bluuebunny/crossref_metadata_2025_split huggingface dataset:
The importance of genetic and environmental effects for pre‐eclampsia and gestational hypertension: a family study
Authors: Nilsson Emma , Salonen Ros Helena , Cnattingius Sven , Lichtenstein Paul 
Published: December 2004

Objectives  To determine the importance of genetic effects in the aetiology of pre‐eclampsia and gestational hypertension and to investigate whether pre‐eclampsia and gestational hypertension share genetic aetiology.Design  Individual record linkage between the population‐based Swedish Multi‐Generation and the Medical Birth Registers.Setting  Sweden.Population  1,188,207 births between 1987 and 1997 and their parents.Methods  Similarities in relatives were measured by the number of pairs concordant and discordant for disease, the odds ratio (OR) and tetrachoric correlations. Estimates of genetic and environmental effect for gestational hypertension, pre‐eclampsia and pregnancy‐induced hypertension were calculated from structural equation model fitting.Main outcome measures  Pre‐eclampsia and gestational hypertension.Results  Full sisters and mother–daughters were more similar for pre‐eclampsia (OR 3.3, 95% confidence interval [CI] 3.0–3.6 and OR 2.6, 95% CI 1.6–4.3, respectively) than half‐sisters (maternal half‐sisters OR 1.4, 95% CI 0.9–2.2 and paternal half‐sisters OR 1.0, 95% CI 0.6–1.6). Full sisters and mother–daughters were also more similar for gestational hypertension than half‐sisters. A full sister to a woman with pre‐eclampsia also had a significantly increased risk of gestational hypertension (OR 2.5, 95% CI 2.2–2.8). In contrast, the risk for half‐sisters was not increased. Model fitting suggested heritability estimates for pre‐eclampsia of 31%, for gestational hypertension 20% and for pregnancy‐induced hypertension 28%.Conclusions  There is a genetic component in the development of pre‐eclampsia and gestational hypertension and the pattern of co‐morbidity suggests that they may share part of their genetic aetiology. This could be important for studies of potential susceptibility genes for these diseases.
Thiol status and antioxidant capacity in women with a history of severe pre‐eclampsia
Authors: Raijmakers Maarten T.M. , Roes Eva Maria , Zusterzeel Petra L.M. , Steegers Eric A.P. , Peters Wilbert H.M. 
Published: December 2004

Objective  To investigate a possible mechanism that could lead to the subsequent development of cardiovascular diseases (CVD) in women with a history of severe pre‐eclampsia.Design  Case–control study.Setting  University Medical Centre Nijmegen, The Netherlands.Sample  Non‐pregnant women with a history of severe pre‐eclampsia (n= 131) and women with an uncomplicated obstetric history (n= 94).Methods  Total plasma levels of cysteine (tCys), homocysteine (tHcy), cysteinylglycine (tCysGly) and glutathione (tGSH), the free‐to‐oxidised ratio of these thiols in whole blood, the glucose‐6‐phosphate dehydrogenase (G6PDH) enzyme activity and antioxidant capacity were assessed at least 6 months following last pregnancy.Main outcome measure  Oxidative stress and antioxidant status.Results  Women with a history of severe pre‐eclampsia showed higher levels (mean [SD]) of tHcy (13.1 [5.0] versus 11.5 [4.8] μmol/L; P= 0.018) and tCysGly (37.5 [5.6] versus 34.0 [5.8] μmol/L; P= 0.0001) compared with controls, whereas tCys was lower (232 [31] versus 242 [39]; P= 0.029). The lower free‐to‐oxidised ratio of homocysteine (2.3 [0.8] versus 2.9 [1.0], P= 0.0001) among women with a history of severe pre‐eclampsia as compared with control subjects might indicate a higher oxidant status for homocysteine. Previous severe pre‐eclamptic patients had also a higher antioxidant capacity as compared with controls (0.79 [0.14] versus 0.74 [0.11] mmol Fe2+/L, P= 0.002).Conclusion  Since women with a history of severe pre‐eclampsia showed elevated total homocysteine levels, which is an independent risk factor for CVD, and higher oxidised homocysteine levels in whole blood, these women may have an enhanced risk for the subsequent development of cardiovascular‐related problems in later life.
How should randomised trials including multiple pregnancies be analysed?
Authors: Gates Simon , Brocklehurst Peter 
Published: December 2004

