bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography
Authors: Vuento Maarit H. , Pirhonen Jouko P. , Mäkinen Juha I. , Tyrkkö Juhani E. , Laippala Pekka J. , Grönroos Matti , Salmi Thula A. 
Published: August 2005

Objective
To evaluate endometrial thickness and uterine arterial flow measurement as predictors of endometrial cancer.Design
Prospective study among a cohort of women invited to age‐adjusted, population‐based breast cancer screening by mammography.Setting
City of Turku, Finland.Population
1074 postmenopausal women aged 57–61 years (mean 59 years).Methods
Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was ≥ 4.0 mm, if the uterine artery pulsatility index was ≤ 1.0 or if there was a fluid accumulation in the endometrial cavity.Main outcome measures
Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models.Results
An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result.Conclusion
Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is ≥ 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.
A prospective follow up study of women with colposcopically unconfirmed positive cervical smears
Authors: Milne D. S. , Wadehra V. , Mennim D. , Wagstaff T. I. 
Published: August 2005

Objective
To examine a cohort of women with positive cervical smears, but negative colposcopy, in order to ascertain whether there is a subsequent difference in the incidence of squamous dyskaryosis and cervical intraepithelial neoplasia when compared with a control group.Design
Prospective follow up study.Setting
Colposcopy clinics, antenatal clinics, GP surgeries.Methods
A study group of 255 women with reported abnormal cervical smears but negative colposcopy was subdivided into three groups according to referral smears suggesting high grade dyskaryosis (n= 34), mild dyskaryosis (n= 120) and borderline changes (n= 101). They were followed for at least five years and were compared with a control group of 726 women followed up after a negative smear, using the first and worst follow up smears over a five year recall period.Main outcome measures
Incidence of subsequent cervical cytological and histological abnormalities.Results
The control group had a similar incidence of squamous dyskaryosis as that expected in the screening population. Forty‐six per cent of the study group with colposcopically unconfirmed (‘false positive’) cervical smears subsequently had abnormal smears. When the three groups were compared with controls using a χ2 test, their incidence of abnormal smears was significantly increased. Cervical intrepithelial neoplasia was found in 19% of the study group, and in 3% of the control group (P < 0.0001).Conclusions
The analysis demonstrates that women with so‐called ‘false positive’ smears defined by negative colposcopy have an increased risk of subsequent abnormal smears and cervical intrepithelial neoplasia, suggesting that lesions may have been missed on colposcopy. However, in a significant proportion of women, further abnormalities were not detected during the follow up period, indicating that there may be other causes for positive smears and negative colposcopy.
Antenatal screening for hepatitis B infection and syphilis in the UK
Authors: Newell Marie‐Louise , Thorne Claire , Pembrey Lucy , Nicoll Angus , Goldberg David , Peckham Catherine 
Published: August 2005

Objectives
To assess antenatal hepatitis B and syphilis screening policies in the UK.Design
Postal questionnaire survey.Setting
One hundred and ninety‐two obstetric units and 116 Public Health directorates.Main outcome measures
Antenatal screening policy and line of responsibility for ensuring vaccine uptake in hepatitis B virus exposed children.Results
Replies were received from 140 (73%) obstetric centres and 99 (85%) Public Health directors. Forty per cent of obstetric centres now offer hepatitis B virus tests to all pregnant women, and nearly one‐quarter (24.1 %) of all births in the UK in 1996 occurred in centres with a universal testing policy. The prevalence of chronic hepatitis B virus ranged from 0.3 to 17.5 per 1000 deliveries. Universal antenatal screening for serological evidence of syphilis was the norm, but five obstetric centres respondents and three Public Health directors were considering its discontinuation. In the nine London centres, syphilis prevalence was 2.06 per 1000 pregnant women, compared with 0.24 per 1000 elsewhere. Responses from Public Health directors indicated the nonspecific nature of the antenatal care contract. Responsibility for hepatitis B virus vaccination of the newly born infant rests with the hospital paediatrician, with transfer of responsibility to the community usually occurring through a discharge letter. Only two areas had a monitoring system to ensure full hepatitis B virus vaccination coverage of exposed infants.Conclusions
If antenatal screening policies are to be equitable there is a need for a clear national policy, and systems need to be established to monitor local policy and practice.
Screening for fetal aneuploidies and fetal cardiac abnormalities by nuchal translucency thickness measurement at 10–14 weeks of gestation as part of routine antenatal care in an unselected population
Authors: Schwärzler P. , Carvalho J. S. , Senat M.‐V. , Masroor T. , Campbell S. , Ville Y. 
Published: August 2005

