bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurodevelopmental outcome after intrauterine red cell transfusion for Parvovirus B19‐induced fetal hydrops
Authors: Dembinski J. , Haverkamp F. , Maara H. , Hansmann M. , Eis‐Hübinger A.M. , Bartmann P. 
Published: December 2003

Objective
To assess long term neurodevelopmental outcome of children after intrauterine intravascular red cell transfusion (IUT) for Parvovirus B19‐induced fetal hydrops.Design
Data of study children were investigated retrospectively. Neurodevelopmental evaluation was performed by appropriate standard tests (Griffiths, Snijders–Oomen, Kaufmann Assessment Battery for Children tests).Setting
Tertiary care university teaching hospital.Sample
Twenty children who had Parvovirus‐induced fetal hydrops and intrauterine transfusion of packed red blood cells (IUT).Methods
Retrospective chart analysis and standard neurodevelopmental testing.Main outcome measures
Developmental quotient (DQ) and intelligence quotient (IQ) according to the age at testing.Results
Twenty survivors of Parvovirus B19‐induced fetal hydrops successfully treated by IUT were followed until 13 months to nine years of age. On clinical follow up, no neurologic sequelae were evident. Neurodevelopmental scores of all children ranged within two standard deviations of a normal population (median 101, range 86–116) and exceeded one standard deviation in three children. There was no significant neurodevelopmental delay.Conclusion
Children having survived successful IUT for Parvovirus B19‐induced fetal anaemia and hydrops have a good neurodevelopmental prognosis. Our results support the use of IUT for correction of Parvovirus B19‐induced fetal anaemia and subsequent hydrops.
Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases
Authors: Ashok Premila W. , Templeton Allan , Wagaarachchi Prabhath T. , Flett Gillian M.M. 
Published: December 2003

Objective
To assess the outcome of a regimen of a reduced dose of mifepristone followed by one or two doses of vaginal misoprostol as a non‐surgical method for termination of pregnancy.Design
Prospective observational study.Setting
Aberdeen Royal Infirmary, Aberdeen, Scotland.Population
Women seeking abortion under the 1967 Abortion Act.Methods
Factors influencing the outcome in a consecutive series of 4132 women undergoing early medical abortion in one Scottish teaching hospital since 1994.Main outcome measures
Complete abortion rates following one or two doses of misoprostol. The effect of age, gestation, previous pregnancy and previous termination on complete abortion rates following the medical regimen.Results
Of the 4132 women, 95 (2.3%) aborted within 48 hours of mifepristone and a further 3942 (95.4%) achieved complete abortion following administration of one or two doses of misoprostol. Thus, the overall complete abortion rate was 97.7% (4037/4131). A total of 94 (2.3%) women required surgical intervention of whom 13 (0.3%) had a continuing pregnancy. Following change of the regimen to include the possibility of two doses of misoprostol the continuing pregnancy rates were significantly reduced (OR = 5.88) and gestation ceased to have an effect on overall efficacy. Women who had a previous abortion were more likely to have a failed medical abortion (OR = 2.09), while women with no previous termination, but a previous live birth were more likely to have a failed abortion (OR = 2.03).Conclusion
Mifepristone in combination with one to two doses of vaginal misoprostol is an effective regimen for early medical abortion. The option of administering two doses of misoprostol significantly reduced the ongoing pregnancy rates and abolished the effect of gestation on overall efficacy. Previous termination was the strongest predictor of failed medical abortion.
Mid‐trimester severe intrauterine growth restriction is associated with a high prevalence of thrombophilia
Authors: Kupferminc Michael J. , Many Ariel , Bar‐Am Amiram , Lessing Joseph B. , Ascher‐Landsberg Jessica 
Published: December 2003

