bluuebunny/crossref_metadata_2025_split huggingface dataset:
A longitudinal study of biochemical markers of bone turnover during normal pregnancy and pregnancies complicated by pre‐eclampsia
Authors: Anim‐Nyame N. , Sooranna S.R. , Jones J. , Alaghband‐Zadeh J. , Steer P.J. , Johnson M.R. 
Published: December 2003

Objectives
To test the hypothesis that the increased bone turnover observed in established pre‐eclampsia is present earlier in pregnancy prior to the diagnosis of pre‐eclampsia.Design
A prospective longitudinal study.Setting
Obstetric Unit at Chelsea and Westminster Hospital, London.Population
Nine women who subsequently developed pre‐eclampsia and 17 normal pregnant controls.Methods
Maternal plasma levels of the cross‐linked carboxyl terminal telopeptide of the type I collagen (ICTP), a marker of bone resorption, and of the carboxy‐terminal propeptide of type I collagen (PICP), a marker of bone formation, were measured longitudinally in nine women who developed pre‐eclampsia and 17 women with normal pregnancy. Serial blood samples were obtained at 16, 20, 24, 28, 32 and 36 weeks of gestation and the levels of ICTP and PICP were measured by radio‐immunoassay.Results
ICTP and PICP increased progressively in the normal pregnant and pre‐eclampsia groups, but the rate of increase was significantly greater in the latter (P= 0.00002 and 0.0008, unpaired t test, for ICTP and PICP summary measures, respectively). In the pre‐eclampsia group, positive correlation were observed between ICTP levels at 36 weeks of gestation and plasma uric acid (r= 0.9, P= 0.001) and degree of proteinuria (r= 0.78, P= 0.04). No correlation was observed between the two bone markers and other variables during normal pregnant group.Conclusion
These data show that biochemical markers of bone turnover are greater in pregnancies complicated by pre‐eclampsia compared with normal pregnancy but only when the disease is clinically evident.
Thrombophilia and immunological disorders in pregnancies as risk factors for small for gestational age infants
Authors: Verspyck Eric , Le Cam‐Duchez Véronique , Goffinet François , Tron François , Marpeau Loïc , Borg Jeanne Yvonne 
Published: December 2003

Objectives
To determine if inherited thrombophilia and immunological disorders represent risk factors for small for gestational age infants, and to assess their relationship with neonatal status.Design
Case–control study.Population
Ninety‐seven consecutive women who had pregnancies complicated by unexplained small for gestational age infants, defined as a birthweight below the third centile and 97 women as controls who delivered infants with a birthweight ≥10th centile.Methods
Patients were included in the immediate postpartum period and tested for antithrombin III, protein C, protein S, anticardiolipin and antinuclear antibodies, lupus anticoagulant, Factor V Leiden mutation, prothrombin 20210A mutation, and methylenetetrahydrofolate reductase (MTHFR) polymorphism. Women with small for gestational age infants were then divided into subgroups depending on haemostatic and immunologic status in order to compare neonatal events.Results
Frequencies for anticardiolipin and antinuclear antibodies were higher in women with small for gestational age infants compared with controls (P= 0.02 and P= 0.004, respectively), and overall prevalence of inherited thrombophilia were comparable in cases and controls (19.6% and 18.6%, respectively). The subgroups of patients with small for gestational age infants were women with only one inherited thrombophilia (n= 10), only one imunological disorder (n= 14), combined disorders (n= 9), and no detected abnormality (n= 64). Admission to paediatric ward significantly increased in the group with combined disorders (P= 0.002) compared with the other groups. Also one‐third of the babies from this group had a poor neonatal outcome. However, most of the neonatal deaths (6/7 = 85.7%) occurred in the group with no detected abnormality.Conclusion
The prevalence of inherited thrombophilia was considered to be similar between the case and the control groups even when immunological disorders were significantly elevated in pregnancies complicated by the baby being small for gestational age. Combined disorders may represent a potential risk factor for severe small for gestational age infants. However, the aetiology of small for gestational age infants with poor neonatal outcomes remains unknown in most cases.
Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth—a prospective population‐based study of mothers and fathers
Authors: Skari Hans , Skreden Marianne , Malt Ulrik Fredrik , Dalholt Merethe , Ostensen Anniken Bjornstad , Egeland Thore , Emblem Ragnhild 
Published: December 2003

