bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal genetic services for Down's syndrome: access and provision in 1990–1991
Authors: Williamson P. , Harris R. , Church S. , Fiddler M. , Rhind J. ,   on behalf of the Steering Committee of the National Confidential Enquiry into Counselling for Genetic Disorders
Published: August 2005

Objective
To examine access to and provision of prenatal genetic services relating to Down's syndrome.Design
Retrospective review of obstetric casenotes.Sample
Pregnancies involving Down's syndrome in England and Wales in 1990–1991 in women aged 38 or over. Information was obtained in 430 cases from a questionnaire completed by the obstetric team who were asked to provide details based only on documentation in the antenatal casenotes. The outcome of pregnancy was a termination in 268 (62%) cases, a liveborn child with Down's syndrome in 144(34%), a stillbirth in 9(2%), a miscarriage in 8(2%) and in one case was not known.Results
Overall, prenatal diagnosis was not offered in 7% pregnancies (95% CI: 4.4–9.2%) with late booking given as the main reason. Of women offered prenatal diagnosis, 76% accepted (95% CI: 72.3–80.6%). Counselling was documented before prenatal diagnosis in 89% of cases (95% CI: 86.0–92.3%) and after the procedure, to discuss the results, in 73% (95% CI: 67.5–77.7%). In 10% of pregnancies terminated for Down's syndrome, fetal products were not sent to the laboratory. There was no report of a normal fetus having been terminated as a consequence of incorrect prenatal diagnosis. However, in 10% (95% CI: 5.9 to 14.0%) of cases examined in the laboratory, the diagnosis of Down's syndrome could not be confirmed. Details of prenatal diagnosis were not provided in five cases where a child with Down's syndrome was born. Of the remaining 139 livebirths, prenatal diagnosis was not offered in 27 (19%) cases, offered and declined in 92 (66%) and accepted in 20 (14%). In two cases a normal fetal karyotype was reported following prenatal diagnosis.Conclusions
The study has demonstrated that in 1990–1991: 1. There were certain shortcomings in the documentation of antenatal care; 2. Late booking was the main factor precluding the offer of prenatal diagnosis to women aged 38 or over, and 3. The rate of confirmation of Down's syndrome in terminated fetuses was incomplete.
Head‐to‐cervix force: an important physiological variable in labour. 2. Peak active force, peak active pressure and mode of delivery
Authors: Allman Andrew C. J. , Genevier Eric S. G. , Johnson Mark R. , Steer Philip J. 
Published: August 2005

Objective
To assess the relation between peak active (above baseline) head‐to‐cervix force (paHCF) and peak active (above baseline) intrauterine pressure (paIUP) in labour, and to compare the relation between labours progressing well and ending in vaginal delivery and those labours progressing slowly and ending in caesarean section.Design
Prospective observational study.Setting
The labour ward of a London teaching hospital.Participants
Forty women in labour who agreed to have an experimental head‐to‐cervix force probe and an intrauterine pressure catheter inserted.Results
The relation was linear, with a correlation coefficient which ranged from 0.012 to 0.885 (mean value 0.438). The closeness of the relation did not correlate with the rate of cervical dilatation (r = 00192, P= 0.574) or the mode of delivery (r = 0.215, P= 0.183). However, in women who progressed well to a vaginal delivery, the mean slope of the paHCF to paIUP regression line was 0.72, significantly steeper than in women who progressed slowly and required delivery by caesarean section (mean slope = 0.45, t = 2.31, P= 0.02). Mean paIUPs were significantly higher in women progressing well and achieving a vaginal delivery than in those progressing slowly and requiring caesarean section (45.3 mmHg SD 7.5 vs 38.4 mmHg SD11.4, t = 2.31, P= 0.02), but the overlap between the two groups was considerable. However, in keeping with their steeper paHCF/paIUP slope, women progressing well to a vaginal delivery had substantially higher head‐to‐cervix forces (46.4 gWt SD 11.8 vs 28.3 gWt SD 8.2, t = 5.22, P < 0.00001) than those progressing slowly and requiring caesarean section, and there was much less overlap between paHCF than paIUP. This resulted in paHCF being a much better discriminating variable than paIUP for mode of delivery.Conclusions
The relation between paHCF and paIUP is linear, but there is a wide variation in the degree of correlation between one woman and another. Women with a steep slope of paHCF relative to paIUP are more likely to achieve a high mean paHCF, progress rapidly in labour and achieve a vaginal delivery than women with a flap slope, although mean paIUPs do not differ substantially between the two groups. The level of paHCF was substantially better than cervical dilatation rate at predicting mode of delivery. These results suggest that head‐to‐cervix force is sensitive to factors determining mode of delivery which are not reflected in either the level of uterine activity as measured by intrauterine pressure, or cervical compliance as measured by cervical dilatation rates.
Risk factors and fetal outcome in cases of shoulder dystocia compared with normal deliveries of a similar birthweight
Authors: Bahar Ahmed Mohammed 
Published: August 2005