Objective
To investigate the association between severe mid‐trimester IUGR, whose causes are unknown in most cases, and maternal thrombophilias.Design
Case–control study.Setting
Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University.Population
Twenty‐six women with severe mid‐trimester (22–26 weeks of gestation) IUGR (birthweight <3rd centile) and 52 matched multiparous women with normal pregnancies (controls).Methods
After excluding pregnancies with vascular maternal disease, chromosomal and structural aberrations and cytomegalovirus infection, 26 women out of 35 with severe mid‐trimester IUGR remained and composed the study group. Each was matched for age, ethnicity and smoking status with two healthy women who had normal pregnancies. All the women were tested for genetic and acquired thrombophilias at least eight weeks after delivery.Main outcome measures
Prevalence of maternal thrombophilias.Results
The frequency of thrombophilias was 69% in the study group compared with 14% in the control group [odds ratio (OR) 4.5; 95% confidence interval (CI) 2.3–9, P< 0.001]. The frequencies of factor V Leiden mutation, prothrombin gene mutation and protein S deficiency were significantly increased in the study group compared with the control group. The frequency of multiple thrombophilias was 33% in the study group versus none among the controls. Of the 26 pregnancies with severe mid‐trimester IUGR, 13 ended in intrauterine fetal death before 25 weeks of gestation: 10 of these women had thrombophilia.Conclusion
Women with mid‐trimester severe IUGR have an increased prevalence of inherited and acquired thrombophilias.
Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection
Authors: Nigro Giovanni , Anceschi Maurizio M. , Cosmi Ermelando V. ,   The Congenital Cytomegalic Disease Collaborating Group,   The names of collaborators may be found on page 576
Published: December 2003

Objective
To compare the clinical manifestations and laboratory abnormalities associated with primary cytomegalovirus (CMV) infection in pregnancy with recurrent and non‐active CMV infection (controls).Design
A prospective cohort study.Setting
Rome, Latium and other Italian regions.Population
Three hundred and sixteen pregnant women with CMV infection: 102 had primary infection, 105 had recurrent infection and 109 with non‐active infection were followed up as controls.Methods
CMV diagnosis was based on serological examinations (CMV IgG, IgM and IgG avidity) and detection of CMV DNA by polymerase chain reaction in maternal serum, urine and cervical samples. The clinical history and laboratory evaluations were carried out at enrolment and at each subsequent visit, every one to three months.Main outcome measures
Identification of clinical and laboratory indicators of primary CMV infection in pregnancy.Results
Compared with women with recurrent or non‐active infection, women with primary infection had a statistically significant higher prevalence of fever, asthenia, myalgia and flu‐like syndrome (P < 0.001). In particular, relevant symptomatology was observed in 32 women (31.4%), of whom 25 had flu‐like syndrome and 7 persistent fever as a single manifestation. Moreover, women with primary infection showed a significantly increased rate of lymphocytes ≥40% (39.2% vs 5.7% or 3.7%, respectively, P < 0.001) and elevated aspartate aminotransferase and/or alanine aminotransferase levels (35.3% vs 3.9% or 0.9%, respectively, P < 0.001): lymphocytosis and/or increased aminotransferases occurred in 53 patients (52%). In total, clinical manifestations and/or laboratory abnormalities occurred in 61 women with primary infection (59.8%) compared with 20 with recurrent infection (19%) and 13 controls (11.9%) (P < 0.001).Conclusion
Clinical manifestations (i.e. flu‐like syndrome, fever) and abnormal laboratory findings (i.e. lymphocytes ≥40%, elevated aminotransferases) may suggest the presence of primary CMV infection and should prompt subsequent virological investigations.
Gestational trophoblastic disease in the Asian population of Northern England and North Wales
Authors: Tham B.W.L. , Everard J.E. , Tidy J.A. , Drew D. , Hancock B.W. 
Published: December 2003

