bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twin
Authors: Leung Tak‐Yeung , Lok Ingrid Hung , Tam Wing‐Hung , Leung Tse‐Ngong , Lau Tze‐Kin 
Published: May 2004

Objective  To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin.Design  A retrospective study.Setting  Department of Obstetrics and Gynaecology in a university teaching hospital.Population  Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre‐eclampsia and diabetes were excluded.Methods  The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied.Main outcome measures  The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them.Results  A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1–75) while that of the second twins' was 10 minutes (range 3–26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10−3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10−3 per minute (P < 0.05).Conclusions  During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important.
Ultrasonographic occiput position in early labour in the prediction of caesarean section
Authors: Akmal Serap , Kametas Nikos , Tsoi Elly , Howard Richard , Nicolaides Kypros H. 
Published: May 2004

Objective  To investigate the value of ultrasonographically determined occiput position in the early stages of the active phase of labour, in addition to traditional maternal, fetal and labour‐related characteristics, in the prediction of the likelihood of caesarean section.Design  Prospective observational study.Setting  District general hospital in the UK.Population  Six hundred and one singleton pregnancies with cephalic presentation in active labour at term with cervical dilatation of 3–5 cm.Methods  Transabdominal sonography to determine fetal occiput position was carried out by an appropriately trained sonographer immediately before or after the routine clinical examination by the attending midwife or obstetrician.Main outcome measure  Caesarean section.Results  Delivery was vaginal in 514 (86%) cases and by caesarean section in 87 (14%). The fetal occiput position was posterior in 209 (35%) cases and in this group the incidence of caesarean section was 19% (40 cases), compared with 11% (47 of 392) in the non‐occiput posterior group. Multiple regression analysis revealed that significant independent contribution in the prediction of caesarean section was provided by maternal age (OR 1.1, 95% CI 1.0–1.2), Afro‐Caribbean origin (OR 2.4, 95% CI 1.2–4.6), height (OR 0.93, 95% CI 0.89–0.97), parity (OR 0.2, 95% CI 0.1–0.4), type of labour (OR 2.2, 95% CI 1.3–3.8), gestation (OR 1.4, 95% CI 1.1–1.7), fetal head descent (OR 0.6, 95% CI 0.4–0.9), occiput posterior position (OR 2.2, 95% CI 1.3–3.7) and male gender (OR 2.0, 95% CI 1.2–3.5).Conclusions  The risk of caesarean section can be estimated during the early stage of active labour by the sonographically determined occiput position, in addition to traditional maternal, fetal and labour‐related characteristics.
The effectiveness of GnRHa with and without ‘add‐back’ therapy in treating premenstrual syndrome: a meta analysis
Authors: Wyatt Katrina M. , Dimmock Paul W. , Ismail Khaled M.K. , Jones Peter W. , O'Brien P.M. Shaughn 
Published: May 2004

Objective  To determine the effectiveness of gonadotrophin‐releasing hormone analogues (GnRHa) with and without hormonal add‐back therapy in the management of premenstrual syndrome.Design  Randomised controlled trials were identified by searching multiple databases.Setting  Exeter and North Devon Research and Development Support Unit and Keele University Academic Unit of Obstetrics and Gynaecology.Population  Women with pre‐diagnosed premenstrual syndrome and/or premenstrual dysphoric disorder.Methods  A meta‐analysis of published randomised placebo‐controlled trials assessing the use of GnRHa in the management of premenstrual syndrome. The standardised mean difference for each individual study and subsequently an overall standardised mean difference were calculated after demonstrating the consistency or homogeneity of the study results.Main outcome measures  Overall improvement in premenstrual symptomatology and effectiveness of GnRHa with additional hormonal add‐back therapy were the main outcome measures assessed in this analysis. A secondary analysis was performed to assess the effectiveness of GnRHa in treating physical and emotional symptoms.Results  Overall standardised mean difference for all trials that assessed the efficacy of GnRHa was −1.19 (95% confidence interval [CI] −1.88 to −0.51). The equivalent odds ratio was 8.66 (95% CI 2.52 to 30.26) in favour of GnRHa. GnRHa were more efficacious for physical than behavioural symptoms, although the difference was not statistically significant. The addition of hormonal add‐back therapy to GnRHa did not appear to reduce the efficacy of GnRHa alone; standardised mean difference 0.12 (95% CI −0.35 to 0.58).Conclusions  GnRHa appear to be an effective treatment in the management of premenstrual syndrome. The addition of hormonal add‐back therapy to reduce side effects does not reduce efficacy.
Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle‐aged women
Authors: Teleman Pia M. , Lidfeldt Jonas , Nerbrand Christina , Samsioe Göran , Mattiasson Anders ,   the WHILA study group
Published: May 2004

