bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the cardiotocogram
Authors: Keith Robert D. F. , Beckley Sarah , Garibaldi Jonathan M. , Westgate Jenny A. , Ifeachor Emmanuel C. , Greene Keith R. 
Published: August 2005

ABSTRACTObjectives
To investigate 1. whether an intelligent computer system could obtain a performance in labour management comparable with experts when using cardiotocograms (CTGs), patient information, and fetal blood sampling and 2. whether experts could be consistent and agree in their management of labour.Subjects
An intelligent computer system and 17 clinicians experienced in fetal monitoring from 16 centres in the UK.Design
Fifty cases with complete intrapartum CTGs and clinical data were reviewed by each expert and the system independently on two occasions, at least one month apart. Each CTG was scored in 15 min segments according to a protocol and estimates of the cervical dilatation and fetal scalp blood pH were given when requested.Main outcome measures
Consistency and agreement in the recorded scores, agreement and timing of cases recommended for caesarean sections, fetal blood sampling rates, intervention in cases with poor outcome and intervention in cases with good clinical outcome.Results
The system:

Agreed with experts well and significantly better than chance (67.33%, kappa = 0.31, P 0.001).
Was highly consistent (99.16%, kappa = 0.98, P 4.0001) when used by two operators independently.
Recommended no unnecessary intervention in cases with normal delivery and good condition (cord artery pH > 7.15, vein pH > 7.20, 5 min Apgar ≥ 9 and no resuscitation). This was better than all but two of the experts.
Recommended delivery by caesarean section in 11 cases; at least 15 of the 17 experts in each review also recommended caesarean section delivery in these cases. The majority did so within 15 min of the system and two‐thirds did so within 30 min.
Identified as many of the birth asphyxiated cases (cord arterial pH < 7.05 and BDecf ≥ 12, and Apgar score at 5 min ≤ 7 with neonatal morbidity) as the majority of experts and one more than was acted upon clinically.

The experts were found to be consistent and to agree. There was good agreement in the cases and the timing of caesarean section recommendations. The majority of experts did not recommend operative intervention in cases which had a normal delivery and good outcome, but did recommend operative interventions in 10 of 12 cases delivered with cord arterial pH c 7.05. However, in one of the cases delivered with birth asphyxia, 14 of the 17 experts and the system failed to recommend intervention.Conclusions
The system's performance was found to be indistinguishable from the experts' in the 50 cases examined, but it was more consistent. This demonstrates the potential for an intelligent computer system to improve the interpretation of the CTG and decrease intervention. Furthermore, the good performance of most experts in this study demonstrates the potential effectiveness of the CTG and raises important questions regarding why the CTG has fallen short of expectations in current practice.
Hormone replacement therapy, sleep quality and psychological wellbeing
Authors: Purdie David W. , Empson Jacob A. C. , Crichton Caroline , Macdonald Linda 
Published: August 2005

ABSTRACTObjective
To examine the effect of hormone replacement therapy upon sleep quality and duration in postmenopausal women.Design
Randomised, single‐blind, placebo‐controlled trial.Setting
Sleep research laboratory.Subjects
Thirty‐three healthy postmenopausal women.Interventions
Continuous 0–625 mg conjugated equine oestrogens with 0.15 mg cyclic norgestrel taken for 12 days per 28 day cycle.Main outcome measures
Occurrence of vasomotor symptoms, polysomnographic sleep stage measures, Stanford sleepiness questionnaire, Crown‐Crisp experiential index and the cognitive failures questionnaire.Results
Hormone replacement therapy results in an improvement in menopausal symptoms but not in parameters of sleep quality. Despite this, certain measures of psychological wellbeing showed significant improvement in the hormone replacement therapy group.Conclusion
Hormone replacement therapy results in a measurable improvement in physical and psychological welfare, the latter being independent of improvement in sleep quality.
A comparison of the inactive urinary kallikrein:creatinine ratio and the angiotensin sensitivity test for the prediction of pre‐eclampsia
Authors: Kyle Phillips M. , Campbell Sarah , Buckley Davina , Kissane Jennifer , de Swiet Michael , Albano Janet , Millar J. Gavin , Redman Christopher W. G. 
Published: August 2005

