bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal use of cannabis and pregnancy outcome
Authors: Fergusson David M. , Horwood L. John , Northstone Kate ,   ALSPAC Study Team
Published: December 2003

Objective
To document the prevalence of cannabis use in a large sample of British women studied during pregnancy, to determine the association between cannabis use and social and lifestyle factors and assess any independent effects on pregnancy outcome.Design
Self‐completed questionnaire on use of cannabis before and during pregnancy.Sample
Over 12,000 women expecting singletons at 18 to 20 weeks of gestation who were enrolled in the Avon Longitudinal Study of Pregnancy and Childhood.Methods
Any association with the use of cannabis before and during pregnancy with pregnancy outcome was examined, taking into account potentially confounding factors including maternal social background and other substance use during pregnancy.Main outcome measures
Late fetal and perinatal death, special care admission of the newborn infant, birthweight, birth length and head circumference.Results
Five percent of mothers reported smoking cannabis before and/or during pregnancy; they were younger, of lower parity, better educated and more likely to use alcohol, cigarettes, coffee, tea and hard drugs. Cannabis use during pregnancy was unrelated to risk of perinatal death or need for special care, but, the babies of women who used cannabis at least once per week before and throughout pregnancy were 216g lighter than those of non‐users, had significantly shorter birth lengths and smaller head circumferences. After adjustment for confounding factors, the association between cannabis use and birthweight failed to be statistically significant (P= 0.056) and was clearly non‐linear: the adjusted mean birthweights for babies of women using cannabis at least once per week before and throughout pregnancy were 90g lighter than the offspring of other women. No significant adjusted effects were seen for birth length and head circumference.Conclusions
The results of this study suggest that the use of cannabis during pregnancy was not associated with increased risk of perinatal mortality or morbidity in this sample. However, frequent and regular use of cannabis throughout pregnancy may be associated with small but statistically detectable decrements in birthweight.
Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms?
Authors: Robinson Dudley , Anders Kate , Cardozo Linda , Bidmead John , Toozs‐Hobson Philip , Khullar Vikram 
Published: December 2003

Objective
To determine whether transvaginal ultrasound measurement of bladder wall thickness could replace ambulatory urodynamics when investigating women with lower urinary tract dysfunction not explained by conventional laboratory urodynamic studies.Design
A blinded prospective study.Setting
Tertiary referral unit in a London teaching hospital.Population
One hundred and twenty‐eight women referred for ambulatory urodynamics with equivocal laboratory urodynamic findings or whose symptoms were not explained by the laboratory urodynamic findings.Methods
Transvaginal ultrasound assessment of bladder wall thickness was performed in three planes with an empty bladder prior to ambulatory urodynamics. Mean bladder wall thickness was calculated and the results analysed with respect to the ambulatory urodynamic diagnosis.Main outcome methods
Mean bladder wall thickness in women with a normal ambulatory study or a diagnosis of detrusor instability, genuine stress incontinence (GSI) or mixed incontinence.Results
Using a one way analysis of variance (ANOVA) bladder wall thickness was found to be significantly different in all diagnostic groups and this reached significance (P= 0.0001). There was no overlap in the 95% confidence intervals representing a diagnosis of detrusor instability or genuine stress incontinence.Conclusions
Transvaginal ultrasound assessment of mean bladder wall thickness is a sensitive screening tool, which can detect detrusor instability in those women with equivocal laboratory urodynamics. In women who have no evidence of GSI on laboratory studies, a cutoff of 6.0mm is highly suggestive of detrusor instability. However, in those women with GSI then ambulatory studies probably remain the investigation of choice.
Charts of fetal size: limb bones
Authors: Chitty Lyn S. , Altman Douglas G. 
Published: December 2003

