bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antenatal testing to predict outcome in pregnancies with unexplained antepartum haemorrhage
Authors: AJAYI R. A. , SOOTHILL P. W. , CAMPBELL S. , NICOLAIDES K. H. 
Published: August 2005

ABSTRACTObjective
To investigate whether Doppler studies of placental perfusion and antenatal tests for fetal hypoxia can identify reduced placental functional reserve in women with unexplained antepartum haemorrhage (APH).Design
A prospective, longitudinal study.Setting
Fetal Surveillance Unit, King's College Hospital, London.Subjects
48 women with bleeding from the genital tract after 26 weeks gestation without a clinical diagnosis of abruption or ultrasound evidence of placenta praevia.Interventions
Fetal surveillance by Doppler measurements of the umbilical and uterine arteries, biophysical profile scoring and computerized measurement of the mean minute range of FHR variation.Main outcome measures
A poor outcome was defined by one or more of the following: (i) birthweight >2SD below the normal mean for gestational age and sex, (ii) abnormal FHR pattern in labour resulting in operative delivery, (iii) umbilical vein blood pH at delivery <7.15, (iv) a 5‐min Apgar score <7.Results
Fifteen of the 48 pregnancies had a poor outcome; seven occurred in the 10 women delivered preterm (<37 weeks) and eight in the 36 women delivered between 37 and 42 weeks. Two women were delivered after 42 weeks and both infants had a good outcome. The results of Doppler studies of uterine and umbilical arteries, fetal biophysical profile or FHR variation were not significantly different between the two outcome groups. The 36 pregnancies delivered between 37 and 42 weeks were matched retrospectively for maternal age, parity and race with 36 pregnancies without APH; there was no significant difference in outcome between the women with unexplained APH and the matched comparison group.Conclusion
Morbidity related to unexplained APH is associated with preterm delivery rather than with damage to utero‐placental function.
External ocular trauma in instrumental and normal deliveries
Authors: HOLDEN ROGER , MORSMAN DAVID G. , DAVIDEK GERVASE M. B. , O'CONNOR GERARD M. , COLES E. C. , DAWSON ANDREW J. 
Published: August 2005

ABSTRACTObjective
To compare the occurrence of external ocular trauma in instrumental and normal deliveries.Design
Prospective controlled study.Setting
University Hospital of Wales, Cardiff.Subjects
133 babies born consecutively with the use of forceps and 133 control babies born without instrumentation to women matched for parity.Interventions
External ocular examination.Main outcome measures
The presence within 24 h of birth of corneal oedema, corneal abrasion, conjunctival chemosis, subconjunctival haemorrhage and lid oedema.Results
Lid oedema and multiple minor external ocular trauma occurred in 52 and 22 babies, respectively, in the instrumental delivery group and in 13 and 8 babies, respectively in the control group (P<0.001). Corneal abrasion occurred in two babies and corneal oedema in one baby after forceps delivery but in none of the control group. No more serious injuries occurred. All injuries resolved without long term sequelae.Conclusion
The frequency of sight threatening corneal trauma in instrumental deliveries is low. Specialist ophthalmic screening of these babies is not justified.
Screening for congenital heart disease prenatally. Results of a 2½‐year study in the South East Thames Region
Authors: SHARLAND GURLEEN K. , ALLAN LINDSEY D. 
Published: August 2005

ABSTRACTObjective
To assess the efficacy of four chamber view examination, during routine obstetric scanning, in the prenatal detection of fetuses with congenital heart disease.Design
Prospective observational study.Setting
Ten obstetric ultrasound units in the South East Thames Region.Subjects
All pregnant women attending for routine obstetric ultrasound examination.Intervention
Ultrasonographers performing routine ultrasound examinations were taught to obtain, and correctly interpret, the four chamber view of the fetal heart. When this view could not be achieved adequately, an attempt was made to identify a reason for failure and, if possible, to arrange a repeat scan. All suspected abnormalities were referred to a specialized unit.Main outcome measures
Numbers of true abnormalities detected or overlooked, and the number in whom abnormality was suspected incorrectly.Results
Over a 2.5‐year period, 69% of the known number of cardiac lesions associated with an abnormality of the four chamber view were detected prenatally during the routine obstetric scan, 10% were identified as a result of referal for other high‐risk factors and 21% were overlooked. The overall positive predictive value in the 10 obstetric units was 36%.Conclusions
Prenatal screening for some forms of major congenital heart disease is possible by including examination of the four chamber view of the fetal heart in routine obstetric scans. However, there are important limiting factors that will influence the success of abnormality detection and must be taken into account if screening is to be effective nationwide.
Oral contraceptive use and breast cancer risk: a meta‐analysis of variations with age at diagnosis, parity and total duration of oral contraceptive use
Authors: RUSHTON LESLEY , JONES DAVID R. 
Published: August 2005

