bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antenatal home blood pressure monitoring: a pilot randomised controlled trial
Authors: Ross‐McGill H. , Hewison J. , Hirst J. , Dowswell T. , Holt A. , Brunskill P. , Thornton J. G. 
Published: August 2005

Objective
To measure recruitment to, compliance with, and the acceptability of a trial designed to test whether a reduced schedule of antenatal visits combined with training in self‐measurement of blood pressure at home may improve hypertension screening and save money. To test the specific hypothesis that even after taking into account extra unscheduled visits, the reduced schedule with ambulatory monitoring reduces total visits.Design
A pilot randomised controlled trial.Setting
Four urban and four rural general practices in Yorkshire and Lancashire.Population
One hundred and five low risk women in the third trimester of pregnancy. Eighty women participated.Intervention
Women were invited to participate at 24–28 weeks. Those who accepted were allocated either to a standard nine subsequent visit schedule (30, 32, 34, 36, 37, 38, 39, 40, 41 weeks) or to a reduced schedule (34, 38, 41 weeks). Those in the latter group measured their blood pressure weekly using a portable sphygmomanometer at home.Main outcome measures
Recruitment, total number of clinic visits, frequency of blood pressure measurement, schedule preference, and anxiety.Results
Although there were more unscheduled visits in the home monitoring group, this did not outweigh the reduction in scheduled visits, (total visits reduced from 7.4 to 4.5, P < 0.001), and blood pressure was measured during more weeks (9 vs 7 weeks, P < 0.001) in the experimental group. Most women expressed a preference for the reduced schedule both when the idea was first suggested, and after they had experienced it, and there were no significant differences in anxiety.Conclusion
Replacement of antenatal screening visits with home blood pressure monitoring is acceptable to women. The reduction in clinic visits is not compensated by an increase in visits for other reasons and overall blood pressure measurement is omitted less often. Whether it reduces adverse outcomes or has any rare side effects will require a larger trial, but this pilot study indicates that it is likely to be safe, and that such a large trial would be feasible.
The effect of submucous fibroids on the dose‐dependent modulation of uterine bleeding by trimegestone in postmenopausal women treated with hormone replacement therapy
Authors: Wahab May , Thompson John , Al‐Azzawi Farook 
Published: August 2005

Objective
To assess the value of identifying endometrial structural abnormalities at baseline hysteroscopy in predicting the pattern of bleeding in postmenopausal women treated with hormone replacement therapy.Design
A randomised, double‐blind, dose‐ranging study.Setting
A teaching hospital in the UK.Population
One hundred and seventy‐six healthy postmenopausal women.Methods
Women were randomised to receive one of four doses of oral trimegestone (0.05, 0.1, 0.25 and 0.5 mg per day), from day 15–28, and a daily dose of 2 mg oral micronised oestradiol for six treatment cycles. Women completed diaries in which the bleeding episodes were recorded. Hysteroscopy under local anaesthesia and endometrial biopsy were performed at baseline and on day 24 of the last treatment cycle.Results
Women with submucous fibroids had more prolonged (P= 0.026) and heavier (P= 0.002) progestogen‐associated bleeding (odds ratio 4.54). The incidence of intermenstrual bleeding, but not its duration or severity, was higher in women with submucous fibroids (P= 0.017). There was a clear dose‐dependent effect of trimegestone, with a consistently later onset of progestogen‐associated bleeding occurring with increasing doses of trimegestone (P < 0.001), and such episodes became progressively lighter and of shorter duration over time (P < 0.001).Conclusion
Hysteroscopic evaluation of the endometrial cavity in women treated with hormone replacement therapy, predicts the occurrence of heavy and unscheduled bleeding.
Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation‐wide study of 17,360 users
Authors: Backman Tiina , Huhtala Sakke , Blom Taru , Luoto Riitta , Rauramo Ilkka , Koskenvuo Markku 
Published: August 2005