Objective
To determine the relation between the inactive urinary kallikreimcreatinine ratio (IUK:Cr) and the angiotensin sensitivity test (AST) at 28 weeks of gestation and to assess each as a screening test for pre‐eclampsia.Design
Prospective interventional study.Subjects
Four hundred and fifty‐nine normotensive nulliparous women recruited from hospital antenatal clinics.Setting
John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.Interventions
A urine sample for IUK:Cr measurement was provided before performing the AST at 28 weeks of gestation. Those women who demonstrated increased sensitivity to angiotensin II were entered into a randomised placebo controlled trial of low dose aspirin for the prevention of pre‐eclampsia (CLASP).Main outcome measures
The development of pre‐eclampsia.Results
The IUK:Cr ratio was significantly lower in those women who showed increased sensitivity to angiotensin II (P < 0.0001 Student's t test). The sensitivity and specificity for detecting pre‐eclampsia were, respectively, 22% and 85% for the AST and 67% and 75% for the IUK:Cr. Low‐dose aspirin (60 mg) had no effect on the pregnancy outcome.Conclusion
There appears to be some relation between the IUK:Cr and AST tests in pregnancy. However, in this population, the IUK:Cr ratio was a better screening test for pre‐eclampsia than the AST, but overall neither test was a powerful predictor for the syndrome.
Perinatal morbidity in chronic hypertension
Authors: McCowan Lesley M. E. , Buist Robert G. , North Robyn A. , Gamble Gregory 
Published: August 2005

Objective
To investigate if chronic hypertension in the absence of superimposed pre‐eclampsia is associated with increased perinatal morbidity (especially small for gestational age babies and preterm deliveries) when compared to the general obstetric population.Design
A retrospective cohort study.Setting
A tertiary referral obstetric hospital.Participants
One hundred and fifty‐five pregnant women with chronic hypertension who had a diastolic blood pressure of greater than 90 mmHg before 20 weeks or had pre‐existing essential hypertension were studied. The study period was January 1 1991 to June 30 1993.Main outcome measures
Perinatal related loss rate, birthweight less than the fifth centile (small for gestational age) preterm delivery, placental abruption and development of superimposed pre‐eclampsia.Results
Women with chronic hypertension without superimposed pre‐eclampsia had an increased rate of small for gestational age babies (10.1%) compared with the general population (4.1%) (odds ratio 2.9 [confidence interval 1.6 to 5.01). Women with chronic hypertension without superimposed pre‐eclampsia did not have a significant increase in preterm delivery or perinatal loss. Severe hypertension (diastolic blood pressure ≥ 110) at less than 20 weeks was associated with a trend to an increased risk of small for gestational age babies (odds ratio 3.8 [confidence interval 1.0 to 13.7]), increased rate of delivery at less than 32 weeks (odds ratio 7.4 [confidence interval 1.9 to 29.51) and increased rate of superimposed pre‐eclampsia (odds ratio 5.2 [confidence interval 1.5 to 17.21). Women with superimposed pre‐eclampsia had the greatest perinatal morbidity.Conclusions
Women with chronic hypertension without pre‐eclampsia have an increased risk of delivering a small for gestational age baby. Perinatal morbidity and pre‐eclampsia is greatest in women with severe hypertension at less than 20 weeks. Preterm delivery is more common in women with superimposed pre‐eclampsia.
The haemodynamic and respiratory effects of intravenous nimodipine used in the treatment of eclampsia
Authors: Anthony J. , Mantel G. , Johanson R. , Dommisse J. 
Published: August 2005

