bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum depression: identification of women at risk
Authors: Nielsen D. , Videbech P. , Hedegaard M. , Dalby J. , Secher N. J. 
Published: August 2005

Objective
To identify and test the predictive power of demographic, obstetric, and psychosocial risk factors of postpartum depression.Design
Community‐based, prospective follow up study based on questionnaires on past history of psychiatric disease, psychological distress and social support during pregnancy and depression at four months after delivery. Obstetric files were collected at time of birth.Setting
Antenatal care clinic and delivery ward, Aarhus University Hospital, Denmark.Population
6790 women giving birth between 1 January 1994 and 31 December 1995, who attended the antenatal clinic during pregnancy; 5252 (78%) completed all questionnaires. The validation population comprised 528 women enrolled immediately prior to and after the study period.Main outcome measure
Postpartum depression four months after giving birth assessed by the Edinburgh Postnatal Depression Scale.Results
5.5% of the women suffered from postpartum depression, corresponding to a score of 13 or higher on the Edinburgh Postnatal Depression Scale. Risk factors identified by multivariate logistic regression analysis included psychological distress in late pregnancy (OR 6.3 [95% CI 4.4–9.1]), perceived social isolation during pregnancy (OR 3.6 [95% CI 1.9–7.0]); high parity (OR 3.8 [95% CI 1.8–8.0]); and a positive history of prepregnant psychiatric disease (OR 2.1 [95% CI 1.4–3.2]). No association was found between pregnancy or delivery complications, and postpartum depression. The maximum predictive power of the identified risk factors was 0.3. According to these results, one out of three women who suffers from psychological distress in late pregnancy with perceived social isolation will develop postpartum depression.Conclusion
Antenatal focus on psychosocial wellbeing may help to identify women at risk of postpartum depression.
The views and anticipated needs of women in early pregnancy
Authors: Jewell David , Sanders Julia , Sharp Debbie 
Published: August 2005

Objective
To assess the expectations of antenatal care of pregnant women at the outset of pregnancy.Design
Questionnaire study within a randomised controlled trial, comparing traditional antenatal care with a more flexible schedule.Setting
Eleven primary care centres providing midwifery care in Avon.Population
Five hundred and ninety‐three pregnant women at low risk of obstetric complications presenting for antenatal care.Methods
A questionnaire was completed by women who agreed to participate in the trial shortly after antenatal booking. The questionnaire explored women's views on their attitudes to pregnancy and antenatal care, the locus of control related to pregnancy, the planning of the pregnancy and expectations of care.Main outcome measures
Comparisons between nulliparous and multiparous women in terms of their views of antenatal care, and their stated preference for a particular package of care.Results
There was no difference in their views of pregnancy as an event entailing risk. On a locus of control scale that measured women's perceptions of factors which might affect their babies’ health, nulliparous women rated antenatal care higher than multiparous women (P= 0.0001). However, this was not associated with any difference between the two groups in their stated preference for traditional or flexible care. Approximately half of the women expressed no preference, and of those who did 61% would opt for traditional care. Almost one‐fifth of the whole sample welcomed the idea of flexible care.Discussion
These data support the evidence of previous studies that there remains a strong desire among pregnant women to receive a ‘traditional’ pattern of care, even among those who have previously experienced normal pregnancy. However, a minority can be identified at the outset of pregnancy who may welcome a change to a more flexible pattern of care.
Subcutaneous versus intracutaneous injections of sterile water for labour analgesia: a comparison of perceived pain during administration
Authors: Mårtensson Lena , Nyberg Karin , Wallin Gunnar 
Published: August 2005

Objective
To investigate whether, during injections of sterile water, there is any difference in perceived pain between intracutaneous and subcutaneous injections.Design
Blind controlled trial with cross‐over design.Setting
Göteborg and Skövde, Sweden.Participants
One hundred healthy female volunteers.Methods
The women were randomised into two groups and subjected to two trials, within one week of each other. During the first trial one group (n= 50) received the intracutaneous injection first, followed by the subcutaneous injection. The second group (n= 50) was given the subcutaneous injection first, followed by intracutaneous injection. In both groups all the injections were given in reverse order during the second trial.Main outcome measures
Experienced pain during the administration of sterile water injections, measured by visual analogue scale.Results
The analysis showed intracutaneous injections to be significantly more painful than subcutaneous injections, even after adjusting for injection day and for left/right site of injection (mean 60.8 vs 41.3, P < 0.001).Conclusions
The findings suggest that the less painful subcutaneous injection technique should be used.
A comparison of bladder neck movement and elevation after tension‐free vaginal tape and colposuspension
Authors: Atherton Michelle J. , Stanton Stuart L. 
Published: August 2005