ABSTRACTObjective
To review published reports of risk of breast cancer with oral contraceptive use.Design
Meta‐analysis of study results, using regression techniques to explore the inter‐study heterogeneity.Setting
Twenty‐seven epidemiological studies of breast cancer risk and oral contraceptive use published 1980–1989.Main outcome measures
Relative risk of breast cancer with oral contraceptive use; variations by age at diagnosis, parity, and total duration of use, and with study design characteristics.Results
The overall relative risk estimate was 1.16 (95% CI1 .07–1.25) for the <45 years group, 1.21 (95% CI 0.99–1.47) for the nulliparous subgroup, and 1.27(95%CI 1 12‐1‐44) for durations of use of more than 8 years. Source of subjects, their marital status, the type of study, data collection methods, matching for geographical area, the number of adjustment factors used in the study analysis, the country of study and the calendar period in which the study ended were all important explanatory factors for inter‐study variation, but a substantial proportion of inter‐study variation remained unexplained.Conclusions
These meta‐analyses suggest that risk of breast cancer may be raised by around 20% in younger, nulliparous and long use duration subgroups of oral contraceptive users. Risk estimates appear to be influenced by several study design factors, which should be considered carefully in designing and reviewing future studies.
Present‐day performance qualities of cardiotocographs
Authors: Carter Michael C. 
Published: August 2005

ABSTRACTLegislation and standards applying to medical electrical equipment are reviewed. Although there are no official standards for cardiotocographs, de facto standards can be defined. The paper introduces the present‐day performance qualities of cardiotocographs and the factors which affect the quality of the data. The measures used to evaluate the ability of cardiotocogaphs to indicate correctly the fetal heart rate and maternal uterine activity are discussed. Present‐day cardiotocographs generally perform well but the physiological variables need to be defined in order to produce equipment in keeping with clinical needs.
Communicating the significance of the fetal heart rate record to the user
Authors: Redman C. W. G. 
Published: August 2005

ABSTRACTFetal heart rate (FHR) records should be presented as measurements derived from numerical analysis. Such analysis requires computerized systems. The Oxford system is the longest established and most tested of the systems available. It could provide the basis for a standardized approach to the numerical analysis of antepartum FHR records. Intrapartum FHR monitoring is of uncertain clinical value. It is premature to recommend standards for numerical analysis to upgrade the present methods of data presentation during labour. Once the patterns of abnormality are better defined numerically such standards will be mandatory because intrapartum FHR records cannot be interpreted reliably by eye.
Multifetal pregnancy reduction: a consecutive series of 61 cases
Authors: Boulot P. , Hedon B. , Pelliccia G. , Lefort G. , Deschampsi F. , Arnal F. , Humeau C. , Laffargue F. , Viala J. L. 
Published: August 2005

