bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of a lack of psychosocial resources and the risk of giving birth to small for gestational age infants: a stress hypothesis
Authors: Dejin‐Karlsson Elisabeth , Hanson Bertil S. , Östergren Per‐Olof , Lindgren Anna , Sjöberg Nils‐Otto , Marsal Karel 
Published: August 2005

Objective
To test the stress hypothesis that women who give birth to small for gestational age infants lack important psychosocial coping resources, such as a sufficient social network, social support and control in daily life.Design
A prospective cohort study of nulliparous pregnant women.Setting
Antenatal care units in the city of Malmö, Sweden.Population
All women (n= 994) during a one year period (1991–1992) were invited, and 872 (87.7%) participated. This study was restricted to pregnancies resulting in singleton live birth (n= 826); 6.7% of infants were classified as small for their gestational age.Methods
Self‐administered questionnaires were given to all women at the time of their first antenatal visit.Main outcome measures
The classification of small for gestational age was based on a gender‐specific intrauterine growth reference curve. Newborn babies were classified as being small for gestational age if their birthweight was > 2 SD below the mean weight for gestational age.Results
Lack of psychosocial resources, such as social stability, social participation, emotional and instrumental support, all increased the likelihood of delivering an infant that was small for gestational age. The odds ratios when controlled for demographic background factors, lifestyle factors and anthropomorphic measures were: OR 1.7 (95% CI0.9–3.3) for women with poor social stability; OR 2.2 (95% CI 1.1–4.4) for women with poor social participation; OR 2.6 (95% CI 1.2–5.7) for women with poor instrumental support; and OR 1.5 (95% CI 0.8–2.8) for women with poor emotional support. Simultaneous exposure to a poor total network index, as well as a poor total support index showed a significantly increased odds ratio for having a small for gestational age baby: OR 3.3 (95% CI 1.6–6.7) and OR 2.7 (95% CI 1.3–5.6), respectively. A synergy index of 9.0 and 6.8 supported the assumption of an interaction between immigrant status and poor total network or poor total support, in a synergistic direction.Conclusions
The findings support the stress‐hypothesis that a lack of psychosocial resources might increase the risk of giving birth to a baby that is small for gestational age.
Attitudes toward clinical guidelines among obstetricians in Northern Ireland
Authors: Dye Timothy D. , Alderdice Fiona , Roberge Eric , Jamison James Q. 
Published: August 2005

Objectives
To evaluate the attitudes of, and the influences on decisions made by, obstetricians in Northern Ireland in order to understand the feasibility of applying guidelines to obstetric practice.Design
Cross‐sectional postal survey.Setting
Northern Ireland.Population
Consultants, senior registrars, registrars, and senior house officers in obstetrics in Northern Ireland (n= 170). Responses were received from 68.8% (n= 117), with complete data available for 67.1% (n= 114).Main outcome measures
An attitudes score was constructed by consolidating responses to a variety of statements about guidelines. Individual responses to guidelines statements and the standardised attitudes T‐score were analysed by demographic and practice characteristics.Results
Attitudes toward guidelines were generally positive, with women practitioners more likely to have positive attitudes toward guidelines than did their male counterparts. Younger obstetricians were more likely to report that practitioners should incorporate guidelines into their practices. Doctors who responded that their decisions were influenced by specific tools related to guidelines, such as computerised databases, during the previous three months had more positive attitudes toward guidelines than doctors who did not use such tools. Furthermore, doctors based in teaching hospitals were more likely than others to have been influenced by the guidelines of professional societies.Conclusions
Generally guidelines appear to be quite well received, with doctors reporting that their practice often is influenced by them. Doctors who reported that their decisions were influenced by guidelines had an especially positive attitude toward them. However, some tools which target the application of evidence‐based methods (e.g. computerised databases) are used infrequently by obstetricians. The challenge remains to encourage the further development of guidelines and tools that are useful and appropriate for practitioners.
Evidence of dysfunctional β2‐adrenoceptor signal system in pre‐eclampsia
Authors: Aune B. , Vårtun Å. , Øian P. , Sager G. 
Published: August 2005