Objective
To compare elevation and movement of the bladder neck after tension‐free vaginal tape and open Burch colposuspension, using transperineal ultrasound.Design
Prospective, non‐randomised study using pre‐ and post‐operative transperineal ultrasound of the bladder neck.Setting
Tertiary referral urogynaecology unit at a London teaching hospital.Sample
Thirty consecutive women who underwent tension‐free vaginal tape or colposuspension for primary genuine stress incontinence between March 1998 and June 1999.Methods
Women underwent transperineal ultrasound of the bladder neck prior to and three to four weeks after surgery.Main outcome measures
Bladder neck elevation, angle and movement in relation to the pubic symphysis.Results
For both tension‐free vaginal tape and colposuspension the post‐operative bladder neck angles at rest and valsalva were more acute than pre‐operatively. The post‐operative linear movement on valsalva was less than pre‐operatively. For colposuspension the rotational movement on valsalva was significantly less post‐operatively, but for tension‐free vaginal tape there was only a trend towards less post‐operative rotational movement. Post‐operative angles and movement were significantly less for colposuspension. The resting bladder neck position was elevated significantly more by colposuspension.Conclusion
Both tension‐free vaginal tape and colposuspension decrease bladder neck angles at rest and valsalva, linear movement on valsalva and elevate the bladder neck. The colposuspension causes significantly more change than the tension‐free vaginal tape. This suggests the mechanism of continence for the tension‐free vaginal tape is less dependent on bladder neck change than the colposuspension.
A randomised comparison and economic evaluation of laparoscopic‐assisted hysterectomy and abdominal hysterectomy
Authors: Lumsden M. A. , Twaddle S. , Hawthorn R. , Traynor I. , Gilmore D. , Davis J. , Deeny M. , Cameron I. T. , Walker J. J. 
Published: August 2005

Objectives
To determine the safety, cost effectiveness and effect on quality of life of laparoscopicassisted vaginal hysterectomy (LAVH) compared with total abdominal hysterectomy (TAH) in the management of benign gynaecological disease.Design
Randomised controlled trial and economic evaluation.Setting
Three hospitals in the West of Scotland.Participants
Two hundred women scheduled for an abdominal hysterectomy for benign gynaecological disease.Main outcome measures
Conversion rate of LAVH to TAH, complication rates, NHS resource use and costs, quality of life using EuroQol 5 D visual analogue scale, and achievement of milestones.Results
The overall incidence of operative complications was 14% in the TAH group and 8% in the LAVH group, with an 8% conversion rate. Length of operation was significantly greater in the women having LAVH at 81 ±30 min vs 47 ±16 min (P < 0.001). There was no difference in analgesic requirements between the groups although there was a significantly shorter hospital stay for those having LAVH. The rate of post‐surgery recovery, satisfaction with operation and quality of life at four weeks post‐operative were similar in the two groups of women. LAVH was significantly more expensive than TAH and remained more expensive for all but the most extreme scenario.Conclusions
This study demonstrates that despite the decreased length of hospital stay, LAVH is more expensive than TAH. In addition, recovery following operation and patient satisfaction were not affected by the route chosen. It is unlikely that LAVH represents an efficient use of NHS resources.
The endometrial response to sequential and continuous combined oestrogen‐progestogen replacement therapy
Authors: Sturdee David W. , Ulrich Lian G. , Barlow David H. , Wells Michael , Campbell Michael J. , Vessey Martin P. , Nielsen Bjarne , Anderson Malcolm C. , Bragg Anthony J. 
Published: August 2005