Objective  To compare the effects of four methods of analysis on the results of randomised controlled trials that recruit women with multiple pregnancies and measure outcomes on their babies.Design  Analysis of one real and two simulated data sets.Setting  Secondary analysis of perinatal randomised controlled trials.Population  Randomised controlled trials including women with multiple pregnancies.Methods  The analytical methods compared were (a) assuming independence among babies, (b) analysing outcomes per women, counting a woman as having an outcome if any of her babies had it (equivalent to selecting the worst outcome among any of a woman's babies), (c) randomly selecting one baby from each set of multiples for inclusion in the analysis, (d) adjustment of the analysis to take account of non‐independence of babies from multiple pregnancies, using methods developed for analysis of cluster randomised trials.Main outcome measures  Odds ratios for trials' main outcomes.Results  Results from application of cluster trial methods were similar to those from assuming independence among babies, but with slightly wider confidence intervals, reflecting the reduced effective sample size caused by non‐independence between babies from the same pregnancy. Results were more variable using the other two methods, and in some cases, departed markedly from the results of the cluster trial methods.Conclusions  Cluster trial methods provide a simple way of adjusting the analysis to take account of non‐independence between babies from the same pregnancy. Random selection and analysis by pregnancy (methods (b) and (c)) have disadvantages and do not report outcomes for all of the babies in the trial. This may cause problems with incorporating trials analysed using these methods into systematic reviews.
Isolated oligohydramnios is not associated with adverse perinatal outcomes
Authors: Zhang Jun , Troendle James , Meikle Susan , Klebanoff Mark A. , Rayburn William F. 
Published: December 2004

Objective  To examine fetal growth and perinatal outcomes in pregnancies with isolated oligohydramnios.Design  A cohort study.Setting  Multiple clinics and hospitals.Population  Low risk pregnant women.Methods  We used data from the multicentre clinical trial of Routine Antenatal Diagnostic Imaging with UltraSound (RADIUS), in which 15,151 low risk pregnant women were randomly assigned to the ultrasound screening group or the control group. Women in the screening group underwent sonographic exams at 15–22 and 31–35 weeks of gestation. Both groups could have clinically indicated sonographic exams at any time.Main outcome measures  We used changes of fetal weight z‐score to assess whether fetal growth was compromised from the diagnosis of oligohydramnios until delivery, using a repeated‐measures regression. We used a combined perinatal index as an indicator of adverse perinatal outcome, which consisted of severe perinatal morbidity and mortality.Results  Oligohydramnios (amniotic fluid index ≤5 cm) was diagnosed in 1.5% (113/7617) of women with ultrasound screening compared with 0.8% (57/7534) among the controls. Approximately half of the oligohydramnios cases in the screening group were isolated with no clearly associated factors (e.g. premature rupture of the fetal membranes, congenital anomalies, diabetes, hypertension, postdate and intrauterine growth restriction). Fetal weight centiles in isolated oligohydramnios cases did not change significantly from diagnosis until delivery. Pregnancies with isolated oligohydramnios had perinatal outcomes similar to pregnancies with a normal amniotic fluid index.Conclusion  Isolated oligohydramnios is not associated with impaired fetal growth or an increased risk of adverse perinatal outcomes.
Antenatal screening and intrapartum management of Group B Streptococcus in the UK
Authors: Kenyon Sara , Brocklehurst Peter , Blackburn Ann , Taylor David J. 
Published: December 2004