Objectives
To determine how β2‐adrenoceptor binding and function differ between healthy women and those with pre‐eclampsia.Design
Case‐control study.Setting
Faculty of Medicine, University of Tromsø, Norway.Participants
Two groups of pregnant women: eight cases with pre‐eclampsia, matched with eight healthy controls.Methods
Venous blood was drawn from women in both groups after an overnight rest. The two groups were matched for gestational age which was (mean (SD)) 36.4 (3.8) and 36.5 (4.4) weeks for the pre‐eclamptic and control groups, respectively. Six weeks after delivery a second blood sample was obtained. The binding and function of β2‐adrenoceptors were determined in isolated human mononu‐clear leukocytes. The levels of adrenaline and noradrenaline were determined in plasma from venous blood.Results
An elevated density of functional β2‐adrenoceptors was observed in normal pregnancy [mean (SD) 390 (90) vs 270 (60) sites/cell postpartum], due to an increased fraction of receptors in high affinity state, with unaltered total receptor density. The number of functional β2‐adrenoceptors was reduced in pre‐eclampsia [mean (SD) 80 (40) vs 240 (30) sites/cell postpartum], due to a reduction in the total receptor number with an unaltered fraction of high affinity receptors. In pregnancy, both unstimulated and isoprenaline‐stimulated cAMP levels were reduced in the women with pre‐eclampsia (0.5 (0.2) and 1.7 (0.9) pmol/106 cells, respectively) compared with the normal pregnant controls (mean (SD) 1.2 (0.3) and 4.7 (1.8) pmol/106 cells, respectively). Plasma catecholamine levels were not elevated in the women with pre‐eclampsia.Conclusions
The increased number of functional β2‐adrenoceptors may contribute to the vasodilatation seen in normal pregnancy, while the reduced overall number of receptors may be one of several factors that account for increased peripheral vascular resistance in pre‐eclampsia.
A randomised controlled trial of flexibility in routine antenatal care
Authors: Jewell David , Sharp Debbie , Sanders Julia , Peters Tim J. 
Published: August 2005

Objective
To assess changes in satisfaction associated with a flexible approach to antenatal care schedules offered to women at low obstetric risk.Design
Randomised controlled trial.Setting
Eleven primary care centres providing midwifery care in Avon.Participants
Six hundred and nine women at low risk of obstetric complications presenting for antenatal care.Methods
A standard antenatal care schedule (‘traditional care’) was compared with a schedule based on a minimum number of visits and additional visits with timing agreed between women and midwives (‘flexible care’).Main outcome measures
Women's attitudes to pregnancy and motherhood using a subscale of the Maternal Adjustment and Maternal Attitudes scale, satisfaction with antenatal care, and perception of the speed of recognition of antenatal complications.Results
There was no difference between the two groups in terms of attitudes to pregnancy and motherhood (mean difference on Maternal Adjustment and Maternal Attitudes scale −0.64, 95% CI −1.39 to 0.11, P= 0.068) and no difference in the proportions of women reporting antenatal problems as soon as possible (traditional group 74.5%, flexible group 76.4%, difference −2%, 95% CI −12.1 to 8.2, P= 0.70). Women receiving traditional care reported higher levels of satisfaction for the care provided by community midwives (P < 0.01). Women receiving flexible care were more likely to report having a choice over the number and timing of their antenatal visits (P < 0.001), but were also more likely to report that they would like to have been seen more often (P < 0.01). There was no difference between the groups in rates of obstetric complications.Conclusions
An imposed reduction in antenatal visits has been reported to increase dissatisfaction in other studies. In this study, encouraging women to adopt a flexible approach to antenatal care resulted in a similar finding. Successful implementation of such approaches may depend on more careful selection of women who welcome such an approach, more encouragement to pregnant women to express their own needs and greater feelings of commitment on the part of the care providers.
Expectant management of early onset, severe pre‐eclampsia: maternal outcome
Authors: Hall D. R. , Odendaal H. J. , Steyn D. W. , Grové D. 
Published: August 2005