Objective
To establish the antihypertensive properties of intravenous nimodipine used to treat eclamptic patients. To assess the effects of intravenous nimodipine on oxygen delivery and consumption.Design
A prospective observational study.Setting
The Maternity Centre Obstetric Intensive Care Unit, Groote Schuur Hospital.Participants
Four unselected patients presenting with proteinuric hypertension and seizures.Methods
Haemodynamic observations were obtained by a radial artery catheter and right heart catheterisation with a pulmonary artery flow directed thermodilution catheter. Observations were obtained prior to and after the administration of nimodipine.Resuts
A significant reduction in mean arterial pressure occurred in all patients after administration of nimodipine. This was due to a significant reduction in systemic vascular resistance. Neither oxygen delivery to the tissues nor peripheral oxygen consumption changed significantly during nimodipine infusion. No adverse effects related to the use of nimodipine were documented.Conclusions
Nimodipine is an effective vasodilator. There may be a role for nimodipine as a single agent for the management of eclampsia.
Common iliac artery flow velocity waveforms in fetuses with a single umbilical artery: a longitudinal study
Authors: Sepulveda Waldo , Nicolaidis Peter , Bower Sarah , Ridout Deborah A. , Fisk Nicholas M. 
Published: August 2005

Objective
In fetuses with a single umbilical artery the entire blood flow to the placenta is transported through the common and internal iliac arteries from the side of the single artery, whereas the pelvic vessels from the side of the missing artery do not participate in the fetoplacental circulation. The aim of this study was to investigate the effect of gestational age on pelvic arterial blood flow in fetuses with single umbilical artery.Design
In 15 fetuses with a single umbilical artery (SUA), common iliac artery flow velocity waveforms were studied longitudinally using high resolution colour Doppler ultrasonography at three gestational ages: 18 to 20 weeks, 28 to 30 weeks, and 35 to 37 weeks. The pulsatility index was measured in each common iliac artery and mixed model analysis of variance was used to examine the effect of gestational age and side.Results
There was a highly significant difference in pulsatility index between common iliac arteries at all gestational ages, the values always being higher on the side that did not participate in the fetoplacental circulation (P < 0.001). For increasing gestation, the pulsatility index fell significantly in the SUA side but remained high in the non‐SUA side (P < 0.001).Conclusions
This study shows that the asymmetry in the pelvic arterial blood flow in fetuses with SUA increases as pregnancy progresses, consistent with decreasing vascular resistance in the placenta and increasing resistance in the lower extremities.
Head‐to‐cervix force: an important physiological variable in labour. 1. The temporal relation between head‐to‐cervix force and intrauterine pressure during labour
Authors: Allman Andrew C. J. , Genevier Eric S. G. , Johnson Mark R. , Steer Philip J. 
Published: August 2005

Objective
To investigate the relation between the rise in intrauterine pressure and rise in fetal head to cervix force in normal, slow and induced labour.Design
Prospective observational study.Setting
The labour ward of a London teaching hospital.Participants
Forty patients were recruited from the antenatal clinic and labour ward of a West London Hospital. Five had normal onset and progression of labour, 14 had slow progression of labour and 21 had induced onset of labour.Method
Intrauterine pressure and head‐to‐cervix force was measured simultaneously using an intrauterine pressure catheter and a specially designed four sensor head‐to‐cervix force probe.Results
For each contraction of each labour, scattergrams of force by pressure were plotted. Three patterns were observed. When the rise in pressure preceded the rise in force, a positive ‘loop’ was generated. When the rise in pressure and force occurred simultaneously a linear pattern was generated (a neutral ‘loop’). When the rise in pressure lags the rise in force, a negative ‘loop’ was generated. In normally progressive labour the distribution of loops was 291%, 22.6% and 48‐3 %, respectively, in slow labour the distribution was 26.1 %, 14.1 % and 59.8 % and in induced labour the distribution was 33.8 %, 14.4% and 51.8 %. These distributions were not statistically different. However, a higher proportion of negative loops was observed in labours augmented with oxytocin compared to those receiving no oxytocin (MW‐U = 87, P= 0.036). No differences were observed comparing parity, use of PGE2, epidural analgesia, or mode of delivery. Contraction frequency (number/10 minutes) was inversely correlated to the percentage of negative loops (r8= 0.34, P= 0.033) and positively correlated with percentage of positive loops (r8= 0.36, P= 0.027).Conclusions
This is the first report of the temporal relation between intrauterine pressure and head‐to‐cervix force in labour. The most common pattern is that the rise in pressure lags the rise in force, suggesting that a seal has to be created between the fetal head and cervix before a rise in pressure can occur. When oxytocin is given in labour, a higher proportion of loops are negative indicating that there is poor application of the fetal head and cervix in a greater proportion of contractions.
Antenatal screening for cystic fibrosis
Authors: Cuckle Howard , Quirke Philip , Sehmi Indera , Lewis Fraser , Murray Jennifer , Cross Debra , Cuckle Patricia , Ozols Barbara 
Published: August 2005