Objective  To determine whether there has been any change in UK policy for the screening and intrapartum management of Group B Streptococcus in pregnancy over a two year period.Design  Two national survey's of practice carried out in 1999 and 2001.Setting  All obstetric units in the UK.Population  Clinical directors of maternity services.Methods  A questionnaire was sent to all clinical directors of maternity services in the UK requesting information about their policy and practice with respect to antenatal screening for Group B Streptococcus colonisation. Reminders were sent after one month.Main outcome measures  Number of maternity units in the UK screening and offering intrapartum antibiotic prophylaxis for Group B Streptococcus colonisation in pregnancy.Results  The response rates were 84% in 1999 and 82% in 2001. Of the responding units, six (3%) in 1999 and four (2%) in 2001 used vaginal swab based screening for Group B Streptococcus colonisation in the antenatal period. In 1999, intrapartum antibiotic prophylaxis was offered to women with a previous baby affected by Group B Streptococcus in 85% (176/207) of maternity units and in 2001 this had risen to 95% (193/203). Similarly, in 1999 intrapartum antibiotic prophylaxis was offered to women who were known carriers of Group B Streptococcus in 87% (179/207) of maternity units and in 2001 this had risen to 95% (193/203). Appropriate dosage of a recommended antibiotic was prescribed in 7% (9/123) units in 1999 and in 20% (35/178) units in 2001.Conclusions  Although intrapartum antibiotic prophylaxis for women at high risk of giving birth to babies with Group B Streptococcus is widely practiced in the UK, a programme of antenatal screening for Group B Streptococcus colonisation has not been adopted along the lines advocated in the USA. There therefore remains an opportunity to evaluate such a screening programme in a randomised trial.
Maternal morbidity during labour and the puerperium in rural homes and the need for medical attention: A prospective observational study in Gadchiroli, India
Authors: Bang Rani A. , Bang Abhay T. , Reddy M. Hanimi , Deshmukh Mahesh D. , Baitule Sanjay B. , Filippi Veronique 
Published: December 2004

Objectives  To estimate the incidence of maternal morbidity during labour and the puerperium in rural homes, the association with perinatal outcome and the proportion of women needing medical attention.Design  Prospective observational study nested in a neonatal care trial.Setting  Thirty‐nine villages in the Gadchiroli district, Maharashtra, India.Sample  Seven hundred and seventy‐two women recruited over a one year period (1995–1996) and followed up from the seventh month in pregnancy to 28 days postpartum (up to 10 visits in total).Methods  Observations at home by trained village health workers, validated by a physician. Diagnosis of morbidities by computer program.Main outcomes  Direct obstetric complications during labour and the puerperium, breast problems, psychiatric problems and need for medical attention.Results  The incidence of maternal morbidity was 52.6%, 17.7% during labour and 42.9% during puerperium. The most common intrapartum morbidities were prolonged labour (10.1%), prolonged rupture of membranes (5.7%), abnormal presentation (4.0%) and primary postpartum haemorrhage (3.2%). The postpartum morbidities included breast problems (18.4%), secondary postpartum haemorrhage (15.2%), puerperal genital infections (10.2%) and insomnia (7.4%). Abnormal presentation and some puerperal complications (infection, fits, psychosis and breast problems) were significantly associated with adverse perinatal outcomes, but prolonged labour was not. A third of the mothers were in need of medical attention: 15.3% required emergency obstetric care and 24.0% required non‐emergency medical attention.Conclusions  Nearly 15% of women who deliver in rural homes potentially need emergency obstetric care. Frequent (43%) postpartum morbidity, and its association with adverse perinatal outcome, suggests the need for home‐based postpartum care in developing countries for both mother and baby.
Delivering an effective outpatient service in gynaecology
Authors: Marsh Fiona , Kremer Christian , Duffy Sean 
Published: December 2004

Objective  To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer.Design and interventions  Randomised controlled trial.Setting  The gynaecology clinic of a large teaching hospital.Participants  Ninety‐seven women with abnormal uterine bleeding requiring investigation.Methods  Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy.Main outcome measures  Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses.Results  The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group (£20.40 in the outpatient group vs£50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group—with an average cost of £3.46 in the outpatient group and £6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately £53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service.Conclusion  Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.
A double blinded randomised placebo‐controlled study of intramuscular pethidine for pain relief in the first stage of labour
Authors: Tsui Michelle H.Y. , Ngan Kee Warwick D. , Ng Floria F. , Lau Tze K. 
Published: December 2004

