bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised, double‐blind, placebo‐controlled trial of corticosteroids for the treatment of hyperemesis gravidarum
Authors: Nelson‐Piercy Catherine , Fayers Peter , de Swiet Michael 
Published: December 2003

Objective To assess the efficacy of corticosteroids in the treatment of severe hyperemesis gravidarum refractory to conventional management.Design Multicentre, double‐blind, randomised, placebo‐controlled trial.Setting Inpatient gynaecology wards in eight collaborating centres.Population Twenty‐five women with severe hyperemesis of which 24 completed the one‐ week study period.Methods Twenty‐five women were randomised to receive either 40 mg prednisolone daily in two divided oral doses, or equivalent placebo tablets. If, after three days, a woman was still vomiting, medication was changed to the equivalent intravenous alternative (hydrocortisone 100mg twice daily or normal saline injections)Main outcome measures Frequency of vomiting and the dependence on intravenous fluid replacement therapy after one week of treatment.Results There was a non‐significant trend towards improved nausea and vomiting and reduced dependence on intravenous fluids. However, steroid therapy led to an improved sense of wellbeing (P= 0.021), improved appetite (P= 0.039) and increased weight gain (P= 0.025) compared with placebo. There was no difference in pregnancy outcome between the treatment and placebo groups.Conclusions This study supports a beneficial role for steroids in severe hyperemesis, but did not validate the hypothesis that they lead to rapid and complete remission of symptoms. The study was not large enough to demonstrate a significant improvement in the primary outcome measures.
Is maternal underweight really a risk factor for adverse pregnancy outcome? A population‐based study in London
Authors: Sebire NJ , Jolly M , Harris J , Regan L , Robinson S 
Published: December 2003

Objective To determine the maternal and fetal risk of adverse outcome during pregnancy in relation to low maternal body mass index in an unselected population.Design Retrospective analysis.Methods Information for the years between 1988 and 1997 was extracted from a validated maternity database, including all but one of the maternity units in the North West Thames Region; 215,105 completed singleton pregnancies were studied. Comparison of pregnancy outcome was made on the basis of maternal body mass index at booking. There were 176,923 with a normal weight body mass index (= 20 < 25). There were 38,182 with an underweight body mass index (< 20). Comparisons included antenatal complications (e.g. gestational diabetes, pre‐eclampsia); intervention in labour, maternal morbidities (e.g. infection, postpartum haemorrhage, pulmonary thromboembolism); and neonatal outcome (admitted to special care baby unit at 24 hour of age, gestation at delivery, birthweight, stillbirth). Data are presented as percentages of outcomes in the normal and underweight groups with adjusted odds ratios and confidence intervals according to body mass index group.Results In the underweight group only antenatal anaemia, preterm delivery and birthweight below the 5th centile were more frequent than in women of normal body mass index. The prevalence of certain complications, including development of gestational diabetes mellitus, pre‐eclampsia, obstetric intervention and postpartum haemorrhage, were significantly lower in those with low body mass index.Conclusion Low maternal body mass index is associated with increased prevalence of some pregnancy complications, notably preterm delivery and low birthweight, but overall the outcome is favourable and several adverse outcomes are less common in this group of women.
Age at menarche and age at menopause in relation to hepatocellular carcinoma in women
Authors: Mucci Lorelei A. , Kuper Hannah E. , Tamimi Rulla , Lagiou Pagona , Spanos Evangelos , Trichopoulos Dimitrios 
Published: December 2003