Objective
To compare maternal and paternal psychological responses following birth of a healthy baby; and to explore predictors of parental psychological distress.Design
A prospective, longitudinal, population‐based cohort study.Setting
A Norwegian district general hospital.Population
One hundred and twenty‐seven mothers and 122 fathers were included.Methods
Eligible consenting parents were enrolled. The assessments, which were performed zero to four days after birth, at six weeks and at six months, included General Health Questionnaire‐28 (GHQ‐28), State Anxiety Inventory and Impact of Event Scale. The response rates at the three occasions were 97%, 85% and 71%.Main outcome measures
Symptoms of intrusion, avoidance, arousal and psychological distress including anxiety, depression, social dysfunction and somatisation.Results
Clinically important psychological distress was reported by 37% of the mothers and 13% of the fathers a few days after childbirth (P < 0.001). Severe intrusive stress symptoms were reported by 9% and 2% of mothers and fathers, respectively (P= 0.002). Level of intrusive stress was the outcome that differed most clearly between mothers and fathers at all three points of time. Being a single parent, multiparity and a previous traumatic birth were significant independent predictors of acute maternal psychological distress. After six weeks and six months, the level of psychological distress including symptoms of depression fell to levels found in the general population.Conclusions
Childbirth does not seem to trigger long term psychological distress in most parents. Clinically important psychological distress occurred more frequently in mothers than in fathers. Acute maternal psychological distress was predicted by being a single parent, being multiparous, and having a previous traumatic birth.
Warfarin dosage in postpartum women: a case–control study
Authors: Brooks Cath , Rutherford Jane M. , Gould Jane , Ramsay Margaret M. , James David K. 
Published: December 2003

Objective
To investigate the clinical suspicion that postpartum women are more difficult to anticoagulate with warfarin than non‐pregnant women due to the physiological changes in coagulation proteins that persist into the postpartum period.Design
A retrospective case–control study.Setting
University Hospital, Nottingham, UK.Sample
Twenty‐three postpartum women discharged from the obstetric wards on warfarin and 23 age‐matched control women discharged from the medical wards on warfarin were identified using hospital databases.Methods
Warfarin doses and international normalised ratio values were recorded from day one to 35. The number of days and total warfarin dose to achieve therapeutic international normalised ratio were recorded. Doses were compared with those recommended by a dosing nomogram.Results
The postpartum group took significantly longer and significantly larger doses of warfarin to reach therapeutic international normalised ratio (P < 0.05). The postpartum group required a persistently higher maintenance dose of warfarin. Comparing the warfarin dose given on day three with a standardised nomogram, 79% of women in the postpartum group compared with 57% in the control group were under‐dosed.Conclusion
Postpartum women require larger doses of warfarin to reach therapeutic international normalised ratio than non‐pregnant women. We would recommend the use of a dosing nomogram.
The decision‐to‐delivery interval for emergency caesarean section: is 30 minutes a realistic target?
Authors: Helmy W.H. , Jolaoso A.S. , Ifaturoti O.O. , Afify S.A. , Jones M.H. 
Published: December 2003