Objective  It has recently been suggested that systemic pethidine is ineffective in relieving labour pain. This study aims to evaluate the analgesic efficacy of pethidine in labour.Design  This is a double blinded randomised placebo‐controlled study.Setting  Labour suite, Prince of Wales Hospital, Hong Kong.Population  Fifty normal Chinese pregnant women in early labour.Methods  We planned to randomise 112 women in early labour to receive either intramuscular pethidine 100 mg or normal saline when they requested analgesia. An interim analysis was performed at sample size 50.Main outcome measures  The primary outcome assessed was the visual analogue scale (VAS) pain score after 30 minutes.Results  The study was terminated after recruitment of the first 50 women when planned interim analysis showed a significantly greater reduction of VAS pain score in the pethidine group (P= 0.009). The median difference in VAS pain score between the two groups at 30 minutes was −17 [95% CI −30 to −4]. Mean time to first subsequent request for analgesia was greater in the pethidine group (232 minutes, 95% CI 135 to 329 minutes) compared with the control group (75 minutes, 95% CI 54 to 95 minutes). Eight women (32%) in the pethidine group needed no further analgesia vs one woman (4%) in the control group (P= 0.011). Women in the pethidine group gave greater scores for sedation and satisfaction. Neonatal outcome was similar.Conclusions  Systemic pethidine was more effective at relieving labour pain than placebo. Its analgesic effect, however, was modest.
Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group
Authors: Williamson Catherine , Hems Laura M. , Goulis Dimitrios G. , Walker Ian , Chambers Jennifer , Donaldson Oscar , de Swiet Michael , Johnston Desmond G. 
Published: December 2004

Objective  To explore the clinical features of obstetric cholestasis pregnancies in UK white Caucasians.Design  A questionnaire survey.Setting  Study coordinated at Queen Charlotte's Hospital.Population  Clinical features of 352 affected pregnancies in 227 Caucasian women identified via a patient support group.Methods  Evaluation of the gestation at which prematurity and intrauterine death occur, and recording of additional clinical features in pregnancies complicated by obstetric cholestasis.Main outcome measures  The timing of pregnancies complicated by intrauterine death and prematurity.Results  Among the affected pregnancies, 23 (7%) were complicated by intrauterine death (20 singletons and 3 twins) and 133 (38%) were delivered prematurely (56 spontaneous and 77 iatrogenic). Eighteen of the 20 singleton intrauterine deaths occurred after 37 weeks. All three intrauterine deaths in twin pregnancies occurred before 37 weeks. Pruritus started earlier in pregnancies complicated by spontaneous prematurity, but not in those complicated by intrauterine death.Conclusions  Intrauterine death in singleton pregnancies complicated by obstetric cholestasis death mainly occurs after 37 weeks. The gestation at which pruritus is first reported may help to predict spontaneous prematurity.
The effects of intrapartum hypoxia on the fetal QT interval
Authors: Oudijk Martijn A. , Kwee Anneke , Visser Gerard H.A. , Blad Sofia , Meijboom Erik J. , Rosén Karl G. 
Published: December 2004

Background  The morphology of the fetal ECG complex provides information on the fetal condition during labour, such as the ST segment and T‐wave configuration. We hypothesised that the intrapartum fetal QT interval may provide additional information on the condition of the fetus, as it is known that the QT interval reacts to situations of stress and exercise.Design  Retrospective study.Setting  Data were substracted from a European community multicentre trial.Methods  The intrapartum QT interval was measured in 68 fetuses who were acidemic at birth (pH <7.05 and BD ecf >12 mmol/L) and in a control group of similar size. All of these cases were monitored by STAN S21. Measurements were performed at the start of the recording at baseline heart rate, during variable decelerations and at the end of the recording. The QTc was calculated using Bazett's formula: QT/√RR. The intervals were compared using the Wilcoxon signed ranks test.Main outcome measures  Fetal QT interval, and the corrected QT interval: QTc.Results  In the acidemic fetuses, there was a significant shortening of the QTc interval at the end of the recording compared with the start of the recording (397 ms at the end vs 359.3 ms at start; P < 0.001), in association with a significantly lowered heart rate (136.3 vs 110.9 bpm, P < 0.001). Measurements of QT and QTc during variable decelerations at the start and end of the recording also showed a shortening of the QT interval (301.9 vs 273.3 ms, P≤ 0.001) and QTc interval (381.6 vs 340.3, P < 0.001), and this was not dependent on heart rate. In the control cases, no differences in FHR, QT and QTc intervals were present.Conclusions  In intrapartum hypoxia, resulting in metabolic acidosis, a significant shortening of the fetal QT and QTc is present, irrespective of changes in heart rate. In control cases, this shortening does not occur. The intrapartum fetal QT interval may therefore provide additional information on the condition of the fetus.
Impairment of Nuclear Pores in Bovine Herpesvirus 1-Infected MDBK Cells
Authors: Wild Peter , Engels Monika , Senn Claudia , Tobler Kurt , Ziegler Urs , Schraner Elisabeth M. , Loepfe Eva , Ackermann Mathias , Mueller Martin , Walther Paul 
Published: December 2004

