bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy induced hypertension and sodium pump function in erythrocytes
Authors: MACPHAIL S. , THOMAS T. H. , WILKINSON R. , DAVISON J. M. , DUNLOP W. 
Published: August 2005

ABSTRACTObjective
To determine if erythrocyte sodium pump function is altered with the onset of pregnancy induced hypertension.Design
A prospective descriptive study.Subjects
Thirty‐two primigravid women with pregnancy‐induced hypertension (17 had proteinuria) and 32 gestation‐matched normotensive primigravid pregnant women were studied and measurements repeated 20 weeks after delivery.Intervention
Erythrocyte sodium, ouabain‐sensitive sodium flux and the sodium pump rate constant were measured in whole blood and the maximum velocity and sodium affinity of the sodium pump were measured in vitro.Results
Blood pressure remained higher after delivery in the women who had been hypertensive during pregnancy. In normal pregnancy erythrocyte sodium was decreased, and ouabain‐sensitive sodium flux, the sodium pump rate constant and maximum velocity (Vmax) were increased compared with 20 weeks after delivery. In pregnancy‐induced hypertension erythrocyte sodium and sodium pump changes were the same as in normal pregnancy. The possibility of a positive association between changes in erythrocyte sodium and in blood pressure was excluded. The rate constant of the sodium pump in blood was related to its Vmax measured in vitro but the relation had greater variance in the hypertensives with 7 of the 32 women having rate constants greater than expected from their Vmax.Conclusion
There was no evidence of sodium pump inhibition or a rise in intracellular sodium associated with increased blood pressure in pregnancy. There may have been stimulation of the sodium pump by a plasma factor in some hypertensive woman.
Role of prostaglandin in the management of prelabour rupture of the membranes at term
Authors: MAHMOOD T. A. , DICK M. J. W. , Smith N. C. , TEMPLETON A. A. 
Published: August 2005

ABSTRACTObjectiveTo compare conservativeversusprostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term.DesignA prospective randomized study.SettingLabour Ward, Aberdeen Maternity Hospital.Subjects230 primigravidae at term with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment.InterventionsIn the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses.Main outcome measuresPROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity.ResultsThere was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2gel and fewer women in the PGE2group required oxytocin augmentation (31%vs51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section.ConclusionThe early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.
Determinants of caesarean section rates in Italy
Authors: PARAZZINI FABIO , PIROTTA NICOLETTA , LA VECCHIA CARLO , FEDELE LUIGI 
Published: August 2005

ABSTRACTObjective
To analyse the determinants of caesarean section rates in Italy.Design
Analysis of information using a standard form on all the deliveries after the 28th week of gestation routinely collected by the Italian Central Institute of Statistics.Setting
National data of all Italian deliveries in the periods 1980–1983.Subjects
A total of more than 2 400 000 deliveries occurred in Italy in the period and are considered in this analysis.Results
The frequency of caesarean section rose from 11.2/100 deliveries in 1980 to 14.5/100 in 1983. Caesarean section rates were lower in the Southern (less rich) areas, and rose steadily with maternal age, being about three times higher in women aged ≥40 years than in teenagers. Maternal education was directly associated with caesarean section rates: compared with women with only primary school education, those with a college education reported an about 40% higher rate of caesarean section, but this difference dropped markedly after allowance for maternal age and birth‐weight. The section rate was 13.3/100 deliveries in public hospitals and 11.8/100 in private ones, but this reflected the different utilization of public and private services in various geographical areas. Birthweight and gestational age at delivery were important determinants of caesarean section rates; lowest values were observed for very‐low‐birthweight and very preterm deliveries and babies weighing 3000–3999 g and term deliveries. Caesarean section rates were about 20% higher in nulliparous than in parous women and the rates increased with number of stillbirths or miscarriages; further, the rate ratio was about double in multiple than in single births.Conclusion
Caesarean section rates in Italy in the early 1980s were still lower than in North America, but their determinants share several similarities with those reported in other areas.
Labour induction policy in hospitals of different levels of specialisation
Authors: Järvelin Marjo Riitta , Hartikainen‐Sorri Anna‐Liisa , Rantakallio Paula 
Published: August 2005