Objective
To compare risk factors and fetal morbidity in deliveries complicated by shoulder dystocia with deliveries of similar infant birthweights but not complicated by shoulder dystocia.Design
A retrospective case‐controlled study.Setting
Kuwait Maternity Hospital.Participants
Sixty‐nine cases of true shoulder dystocia and 138 controls matched for exact infant's birth‐weight.Methods
Demographic data and data regarding history of previous shoulder dystocia, diabetes mellitus, labour course, method of delivery and newborns' condition were collected from patients and case notes following delivery. The mothers' height and weight were measured. Oral glucose tolerance test were performed on patients who were not known as diabetics. The infants' head and chest circumferences and bisacromial diameter were measured.Results
There were no significant differences between cases and controls when mean age, parity, height, weight and gestational ages were compared. The cases demonstrated a higher incidence of previous shoulder dystocia (P < 0.01), diabetes mellitus (P < 0.001), use of oxytocin for acceleration of labour (P < 0.01) and operative vaginal deliveries (P < 0.01). Differences between cases and controls in their newborn infants' head and chest circumferences were not significant, but the newborns of cases have a longer mean bisacromial diameter and a shorter head circumference: bisacromial diameter ratio (P < 0.001 and P < 0.001, respectively). Thirty‐seven infants (53.6%) from cases and two from controls (1.4%) sustained birth injuries. There were two stillbirths among the cases.Conclusions
Although fetal macrosomia is the principal risk factor for shoulder dystocia, other important risk factors include diabetes mellitus, previous history of shoulder dystocia, prolonged labour, delay in the second stage of labour and fetal shoulder width which appear to be independent of fetal weight.
Combining nuchal translucency with umbilical Doppler velocimetry for detecting fetal trisomies in the first trimester of pregnancy
Authors: Martinez J. M. , Borrell A. , Antolin E. , Puerto B. , Casals E. , Ojuel J. , Fortuny A. 
Published: August 2005

Objective
The aim of our study was to evaluate whether the combined use of umbilical artery pulsatility index (UAPI) and nuchal translucency (NT) measurements would be useful in the prediction of fetal chromosomal abnormalities at 10 to 13 weeks of gestation.Design
A prospective study.Population and methods
Five hundred and fifty‐three consecutive women with singleton pregnancies between 10 and 13 weeks of gestation, who underwent chorionic villus sampling at our institution. UAPI and fetal NT thickness were measured immediately before the invasive procedure. Pregnancies in which structural malformations had been detected by ultrasound were excluded.Results
Using the 95th centile and 3 mm as the cutoffs for UAPI and NT, respectively, the detection rate for all chromosomal anomalies was 84.2%, with a false positive rate (1‐specificity) of 6.6%, a positive predictive value of 31.3%, and a negative predictive value of 99.4%. Out of the 553 tested pregnancies 502 had both parameters within the normal range and only three of them (0.6%) were chromosomally abnormal; in six of the eight cases (75%) in which both parameters were abnormal a chromosome anomaly was present. Of the 43 cases in which only one parameter was abnormal, 10 were chromosomally abnormal (23.2%).Conclusions
Our results suggest that the presence of chromosomal anomalies may be strongly suspected when an increased NT thickness (NT 3 mm) is associated with an abnormally high UAPI at 10 to 13 weeks of gestation. The number of cases studied is small, however, and these conclusions are tentative and preliminary. The value of a single measurement of NT and UAPI for screening purposes needs to be substantiated by further investigation.
Fetal Rhesus D genotyping on amniocytes in alloimmunised pregnancies using fluorescence duplex polymerase chain reaction
Authors: Crombach †Gerd , Picard Frauke , Beckmann Matthias , Resident Boris Tutschek , Bald Reiner , Niederacher Dieter 
Published: August 2005