ABSTRACT
Herpesvirus capsids originating in the nucleus overcome the nucleocytoplasmic barrier by budding at the inner nuclear membrane. The fate of the resulting virions is still under debate. The fact that capsids approach Golgi membranes from the cytoplasmic side led to the theory of fusion between the viral envelope and the outer nuclear membrane, resulting in the release of capsids into the cytoplasm. We recently discovered a continuum from the perinuclear space to the Golgi complex implying (i) intracisternal viral transportation from the perinuclear space directly into Golgi cisternae and (ii) the existence of an alternative pathway of capsids from the nucleus to the cytoplasm. Here, we analyzed the nuclear surface by high-resolution microscopy. Confocal microscopy of MDBK cells infected with recombinant bovine herpesvirus 1 expressing green fluorescent protein fused to VP26 (a minor capsid protein) revealed distortions of the nuclear surface in the course of viral multiplication. High-resolution scanning and transmission electron microscopy proved the distortions to be related to enlargement of nuclear pores through which nuclear content including capsids protrudes into the cytoplasm, suggesting that capsids use impaired nuclear pores as gateways to gain access to the cytoplasmic matrix. Close examination of Golgi membranes, rough endoplasmic reticulum, and outer nuclear membrane yielded capsid-membrane interaction of high identity to the budding process at the inner nuclear membrane. These observations signify the ability of capsids to induce budding at any cell membrane, provided the fusion machinery is present and/or budding is not suppressed by viral proteins.
Infection of Ciliated Cells by Human Parainfluenza Virus Type 3 in an In Vitro Model of Human Airway Epithelium
Authors: Zhang Liqun , Bukreyev Alexander , Thompson Catherine I. , Watson Brandy , Peeples Mark E. , Collins Peter L. , Pickles Raymond J. 
Published: December 2004

ABSTRACT
We constructed a human recombinant parainfluenza virus type 3 (rPIV3) that expresses enhanced green fluorescent protein (GFP) and used this virus, rgPIV3, to characterize PIV3 infection of an established in vitro model of human pseudostratified mucociliary airway epithelium (HAE). The apical surface of HAE was highly susceptible to rgPIV3 infection, whereas only occasional cells were infected when virus was applied to the basolateral surface. Infection involved exclusively ciliated epithelial cells. There was little evidence of virus-mediated cytopathology and no spread of the virus beyond the ciliated cell types. Infection of ciliated cells by rgPIV3 was sensitive to a neuraminidase specific for α2-6-linked sialic acid residues, but not to a neuraminidase that cleaves α2-3- and α2-8-linked sialic acid residues. This provided evidence that rgPIV3 utilizes α2-6-linked sialic acid residues for initiating infection, a specificity also described for human influenza viruses. The PIV3 fusion (F) glycoprotein was trafficked exclusively to the apical surface of ciliated cells, which also was the site of release of progeny virus. F glycoprotein localized predominately to the membranes of the cilial shafts, suggesting that progeny viruses may bud from cilia per se. The polarized trafficking of F glycoprotein to the apical surface also likely restricts its interaction with neighboring cells and could account for the observed lack of cell-cell fusion. HAE derived from cystic fibrosis patients was not more susceptible to rgPIV3 infection but did exhibit limited spread of virus due to impaired movement of lumenal secretions due to compromised function of the cilia.