Objectives
To assess whether age at menarche, age at menopause, parity, and selected blood hormones are associated with risk of hepatocellular carcinoma among women.Design
Case–control.Sample and setting
Data collected from 50 cases of hepatocellular carcinoma among women and 62 female controls with minor trauma or surgical conditions who attended one of three hospitals in Athens, Greece between 1995 and 1998.Methods
Researchers collected information on Reproductive variables and assayed sera samples for blood hormone levels and for chronic infection with Hepatitis B and C viruses.Results
Individuals with hepatocellular carcinoma had a lower mean age at menarche and a significantly higher mean age at menopause. After adjusting for potential confounding, age at menopause remained an important and significant predictor, increasing the risk of hepatocellular carcinoma 24% for each later year of menopause (P < 0.001). For each year that menarche was delayed, risk of hepatocellular carcinoma declined 21% (P= 0.100). Mean levels of insulin‐like growth factor‐1 and its binding protein were significantly reduced in cases compared with controls, while levels of oestradiol, testosterone and sex hormone binding globulin were somewhat higher among the cases.Conclusions
This study provides indirect, but converging evidence that steroid hormones in general, and oestrogens in particular, play an important role in the aetiology of hepatocellular carcinoma among women.
Oxytocics reverse the tocolytic effect of glyceryl trinitrate on the human uterus
Authors: Lau L.C. , Adaikan P.G. , Arulkumaran S. , Ng S.C. 
Published: December 2003

Objectives To investigate the effect of glyceryl trinitrate on isolated human pregnant uterine strips and whether the uterine relaxation induced by glyceryl trinitrate could be reversed by oxytocics used in current clinical practice.Design In vitro pharmacological study.Setting Department of Obstetrics & Gynaecology, National University of Singapore, National University Hospital.Participants Eighteen women who delivered by caesarean section at term.Methods Myometrial strips were preloaded with an initial tension of 1.5g in organ baths containing Krebs‐Henseleit solution which was aerated with oxygen in 5% carbon dioxide and maintained at 37°C, pH 7.4. The effect of glyceryl trinitrate was studied in strips displaying regular spontaneous contractions. The ability of oxytocin, ergometrine or prostaglandin F2α to stimulate uterine contractions was assessed in strips where uterine activity was significantly inhibited by glyceryl trinitrate.Results Glyceryl trinitrate reduced the amplitude and frequency of spontaneous uterine contractions in a concentration‐dependent manner, although the sensitivity of the myometrial strips varied considerably from one specimen to another. The concentration of glyceryl trinitrate producing complete inhibition of myometrial contractions ranged from 44‐705μM. In the presence of glyceryl trinitrate which markedly depressed spontaneous contractions, oxytocin (20mU/mL), ergometrine (6.15μM) and prostaglandin F2α (6.15μM) were capable of reversing the uterine activity to either higher than or the untreated level of contractility.Conclusions This study demonstrates that glyceryl trinitrate is a potent uterine relaxant in vitro and that the tocolytic effect could be reversed with ease by oxytocics.
An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy
Authors: Sowter Martin C. , Farquhar Cindy M. , Gudex Guy 
Published: December 2003

Objective To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy.Design A cost minimisation study undertaken alongside a randomised trial.Setting Departments of Obstetrics and Gynaecology in three hospitals in Auckland, New Zealand.Participants Sixty‐two women with an ectopic pregnancy randomised to treatment with either a single dose of methotrexate (50mg/m2) or laparoscopic surgery.Main outcome measures Direct and indirect costs based on the results of the randomised trial.Results Direct costs per case were significantly lower in the methotrexate group (mean $NZ 1470) than in the laparoscopy group (mean $NZ 3083) with a mean difference of $NZ 1613 (95% CI $NZ 1166 ‐ $NZ 2061). These significant differences existed under a wide range of alternative assumptions about unit costs. The difference in direct costs in favour of methotrexate was greatest for women presenting with low pretreatment serum β‐hCG concentrations. Mean indirect costs were also significantly lower in the methotrexate group (mean $NZ 1141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 ‐ $NZ 1240). For women presenting with pretreatment serum β‐hCG concentrations of over 1500 IU/L this difference in indirect costs is lost due to the prolonged follow up required and a higher rate of surgical intervention in women receiving methotrexate.Conclusion This economic evaluation shows that treating suitable women with an ectopic pregnancy using systemic methotrexate therapy results in a significant reduction in direct costs. The indirect costs borne by the woman and her carers are only likely to be reduced in women with pretreatment serum β‐hCG concentrations under 1500 IU/L.
A comparison of isosorbide mononitrate, misoprostol and combination therapy for first trimester pre‐operative cervical ripening: a randomised controlled trial
Authors: Ledingham Marie‐Anne , Thomson Andrew J. , Lunan C. Burnett , Greer Ian A. , Norman Jane E. 
Published: December 2003