Objective
To construct new size charts for all fetal limb bones.Design
A prospective, cross sectional study.Setting
Ultrasound department of a large hospital.Sample
663 fetuses scanned once only for the purpose of the study at gestations between 12 and 42 weeks.Methods
Centiles were estimated by combining separate regression models fitted to the mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age.Main outcome measures
Determination of fetal limb lengths from 12 to 42 weeks of gestation.Results
Size charts for fetal bones (radius, ulna, humerus, tibia, fibula, femur and foot) are presented and compared with previously published data.Conclusions
We present new size charts for fetal limb bones which take into consideration the increasing variability with gestational age. We have compared these charts with other published data; the differences seen may be largely due to methodological differences. As standards for fetal head and abdominal measurements have been published from the same population, we suggest that the use of the new charts may facilitate prenatal diagnosis of skeletal dysplasias.
Sperm motility in the semen analysis affects the outcome of superovulation intrauterine insemination in the treatment of infertile Asian couples with male factor infertility
Authors: Lee Vincent M.S. , Wong Joycelyn S.Y. , Loh Sheila K.E. , Leong Noel K.Y. 
Published: December 2003

Objective
To ascertain the relationship between the initial and unprocessed sperm parameters and pregnancy rates in SOIUI, for Asian couples with male factor infertilityDesign
Retrospective study.Setting
A large government tertiary‐care women's hospital with 15,000 deliveries per yearPopulation
One thousand four hundred and seventy nine couples undergoing 2846 cycles of SOIUIMethods
All couples enrolled in the SOIUI programme were analysed, comparing initial sperm parameters and the post‐processed total motile sperm, against pregnancy rates per cycleMain outcome measures
Pregnancy rates in relation to initial sperm parameters and post‐processed total motile spermResults
Ninety‐three percent of the couples had male factor infertility. The average normal forms for these men was 14.7%. Overall pregnancy rate was 12.1% per completed SOIUI cycle. We found a significant drop in pregnancy rates if the percentage of motile sperms in the unprocessed sperm sample fell below 30%. We also found that insemination of at least 1 million motile sperm resulted in a significant increase in pregnancy ratesConclusions
We recommend SOIUI as an effective treatment of suitable couples with male infertility, before embarking on IVF. However, if the initial percentage of motile sperm fell below 30%, or if after processing, the total motile sperm count was fewer than 1 million, these couples should consider in vitro fertilisation
A randomised placebo‐controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women
Authors: Fung T.M. , Lam M.H. , Wong S.F. , Ho L.C. 
Published: December 2003

Objective
To investigate the effectiveness of misoprostol given vaginally for cervical priming before hysteroscopy in postmenopausal women.Design
Double‐blind randomised controlled study.Setting
Regional hospital, Hong Kong.Participants
One hundred women with postmenopausal bleeding scheduled for hysteroscopy from October 1998 to September 2001 were randomly assigned to receive either misoprostol or placebo vaginally before the operation.Main outcome measures
The number of women requiring cervical dilatation, outcome of hysteroscopy and side effects of the medication were assessed.Results
Forty‐eight women receiving misoprostol and 48 women receiving placebo were compared. The mean degree of endocervical diameter estimated by Hegar's dilator was similar between the treatment group and the control group. A similar number of women in the treatment group and the control group required cervical dilatation. The operative times for both groups were similar. The incidence of side effects was comparable in both groups. The most common side effects for misoprostol were febrile episodes and diarrhoea. There was no cervical tear nor uterine perforation encountered in both groups. The mean duration of hospital stay in both groups were similar. Subanalysis of results were similar in women receiving vaginal medication at least five hours before the operation.Conclusion
Vaginal misoprostol was not shown to reduce the need for cervical dilatation in postmenopausal women. It cannot convert diagnostic hysteroscopy from a hospital procedure into an office one in postmenopausal women with tight cervical os.
Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services?
Authors: Essén Birgitta , Bödker Birgit , Sjöberg N.‐O. , Langhoff‐Roos Jens , Greisen Gorm , Gudmundsson Saemundur , Östergren P.‐O. 
Published: December 2003