Objective
To establish the continuation rates of the levonorgestrel intrauterine system (LNG IUS) and symptoms associated with its premature removal.Sample and Setting
All women in Finland who had a LNG IUS inserted between April 1990 and December 1993 and whose doctor had filled in and returned a form at the insertion visit. This study population consists of 46% of all the LNG IUSs sold in Finland between 1990 and 1993.Design
A questionnaire on reproductive and contraceptive history, gynaecological problems and symptoms experienced during the use of the LNG IUS was sent to 23,885 LNG IUS users. A total of 17,914 questionnaires were returned (response rate 75%). The results cover experience from 58,600 woman years. A log‐rank‐test was used to test differences in continuation rates. Multivariate analyse were performed using Cox's proportional hazard model.Results
The LNG IUS was prematurely removed from 5175 women. The one, two, three, four and five year continuation rates were 93%, 87%, 81%, 75% and 65%, respectively. The symptoms during the use of the LNG IUS most strongly associated with its premature removal were excessive bleeding and spotting, and infections and pain. The risk of premature removal was markedly lower among women who had occasional or total absence of menstruation. Premature removal was less likely in the oldest age group.Conclusions
The continuation rate of the LNG IUS compares favourably with other long‐acting contraceptive systems. Totally or occasionally absent menstruation was strongly associated with prolonged continuation.
Piperazine oestrone sulphate and interrupted norethisterone: effects on the postmenopausal endometrium
Authors: Byrjalsen Inger , Alexandersen Peter , Christiansen Glaus 
Published: August 2005

Objective
To assess the effects on the postmenopausal endometrium of two doses of oral piperazine oestrone sulphate and interrupted norethisterone in comparison with a continuously combined regimen and placebo.Design
A prospective randomised trial.Participants
Two hundred healthy postmenopausal women.Methods
Random assignment to two years of treatment with alternating three‐day cycles of 1.5 mg piperazine oestrone sulphate and 1.5 mg piperazine oestrone sulphate + 0.7 mg norethisterone (highEP), or alternating three‐day cycles of 0.75 mg piperazine oestrone sulphate and 0.75 mg piperazine oestrone sulphate + 0.35 mg norethisterone (lowEP), or 2 mg 17 β‐oestradiol continuously combined with 1 mg norethisterone acetate (E2+NETA), or placebo.Main outcome measures
Effect of treatment on endometrial histology, endometrial thickness, occurrence of uterine bleeding, endometrial oestrogen and progesterone receptor content, endometrial isocitrate dehydrogenase activity, and serum placental protein 14.Results
The incidence of bleeding declined with time. In the second treatment year, the women receiving lowEP reported on average 7.3 days of bleeding, highEP 16.7 days, and E2+NETA 11.2 days. Histological assessment of endometrial biopsies revealed an atrophic or slightly secretory endometrium. Serum placental protein 14 increased slightly, but was statistically highly significant, during treatment, but no cyclical variation was observed. Endometrial isocitrate dehydrogenase was low in all three hormone groups and the same low level of endometrial oestrogen receptor and progesterone receptor was found comparable to the level in the placebo group.Conclusions
Histological and biochemical assessment of the endometrium showed that interrupted hormone replacement therapy induced the same pattern in endometrial parameters as continuous combined hormone replacement therapy.
The effect of a group programme on women with the Mayer‐Rokitansky‐Küster‐Hauser Syndrome
Authors: Weijenborg Philomeen T. M. , ter Kuile Moniek M. 
Published: August 2005

Objective
To evaluate the effect of a group programme on psychological distress in women with the Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome.Setting
Gynaecologic outpatient clinic.Sample
Seventeen women with MRKH syndrome participated in this study.Method
A semi‐structured programme of seven sessions was offered dealing with themes of the MRKH syndrome. Psychological distress was measured at the first visit 3–6 month before the group programme was started (pre‐test‐0), at the first (pre‐test) and then at the last group session (post‐test).Main outcome measure
The Symptom Check List‐90 was used to assess feelings of psychological distress.Results
The post‐test subscale scores for anxiety, depression, interpersonal sensitivity and the total score for psychological distress were significantly lower than the pre‐test‐0 and pre‐test scores (P < 0.05). No significant differences were found between the pre‐test‐0 and pre‐test subscale scores and total score.Conclusion
A semi‐structured group programme seems valuable in helping women with the MRKH syndrome to deal with their psychological stress.
Randomised clinical trials of fish oil supplementation in high risk pregnancies
Authors: Olsen Sjúrour F. , Secher Niels J. , Tabor Ann , Weber Tom , Walker James J. , Gluud Christian 
Published: August 2005

