bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the prophylactic administration of magnesium sulphate in women with pre‐eclampsia indicated prior to labour?
Authors: Hall D. R. , Odendaal H. J. , Smith M. 
Published: August 2005

Objective
To determine whether prophylactic magnesium sulphate is necessary to prevent eclampsia and associated complications among women with pre‐eclampsia prior to labour.Design
Case series.Setting
Tertiary referral centre.Population
Three hundred and eighteen women with pre‐eclampsia (blood pressure > 140/90 mmHg and > 2+ proteinuria) who were not in labour or for planned induction thereof and had not received magnesium sulphate during transfer.Methods
Clinical evaluation of the pregnant women with careful blood pressure control. Magnesium sulphate was withheld even in the presence of imminent eclampsia. During labour, the option of magnesium sulphate prophylaxis was left to the clinician, but magnesium sulphate was administered in cases of eclampsia.Main outcome measures
Eclampsia and related complications.Results
Five women (1.5%) developed eclampsia, although none developed related complications. Women presented at an early gestational age (mean 30 weeks), with high blood pressure, often suffering from headaches. Twenty pregnancies were terminated prior to viability, of which half were terminated for maternal reasons. Ten intrauterine deaths occurred. Most often fetal distress (38.6%) initiated the delivery process, which was mainly by caesarean section (68.5%). With the exception of epigastric discomfort, symptoms and signs of imminent eclampsia decreased after admission. Blood pressure values were significantly lower at delivery although biochemistry results deteriorated from admission to delivery.Conclusion
In women with pre‐eclampsia prior to labour, where blood pressure control was carefully applied but magnesium sulphate not given, the eclampsia rate was low and eclampsia did not appear to worsen the existing prognosis for mother or fetus.
Which women should be tested for Chlamydia trachomatis?
Authors: Macmillan Susan , McKenzie Hamish , Flett Gillian , Templeton Allan 
Published: August 2005

Objective
To assess the prevalence of genitourinary Chlamydia trachomatis infection among women in different clinical settings, with a view to making decisions about who should be tested routinely.Design
Cross sectional study.Setting
One regional hospital and family planning clinic serving an urban centre.Population
Two thousand thirty‐five sexually active women attending various outpatient settings.Main outcome measures
Prevalence of positivity by clinical setting, stratified by age.Results
Overall, prevalence of lower genital tract chlamydial infection was similar in a variety of clinical settings. Infertile women were the only exception, demonstrating a much lower prevalence. Stratifying the study population by age found a clear trend towards high prevalence in teenagers and virtually no infection in women over the age of 30 years.Conclusions
The prevalence of chlamydial infection in women is related to age, regardless of clinical presentation. In practice, opportunistic screening should target sexually active women under 30 years of age.
A double‐blind placebo controlled randomised trial of misoprostol and oxytocin in the management of the third stage of labour
Authors: Walley Robert L. , Wilson John B. , Crane Joan M. G. , Matthews Kay , Sawyer Elizabeth , Hutchens Donna 
Published: August 2005

Objective
To compare oral misoprostol 400 μg with intramuscular oxytocin 10 IU in the routine management of the third stage.Design
Double‐blind placebo controlled trial.Setting
Main referral hospital and its associated polyclinics in Accra, Ghana.Population
Four hundred and one low risk women, in the second stage of labour with anticipated vaginal delivery, who entered labour spontaneously.Methods
After delivery of the anterior shoulder of the baby, the women were randomised to receive either: 1. misoprostol 400 μg powder in water orally and 1 mL normal saline intramuscular injection (placebo); or 2. powdered cellulose in water orally (placebo) and 1 mL oxytocin 10 IU intramuscular injection.Main outcome measures
Change in haemoglobin concentration from before delivery to 12 hours postpartum. Secondary outcomes included need for additional oxytocics, blood loss > 500 mL and > 1000 mL, operative intervention for postpartum haemorrhage, and side effects, including nausea, vomiting, diarrhoea, shivering and elevated temperature.Results
Demographic characteristics were similar. There was no significant difference in change in haemoglobin concentration between the two groups (0.60 g/dL for misoprostol and 0.55 g/dL for oxytocin; relative difference 9.6%; 95% CI 20.5–39.6%; P= 0.54). There were no significant differences in secondary outcomes with the exception of shivering, which occurred more frequently in the misoprostol group (22.2%vs 5.7%; relative risk 4.73; 95% CI 2.31–9.68; P < 0.0001).Conclusions
In low risk women oral misoprostol appears to be as effective in minimising blood loss in the third stage of labour as intramuscular oxytocin. Shivering was noted more frequently with misoprostol use, but no other side effects were noted. Misoprostol has great potential for use in the third stage of labour especially in developing countries.
A comparison of the side effects of prilocaine with felypressin and lignocaine with adrenaline in large loop excision of the transformation zone of the cervix: results of a randomised trial
Authors: Howells R. E. J. , Tucker H. , Millinship J. , Shroff J. Foden , Dhar K. K. , Jones P. W. , Redman C. W. E. 
Published: August 2005

