bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal size and growth velocity in the prediction of intrapartum caesarean section for fetal distress
Authors: Owen Philip , Harrold Anthony J. , Farrell Thomas 
Published: August 2005

Objective
To evaluate and compare third trimester ultrasound measurements of fetal size and growth velocity in the prediction of intrapartum operative delivery for fetal distress and admission to the special care baby unit in a low risk antenatal population undergoing labour at term.Design
Retrospective analysis of prospectively collected ultrasound data.Setting
Ninewells Hospital, Dundee, Scotland.Population
Three hundred and ninety‐eight women previously enrolled in a longitudinal study of intrauterine volume undergoing labour at a gestational age of > 37 weeks.Method
Fetal abdominal area (FAA) standard deviation scores (Z scores) were calculated for size at 32 and 36 weeks of gestation together with the growth velocity Z scores between these two gestational ages. Receiver–operator characteristics were calculated for fetal abdominal area Z scores at 32, 36 weeks and velocity Z scores in the prediction of caesarean section for fetal distress and/or admission to the special care baby unit.Main outcome measures
Intrapartum caesarean section for fetal distress and admission to the special care baby unit with a diagnosis of perinatal hypoxia.Results
Pregnancies ending in caesarean section for fetal distress or admission to the special care baby unit (n= 17) had significantly lower fetal abdominal area Z scores at 36 weeks of gestation (mean Z score −0.71 vs−0.18) and lower fetal abdominal area growth velocity (mean Z score −1.31 vs−0.01). Taking a cutoff Z score of −1.2 derived from the receiver–operator characteristic curve, fetal abdominal area velocity has a sensitivity of 65% and specificity 75% for caesarean section for fetal distress and/or admission to the special care baby unit.Conclusion
Growth velocity of the fetal abdominal area in the third trimester is superior to a single measurement of the fetal abdominal area at either a mean of 32 or 36 weeks of gestation in the prediction of caesarean section for fetal distress and admission to the special care baby unit in low‐risk women labouring at term. These results support the hypothesis that in the third trimester at least, growth rate in utero is more relevant to intrapartum performance and immediate perinatal outcome than estimates of fetal size alone.
External cephalic version at term: a survey of consultant obstetric practice in the United Kingdom and Republic of Ireland
Authors: Coltart Tim , Edmonds D. Keith , Al‐Mufti Raghad 
Published: August 2005

Objective
To undertake a survey of external cephalic version (ECV) in the United Kingdom and Republic of Ireland.Design
In June 1995 every consultant obstetrician and gynaecologist in the United Kingdom and Republic of Ireland was sent a postal questionnaire which asked whether ECV was routinely performed for breech presentation after 37 weeks of gestation, assuming no contraindications. If consultants did not perform ECV, a supplementary question enquired whether they referred patients to a colleague who would perform ECV. The questionnaires were colour coded for country and dispatched from the Postgraduate Education Department of the Royal College of Obstetricians and Gynaecologists (RCOG).Results
Overall, 78% of questionnaires were returned. The percentage of consultants routinely practising ECV in each country was as follows: Northern Ireland 82%; Scotland 64%; Republic of Ireland 64%; England 43%; and Wales 41%. When these figures were compared with the latest RCOG Annual Statistical Returns for breech delivery and caesarean section for breech delivery, there was an inverse correlation between the percentage of obstetricians performing ECV in any one country and the incidence of breech delivery (P < 0.001). There was a similar inverse correlation for the percentage of obstetricians performing ECV and the caesarean section rate for breech delivery (P < 0.001).Conclusion
Although postal survey results are not necessarily an accurate reflection of what happens in clinical practice, these data are supported by evidence from the Cochrane Database of Systematic Reviews indicating that ECV after 37 weeks reduces the incidence of both breech delivery and caesarean section for breech delivery.
Female victims of rape and their genital injuries
Authors: Bowyer Lucy , Dalton Maureen E. 
Published: August 2005