Objective
To test the postulated preventive effects of dietary n‐3 fatty acids on pre‐term delivery, intrauterine growth retardation, and pregnancy induced hypertension.Design
In six multicentre trials, women with high risk pregnancies were randomly assigned to receive fish oil (Pikasol) or olive oil in identically‐looking capsules from around 20 weeks (prophylactic trials) or 33 weeks (therapeutic trials) until delivery.Setting
Nineteen hospitals in Europe.Samples
Four prophylactic trials enrolled 232, 280, and 386 women who had experienced previous pre‐term delivery, intrauterine growth retardation, or pregnancy induced hypertension respectively, and 579 with twin pregnancies. Two therapeutic trials enrolled 79 women with threatening pre‐eclampsia and 63 with suspected intrauterine growth retardation.Interventions
The fish oil provided 2.7 g and 6.1 g n‐3 fatty acids/day in the prophylactic and therapeutic trials, respectively.Main outcome measures
Preterm delivery, intrauterine growth retardation, pregnancy induced hypertension.Results
Fish oil reduced recurrence risk of pre‐term delivery from 33% to 21% (odds ratio 0.54 (95% CI 0.30 to 0.98)) but did not affect recurrence risks for the other outcomes (OR 1.26; 0.74 to 2.12 and 0.98; 0.63 to 1.53, respectively). In twin pregnancies, the risks for all three outcomes were similar in the two intervention arms (95% CI for the three odds ratios were 0.73 to 1.40, 0.90 to 1.52, and 0.83 to 2.32, respectively). The therapeutic trials detected no significant effects on pre‐defined outcomes. In the combined trials, fish oil delayed spontaneous delivery (proportional hazards ratio 1.22; 1.07 to 1.39, P= 0.002).Conclusions
Fish oil supplementation reduced the recurrence risk of pre‐term delivery, but had no effect on pre‐term delivery in twin pregnancies. Fish oil had no effect on intrauterine growth retardation and pregnancy induced hypertension, affecting neither recurrence risk nor risk in twin pregnancies.
Outcome of labour after successful external cephalic version at term complicated by isolated transient fetal bradycardia
Authors: Lau Tze Kin , Lo Keith Wing Kit , Leung Tak Yeung , Fok Wing Yee , Rogers Michael S. 
Published: August 2005

Objectives
To investigate factors associated with the occurrence of transient fetal bradycardia after external cephalic version, and labour outcome after isolated transient fetal bradycardia.Design
Cohort study.Setting
Teaching hospital with a policy of offering external cephalic version for breech presentation at or beyond 36 weeks of gestation.Population
Four hundred and twenty‐nine external cephalic versions performed over a 5‐year period.Methods
Between group differences were compared with the unpaired t test or the χ2 test. Logistic regression analysis was performed to exclude confounding effects.Main outcome measures
Incidence of caesarean section for fetal distress.Results
Transient fetal bradycardia occurred in 8.4% of external cephalic versions, and was associated with a successful version (OR 16.45, P < 0.001), a difficult procedure (OR 3.70, P= 0.001), and nulliparity (OR 2.83, P= 0.007). The incidence of intrapartum caesarean section for fetal distress was 16.7% in pregnancies with transient fetal bradycardia, compared with 7.9% in those without (OR 2.34, 95% CI 0.81, 6.71).Conclusions
Transient fetal bradycardia after external cephalic version may be associated with a higher risk of intrapartum caesarean section for fetal distress.
External cephalic version with epidural anaesthesia after failure of a first trial with beta‐mimetics
Authors: Rozenberg Patrick , Goffinet François , de Spirlet Marina , Durand‐Zaleski Isabelle , Blanié Pierre , Fisher Catherine , Lang Anne‐Christine , Nisand Israel 
Published: August 2005

Objective
To assess the efficacy, tolerance, and cost of external version under epidural anaesthesia and beta‐mimetic tocolysis after the failure of an initial attempt with tocolysis alone.Design
Prospective open study.Participants
Sixty‐eight women with breech presentation at around 36 weeks of gestation and an attempted external cephalic version under salbutamol that failed, who consented to try a second attempt under epidural anaesthesia.Results
The overall success rate under epidural anaesthesia was 39.7% (27/68), and complications occurred in two cases. The total cost of attempting external version was higher than the cost of expectant management.Conclusions
The efficacy of external cephalic version under epidural reduces the rate of caesarean sections associated with breech presentation, but its relative safety remains in question. Moreover, our economic analysis discourages the hope of lowered costs suggested by earlier reports that this technique is more expensive than expectant management, except in institutions with a policy of systematic caesarean sections when version fails.
The effect of thrombophylaxis on pregnancy outcome in patients with recurrent pregnancy loss associated with factor V Leiden mutation
Authors: Younis Johnny S. , Ohel Gonen , Brenner Benjamin , Haddad Sami , Lanir Naomi , Ben‐Ami Moshe 
Published: August 2005