Objective
To evaluate whether a 30‐minute decision‐to‐delivery interval is a realistic target for emergency caesarean section.Design
An audit of all emergency caesarean sections over five separate periods.Setting
A district general hospital.Participants
Five groups of women (343 women) with an indication for emergency caesarean section.Methods
Following an initial survey, a structured time sheet was introduced, followed by four other surveys to complete the audit cycle.Main outcome measure
The proportion of caesarean sections where the decision‐to‐delivery interval measures was achieved within 30 minutes. The reasons for delay.Results
In the first survey of 73 emergency caesarean sections, the time to deliver the infant exceeded 30 minutes in 47 women (64%). The main sources of delay were transferring the women to the operating theatre and starting the anaesthetic. After the introduction of a structured time sheet, there was an improvement with each survey, but the target of 30 minutes was reached in only 71% of caesarean sections in the final survey.Conclusions
The introduction of a time sheet can improve the decision‐to‐delivery interval for emergency caesarean section; however, a universal standard of 100% in 30 minutes is unrealistic.
A comparison of urethral pressure profilometry using microtip and double‐lumen perfusion catheters in women with genuine stress incontinence
Authors: Wang Alex C. , Chen Min‐Chi 
Published: December 2003

Objective
To compare urethral pressure profilometry measurements using microtip transducer and double‐lumen perfusion catheters.Design
Prospective study.Setting
Tertiary referral urogynaecology unit.Sample
Three hundred and ninety two non‐pregnant women with various lower urinary tract symptoms.Methods
Multichannel urodynamic investigations were performed using double‐lumen perfusion catheters with external pressure transducers in 392 women. For those 301 (76.8%) diagnosed as having genuine stress incontinence, an investigation with microtip transducers followed. For data analysis, a mixed‐effects model was used to evaluate changes in the urethral profilometry and an approach proposed by Bland and Altman was applied to access agreement between the two techniques.Results
Of the 301 women with genuine stress incontinence, 272 were eligible for this study. In resting status, the differences between the two techniques were statistically significant (48.9cm H2O vs 73.4cm H2O, P= 0.0001) after adjusting for age. Moreover, the agreement study also confirmed that these two techniques do not agree sufficiently.Conclusion
Maximum urethral closure pressure obtained from the double‐lumen catheter was significantly higher than that obtained from the microtip catheter. Use of the double‐lumen catheter for the measurement of maximum urethral closure pressure can be considered a reliable technique since its reproducibility is as good as that of the microtip catheter. Therefore, the diagnosis of ‘low pressure urethra’ will be different between the two techniques.
Effects of vitamin A deficiency during pregnancy on maternal and child health
Authors: Radhika M.S. , Bhaskaram P. , Balakrishna N. , Ramalakshmi B.A. , Devi Savitha , Kumar B. Siva 
Published: December 2003

Objective
To examine the association between biochemical vitamin A deficiency in pregnancy and maternal and fetal health.Design
A cross sectional clinical study.Setting
Antenatal clinic of nutrition unit of Niloufer Hospital catering for a low socio‐economic population, and a private nursing home (Swapna nursing home) catering for a high socio‐economic population.Population
736 pregnant women in their third trimester of pregnancy belonging to low (n= 522) and high socio‐economic groups (n= 214).Methods
All the women were subjected to a detailed clinical, anthropometric and obstetric examination. Night blindness was assessed by administering the standard WHO questionnaire. Birthweight and gestational age of the infants, maternal anaemia and development of pregnancy‐induced hypertension in the mother were recorded. Haemoglobin and serum retinol were estimated at the time of recruitment to the study.Main outcome measures
Serum retinol levels, anaemia, pregnancy‐induced hypertension, birthweight and gestational age of the infant.Results
Night blindness was observed in 2.9% of the women and subclincal vitamin A deficiency (serum retinol <20 μg/dL with no clinical signs) in 27% of the women. Moderate to severe anaemia was observed in 41.2% of the women, and 15.8% of the women developed pregnancy‐induced hypertension. Sixty‐one (9.4%) women delivered preterm. Univariate analysis identified a significant association between serum retinol <20 μg/dL and preterm delivery (OR = 1.74, 95% CI 1.03–2.96), maternal anaemia (OR = 1.82, 95% CI 1.28–2.60) and pregnancy‐induced hypertension (OR = 1.56, 95% CI 1.02–2.83). After adjusting for the confounding variables (body mass index, parity, age and socio‐economic status) in a multivariate analysis, the significant associations between serum retinol <20 μg/dL and preterm delivery (P= 0.02) and anaemia (P= 0.003) persisted, while that for pregnancy‐induced hypertension disappeared (P= 0.71).Conclusion
The study suggests that subclinical vitamin A deficiency is a problem during the third trimester of pregnancy. Serum concentration of retinol <20 μg/dL appears to indicate a deficient status, and is associated with an increased risk of preterm delivery and maternal anaemia.
Neonatal survival rates in 860 singleton live births at 24 and 25 weeks gestational age. A Canadian multicentre study
Authors:   The names of collaborators may be found on page 744, Effer Sidney B. , Moutquin Jean‐Marie , Farine Dan , Saigal Saroj , Nimrod Carl , Kelly Edmond , Niyonsenga Theophile 
Published: December 2003