Objective  To investigate the prevalence of and factors associated with overactive bladder in middle‐aged women.Design  Cross sectional population‐based study.Setting  Southern Sweden and the Women's Health in the Lund Area study (WHILA 1995–2000) where 6917 (64% of the invited) women, 50–59 years old in 1995, participated.Population  From the WHILA study, 1500 women reporting troublesome urinary incontinence (INCONT‐1) and 1500 without incontinence (CONT‐1) were selected by computerised randomisation and received the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire in January 2001.Methods  Overactive bladder was defined in two versions using the ICS definition of 2002 as either urgency alone (OAB‐1) or urgency combined with frequency more than eight times per day and/or nocturia twice or more per night (OAB‐2). Risk factors were analysed by multiple logistic regression analyses.Main outcome measures  Prevalence figures and odds ratios with corresponding 95% confidence intervals.Results  The prevalence of OAB‐1 was 46.9% in the INCONT‐1 and 16.7% in the CONT‐1 group, and that of OAB‐2 was 21.6% and 8.1%, respectively. Most urgency occurred in combination with stress incontinence (i.e. as mixed incontinence). The overlap between stress and urge symptoms increased with the frequency of stress incontinence episodes (P < 0.001). Metabolic risk factors were body mass index (BMI) ≥ 30 for OAB‐1, OAB‐2 and stress incontinence, positive metabolic screening for OAB‐1, family history of diabetes for OAB‐2 and elevation of BMI ≥ 25% since the age of 25 for stress incontinence. Stress incontinence was associated with the current use of hormonal replacement therapy.Conclusions  Overactive bladder and stress incontinence are intimately associated with each other. Both OAB and stress incontinence are associated with abnormal metabolic factors, mainly increased BMI.
Increased levels of gangliosides in the plasma and ascitic fluid of patients with advanced ovarian cancer
Authors: Santin Alessandro D. , Ravindranath Mepur H. , Bellone Stefania , Muthugounder Sakunthala , Palmieri Michela , O'Brien Timothy J. , Roman Juan , Cannon Martin J. , Pecorelli Sergio 
Published: May 2004

Objectives  To assess the expression of total gangliosides in primary ovarian cancer cell lines, ascitic fluid and plasma of advanced ovarian cancer patients.Design  A prospective study.Setting  The Department of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences and the Laboratory of Glycolipid Immunotherapy, John Wayne Cancer Institute.Population  Twenty‐two women diagnosed with advanced ovarian cancer and seven normal female controls.Methods  Total gangliosides shedding from primary ovarian cancer cell lines were measured by estimating lipid‐associated sialic acids (LASAs test) and compared with the ganglioside levels shed by primary cervical and uterine cancer cell lines. In addition, plasma and ascitic samples from advanced ovarian cancer patients were collected at the time of surgery and analysed for the presence of total gangliosides.Main outcome measures  Levels of total ganglioside in plasma and ascites fluid samples drawn from ovarian cancer patients, relative to total gangliosides levels in plasma from normal female controls.Results  All primary ovarian tumours secreted high levels of total gangliosides (mean 4 mg/mL, range between 2.7 and 4.8 mg/mL/105 cells/24 h) when compared with primary cervical cancers (mean 1.4 mg/mL, range between 0.7 and 2.2 mg/mL/105 cells/24 h) (P < 0.008) and uterine carcinoma cell lines (mean 1.4 mg/mL, range between 1.3 and 1.6 mg/mL/105 cells/24 h) (P < .004). Elevated levels of total gangliosides were detected in the plasma [mean (SD) 31 (12) mg/mL, range between 18 and 57 mg/mL] (P < .001), and in the peritoneal fluid [mean (SD) 27 (9) mg/mL, range between 14 and 40 mg/mL] (P < .003) of ovarian cancer patients when compared with the levels detectable in the plasma samples of normal female controls tested [mean (SD) 15 (2) mg/mL, range between 12 and 18 mg/mL].Conclusions  Increased serum levels of total gangliosides may reflect shedding or release of gangliosides from the surface of ovarian tumour cells. Secretion of gangliosides may play an important role in the inhibition of anti‐tumour immune function commonly observed in advanced ovarian cancer.
VEGF expression in the placenta from pregnancies complicated by hypertensive disorders
Authors: Sgambati Eleonora , Marini Mirca , Zappoli Thyrion Giorgia D. , Parretti Elena , Mello Giorgio , Orlando Claudio , Simi Lisa , Tricarico Carmela , Gheri Gherardo , Brizzi Enzo 
Published: May 2004