Objective
To observe the effect of thrombophylaxis on pregnancy in women with a history of unexplained recurrent pregnancy loss also carrying the factor V Leiden mutation.Methods
Between 1 January and 31 December 1996, activated protein C (APC) resistance and factor V Leiden mutation were prospectively measured in 56 nonpregnant women, with a history of two or more unexplained recurrent pregnancy losses. During the same study period, seven women carrying the factor V Leiden mutation conceived, and were subsequently followed throughout their pregnancy. Subcutaneous low molecular weight heparin (LMWH, enoxaparin, 40 mg/day) and oral low dose aspirin (100 mg/day) were administered throughout the pregnancies, starting at early first trimester. Ultrasound and Doppler umbilical and fetal middle cerebral arterial flow studies were performed in the second and third trimesters, and the course and outcome of the pregnancies were documented.Results
Activated protein C resistance and factor V Leiden were found in 20 (36%) and 12 (21%) women of the study, respectively. Five of the seven pregnancies occuring progressed uneventfully to term with normal fetal growth, normal Doppler flow studies and uneventful neonatal outcome. Two of the seven women had early missed abortions.Conclusions
Thrombophylaxis, beginning in early pregnancy, in women with unexplained recurrent pregnancy loss associated with factor V Leiden mutation, seems to be safe and allow normal fetal development and good neonatal outcome. To prove the efficacy of thrombophylaxis by LMWH and low dose aspirin in this setting prospective controlled studies seem to be justified.
Comparative trends in cause‐specific fetal and neonatal mortality in twin and singleton births in the North of England, 1982–1994
Authors: Glinianaia Svetlana V. , Pharoah Peter , Sturgiss Steve N. 
Published: August 2005

Objective
To examine trends in cause‐ and birthweight‐specific fetal and neonatal mortality rates in twins and singletons.Design
Descriptive analysis based on a regional register.Setting
The Northern Health Region of England, 1982–1994.Sample
Two hundred and thirty‐six fetal and 356 neonatal twin deaths; 2687 fetal and 2301 neonatal singleton deaths from a population of 10,734 twins and 505,477 singletons.Main outcome measures
Fetal and neonatal autopsy rates, cause‐ and birthweight‐specific fetal and neonatal mortality rates in twins and singletons.Results
The extended perinatal mortality (including stillbirths and neonatal deaths) rate (EPMR) was 55.2 per 1000 in 1982–1994 in twins compared with 9.9 per 1000 in singletons. The relative risk for twin compared with singleton deaths was 5.6 (95% CI 5.1‐6.1) being highest for immaturity (12.9, 95% CI 11.1–15.0). A significant decrease in the EPMR occurred in both twins and singletons in 1988–1994 compared with 1982–1987. The EPMR decreased mainly due to a reduction of deaths from antepartum asphyxia in twins and intrapartum asphyxia and trauma in singletons, as well as a reduction in congenital malformations in both groups. In both twins and singletons, birthweight‐specific mortality rates improved between 1982–1987 and 1988–1994.Conclusion
The higher relative risk for twin deaths remained stable due to a similar decrease in the EPMR for both twins and singletons. The cause‐specific relative risk in twins declined for antepartum asphyxia. The mortality rate resulting from lethal congenital malformations decreased in twins and singletons mainly due to earlier detection and subsequent termination of pregnancy.
The continuing fall in incidence of hypoxic‐ischaemic encephalopathy in term infants
Authors: Smith Julie , Wells Louise , Dodd Keith 
Published: August 2005