Objective
To determine the incidence and trends of gestational trophoblastic disease in the Asian population of Northern England and North Wales.Design
A prospective observational study.Setting
Trophoblastic Screening and Treatment Centre, Weston Park Hospital.Population
A total of 3660 women registered with gestational trophoblastic disease between 1991 and 1999.Main outcome measures
1. The incidence of gestational trophoblastic disease in Asian and non‐Asian population. 2. Trend in incidence over study period.Results
Three hundred and twenty‐two Asian patients were registered. The incidence of gestational trophoblastic disease in the northern part of England and Wales averaged 1 per 714 live births. The incidence of gestational trophoblastic disease in the Asian population was 1.95 times higher than in the non‐Asian population (1 per 387 live births vs 1 per 752 live births). There was an excess of molar pregnancies in the extreme maternal age groups; the incidence in these women was twice as high as in the whole reproductive cohort. The ratio of partial to complete hydatidiform mole increased from 0.9 in the lower age to 2.6 in the older age group. There appeared to be a slowly rising trend in the incidence of gestational trophoblastic disease; the increase was higher in the Asian than in the non‐Asian population. The ratio of partial to complete moles increased with age in both populations.Conclusions
Asian women are at increased risk of having molar pregnancies. Molar pregnancies are more common at the extremes of reproductive age. The setting up of regional or national registration centres has helped to provide more accurate estimates of the true incidence of the disease.
Assessing urinary albumin excretion in pre‐eclamptic women: which sample to use?
Authors: Kieler Helle , Zettergren Tuttan , Svensson Hanna , Dickman Paul W. , Larsson Anders 
Published: December 2003

Objective
To evaluate whether the gold standard of 24‐hour urine collection for measuring albumin excretion in pre‐eclamptic women could be substituted by shorter collection periods.Design
Prospective study.Setting
Fetal maternity ward, university hospital.Participants
Thirty women with pre‐eclampsia and a positive urinary test strip for protein of at least 2+.Methods
From each woman, within a 25‐hour period, three spot, two 12‐hour (day and night) and one 24‐hour urine sample were collected. Urine albumin concentrations in milligrammes per litre were analysed by rate nephelometry on a Beckman Array protein system. The urinary albumin concentrations in the spot and the 12‐hour samples were compared with the concentration in the 24‐hour urine collection.Main outcome measures
Urinary albumin concentrations in spot and 12‐hour samples measured against the standard 24‐hour albumin excretion.Results
Albumin concentrations in the day and night collection fitted closely with the concentrations of the 24‐hour collection. The median difference between the 24‐hour and the day collection was −3 mg/L (interquartile range −264 to 116 mg/L). The median difference between the 24‐hour and the night collection was 17 mg/L (interquartile range −186 to 210 mg/L). The association of urinary albumin concentration in the 24‐hour collection and the spot samples was much weaker. Of the spot urine samples, the albumin concentration in the sample taken on the morning after admission to hospital was closest to the 24‐hour urinary albumin excretion, with a median difference of −62 mg/L (interquartile range −1131 to 285 mg/L).Conclusion
The gold standard of 24‐hour urinary excretion for assessment of albuminuria in pre‐eclamptic women can be substituted with a 12‐hour collection. Spot urine samples were inaccurate and are therefore not recommended for quantification of albumin excretion.
Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33,824 infants
Authors: Rietberg Christine C.Th. , Elferink‐Stinkens Patty M. , Brand Ronald , van Loon Aren J. , Van Hemel Oscar J.S. , Visser Gerard H.A. 
Published: December 2003

Objective
To analyse neonatal mortality and morbidity in term infants born in breech presentation in relation to the mode of delivery (planned caesarean section, emergency caesarean section or vaginal delivery) and to compare these findings with those of the Term Breech Trial Collaborative Group [Hannah et al. Lancet 2000; October].Design
Retrospective observational study.Setting
The Netherlands.Population
Infants (n= 33,824) born at term in breech presentation in the Netherlands between 1995 and 1999. Multiple pregnancies, antenatal death and major congenital malformations were excluded.Methods
Data derived from the Dutch Perinatal Database were used to compare neonatal outcome of infants born in breech presentation in relation to the different modes of delivery (i.e. planned caesarean section, emergency caesarean section and vaginal delivery). Correction was made for differences in parity, duration of gestation and birthweight, using logistic regression.Main outcome measures
Intrapartum and first‐week neonatal death, 5 minute Apgar score and birth trauma.Results
Vaginal delivery and emergency caesarean section resulted in a sevenfold increase in low Apgar score, a threefold increase in birth trauma and a twofold increase in perinatal mortality when compared with the results of planned caesarean section.Conclusions
This study confirms the data found by Hannah et al. on an increase in early neonatal morbidity and mortality, following a trial of labour in cases of term breech presentation. These data require carefully weighed consideration against increased maternal (long term) risks due to a rise in caesarean sections.
High caesarean rates in Madras (India): a population‐based cross sectional study
Authors: Sreevidya S. , Sathiyasekaran B.W.C. 
Published: December 2003

