bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monozygotic twin pregnancy: diagnostic and Doppler ultrasound studies
Authors: NEILSON J. P. , DANSKIN F. , HASTIE S. J. 
Published: August 2005

SummaryOf 178 consecutive twin pregnancies, 63 were both monozygotic and also studied prenatally by real‐time B‐scan (and usually Doppler) ultrasound. The 48 pregnancies with monochorionic placentas (in which vascular anastomoses are almost universal) were compared with the 15 monozygotic pregnancies having dichorionic placentas. The type of placenta found at delivery was predicted with substantial accuracy by ultrasound examination in mid‐pregnancy. We were unable to identify any inter‐group difference in fetal growth rate, discordance of fetal growth between twins or pattern of umbilical artery flow velocity waveform. In the absence of the rare florid twin transfusion syndrome, the vascular anastomoses that have been shown to be common in monochorionic placentas do not exert a strong influence on fetal growth or fetoplacental blood flow.
Babies born before arrival at hospital
Authors: BHOOPALAM PRAKASH S. , WATKINSON M. 
Published: August 2005

AbstractObjective— To establish the prevalence of babies born before arrival at two local hospitals. To identify women at risk of giving birth before arrival, and the morbidity and mortality associated with such births.Design— A. case control study. Each baby born before arrival and its mother were compared with the next born in the hospital (random control), and one matched for gestation and birthweight, together with their mothers.Setting— Two maternity units serving East Birmingham and Solihull.Subjects— All babies (and their mothers) born before arrival at these hospitals from January 1983 to December 1987.Main outcome measures— Perinatal mortality rates, patterns of perinatal morbidity, demographic, social and obstetric features of the mothers.Results— 137 (0.44%) of 31 140 consecutive births were before arrival at hospital (BBA group). The perinatal mortality rate in the BBA group was 58.4/1000 (8 deaths) compared with 10.1/1000 for all inborn babies (relative risk 5.8, 95% confidence interval 2.9–11.4). In the BBA group the mean birthweight of 3008 g was 212 g (95% CI 50–374 g) less than that in the random control group; the mean gestation of 266 days was 10 days less (95% CI 5.9–14.1 days) than in the random control group. Hypothermia was the commonest morbidity. Women delivered before arrival tended to be either multigravid inner city Asians living a long way from the hospital or unmarried unbooked younger white Europeans.Conclusions— The high perinatal mortality was related to immaturity and low birthweight, rather than to birth before arrival itself. Although groups of mothers at risk of delivery before arrival can be identified more information is needed to establish whether additional antenatal care would be beneficial for these women and their babies.
A randomized controlled trial of early amniotomy
Authors: FRASER WILLIAM D. , SAUVE REG , PARBOOSINGH I. JOHN , FUNG TAK , SOKOL ROBERT , PERSAUD DAVID 
Published: August 2005

AbstractObjective— To determine if a policy of early amniotomy resulted in a reduction in mean labour duration when compared to a policy of conservation of the membranes.Design— A single‐centre randomized controlled trial.Setting— A tertiary care teaching hospital in Alberta, Canada.Subjects— Ninety‐seven term nulliparae in spontaneous labour, baby in cephalic presentation.Intervention— Early amniotomy versus intent to keep membranes intact.Main outcome measures— Interval from randomization to delivery, rate of abnormalities of fetal heart rate tracings, cord artery blood pH, Apgar scores.Results— The mean interval from randomization to delivery was 390.9 (SE 29.1) min in the amniotomy group and 442.9 (SE 34.1) min in the control group (P= 0.251). There were no differences between groups in the occurrence of fetal heart rate tracing abnormalities, nor was there a difference in the proportion of babies with abnormal Apgar scores, or abnormal cord pH (< 7.20).Conclusion— The results of the study fail to support the long held belief that early amniotomy is an effective method for reducing labour duration.
Vaginal infection and preterm labour
Authors: McDONALD H. M. , O'LOUGHLIN J. A. , JOLLEY P. , VIGNESWARAN R. , McDONALD P. J. 
Published: August 2005