Objective
A minority (some report < 10%) of women report sexual assault. Of those that negotiate the police process, only a minority will come to a court hearing. It is thought that the courts still rely upon medical evidence, in particular evidence of genital injury to ‘prove’ the rape. This study aimed to ascertain the incidence of genital injury in victims of alleged rapeDesign
Retrospective review of case records of women who reported they had had been raped, provided by women doctors on the Northumbrian Police Doctors scheme.Sample
Case records from Newcastle, North and South Tyneside, Sunderland and Northumbria.Methods
Analysis of records in the standardised booklet used by police surgeons to examine women reporting rape.Main outcome measures
Presence of genital injury, presence of other physical injuries.Results
A minority of women had genital injuries (22/83); the majority had some form of physical injury (68/83), although most of these were minor.Conclusion
The study shows that only a minority of women examined by specifically trained police doctors show evidence of genital injury. The absence of genital injury does not exclude rape.
Effects of transdermal oestrogen therapy in postmenopausal women: a comparative study of an oestradiol gel and an oestradiol delivering patch
Authors: Hirvonen E. , Cacciatore B. , Wahlström T. , Rita H. , Wilén‐Rosenqvist G. 
Published: August 2005

Objective
To compare the efficacy, safety and tolerability of an oestradiol gel (1.0 mg of oestradiol daily, Divigel®/Sandrena®) with those of an oestradiol delivering patch (delivering 50 μg oestradiol/24 h, Estraderm TTS®) in hormone replacement therapy of postmenopausal women. Dydrogesterone tablets (Terolut®), 10 mg daily for the first 12 days of every month, were used as the progestogen component of the therapy.Main outcome measures
The effect of treatment on clinical symptoms and on endometrium, total body bone mineral density and lipid metabolism as well as the tolerability of the treatments with special emphasis on skin irritation and compliance were evaluated.Design
An open, randomised, controlled, parallel‐group trial of 12 months duration.Setting
The Medical Clinic of Kalevankatu, Helsinki, Finland.Participants
One hundred twenty postmenopausal women were treated with transdermal oestradiol combined with dydrogesterone. In addition, 25 women without HRT served as a reference group for the bone mineral density measurements.Results
Both treatment regimens were equally effective in alleviating climacteric symptoms, preserving bone mineral density and were equally safe. A trend towards heavier bleeding was detected in patients treated with the oestradiol delivering patch. A statistically nonsignificant decrease of total cholesterol and triglyceride concentrations but no change in high‐density lipoprotein cholesterol concentration was observed in both groups. The acceptability of the treatment was higher in the gel group (96.4%) than in the patch group (90.7%). Only two (3.3%) women using the oestradiol gel complained of skin irritation whereas 28 patients (46.7%, P<0.001) using the oestradiol delivering patch reported this adverse effect.Conclusions
Both the oestradiol gel and the oestradiol delivering patch are equally effective in hormone replacement therapy but the gel preparation is less irritative to the skin.
Effects on bone mass after eight years of hormonal replacement therapy
Authors: Eiken P. , Nielsen S. Pors , Kolthoff N. 
Published: August 2005

Objective
The purpose of this randomised double‐blind placebo‐controlled study over two years followed by a six year open controlled extension phase was to investigate the effects of hormonal replacement therapy (HRT) both continuous combined HRT and sequential HRT) versus no treatment on lumbar spine bone mineral density (L‐BMD) and distal forearm bone mineral content (F‐BMC). Further, bone mineral density of the proximal femur, lateral spine, and distal forearm was studied after eight years.Design
Prospective study of normal, early postmenopausal women, initially in a double‐blind, placebo controlled study, subsequently an open, controlled investigation.Setting
Clinical physiology unit of a general second degree referral hospital.Sample
Seventy‐three normal, early postmenopausal women (HRT n= 47; placebo/untreated n= 26).Methods
Dual photon absorptiometry, dual X‐ray absorptiometry, single photon absorptiometry.Main outcome measures
HRT resulted in a significantly (P < 0.001) higher mean L‐BMD after eight years, when it was 12.1% higher than the mean initial value and 14.8% higher than the mean bone mineral density of the untreated group. L‐BMD increased by 14.6% in women receiving continuous combined HRT compared with 11.1% in those on sequential HRT but intergroup differences were not statistically significant. Mean F‐BMC measured with SPA decreased in the HRT group and in the placebo/untreated group by 0.2% and 14.8% (P < 0.001), respectively. However, after eight years mean F‐BMC was 14.5% higher in the HRT group than in the placebo/untreated group. The study showed after eight years for all regions of the distal radius and ulna a significantly higher bone mineral density value compared with the placebo/untreated group (P < 0.001). An especially large effect of HRT was found on the bone mineral density of the vertebral body of the 3rd lumbar vertebra (L3), this one, measured by lateral scanning, being 18.7% higher than that of the placebo/untreated group. For the proximal femur, only the bone mineral density of Ward's triangle was significantly higher in the HRT group than in the placebo/untreated group.Conclusion
Eight years of treatment with HRT resulted in a significant, substantial gain of bone mineral density in the lumbar spine. The distal radius, ulna and Ward's triangle showed a significantly higher bone mineral density in the HRT group compared with the placebo/untreated group.
The obstetric experience of carriers of haemophilia
Authors: Kadir R. A. , Economides D. L. , Braithwaite J. , Goldman E. , Lee C. A. 
Published: August 2005

