bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age related detection and false positive rates when screening for Down's Syndrome in the first trimester using fetal nuchal translucency and maternal serum free βhCG and PAPP‐A
Authors: Spencer Kevin 
Published: December 2003

Objective
To determine how first trimester detection rates for Down's Syndrome vary with maternal age and to calculate the predictive value of an increased risk report at various maternal ages.Design
Mathematical modelling of first trimester screening performance using fetal nuchal translucency and maternal serum free βhCG and pregnancy associated plasma protein‐A (PAPP‐A).Methods
From within the Gaussian distributions of each marker in normal pregnancies and those affected by Down's Syndrome a series of 15,000 marker multiple of the medians were obtained for each group. These markers were then used to calculate the risks of Down's Syndrome using maternal ages ranging from 15 to 49 and the background risk of Down's Syndrome at each age. Using a 1 in 300 risk cutoff (at time of sampling) the false positive rate and detection rate was assessed at each year of maternal age. The predictive value of a positive result was calculated using Baye's theorem.Outcome
measures False positive rates and detection rates at each year of maternal age between 15 and 49; the predictive value of a positive result for each maternal age between 15 and 49.Results
At 15 years of age the detection rate was 77% at a 1.9% false positive rate, 84% at a 4% false positive rate at age 30, rising to 100% at a 67% false positive rate at age 49. The probability of Down's Syndrome once identified with an increased risk was 1:34 at 15 years, 1:29 at 30 years and 1:6 at 49 years.Conclusions
As with second trimester biochemical screening, the detection rate and false positive rate vary considerably with age. However, detection rates across all ages are significantly higher than with second trimester screening. The risk of a positive screening result being a Down's pregnancy is considerably greater than with second trimester screening with an average probability of 1:29, compared with 1:55 in the second trimester. This information may be useful in counselling women with an increased risk result in first trimester screening.
Dyslipidemia in early second trimester is mainly a feature of women with early onset pre‐eclampsia
Authors: Clausen Torun , Djurovic Srdjan , Henriksen Tore 
Published: December 2003

Objective
To investigate whether hypertriglyceridemic dyslipidemia is a risk factor for either early or late onset pre‐eclampsia.Design
Prospective cohort study and nested case–control study.Setting
Aker Hospital: a university hospital with all levels of obstetric care.Participants
2157 Caucasian pregnant women.Methods
Blood samples were obtained from non‐fasting subjects at 18 weeks of gestation. All samples were analysed for triglycerides, total‐cholesterol, high density lipoproteins cholesterol and non‐high density lipoproteins cholesterol. ApoB‐100 were analysed in pre‐eclamptic women and in 3:1 matched controls. The cohort data were analysed by multiple logistic regression and the case–control data by conditional logistic regression.Main
outcome measures Adjusted odds ratios of early and late onset pre‐eclampsia according to early second trimester serum concentration levels of lipids and ApoB‐100.Results
Eighteen women developed early onset pre‐eclampsia and 53 women developed late onset pre‐eclampsia. In the cohort model, women with triglycerides above 2.4mmol/L had increased risk (OR 5.1; 95% CI 1.1–23.1) of early onset pre‐eclampsia compared with those with triglycerides levels ≤ 1.5mmol/L. For women with high triglycerides: non‐high density lipoproteins cholesterol ratios (>90 centile) the OR (95% CI) for early onset pre‐eclampsia was 7.1 (2.3–22.0) compared with those with low ratios (≤ 50 centile). Similar associations were found in the case control model. We found no associations between plasma lipids and risk of late onset pre‐eclampsia.Conclusions
Hypertriglyceridemic dyslipidemia before 20 weeks of gestation is associated with the risk of developing early but not late onset pre‐eclampsia, giving support to the contention that these two variants of the disease are at least partly pathogenically different.
Influence of training on reliability of surgical knots
Authors: Ind Thomas E. J. , Shelton Julia C. , Shepherd John H. 
Published: December 2003