Objective
1. To establish the reliability of fetal amniocyte Rhesus D (RhD) genotyping using fluorescence duplex polymerase chain reaction (PCR) and 2. to assess the potential clinical impact on management of alloimmunised pregnancies.Design
Multicentre observational study.Setting
Four departments of obstetrics and gynaecology in Germany.Methods
Fourty‐four amniotic fluid samples were obtained by amniocentesis from a retrospective group of 27 RhD alloimmunised pregnancies and 15 samples from 14 women treated prospectively. Two RhD gene specific fragments (exon 7 and 10) were amplified using two separate fluorescence duplex PCR assays, and laser detected in an automated DNA sequence analyser.Results
Amplification of the Rh gene sequences was successful in all samples. PCR at the two RhD gene regions resulted in complete concordance. Genotyping correctly predicted the RhD status of all fetuses serotyped (n= 41). After intrauterine transfusions, PCR identified the RhD type of two fetuses more accurately than serotyping. Earlier knowledge of a negative RhD status would have rendered unneccessary 12 amniocenteses in four fetuses of the retrospective study group, and pre‐ vented further invasive testing in one fetus treated prospectively. In the latter group, women with a positive fetal RhD genotype underwent intensive prenatal care including serial invasive monitoring and intrauterine treatment.Conclusions
Fetal RhD genotyping of amniocytes is a reliable technique with the potential to improve routine management of alloimmunised pregnant women.
Ripening and dilatation of the unfavourable cervix for induction of labour by a double balloon device: experience with 250 cases
Authors: Atad Jack , Hallak Mordechai , Ben‐David Yehuda , Auslender Ron , Abramovici Haim 
Published: August 2005

Objective
To determine the efficacy of the double balloon device (the Atad Ripener Device) in ripening and dilatation of the unfavourable cervix for induction of labour.Methods
Two hundred and fifty women with unfavourable cervices (Bishop score 4) underwent induction of labour with the Atad Ripener Device. Indications were pregnancy induced hypertension (n= 118), post‐dates (n= 69), elective inductions (n= 23), other reasons including nonreassuring nonstress test, intrauterine growth retardation, previous caesarean section and diabetes mellitus (n= 40). The Atad Ripener Device was inserted into the cervix, the uterine balloon inflated in the internal os, and the cervico‐vaginal balloon in the external os of the cervix (100 mL of normal saline to each balloon). Pressure produced by the inflated balloons caused gradual dilatation and effacement of the cervix. The Atad Ripener Device was removed 12 h after insertion, the cervix assessed again, and labour managed according to obstetrical criteria.Results
The Atad Ripener Device caused an increase in the Bishop score in all subgroups with a mean change of 4.6 (from 2.0 prior to induction to 6.6 upon removal of the Atad Ripener Device; P < 0.05). The mean time interval from insertion of the Atad Ripener Device to delivery was 18.9 h, and from removal to delivery was 6.9 h. Caesarean section was performed in 39/250 patients (16%), and the others had a normal vaginal delivery.Conclusions
1. The double balloon device induces significant ripening and dilatation of the unfavourable cervix. 2. Induction of labour was successfully achieved following removal of the Atad Ripener Device. 3. Our caesarean section rate was low compared with rates reported for women with an unfavourable cervix induced by other methods.
Reversal of sterilisation by the railroad technique
Authors: Edozien L. C. , Anastassopulos D. , Mander A. M. 
Published: August 2005

Objective
To show that a simple, easily learned and relatively inexpensive method of reversal of sterilisation provides good results.Design
Retrospective observational study.Setting
An NHS Trust Hospital.Sample
Sixty‐seven women aged 19 to 39 years who underwent reversal of sterilisation between January 1984 and December 1993.Main outcome measures
Pregnancy rate following reversal; rate of ectopic pregnancy.Results
Thirty‐four women (51%) had intrauterine pregnancies after reversal of sterilisation; intrauterine pregnancy rate in women who had been sterilised with rings or clips was 64%. Five women (7.5%) had ectopic pregnancies.Conclusion
This technique provides results that compare favourably with those of microsurgery. It offers hope to couples who do not meet the restrictive criteria for microsurgery and in vitro fertilisation and should appeal to purchasing authorities.
Loss of endothelium‐dependent relaxation in myometrial resistance arteries in pre‐eclampsia
Authors: Ashworth Janet R. , Warren Averil Y. , Baker Philip N. , Johnson Ian R. 
Published: August 2005