ABSTRACTObjective
The effect of selective fetocide on the course of 61 multiple pregnancies.Design
An observational study.Setting
A tertiary centre.Subjects
61 women whose pregnancies included 37 triplets, 18 quadruplets, 5 quintuplets and 1 heptuplet; 97% followed IVF or the induction of ovulation. The aim of the procedure in most cases was to obtain twins.Interventions
Selective reduction was performed before 13 weeks gestation under general anaesthesia, using either a transcervical (n= 26) or transabdominal approach (n= 35). Fifty‐four twins, 4 singletons and 3 triplets were obtained after the procedure.Main outcome measure
Preterm labour rate.Results
The rate of unplanned fetal loss was 13% and was related to the number of suppressed embryos (P<0.05). The preterm labour rate was 56.6%, the mean gestation at delivery was 35.6 weeks. Seven deliveries were before 32 weeks and led to all neonatal deaths. A comparison with published data suggested that fetal reduction reduced the rate of preterm labour in high multiple pregnancies; in 24 twin pregnancies obtained after reduction of triplets there was probably a gain of 2 weeks gestation. Severe growth retardation occurred in 13%. The perinatal mortality rate was 10.8%.Conclusions
Selective termination reduces but does not prevent early preterm labour. The procedure is of value in pregnancies with more than 3 fetuses and should be considered carefully for triplet pregnancies.
Simulated home delivery in hospital: a randomised controlled trial
Authors: MacVicar John , Dobbie Gordon , Owen‐Johnstone Lucy , Jagger Carol , Hopkins Margaret , Kennedy June 
Published: August 2005

ABSTRACTObjectives
To compare the outcome of two methods of maternity care during the antenatal period and at delivery. One was to be midwife‐led for both antenatal care and delivery, the latter taking place in rooms similar to those in one's own home to simulate home confinement. The other would be consultant‐led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence, monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out.Design
Randomised controlled trial.Setting
Leicester Royal Infirmary Maternity Hospital.Subjects
Of 3510 women who were randomised, 2304 were assigned to the midwife‐led scheme and 1206 were assigned to the consultant‐led scheme.Main outcome measures
Complications in the antenatal, intrapartum and postpartum periods were compared as was maternal morbidity and fetal mortality and morbidity. Satisfaction of the women with care over different periods of the pregnancy and birth were assessed.Results
There were few significant differences in antepartum, intrapartum and postpartum events between the two groups. There was no difference in the percentage of mothers and babies discharged home alive and well. Generally higher levels of satisfaction with care antenatally and during labour and delivery were shown in those women allocated to midwife care.
Changes in platelet intracellular free calcium in normal pregnancy
Authors: Kilby Mark D. , Pipkin F. Broughton , Symonds E. Malcolm 
Published: August 2005

ABSTRACTObjective
To determine if platelet intracellular free calcium concentration (p.(Ca2+)i) changes with gestation in normotensive, uncomplicated pregnancy.Design
A prospective, longitudinal study of primigravid pregnant women compared to a large control group consisting of nulliparous nonpregnant volunteers.Setting
The antenatal clinic at University Hospital, Queen's Medical Centre, Nottingham.Subjects
Two groups of women were studied. Thirty‐one nulliparous, nonpregnant women not using oral contraception were investigated in the early follicular phase of their menstrual cycles. Also, 24 primigravid women with normotensive, uncomplicated pregnancies were investigated on eight separate occasions during their pregnancies.Results
A significant increase in mean p.(Ca2+)i was demonstrated by 28 weeks gestation in the pregnant women as compared to the nonpregnant control group and the same individuals when investigated at 12 weeks postpartum (P<0.05; ANOVA). This change was maximal at 36 weeks gestation (P<0.001; ANOVA); concentrations had returned to those not significantly different from nonpregnant women by six weeks postpartum.Conclusions
Basal platelet (Ca2+)i increases significantly by the third trimester of normal, primigravid pregnancy as compared to prepregnancy values and postnatal values. These data mirror the previously described observations of platelet behaviour noting increased activity at this gestation of pregnancy. It may be that the increased basal p.(Ca2+)i indicates that smaller transient signals have to be generated to induce platelet activity, such as shape change, aggregation and exocytosis.
Trends in multiple deliveries and infertility treatments in France
Authors: Tuppin Philippe , Blondel Beatrice , Kaminski Monique 
Published: August 2005

