bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomised trial of two expectant managements of prelabour rupture of the membranes at 34 to 42 weeks
Authors: Ladfors Lars , Mattsson Lars‐Åke , Eriksson Margareta , Fall Ole 
Published: August 2005

Objective
To compare obstetric and perinatal outcome between two different expectant managements in women with prelabour rupture of the membranes (PROM).Design
A randomised study.Participants
One thousand three hundred and eighty‐five women with rupture of the membranes at 34 to 42 weeks without contractions.Interventions
Women without contractions 2 h after admission were randomised to early induction the following morning after PROM (early induction group) or induction two days later (late induction group). Women with contractions starting within 2 h after admission were included in the calculations as a short latency group. Digital examinations of the cervix were avoided until onset of active labour. Labour was induced with oxytocin in both groups if no spontaneous contractions occurred or if chorioamnionitis or fetal distress was detected.Main outcome measures
The frequency of spontaneous deliveries, operative deliveries, maternal and neonatal infections.Results
In nulliparous women, a higher rate of spontaneous deliveries was found in the late induction group (89%) compared with the early induction group (81%) (P < 0.05). The ventouse extraction rate was 7% and 14% respectively (P < 0.05). A low (2–4%) caesarean section rate was recorded and did not differ between the groups. Endometritis was detected in six women after delivery. Sixty‐one children were treated with antibiotics, and no difference could be detected between the groups.Conclusions
A higher rate of spontaneous deliveries was found among nulliparous women with prolonged latency as compared with brief latency prior to induction. A protocol of no digital examination before labour was associated with infrequent maternal and fetal morbidity, regardless of latency.
Smoking during pregnancy: the dose dependence of birthweight deficits
Authors: Ellard Gordon A. , Johnstone Frank D. , Prescott Robin J. , Ji‐Xian Wang , Jian‐Hua Mao 
Published: August 2005

ObjectiveTo assess whether a simple urine based estimate of relative daily nicotine intake could predict smoking related birthweight deficits more accurately than self‐reported cigarette consumption.DesignActive smokers were identified by a simple qualitative colorimetric urine test procedure and their relative nicotine intakes assessed by determining the ratios of the urinary concentrations of nicotine plus its metabolites to creatinine using automated colorimetric methods.SettingA large teaching hospital.ParticipantsThree thousand and thirty‐eight mothers from whom smoking histories had been elicited and who gave birth to live singleton babies after 28 weeks of gestation.Main outcome measuresBirthweights (adjusted for maternal weight, maternal age, baby's sex, parity and length of gestation), maternal weight gains during pregnancy and placental weights.ResultsThe adjusted birthweight deficits of babies born to proven active smokers averaged 226 g (95 % confidence interval 194 g to 258 g), but dose dependent effects were only apparent when nicotine intake was based on urinary nicotine metabolites/creatinine ratios. Among the smokers, adjusted birthweights fell linearly with increasing nicotine intakes but gave a predicted mean birthweight for nonsmokers that was 102 g (95 % CI 50 g to 154 g) lighter than that actually found (P< 0.0001). Maternal weight gains during pregnancy were substantially reduced in smokers and correlated more closely with urinary nicotine metabolite excretions than with reported daily cigarette consumptions. Placental weights were unaffected by smoking.ConclusionsThere was a closer dose‐effect relationship between birthweight deficits and urinary nicotine metabolites/creatinine ratios than with self‐reported daily cigarette consumptions. The influence of nicotine exposure on birthweight appears to be biphasic, with one mechanism operating at very low levels of tobacco smoke intake and the other causing seemingly linearly related effects over the whole range of nicotine intakes of active smokers. These findings support recent evidence that passive smoking can cause substantial birthweight deficits.
Systemic and fetal–maternal nitric oxide synthesis in normal pregnancy and pre‐eclampsia
Authors: Boccardo Paola , Soregaroli Mirella , Aiello Sistiana , Noris Marina , Donadelli Roberta , Lojacono Andrea , Benigni Ariela 
Published: August 2005