Objectives
1. To determine the prevalence of endometrial hyperplasia in postmenopausal women taking standard proprietary regimens of sequential oestrogen/progestogen; 2. to determine the effects of nine months treatment with an oral continuous combined regimen of 2 mg 17ß‐oestradiol and 1 mg norethisterone acetate (Kliofem [Kliogest outside the UK]; Novo Nordisk, Denmark) on endometrial histology in postmenopausal women.Design
An open, prospective study in postmenopausal women.Setting
Fifty‐four menopause clinics in the UK.Participants
2028 postmenopausal women: 1312 (Group A) taking sequential oestrogen‐progestogen hormone replacement therapy (HRT), and 716 (Group B) not taking HRT, were recruited. In Group A, 388 women took preparations containing 10 days of progestogen, 921 had 12 days, and 3 had 13 days per cycle.Methods
Endometrial aspiration biopsies were taken towards the end of a three‐month run‐in period (Group A) or at study entry (Group B), before administration of the continuous combined HRT regimen. Biopsies were repeated at the end of the nine month treatment period.Main outcome measure
Endometrial histology.Results
Initial endometrial biopsy data were available for 1106 women in Group A, who by the time of endometrial investigation had been taking HRT for a median duration of 2.56 years (5th to 95th centiles: 0.77 to 8.49 years). Data were available for 661 untreated women, who had no bleeding and had not taken HRT within the last year (Group B). Complex hyperplasia was found in 59 women (5.3%), and atypical hyperplasia in a further eight (0.7%) in Group A. In Group B there were no cases with complex hyperplasia, but one woman showed atypical hyperplasia (0.2%). At the end of the nine months of continuous combined therapy there was no case of hyperplasia among 1196 biopsies (upper 95% confidence limit of risk 0.31%) in women completing the study. Within this Group all of the women with complex hyperplasia arising during previous sequential HRT and who completed the study (n= 38) reverted to normal endometrial patterns. There was no case of endometrial carcinoma during the study.Conclusions
Despite taking standard regimens of sequential HRT containing at least 10 days of progestogen, there was a 5.3% prevalence of complex endometrial hyperplasia, and a 0.7% prevalence of atypical hyperplasia. However, continuous combined HRT (Kliofem) containing daily progestogen is not associated with an increased risk of hyperplasia and will convert the endometrium to normal in those with complex hyperplasia arising during previous sequential HRT.
A randomised controlled trial of vaginal clindamycin for early pregnancy bacterial vaginosis
Authors: Kurkinen‐Räty Merja , Vuopala Salme , Koskela Markku , Kekki Minnamaija , Kurki Tapio , Paavonen Jorma , Jouppila Pentti 
Published: August 2005

Objective
To determine whether treatment of bacterial vaginosis (BV) with vaginal clindamycin affects pregnancy outcome.Materials and methods
Mothers with singleton pregnancies and without previous preterm delivery in 17 health centres in Oulu from March 1996 Until March 1998, in whom BV was diagnosed by Gram stain of a vaginal swab at the first antenatal visit (at the 12th gestational week) were randomised at Oulu University Hospital to have a one‐week course of vaginal clindamycin, or placebo. A follow up sample of Gram stain was taken two weeks after randomisation and at the 30th gestational weeks. Pregnancy outcome data was obtained from hospital records. Primary outcome was preterm birth, and puerperal infectious morbidity the other outcome measure.Results
During the study period 1956 women were screened, of whom 143 (7.3%) were BV‐ positive. One hundred and one were randomised. The total preterm birth rate of BV+ women randomised was 9.9% (10/101). Preterm birth occurred in 20.7% (6/29) vs 0% (0/26) according to whether BV persisted or not (P < 0.01). The preterm birth rate was 13.7% (7/51) in the clindamycin group vs 6.0% (3/50) in the placebo group (OR 2.5, 95% CI 0.6–10). BV was cured just after treatment in 17 out of 51 (33%) of the clindamycin‐ treated patients vs 17 out of 50 (34%) of the placebo‐ treated patients (OR 1.0, 95% CI 0.4–2.2). There was a difference in puerperal infectious morbidity in patients where BV persisted (31%, 9/29) compared with those in which BV did not persist (7.7%, 1/26) (OR 5.4, 95% CI 1.04–28). Infections were seen in 4/51 (8%) of the clindamycin treated vs 10/50 (20%) of the placebo treated cases, (OR 0.3, 95% CI 0.1–1.2).Conclusion
The prevalence of BV was lower than expected in this low risk population, but nevertheless it increased the risk of preterm birth and puerperal infectious morbidity, the risk being highest in cases where BV persisted during pregnancy. Vaginal clindamycin treatment for BV in the first trimester of pregnancy did not appear to reduce the risk of preterm birth or puerperal infections.
Accuracy and limitations of transabdominal fetal echocardiography at 12–15 weeks of gestation in a population at high risk for congenital heart disease
Authors: Simpson John M. , Jones Annette , Callaghan Nicky , Sharland Gurleen K. 
Published: August 2005