Objectives
To determine whether trainees in obstetrics and gynaecology tie adequate surgical knots and to assess whether formal training improves knot tying skills.Design
A comparative study assessing surgical knots before and after tuition.Population
Fourteen trainees in a single obstetrics and gynaecology department.Setting
A basic surgical skills workshop based in a London teaching hospital.Methods
Trainees tied surgical knots around a 120mm jig using 2/0 glycan polymer. Each trainee tied 11 knots before and after a two and a half hour teaching session. Knots were tested using a mechanical testing machine.Outcome
measures Knot strength (N); proportion of knots that were ‘secure’ (defined as those that eventually failed on the testing device by breakage rather than slippage); proportion of knots that were ‘dangerous’ (defined as those with a tensile strength of < 5 N).Results
After tuition, the median knot strength of the whole group was 5.7 N stronger than before instruction (95% CI 4.6–12.3 N). Prior to tuition 13.5% (20/148) knots tied had a tensile strength of < 5 N. This was compared with 3.4% (5/148) after tuition (OR = 0.2, 95% CI 0.1–0.6). Before instruction 55.4% (82/148) of the knots were secure compared with 66.9% (99/148) after tuition (OR = 1.6, 95% CI 1.0–2.7).Conclusion
Knot tying workshops can improve the ability of trainees in obstetrics and gynaecology to tie reef knots.
Insulin‐mediated vasorelaxation in pregnancy
Authors: Ang Christine , Hillier Chris , MacDonald Alisdair , Cameron Alan , Greer Ian , Lumsden Mary Ann 
Published: December 2003

Objective
To investigate insulin‐mediated vasorelaxation in pregnancy, and the role of nitric oxide in this response.Design
In vitro study of isolated subcutaneous resistance arteries from pregnant and non‐pregnant women.Methods
Small arteries (mean vessel diameter <300μm) were isolated from biopsies of subcutaneous fat from 14 pregnant and seven non‐pregnant women. Insulin‐mediated attenuation of the vasoconstriction response to noradrenaline, before and after nitric oxide synthase inhibition, was studied in isolated arteries using wire myography. Vessel responses to noradrenaline following incubation with insulin were also tested after endothelial denudation. Maximum responses were compared using one‐way ANOVA and Bonferroni's post hoc test for multiple comparisons.Results
In pregnancy, the maximum vasoconstriction produced by noradrenaline was increased (P<0.01). Insulin significantly reduced this response in pregnant women (P<0.01), while inhibition of nitric oxide synthase with Nω‐nitro‐L‐arginine methyl ester (L‐NAME) resulted in potentiation (P<0.05). Following inhibition of nitric oxide synthase with L‐NAME, addition of the insulin was still able to produce a significant attenuation in maximum vasoconstriction to noradrenaline in pregnant women (P<0.01). Furthermore, the absence of functioning endothelium did not abolish the attenuating effect of the insulin on noradrenaline‐induced vasoconstriction in pregnant women (P<0.01).Conclusions
The vasodilatory effect of insulin is not diminished in pregnancy, despite the development of insulin resistance. Furthermore, the attenuation of vasoconstrictor tone is via an endothelium‐independent mechanism. This suggests that the vascular dysfunction associated with diabetes mellitus does not occur with physiological insulin resistance.
Maternal endothelial soluble cell adhesion molecules with isolated small for gestational age fetuses: comparison with pre‐eclampsia
Authors: Bretelle Florence , Sabatier Florence , Blann Andrew , D'Ercole Claude , Boutière Brigitte , Mutin Muriel , Boubli Léon , Sampol José , Dignat‐George Franc¸oise 
Published: December 2003