AbstractObjective— To study the vaginal flora of women in preterm labour (PTL) and determine whether the presence of specific vaginal microflora is significantly associated with onset of PTL.Design— A comprehensive prospective study of the vaginal microflora of women in early labour comparing women in PTL with term controls. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Trichomonas vaginalis. Multiple logistic regression analysis was used to adjust for confounding obstetric and demographic variables.Setting— The Queen Victoria Hospital, Adelaide.Patients— 428 Women in PTL compared to 568 women in labour at term.Main outcome measure— PTL and preterm prelabour rupture of membranes (PPROM) in relation to specific vaginal microflora.Results— After multiple logistic regression analysis, two distinct bacteriological groupings were associated with PTL <37 weeks gestation, namely, the bacterial vaginosis group of organisms, Gardnerella vaginalis and Bacteroides spp., and a group of enteropharyngeal organisms, E. coli, Klebsiella spp., Haemophilus spp. and S. aureus. G. vaginalis was found in 12% of women in PTL compared to 6% at term [regression odds ratio (ROR) 1.8, 95% confidence intervals (CI) 1.1–3.1] whereas Bacteroides spp. were detected in 45% of women in PTL compared with 35% at term (ROR 1.6, CI 1.2–2.1). The prevalence of G. vaginalis (17%) and Bacteroides spp. (50%) was even higher in women in PTL <34 weeks gestation. The enteropharyngeal group of organisms were more commonly present in women in PTL <37 weeks (E. coli 10% vs 6%, ROR 1.4, CI 0.8–2.4; Klebsiella spp. 3% vs <1%, ROR 5.4, CI 1.1–26.7; Haemophilus spp. 2% vs <1%, ROR 5.5, CI 1.1–28.6; aureus 6% vs 4%, ROR 1.8, CI 0.9–3.3) and were isolated even more frequently in women in PTL <34 weeks (E. coli 15%; Klebsiella spp. 4%; S. aureus 7%). Bacteroides spp., Klebsiella spp., and Haemophilus spp. were all found to be associated with PPROM.Conclusion— There are two distinct bacteriological groupings commonly found in women in PTL, especially in PTL <34 weeks gestation. These bacteriological groups are women with bacterial vaginosis in pregnancy and women who demonstrate enteropharyngeal bacteria in the vagina.
Congenital and maternal cytomegalovirus infections in a London population
Authors: GRIFFITHS P. D. , BABOONIAN C. , RUTTER D. , PECKHAM C. 
Published: August 2005

AbstractObjective— To determine if women at risk of having babies infected with cytomegalovirus (CMV) can be identified antenatally.Design— Prospective serological and demographic study of pregnant women and virological study of their newborn infants.Setting— Teaching hospital in London.Subjects— 3315 pregnant women and 2737 of their babies.Main outcome measures— Quantitative detection of CMV IgG antibodies; qualitative detection of CMV IgM antibodies; demographic characteristics of mothers; qualitative and quantitative titration of CMV viruria in newborn.Results— Congenital CMV infection was found in nine newborn babies (0.33%) two of whom had symptoms. Serological testing of the nine mothers showed four primary and five recurrent infections; both of the symptomatic children were born in the latter group. Testing for CMV specific IgM antibodies or quantitation of IgG antibodies in early pregnancy sera could not differentiate those women at risk of giving birth to babies infected or damaged by CMV from the rest of the population. Quantitation of viruria confirmed that those babies most at risk of CMV disease have the highest titres of CMV.Conclusions— (i) Since laboratory tests in pregnant women cannot reliably identify fetuses at risk of disease, screening for asymptomatic maternal infection coupled with termination of pregnancy cannot be recommended. (ii) Since ‘immune’ women can still give birth to babies affected by CMV, we propose that future CMV vaccines should be used to immunize children with the aim of eradicating CMV infection in preference to selective immunization of sero‐susceptible females.
The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight
Authors: GODFREY K. M. , REDMAN C. W. G. , BARKER D. J. P. , OSMOND C. 
Published: August 2005