Objective
To investigate systemic and fetal‐placental nitric oxide synthesis by biochemical and molecular biology means in normal human pregnancy and pre‐eclampsia.Design and participants
Three groups of women were studied healthy pregnant women (n= 8), pregnant women with pre‐eclampsia (n= 8), and age‐matched nonpregnant controls (n= 8). Pre‐eclamptic patients were treated with nifedipine (30–60 mg/day) for severe hypertension. Systemic nitric oxide synthesis was assessed in normal pregnant women at weeks 18–21, 29–32 and 38–39 and in pre‐eclamptic women on admission to the hospital (29–32 weeks, 30 on average), before the morning nifedipine administration. Nonpregnant women were studied twice at four‐week intervals as controls. The pattern of nitric oxide biosynthesis in fetal‐placental circulation was studied in normal and pre‐eclamptic women at the delivery.Setting Mario
Negri Institute for Pharmacological Research, Bergamo, and the Division of Obstetrics and Gynaecology of the University of Brescia.Main outcome measures
Plasma cGMP levels and platelet nitric oxide synthesis, assessed by measuring the conversion of [3H]L‐arginine to [3H]L‐citrulline as well as intracellular cGMP, were evaluated. Constitutive nitric oxide synthase (EC‐NOS) gene expression by Northern blot analysis and nitric oxide release by the conversion of [3H]L‐arginine to [3H]L‐citrulline were assessed in umbilical vein endothelial cells (HUVEC) and in placenta. Inducible nitric oxide synthase activity was also evaluated in HUVEC exposed to tumour necrosis factor α (TNFα) and in placenta homogenates incubated in calcium free medium.Results
Plasma cGMP was higher in both normal pregnant and pre‐eclamptic women than in nonpregnant controls. In normal pregnancy cGMP rose as early as 18–21 weeks and remained elevated throughout pregnancy. [3H]L‐citrulline production and intracellular cGMP were comparable in platelets from all women. EC‐NOS gene expression and nitric oxide synthesis were identical in HUVEC and placenta from normal pregnant and pre‐eclamptic women.Conclusions
Systemic levels of cGMP, the nitric oxide second messenger, are increased in normal pregnancy. Excessive nitric oxide production does not derive from platelets. Pre‐eclampsia is not associated with changes in fetal‐placental nitric oxide synthesis.
Posterior colporrhaphy: its effects on bowel and sexual function
Authors: Kahn Margie A. , Stanton Stuart L. 
Published: August 2005

Objective
To determine the anatomical cure rate of posterior colporrhaphy and its effect on bowel and sexual function one to six years later.Design
Retrospective observational study.Setting
Urogynaecology Unit, St George's Hospital, London.Participants
Two hundred and thirty‐one women who underwent posterior colporrhaphy.Main outcome measures
Anatomical and symptomatic cure of rectocoele.Methods
The charts of 231 women who underwent 244 posterior colporrhaphies between 1 January 1989 and 4 January 1994 were reviewed. One hundred and seventy one (74%) were interviewed; 140 (61%) were examined. Mean follow up time was 42.5 months (range 11–74).Results
Two hundred and nine women had prior or concurrent vaginal and/or bladder neck surgery including 38 previous posterior colporrhaphies. Postoperatively prolapse symptoms due to rectocoele decreased (64%vs 31%). Constipation (22%vs 33%), incomplete bowel emptying (27%vs 38%), incontinence of faeces (4%vs 11%) and sexual dysfunction (18%vs 27%) increased. Those with incontinence of stool were more likely to have had two or more posterior colporrhaphies. Sixty‐two percent felt that they improved over all after surgery. Additional postoperative symptoms included: vaginal and/or perineal splinting (33%), soiling and/or inability to wipe clean (16%), rectal digitation (23%), incontinence of flatus (19%), and rectal and/or vaginal pain (22%). Thirty‐three women (24%) had large rectocoeles, seven of whom did not have impaired bowel emptying.Conclusions
Posterior colporrhaphy corrects the vaginal defect in 76% of women. It does not necessarily correct and may contribute to bowel and sexual dysfunction, particularly in those requiring multiple procedures. The presence of the anatomical defect does not imply dysfunction. The prevalence of bowel symptoms suggests the need for close questioning about bowel habits and the selective use of bowel investigations for some women before surgery.
Low dose dopamine in postpartum pre‐eclamptic women with oliguria: a double‐blind, placebo controlled, randomised trial
Authors: Mantel Gerald D , Makin Jenny D. 
Published: August 2005