Objective
1.To evaluate the activation profile of the endothelium in pregnancies complicated by small for gestational age fetuses compared with pre‐eclampsia and normal pregnancy, by measuring the plasma levels of soluble adhesion molecules soluble E‐selectin, intercellular cell adhesion molecule‐1 and vascular cell adhesion molecule‐1. 2. To determine whether soluble adhesion molecules were related to the severity of small for gestational age fetuses and pre‐eclampsia.Design
Observational study.Participants
Sixteen women with small for gestational age fetuses; 15 women with pre‐eclampsia and 15 healthy primigravidae were recruited as controls.Methods
Plasma levels of soluble E‐selectin, intercellular cell adhesion molecule‐1 and vascular cell adhesion molecule‐1 were measured by ELISA.Results
Compared with the healthy controls, soluble E‐selectin was significantly increased in both small for gestational age fetuses and pre‐eclampsia, whereas intercellular cell adhesion molecule‐1 and vascular cell adhesion molecule‐1 were increased only in pre‐eclampsia. In the small for gestational age fetuses group, soluble E‐selectin correlated inversely with the ratio between birthweight and the expected normal birthweight (r=‐0.4, P=0.007). In the pre‐eclampsia group, a significant correlation was observed between vascular cell adhesion molecule‐1 and blood pressure (r=0.54, P=0.039).Conclusions
Endothelial activation, reflected by raised levels of soluble E‐selectin, is a feature of small for gestational age fetuses and is correlated with the severity of the disease. Differences in the profile of soluble cell adhesion molecules suggest variations in the degrees of endothelial activation between pre‐eclampsia and small for gestational age fetuses.
Five‐year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes
Authors: Cooper Kevin G. , Jack Stuart A. , Parkin David E. , Grant Adrian M. 
Published: December 2003

Objective
To assess clinical status, changes in health related quality of life, and subsequent management five years after medical management or transcervical resection of the endometrium for treatment of heavy menstrual loss.Design
Five year follow up using postal questionnaires and operative databank review.Setting
Gynaecology department of a large UK teaching hospital.Population
Women referred to the gynaecologist for treatment of heavy menstrual loss.Methods
Eligible women, without a treatment preference, were randomised equally to either medical treatment or transcervical resection of the endometrium.Main Outcome Measures
Women's satisfaction with treatment, menstrual status, changes in health related quality of life, and additional treatments received at five years.Results
One hundred and forty‐four patients completed questionnaires, achieving 77% follow up (medical n=71/94; transcervical resection of the endometrium n=73/93). At five‐year follow up, 7/71 (10%) of those randomised to the medical arm still used medical treatment, while 72/94 (77%) had undergone surgical treatment and 17/94 (18%) a hysterectomy. Twenty‐five (27%) women allocated to transcervical resection of the endometrium had undergone further surgery, 18/93 (19%) a hysterectomy. At five years women initially randomised to medical treatment were significantly less likely to be totally satisfied (P<0.01, difference 21%, 95% CI –37% to –4%), or to recommend their allocated treatment to a friend (P<0.001, difference 59%, 95% CI –73% to –45%). Bleeding and pain scores were similar in both groups and highly significantly reduced. Significantly more women in the transcervical resection of the endometrium arm had no bleeding or very light bleeding (P<0.02, difference ‐22%, CI –31% to –4%), and they had significantly less days heavy bleeding (P<0.02). Short Form 36 health survey scores were significantly improved from baseline for all eight health scales in the transcervical resection of the endometrium arm, and four in the medical arm.Conclusions
A policy of immediate transcervical resection of the endometrium for women referred to a gynaecologist for treatment of heavy menstrual loss achieves higher levels of satisfaction, better menstrual status, and greater improvements in health related quality of life than medical treatment. In addition, transcervical resection of the endometrium is safe and does not lead to an increase in the number of hysterectomies. An effective endometrial ablative technique should be offered to all eligible women seeking treatment of their heavy menses from a gynaecologist.
Comparability of published perinatal mortality rates in Western Europe: the quantitative impact of differences in gestational age and birthweight criteria
Authors: Graafmans Wilco C. , Richardus Jan‐Hendrik , Macfarlane Alison , Rebagliato Marisa , Blondel Beatrice , Verloove‐Vanhorick S. Pauline , Mackenbach Johan P. 
Published: December 2003