Objective
To evaluate the safety and outcome of women undergoing expectant management of early onset, severe pre‐eclampsia.Design
Prospective case series extending over a five‐year period.Setting
Tygerberg Hospital, a tertiary referral centre.Population
All women (n= 340) presenting with early onset, severe pre‐eclampsia, where both the mother and the fetus were otherwise stable.Methods
Frequent clinical and biochemical monitoring of maternal status, together with careful blood pressure control, in a high care obstetric ward.Main outcome measures
Major maternal complications and prolongation of gestation.Results
Multigravid women constituted 67% of the group. Antenatal biochemistry was reassuring with some expected, but not severe, deteriorations. Twenty‐seven percent of women experienced a major complication, but few had poor outcomes. No maternal deaths occurred. Most major complications resolved quickly, necessitating only three admissions (0.8%) to the intensive care unit. One woman required dialysis. Pregnancies were prolonged by a mean (median) number of 11 days (9) before delivery, with more time being gained at earlier gestations. The postpartum inpatient stay (89%≤ 7 days, bearing in mind that 82% of women were delivered by caesarean section) was not extended.Conclusion
Careful noninvasive management of early onset, severe pre‐eclampsia in a tertiary centre can diminish and limit the impact of serious maternal complications. Valuable time to prolong the pregnancy and improve neonatal outcome is thereby gained.
First trimester maternal serum free β human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications
Authors: Ong Charas Y. T. , Liao Adolfo W. , Spencer Kevin , Munim Shama , Nicolaides Kypros H. 
Published: August 2005

Objective
To examine the value of first trimester maternal serum free β human chorionic gonadotrophin (β hCG) and pregnancy associated plasma protein A (PAPP‐A) as predictors of pregnancy complications.Design
Screening study.Setting
Antenatal clinics.Population
Singleton pregnancies at 10–14 weeks of gestation.Methods
Maternal serum free β hCG and PAPP‐A were measured at 10–14 weeks of gestation in 5584 singleton pregnancies. In the 5297 (94.9%) pregnancies with complete follow up free β hCG and PAPP‐A were compared between those with normal outcome and those resulting in miscarriage, spontaneous preterm delivery, pregnancy induced hypertension or fetal growth restriction and in those with pre‐existing or gestational diabetes.Results
Maternal serum PAPP‐A increased and β hCG decreased with gestation. The multiple of median maternal serum PAPP‐A was significantly lower in those pregnancies resulting in miscarriage, pregnancy induced hypertension, growth restriction and in those with pre‐existing or gestational diabetes mellitus, but not in those complicated by spontaneous preterm delivery. The level was < 10th centile of the reference range in about 20% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 27% of those that developed gestational diabetes. Maternal serum free β hCG was < 10th centile of the reference range in about 15% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 20% of those that developed gestational diabetes.Conclusion
Low maternal serum PAPP‐A or β hCG at 10–14 weeks of gestation are associated with subsequent development of pregnancy complications.
One stop clinic for assessment of risk for fetal anomalies: a report of the first year of prospective screening for chromosomal anomalies in the first trimester
Authors: Spencer Kevin , Spencer Christine E. , Power Maureen , Moakes Andy , Nicolaides Kypros H. 
Published: August 2005