Objective
To test the hypothesis that suboptimal factors in perinatal care services resulting in perinatal deaths were more common among immigrant mothers from the Horn of Africa, when compared with Swedish mothers.Design
A perinatal audit, comparing cases of perinatal deaths among children of African immigrants residing in Sweden, with a stratified sample of cases among native Swedish women.Population and setting
Sixty‐three cases of perinatal deaths among immigrant east African women delivered in Swedish hospitals in 1990–1996, and 126 cases of perinatal deaths among native Swedish women. Time of death and type of hospital were stratified.Main outcome measures
Suboptimal factors in perinatal care services, categorised as maternal, medical care and communication.Results
The rate of suboptimal factors likely to result in potentially avoidable perinatal death was significantly higher among African immigrants. In the group of antenatal deaths, the odds ratio (OR) was 6.2 (95% CI 1.9–20); the OR for intrapartal deaths was 13 (95% CI 1.1–166); and the OR for neonatal deaths was 18 (95% CI 3.3–100), when compared with Swedish mothers. The most common factors were delay in seeking health care, mothers refusing caesarean sections, insufficient surveillance of intrauterine growth restriction (IUGR), inadequate medication, misinterpretation of cardiotocography (CTG) and interpersonal miscommunication.Conclusions
Suboptimal factors in perinatal care likely to result in perinatal death were significantly more common among east African than native Swedish mothers, affording insight into socio‐cultural differences in pregnancy strategies, but also the suboptimal performance of certain health care routines in the Swedish perinatal care system.
Epidemiology of pelvic organ prolapse in rural Gambia, West Africa
Authors: Scherf Caroline , Morison Linda , Fiander Alison , Ekpo Gloria , Walraven Gijs 
Published: December 2003

Objectives
To investigate the prevalence of pelvic organ prolapse in rural Gambia.Design
Community‐based reproductive health survey.Population
1348 women residing in 20 villages in rural Gambia.Methods
Health questionnaire and standard gynaecological examination to detect symptoms and signs of pelvic organ prolapse and other reproductive diseases. Association between prolapse, socio‐demographic data and other morbidities was examined.Main outcome measures
Presence and degree of pelvic organ prolapse.Results
Out of 1067 women consenting to speculum examination 488 (46%) were found to have some degree of prolapse. In 152 women (14%) the prolapse was severe enough to warrant surgical intervention. After adjustment for confounders the likelihood of pelvic organ prolapse increased with parity and age and was higher in women of the Wolof tribe, pregnant women, those with insufficient perineum, and moderately and severely anaemic women. Only 13% of women with moderate or severe prolapse reported symptoms on direct questioning.Conclusions
Pelvic organ prolapse has a high prevalence in this first community‐based study of prolapse in West Africa. Many of those affected did not complain about their problem, thus increasing the large, silent burden of reproductive morbidity in this population. Parity was confirmed to be the strongest risk factor followed by age and anaemia. Ethnic origin was a previously unknown risk factor suggesting possible genetic factors in the pathogenesis of prolapse.
Oral versus intra‐vaginal imidazole and triazole anti‐fungal agents for the treatment of uncomplicated vulvovaginal candidiasis (thrush): a systematic review
Authors: Watson Margaret C. , Grimshaw Jeremy M. , Bond Christine M. , Mollison Jill , Ludbrook Anne 
Published: December 2003