Objective
To examine trends in incidence of hypoxic‐ischaemic encephalopathy in term infants over a twenty‐one year period.Design
A retrospective analysis of medical records of all term infants admitted to a neonatal unit with hypoxic‐ischaemic encephalopathy during the years 1992–1996 (period C) and a comparison with data from the years 1976–1980 (period A) and 1984–1988 (period B) from the same unit (previously published1).Setting
A District Health Authority in Central England serving a population of about 450,000.Sample
All term infants admitted with clinical features of hypoxic‐ischaemic encephalopathy.Main outcome measures
Incidence of three grades of hypoxic‐ischaemic encephalopathy, disability and mortality.Results
In each five year period there were similar numbers of births. Over the time‐span of this study the stillbirth rate and neonatal mortality rate has consistently fallen. The overall incidence of hypoxicischaemic encephalopathy in term infants was significantly lower (P < 0.001; OR 0.42 CI 0.29–0.59) in the present study period (C) compared with the earlier study period B (1.9 vs 4.6 per 1000 total live births). The fall in moderately and severely affected infants between the present and the first study period was significant (1.2 vs 2.6 per 1000 total live births, P < 0.001: OR 0.46 CI 0.29–0.72). The number of deaths and the incidence of cerebral palsy in survivors fell progressively over the 21 years spanned by this study.Conclusion
This study shows that the incidence of hypoxic‐ischaemic encephalopathy and its sequelae in term infants has fallen significantly. The use of cardiotocography and caesarean section rates have risen but the relative contributions of changes in clinical practice are uncertain.
Decision to delivery intervals for assisted vaginal vertex delivery
Authors: Okunwobi‐Smith Yetunde , Cooke Inez , MacKenzie I. Z. 
Published: August 2005

Objective
To describe the time interval between decision for assisted vaginal delivery and the birth of the baby in different clinical circumstances.Design
A prospective analysis of 225 consecutive women with a singleton fetal cephalic presentation in the second stage of labour requiring an operative vaginal delivery for various reasons.Setting
A maternity unit in a district general hospital delivering more than 6000 women annually.Main outcome measures
The decision to delivery interval and the immediate and short term maternal and neonatal outcomes according to indication for operative vaginal delivery.Results
The mean (SD) decision to delivery interval was 34.4 minutes (28.3) with a range of 5 to 101 minutes. For those delivered because of suspected fetal distress, the interval of 26.5 minutes (14.0) was significantly shorter than for those performed without fetal distress 39.5 minutes (19.0) (P < 0.0001); for cases with fetal distress, forceps were significantly quicker at 23.3 minutes (14.3) than the ventouse 29.2 minutes (13.2) (P= 0.04). The longer the interval in cases of fetal distress the less favourable the condition of the neonate at birth, although this trend did not reach statistical significance and was not seen for deliveries expedited for other reasons. Perineal repair was required following 96% forceps deliveries compared with 87% ventouse (P= 0.015). Perineal trauma was not influenced by the interval between decision and delivery.Conclusions
If speed of delivery is important, use of forceps results in a quicker birth than use of the ventouse, without any compromise to the condition of the baby at delivery, and with similar rates of perineal trauma.
The outcome of pregnancy in Kell alloimmunisation
Authors: Grant S. R. , Kilby M. D. , Meer L. , Weaver J. B. , Gabra G. S. , Whittle M. J. 
Published: August 2005

Objective
To assess management and outcome of pregnancies with anti‐Kell in the West Midlands in the UK over 13 years.Design
A retrospective review of casenotes.Setting
A regional referral clinic for red cell alloimmune disease and fetal medicine unit at a university hospital.Population
Sixty‐five pregnancies were identified in 52 Kell‐sensitised women with Kell positive partners from the records of the Birmingham Blood Transfusion Centre.Methods
Information from the casenotes was entered on a database and comparisons were made using the SPSS for Windows statistics package.Main outcome measures
Mode of sensitisation, degree of fetal or neonatal anaemia, need for transfusion, gestation at delivery, birthweight and pregnancy outcome.Results
Alloimmunisation was transfusion‐related in 29 pregnancies and pregnancy‐induced in 33. The cause could not be identified in three cases. There were 22 proven Kell positive fetuses, of which 18 were affected, in which alloimmunisation was pregnancy‐related in 12 cases and transfusion‐related in five. Antibody titres and amniotic fluid OD450 were not helpful in management. Severe or very severe disease occurred in 50% of the affected pregnancies (9/18). There was no difference in pregnancy outcome between transfusion or pregnancy induced sensitisation.Conclusions
Anti‐Kell alloimmunisation is an uncommon cause of serious anaemia in a significant proportion of affected pregnancies. There appears to be no difference between that caused by pregnancy or transfusion. Estimation of fetal haemoglobin concentration by cordocentesis is recommended, as antibody titres and amniocentesis are not helpful.