Objective
To quantify the impact of publication criteria on differences in published national perinatal mortality rates among Western European countries.Design
Descriptive study of perinatal mortality rates in Western European countries with adjustments for international differences in publication data.Population
All live births and perinatal deaths in 1994 in Western European countries.Methods
The 1994 perinatal mortality rates were obtained from national and Eurostat publications for Belgium, Denmark, Finland, France, Germany, Greece, The Netherlands, Norway, Portugal, Spain, Sweden, United Kingdom (England, Wales, Scotland, Northern Ireland). Two methods, one direct and one indirect, were used for adjusting these officially published rates for differences in registration laws or publication practices. For the indirect method adjustment factors were derived from an analysis of a large Finnish database using different cutoff points for gestational age and birthweight. For the direct method a common cutoff point was imposed for birthweight (1000g) and gestational age (28 completed weeks) on national perinatal mortality data, obtained from civil registration or hospital/obstetrics databases in each country.Results
The published perinatal mortality rates ranged from 5.4 per 1000 total births in Sweden and Finland to 9.7 in Greece and Northern Ireland. The indirect adjustment method showed that some countries apply cutoff points for registration or publication of perinatal mortality which may raise the perinatal mortality rate by up to 17% above the most commonly used threshold for including live and stillbirths. The direct adjustment method showed that a common lower limit of 1000g for birthweight or 28 weeks for gestational age would reduce the perinatal mortality rate, but by a differing extent ranging from 14% to 40%. Both adjustment methods reduced the contrast between the countries’ perinatal mortality rates, and changed their rank order.Conclusion
These quantitative results confirm that international differences in countries’ published perinatal mortality rates partly reflect differences between countries’ criteria for registration and publication of perinatal deaths.
Fetal magnetoencephalography: a non‐invasive method for the assessment of fetal neuronal maturation
Authors: Schleussner Ekkehard , Schneider Uwe , Kausch Sylvia , Kähler Christiane , Haueisen Jens , Seewald Hans‐Joachim 
Published: December 2003

Objective
To assess the maturation of auditory evoked cortical responses in the human fetus using fetal magnetoencephalography.Design
Prospective case series over a three‐year period.Setting
Antenatal clinics, university hospital.Population
Singleton pregnancies at 29–40 weeks of gestation.Methods
We used a 31‐channel‐SQUID‐biomagnetometer in a magnetically‐shielded room to perform fetal magnetoencephalography. To record auditory evoked fields from the fetal brain we applied 500 monotonal bursts generated by a computerised sound generator directly to the maternal abdominal wall near the fetal head. The continuously recorded data sets were analysed stepwise using a specially developed heart artefact rejection software, Fourier filtering, principle component analysis and half split analysis of the averaged data.Results
In 36 of 64 examinations we detected signals of auditory evoked fields comparable to the P2m component in adults. The earliest recording succeeded in the 29th gestational week. The latencies of the auditory evoked responses declined during the third trimester from 300ms to nearly 150ms at term. The maturation of different components of the auditory evoked field could be demonstrated from the 31st gestational week onwards.Conclusion
The maturation of a fetal auditory cortical function using fetal magnetoencephalography could be assessed directly for the first time. We believe that this method will add information to current indirect methods of assessing the normal maturation of the human fetal brain.
Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula
Authors: Murray Christine , Goh Judith T. , Fynes Michelle , Carey Marcus P. 
Published: December 2003