Objective
To assess the effect of low dose dopamine on the urine output in postpartum pre‐eclamptic or eclamptic women with oliguria.Design
A double blind, randomised controlled study.Setting
The high care area of the labour ward in a teaching hospital.Sample
Forty postpartum pre‐eclamptic women with oliguria, defined as < 30 mL/hour, who have not responded to a 300 mL crystalloid fluid challenge.Intervention
Dopamine was infused at a rate of 1 to 5 ng/kg per minute, or sterile water was given as placebo in the same dilution.Main outcome measure
Urine output, blood pressure and pulse was measured for six hours before and for six hours after the intervention.Results
Women who received dopamine (344 mL over 6 hours) showed a clinically and statistically significant (P= 0.0014, Mann‐Whitney U test) higher median urine output compared with those receiving placebo (135 mL over 6 hours) for the duration of therapy. The respective 95% confidence intervals were 212.3 to 712.7 mL compared with 73.8 to 244.7 mL. No differences in blood pressure or pulse were found between the two groups.Conclusions
The use of low dose dopamine in a labour setting improved urine output in postpartum pre‐eclamptic women with oliguria who had not responded to a single fluid challenge without a detrimental effect on the blood pressure or pulse.
Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies
Authors: de Vries J. I. P. , Dekker G. A. , Huijgensb P. C. , Jakobs C. , Blomberg B. M. E. , van Geijn H. P. 
Published: August 2005

Objective
The aim of our study was to investigate whether women with placental abruption, intrauterine fetal death or small for gestational age infants have metabolic and/or haemostatic abnormalities which are known to be risk factors for intravascular thrombosis.Design
For two years blood tests were performed at > 10 weeks after delivery on all women without hypertensive disorders either before or during pregnancy, who had been consecutively admitted to our hospital with placental abruption, intrauterine fetal death and small for gestational age.Sample
A total of 62 women who had placental abruption (n= 13), intrauterine fetal death (n = 18) and a small for gestational age infant (n= 13).Setting
Obstetric outpatient clinic in a university hospital (Free University Hospital, Amsterdam).Methods
Presence of hyperhomocysteinaemia, various coagulation abnormalities and anticardiolipins was investigated.Results
Abnormalities were found in 20 women in the placental abruption group (20/31, 65%), in 10 women in the intrauterine fetal death group (10/18, 56%) and in 11 women in the small for gestational age group (11/13, 85%). Eight out of these 31 women had more than one abnormality. In the group of 62 women protein S deficiency was demonstrated in 26%, hyperhomocysteinaemia in 24%, Protein C deficiency in 6%, anticardiolipin IgG in 11%, anticardiolipin IgM in 5%, Lupus anticoagulant in 2%. An antithrombin III deficiency was not found. Thirty‐three women were tested for activated protein C resistance (9% positive) and factor V Leiden mutation (6% positive). Hyperhomocysteinaemia was treated with a daily oral dose of 250 mg pyridoxine and 5 mg folic acid. After six weeks of vitamin supplementation homocysteine levels were tested again. At that tune a mean reduction of fasting homocysteine value of 68% (95% CI 57–79) was found and of post‐load value of 65% (95% CI 55–76).Conclusions
Based on the results of our study, it can be concluded that women whose pregnancies are complicated by either placental abruption, intrauterine fetal death or small for gestational age, even if there is no history of thrombo‐embolic disorders or hypertension during pregnancy, should be advised to undergo an examination for metabolic and/or haemostatic abnormalities.
Satisfaction and the three C's: continuity, choice and control. Women's views from a randomised controlled trial of midwife‐led care
Authors: Hundley V. A. , Milne J. M. , Glazener C. M. A. , Mollison J. 
Published: August 2005