Objective
To determine the current survival rate of singleton living newborns born at gestational age of 24 and 25 weeks, using obstetric factors available to the physician before birth.Design
Retrospective study of all live births in 13 of 17 Canadian tertiary centres.Population
All singleton live births without congenital abnormalities.Methods
During the years 1991–1996, data were abstracted from clinical databases and charts of 860 live births, in 13 of the 17 tertiary centres in Canada, all with major neonatal intensive care units. Newborn survival was defined as alive at discharge from neonatal intensive care unit. Abstracted elements included gestational age, maternal antenatal corticosteroid treatment, birthweight, gender, fetal presentation and mode of delivery.Results
Average survival rates increased from 56.1% at 24 weeks (n= 406) to 68.0% at 25 weeks (n= 454). Survival rates ranged from 53.1% at day 168 to 81.6% at day 181 (r = 0.802, P < 0.05). Steroid administration improved the survival rates at 24 and 25 weeks compared with that of unexposed fetuses, respectively (58.9%vs 41.8%; OR 1.70; 95% CI 1.03–2.08 and 74.2%vs 56.8%; OR 2.19; 95% CI 1.41–3.38). Caesarean delivery for breech presentation improved survival compared with vaginal delivery, both at 24 and 25 weeks (56.1%vs 36.0%; OR 2.19; 95% CI 1.10–4.34, and 68.7%vs 55.2% OR 1.78; 95% CI 0.093–3.43). Female neonates displayed better survival rates (59.6%vs 52.1% OR 1.36; 95% CI 0.92–2.01, and 72.6%vs 63.1% OR 1.51; 95% CI 1.02–2.25) at 24 and 25 weeks, respectively. Explanatory regression model confirmed these factors as prognostic variables associated with survival.Conclusions
This extensive collaborative study confirms that several prognostic factors, known before birth, including gestational age in days, steroid treatment, mode of presentation and fetal sex may help obstetricians, neonatologists and parents in their decision‐making process at 24 and 25 weeks of pregnancy.
Long term follow up of the cruciate fascial sling for women with genuine stress incontinence
Authors: Hawkins Emma , Taylor Debbie , Hughes‐Nurse Jennifer 
Published: December 2003

Objective
To determine the long term success of the cruciate fascial sling procedure for the treatment of genuine stress incontinence in women.Design
In 1998, a pre‐validated questionnaire was sent to all women who had a cruciate fascial sling between 1979 and 1996 under the care of the senior author at a District General Hospital and in private practice.Participants
Questionnaires were sent to 246 women; 198 (80%) were returned.Results
Overall, 142 women felt that they were much improved or cured. The success rate was 74% (95% CI 70%–81%) in women having the sling as a primary procedure and 67% (95% CI 54%–81%) in women having the sling as a secondary procedure. There was no relationship between symptom severity score and age at time surgery, duration of follow up, current weight or body mass index, previous surgery for stress incontinence or concomitant surgery. Of the 103 women with six or more years of follow up, 29 felt that their operation had failed, 16 of whom thought that it lasted between five and 10 years. Urgency was experienced by 29% of women, three needed to perform intermittent self‐catheterisation, and 9% found it difficult to empty their bladder. Thirty‐seven women (19%) experienced problems that they attributed to the abdominal wound.Conclusion
Although inevitably there are some failures over time, the cruciate fascial sling has good long term success rates. Direct comparison with the literature is impossible, as few studies have relied on properly validated questionnaires.
Effect of inhibiting the sarcoplasmic reticulum on spontaneous and oxytocin‐induced contractions of human myometrium
Authors: Kupittayanant S. , Luckas M.J.M. , Wray S. 
Published: December 2003