Objective
To estimate the population caesarean section rate in urban India.Design
Population‐based cross sectional study.Setting
Madras City (Chennai), India.Sample
Seven hundred and eighty resident women who delivered in Madras between June 1997 and May 1999.Methods
Cluster sampling was done using streets as cluster units. Thirty clusters were selected from 1255 clusters by the probability proportion to size method and 26 women were selected randomly from each cluster.Main outcome measures
Total and primary caesarean rates.Results
Total population caesarean section rate was 32.6% (95% CI 27–38) and primary caesarean section rate was 25% (95% CI 20–30). Total caesarean section rates in the public, charitable and private sectors were 20%, 38% and 47%, respectively. Private sector deliveries had an odds ratio of 2.4 (95% CI 1.5, 3.8) of a primary caesarean section delivery in comparison with the public sector after adjustment for parity, age at delivery of mother and educational status.Conclusions
Forty‐seven percent of births by caesarean section in the private sector is alarming and could implicate private sector care as the main contributing factor behind the high population caesarean section rates. Policymakers should urgently institute systems for accountability and ethical practice and regularly monitor all medical interventions, before large scale exploitation of the rural markets begins.
Birth outcomes: utility values that postnatal women, midwives and medical staff express
Authors: Pham C.T. , Crowther C.A. 
Published: December 2003

Objective
To determine if and to what extent postnatal women's preferences for birth outcomes differ from those of midwives and medical staff, and whether any variations in utility scores are associated with demographic variables.Design
Cross sectional cohort study.Setting
The Women's and Children's Hospital, Adelaide.Population
A total of 180 participants which included 90 postnatal women, 59 midwives and 31 medical staff.Methods
Preferences (utility scores) for eight birth outcomes were measured by direct interviews using two utility techniques: the visual analogue scale and the standard gamble.Main outcome measures
Preferences (utility scores) for eight birth outcomes.Results
Women assigned higher utility scores for the five birth outcomes of jaundice requiring phototherapy, admission to neonatal nursery, shoulder dystocia, nerve palsy and transient neurological symptoms than midwives, which suggested that women regarded these outcomes as less severe (P < 0.01). Utility scores for the women and medical staff were similar. The majority of postnatal women, midwives and medical staff preferred permanent neurological sequelae to perinatal death. Eighty‐nine percent of postnatal women preferred permanent neurological sequelae to perinatal death compared with 71% of midwives (P < 0.01), and 68% of medical staff (P < 0.01).Conclusion
Utility values for important birth outcomes varied between women who had recently given birth and health professionals. Clinical practice should recognise and respect the preferences of women, with appropriate balance between their preferences, those of health professionals and the known benefits of care.
Maternal serum activin, inhibin, human chorionic gonadotrophin and α‐fetoprotein as second trimester predictors of pre‐eclampsia
Authors: Davidson Emma J. , Riley Simon C. , Roberts Stephen A. , Shearing Catherine H. , Groome Nigel P. , Martin Cameron W. 
Published: December 2003