Objective
To evaluate the introduction of a one stop multidisciplinary clinic for screening for fetal chromosomal abnormalities in the first trimester by a combination of maternal serum biochemistry and ultrasonography providing a risk of chromosomal abnormalities within a one hour clinic visit.Design
One year retrospective review of screening performance.Population
All women attending for routine antenatal care. The population included 4190 singleton pregnancies in women of all ages screened between 10 weeks and 3 days and 13 weeks and 6 days of gestation between the periods 1 June 1998 and 31 May 1999 in a district general hospital antenatal clinic.Methods
All women booked into the clinic were offered screening by a combination of maternal serum free β human chorionic gonadotrophin (hCG) and pregnancy associated plasma protein A (PAPP‐A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 18/13 (≥ 1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out.Main outcome measures
The detection rate for trisomy 21, trisomy 18/13 and all aneuploides, false positive rate, uptake of screening, uptake of chorionic villus sampling in women identified at increased risk and fetal loss after chorionic villus sampling.Results
Overall 97.6% of the women (4088/4190) accepted first trimester screening. The rate of detection of trisomy 21 was 86% (6/7), for trisomy 18/13 100% (9/9) and for all aneuploides 95% (18/19). Fetal death at presentation was found in 1.6% of pregnancies (69/4088). Of women who accepted screening, 6.1% (257/4088) presented too late for fetal nuchal translucency measurement and 6.5% of the women (271/4088) presented too early. The false positive rate was 6.7% (253/3762). Uptake of invasive testing was 83% (207/253).Conclusion
First trimester prenatal screening for chromosomal abnormalities using a combination of maternal serum biochemistry and fetal nuchal translucency thickness can achieve detection rates in excess of 90%. These services can be provided in a one stop multidisciplinary clinic.
Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study
Authors: Irving W. L. , James D. K. , Stephenson T. , Laing P. , Jameson C. , Oxford J. S. , Chakraverty P. , Brown D. W. G. , Boon A. C. M , Zambon M. C. 
Published: August 2005

Objective
To determine whether maternal influenza virus infection in the second and third trimesters of pregnancy results in transplacental transmission of infection, maternal auto‐antibody production or an increase in complications of pregnancy.Design
Case‐control cohort study.Population
Study and control cohorts were derived from 3975 women who were consecutively delivered at two Nottingham teaching hospitals between May 1993 and July 1994. A complete set of three sera was available for 1659 women.Methods
Paired maternal ante‐ and postnatal sera were screened for a rise in anti‐influenza virus antibody titre by single radial haemolysis and haemagglutination inhibition. Routine obstetric data collected during and after pregnancy were retrieved from the Nottingham obstetric database. Cord samples were tested for the presence of IgM anti‐influenza antibodies, and postnatal infant sera were tested for the persistence of influenza‐virus specific IgG. Paired antenatal and postnatal sera were tested against a standard range of auto‐antigens by immunofluorescence.Main outcome measures
Classification of women as having definite serological evidence of an influenza virus infection in pregnancy (cases) or as controls.Results
Intercurrent influenza virus infections were identified in 182/1659 (11.0%) pregnancies. None of 138 cord sera from maternal influenza cases was positive for influenza A virus specific IgM. IgG anti‐influenza antibodies did not persist in any of 12 infant sera taken at age 6–12 months. Six of 172 postnatal maternal sera from cases of influenza were positive for auto‐antibodies. In all cases the corresponding antenatal serum was also positive for the same auto‐antibody. There were no significant differences in pregnancy outcome measures between cases and controls. Overall, there were significantly more complications of pregnancy in the cases versus the controls, but no single type of complication achieved statistical significance.Influenza infection in the second and third trimesters of pregnancy is a relatively common event. We found no evidence for transplacental transmission of influenza virus or auto‐antibody production in pregnancies complicated by influenza infections. There was an increase in the complications of pregnancy in our influenza cohort.
Estimates of maternal mortality by the sisterhood method in rural northern Tanzania: a household sample and an antenatal clinic sample
Authors: Olsen Bjørg Evjen , Hinderaker Sven Gudmund , Kazaura Method , Lie Rolv Terje , Bergsjø Per , Gasheka Petro , Kvåle Gunnar 
Published: August 2005