Objective
1. To assess the contribution of the sarcoplasmic reticulum calcium store in the generation of uterine smooth muscle contractions; 2. to evaluate the contribution of calcium induced calcium release or ryanodine gated calcium channels to myometrial force production.Design
Laboratory scientific study.Methods
Myometrial strips were obtained from women undergoing elective prelabour caesarean section at term. These were loaded with the calcium sensitive indicator Indo‐1 allowing simultaneous assessment of intracellular calcium concentrations and force production. The effect of exposing the strips to ryanodine (which abolishes calcium induced calcium release), caffeine (which activates calcium induced calcium release) and cyclopiazonic acid (which abolishes the sarcoplasmic *reticulum calcium store) was examined.Results
Exposure to ryanodine had no appreciable effect on either the amplitude or the duration of the myometrial calcium and force transients but did increase the frequency of contractions (139 ± 5%). Caffeine did not potentiate force. Cyclopiazonic acid increased frequency, duration and amplitude of both calcium and force transients. The ability of oxytocin to provoke calcium and force transients in the absence of extracellular calcium was abolished by cyclopiazonic acid but not by ryanodine.Conclusions
These results demonstrate that calcium induced calcium release does not play a significant role in human myometrium and that no functioning role for the ryanodine receptors in human myometrial tissue could be shown. These data suggest that the sarcoplasmic reticulum may act to limit contractions and act as a calcium sink, rather than to amplify contractions.
A randomised comparison of early versus late amniotomy following cervical ripening with a Foley catheter
Authors: Levy Roni , Ferber Asaf , Ben‐Arie Alon , Paz Beatrice , Hazan Ynon , Blickstein Isaac , Hagay Zion J. 
Published: December 2003

Objectives
Ripening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomyDesign
Prospective randomised clinical trialSetting
Labour and delivery ward of a university teaching hospitalParticipants
Pregnant women ≥38 weeks of a singleton gestation, who had had no prior caesarean sectionMethods
All women underwent cervical ripening using a Foley catheter. Following removal of the catheter, women were randomly assigned to either early (n= 80) or late amniotomy (n= 88).Main outcome measures
Comparison of mode of delivery and duration of labour between the two groupsResults
The rate of caesarean section was significantly higher in the early amniotomy group compared with the late amniotomy group (25%vs 7.9%; relative risk 1.74; 95% CI 1.3 – 2.34). The increase in caesarean section rate was due primarily to dystocia (15%vs 3.3%; relative risk 1.8; 95% CI 1.32 – 2.45). When excluding caesarean deliveries, no significant difference was found in duration of labour between the groups (8.3 hours (3.8) vs 7.7 hours (2.9))Conclusions
In women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia
Randomised trial of amnioinfusion during labour with meconium stained amniotic fluid
Authors: Rathorea Asmita Muthal , Singh Ruchira , Ramji S. , Tripathi Reva 
Published: December 2003

Objective
To assess the effect of amnioinfusion during labour with meconium stained amniotic fluid on caesarean section rate and perinatal outcome.Design
Prospective randomised controlled study.Setting
A tertiary care teaching hospital in India.Population
Women in labour at term with meconium stained amniotic fluid.Methods
Two hundred women in labour with ≥37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour.Main outcome measures
The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar <7, hypoxic ischaemic encephalopathy, neonatal intensive care unit admission, meconium at the level of vocal cords.Results
The caesarean section rate in the amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24–0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P= 0.001); improvement in 1 minute apgar scores (P <0.05), respiratory distress (P= 0.002) and fewer admissions to nursery compared with the controls. This sample size was inadequate to study the impact on meconium aspiration syndrome.Conclusion
Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.