Objective  To determine the expression of VEGF in the placental tissue from pregnancies complicated by hypertension disorders of different clinical severity.Design  Prospective cohort study.Setting  Polyclinic of Careggi, University of Florence, Italy.Sample  Placentas from women with gestational hypertension (n= 20), pre‐eclampsia (n= 20) and pre‐eclampsia with HELLP syndrome (n= 20) and from normotensive women (n= 20), as control group (gestational age comprised between 35 and 38 weeks).Methods  An immunohistochemical technique and a quantitative analysis to measure mRNA levels (RT‐PCR) were employed.Main outcome measures  Intensity of immunoreactivity and mRNA levels in the placental components. Differences between the data.Results  VEGF immunoreactivity was observable in all the placental components in the gestational hypertension cases as in the control ones. In the cases with pre‐eclampsia and pre‐eclampsia with HELLP syndrome, some placental components were not immunoreactive. However, the VEGF positive components of all the pathological groups showed a higher intensity of reactivity with respect to that of the control group. The levels of VEGF mRNA were higher in the gestational hypertension cases and lower in the cases of pre‐eclampsia with HELLP syndrome with respect to the control ones; in the cases of pre‐eclampsia, the levels were the same as the control ones.Conclusion  The different expression of VEGF in the placenta of the pathological cases is probably related to haemodynamic changes that take place in these disorders, in order to attempt restoration of a normal uteroplacental flow.
Teenage antenatal clinics may reduce the rate of preterm birth: a prospective study
Authors: Quinlivan Julie A. , Evans Sharon F. 
Published: May 2004

Objective  To examine whether teenage antenatal clinics reduce the incidence of preterm birth.Design  A multicentre prospective study was performed.Setting  Three Australian hospitals with maternity services.Population  Consecutive teenage patients (N= 731) were approached at their first or second antenatal visit.Methods  Cases were women attending multidisciplinary teenage antenatal clinics and controls attended general hospital‐based antenatal clinics. Teenage antenatal clinics involved multidisciplinary care and included guidelines to screen and treat all patients for infectious and social pathology. General antenatal clinic care was in accordance with Australian standards.Main outcome measures  Preterm birth, newborn biometry adjusted for gestational age, breastfeeding and contraception plans at discharge.Results  Consent was obtained from 651 (89%) patients. Teenage pregnancy clinic patients were significantly less likely to present with threatened preterm labour (OR 0.45; 95% CI 0.29–0.68), preterm, prelabour, prolonged rupture of membranes (OR 0.34; 95% CI 0.18–0.63) or deliver preterm (OR 0.40; 95% CI 0.25–0.62) compared with those from general clinics. However, there was no independent effect of clinic care upon newborn biometry outcomes. Clinic care did not significantly alter rates of initiation of breastfeeding in hospital. However, significantly more of the teenage antenatal clinic mothers were discharged on contraception (OR 1.58; 95% CI 1.07–2.25).Conclusion  Teenage‐specific antenatal clinics may reduce the rate of preterm birth.
Perinatal HIV‐1 transmission among low income women participants in the HIV/AIDS Control Program in Southern Brazil: a cohort study
Authors: Kreitchmann Regis , Fuchs Sandra Costa , Suffert Theodoro , Preussler Gisele 
Published: May 2004

Objective  To determine the rate and factors associated with perinatal transmission among women infected with HIV‐1.Design  Cohort study.Setting  Centro Municipal de Atendimento em DST/AIDS is a major reference centre for HIV treatment in Porto Alegre city, southern Brazil.Population  Pregnant and puerperal women infected with HIV‐1.Methods  Women were enrolled during pregnancy and seen monthly at the antenatal care centre. Those detected at delivery that presented at the centre within the first 10 days of postpartum were included. Maternal, obstetric and infant‐related characteristics were ascertained and testing for CD4 cell count, HIV PCR/RNA assay, anti‐HCV, HBSAg and syphilis were performed. Antiretrovirals and formula were provided free of charge following Brazilian guidelines.Main outcome measure  HIV‐1 infection status in the infant.Results  Perinatal transmission was assessed in 343 children (95% of the whole sample). Overall, the transmission rate was 3.2% (95% CI: 1.7–5.8%). Perinatal transmission rates increased with maternal viral load (≥10,000 copies/mL; RR: 11.27; 95% CI: 1.38–92.23). In multivariate analyses, the only independent risk factor for perinatal transmission was the maternal viral load at baseline (OR = 2.72 per log increase in the number of copies; 95% CI: 1.17–6.50).Conclusion  Perinatal transmission rate was low among HIV‐1 infected women in clinical care and on antiretroviral therapy despite poor socio‐economic conditions. Viral load level was the only independent predictor of perinatal transmission. It is possible to prevent HIV‐1 perinatal transmission in a developing country if we provide antiretrovirals and formula.
Are women's expectations and preferences for intrapartum care affected by the model of care on offer?
Authors: Hundley Vanora , Ryan Mandy 
Published: May 2004