Objective
To measure endothelium‐dependent relaxation in myometrial resistance arteries and to compare this parameter in nonpregnant and normotensive pregnant women and those with pregnancies complicated by pre‐eclampsia.Design
A prospective study.Setting
Nottingham City Hospital.Sample
Thirty‐seven nonpregnant women undergoing hysterectomy and 51 pregnant women undergoing caesarean section, of whom there were 39 normotensive and 12 with pre‐eclampsia.Methods
Resistance arteries, dissected from myometrial biopsies, were mounted on a wire myograph and preconstricted with vasopressin then subjected to incremental doses of bradykinin.Results
Endothelium‐dependent relaxation to bradykinin was seen in the vessels of nonpregnant and normotensive pregnant women. Markedly reduced endothelium‐dependent relaxation was found in the myometrial arteries from women with pre‐eclampsia when compared with both nonpregnant (P < O.000l) and normotensive pregnant (P < 0.0001) women.Conclusion
A significant loss of endothelium‐dependent relaxation in myometrial resistance arteries in pre‐eclampsia may contribute to the altered vasoreactivity seen in pre‐eclampsia, and particularly to the decreased placental perfusion and fetal growth retardation commonly associated with this condition.
Continuous transdermal oestrogen and interrupted progestogen as a novel bleed‐free regimen of hormone replacement therapy for postmenopausal women
Authors: Cameron Sharon T. , Critchley Hilary O. D. , Glasier Anna F. , Williams Alistair R. , Baird David T. 
Published: August 2005

Objective
To investigate the effects of a hormone replacement therapy regime of continuous oestrogen and interrupted progestogen, administered transdermally, on the endometrium of postmenopausal women, the pattern of bleeding and relief of menopausal symptoms.Design
Volunteer pilot study of up to six months duration involving weekly application of an oestrogen‐only skin patch releasing 50 μg oestradiol per day interspersed with a combined oestrogen and progestogen patch releasing 50 μg oestradiol and 250 μg norethisterone acetate per day for three days. Transvaginal ultrasound measurements of endometrial thickness and endometrial biopsies were performed in the third month of treatment at the end of both an oestrogen‐only phase of treatment and a combined oestrogen‐progestogen phase.Setting
Specialist community menopause clinic, Dean Terrace Centre, Edinburgh.Participants
Fifteen healthy postmenopausal women.Main outcome measures
Effect of treatment on endometrial histology, the immunolocalisation of oestrogen and progesterone receptors and the cell proliferation marker Ki 67 after three months of treatment and the proportion of women without bleeding at six months.Results
Treatment provided relief of hot flushes and by the sixth month of study 10 of the 14 women who completed treatment had no vaginal bleeding (71 %). No endometrial hyperplasia or atypical changes were observed in biopsies and ultrasound measurements of endometrial thickness demonstrated a thin endometrium. Reduced immunostaining for Ki 67 was observed in endometrium from the combined phase of treatment compared with the oestrogen‐only phase, consistent with a progestogenic‐antagonism of proliferation. Exposure to progestogen did not suppress steroid receptors as similar immunostaining was observed in both treatment phases.Conclusions
Continuous oestrogen and interrupted progestogen administered transdermally offers promise as a novel bleed‐free hormone replacement therapy for postmenopausal women.
The fetal aortic pressure pulse waveform in normal and compromised pregnancy
Authors: Mori Akira , Trudinger Brian , Mori Ranko , Reed Vivienne , Takeda Yoshihiko 
Published: August 2005