Objectives
To compare the relative effectiveness, cost effectiveness and safety of oral versus intra‐vaginal anti‐fungal treatments for uncomplicated vulvovaginal candidiasis (thrush) and establish patient preference for the route of anti‐fungal administrationDesign
A systematic review of studies comparing oral and intra‐vaginal anti‐fungal treatments for uncomplicated vulvovaginal candidiasis. Standard Cochrane Collaboration methods were usedData sources
The following sources were searched: the Cochrane Controlled Trials Register; the Cochrane Sexually Transmitted Disease review group Specialised Register of Controlled Trials; EMBASE (January 1980 to January 2000); and MEDLINE (January 1985 to May 2000). The reference list of each trial was checked for additional references. The manufacturers of anti‐fungal treatments in the UK were asked for information on trials fulfilling the inclusion criteriaMethods
There was duplicate, independent examination and selection of the electronic search results followed by duplicate data abstraction. Disagreements regarding inclusion status and data abstraction were resolved by discussion between reviewers and the editor of the Cochrane Sexually Transmitted Disease group. Randomised controlled trials conducted worldwide and published in any language were included. The primary outcome measure was clinical cure. Mycological cure, patient preference and safety were secondary outcome measuresResults
Seventeen trials were included in the review, reporting 19 oral versus intra‐vaginal anti‐fungal treatment comparisons. No statistically significant differences were shown between oral and intra‐vaginal anti‐fungal treatment for clinical or mycological cure. All 10 trials that reported a preference favoured oral treatment (compared with intra‐vaginal or no preference). No trials presented cost dataConclusions
There is no difference between the relative effectiveness of oral and intra‐vaginal anti‐fungal treatment for thrush
Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence
Authors: Pregazzi Roberto , Sartore Andrea , Bortoli Paolo , Grimaldi Eva , Troiano Luigi , Guaschino Secondo 
Published: December 2003

Objectives
1. To assess the reproducibility of an electronic ultrasonographic technique for the measurement of urethral angulation; 2. To test the ability of measurement of the urethral angle and bladder neck mobility to predict genuine stress incontinence; 3. To compare ultrasound variables in stress incontinent women and in controls.Design
Case–control study.Population
Twenty‐three incontinent women and 50 controls.Methods
Electronic measurements of the distance between the bladder neck and the symphysis pubis, the bladder neck and the symphysis pubis line and the midline of the symphysis (alpha angle) and the angle between the proximal and distal urethra (beta angle) by means of perineal ultrasonography with a comfortably full bladder at rest, during the Valsalva manoeuvre and during maximal pelvic floor contraction. The same procedure was performed by a second investigator. Repeatability was evaluated by the technique described by Bland and Altman. Statistical analysis was performed using Student's t test and the two‐tailed paired t test.Main outcome measures
To test the possible role of the urethral angle in maintaining female continence.Results
Ultrasound analysis showed good repeatability between the two observers and is not influenced by vesical volume. Beta angle and urethrovesical mobility are inversely proportional, both in continent and in incontinent women. Urethral angle identifies genuine stress incontinence better than urethrovesical mobility (sensitivity 96%vs 87%; specificity 92%vs 68%; positive predictive value 85%vs 55%). There are significant differences in all ultrasound variables between incontinent women and continent controls.Conclusions
This study suggests a significant role of the urethral angle in maintaining female continence (in incontinent women it is lower at rest and lowers with straining). Measurement of the urethral angle can provide useful additional information to that provided by ultrasound evaluation of bladder neck mobility.
Intrauterine 10μg and 20μg levonorgestrel systems in postmenopausal women receiving oral oestrogen replacement therapy: clinical, endometrial and metabolic response
Authors: Raudaskoski T. , Tapanainen J. , Tomás E. , Luotola H. , Pekonen F. , Ronni‐Sivula H. , Timonen H. , Riphagen F. , Laatikainen T. 
Published: December 2003