ABSTRACTObjective
To point out the association between infertility treatments and the increasing number of multiple deliveriesDesign
Comparison over time of the incidence of multiple deliveries, the proportion of deliveries resulting from assisted conception (AC), and ovulation inductor sales.Data
Use of existing statistics: vital statistics, surveys of AC centres and ovulation inductor sales.Results
Between 1972 and 1989 the incidence of twin deliveries rose from 8.8/1000 to 11.2/1000, and the incidence of triplet deliveries from 0.9/10 000 to 4.4/10 000. This upward trend was particularly remarkable among women aged 30 to 39. Since 1978, the triplet delivery rates and the sales of Human Menopausal Gonadotrophin have been rising similarly. Between 1985 and 1989, 26 per cent of the triplet deliveries followed assisted conception and nearly 50 per cent were estimated to be due to ovulation inductor agents.Conclusions
The results suggest a strong influence of infertility treatments and especially ovulation inductor agents in the dramatic increase of triplet deliveries.
Cervical contractions: the response of the cervix to oxytocic stimulation in the latent phase of labour
Authors: Oláh Karl S. , Gee Harry , Brown Jeremy S. 
Published: August 2005

ABSTRACTObjective
To assess the cervical response to myometrial activity in early labour.Design
Prospective observational study.Subjects
Women requiring oxytocin stimulation in induced and spontaneous labours.Setting
A teaching hospital in Birmingham.Main outcome measures
Simultaneous comparison of the cervical response to myometrial contractions was made on a cycle by cycle basis to deduce the properties of the cervix in early labour.Results
Sixty‐seven patients have been monitored, of whom 63 had satisfactory cervimetry data. Thirty (47.6%) women exhibited cervical contractions in response to myometrial activity. This response was only observed at dilatations up to 4 cm. The change in behaviour coincides with the transition from latent to active phases of dilatation. The length of the latent phase of labour was significantly longer in those women who exhibited cervical contractions (P<0.001), although the active phase was similar in the two groups (P>0.1). The group without cervical contractions exhibited a greater degree of efface‐ment (P<0.05) and tended to have more dilated cervices (P<0.01) than those who showed cervical contractions.Conclusions
It is possible for the cervix to contract in early labour. This response may be the result of incomplete preparation of the cervix for the process of dilatation, and is seen during what is recognised as the latent phase in those women in whom the cervix is uneffaced and undilated. These properties of the cervix may explain the poor results obtained from oxytocin stimulation of labour in the latent phase.
Are the WHO (1980) criteria for the 75 g oral glucose tolerance test appropriate for pregnant women?
Authors: Cheng Li‐Chang , Salmon Yvonne M. 
Published: August 2005

ABSTRACTObjectiveTo determine the normal response to a 75 g glucose challenge in the context of an oral glucose tolerance test in the third trimester of pregnancy.DesignProspective observational study.SettingAntenatal clinic, Kandang Kerbau Hospital, Singapore.SubjectsSixty‐four normal pregnant women with a low risk for diabetes.InterventionsGlucose (75 g) challenge following an overnight fast after 28 weeks of gestation.Main outcome measureVenous plasma glucose levels taken before and 2 h after the glucose challenge.ResultsUpper limits of normality were found to be fasting glucose 4·9 mmol/l and 2 h glucose 9·2 mmol/l.ConclusionTheWHO (1980)criteria should not be used in pregnancy.
Effectiveness of antenatal care: a population based study
Authors: Backe Bjørn , Consultant Jakob Nakling 
Published: August 2005

ABSTRACTObjective
To analyse the effectiveness of antenatal care as a screening for nonsymptomatic disease and obstetrical risk conditions.Design
Programme evaluation of antenatal care in a geographically based cohort.Setting
Routine clinical practice in primary and specialist level of health care without intervention.Subjects
One thousand nine hundred and eight women residing in one Norwegian county giving birth during a 12 month period, 1988 to 1989.Outcome measures
The detection rates at the time of delivery, for women with five conditions: twin pregnancies, placenta praevia, breech presentation, small for gestational age (SGA) and pre‐eclampsia.Results
Two hundred and ninety‐two women had one or more of the actual conditions, 124 (42%) had been diagnosed at the time of the delivery. The detection rate for SGA was remarkably low (14%). The detection rates for pre‐eclampsia (75%), breech presentation (69%), placenta praevia (57%) and twin pregnancies (94%) were in the same range as results reported in the literature. The number of false positive antenatal diagnosis was insignificant.Conclusions
Assessing the effectiveness of antenatal diagnosis of growth retardation is connected with major unsolved methodological problems. Clinical management of such cases may be better than indicated by the results based on the ultimate SGA classification. For important obstetrical conditions this study describes an applicable method for practical evaluation of the effectiveness of antenatal care. Areas where care could be improved are demonstrated.
The effect of introduction of umbilical Doppler recordings to obstetric practice
Authors: Johnstone Frank D. , Prescott Robin , Hoskins Peter , Greer Ian A. , McGlew Tom , Compton Mary 
Published: August 2005