Objective
To determine whether a combined therapy with isosorbide mononitrate (40mg) and misoprostol (400μg) for pre‐operative cervical ripening in the first trimester would result in improved clinical effectiveness, and fewer side effects compared with each agent used alone.Design
Randomised controlled trial.Setting
Glasgow Royal Infirmary.Population
Sixty‐six primigravid women scheduled for suction termination of pregnancy.Methods
Women were randomly assigned to receive before surgery, per vaginam, isosorbide mononitrate 40 mg (n=22), misoprostol 400 μg (n=22) or both agents together [isosorbide mononitrate 40 mg and misoprostol 400 μg] (n=22).Main outcome measures
1. To assess the cumulative force required to dilate the cervix to 8 mm; 2. the onset of new symptoms before termination of pregnancy.Results
The cervical resistance following combination therapy with isosorbide mononitrate and misoprostol was not significantly different than following misoprostol alone [24.5N vs 18.5N; median difference (95% CI) 19N (‐22 to 49)]. Pre‐treatment with misoprostol used alone resulted in a lower cervical resistance than isosorbide mononitrate alone (18.5Nvs 39N, P=0.04, Mann‐Whitney U test). There was no difference in the number of women remaining asymptomatic following either isosorbide mononitrate or misoprostol or combination therapy [14/22 (64%) vs 11/21 (52%) vs 11/22 (50%), Fisher's exact test].Conclusions
We have not shown any advantage of combining misoprostol with the nitric oxide donor isosorbide mononitrate compared with misoprostol alone for pre‐operative cervical ripening in the first trimester.
A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery
Authors: Bagratee J.S. , Moodley J. , Kleinschmidt I. , Zawilski W. 
Published: December 2003

Objective To determine whether prophylactic antibiotic administration using cefoxitin at the time of elective caesarean section significantly reduces infectious morbidity.Setting A tertiary teaching hospital in a large urban city in South Africa.Participants Women undergoing elective caesarean section.Design A prospective, double‐blind randomised placebo‐controlled trial.Methods Four hundred and eighty women undergoing elective caesarean section had cefoxitin or placebo administration after umbilical cord clamping. Postpartum complications including febrile morbidity, wound infection, endometritis, urinary tract infection, pneumonia and transient postpartum fever were recorded, as were the duration of hospital stay and the need for therapeutic antibiotics.Results Wound infection was the most common complication occurring in 13.3% and 12.5% of women in the placebo and cefoxitin groups, respectively. Prophylactic antibiotics did not decrease febrile morbidity, wound infection, endometritis, urinary tract infection and pneumonia. Women who received cefoxitin stayed on average a day less in hospital than those who received placebo (6.9 vs 7.8 days, risk difference −0.94 CI 1.57 –−0.31 days). Eleven women (4.6%) in the placebo group and eight (3.4%) in the cefoxitin group had microbiological evidence of wound infection. Staphylococcus aureus was the most common pathogen (43%) isolated. Similar proportions in both groups (6.3% placebo and 5.1% cefoxitin) required a course of therapeutic antibiotics.Conclusion Antibiotic prophylaxis with cefoxitin in elective caesarean section did not reduce post‐operative infectious morbidity in this double‐blind randomised placebo controlled trial.
Systematic review of economic aspects of alternative modes of delivery
Authors: Henderson Jane , McCandlish Rona , Kumiega Lesley , Petrou Stavros 
Published: December 2003

Objective To carry out a systematic review of the literature relating to economic aspects of alternative modes of delivery.Methods A comprehensive literature search of the years 1990–1999 was conducted of electronic and non‐electronic sources using a tested search strategy. Papers considered to contain useful cost or resource use data were read in full and classified according to their relevance to the review and their methodological quality. Relevant cost and resource use data were converted to £ sterling and inflated to 1998‐1999 price levels.Results The literature search resulted in 975 papers, 49 of which met criteria for the review. Thirty‐two papers were from the USA where the organisation, structure and costs of health care are significantly different from that of other industrialised countries. The aggregate costs of different modes of delivery reported in these American studies were between four and five times higher than costs reported in other studies. The majority of included studies were of poor quality. Data from the better quality studies demonstrated that caesarean section costs a health service substantially more than other modes of delivery. The range of costs of an uncomplicated vaginal delivery were £629‐£1298 compared with £1238‐£3551 for a caesarean section. However, papers have so far only considered short term health service costs.Conclusions Research is required to estimate the cost and resource use attributable to alternative modes of delivery. Future research should investigate the long term health service costs and the costs that arise outside the health service which are likely to vary according to mode of delivery.
The development of high venous velocity at the fetal umbilical ring during gestational weeks 11–19
Authors: Skulstad Svein M. , Rasmussen Svein , Iversen Ole‐Erik , Kiserud Torvid 
Published: December 2003