Objective
To estimate maternal mortality in two samples of a population in northern Tanzania.Setting
Rural communities and antenatal clinics, Mbulu and Hanang districts, Arusha region, Tanzania.Population
From a household survey 2043 men and women aged 15–60, and from an antenatal clinic survey 4172 women aged 15–59.Method
The indirect sisterhood method.Main outcome measures
The risk of maternal deaths per 100,000 live births (maternal mortality ratio), and the lifetime risk of a maternal death.Results
The risk of a maternal death per 100,000 live births was 362 (95% CI 269–456) and 444 (95% CI 371–517) for the household and antenatal clinic surveys, respectively. The lifetime risk of maternal death was 1 in 38 and 1 in 31, respectively, for the two surveys. A significantly lower risk of maternal death was observed for the respondents attending antenatal clinics closer to the hospital than for those attending clinics further away: 325 (95% CI 237–413) compared with 561 (95% CI 446–677) per 100,000 live births. Lifetime risk of maternal death was 1 in 42 and 1 in 25, respectively.Conclusions
The risk of maternal death per 100,000 live births in this area were comparatively high, but in our survey substantially lower than in previous surveys in Tanzania. Increasing distance from the antenatal clinics to the hospital was associated with higher maternal mortality. There was no significant difference between results based on household and antenatal clinic data, suggesting that accessible health facility data using the sisterhood method may provide a basis for local assessment of maternal mortality in developing countries.
Pregnancy and delivery: a urodynamic viewpoint
Authors: Chaliha C. , Bland J. M. , Monga A. , Stanton S. L. , Sultan A. H. 
Published: August 2005

Objective
The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function.Design
Prospective longitudinal study. Twin channel subtracted cystometry was performed in the standing and sitting position, with a cough stress test at the end of filling. The investigations were repeated three months postpartum.Participants
Two hundred and eighty‐six nulliparae with singleton pregnancies who were delivered between April 1996 and November 1997 attended for antenatal assessment after 34 weeks of gestation and 161 who returned postpartum.Setting
Department of Obstetrics and Gynaecology in a London teaching hospital.Results
The mean urodynamic values both in pregnancy and postpartum lower than values defined in a non‐pregnant population. The prevalence of genuine stress incontinence and detrusor instability were antenatally 9% and 8%, respectively, and postpartum 5% and 7%, respectively. Obstetric and neonatal factors were not related to urodynamic variables.Conclusions
Despite the reported high prevalence of urinary incontinence related to pregnancy and childbirth, neither pregnancy nor delivery resulted in any consistent effects on objective bladder function. Postpartum urodynamic measurements were not related to either obstetric or neonatal variables, but were dependent on antenatal values.
Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters
Authors: Meyer S. , Hohlfeld P. , Achtari C. , Russolo A. , De Grandi P. 
Published: August 2005

Objective
To compare the effects of forceps delivery and spontaneous delivery on pelvic floor functions in nulliparous women.Design
A longitudinal prospective study with investigations during the first pregnancy, 10 weeks and 10 months after delivery.Setting
Antenatal clinic in a teaching hospital.Population
One hundred and seven patients aged 28.4 years, divided into those with forceps (n= 25) or spontaneous (n= 82) delivery.Methods
Investigations with a questionnaire, clinical examination, assessment of bladder neck behaviour, urethral sphincter function, intra‐vaginal/intra‐anal pressures during pelvic floor contractions.Results
The incidence of stress urinary incontinence was similar in both groups at 9 weeks (32%vs 21%, P= 0.3) and 10 months (20%vs 15%, P= 0.6) after delivery, as was the incidence of faecal incontinence (9 weeks: 8%vs 4%, P= 0.9; 10 months: 4%vs 5%, P= 1) and the decreased sexual response at 10 months (12%vs 18%, P= 0.6). Bladder neck behaviour, urethral sphincter function and intra‐vaginal and intra‐anal pressures were also similar in the two groups. However, 10 months after delivery, the incidence of a weak pelvic floor (20%vs 6%, P= 0.05) and the decrease in intra‐anal pressure between the pre‐ and post‐delivery values (−17±28 cm H2O vs 3±31 cm H2O, P= 0.04) were significantly greater in the forceps‐delivered women.Conclusions
Forceps delivery is not responsible for a higher incidence of pelvic floor complaints or greater changes in bladder neck behaviour or urethral sphincter functions. However, patients with forceps delivery have a significantly greater decrease in intra‐anal pressure and a greater incidence of a weak pelvic floor.