Objective
To compare the serum levels of human chorionic gonadotrophin (hCG), α‐fetoprotein, activin A, inhibin A and inhibin isoforms containing pro and αC in the second trimester serum of women who subsequently developed hypertensive disorders of pregnancy with those who remained normotensive throughout pregnancy.Design
Retrospective case–control study of 15–20 week serum samples matched for duration of storage at −20°C.Setting
Antenatal clinics at a teaching hospital in Scotland.Sample
Second trimester serum samples of 39 women who subsequently developed pre‐eclampsia, 31 who subsequently developed pregnancy‐induced hypertension and 155 women who remained normotensive throughout pregnancy.Main outcome measures
hCG, α‐fetoprotein, activin A, inhibin A and inhibin pro–αC serum levels.Results
Activin A levels in serum were significantly elevated in women who later developed pregnancy‐induced hypertension (26% increase compared with controls) and hCG levels were significantly elevated in women who later developed pre‐eclampsia (24% increase compared with controls). α‐Fetoprotein, inhibin A and inhibin pro–αC levels were not significantly elevated in the patient groups compared with their controls.Conclusions
A combination of analyses including second trimester serum activin A and hCG may yet prove to be helpful predictors of women at risk of hypertensive disorders of pregnancy. While the results proved significant, the effects reported in this study are too modest compared with natural variability to be useful as screening tools on their own.
Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit
Authors: Richardus Jan H. , Graafmans Wilco C. , Verloove‐Vanhorick S. Pauline , Mackenbach Johan P. ,   The EuroNatal International Audit Panel,   The EuroNatal Working Group,   A list of the members of the EuroNatal International Audit Panel and the EuroNatal Working Group may be found on page 104
Published: December 2003

Objective
A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death.Design
Retrospective audit study.Setting
Regions of 10 European countries.Population
1619 cases of perinatal death.Methods
Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of gestational age), intrapartum deaths (28 or more weeks) and neonatal deaths (34 or more weeks). Deaths with (major) congenital anomalies were excluded. Cases were blinded for region and an international audit panel reviewed them using explicit audit criteria.Main outcome measures
Presence of suboptimal factors.Results
The audit covered 1619 cases of perinatal death, representing 90% of eligible cases in the regions. Consensus was reached on 1543 (95%) cases. In 715 (46%) of these cases, suboptimal factors, which possibly or probably had contributed to the fatal outcome, were identified. The percentage of cases with such suboptimal care factors was significantly lower in the Finnish and Swedish regions compared with the remaining regions of Spain, the Netherlands, Scotland, Belgium, Denmark, Norway, Greece and England. Failure to detect severe IUGR (10% of all cases) and smoking in combination with severe IUGR and/or placental abruption (12%) was the most frequent suboptimal factor. There was a positive association between the proportion of cases with suboptimal factors and the overall perinatal mortality rate in the regions.Conclusions
The findings of this international audit suggest that differences exist between the regions of the 10 European countries in the quality of antenatal, intrapartum and neonatal care, and that these differences contribute to the explanation of differences in perinatal mortality between these countries. The background to these differences in quality of care needs further investigation.
The Doppler Assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy
Authors: Giles Warwick , Bisits Andrew , O'Callaghan Stephen , Gill Andrew ,   DAMP Study Group,   Names of group collaborators may me found on page 596
Published: December 2003

Objective
To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies.Design
A prospective randomised controlled multicentre trial of women with twin pregnancies.Setting
Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia.Population
Pregnant women with twin pregnancies.Methods
Women were randomised at 25 weeks of gestation to receive either standard ultrasound biometric assessment or standard assessment plus Doppler ultrasound umbilical artery flow velocity waveform analysis. The studies were repeated at 30 and 35 weeks unless otherwise indicated. Physicians were advised to institute close fetal surveillance in the presence of an abnormal umbilical artery Doppler study or with biometry indicators of fetal compromise.Main outcome measures
Standard obstetric (mode of delivery, perinatal mortality, hypertension, antenatal admissions and gestation at delivery) and neonatal (5 minute Apgar scores <5, admissions to neonatal nursery and requirements for ventilation) outcomes and statistical analysis was on intention‐to‐treat.Results
There were no significant differences between the two groups with respect to demography, antenatal, peripartum and neonatal outcomes. There was no difference in the perinatal mortality rate in the no Doppler group (n= 264), which was 11/1000 live births, and the Doppler group (n= 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01–1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance.Conclusions
In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 weeks of gestation in both the no Doppler and Doppler groups. The lower rate of unexplained fetal death in the no Doppler group was not significantly different from the Doppler group.