Objective
To determine the occurrence of high venous velocities at the umbilical ring in the normal early second trimester, based on the assumption that a narrow umbilical ring may cause obstruction and increased venous blood velocity at the abdominal wall.Design
sectional study.Setting
Hospital antenatal clinic.Population
One hundred and one low risk singleton pregnancies specifically recruited for the study.Methods
Ultrasound was used at 11–19 weeks to determine the diameter and velocity in the umbilical vein at the fetal end of the cord and at the inlet through the abdominal wall.Outcome
measures 10th, 50th and 90th centiles were estimated for the time‐averaged maximum velocity in the cord and at the abdominal inlet. The increase of velocity as the blood entered the abdominal wall was calculated in percent of the velocity in the cord.Results
During weeks 11‐12 there was hardly any difference between blood velocity in the umbilical vein at the umbilical ring and that in the cord. From week 13 onwards it was increasingly common to find blood acceleration at the umbilical ring of 50–500%. Velocity increment >50% was found in 0/12 fetuses (0%) at 11–12 weeks, 5/20 (25%) at 13–14 weeks, and in 21/28 (75%) at 17–19 weeks.Conclusions
Blood velocity is higher in the umbilical vein at the abdominal wall than the cord, particularly after 13 weeks of gestation. If acceleration of blood velocity at the umbilical ring is a sign of a narrow inlet, it seems that a progressive tightening occurs during the second trimester.
Differences in hormone replacement therapy use by social class, region and psychological symptoms
Authors: Shah Sunil , Harris Tess J. , Cook Derek G. 
Published: December 2003

Objective
To describe the relationship between socio‐demographic factors, heart disease risk factors, psychological symptoms and the use of hormone replacement therapy by English women.Design
sectional analysis of a population‐based survey.Setting
England.Population
13,214 women aged 40–69 years who participated in the nurse‐administered schedule of the Health Survey for England between 1993 and 1996.Outcome
Current hormone replacement therapy use.Results
Women from social classes II and I and women who live in the south of England were more likely to use hormone replacement therapy independently of a range of socio‐demographic factors including education. The adjusted odds ratio for social classes II and I compared with social classes IV and V was 1.51 (95% CI 1.20 to 1.91) and for women in the South of England was 1.38 (95% CI 1.18 to 1.62). Women with a history of heart disease and those with high cholesterol levels were less likely to use hormone replacement therapy. Women with psychological symptoms were more likely to be prescribed hormone replacement therapy, as were those who had recently seen a doctor.Conclusion
There is marked socio‐demographic inequity in use of hormone replacement therapy. This may accentuate existing inequalities in health and reduce any potential benefits of Hormone Replacement Therapy for public health. The relationship between psychological symptoms, use of medical services and use of hormone replacement therapy suggests that hormone replacement therapy is prescribed for the management of psychological symptoms.
Hepatitis C virus among high and low risk pregnant women in Dundee: unlinked anonymous testing
Authors: Goldberg D. , McIntyre P.G. , Smith R. , Appleyard K. , Dunlop J. , Taylor A. , Hutchinson S. 
Published: December 2003