AbstractObjective— To examine the maternal influences which determine large placental weight and a high ratio of placental weight to birthweight. These are known predictors of adult blood pressure.Design— Retrospective analysis of routine obstetric and haematology department records for a large cohort of pregnant women.Setting— John Radeliffe Hospital, Oxford.Subjects— 8684 pregnant women who were delivered between January 1987 and January 1989 and whose records could be linked to the results of two or more pregnancy blood counts.Main outcome measures— Placental weight and the ratio of placental weight to birthweight.Results— Large placental weight was associated with a low maternal haemoglobin and a fall in maternal mean cell volume during pregnancy. The highest ratio of placental weight to birthweight occurred in the most anaemic women with the largest falls in mean cell volume. Large placental weight and a high ratio of placental weight to birthweight were also independently associated with a high maternal body mass index. Maternal smoking reduced placental weight, but increased the ratio of placental weight to birthweight.Conclusions— Anaemia and iron deficiency during pregnancy are associated with large placental weight and a high ratio of placental weight to birthweight. This points to maternal nutritional deficiency as a cause for discordance between placental and fetal growth. This may have important implications for the prevention of adult hypertension, which appears to have its origin in fetal life.
Trophoblast deportation in pre‐eclamptic pregnancy
Authors: CHUA SELINA , WILKINS THURL , SARGENT IAN , REDMAN CHRISTOPHER 
Published: August 2005

AbstractObjectives— To examine the deportation of trophoblast cells into the maternal blood in pre‐eclamptic (gestational proteinuric hypertension) and normal pregnancy.Design— The monoclonal anti‐cytokeratin antibody JMB2 was used in the APAAP technique to label trophoblast cells in cell smears of uterine vein blood obtained at caesarean section.Subjects— 10 women with proteinuric pre‐eclampsia requiring caesarean section, 10 pregnant women requiring elective caesarean section for reasons other than pre‐eclampsia and five control women who had never been pregnant.Results— Three populations of trophoblast cells were identified; two mononuclear cytotrophoblast types with diameters varying from 11–14 μm and 19–25 μm respectively, and multinucleated syncytiotrophoblast cells varying in size from 23–88 μm. Women with pre‐eclampsia had more trophoblast cells in uterine vein blood than were found in pregnant women without pre‐eclampsia. There was no correlation between the numbers of trophoblast cells and the stage of gestation or severity of the pre‐eclampsia, although an acute maternal or fetal event necessitating delivery was associated with increased deportation of trophoblast. Mononuclear cytotrophoblast cells were detected in the peripheral blood of only 1 of 5 pre‐eclamptic patients, despite their presence in the uterine vein blood of all 5 women.Conclusions— Trophoblast deportation is increased in pre‐eclamptic pregnancy, with both cytotrophoblast and syncytiotrophoblast present in the uterine vein blood, but there is no correlation with the severity of the disease. In some cases cytotrophoblast may also enter the peripheral circulation.
Prospective serial study of viral change in the cervix and correlation with human papillomavirus genome status
Authors: KITCHENER H. C. , NEILSON L. , BURNETT R. A. , YOUNG L. , MACNAB J. C. M. 
Published: August 2005

AbstractObjective— To observe in serial fashion the histological changes of human papilloma virus (HPV) infection of the cervix and to correlate these with the detection of HPV genomes.Design— A prospective longitudinal study to perform colposcopy and at 0,9 and 18 months to obtain a smear, a biopsy for histology and HPV‐16 genome detection by DNA/DNA hybridization.Setting— Glasgow Family Planning Centre.Subjects— Eighty‐two women recruited on the basis of a routine smear showing viral change without dyskaryosis.Interventions— Women found to have CIN 3 were treated with laser.Main outcome measures— Cytology and cervical biopsy results and HPV‐16 DNA detection by Southern blotting obtained serially from individual subjects.Results— Of 82 women recruited, 10% were positive for HPV‐16 detection by Southern blotting. Detection of HPV‐16 genomes did not correlate with either CIN or viral infection assessed histologically and serial hybridizations in a given individual showed fluctuation in HPV‐16 detection. Polymerase chain reaction in a subset of samples revealed 46% positive for HPV DNA.Conclusion— No clear correlation exists between HPV genome detection and the histological appearance. HPV‐16 genome detection alone may not be a useful predictor of precancerous progression.
Gamete intrafallopian transfer (GIFT) compared with intrauterine insemination in the treatment of unexplained infertility
Authors: MURDOCH A. P. , HARRIS M. , MAHROO M. , WILLIAMS M. , DUNLOP W. 
Published: August 2005