Objective
To assess the practicality of implementing antenatal screening for cystic fibrosis in Yorkshire.Design
Prospective study in which all pregnant women were offered testing for the AF508 mutation which accounts for about 85 % of carriers in Yorkshire. The reproductive partners of those found to be cystic fibrosis carriers were then tested and any carrier referred for genetic counselling.Setting
Antenatal clinics in two hospitals and eight general practices.Population
Six thousand and seventy‐one pregnant women.Results
A total of 3773 women (62 %) accepted the screening offer. This was a lower uptake rate than in other published UK studies: Aberdeen (85–91%), Manchester (85%), Edinburgh (76–84%) and Oxford (67%). Nonetheless there were large and statistically significant differences in the uptake rate between centres within the study: 78% and 60% for the two hospitals and 67% for the general practices. One hundred and thirty women (3.4%) were found to be carriers and three carrier couples were identified. The median time interval for the laboratory to produce a result was five days and the cost was £16 on average.Conclusions
Antenatal screening for cystic fibrosis does not pose any special practical difficulties. It would be feasible to introduce it into routine practice in Yorkshire.
Ultrasound: a noninvasive screening test for detrusor instability
Authors: Khullar V. , Cardozo L. D. , Salvatore S. , Hill S. 
Published: August 2005

Objective
To determine whether transvaginal ultrasound measurement of bladder wall thickness can be used as a screening test for detrusor instability in women with urinary symptoms.Design
A blinded prospective study.Setting
A London teaching hospital.Participants
One hundred and eighty‐four symptomatic women presenting to a urodynamic clinic.Main outcome measure
The detection of detrusor instability by means of videocystourethrography (VCU) and ambulatory urodynamics in women with a mean bladder wall thickness of greater than 5 mm measured by transvaginal ultrasound.Results
One hundred and eight women had a mean bladder wall thickness of greater than 5 mm. Ninety‐four percent (102) of these women had detrusor instability either when undergoing VCU or ambulatory urodynamics. Seventeen women had a bladder wall thickness of less than 3.5 mm of whom three were found to have detrusor instability on VCU.Conclusion
The measurement of a mean bladder wall thickness greater than 5 mm with transvaginal ultrasound is a sensitive screening method for diagnosing detrusor instability in symptomatic women without outflow obstruction.
A prospective study to evaluate oophorectomy at the time of vaginal hysterectomy
Authors: Davies Anthony , O'Connor Hugh , Magos Adam L. 
Published: August 2005

Objective
To assess the feasibility and safety of vaginal removal of ovaries at the time of vaginal hysterectomy.Design
Prospective study.Setting
London teaching hospital.Population
Between March 1993 and March 1995, 40 women were admitted under the care of one consultant for vaginal hysterectomy and bilateral oophorectomy.Methods
The success rate of removing the ovaries vaginally was calculated and the operative time, blood loss, intra‐ and post‐operative complications and patient recovery were analysed and compared with 48 patients who had a vaginal hysterectomy but retained their ovaries during the same time period.Results
Thirty‐nine (97.5%) of the 40 women due to undergo removal of the ovaries were managed successfully via the vaginal route; one woman required laparoscopic removal of one of her ovaries containing an ovarian cyst which was not diagnosed pre‐operatively. A variety of techniques were used for vaginal oophorectomy which included salpingo‐oophorectomy, oophorectomy without salpingectomy, and transvaginal endoscopic oophorectomy utilising endoloop sutures or bipolar electrosurgery. Oophorectomy added a mean of 23.4 min (88.3 vs 64.9 min, 95% CI 10.2–36.7, P < 0.001) to the total operating time compared with vaginal hysterectomy alone. No laparotomies were required, and both the complication rate and post‐operative inpatient stay were similar for the two groups.Conclusion
The need to perform oophorectomy should not be considered a contraindication to vaginal hysterectomy.
Faecal incontinence after childbirth
Authors: MacArthur Christine , Bick Debra E. , Keighley Michael R. B. 
Published: August 2005