Objective
To determine the prevalence of the hepatitis C virus among pregnant women, to gauge the non‐injecting, particularly sexual, risk of them being hepatitis C virus infected and to assess the potential impact of selective antenatal screening.Population
Antenatal clinic attenders and women undergoing termination of pregnancy in 1997.Setting
Ninewells Hospital, Dundee.Design
Unlinked anonymous hepatitis C virus antibody testing of residual sera from specimens sent to the virus laboratory for routine serological testing. The results were linked to non‐identifying risk information.Results
Overall anti‐hepatitis C virus prevalence was 0.6% (23/3548). Prevalences among injecting drug users, non‐injectors who had a sexual partner who injected, and those with neither risk respectively were 41% (7/17), 15% (5/33) and 0.3% (11/3498). Relative risks for being an injector and a sexual partner of an injector respectively were 131 (95% CI 58‐297) and 48 (95% CI 5‐32). It is estimated that one of the 18 antenatal clinic attenders gave birth to an infected child.Conclusion
Findings suggest that non‐injecting partners of injectors may be at considerable risk of acquiring hepatitis C virus sexually. Efforts to promote the use of condoms among injectors and their sexual partners should be increased. Selective anti‐hepatitis C virus screening of women who reported high risk behaviour would have failed to detect half the cases. Research to gauge the views of women of childbearing age on anti‐hepatitis C virus testing is required.
The tension‐free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence
Authors: Nilsson Carl Gustaf , Kuuva Nina 
Published: December 2003

Objectives
To evaluate the effectiveness and safety of the ambulatory, minimally invasive tension‐free vaginal tape procedure in women scheduled for incontinence surgery.Design
A prospective open study with a standardised protocol for pre‐ and post‐operative evaluation.Participants
One hundred and sixty‐one consecutive women with urodynamically proven stress incontinence. The mean age was 56 years; 45 women (28%) had recurrent incontinence, 59 women (37%) had mixed incontinence and 18 women (11%) had a low pressure urethra.Main outcome measures
Subjective and objective cure rates, complications and length of hospital stay.Results
The average follow up time was 16 months. Ninety‐four percent of the treated women were completely cured or significantly improved. Eighty percent of the women were released from hospital on the afternoon of the day of surgery. There were no major complications and 80.2% of the women had no complication at all. Seven women (4.3%) had no more than four days of urinary retention problems, five women (3.1%) developed de novo urge symptoms, ten women (6.1%) had urinary tract infection, six cases (3.7%) of intraoperative bladder perforation occurred and less than 3% had bleeding or infection problems. There was no difference in the cure rate between women suffering from primary, recurrent or mixed incontinence.Conclusions
The tension‐free vaginal tape operation is an effective and safe procedure for treatment of most cases of female urinary stress incontinence. The operation can be performed as an ambulatory procedure because of the low risk of post‐operative morbidity.
A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women
Authors: Bidmead John , Cardozo Linda , McLellan Anne , Khullar Vik , Kelleher Cornelius 
Published: December 2003

Objectives
To investigate the impact of colposuspension for stress incontinence on the symptoms and quality of life of women undergoing both primary and repeat surgery for genuine stress incontinence and in addition to assess the use of a condition specific quality of life questionnaire as an outcome measure following surgery.Design
Prospective case series: videocystourethrography performed before and between six and twelve months after surgery. Validated condition specific quality of life (QoL) questionnaires completed by women before and six to twelve months after surgery.Setting
A tertiary referral Urogynaecology Unit in a teaching hospital.Participants
A consecutive series of 83 women undergoing colposuspension between March 1995 and December 1997. Pre‐operative assessment and surgery was performed by, or was under the direct supervision of, the unit director.Intervention
Modified Burch colposuspension.Main outcome measures
Objective results of surgery assessed with videocystourethrography. Subjective results evaluated using a condition specific QoL tool, the Kings Health Questionnaire (KHQ). Symptom severity was evaluated as a component of the condition specific QoL questionnaire.Results
Objective cure was demonstrated in 92% of women undergoing primary surgery with an 8% incidence of de‐novo detrusor instability and a 10% incidence of voiding difficulties. In the group of women having repeat surgery the objective cure rate was 81% with no de‐novo detrusor instability and a 6% incidence of post‐operative voiding difficulties. QoL scores improved in 95% of women. Improvements of over 25% were seen in 70% of women and of over 50% in 28%. However, 2.4% of women recorded a deterioration in QoL scores.Conclusions
Colposuspension performed in this setting, assessed using both objective and standardised subjective measures, completed by women themselves, appears to produce good objective and subjective results and leads to enhanced quality of life in the great majority of women.