ABSTRACTObjective
To examine indications for the induction of labour and variations in the current policy of induction at different levels of obstetric specialisation and to compare the outcome of induced and spontaneous labour.Design
A prospective 1 year birth cohort.Setting
Maternity hospitals in the two northernmost administrative provinces of Finland, including one university hospital and three central hospitals, three local hospitals and five health centres.Subjects
Eight thousand six hundred and six singleton pregnancies, including 1679 with induced labour.Main outcome measure
Data collection on age, parity, social factors and education at antenatal clinic. Data on labour collected from the hospital records after delivery.Results
Labour was induced significantly more often at units of the lowest level of specialisation, the health centres (29.4%) than at the local hospitals (23.6%, P<0.003) or in the most specialised central hospitals (17.7%, P<0.0001). Cases of induced labour accumulated on working days. Indicative reasons, such as maternal or fetal conditions, comprised 45.0% of the indications for induction, the most common causes being elective reasons, e.g. timing of labour (51.3%). The risk of elective induction was 2.6 times greater at the primary care level than at the central hospitals (95% confidence limit, CL 2.0.3.2). The corresponding risk ratio for local hospitals was 1.8 (CL 1.5–2.1). The risk of caesarean section was 1.5 times greater in the elective induction group than in the spontaneous group (CL 1.1–1.9) and 2.9 times greater in the indicative induction group. The most common indication for caesarean section was dysfunctional, arrested labour; causes such as fetal asphyxia or antenatal haemorrhage were not seen in excess.Conclusion
The practice of induction of labour are not consistent in different hospitals. The opinions of individual practitioners and staff routines influence the induction policy nearly as much as do medical reasons. Despite the safety of induction, a liberal induction policy leads to an increase in operative deliveries creating potential risks for the mother and child and greater expense.
An alternative to hysterectomy? GnRH analogue combined with hormone replacement therapy
Authors: Gangar Kevin F. , Stones R. William , Saunders Dawn , Rogers Vera , Rae Toni , Cooper Susan , Beard Richard W. 
Published: August 2005

ABSTRACTObjective
To assess whether GnRH analogues are effective in relieving pelvic pain and congestion and whether menopausal symptoms caused by GnRH analogues can be minimised by supplementation with low dose continuous combined hormone replacement therapy (HRT).Design
Open prospective study.Setting
Tertiary referral clinic at a teaching hospital.Patients
Twenty‐one women with chronic pelvic pain.Intervention
Four months’ therapy with goserelin 3.6 mg/month combined with continuous oestradiol valerate 1 mg daily and medroxyprogesterone acetate 5 mg daily.Main outcome measures
Visual analogue scale for pain, menopausal symptoms, bleeding patterns, uterine area, endometrial status, oestradiol concentrations and venogram scores.Results
Amenorrhoea was maintained in all but two women. Endometrial atrophy was maintained despite HRT supplementation. Two women had moderate menopausal symptoms but none had severe symptoms. Significant reduction of uterine cross sectional area was maintained throughout the study. There was no significant relief of pain.Conclusions
HRT supplementation of GnRH analogues abolishes menopausal symptoms and thus may improve patient acceptability. Potentially beneficial effects such as endometrial atrophy, reduction of uterine volume and amenorrhoea were not negated by HRT. This combination is not effective in the treatment of chronic pelvic pain and congestion.
Plasminogen activator inhibitors (PAI‐1 and PAI‐2) in normal pregnancies, pre‐eclampsia and hydatidiform mole
Authors: Reith A. , Booth N. A. , Moore N. R. , Cruickshank D. J. , Bennett B. 
Published: August 2005

