bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transplacental transfer of citalopram, fluoxetine and their primary demethylated metabolites in isolated perfused human placenta
Authors: Heikkinen Tuija , Ekblad Ulla , Laine Kari 
Published: December 2003

Objective
To investigate the transplacental transfer and the effects of protein binding on the transfer of citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine in the isolated perfused human placenta model.Design
Prospective observational study.Methods
Fifteen term human placentas were obtained immediately after delivery with maternal consent and a 2‐hour non‐recirculating perfusion cycle of a single placental cotyledon was set up. Citalopram (1230 nmol/L) and desmethylcitalopram (600 nmol/L) or fluoxetine (1455 nmol/L) and desmethylfluoxetine (1525 nmol/L) were added to the maternal reservoir and their appearance to the fetal circulation was followed by repeated measurements. To investigate the effect of protein binding on the transfer of citalopram and fluoxetine, nine additional perfusions were performed without albumin in the perfusion medium. Citalopram and desmethylcitalopram concentrations were measured by reversed‐phase high performance liquid chromatography. Fluoxetine and desmethylfluoxetine concentrations was measured by gas chromatography and antipyrine (used as a reference compound) concentrations spectrophotometrically.Results
The mean (SD) steady‐state transplacental transfer (TPTSS%) for citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine was 9.1%, 5.6% (P= 0.017 compared with citalopram), 8.7% and 9.1%, respectively, calculated as the ratio between the steady‐state concentrations in fetal venous and maternal arterial sides. The TPTSS%s of citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine were 86%, 50%, 88% and 91% of that of freely diffusable antipyrine. The absence of albumin significantly reduced the transfer of citalopram and fluoxetine (TPTSS% 1.1% and 4.8%, respectively) but not the transfer of antipyrine.Conclusion
Citalopram, fluoxetine and desmethylfluoxetine all cross the human placenta, and may, therefore, affect the perinatal outcome of infants exposed to these drugs during pregnancy. The transfer of desmethylcitalopram was significantly lower, which in the clinical setting may suggest lower fetal exposure of serotonin re‐uptake inhibition by citalopram compared with fluoxetine. The presence of albumin was necessary for the transplacental transfer of both citalopram and fluoxetine.
Inflationary oscillometry provides accurate measurement of blood pressure in pre‐eclampsia
Authors: Golara Moneli , Benedict Amanda , Jones Clare , Randhawa Manjit , Poston Lucilla , Shennan Andrew H. 
Published: December 2003

Objective
To evaluate the accuracy of the OMRON‐MIT inflationary oscillometric device for blood pressure measurement in pregnancy and pre‐eclampsia.Design
Prospective observational study, using validation methods recommended by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI).Settings
Antenatal clinics and ward, Guy's Hospital, London.Population
Normotensive pregnant women and those diagnosed with pre‐eclampsia according to the definition of the International Society for the Study of Hypertension in Pregnancy.Methods
Validation according to BHS protocol.Main outcome measures
Proportion of readings within 5, 10 and 15 mmHg (absolute differences) between the automated device and two trained, blinded observers, according to the BHS and AAMI criteria.Results
The OMRON‐MIT achieved an overall BHS grade B for systolic and grade A for diastolic blood pressure measurement in both pregnancy and pre‐eclampsia. The mean (SD) differences between the standard and the test device were −5 (7) mmHg for systolic and 2 (6) mmHg for diastolic blood pressure in pregnancy and −4 (6) mmHg for systolic and 2 (7) mmHg for diastolic blood pressure in pre‐eclampsia. This device therefore fulfils the AAMI criteria.Conclusion
The OMRON‐MIT is the only automated oscillometric device that has proven to be accurate for blood pressure measurement in pre‐eclampsia according to the BHS protocol in pregnancy. Inflationary oscillometry may correct the error associated with oscillometric devices in pre‐eclampsia.
Active labour is associated with increased oxidisibility of serum lipids ex vivo
Authors: Fainaru Ofer , Almog Benny , Pinchuk Ilya , Kupferminc Michael J. , Lichtenberg Dov , Many Ariel 
Published: December 2003