Objectives
To evaluate first trimester pregnancy screening for fetal aneuploidy and congenital heart defects by maternal age and nuchal translucency measurement and screening for fetal aneuploidies and congenital heart defects by ultrasound in an unselected population.Design
A prospective study.Setting
Fetal medicine unit, St George's Hospital, London.Sample
4523 consecutive viable fetuses at 10–14 weeks with a crown–rump length between 38 and 80 mm were scanned transabdominally (93%) or transvaginally (7%).Methods
Screening was performed by calculating the background risk from maternal age, gestational age and obstetric history, which was then adjusted with the nuchal translucency measurement in relation to crown–rump length (adjusted risk).Main outcome measures
Measurements of crown–rump length and nuchal translucency thickness. An adjusted risk of > 1:270 was considered as a positive screening test. Pregnancy outcome was obtained through karyotyping, outcome questionnaires and examination of the newborn infants.Results
Mean maternal age was 29.4 years and mean gestational age 12.2 weeks. Screening was positive in 230/4523 fetuses (5.1%), when the adjusted risk (mean 1:2649) was > 1:270. Fetal karyotype was abnormal in 23 (0.51%) cases, including twelve with trisomy 21, five trisomy 18, one trisomy 13, one trisomy 10, one monosomy X and two triploidies. For a false positive rate of 4.7%, the sensitivity of this test was 78% in detecting any fetal aneuploidy. Only one out of nine major congenital heart defects in this population was found within the 110 euploid fetuses with increased nuchal translucency thickness (> 2.5 mm).Conclusion
Screening for fetal aneuploidy by maternal age and nuchal translucency measurement can be effective in an unselected population. However, our results do not support its effectiveness in the detection of cardiac abnormalities.
Misoprostol compared with methylergometrine for the prevention of postpartum haemorrhage: a double–blind randomised trial
Authors: Amant Frédéric , Spitz Bernard , Timmerman Dirk , Corremans Annick , Van Assche Frans André 
Published: August 2005

Objective
To compare the efficacy and side effects of misoprostol, compared with methylergometrine, for the prevention of postpartum haemorrhage.Design
A double–blind, randomised clinical trial of 200 women with apparently normal pregnancies.Setting
University teaching hospital.Participants
Two hundred women with apparently normal pregnancies.Methods
After the baby had been born, all women received two capsules by mouth and the contents of an ampule by intravenous injection. Each woman only received one active product. The capsules contained either a total of 600 μg misoprostol or placebo, and the ampule 200 μg of methylergometrine or placebo.Main outcome measures
Need for further oxytocic drugs, blood pressure, the presence of side effects, mean haemoglobin and haematocrit three days after delivery.Results
Two hundred women completed the study (100 received methylergometrine and 100 misoprostol). Postpartum haemorrhage occurred in 4.3% of the methylergometrine group and 8.3% of the misoprostol group (P= 0.57). The need for further oxytocic drugs was 4.4% and 12.8% after methylergometrine and misoprostol, respectively (P= 0.065). One hour after the birth of the baby there was no difference in the mean systolic blood pressure (117 ± 12 mmHg versus 115 ± 11 mmHg) (P= 0.26) or the mean diastolic blood pressure (72 ± 10 mmHg versus 71 ± 11 mmHg for the groups receiving methylergometrine or misoprostol, respectively) (P= 0.97). The mean temperature in the misoprostol group rose to 37.4°C, compared with 37°C in the methylergometrine group (P < 0.0001). In the misoprostol group 34% developed fever (> 38°C) compared with 3% in the methylergometrine group (P < 0.0001). Shivering (visual analogue score ≥ 8) also occurred more often after misoprostol (42%) than after methylergometrine (8.5%) (P < 0.0001). The haemoglobin level (g/dL) on the third postpartum day was similar for both groups (11.O and 11.2 for methylergometrine and misoprostol, respectively) (P= 0.39).Conclusions
This study suggests that although protection from postpartum haemorrhage using parenteral methylergometrine and oral misoprostol is nearly equal, misoprostol is associated with more side effects.
Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine
Authors: Fairlie F. M. , Marshall L. , Walker J. J. , Elbourne D. 
Published: August 2005