AbstractObjective— To compare GIFT, intrauterine insemination (IUI) with, and without, ovarian hyperstimulation in the treatment of unexplained infertility.Design— Women randomly allocated to one of three treatment protocols.Setting— Northern Regional Fertility Centre.Subjects— 59 couples with unexplained infertility of more than 3 years duration.Interventions— Three cycles of either GIFT, IUI after ovarian hyperstimulation or IUI in a spontaneous cycle.Main outcome measures— Pregnancy resulting in a live birth.Results— Fecundabilities were 0.12 after GIFT, 0.018 after ovarian hyperstimulation and IUI, and 0.018 after IUI in a spontaneous cycle. The fecundability after IUI was no different from that which would be expected without treatment in these couples but fecundability was significantly better (P>0.02) after GIFT.Conclusions— This trial does not support the use of IUI in the treatment of unexplained infertility but confirms the value of GIFT.
Ureteric obstruction in pregnancy—diagnosis and management
Authors: ECKFORD S. D. , GINGELL J. C. 
Published: August 2005

AbstractObjective— To discuss the aetiology, diagnosis and management of ureteric obstruction in pregnancy and to describe the use of double‐pigtail ureteric stents in a series of 10 patients.Design— Retrospective study of women presenting to a maternity unit in whom the diagnosis of ureteric obstruction is reached.Setting— Southmead Hospital in Bristol; a large district general hospital with a throughput of around 6OOO maternity patients per year.Subjects— 10 women (8 in their first pregnancy, 1 in her second and 1 in her third; mean age 29.2 years (range 18–31 years).Interventions— Double‐pigtail ureteric stents were electively passed after a diagnosis of ureteric obstruction. Stents remained in situ for a mean 15.5 weeks (range 8–25 weeks) and were electively removed 4–6 weeks post partum.Results— Nine women progressed uneventfully through the remainder of their pregnancy. One developed strangury, haematuria and discomfort after stent insertion. Seven women had normal vaginal deliveries, two assisted vaginal deliveries and one was delivered by caesarean section. None required to have external urinary drainage.Conclusions— Double‐pigtail ureteric stents are easy to place and remove and are well tolerated. They provide a simple, safe and effective method of internal upper urinary tract drainage in ureteric obstruction in pregnancy.
Insufficient remodelling of the uterine connective tissue in women with protracted labour
Authors: GRANSTRÖM L. , EKMAN G. , MALMSTRÖM A. 
Published: August 2005

AbstractObjective— To investigate the association between a slow progress of labour and insufficient remodelling of the uterine connective tissue.Design— An open comparative study.Setting— Danderyd Hospital, Department of Obstetrics and Gynaecology, referral centre.Subjects— Eleven women (study group) in oxytocin augmented labour but with an unripe cervix in whom vaginal delivery could not be accomplished and 12 women (normal labour group) in normally progressing spontaneous labour and a favourable cervix but who needed to be delivered by caesarean section due to signs of fetal distress.Interventions— At caesarean section tissue specimens were obtained from the fundus, the isthmus and the cervix uteri.Main outcome measures— Collagen concentration and extractability, collagenolytic activity expressed as DNP‐peptide hydrolytic activity and the concentrations of sulphated glycosaminoglycans (S‐GAG) and hyaluronic acid (HA) in the tissue specimens.Results— Statistically significantly higher concentrations and lower extractability of collagen in the isthmus and the cervix uteri was found in women with slow progress of labour compared with those with normal labour.Conclusions— An insufficient remodelling of the connective tissue in the cervix and isthmus uteri may contribute to slow progress of labour.
Emergency cervical cerclage
Authors: MacDOUGALL JANE , SIDDLE NICHOLAS 
Published: August 2005