Objective
To evaluate: (1) the factors associated with the development of obstetric genitourinary fistula, (2) the incidence of urinary and faecal incontinence following closure of the fistula and (3) the urodynamic findings in women with persistent urinary incontinence.Design
An observational clinical study.Setting
A specialised fistula unit in a developing country.Population
Women following successful anatomical closure of obstetric genitourinary fistula.Methods
Fifty‐five women were enrolled from the Fistula Hospital in Ethiopia, following obstetric fistula repair. Their case records were reviewed and details regarding (1) antecedent obstetric factors, (2) the site, size and type of fistula and (3) pre‐operative bladder neck mobility and vaginal scarring were recorded. All women were questioned regarding symptoms of faecal and urinary incontinence. Women reporting urinary incontinence following fistula repair underwent urodynamic investigations.Main outcome measures
Clinical and urodynamic assessment.Results
The mean age of the women was 23 years (range 16–45 years). The fistula in 38 women (69%) followed the first delivery and in 17 women (31%) following a subsequent delivery. The mean duration of labour was four days (range 1–9 days). Forty‐four women (80%) had an isolated vesico‐vaginal fistula and 11 (20%) had a combined vesico‐vaginal and recto‐vaginal fistula. The mean diameter of the fistula was 2.9 cm (0.5–6 cm). Successful repair occurred in all women. Thirty women (55%) reported persistent urinary incontinence and 21 (38%) altered faecal continence at follow up. In the former group, urodynamic investigations identified genuine stress incontinence in 17 women (31%), detrusor instability in two (4%) and mixed incontinence in 11 (20%).Conclusion
This study demonstrates the high rate of successful closure of the fistula in a specialised fistula unit, but highlights the problem of persistent urinary incontinence following closure.
Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness
Authors: Roberts Tracy , Henderson Jane , Mugford Miranda , Bricker Leanne , Neilson James , Garcia Jo 
Published: December 2003

Objective
To review systematically and critically evidence to derive estimates of costs and cost effectiveness of routine ultrasound screening for fetal abnormalities.Design
A systematic review of the literature using explicit criteria for inclusion of primary research studies, a stated electronic strategy to identify relevant material, and an explanation of why apparently relevant studies have not been included.Setting
All countries of origin were included. The results of this review are important to obstetricians and to health service managers in the allocation of resources, and others who are considering conducting further research in this area.Main outcome measure
Formal economic evaluations and cost studies of routine ultrasound screening. Costs of routine anomaly scans and costs of other procedures carried out as part of antenatal screening by ultrasound.Results
One hundred and ninety‐nine studies were identified in total, 24 reaching the final stage of the review. Nine studies were formal economic evaluations and 15 reported costs studies or clinical effectiveness studies with some assessment of cost. The studies were carried out mainly in Europe and in the United States. After quality criteria were applied, data were extracted from six of the economic evaluations and six of the costs studies. One economic evaluation conducted alongside a randomised trial concluded that screening for fetal abnormalities by ultrasound in the second trimester was cost effective, compared with routine antenatal care. The costs of routine scans ranged from £18 to £204 and for non‐routine ranged from £32 to £113.Conclusions
There is a lack of good quality primary studies of the costs of ultrasound screening in pregnancy. Typically, economic evaluations of ultrasound screening have been based on poor quality evidence of clinical effectiveness. There is a need for more published data on the costs and cost effectiveness of routine ultrasound screening for fetal anomalies, and of the longer term consequences of screening for anomalies.
Alteration of anal sphincter morphology following vaginal delivery revealed by multiplanar anal endosonography
Authors: Williams A.B. , Bartram C.I. , Halligan S. , Marshall M.M. , Spencer J.A.D. , Nicholls R.J. , Kmiot W.A. 
Published: December 2003

Objective
To assess morphologic change in the anal sphincters in the absence of endosonographic evidence of trauma after vaginal delivery.Design
Prospective observational study.Setting
District general hospital.Population
Consecutively booked nulliparous pregnant women attending antenatal clinic.Methods
All women were examined using three‐dimensional anal endosonography, simple manometry and had questionnaire assessment of incontinence before and after delivery.Main outcome measures
Components of the anal canal were measured in the axial, sagittal and coronal planes and paired pre‐ and post‐delivery examinations were compared. Any changes were related to changes in continence and anal canal manometry.Results
Twenty‐two women had a vaginal delivery and no endosonographic evidence of perineal trauma after delivery. After delivery, there was significant shortening of the length of the anterior external anal sphincter [EAS] (mean 21.7 vs 20.5 mm, P= 0.02) when measured in the sagittal plane, which increased in anterior angulation with respect to the axis of the anal canal (10°vs 13.8°, P= 0.03). In the axial plane, no change was seen in the thickness of any of the sphincter components after delivery. None of these morphologic changes correlated with changes in manometry or continence score.Conclusions
Anal sphincter morphology changes after an otherwise atraumatic vaginal delivery. This change does not correlate with any functional symptoms.