures
The incidence of formal induction of labour was compared between the two groups. Possible complications of sweeping of membranes such as rupture of membranes, intrapartum infection, postpartum infection, and neonatal infection were also assessed. Maternal and perinatal outcomes were also assessed.Results
The recruitment to delivery interval was significantly shorter among women who had sweeping of membranes (3.2 versus 4.2 days, P < 0.05). The incidence of induction of labour was comparable (35.5%versus 38%, RR 0.91, 95% CI 0.57–1.46). The incidences of caesarean section and assisted vaginal delivery were comparable. The incidences of premature rupture of membranes, intrapartum, and postpartum infection were comparable. The perinatal outcomes were also comparable between the two groups. Up to 70% of women found that this procedure was associated with significant discomfort. One third of these women complained of significant pain.Conclusions
Sweeping of membranes beyond 40 weeks does not reduce the need for formal induction of labour at 42 weeks. Although it is safe, the majority of women felt uncomfortable during the procedure.
A randomised controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour
Authors: Choy C.M.Y. , Lau W.C. , Tam W.H. , Yuen P.M. 
Published: December 2003

Objective
To compare the efficacy and safety of intravenous oxytocin with intramuscular syntometrine in the management of the third stage of labourDesign
A prospective randomised trialSetting
A university teaching hospitalMethods
A total of 991 women having a singleton pregnancy and vaginal delivery were randomised by a computer‐generated number to receive either 1ml syntometrine intramuscularly or 10 units of intravenous Syntocinon after delivery of the anterior shoulder of the fetusMain outcome measures
Blood loss during delivery, rate of postpartum haemorrhage, need for repeated oxytocics, haemoglobin level before and 24 hours after delivery, duration of third stage, need for manual removal of placenta and sides effects including hypertension, nausea, vomiting, headache and chest painResults
The use of intravenous oxytocin was associated with a reduction in postpartum blood loss (P < 0.001) but there was no difference in the risk of postpartum haemorrhage in the need for repeated oxytocic injections and the drop in peripartum haemoglobin level between the two groups. There was also no difference in the risk of prolonged third stage, or in the need for manual removal of placenta. The use of syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% CI 1.00–5.70). Other side effects were mild in nature with no differences between the two groupsConclusions
There are no important clinical differences in the effectiveness of intramuscular syntometrine and intravenous oxytocin for the prevention of postpartum blood loss. Intravenous oxytocin is less likely to cause hypertension
Acupuncture treatment during labour—a randomised controlled trial
Authors: Ramnerö Agneta , Hanson Ulf , Kihlgren Mona 
Published: December 2003

Objective
To investigate acupuncture treatment during labour with regard to pain intensity, degree of relaxation and outcome of the delivery.Design
Randomised controlled trial.Setting
Delivery ward at a tertiary care centre hospital in Sweden.Population
Ninety parturients who delivered during the period April 12, 1999 and June 4, 2000.Methods
Forty‐six parturients were randomised to receive acupuncture treatment during labour as a compliment, or an alternative, to conventional analgesia.Main outcome measures
Assessments of pain intensity and degree of relaxation during labour, together with evaluation of delivery outcome.Results
Acupuncture treatment during labour significantly reduced the need of epidural analgesia (12%vs 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30 to 0.92). Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group (mean difference −0.93, 95% CI −1.66 to −0.20). No negative effects of acupuncture given during labour were found in relation to delivery outcome.Conclusions
The results suggest that acupuncture could be a good alternative or complement to those parturients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.