Objective
As a first step towards evaluating the role of oxidative stress in the process of labour, we tested whether term labour is associated with increased oxidisibility of maternal serum lipids.Design
A controlled prospective study.Setting
Tertiary care centre.Population
Twenty healthy women in active labour and 20 healthy pregnant women not in labour (controls) matched for maternal and gestational age.Methods
Venous blood was drawn from women in both groups. Serum levels of lipid peroxidation products and the kinetics of copper‐induced oxidation ex vivo were monitored spectroscopically at 37°C by continuous recording of absorbance at 245 nm.Main outcome measures
Oxidative stress parameters.Results
The initial optical density (OD) at 245 nm, attributed to preformed dienic hydroperoxides and 7‐keto‐cholesterol (main products of lipid peroxidation), was higher in the labouring group than in the controls (1.30 ± 0.11 vs 1.18 ± 0.09, OD 245 nm, respectively, P < 0.001). The lag phase, reflecting resistance of serum lipids to oxidation, was significantly shorter in the labouring group than in the controls (43.2 ± 1.4 vs 56.2 ± 4.7 min, respectively, P= 0.01).Conclusion
High levels of serum hydroperoxides and decreased resistance of serum lipids to copper‐induced peroxidation ex vivo suggest labour to be associated with high oxidative stress. Whether oxidative stress is involved in initiating the labour process or is consequent awaits further studies.
Cystic fibrosis and pregnancy. Report from French data (1980–1999)
Authors: Gillet Dominique , de Braekeleer Marc , Bellis Gil , Durieu Isabelle ,   The participating centres to the French Cystic Fibrosis Registry
Published: December 2003

Objective
To study the consequences of pregnancy on women affected by cystic fibrosis and to clarify the impact of the disease on maternal and newborn health.Design
Retrospective study.Setting
Pregnancy survey from the French Cystic Fibrosis Registry.Population
Women with cystic fibrosis having a pregnancy between 1980 and 1999.Methods
During the 1980–1999 period, 90 pregnancies in 80 French female patients were registered in the pregnancy survey of the French Cystic Fibrosis Registry. General and clinical data before pregnancy were noted. Outcome of the pregnancy was described. Variations of pulmonary function and body weight during pregnancy were evaluated. Comparison between a group of pregnant women and a group of non‐pregnant cystic fibrotic women of same age and genotype, followed in the same care centre network, was made.Main outcome measures
Spirometric and nutritional parameters, vital status and perinatal health indicators.Results
The outcome was identified for 75 cases: 64 delivered babies (45 at term and 10 prematurely, prematurity rate: 18%), 10 abortions (five spontaneous and five therapeutic or medical), and one maternal death during pregnancy. The proportion of newborns with low weight was 29.8%. Mean maternal weight gain during pregnancy was 5.5 kg. Four affected children were diagnosed after birth. A decline in the forced expiratory volume in one second (FEV1) and forced vital capacity was observed between the beginning of pregnancy and the year following the delivery. However, no significant difference was found when comparing the variation in the pulmonary function during pregnancy between cases and controls. Moreover, the pulmonary status before pregnancy was better than the status of non‐pregnant women. Among 12 deaths recorded after pregnancy, only three happened in the year following the pregnancy. All three women had an FEV1 <50% before pregnancy.Conclusion
Pregnancy only has a slight adverse effect on maternal health if the women are in good general condition before starting pregnancy. Women with a better health status are more inclined to initiate and successfully complete a pregnancy. Complete collaboration between cystic fibrosis practitioners and obstetricians should be observed to allow women to deliver children in the best conditions.
High incidence of obstetric interventions after successful external cephalic version
Authors: Chan Louis Yik‐Si , Leung Tak Yeung , Fok Wing Yee , Chan Lin Wai , Lau Tze Kin 
Published: December 2003

Objective
To investigate the delivery outcome after successful external cephalic version (ECV).Design
Case–control study.Setting
University teaching hospital.Population
The study group consisted of 279 consecutive singleton deliveries at term over a six‐year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six‐year period.Methods
Between group differences were compared with the Mann–Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables.Main outcome measures
Incidence of and indications for obstetric interventions.Results
The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0–2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3–4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5–2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4–2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin.Conclusion
The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions.
Respiratory function in singleton and twin pregnancy
Authors: McAuliffe Fionnuala , Kametas Nikos , Costello John , Rafferty Gerrard F. , Greenough Anne , Nicolaides Kypros 
Published: December 2003