Objective
1. To explore whether there are differences in women's satisfaction with care in a midwife‐managed delivery unit compared with that in a consultant‐led labour ward. 2. To compare factors relating to continuity, choice and control between the two randomised groups.Design
A pragmatic randomised controlled trial.Setting
Aberdeen Maternity Hospital, Grampian.Sample
2844 women, identified at booking as low risk, were randomised in a 2:1 ratio between the midwives’ unit and the labour ward.Main outcome measures
Satisfaction, continuity of carer, choice, and control.Results
Satisfaction with the overall experience did not differ between the groups. Satisfaction with how labour and delivery was managed by staff was slightly higher in the midwives’ unit group, but this did not reach the 0.1% level of significance. Women allocated to the midwives’ unit group saw significantly fewer medical staff and were less likely to report numerous individuals entering the room. They were more likely to report having had a choice regarding mobility and alternative positions for delivery and were significantly more likely to have made their own decisions regarding pain relief.Conclusions
The issues surrounding the measurement of satisfaction with childbirth need further investigation. Until this area is clarified it would be unwise to use an overall measure of satisfaction as an indicator of the quality of maternity service provision. In particular, the current measures are not sensitive enough to examine the specific factors which affect women's satisfaction. Further research is required to assess which factors are important to women if they are to have a positive experience of childbirth and how these priorities change over time.
Recurrence of endometrial carcinoma and the value of routine follow up
Authors: Salvesen H. B. , Akslen L. A. , Iversen T. , Iversen O. E. 
Published: August 2005

ObjectiveTo identify women treated for endometrial carcinoma with increased risk for recurrent disease, to examine how and when recurrences are discovered, and to assess the clinical benefit of routine follow up investigations.DesignRetrospective case analysis.SettingHordaland county, Norway.PopulationAll women treated for endometrial carcinoma in a demographically well defined area, in a 10‐year period (1981–1990).MethodsData concerning patient characteristics and course of the disease were collected through review of the medical records, correspondence with the primary physician and from the Norwegian Cancer Registry. Univariate and multivariate survival analysis.ResultsAfter curative surgical treatment 249 women diagnosed with endometrial carcinoma were followed for a median period of 9 years (range 4–16) or until death. Among these 249 radically treated patients, 47 had recurrent disease, 32 within the first two years. Ten of the recurrences were diagnosed at routine follow up, but only four were asymptomatic. In our follow up programme, one asymptomatic recurrence was detected for every 653 routine consultations. A low risk group, with FIGO Stage IA/IB or patient age below 60 years at primary operation was identified in multivariate recurrence‐free survival analysis. No asymptomatic recurrences were found in this group.ConclusionsLow risk women should be considered for an alternative, less frequent follow up. The sensitivity for current practice of routine follow up in detecting asymptomatic recurrences is so low that other beneficial effects should be documented to defend the large resources spent on this programme.
What changes in the organisation of cancer services will improve the outcome for women with ovarian cancer?
Authors: Woodman Ciaran , Baghdady Ashraf , Collins Stuart , Clyma Julie‐Anne 
Published: August 2005

ObjectiveTo examine the influence of operator specialty, volume of work and referral to an oncologist on the survival of women with ovarian cancer.DesignPopulation‐based retrospective cohort study, using hospital records and Cancer Registry data.SettingThe North Western Region, UK.PopulationSix hundred and ninety‐one women undergoing laparotomy for histologically confirmed ovarian malignancy during 1991 to 1992.MethodsUnivariate and multivariate survival analyses.Main outcome measuresUnivariate survival estimates. Relative risks, derived from Cox's proportional hazards model, describing the effect on survival of surgeonsvsgynaecologists as baseline, high volumevslow volume operators and referralvsnonreferral to an oncologist.ResultsAfter adjusting for woman and disease‐related prognostic factors, operation by a surgeon was shown to have an adverse impact on survival (RR = 1.58, 95% CI 1.19 to 2.10). Regardless of how a high volume operator was defined (in terms of the number of laparotomies performed), no survival advantage over low volume operators could be demonstrated. Women referred to an oncologist had significantly better survival than women not referred (RR = 0.54, 95% CI 0.43 to 0.68)ConclusionsAll women undergoing surgery for ovarian cancer should have access to a gynaecological opinion and postoperatively should be referred for a nonsurgical oncological opinion.
Hormone replacement therapy with dydrogesterone and 17β‐oestradiol: effects on serum lipoproteins and glucose tolerance during 24 month follow up
Authors: Crook David , Godsland Ian F. , Hull Jane , Stevenson John C. 
Published: August 2005