Objective
To study the arterial pressure waveform in the descending thoracic aorta during pregnancy in both normal and compromised fetuses.Design
The pressure pulsation waveform propagated along the vascular tree, and acting laterally on the arterial wall, produces a corresponding change in the vessel diameter. The distance between diametrically opposite points of the aortic lumen was followed using a phase locked loop echo tracking system coupled to a B‐mode ultrasonic imager (central frequency 3.5 MHz).Setting
Tertiary referral unit, teaching hospital.Participants
A cross‐sectional study of 80 normal fetuses between 20 and 40 weeks yielded normal data. We studied 58 women with evidence of potential fetal compromise (high umbilical artery systolic: diastolic ratio).Main outcome measures
From the aortic diameter waveform we measured the maximum systolic and minimum diastolic dimension and calculated pulse amplitude. The first derivative of the aortic diameter waveform identified the incisura of aortic and pulmonary valve closure and was used to time the end of ventricular ejection and systole.Results
In normal pregnancy there was an increase in systolic and diastolic diameter and pulse amplitude with advancing gestation. Ventricular ejection time was constant. In the fetal compromised group the absolute systolic and diastolic diameters were within the normal range, but diastolic diameter per unit fetal weight was increased. There was a decrease in pulse amplitude as a percentage of diastolic diameter and an increase in the diastolic systolic diameter ratio. Fetal outcome was examined in relation to the diastolic systolic diameter ratio. Those with a high ratio (above 90th centile of normal group) exhibited significantly more adverse indices of fetal outcome.Conclusions
The fetal aortic pressure pulse waveform was represented by the vessel diameter waveform. In fetal compromise reduced pulse amplitude and increased diastolic to systolic diameter ratio suggest corresponding changes in arterial pressure pulse. We suggest these are the response of the cardiac pump to increased afterload imposed by the high umbilical placental vascular resistance.
The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence
Authors: Rasmussen Svein , Irgens Lorentz M. , Dalaker Knut 
Published: August 2005

Objective
To assess the effect of having a placental abruption on 1. the probability of having further pregnancies, and 2. the rate of recurrence in such pregnancies.Design
A cohort study based on the Medical Birth Registry of Norway.Results
From 1967 to 1989, placental abruption occurred in 218/4951 subsequent deliveries after a placental abruption index case. After placental abruption with perinatal survival in the first delivery 59% of women had a further delivery, compared with 71% who did not have placental abruption at delivery. After a perinatal loss corresponding rates were 83% and 85%, respectively. Odds ratios of recurrence of abruption, crude and adjusted for maternal age, birth order and time period were 7.1 and 6.4, respectively. No secular trends were found. Caesarean section rates increased and were higher in pregnancies with recurrent placental abruption and in subsequent pregnancies without placental abruption than in the total birth population.Conclusions
Women who have placental abruption are less likely than other women to have another pregnancy. For women who do have subsequent pregnancies placental abruption occurs significantly more frequently.
The impact of using a partially randomised patient preference design when evaluating alternative managements for heavy menstrual bleeding
Authors: Cooper Kevin G. , Grant Adrian M. , Garratt Andrew M. 
Published: August 2005

Objective To identify the advantages and disadvantages of using a partially randomised patient preference design rather than a conventional randomised controlled design when evaluating alternative managements for heavy menstrual bleeding.Design Randomised controlled comparison of two clinical trial designs with subsequent follow up of the cohorts of women generated.Participants Women attending a general gynaecology clinic for the first time because of heavy menstrual bleeding.Interventions Partially randomised patient preference clinical trial design and conventional randomised controlled design.Main outcome measures Overall participation; participation in randomised clinical trial of medical management compared with transcervical surgical resection of the endometrium; prognostic characteristics (socio–demographic and Short Form 36) of clinical trial groups; outcomes (clinical and Short Form 36) of clinical trial groups.Results Overall, more women participated in the partially randomised patient preference design (130/135 vs97/138; difference 27%, 95% CI 18% to 34%) but there was no difference in the numbers who agreed to be randomised (90/135 vs97/138; difference −3%, 95% CI −15% to 7%). Women who chose medical management tended to have better general health, to be less restricted by their menstrual problems, with fewer having been previously treated by their general practitioner. Those who chose transcervical resection of the endometrium had all tried medical management and had higher bleeding scores. Follow up satisfactions and acceptability rates, and Short Form 36 scores were highest after transcervical resection of the endometrium, whether chosen or randomised. Acceptability and a desire to continue the same treatment was greater among those who chose medical management than those randomly allocated it.Conclusions Use of the partially randomised patient preference design did not affect recruitment to the randomised controlled trial suggesting that a conventionally designed trial would not be biased by motivational factors in this context. Data from the preference groups informed the generalisability of the results but did tend to confirm conclusions that anyway reasonably followed from the randomised controlled trial. The extra resource implications of using the partially randomised patient preference design were significant reflecting the additional 40% who participated and the extra analyses entailed.