Objective
Singleton pregnancy causes important changes in respiratory function. The incidence of twin pregnancies is increasing, but it is not known whether affected women suffer greater respiratory compromise. The aim of this study was to determine if changes in respiratory function during pregnancy in healthy women were greater in those with a twin pregnancy compared with those with a singleton pregnancy.Design
Cross sectional study.Setting
London teaching hospital.Population
Healthy pregnant women attending the antenatal clinic and ultrasound department.Methods
A cross sectional study of respiratory function was performed in 68 women with twin pregnancies (17 examined in the first trimester, 35 second trimester, 16 third trimester) and 140 women with singleton pregnancies (28, 80, 40, respectively) and 22 non‐pregnant women. Women were examined once between 7 and 40 weeks of gestation. Forced vital capacity, relaxed vital capacity, forced expiratory volume in 1 second (FEV1), peak flow, inspiratory capacity, functional residual capacity (FRC), expiratory reserve volume, pulmonary diffusing capacity and minute ventilation were measured.Results
Both in twin and singleton pregnancies, the mean FRC and expiratory reserve volume of women studied in the third trimester and minute ventilation of women studied in each trimester differed significantly from that of the non‐pregnant women. There were, however, no significant differences demonstrated in respiratory function between healthy women with twin as compared with singleton pregnancies.Conclusion
In healthy women, the extra demands of a twin compared with a singleton pregnancy do not compromise further the respiratory system.
The impact of continuing illegal drug use on teenage pregnancy outcomes—a prospective cohort study
Authors: Quinlivan Julie A. , Evans Sharon F. 
Published: December 2003

Objective
To evaluate the impact of continuing illegal drug use on teenage pregnancy outcomes.Design
Prospective cohort study.Setting
Three Australian obstetric hospitals.Sample
Four hundred and fifty‐six teenage antenatal patients.Methods
Teenage antenatal patients were interviewed and completed questionnaires to establish their pattern of non‐prescription drug use before and during pregnancy. Illegal drug use data provided by the participants were validated in a subgroup of 180 who were interviewed six months postpartum. Antenatal, intrapartum and postnatal outcomes were collated independently. Data were analysed using SAS.Main outcome measures
Antenatal co‐morbidity, delivery and newborn outcomes.Results
In the cohort, 20.3% used marijuana throughout their pregnancy. However, 33.5% of these were multidrug users. The remaining 79.6% did not use illegal drugs throughout pregnancy (non‐users). However, half the ‘non‐users’ were ‘ex‐users’ who ceased drug use immediately before or during early pregnancy. Illegal drug use was associated with an increased incidence of concurrent cigarette and alcohol use (both OR > 4.1 and P < 0.0001) and social and psychiatric morbidity (all OR > 1.95 and P < 0.001). Multidrug use was associated with a significant increase in the incidence of chlamydial and other endocervical infections (chlamydia: OR = 4.2, 95% CI = 1.6–10.9; endocervical infections: OR = 2.6, 95% CI = 1.1–5.7). After controlling for significant covariates, and in the setting of good antenatal care, the only difference in outcome was a significant linear trend towards an increased incidence of threatened preterm labour across the three groups (P= 0.02). Of note, there were no effects on birthweight, birthweight ratio or preterm birth.Conclusion
Good antenatal care may be able to ameliorate many adverse pregnancy outcomes in teenagers who use illegal drugs throughout pregnancy. The high levels of coexisting psychosocial morbidity are a concern for future mothercrafting.
Total alpha‐fetoprotein and Lens culinaris agglutinin‐reactive alpha‐fetoprotein in fetal chromosomal abnormalities
Authors: Yamamoto Ritsu , Azuma Masaki , Kishida Tatsuro , Yamada Hideto , Satomura Shinji , Fujimoto Seiichiro 
Published: December 2003