Objective
To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors.Design
A cohort study with information on symptoms collected in home‐based interviews and obstetric data from hospital casenotes.Setting
Deliveries from a maternity hospital in Birmingham.Participants
Nine hundred and six women interviewed a mean of 10 months after delivery.Main outcome measures
New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.Results
Thirty‐six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty‐seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.Conclusions
Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.
Local immune response in endometrial carcinomas
Authors: Hachisuga Toru , Fukuda Koichi , Nakamura Satoru , Iwasaka Tsuyoshi , Sugimori Hajime 
Published: August 2005

Objective
To determine whether Langerhans cells act as antigen‐presenting cells in endometrial carcinomas and their related lesions.Samples
Frozen endometrial samples were obtained from 13 women with normal menstrual cycles, 3 postmenopausal women, 11 women with hyperplasia (simple 4, complex 4 and atypical 3) and 32 women with endometrial carcinomas.Main outcome measures
Langerhans cells (CD1), T lymphocytes (CD4 and CD8), B lymphocytes (CD22), natural killer (NK) cells (CD57) and HLA‐DR were all quantitatively assessed in endometrial samples using immunohistochemical method.Results
The numbers of Langerhans, CD4+, CD8+ and B cells were higher in the secretory phase than in the proliferative endometrium. The CD8+ cells appeared to be more plentiful than the CD4+ cells. When compared with the proliferative endometrium, the numbers of Langerhans cells were higher in hyperplasias and carcinomas. Most of Langerhans cells were HLA‐DR+, showing a strong correlation with CD4+ cells in carcinomas. This suggests that MHC class II antigen restricted lymphocytes in carcinomas are activated by HLA‐DR+ Langerhans cells. However, epithelial expression of HLA‐DR in carcinomas did not show on association with high numbers of Langerhans and CD4+ cells. No correlation was observed between Langerhans cells and clinicopathologic features of carcinomas. In contrast, the number of NK cells significantly decreased in noninvasive carcinomas but increased in Grade 3 tumours.Conclusion
Based on the above findings, Langerhans cells are considered to act as antigen‐presenting cells in carcinomas, but it was not shown that they were activated by epithelial expression of HLA‐DR in carcinomas.
Amniotic fluid nitric oxide and uteroplacental blood flow in pregnancy complicated by intrauterine growth retardation
Authors: Di Iorio Romolo , Marinoni Emanuela , Coacci Federica , La Torre Renato , Cosmi Ermelando V. 
Published: August 2005

Objective
To examine the correlation between placental nitric oxide production and uteroplacental blood flow.Participants
Thirty‐one pregnant women with fetuses with intrauterine growth retardation and 27 normal pregnancies as controls.Design
Correlation between amniotic fluid measurements of nitrite metabolite in the third trimester and flow velocimetry waveforms recorded from uterine, umbilical and fetal middle cerebral arteries. Intrauterine growth retarded pregnancies were compared with controls.Main outcome measures
Concentrations of nitric oxide metabolites (NO2‐ and NO3‐) in amniotic fluid were correlated with flow velocimetry waveforms findings by the determination of correlation coefficient.Results
Overall median nitrite values in amniotic fluid were higher (P < 0.01) in intrauterine growth retarded patients (median 8.6 μmol/mg creatinine) than in controls (5.6 μmol/mg creatinine). Pathologic uterine flow velocimetry waveforms in uterine artery (‐2SD) were observed in 12 women of the intrauterine growth retarded group, and the concentration of amniotic fluid nitrite was significantly lower (P < 0.01) in these patients (median 4.45 μmol/mg creatinine) than in those with normal flow velocity waveforms (median 11.43 μmol/mg creatinine). A significant negative correlation was observed between nitrite concentrations and uterine artery resistance index, umbilical artery pulsatility index and umbilical artery pulsatility index:middle cerebral artery pulsatility index ratio.Conclusions
We conclude that placental nitric oxide is significantly associated with uteroplacental blood flow and may be important in maintaining adequate uteroplacental perfusion in intrauterine growth retarded pregnancies.