Objective
To review the obstetric problems, pregnancy outcome and management of carriers of haemophilia.Design
Retrospective review of haemophilia and maternity unit records.Setting
Haemophilia Comprehensive Care Centre.Participants
Thirty‐two carriers of haemophilia (24 haemophilia A, eight haemophilia B) who had their obstetric care at the Royal Free Hospital over a 10‐year period (1985–1995).Main outcome measures
Uptake and results of prenatal diagnosis, changes in factor levels during pregnancy, effect of knowledge of fetal gender on obstetric management and neonatal outcome, and maternal haemorrhagic complications.Results
There were 82 pregnancies and 32 resulted in miscarriage or social abortion. The option of prenatal diagnosis was taken up in only 35% (17/48) of pregnancies. There were five affected male fetuses diagnosed prenatally but only three women opted for termination of the pregnancy. Knowledge of fetal gender was unavailable to the attending obstetrician in 46% (21/46) of pregnancies. A fetal scalp electrode was applied in eight, fetal blood sampling was performed in four, and ventouse delivery was conducted in one of these pregnancies. No adverse effects were reported from the first two procedures, but the ventouse delivery was associated with a huge cephalhaematoma requiring blood transfusion. On the other hand, in five cases fetal blood sampling was withheld because fetal gender was unknown. Four of the eight caesarean sections performed might have been avoided if the gender had been known. The incidence of primary and secondary postpartum haemorrhage was high, 22% (including two cases with massive haemorrhage) and 11%, respectively.Conclusion
Carriers of haemophilia A and B require special obstetric care with close liaison with the haemophilia centre, and management guidelines should be available and observed. Knowledge of fetal gender is very valuable for management in labour and should be determined antenatally even if the mother declines prenatal diagnosis.
The disappearance of fetal and donor red blood cells in alloimmunised pregnancies: a reappraisal
Authors: Egberts J. , van Kamp I. L. , Kanhai H. H. H. , Meerman R. H. , Giordano P. C. , Gravenhorst J. Bennebroek 
Published: August 2005

Objective
To determine the proportional reduction per day in the number of fetal and donor red blood cells from the fetal circulation after intrauterine intravascular transfusions.Design
A retrospective study of 302 transfusions in 101 fetuses.Setting
The Department of Obstetrics and Gynaecology of the University Medical Centre Leiden, The Netherlands.Methods
We measured the haematocrit in fetal samples both before and after repeated intravascular intrauterine transfusion in fetuses with alloimmune disease. The percentage of fetal erythrocytes was determined in Kleihauer‐Betke stained smears. The decline of fetal, donor and mixed red blood cells was calculated by dividing the proportional decrease of the haematocrit values by the number of days between transfusions, also after correction for changes in fetoplacental volumes. Results (given as mean [SD]) are derived from the proportional changes of haematocrit per day.Results
The interval between the first and second transfusion (15.5 days [SD 5.2]) was shorter than between subsequent transfusions (means ranging from 21.4 to 21.9 days; P 0.0001). The decline per day of mixed, and of donor red blood cells, calculated without corrections for volume changes did not differ from those corrected for volume changes resulting from the transfusion and from fetal growth (correction factor 1.1 [SD 0.4]). Since the coefficient of variance is smaller for the uncorrected decline values, this type of calculation is preferable for clinical purposes. The disappearance of fetal erythrocytes after the first transfusion (6.1 %/day [SD 2.9]) was faster than that of mixed fetal and donor red blood cells (3.2%/day [SD 1.2]; P < 0.0001) and of donor cells alone (1‐4%/day [SD 1.6]; P < 0.0001). The decline of the mixed red blood cell population became the same as that of the donor cells (2.2%/day [SD 0.8]) after the second transfusion. This decline of donor cells was higher than after the first transfusion (1.4%/day [SD 1.6]; P < 0.05). After the first transfusion the fetal erythrocytes disappeared faster after transplacental puncture of the umbilical cord (6.6%/day [SD 2.8]) than after transamniotic punctures (5.4%/day [SD 2.7]; P= 0.05). The mixed red blood cell also decreased faster (3.5%/day [SD 1.3] versus 2.8%/day [SD 0.9]; P < 0.01).Conclusion
The fast disappearance of fetal erythrocytes, especially after transplacental punctures, shows that the interval between the first and second transfusion needs to be shorter than that for intervals between subsequent transfusions. The number of donor erythrocytes declines by approximately 2% per day.
Circadian rhythm of frequency‐domain measures of heart rate variability in pregnancy
Authors: Ekholm Eeva M. K. , Hartiala Jaakko , Huikuri Heikki V. 
Published: August 2005