Objective To examine the differences in multiples of the median (MoM) of total alpha‐fetoprotein, and the proportion of Lens culinaris agglutinin reactive alpha‐fetoprotein (% alpha‐fetoprotein‐L2+L3) in the maternal serum and amniotic fluid of pregnant women whose fetuses were diagnosed with autosomal or sex chromosomal abnormalities.Design Prospective consecutive series.Setting University hospital.Sample Maternal sera and amniotic fluids from 46 pregnant women with trisomy 21 fetuses, 10 pregnant women with trisomy 18 fetuses, one pregnant woman with a trisomy 13 fetus, six pregnant women with fetal sex chromosomal abnormalities, and 100 pregnant women for whom the fetal karyotype was diagnosed as normal following a genetic amniocentesis.Results The proportion of alpha‐fetoprotein‐L2+L3 in maternal serum for trisomy 21 (40.3%, P<0.0001) and trisomy 18 (39.8%, P<0.05) showed a significantly higher value compared with normal (32.6%). The proportion of alpha‐fetoprotein‐L2+L3 in amniotic fluid was significantly higher (P<0.0001) for trisomy 21 (46.6%) than for a normal karyotype (41.5%). Only for the trisomy 21 group was there a strong correlation in the % alpha‐fetoprotein‐L2+L3 between maternal serum and amniotic fluid (r=0.840, P<0.0001). For all groups, there was no correlation between alpha‐fetoprotein MoM and % alpha‐fetoprotein‐L2+L3 in maternal serum and amniotic fluid.Conclusion The proportion of alpha‐fetoprotein‐L2+L3 in maternal serum is an appropriate choice for a trisomy 21 biochemical marker, and it is possible that combining alpha‐fetoprotein‐L2+L3 analysis with assays of alpha‐fetoprotein in maternal serum could further improve the sensitivity and specificity of multiple marker screening.
Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies
Authors: Lepercq Jacques , Conard Jacqueline , Borel‐Derlon Annie , Darmon Jean‐Yves , Boudignat Odile , Francoual Christine , Priollet Pascal , Cohen Corinne , Yvelin Nicole , Schved Jean‐François , Tournaire Michel , Borg Jeanne‐Yvonne 
Published: December 2003

Objective To assess the maternal, fetal and neonatal safety of enoxaparin in pregnant women who require antithrombotic therapy.Design Retrospective analysis of case notes of women who received enoxaparin during pregnancy, irrespective of dose, duration and reason for treatment.Setting Fifty‐five French perinatal centres.Sample Data from 624 pregnancies in 604 women between 1988 and 1997. The incidence of previous thromboembolism was 29.8%, known thrombophilia 15.2%.Methods Indication, regimen of enoxaparin and outcome measures were reported for each pregnancy. Information was obtained from case records, validated by research staff and analysed by an independent scientific committee.Main outcome measures Incidence, seriousness and causality of maternal, fetal and neonatal adverse events, pregnancy outcome, and incidence of venous thromboembolism.Results Enoxaparin was administered for treatment of an acute episode in 49 cases and for thromboprophylaxis in 574 cases. Serious maternal haemorrhage occurred in 11 cases during pregnancy (1.8%), one being reasonably related to enoxaparin, and in nine cases at delivery (1.4%), all unrelated to enoxaparin. Maternal thrombocytopenia was reported in 10 cases (1.6%), two being serious but unrelated to enoxaparin. Eight pregnancies ended in stillbirth (1.1%). Among the 693 live births, 17 major congenital abnormalities (2.5%) and 10 serious neonatal haemorrhages (1.4%) were reported. None of the fetal or neonatal adverse events was related to enoxaparin. Eight venous thromboembolic events (1.3%) were reported.Conclusions The incidence of adverse events reported could be explained by the high risk profile of the study population. Overall, this retrospective study suggests enoxaparin is well tolerated during pregnancy.
Pregnant women with chronic hypertension and superimposed pre‐eclampsia have high cerebral perfusion pressure
Authors: Belfort Michael A. , Tooke‐Miller Cathy , Allen John C. , Varner Michael A. , Grunewald Charlotta , Nisell Henry , Herd J. Alan 
Published: December 2003