Objective  To investigate the effect of service provision on consumer preferences, in particular, whether women who have access to systems of care which offer particular attributes (such as continuity of carer) value these attributes more highly than women for whom the attributes are not a realistic option.Design  Simple rating scales and a discrete choice experiment were used to assess the importance to women of different aspects of intrapartum care.Sample and setting  The sample consisted of 301 women at low obstetric risk, identified from three geographical areas, each with a different system of maternity care provision.Methods  Midwives gave an anonymous, self‐complete questionnaire to the women at the booking visit. Categorical data from the rating scales were analysed using the χ2 test. Analysis of the discrete choice experiment was conducted using random effect probit regression.Main outcome measures  Women's preference for different attributes of intrapartum care.Results  From the rating scales, it appeared that women in the area with least continuity rated this aspect of care significantly lower than women in other areas (P= 0.007). Although the discrete choice experiment appeared to confirm this, the difference was not statistically significant.Conclusions  The findings from this study suggest that the systems of care on offer do influence women's preferences for aspects of intrapartum care. Women in areas where continuity of carer was a realistic option appeared to value this aspect of care more highly. The tendency for preferences to be influenced not only by previous experience of a service but also by knowledge of its availability has important implications for the inclusion of consumers' values in deciding whether to introduce innovations in care. It has been suggested that greater consumer involvement may be a useful means of challenging the accepted view of what is important in health services and of facilitating change. However, the findings from this study suggest that consumer views may have the opposite effect. If consumers do prefer what they know, then a policy of tailoring health services to local preferences will simply reinforce current provision of services, reinforcing existing inequalities in the provision of care.
Outcome after a high number (4–10) of repeated caesarean sections
Authors: Juntunen Kaisa , Mäkäräinen Leo , Kirkinen Pertti 
Published: May 2004

Objective  To evaluate outcomes in caesarean sections repeated several times.Population  Sixty‐four women had had four or more (up to 10) caesarean sections.Methods  The outcomes of these operations N= 149, study group) were compared with other caesarean sections.Results  A quarter of the women in the study group complained of low abdominal pains during the late pregnancy. A thin or fenestrated isthmic myometrial layer was observed in 55% of their operations. Abnormal placentation with an increased risk of major operative complications occurred more often in the study group. No differences in post‐operative complications or perinatal outcome emerged between the groups.Conclusion  Thus, no definitive upper limit for the number of caesarean sections per individual woman can be given.
SURUSS in perspective
Authors: Wald N.J. , Rodeck C. , Hackshaw A.K. , Rudnicka A. 
Published: May 2004

Background  Until the publication of the Serum Urine and Ultrasound Screening Study (SURUSS) report, it was difficult to compare the different antenatal screening tests for Down's Syndrome because of variations in study designs. We here present the main results from SURUSS, updated to take account of recent information on nuchal translucency in Down's Syndrome pregnancies, and discuss their implications.Methods  SURUSS was a prospective study of 47,053 singleton pregnancies (including 101 pregnancies with Down's Syndrome) conducted in 25 maternity units. Nuchal translucency measurements were taken. Serum and urine samples collected between 9 and 13 weeks, and again between 14 and 20 weeks of pregnancy were stored. Samples from each affected pregnancy and five matched controls were tested for currently used or suggested biochemical Down's Syndrome screening markers. Pregnancies were followed up to determine the presence or absence of Down's Syndrome. For an 85% Down's Syndrome detection rate, the false‐positive rate for the Integrated test (nuchal translucency and pregnancy associated plasma protein‐A [PAPP‐A] at 11 completed weeks of pregnancy, and α‐fetoprotein, unconjugated oestriol [uE3], free β or total human chorionic gondaotrophin (hCG) and inhibin‐A in the early second trimester) was 0.9%, the Serum integrated test (without nuchal translucency) 2.7%, the Combined test (nuchal translucency with free β‐hCG and PAPP‐A at 11 weeks) 4.3%, the Quadruple test (α‐fetoprotein, uE3, free β or total hCG and inhibin‐A) 6.2%, and nuchal translucency at 11 weeks, 15.2%. All tests included maternal age. Using the Integrated test at an 85% detection rate, there would be six diagnostic procedure‐related unaffected fetal losses following amniocentesis per 100,000 women screened compared with 35 using the Combined test or 45 with the Quadruple test.Conclusions  The Integrated test offers the most effective and safe method of screening for women who attend in the first trimester. The next best test is the Serum integrated test. The Quadruple test is the best test for women who first attend in the second trimester. There is no justification for retaining the Double (α‐fetoprotein and hCG) or Triple (α‐fetoprotein, uE3, and hCG) tests, or nuchal translucency alone (with or without maternal age) in antenatal screening for Down's Syndrome.