Objective
To examine frequency domain measures of heart rate variability and their circadian rhythms in pregnancy.Design
A longitudinal study.Setting
University hospital in Turku, Finland.Participants
Sixteen healthy women between 11 and 27 weeks of pregnancy; 12 women before pregnancy; and four women postpartum.Main outcome measures
Heart rate variability as measured in frequency domain from 24‐hour ambulatory electrocardiography.Results
Pregnancy was associated with a lower standard deviation of R‐R intervals (P < 0.01), with reduced very low (P < 0.05), low (P < 0.01), and high frequency (P < 0.05) power spectral components of heart rate variability. The high frequency power was lower at night in pregnancy, but similar in the daytime in pregnant and nonpregnant women.Conclusions
Pregnancy is associated with an overall reduction in heart rate variability, most markedly reflected in the low frequency component. This suggests altered baroreflex or sympathetic modulation of heart rate, and decreased vagal activation at night.
A medium term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance
Authors: Kelleher C. J. , Cardozo L. D. , Khullar V. , Salvatore S. 
Published: August 2005

Objective
The aims of this study were to determine the medium term subjective outcome of treatment for women with a urodynamic diagnosis of detrusor instability and low bladder compliance.Setting
A tertiary referral Urogynaecology clinic.Participants and methods
One thousand one hundred and five women referred for the investigation of their urinary symptoms were entered into a prospective, long term, quality of life study. Of these, 348 had a videourodynamic diagnosis of detrusor instability or low bladder compliance and form the basis of this paper. Women were contacted by post at least six months following their urodynamic assessment and asked to complete a questionnaire detailing their treatment, its efficacy and side effects, and any residual urinary symptoms.Results
Two hundred and fifty‐six women (73.6%) responded to follow up; only 5.5% were cured of their urinary symptoms. The majority (90.2%) had received anticholinergic medication, although only 18.2% continued with this treatment in excess of six months. Many women had residual urinary symptoms following their investigation and treatment.Conclusion
The medium term efficacy of the treatment of detrusor instability and low compliance is disappointing, and a large part of this failure may be attributable to poor treatment efficacy, side effects of medication, or inadequate follow up following the diagnosis and instigation of therapy.
Nitric oxide donors induce ripening of the human uterine cervix: a randomised controlled trial
Authors: Thomson Andrew J. , Lunan C. Burnett , Cameron Alan D. , Cameron Iain T. , Greer Ian A. , Norman Jane E. 
Published: August 2005