Objective
To test the hypothesis that prilocaine with felypressin causes fewer side effects than lignocaine with adrenaline when performing large loop excision of the transformation zone of the cervix.Design
Randomised trial.Setting
Colposcopy clinic in a large district general hospital.Participants
Two hundred consecutive women undergoing large loop excision of the transformation zone of the cervix.Methods
Two different local anaesthetic combinations (prilocaine with felypressin and lignocaine with adrenaline) were compared in women undergoing large loop excision of the transformation zone. Prospective collection of clinical and treatment data was undertaken with scoring using an ordinal scale of pain experienced by the women during the procedure. Peri‐operative blood loss and any side effects were also recorded.Main outcome measures
Side effects associated with the local anaesthetic agents.Results
Lignocaine with adrenaline resulted in less blood loss (P= 0.006) but was more likely to cause side effects, such as feeling faint (P= 0.017) and shaking (P < 0.001).Conclusion
Prilocaine with felypressin causes fewer side effects than lignocaine with adrenaline and is therefore the preferred local anaesthetic combination for large loop excision of the transformation zone.
The effect of endometriosis and its radical laparoscopic excision on quality of life indicators
Authors: Garry Ray , Clayton Richard , Hawe Jeremy 
Published: August 2005

Objective
To assess the effect of endometriosis and radical laparoscopic excision on the quality of life of women with this condition.Design
A prospective study.Setting
The Northern Endometriosis Centre at South Cleveland Hospital, Middlesbrough and St. James's University Hospital, Leeds.Population
Fifty‐seven consecutive patients undergoing laparoscopic excision of invasive endometriosis.Methods
Questionnaires, both pre‐operatively and four‐month post‐operatively, for a number of different symptoms associated with endometriosis were completed by patients. Details of fertility, previous treatments and quality of life as measured by SF12 and EuroQOL (EQ‐5D) and sexual activity questionnaire, as well as linear pain scores for several symptoms, were recorded. Details of intra‐operative findings was also collected.Main outcome measures
Effect of laparoscopic excision on pain scores and quality of life, operative findings, type of surgery, length of surgery and incidence of intra‐ and post‐operative complications.Results
Patients with endometriosis were severely ill with significant pain and impairment of quality of life and sexual activity. Four months after radical laparoscopic excision for deep endometriosis there was significant improvement in all the parameters measured including their quality of life based on EuroQOL evaluation: EQ‐5D (0.595:0.729, P= 0.002) and EQ thermometer (68.9:77.7, P= 0.008); SF12 physical score (44.8:51.9, P= 0.015); sexual activity (habit P= 0.002, pleasure P= 0.002 and discomfort P≤ 0.001). Only the mental health score of SF12 failed to show any statistical improvement (47 1:48.4, P= 0.84). Symptomatically, there was a significant reduction in dysmenorrhoea (median 8.0:4.0, P≤ 0.001), pelvic pain (median 7.0:2.0, P≤ 0.001), dyspareunia (median 6.0:0.0, P≤ 0.001) and rectal pain scores (median 4.0:0.0, P≤ 0.001). Complications were noted, but were deemed to be acceptable for the extent of the surgery.Conclusions
This is an early analysis of the first 57 cases studied, but structured evaluation suggests that meaningful improvements in clinical symptoms and quality of life can be obtained with this approach with acceptable levels of operative morbidity. Further follow up of this series is required, but early evidence would suggest that the technique should be further evaluated as part of a randomised trial.
Factors associated with male infertility: a case‐control study of 218 infertile and 240 fertile men
Authors: Chia Sin‐Eng , Lim Soon‐Tiong Alvin , Tay Sun‐Kuie , Lim Swee‐Tee 
Published: August 2005