ABSTRACTObjective
To examine the behaviour of the major inhibitors of fibrinolysis (PAI‐1 and PAI‐2) in normal pregnancy and pregnancy complicated by either pre‐eclampsia or hydatidiform mole.Design
Prospective study.Setting
Antenatal Clinic and Maternity Hospital.Subjects
Eleven women with established pre‐eclampsia and eleven women, matched by age, parity, and duration of pregnancy who were undergoing uncomplicated pregnancy. Two women having surgery for hydatidiform mole.Main outcome measure
Plasma levels of PAI‐1 and PAI‐2 antigens determined by sensitive specific ELISA. Functional identification of PAI‐2 by nondenaturing gel electrophoresis with overlay zymography.Results
In pre‐eclampsia PAI‐2 antigen was significantly lower than in normal pregnancy (105.3 ± 34.9 versues 187.1 ± 67.9 ng/ml; P<0.001). In contrast PAI‐1 antigen was significantly higher in pre‐eclampsia than in normal pregnancy (170.7 ± 71.2 versus 113.8 ± 35.6 ng/ml; P<0.05). In consequence the ratio of PAI‐1/PAI‐2 increased markedly in pre‐eclampsia (2.5 versus 0.6). No PAI‐2 was detected in plasma of women with hydatidiform moles.Conclusions
PAI‐2 levels fell significantly in pre‐eclampsia probably as a result of decreased placental mass or function. The raised PAI‐1 level in pre‐eclampsia may reflect a response to hypertension or renal damage that is not specific to pregnancy or may reflect altered placental function. The use of the ratio of PAI‐1/PAI‐2 assists in separating normal from abnormal pregnancies.
Alterations in erythrocyte chloride content accompanying the changes in erythrocyte hydration and potassium content in normal human pregnancy: a comparison with pregnancy induced hypertension
Authors: Bolton L. M. , Thomas T. H. , Macphail S. , Taylor A. , Davison J. M. , Dunlop W. 
Published: August 2005

ABSTRACTObjectives
To determine whether the change in erythrocyte potassium content in normal human pregnancy is accompanied by a similar change in erythrocyte chloride content. To assess erythrocyte hydration and potassium and chloride content in pregnancies complicated by proteinuric pregnancy induced hypertension.Design
A serial study during and after normal pregnancy. A comparative study during and after pregnancies complicated by proteinuric pregnancy induced hypertension (PIH). Erythrocyte hydration, total osmoles, potassium and chloride and plasma osmolality were determined.Setting
University teaching hospital, UK.Subjects
Twenty‐eight women studied at 14, 28 and 36 weeks of normal pregnancy and ten women with PIH studied during the third trimester of pregnancy. All women were reinvestigated 20 weeks after delivery.Results
The fall of erythrocyte potassium early in normal pregnancy (277.4 vs 265.2 mmol/kg; P<0.02) and its rise between 28 and 36 weeks (272.3 vs 288.0 mmol/kg; P<0.005) were accompanied by similar changes in erythrocyte chloride content (151.9 vs 131.1 mmol/kg; P<0.001 and 129.4 vs 141.3 mmol/kg; P<0.001, respectively). Plasma osmolality in PIH was raised above that normal in pregnancy (287.2 vs 283.0 mosm/kg; P<0.005). In PIH, compared to normal pregnancy, erythrocyte hydration (2.00 vs 1.89 l/kg dry weight cells), total osmoles (573.0 vs 534.2 mosm/kg), potassium (303.0 vs 288.0 mmol/kg) and chloride (154.9 vs 141.3 mmol/kg) were greater.Conclusions
These findings further support the hypothesis that changes in plasma osmolality in pregnancy are secondary to alterations in cell osmoles and serve to limit changes in cell hydration. Erythrocyte composition and plasma osmolality are altered in PIH.
Neural tube defects and serum zinc
Authors: Hambidge Michael , Hackshaw Allan , WALD Nicholas 
Published: August 2005