Objective
To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour.Design
Double‐blind randomised controlled trial.Setting
The labour ward in a UK teaching hospital.Participants
Sixty‐nine nulliparous women and 64 multiparous women in labour who requested narcotic analgesia and remained undelivered one hour after trial entry.Methods
Nulliparous women were randomised to receive either 150 mg intramuscular pethidine or 7–5 mg intramuscular diamorphine. Multiparous women were randomised to receive either 100 mg intramuscular pethidine or 5 mg intramuscular diamorphine. All participants received the anti‐emetic prochloroperazine at the same time as the trial drugs.Main outcome measures
Maternal analgesia assessed by a visual analogue score and verbal scales of pain intensity and pain relief, maternal sedation and vomiting, neonatal outcome assessed by Apgar scores and the need for resuscitation.Results
More women allocated to receiving pethidine than to diamorphine reported slight or no pain relief at 60 minutes after administration of these drugs (P= 0.03). This trend was repeated in most of the other measures for maternal analgesia. There was no difference in maternal sedation, but the incidence of vomiting within 60 minutes was lower for women who received diamorphine (P= 0.02). Pethidine was associated with lower Apgar scores at 1 minute (P < 0.05).Conclusion
Intramuscular diamorphine in labour appears to have some benefits, compared with intramuscular pethidine, but the trial was small and further research, particularly into alternative opioids and long term effects on the infants is still needed.
Fetal ultrasound biometry: 1. Head reference values
Authors: Kurmanavicius Juozas , Wright Eileen M. , Royston Patrick , Wisser Joseph , Huch Renate , Huch Albert , Zimmermann Roland 
Published: August 2005

Objective
To create reliable reference ranges and calculate Z scores for fetal head ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.Design
A prospective, cross‐sectional study.Setting
Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich.Sample
The study data were obtained from 6557 pregnant women.Methods
Only the first ultrasound examination between 12 and 42 weeks of each fetus with exactly established gestational age was used for analysis. No exclusions were made on the grounds of small‐for‐date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter.Results
A total of 6217 fetal head biparietal diameters and 5510 occipito‐frontal diameters were measured. Both head circumference and cephalic index were derived in 5462 cases where both biparietal diameter and occipito‐frontal diameter could be measured on the same fetus. The centile charts, tables and regression formulae for biparietal and occipito‐frontal diameters, head circumference and cephalic index are presented. An application to calculate 2 scores was developed using Excel (Microsoft Corporation, USA) and macros are presented in detail in the Figure 8 footnote. The comparison of our charts with those of the two most recent studies revealed almost no differences in biparietal diameter centiles. In one publication, occipito‐frontal diameter charts, and in another, head circumference charts were different from the current study.Conclusions
We have presented centile charts, tables and regression formulae for fetal head ultrasound biometry derived from a large and minimally selected sample size in a carefully designed cross‐sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented for use in computer‐aided evaluation of fetal ultrasound biometry.
An investigation of women's involvement in the decision to deliver by caesarean section
Authors: Graham W. J. , Hundley V. , McCheyne A. L. , Hall M. H. , Gurney E. , Milne J. 
Published: August 2005

Objective
To assess the degree and nature of women's involvement in the decision to deliver by caesarean section, and women's satisfaction with this involvement.Design
Observational study.Setting
The maternity unit in a large teaching hospital.Sample
One hundred and sixty‐six women undergoing caesarean section.Methods
Interviews with the women on the third or fourth day postpartum, questionnaires sent to the women at 6 weeks and at 12 weeks postpartum, and extraction of information from the women's medical records.Main outcome measures
Women's knowledge, satisfaction, and involvement in making the decision concerning their caesarean section.Results
The majority of the women were satisfied with the information they received during pregnancy on caesarean section and with their involvement in making the decision, but the proportions were significantly higher for elective than emergency sections. For 7% of the women, maternal preference for caesarean section was a direct factor in making the decision. Just over half of the 166 women reported that they were not debriefed on the reasons for their caesarean section before their discharge from hospital. Almost a third of the women undergoing emergency caesarean section expressed negative feelings towards their delivery, compared with 13% of those undergoing elective caesarean sections.Conclusion
Women are not a homogeneous group in terms of their requirements for information, nor their desire to be involved in the decision on mode of delivery. Health professionals need to be responsive to this variability and to agree on standards for communicating with women during pregnancy about the possibility of operative delivery and for debriefing women after caesarean section. sarean section, and women's satisfaction with this involvement.
Vaginal misoprostol for pre‐abortion cervical priming: is there an optimal evacuation time interval?
Authors: Singh Kuldip , Fong Y. F. , Prasad R. N. V. , Dong F. 
Published: August 2005