Objective
Evaluation of transabdominal fetal echocardiography at 12–15 weeks of gestation.Design
Retrospective analysis.Setting
Tertiary fetal cardiology unit.Sample
Two hundred twenty‐nine consecutive fetuses imaged at 12–15 weeks of gestation over a 45‐month period.Methods
Retrospective analysis of echocardiography and autopsy reports.Main outcome measures
Accuracy of early echocardiography for the detection of abnormalities of the cardiac connections.Results
Diagnostic images were obtained in 226/229 fetuses (98.7%). Abnormalities of the cardiac connections were detected in 13 fetuses (5.7%) on the initial scan. Where information was available (n= 11), the echocardiographic findings were confirmed at autopsy or postnatally. In two of the 13 cases of congenital heart disease, repeat echocardiography was necessary to provide additional cardiological information. Of the 213 cases in whom a normal initial report was issued, four (1.7%) had congenital heart disease diagnosed later in pregnancy (n= 3) or postnatally (n= 1). Three of these fetuses had haemodynamically insignificant ventricular septal defects and one developed a dilated cardiomyopathy later in gestation.Conclusions
Transabdominal fetal echocardiography can be performed at 12–15 weeks of gestation permitting accurate early detection of major congenital heart defects in a high risk population. Some forms of congenital heart disease, usually minor, may not be detectable at such an early stage.
Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening
Authors: Menon Usha , Talaat Ahmed , Rosenthal Adam N. , Macdonald Nicola D. , Jeyerajah Arjun R. , Skates Steven J. , Sibley Karen , David H. , Jacobs Ian J. 
Published: August 2005

Objective
To assess the performance of ultrasonography in a multimodal ovarian cancer screening strategy.Design
Prospective ovarian cancer screening trial between December 1986 and June 1993.Setting
General practice, occupational health departments and an ovarian cancer screening clinic at a London teaching hospital.Population
Postmenopausal women, ≥ 45 years with a raised CA125.Methods
Volunteers with a CA125 ≥ 30 U/mL underwent a pelvic ultrasound. Scans were classified as normal, abnormal (ovarian volume ≥ 8.8 mL) or equivocal (normal volume with abnormal morphology). Abnormal ovarian morphology was subclassified as simple cyst (single, thin walled cyst with no septa or papillary projections) or complex (all other abnormalities). Volunteers with abnormal scans were referred for a gynaecological opinion. Follow up was via the cancer registry and postal questionnaires.Main outcome measures
Sensitivity, specificity and positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary invasive epithelial carcinoma of the ovary and fallopian tube).Results
Seven hundred and forty‐one women underwent 1219 scans and 20 index cancers occurred during a median follow up of 6.8 years. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal morphology, 89.5% for abnormal volume and 84% for complex morphology. The highest specificity (97%) and positive predictive value (37.2%) was achieved using complex morphology.Conclusion
A variety of ultrasound criteria can achieve high sensitivity, specificity and positive predictive value for index cancers in postmenopausal women with an elevated CA125. Use of ovarian morphology to interpret ultrasound may increase sensitivity and use of complex ovarian morphology may increase the positive predictive value.
Can diagnostic laparoscopy be avoided in routine investigation for infertility?
Authors: Johnson N. P. , Taylor K. , Nadgir A. A. , Chinn D. J. , Taylor P. J. 
Published: August 2005