ABSTRACTObjective
To investigate the relationship of zinc in the causation of neural tube defects and so explore the possible role as a cause of these defects.Design
Stored serum samples collected as part of the Medical Research Council's multicentre randomised trial§ of vitamin supplementation in the prevention of neural tube defects were retrieved in respect of women who had had an affected pregnancy together with four matched unaffected controls per case. One control was selected from each of the four randomisation groups: 1. no extra vitamins; 2. folic acid supplementation alone; 3. folic acid and other vitamin supplementation; and 4. other vitamin supplementation, such that it was matched with an NTD case by study centre, maternal age (the year of birth differed at most by one year) and duration of storage of the serum sample (in most instances to within the same year).Setting
A prospective case‐control study using serum samples stored at ‐40°C. The serum samples were collected from women at entry to the trial, immediately before the women became pregnant and at about 12 weeks of pregnancy.Subjects
Twenty‐seven women with a pregnancy associated with a neural tube defect and 108 matched controls with unaffected pregnancies.Results
There was no association between serum zinc levels and neural tube defects; the mean values in μg/dl were: 82 and 85 in cases and controls, respectively, at entry to the study; 86 and 87 μg/dl just before pregnancy; and 76 and 80 μg/dl in the first trimester of pregnancy. Folic acid supplementation did not have an effect on serum zinc levels.Conclusion
Within the range of serum zinc levels observed among women in our study, serum zinc is not a cause of neural tube defects, and periconceptional folic acid supplements do not compromise the zinc status of the mother or the embryo with respect to zinc intake.
Sweeping the membranes: a valid procedure in stimulating the onset of labour?
Authors: Allott Helen A. , Palmer Christopher R. 
Published: August 2005

ABSTRACTObjective
To determine whether sweeping the membranes in pregnancies of longer than 40 weeks gestation results in an accelerated onset of labour and a reduction in the incidence of induction of labour.Design
A prospective randomised controlled study.Setting
The antenatal clinic of a district general hospital.Subjects
One hundred and ninety‐five antenatal women with pregnancies proceeding beyond 40 weeks gestation.Interventions
A Bishop score assessment of the cervix alone or combined with a membrane sweep, on a randomised basis.Outcome measures
Subsequent duration of pregnancy to the onset of spontaneous labour. The incidence of induction of labour for post‐maturity.Results
Sweeping the membranes significantly reduces the subsequent duration of pregnancy, from an average of five days to two days following the procedure. The proportion of inductions of labour was 8.1 % in the swept group and 18.8% in the control group. No harmful side effects to the procedure were noted.Conclusions
Sweeping the membranes is a safe and useful procedure which results in a reduced incidence of post‐mature pregnancies, and a subsequent reduction in the labour induction rate.
Undiagnosed breech
Authors: Nwosu Ezechi Cally , Walkinshaw Steve , Chia Philip , Manasse Paul R. , Atlay Robert D. 
Published: August 2005

ABSTRACTObjectives
To assess the proportion of breech presentations diagnosed in labour and to compare their outcomes with those diagnosed prior to the onset of labour.Design
Retrospective casenote review.Setting
Mill Road Maternity Hospital, a teaching hospital in central Liverpool.Subjects
Three hundred and five singleton breech presentations delivered in the hospital between January 1988 and July 1991; 226 cases prior to the onset of labour and 79 cases diagnosed for the first time in labour.Main outcome measures
Rates of vaginal delivery and caesarean section, birthweight, short term morbidity as assessed by trauma, signs of cerebral irritation and admission to the newborn intensive care unit (NBICU), and Apgar scores.Results
Breech presentations diagnosed for the first time in labour were more likely to deliver vaginally than those assessed and allowed to go into labour (odds ratio 1:68 95% CI 1.0–3.0). This difference was not due to demographic variables or differences in birthweight. There was no short term morbidity attributable to vaginal breech delivery.Conclusion
A significant number of breech presentations are not detected until labour despite rigorous antenatal surveillance. Our results show that undiagnosed breeches may not be important as they are more likely to deliver vaginally, with no excess morbidity or mortality, compared to diagnosed breeches in labour, carefully assessed for vaginal delivery. There are, therefore, no grounds for delivering all undiagnosed breeches by caesarean section.
Experience of autologous blood transfusion in an obstetrics and gynaecology department
Authors: O'Dwyer Gearoid , Mylotte Michael , Sweeney Maura , Egan Ernest L. 
Published: August 2005