Objective To determine any differences in cerebral perfusion pressure in patients with chronic hypertension compared with those with chronic hypertension and superimposed pre‐eclampsia.Design A prospective observational study.Setting University hospital clinic and labour and delivery suite.Participants Fifteen women with chronic hypertension and 15 with superimposed pre‐eclampsia.Methods Transcranial Doppler ultrasound was used to measure blood velocity in the middle cerebral arteries of the patients. Systemic blood pressure in the brachial artery was measured simultaneously. Middle cerebral artery, resistance index, pulsatility index, and cerebral perfusion pressure were calculated and plotted on the same axes as data from normal pregnant women. Cerebral perfusion pressure values outside of the 5th and 95th centiles were regarded as abnormal. Cerebral perfusion pressure data from the chronic hypertension and superimposed pre‐eclampsia groups were also expressed in terms of the number of normative standard deviations from the mean value for normal pregnancy (Multiples of the Standard Deviation: MOS). All studies were conducted before labour, under similar conditions, and before volume expansion or treatment. Statistical analysis was by Student's t test and Fisher's exact test as appropriate with significance set at a two‐tailed P<0.05.Results Patient demographics and blood pressure were not significantly different between the two groups. The resistance index and pulsatility index were not significantly different (neither absolute nor multiples of the standard deviation values). The absolute cerebral perfusion pressure was significantly higher in the patients with superimposed pre‐eclampsia. The group of women with superimposed pre‐eclampsia had a significantly higher mean value of cerebral perfusion pressure measured as multiples of the standard deviation from the mean value for normal pregnancy, despite there being no blood pressure difference.Conclusions Superimposed pre‐eclampsia is associated with significantly higher cerebral perfusion pressure measurements compared with women with uncomplicated chronic hypertension. This is not directly related to a higher blood pressure. The difference in cerebral perfusion pressure may be used to speculate upon the pathophysiology of the increased risk for eclampsia seen in patients with superimposed pre‐eclampsia.
Is conservative treatment for adenocarcinoma in situ of the cervix safe?
Authors: Soutter W.P. , Haidopoulos D. , Gornall R.J. , McIndoe G.A. , Fox J. , Mason W.P. , Flanagan Adrienne , Nicholas N. , Barker F. , Abrahams J. , Lampert I. , Sarhanis P. 
Published: December 2003

Objective To determine the long term results of treatment of adenocarcinoma in situ by conisation of the cervix using survival analysis.Design A retrospective study in six teaching hospitals in North West Thames.Population Eighty‐five women with a histological diagnosis of adenocarcinoma in situ of the cervix in punch or cone biopsy were identified from pathology and clinical databases.Results In one patient a small focus of adenocarcinoma in situ was found in a cervical polyp. Subsequent cytology was normal and no further treatment was undertaken. The 84 remaining women underwent diathermy loop, cold knife cone biopsy, laser cone biopsy, or needle excision of the transformation zone. A hysterectomy or second conisation was performed in 31/84 women (36.9%) as part of the initial treatment. In all, nine (10.6%) had early invasive lesions of which four were squamous. Fifty‐nine patients were treated conservatively following one or two conisations (median follow up 78 weeks, range 0–543 weeks). One had a subsequent hysterectomy for menorrhagia. Five women have undergone treatment for suspected recurrence, a 21.5% cumulative rate of further treatment by four years. The cumulative rate of histologically proven recurrence after conservative management was 4.3% at one year and 15% at four years.Conclusions In those cases with clear margins in the cone biopsy, there is a place for conservative management of a selected group of patients who wish to preserve fertility. However, 16.7% of these will require further treatment after four years because of recurrent cytological abnormalities. Women who opt for conservative management should undergo regular, long term surveillance in a colposcopy clinic. Among those women with involved margins in the initial cone biopsy, there is a high incidence of residual disease. A second cone biopsy may be appropriate ‘definitive treatment’ for young women who wish to preserve their fertility if the margins of the second biopsy are clear and there is no evidence of invasion. Even among those for whom a hysterectomy is the proposed ‘definitive treatment’, a second cone biopsy may be required before hysterectomy to avoid inappropriate treatment of an occult invasive lesion.