Objective
To determine the likely risk factors, such as smoking and drinking habits, and occupational groups, for infertility in a group of infertile men with no known cause, compared with a group of fertile men; and to examine the effects of the semen parameters, such as volume, density, motility, viability and normal morphology, on fertility.Design
A case‐control study.Setting
The department of obstetric and gynaecology of a tertiary general hospital.Participants
Six hundred and forty consecutive male partners of couples trying to conceive were recruited from an infertility clinic. Of these, the cases comprised 218 men who had no known cause for their infertility. Two hundred and forty men whose wives were pregnant at the time of the study were recruited as controls.Results
The semen parameters (e.g. density, total sperm counts, motility, viability and normal morphology) of all cases were significantly poorer than that of the controls. The risk of infertility is associated with smoking (crude OR 2.82, 95% CI 1.93–4.13; adjusted OR 2.96; 95% CI 1.98–4.42). Technicians (adjusted OR 2.81; 95% CI 1.51–4.24) and professional, senior officials and managers were also at a greater risk of infertility (adjusted OR 2.36; 95% CI 1.26–4.40), compared with service and clerical workers. The significant factors predicting infertility were smoking, density of sperm, and viability of sperm. Smoking increased the odds of being infertile. Higher sperm counts and larger percentage of viable sperm decrease the odds of infertility. Based on the multiple logistic regression model, the odds ratio for infertility = 94.70 × 2.88smoking× 0.29logdensity× 0.95viability.Conclusion
Smoking, density of sperm and the viability of sperm are significant predictors for infertility among men.
Maternal morbidity and mortality in two different populations of Senegal: a prospective study (MOMA survey)
Authors: de Bernis Luc , Dumont Alexandre , Bouillin Dominique , Gueye Abdoulaye , Dompnier Jean‐Pierre , Bouvier‐Colle Marie‐Hélène 
Published: August 2005

Objective
To compare maternal morbidity and mortality in two urban populations with contrasting availability of health care, and to test the hypothesis that differences in maternal outcome result mainly from the management of delivery in health facilities.Design
A population‐based study of a cohort of pregnant women which was part of a multicentre study of maternal morbidity in six countries of western Africa (MOMA).Setting
Two different urban areas of Senegal (Saint‐Louis and Kaolack).Population
3777 pregnant women who were followed up throughout pregnancy, delivery and puerperium.Main outcome measures
Maternal morbidity and mortality: morbidity was assessed from women's recall at each visit by the investigator and from obstetric complications diagnosed by the birth attendant within health facilities.Results
Maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centres, usually assisted by traditional birth attendants, than in Saint‐Louis where women giving birth in health facilities went principally to the regional hospital and were usually assisted by midwives (874 and 151 maternal deaths per 100,000 live births, respectively, P < 0.01). Maternal morbidity, however, was higher in Saint‐Louis than in Kaolack area, especially for births in health facilities (9.50 and 4.84 episodes of obstetric complications per 100 live births, respectively, P < 0.01). Univariate and multivariate analyses showed that morbidity was mainly associated with the training of the birth attendant in facility deliveries and that antenatal care had no effect.Conclusion
Midwives in health facilities appear to detect more obstetric complications than traditional birth attendants. Immediate detection leads to immediate care and to low fatality rates. This could explain differences in maternal outcome between two urban centres with contrasting health care availability. These results suggest that one of the strongest weapons in the fight against maternal mortality is the employment of the most qualified personnel possible for monitoring labour.
Women's health after childbirth: a longitudinal study in France and Italy
Authors: Saurel‐Cubizolles Marie‐Josèphe , Romito Patrizia , Lelong Nathalie , Ancel Pierre‐Yves 
Published: August 2005

Objective
To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner.Design
Longitudinal multicentre survey with a similar design in France and Italy. Women were interviewed three times: at birth and twice after childbirth. At 12 months after childbirth, the survey was postal in both countries.Population
Women who had been delivered of their first or second baby in three maternity units in France and five units in Italy. Women who had multiple pregnancies, a stillbirth or known neonatal death were excluded.Results
The response rates were 83% in France and 88% in Italy. Fifteen symptoms were considered. The results were similar in the two countries and showed that the prevalence of most symptoms was higher at 12 months than at five months after childbirth. When their baby was one year old, more than half of the women reported backache, anxiety and extreme tiredness. Around one‐third of women reported headache, lack of sexual desire, sleep disorders and depression. Piles, constipation and painful intercourse were also common. One year postpartum women with financial problems or a difficult relationship reported poor psychological health more frequently.Conclusion
Physical and emotional problems are common after birth, and they tend to increase over time. Backache, headache and piles can seriously interfere with day‐to‐day life. Sexual problems also may be a source of unhappiness for the woman and her partner. Extreme tiredness, anxiety and depression may make a woman feel guilty for not corresponding to the image of a healthy, happy and well‐coping mother. There is a link between financial problems or a difficult relationship with her partner and her own wellbeing. Health professionals should be aware of the high prevalence of health problems among new mothers, and of the social context of women who are more likely to suffer from them. They should counsel the women in their care, in order to help them to find the best solution, be it medical or social in nature.
Descriptive terms for women attending antenatal clinics: mother knows best?
Authors: Byrne Dominic L. , Asmussen Tilo , Freeman Janet M. 
Published: August 2005