Objective
To determine whether routine testing for serum Chlamydia trachomatis antibodies, considered in combination with a woman's clinical features, may avoid the need for diagnostic laparoscopy in routine investigation for infertility.Design
Retrospective case notes analysis.Setting
Secondary level care infertility clinic.Population
Eighty women who had undergone both laparoscopy and serum Chlamydia trachomatis antibody testing.Methods
Ascertainment of any history of suspected pelvic inflammatory disease, pelvic pain, cervical intraepithelial neoplasia, pelvic surgery or appendicectomy; any abnormality on clinical pelvic examination; the findings at laparoscopy; the result of serum Chlamydia trachomatis antibody testing by enzyme‐linked immunosorbent assay (ELISA) screening with microimmunofluorescence (MIF) confirmatory diagnostic testing. The usefulness of clinical features, the serum Chlamydia trachomatis antibody test and these two variables combined in the detection of tubal disease and pelvic pathology of relevance to infertility were measured statistically.Main outcome measures
Specificity, sensitivity, positive predictive value, negative predictive value and likelihood ratio for each of the tests.Results
The combination of any positive clinical feature with a positive test for serum Chlamydia trachomatis antibodies detects tubal disease with sensitivity 92%, specificity 70%, positive predictive value 72%, negative predictive value 91% and likelihood ratio 3.1; it detects bilateral tubal obstruction with sensitivity 84%, specificity 51%, positive predictive value 35%, negative predictive value 91% and likelihood ratio 1.7; it detects pelvic pathology relevant to infertility with sensitivity 76%, specificity 71%, positive predictive value 80%, negative predictive value 65% and likelihood ratio 2.6. The negative predictive value for pelvic pathology from the use of clinical features in addition to the chlamydia antibody test is not significantly higher than that from the chlamydia antibody test alone (53%).Conclusions
A policy of selective laparoscopy in routine investigation for infertility, based on the result of the test for serum Chlamydia trachomatis antibodies and a woman's clinical features, is not supported.
How useful is uterine artery Doppler flow velocimetry in the prediction of pre‐eclampsia, intrauterine growth retardation and perinatal death? An overview
Authors: Chien Patrick F. W. , Arnott Neil , Gordon Adam , Owen Philip , Khan Khalid S. 
Published: August 2005

Objective
To evaluate the clinical usefulness of Doppler analysis of the uterine artery velocity waveform in the prediction of pre‐eclampsia and its associated complications of intrauterine growth retardation and perinatal death.Design
Quantitative systematic review of observational diagnostic studies using online searching of the MEDLINE database coupled with scanning of the bibliographies of primary and review articles including known unpublished studies.Material
Twenty‐seven studies involving 12,994 subjects stratified into population subgroups at low and high risk of developing pre‐eclampsia and its complications.Outcome measures
The outcome measures studied were: 1. the development of pre‐eclampsia; 2. intrauterine growth retardation; and 3. perinatal death. The main meta‐analyses were the flow velocity waveform ratio ± diastolic notch derived by transabdominal Doppler ultrasound as the measurement parameter. The analyses were conducted using likelihood ratio as a measure of diagnostic accuracy. A likelihood ratio of 1 indicates that the test has no predictive value for the outcome. Prediction for the outcome event is considered conclusive with likelihood ratios of > 10 or < 0.1 for a positive and negative test result, respectively. Moderate prediction can be achieved with likelihood ratios of 5–10 and 0.1–0.2 whereas likelihood ratios values of 1–5 and 0.2–1 would generate only minimal prediction.Results
In the low risk population a positive test result, predicted pre‐eclampsia with a pooled likelihood ratio of 6.4 (95% CI 5.7–7.1), while a negative test result had a pooled likelihood ratio of 0.7 (95% CI 0.6–0.8). For intrauterine growth retardation the pooled likelihood ratio was 3.6 (95% CI 3.2–4.0) for a positive test result and 0.8 (95% CI 0.8–0.9) for a negative test result. Using perinatal death as outcome measure, the pooled likelihood ratio was 1.8 (95% CI 1.2–2.9) for a positive test result and 0.9 (95% CI 0.8–1.1) for a negative test result. In the high risk population a positive test result predicted pre‐eclampsia with a pooled likelihood ratio of 2.8 (95% CI 2.3–3.4), while a negative test had a likelihood ratio of 0.8 (95% CI 0.7–0.9). For intrauterine growth retardation the pooled likelihood ratio was 2.7 (95% CI 2.1–3.4) for a positive test result and 0.7 (95% CI 0.6–0.9) for a negative result. For perinatal death the pooled likelihood ratio was 4.0 (95% CI 2.4–6.6) for a positive test result and 0.6 (95% CI 0.4–0.9) for a negative result.Conclusion
Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting preeclampsia, intrauterine growth retardation and perinatal death.