Objective
To determine whether nitric oxide donors can induce cervical ripening before surgical termination of pregnancy in the first trimester.Design
Prospective, randomised controlled trial.Setting
Department of Obstetrics and Gynaecology, Royal Infirmary, Glasgow.Participants
Forty‐eight primigravid women undergoing surgical termination of pregnancy before 12 weeks of gestation.Methods
The women were randomised to receive per vaginam before surgery either the nitric oxide donor isosorbide mononitrate, the nitric oxide donor glyceryl trinitrate, the prostaglandin analogue gemeprost, or no treatment.Main outcome measures
The cumulative force required to dilate the cervix to 8 mm was measured objectively and the cervical diameter before surgical dilatation was recorded.Results
Following isosorbide mononitrate or gemeprost, a lower cumulative force was required to dilate the cervix to 8 mm and a higher cervical diameter before dilatation was recorded. Pretreatment with glyceryl trinitrate reduced the cumulative force required to dilate the cervix but had no effect on cervical diameter.Conclusions
Like the prostaglandin analogue gemeprost, the nitric oxide donors isosorbide mononitrate and glyceryl trinitrate can effect cervical ripening. Nitric oxide donors may provide an alternative to prostaglandins for cervical ripening before surgical procedures in the first trimester.
Effect of location of the sensor on reflectance pulse oximetry
Authors: Dassel A. C. M. , Graaff R. , Aardema M. , Zijlstra W. G. , Aarnoudse J. G. 
Published: August 2005

Objective
The influence of the location of the sensor on reflectance pulse oximetry during fetal monitoring in labour was investigated using the newborn infant as a model.Methods
Seven healthy infants were studied between 19 and 48 hours after term delivery. Recordings of reflectance pulse oximetry were obtained from eight different sites on the infant's head. The relative changes in red to infrared light (R/IR) were determined. In pulse oximetry R/IR values are converted to arterial oxygen values by means of an empirically derived calibration curve.Results
Significantly lower R/IR values were found at the forehead compared with the fontanelle, the parietal and occipital position, and the temporal area. Conversion to oxygen saturation values revealed a difference of up to 13.4% in oxygen saturation between the forehead and the occipital area.Conclusion
Assuming that the arterial blood oxygen saturation did not change substantially, our findings indicate that in reflectance pulse oximetry there is no unique relation between R/IR and arterial oxygen saturation. The differences in reflectance pulse oximetry at the various sites are explained by differences in optical properties (scattering and absorption) of the tissue underneath the sensor. These will affect the red and infrared light reaching the detectors in a different way, and consequently R/IR changes. Because during intrapartum monitoring exact positioning of the sensor on the fetal head is usually impossible, the accuracy of fetal reflectance pulse oximetry is impaired.
Uterine exteriorisation at caesarean section: influence on maternal morbidity
Authors: Edi‐Osagie Edmond C. O. , Hopkins Ronald E. , Ogbo Victor , Lockhat‐Clegg Farhana , Ayeko Michael , Akpala William O. , Mayers Frederick N. 
Published: August 2005

Objective
To compare the influence on caesarean section morbidity of uterine exteriorisation or inDesign
Randomised controlled trial.Setting
Princess Anne Maternity Unit of the Royal Bolton Hospital, UK.Population
One hundred and ninety‐four women undergoing delivery by caesarean section.Methods
Two intra‐operative readings of arterial pulse rate, mean arterial blood pressure, and arterial haemoglobin oxygen saturation were obtained. Pre‐operative and day‐3 haemoglobin concentrations were determined. Intra‐ and post‐operative complications, puerperal pain scores, and febrile and infectious morbidity were assessed. A postal questionnaire was used to assess morbidity six weeks after delivery.Main outcome measures
Intra‐operative changes in pulse rate, mean arterial blood pressure and oxygen saturation; peri‐operative changes in haemoglobin concentration; incidence of intraoperative vomiting, pain, intra‐ and post‐operative complications, and febrile and infectious morbidity; immediate and late puerperal pain scores; satisfaction with the operation.Results
No clinically significant differences between uterine exteriorisation and in situ repair were found in pulse rate, mean arterial pressure, oxygen saturation and haemoglobin changes. Likewise, the incidence of vomiting and pain was similar. Vomiting occurred in 10% of all the women, and 57% of all pain complaints occurred at the initial skin incision. There was a trend towards higher immediate and late pain scores in the exteriorisation group, reaching statistical significance on day 3. Overall, pain scores averaged 6/10 on day 1 despite patient‐controlled analgesia, and three‐quarters of all women reported persisting pain on day 42. Intra‐ and postoperative complications, febrile and infectious morbidity, and duration of hospital stay were similar in both groups.Conclusions
We have demonstrated that uterine exteriorisation and in situ repair have similar effects on peri‐operative caesarean section morbidity. Intra‐operative pain reflected adequacy of anaesthesia, while vomiting reflected adequacy of pre‐operative preparation of patients. Exteriorising the uterus at caesarean section is a valid option.