Objective
To determine the noun for ‘women who attend antenatal clinics’ that is most accepted by the women themselves.Design
Cross sectional study.Setting
Consultant‐led antenatal clinics in Cornwall.Population
All women attending consultant‐led antenatal clinics over a two‐month period.Methods
The women were surveyed by written questionnaire.Main outcome measures
The first, second and third choices of descriptions offered to women attending antenatal clinics. Secondary outcome measures include the relation of maternal age, gestation, civil status, occupation and obstetric history to the individual's choice of description.Results
Questionnaires were received from 446 women, constituting 13% of the antenatal population of Cornwall. Their median age was 28 years and median gestation 22 weeks; 255 (57%) had one or more children and 289 (65%) were married. The most popular choice of description was ‘patient’ (39% of first choices made), whereas the most accepted description was ‘pregnant woman’ (26% of totalled second and third choices). While women who selected ‘patient’ as first choice were slightly younger (mean 27.5 years) than the remaining women (mean 28.4 years), the choice of ‘pregnant woman’ was not related to any of the other recorded characteristics of the respondents. Commercial terms that consistently were selected least included ‘client’, ‘consumer’ and ‘customer’.Conclusion
Some professional bodies and government organisations have criticised the use of the term ‘patient’ to describe antenatal women. In this, the largest study to investigate what the women themselves would choose, ‘patient’ is the most favoured term.
Expectant management of early onset, severe pre‐eclampsia: perinatal outcome
Authors: Hall D. R. , Odendaal H. J. , Kirsten G. F. , Smith J. , Grové D. 
Published: August 2005

Objective
To evaluate the perinatal outcome of expectant management of early onset, severe pre‐eclampsia.Design
Prospective case series extending over a five‐year period.Setting
Tertiary referral centre.Population
All women (n= 340) presenting with early onset, severe pre‐eclampsia, where both mother and the fetus were otherwise stable.Methods
Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six‐hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward.Main outcome measures
Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications.Results
A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (≥ 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care.Conclusion
Expectant management of early onset, severe pre‐eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern.
Does histological incomplete excision of cervical intraepithelial neoplasia following large loop excision of transformation zone increase recurrence rates? A six year cytological follow up
Authors: Dobbs S. P. , Asmussen T. , Nunns D. , Hollingworth J. , Brown L. J. R. , Ireland D. 
Published: August 2005

Objective
To determine the risk of recurrent cervical intraepithelial neoplasia (CIN) in women with complete or incomplete excision of cervical intraepithelial neoplasia treated by large loop excision of transformation zone (LLETZ).Design
A retrospective studySetting
One consultant‐led colposcopy clinic at Leicester Royal InfirmaryPopulation
Three hundred and ninety‐four women referred consecutively to the colposcopy clinic between 1991 and 1992.Main outcome measures
The histological recurrence rate of CIN, length of cytological follow up following treatment related to degree of completeness of excision at initial treatment.Results
Three hundred and twenty‐two women had complete cytological or histological follow up. The mean length of follow up was 73 months with a mean number of six smears. Women with incomplete excision of CIN had a significantly higher risk of recurrent CIN (relative risk 8.23) occurring in a significantly shorter time compared with women with complete excision.Conclusions
This study demonstrates that large loop excision of transformation zone is successful in over 95% of cases. Cytological surveillance is satisfactory for follow up of women who have complete excision of CIN. Women with incomplete excision of CIN at initial LLETZ remain at significant risk of developing further CIN and long term colposcopic and cytological follow up is necessary.
Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition
Authors: Fox Sarah D. , Stanton Stuart L. 
Published: August 2005

Objective
To assess the sacrocolpopexy with mesh interposition in women with pelvic organ prolapse.Design
A prospective study.Setting
Tertiary referral urogynaecology and pelvic floor reconstruction unit.Population
Twenty‐nine consecutive women with symptomatic vault prolapse and rectocele.Main outcome measures
Subjective and objective success rates and complications.Results
The mean age was 57 years. The mean number of past prolapse operations was 2.6 which included two past sacrospinous ligament fixations and 17 past posterior repairs. The mean follow up was 14 months. There was an increase in constipation from 41% to 50%, a decrease in faecal soiling from 21% to 10%, and an increase in incomplete defecation from 24% to 36%. Dyspareunia decreased from 38% to 17%, and there was some improvement in the stress and urge incontinence. There was a significant reduction of vault prolapse and rectocele (P < 0.001). All women with Stage II and Stage III vault prolapse were corrected, with an increase in Stage I prolapse from 20% to 27%. All women with Stage II and Stage III rectocele were corrected with a decrease in Stage I prolapse from 36% to 7%. The only significant interoperative complication was a cystotomy. One mesh became infected post‐operatively which required removal.Conclusions
Sacrocolpopexy and mesh interposition is a safe and reliable operation for the correction of vault prolapse and rectocele. A long term follow up is necessary to detect any late complications.