Objective
To assess serum lipid and lipoprotein concentrations and oral glucose tolerance in postmenopausal women treated with 17β‐oestradiol (2 mg/day) and cyclical dydrogesterone (10 mg/day for 14 days per 28 day cycle).Design
A 24 month prospective study of 29 women acting as their own controls. On‐treatment samples were taken during the combined (oestrogen–progestogen) phase of therapy.Setting
Metabolic research unit in London.Population
Postmenopausal women with no previous exposure to hormone replacement therapy attending a menopause clinic in a London hospital.Methods
Fasting serum sampling and oral glucose tolerance testing.Main outcome measures
Serum lipids and lipoprotein concentrations and plasma glucose, insulin and C‐peptide responses to an oral glucose load.Results
Restricting the analysis to the 17 women who completed the study, no effect was seen on serum triglyceride concentrations. There was a mean fall of 5.9% (95% CI 1.2 to −13.0) in concentrations of serum total cholesterol, reflecting the balance of a 10.7% fall (95% CI 4.3 to −25.8) in low density lipoprotein cholesterol concentrations and a 16.3% increase (95% CI 7.3 to −25.3) in those of high density lipoproteins. Fasting glucose concentrations and glucose tolerance test responses were unchanged. Fasting insulin concentrations fell substantially (–41.6%, 95% CI −23.4 to −59.8) with falls also being seen in insulin responses to glucose. Fasting C‐peptide concentrations increased by 36.2% (95% CI 9.17 to 63.3), with no consistent effect on C‐peptide responses to glucose.Conclusions
Dydrogesterone did not appear to oppose the potentially beneficial effects of oestradiol on insulin or either low or high density lipoproteins, making the combination with 17β‐oestradiol a potentially useful option for postmenopausal women particularly those at risk of cardiovascular disease or diabetes mellitus.
The influence of oestrogen replacement on faecal incontinence in postmenopausal women
Authors: Donnelly Valerie , O'Connell P. Ronan , O'Herlihy Colm 
Published: August 2005

Objective
To assess the value of hormone replacement therapy (HRT) in postmenopausal women with faecal incontinence.Design
Prospective observational study using a bowel function questionnaire and anorectal physiological testing before and after six months of standard oestrogen hormone replacement therapy.Setting
Menopause and colorectal clinics of two university teaching hospitals.Participants
Twenty postmenopausal women (mean age 61 years) with demonstrable faecal incontinence (mean duration 6.1 years) previously untreated with HRT.Main outcome measures
Improvement in symptoms and objective alteration in anorectal physiology tests.Results
All women had significant symptoms of anorectal dysfunction before treatment, whereas 5/20 (25%) were asymptomatic after six months of HRT, and a further 13/20 (65%) were symptomatically improved in terms of flatus control, urgency, and faecal staining. There was no change in bowel frequency or stool consistency following HRT, but social activity was considerably improved. Anal resting pressures and voluntary squeeze increments were significantly increased following oestrogen therapy, although no differences in anal canal vector symmetry index were observed. Insignificant changes occurred in threshold volume of rectal sensation and volume of defaecatory urge, but there was a significant change in maximum tolerated rectal volume after six months. Neither anal canal electrosensitivity nor pudendal nerve terminal motor latency was altered following HRT. Seven of the 20 women (35%) had an identifiable anal sphincter defect on anal endosonography. Statistical analysis, however, showed no significant difference in outcome in this group compared with those with an intact anal sphincter. A larger population sample may demonstrate this.Conclusion
This observational study has shown a possible benefit of oestrogen replacement in postmenopausal women with symptoms of impaired faecal continence. A prospective randomised controlled trial is now advisable to test this hypothesis.
Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo‐controlled double‐blind study
Authors: Cicinelli Ettore , Didonna Teodora , Ambrosi Glauco , Schönauer Luca Maria , Fiore Giuseppe , Matteo Maria G. 
Published: August 2005

Objective
To evaluate the efficacy and safety of topical anaesthesia in reducing pain and incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women.Design
Randomised placebo‐controlled double‐blind study. Setting University hospital.Participants
Eighty postmenopausal women undergoing diagnostic hysteroscopy and endometrial biopsy.Interventions
Two millilitres of 2% mepivacaine or saline solution were injected transcervically into the uterine cavity before performing the procedures.Main outcome measures
Evaluation of pain reduction on a visual analogue scale and continuous monitoring of heart rate and blood pressure.Results
The use of the anaesthetic significantly reduced the pain experienced at hysteroscopy and endometrial biopsy. The occurrence of vasovagal reactions was significantly lower in the anaesthetised group.Conclusions
Topical anaesthesia attenuated pain and effectively prevented the occurrence of vasovagal reactions during hysteroscopy and endometrial biopsy in postmenopausal women.