AbstractObjective— To assess the efficacy of emergency cervical cerclage.Design— Retrospective review of patients who underwent emergency cervical cerclage between August 1986 and August 1989.Setting— University College and the Middlesex Hospitals obstetric unit, a neonatal referral centre.Subjects— 19 women between 16 and 28 weeks gestation with a cervical dilatation between 3 and 10 cm. There were two twin pregnancies.Interventions— Amniocentesis and bacteriological assessments were performed prior to cerclage and prophylactic antibiotics were given. Insertion of sutures was aided by a combination of techniques described previously.Main outcome measures— Prolongation of gestation and pregnancy outcome. Bacteriological findings at delivery and maternal and fetal morbidity were also recorded.Results— Membranes remained intact in all the women after cerclage. Fifteen live babies were born and 13 of them survived (survival rate 63%). Gestation was prolonged from between 1 and 19 weeks in these patients and the gestational age at delivery ranged from 25 to 41 weeks. All eight intrauterine or neonatal deaths were associated with infection. Infecting organisms included Escherichia coli, Gardnerella vaginalis, Mycoplasma hominis, Trichomonas vaginalis and Fusobacterium spp. Pregnancy was prolonged for <5 weeks in these infected pregnancies. A cervical laceration occurred in a patient who had the suture inserted at full dilatation and subsequently laboured, but there were no other maternal complications.Conclusions— Emergency cervical cerclage can prolong pregnancy and influence the outcome favourably.
Conservative laparoscopic treatment of ectopic pregnancies using the CO2‐laser
Authors: KONINCKX P. R. , WITTERS K. , BROSENS J. , STEMERS N. , OOSTERLYNCK D. , MEULEMAN C. 
Published: August 2005

AbstractObjective—To assess the feasibility of CO2‐laser‐endoscopic surgical treatment for large and/or ruptured ectopic pregnancies, and to compare the results with those of microsurgical salpingotomy.Design—A retrospective review of all women treated for an ectopic pregnancy during a 6‐year period, 1984–1989. During 1988 and 1989 treatment was randomized by the day of admission, depending only upon the surgeon in charge, some performing a linear salpingotomy (n=42) and some a CO2laser laparooscopy (n=34) in all women haemodynamically stable.Setting—Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven.Subjects—135 women with ectopic pregnancies of whom 76 were included in the randomized series between 1988 and 1989. Overall 11 were treated by pelvic lavage, 78 by laparotomy and 46 by laparoscopic procedures.Main outcome measures—Postoperative complications, duration of hospital stay. Cumulative pregnancy rates after the procedures.Results—The two groups of women analysed in the randomized series were comparable for duration of amenorrhoea, diameter of the ectopic pregnancy and prevalence of ‘ruptured’ ectopics, but the duration of stay in hospital was much shorter (mean 2–9, SD 1.8 days) for the 34 women treated by laparoscopy than for the 42 women treated by laparotomy (mean 6.8, SD 1.6 days). The postoperative cumulative pregnancy rate was higher in nulliparous women with a history of infertility or pelvic inflammatory disease (PID), when treated with CO2‐laser‐laparoscopy (P=0.009). The recurrency rate was low (<5% in both groups). Overall in the women treated by laparotomy, postoperative cumulative pregnancy rates were lower following excision or adnexectomy than after a microsurgical linear salpingotomy (P=0.01). Four women treated by laparoscopy required a second procedure.Conclusion—Endoscopic treatment of large and/or ruptured ectopic pregnancies is feasible and resulted in a shorter hospital stay and, in nulliparous women with a history of PID or infertility, in higher cumulative pregnancy rates, than after microsurgical salpingotomies.
An audit of the management of ectopic pregnancy
Authors: NORMAN S. G. 
Published: August 2005

AbstractObjective— To estimate the local incidence of ectopic pregnancy and to review the management of ectopic pregnancy with reference to those misdiagnosed at presentation. To establish management guidelines to be applied to all possible ectopic pregnancies.Design— A review of all ectopic pregnancies presenting over a 2‐year period, and of emergency gynaecological admissions during 4 months.Setting— A teaching hospitalResults— The local rate of ectopic pregnancy was similar to that seen in other UK studies. Nineteen (13%) women with ectopic pregnancies were sent home with an incorrect diagnosis. Eight were recalled but eight required emergency admission and one died at home. Undue confidence in ultrasound reports and failure to follow up inconclusive histology results were a feature in cases where patients were not recalled. A set of simple management guidelines has been drawn up. Amongst general gynaecological admissions 1 in 12 of all first trimester complications was an ectopic pregnancy. Amongst apparently true uterine miscarriages 20% of histological examinations were inconclusive and histology and ultrasound examinations failed to confirm a uterine miscarriage in 14% of apparently true missed miscarriages.Conclusions— Ectopic pregnancy is common amongst first trimester complications. Adherence to simple management guidelines would minimize the number of patients requiring emergency admission, though up to 20% of patients with apparently true uterine miscarriages would also require further investigation.