ABSTRACTObjective
To demonstrate the potential and effectiveness of autologous blood transfusion in an obstetric and gynaecological practice.Setting
The Department of Obstetrics and Gynaecology and the department of Haematology, University College Hospital, Galway, Ireland.Subjects
One hundred and sixty‐eight women undergoing abdominal hysterectomy, 42 women undergoing repair procedures, and 56 women undergoing elective caesarian sections participated in this programme.Results
In the abdominal hysterectomy group 329 units of blood were collected of which 48% were transfused to the donors. In the repair group 82 units of blood were collected of which 21.9% were transfused to the donors. In the elective caesarian section group 105 units of blood were collected of which 64.7% were transfused to the donors. Overall the donation procedure was well tolerated with infrequent donor reactions.Conclusion
Our experience demonstrates that autologous blood transfusion is a safe and reasonable transfusion practice in the setting of obstetrics and gynaecology.
Prediction of perinatal morbidity at term in small fetuses: comparison of fetal growth and Doppler ultrasound
Authors: Chang Tou C. , Robson Stephen C. , Spencer John A. D. , Gallivan Steven 
Published: August 2005

ABSTRACTObjective
To compare fetal growth assessed by ultrasound (change in standard deviation score of abdominal circumference and estimated fetal weight) during the third trimester with predelivery ultrasound measurements of fetal size and Doppler measurements from the umbilical and fetal arteries in order to predict suboptimal perinatal outcome in small babies at term.Design
Prospective observational study.Setting
Day assessment unit in a university hospital.Subjects
One hundred and four consecutive women with a clinical suspicion of a small fetus during the third trimester confirmed by ultrasound (abdominal circumference below the 10th centile) and ultimately delivered at term.Main outcome measures
Acidaemia at birth, fetal distress requiring emergency caesarean section in labour, admission to the neonatal intensive care unit.Results
Ninety‐four babies (90%) weighed less than the 10th centile and the incidence of suboptimal perinatal outcome was 27%. The largest areas under the receiver operating characteristic curves for suboptimal perinatal outcome were obtained with the change in standard deviation score of abdominal circumference and estimated fetal weight, and the ratios of aortic/middle cerebral and renal/middle cerebral pulsatility index. Although low, the odds ratios of the change in estimated fetal weight standard deviation score and the Doppler ratios were significantly different from zero.Conclusion
Ultrasound assessment of fetal growth and predelivery fetal Doppler pulsatility index ratios were superior to predelivery estimates of fetal size and umbilical artery pulsatility index in predicting suboptimal perinatal outcome in small fetuses delivering at term, although the clinical value of such a prediction may be limited.
Reduction of pain after laparoscopic sterilisation with local bupivacaine: a randomised, parallel, double‐blind trial
Authors: Wheatley S. A. , Millar J. M. , Jadad *A. R. 
Published: August 2005

ABSTRACTObjective
To investigate the efficacy of applying 10 ml bupivacaine 0.5%versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia.Design
Randomised, parallel, double‐blind controlled trial.Setting
Day Surgery Unit.Subjects
Sixty women presenting for day case laparoscopic sterilisation.Main outcome measures
Time to first post‐operative analgesia, and pain levels at 1 h, at discharge, and at time of first analgesia.Results
In the group receiving bupivacaine, time to first analgesia was significantly longer (P= 0.03) and significantly fewer patients requested escape analgesia before the 1 h assessment (P= 0.01). This group also had significantly less pain on visual analogue scale (P= 0.04) and significantly lower categorical verbal pain scores (P= 0.01) at the 1 h assessment. By the time of discharge, there were no significant differences between the groups. Eight women in the saline group and 15 in the bupivacaine group required no escape analgesia. This difference was not significant. One woman who received saline required to be admitted overnight for severe pain.Conclusion
Topical application of bupivacaine to the fallopian tubes during laparoscopic sterilisation is an easy and effective contribution to the management of pain in the immediate post‐operative period after day case laparoscopic sterilisation under general anaesthesia.