Objective
To determine the optimal evacuation time interval in the use of vaginal misoprostol for cervical priming before first trimester termination of pregnancy.Design
Prospective double‐blind randomised study.Setting
Fertility Control Centre, National University Hospital, Singapore.Methods
Sixty healthy nulliparous women requesting legal termination of pregnancy between 6 and 11 weeks of gestation were randomly allocated to either the 400 pg or 600 μg misoprostol group. Vacuum aspiration was performed after three hours in the 400 pg group and at the end of two hours in the women given 600 μg misoprostol. Using Hegar's dilator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if < Hegar 8), pre‐operative and intra‐operative blood loss, and associated side effects.Results
For the 600 pg group, only five women (16.7%) achieved a cervical dilatation of 2.8 nun, compared with 28 women (93.3%) in the 400 μg group. Using the 400 μg misoprostol group as a baseline, the odds ratio was 0.014 (95% CI 0.003–0.080) for 600 pg for successful pre‐operative cervical dilatation of 2.8 mm. The mean cervical dilatation for 400 and 600 μg misoprostol was 8.1 mm and 6.6 mm, respectively (P < 0.001). Despite the shorter evacuation time interval of two hours, the 600 μg dose was associated with an increase in side effects such as vaginal bleeding, abdominal pain and a fever of > 38.°C. However, other than abdominal pain, no significant differences in the frequency of these side effects were shown.Conclusion
Use of 400 μg misoprostol with a minimal evacuation time interval of three hours still appears the optimal dosage and evacuation time for cervical priming before fiist trimester termination of pregnancy.
Anal incontinence after vaginal delivery: a prospective study in primiparous women
Authors: Zetterstrom Jan P. , López Annika , Anzén Bo , Dolk Anders , Norman Margareta , Mellgren Anders 
Published: August 2005

Objective
To investigate the incidence and degree of anal incontinence after vaginal delivery among primiparous women and to define associated risk factors.Design
Prospective observational study.Setting
Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital.Participants
Three hundred and forty‐nine primiparous women.Methods
Questionnaires distributed within the first days after delivery and re‐distributed five and nine months postpartum. Analysis of delivery records.Results
Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1 % of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery.Conclusions
The present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.
Doppler fetal circulation in pregnancies complicated by pre‐eclampsia or delivery of a small for gestational age baby: 2. Longitudinal analysis
Authors: Harrington K. , Thompson M. O. , Carpenter R. G. , Nguyen M. , Campbell S. 
Published: August 2005

Objective
To observe the longitudinal changes in growth, and associated Doppler measurements, of the fetal circulation in pregnancies with a normal outcome and those complicated by pre‐eclampsia, birth of a small for gestational age baby, or a combination of these complications.Methods
Two hundred and ninety‐two women had serial ultrasound scans performed from the 24th week of pregnancy. Measurements obtained included: the abdominal circumference, umbilical artery pulsatility index, the middle cerebral artery pulsatility index and time‐averaged velocity, and the thoracic aorta pulsatility index and time‐averaged velocity. Outcome measures included the birth of a small for gestational age infant, pre‐eclampsia or a combination of these complications.Results
One hundred and sixty‐seven pregnancies ended in the normal birth of an appropriately grown infant at term, while 105 had a complicated outcome. They were divided into three categories: pre‐eclampsia only (i.e. with the birth of an appropriately grown fetus, n= 13); small for gestational age only with no evidence of pre‐eclampsia, n= 55; and pre‐eclampsia complicated by the birth of a small for gestational age infant, n = 37. The group with pre‐eclampsia complicated by small for gestational age was closest in characteristics to true clinical intrauterine growth restriction. A reduction in the abdominal circumference mirrored a rise in the umbilical artery pulsatility index and preceded changes in the middle cerebral artery and thoracic aorta. The greatest degree of change in the fetal circulation was observed during the three weeks preceding delivery. Ratios of the values obtained from the fetal and umbilical circulation demonstrated the greatest deviation from normal.Conclusions
A reduction in fetal growth velocity preceded changes observed in the fetal circulation. Ratios of the fetal Doppler parameters provided the clearest evidence of deterioration in the fetal condition. The information provided may be of use in the diagnosis and management of the growth‐restricted fetus.