ABSTRACTObjective
To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results.Design
Randomised controlled trial.Setting
A large teaching hospital.Subjects
Two thousand two hundred and eighty‐nine pregnancies defined as being at risk by referral for Doppler or fetal monitoring.Interventions
Continuous wave Doppler studies of umbilical artery. Results immediately available to clinicians.Main outcome measures
Fetal outcome: perinatal mortality, Apgar score and admission to the neonatal unit. Obstetric intervention: admission to hospital, induction of labour and caesarean section. Use of tests of fetal well being: cardiotocography, biophysical profile and ultrasound biometry.Results
The treatment and control groups were comparable in age, parity, gestation at point of entry and risk features. There were no overall differences in perinatal outcome, obstetric intervention or use of fetal monitoring. Examination of a subset recruited only because of hypertension or suspected intrauterine growth retardation (n = 754) similarly showed no difference attributable to group randomisation. Comparison of only those pregnancies retrospectively defined as low risk and high risk showed more use of cardiotocography in the high risk group with access to Doppler (P= 0.007) but no difference in the low risk group.Conclusion
Doppler umbilical artery recording has been shown to perform well in prediction power of antenatal fetal compromise. What has been examined in this study is the response of clinicians to the test. The results suggest that obstetricians do not use the test to modify their risk assessment, and, therefore, the need for fetal monitoring in particular pregnancies. There is a real need for accumulation of information from very large data sets, particularly in the prediction power of Doppler for antenatal fetal compromise from apparently chronic utero‐placental cause to guide use of monitoring resources. If simply added to existing fetal monitoring techniques in a hospital where these are widely used, then umbilical artery Doppler recordings may at present simply involve extra resources of staff and expenses, without benefit.
The effect of cordocentesis on umbilical and middle cerebral artery blood flow velocity waveforms
Authors: Hecher K. , Stettner H. , Spernol R. , Harrington K. , Szalay S. 
Published: August 2005

ABSTRACTObjective
To investigate the effect of cordocentesis on the umbilical and fetal cerebral circulation.Design
Cross sectional study.Setting
Department of Obstetrics and Gynaecology, Regional Referral Centre for Fetal Medicine, Klagenfurt Hospital, Austria.Subjects
Thirty pregnant women undergoing diagnostic cordocentesis at 18 to 38 weeks' gestation.Interventions
The pulsatility index (PI) in the umbilical artery and fetal middle cerebral artery was measured by pulsed Doppler ultrasound before and immediately after cordocentesis.Main outcome measures
Change in umbilical artery PI and middle cerebral artery PI.Results
Cordocentesis was associated with a significant decrease in both umbilical artery PI (median −0.18, range −2.21 to 1.5, P<0.004) and middle cerebral artery PI (mean ‐0.15, SD 0.32, P<0.03) and the decrease in umbilical artery PI was most marked when cordocentesis was performed transplacentally. In four cases, there were absent or reversed frequencies at the end of diastole (EDF) in the umbilical artery before cordocentesis, and in all cases there were positive EDF after the procedure. In contrast, one of the 26 cases with positive EDF developed reversed EDF following the procedure.Conclusions
Acute alterations in the waveforms from both the umbilical and fetal cerebral circulation can be induced by cordocentesis. The decrease in resistance in the fetoplacental circulation could be attributed to the release of vasodilators, and the increase in resistance observed in some cases could be secondary to arterial vasospasm. Better understanding of the underlying mechanisms might help in making cordocentesis a safer procedure.