Objective
The clinical and endometrial efficacy and lipid response of two different doses of intrauterine levonorgestrel were assessed in comparison with sequential oral medroxyprogesterone acetate in postmenopausal women receiving continuous oral E2‐valerate.Design
One‐year prospective multicentre randomised control trial.Setting
Four outpatient clinics in Oulu, Helsinki and Jyväskylä, Finland.Population
A total of 163 healthy volunteer postmenopausal women with climacteric complaints or already using hormone replacement therapy (HRT).Interventions
Subjects were randomly allocated to receive a new intrauterine system releasing 10μg of levonorgestrel daily or an established intrauterine system (Mirena) releasing 20μg of levonorgestrel daily or sequential oral medroxyprogesterone acetate (5mg/day, 14/30 days). All three regimens were combined with an oral daily dose of 2mg of E2‐valerate.Main outcome measures
Bleeding patterns were assessed by diaries kept by the subjects. Endometrial effects were evaluated by histologic biopsies taken at the baseline and after six and 12 months of therapy. Serum concentrations of total, HDL and LDL cholesterol, triglycerides and lipoprotein(a) were determined at the baseline and after six and 12 months of therapy.Results
Insertion of the smaller 10μg levonorgestrel system was easy in 70% and difficult in 4% and that of Mirena was easy in 46% and difficult in 21% of the subjects. After six months of therapy, 43 (95.6%) of the 47 subjects receiving 10μg levonorgestrel and 54 (98.2%) of the 55 subjects receiving 20μg levonorgestrel had no bleeding, while the sequential medroxyprogesterone acetate regimen produced typical cyclic withdrawal bleedings. Endometrial hyperplasia was not observed in any of the treatment groups during the 12‐month study. After 12 months of therapy, strong endometrial suppression was found in 46/47 and 55/55 of the subjects receiving 10μg and 20μg of levonorgestrel, respectively, while the endometrium was proliferative in 18/47 of the subjects in the medroxyprogesterone acetate group. Serum total cholesterol decreased in all treatment groups. HDL cholesterol increased in women receiving medroxyprogesterone acetate or the smaller intrauterine dose of levonorgestrel.Conclusions
Both intrauterine doses of levonorgestrel provided good endometrial protection in postmenopausal women on oestrogen replacement therapy. The advantage of the 10μg system with a smaller size is the easier insertion of the system and a minimal attenuation of the favourable effects of oral oestrogen on the serum lipid profile.
The association of pre‐eclampsia with the Duffy negative phenotype in women of West African descent
Authors: Velzing‐Aarts Francien V. , van der Dijs Fey P.L. , Muskiet Frits A.J. , Duits Ashley J. 
Published: December 2003

Objective
To investigate whether pre‐eclampsia in Curaçao is associated with the Duffy negative phenotype.Design
Retrospective study. Setting Population Methods Results
Women with a history of pre‐eclampsia had a higher Duffy negative phenotype frequency compared with women with a history of uncomplicated pregnancies (52.8 vs 27.3%, respectively; odds ratio 2.98; 95% CI 1.40–6.32; P= 0.004).Conclusions
Pre‐eclampsia is associated with the Duffy negative phenotype in women of West‐African descent in the island of Curaçao.
Rates of bacterial vaginosis in women undergoing in vitro fertilisation for different types of infertility
Authors: Wilson Janet D. , Ralph Susan G. , Rutherford Anthony J. 
Published: December 2003

Objective
To assess whether the rate of bacterial vaginosis (BV) is higher in women with tubal factor infertility compared with those with other causes of infertility.Design
Cross‐sectional study.Setting
Assisted conception unit of a teaching hospital in Leeds.Population
Consecutive women undergoing in vitro fertilisation.Methods
Women undergoing in vitro fertilisation (IVF) had a vaginal smear taken at the time of their egg collection. The smear was Gram‐stained and graded as normal, intermediate or BV.Main outcome measures
The presence of bacterial vaginosis and the causes of infertility.Results
A total of 749 women were included. The vaginal smears were normal in 63.6%, intermediate in 12.1%, and BV in 24.3%. The rates of BV in women with different types of infertility were 36.4% in tubal factor, 15.6% in male factor, 33.3% in anovulation, 12.5% in endometriosis and 18.9% in unexplained infertility. After controlling for the effects of age and smoking using a multivariate logistic regression model, women with tubal infertility were significantly more likely to have BV than women with endometriosis OR 3.63 (95% CI 1.52–8.67); male factor OR 2.98 (95% CI 1.80–4.90); and unexplained infertility OR 2.20 (95% CI 1.35–3.59). The adjusted figures for the increase of BV in women with anovulation were: endometriosis OR 3.77 (95% CI 1.28–11.08); male factor OR 3.09 (95% CI 1.37–6.96); and unexplained infertility OR 2.29 (95% CI 1.02–5.12).Conclusions
Women with tubal infertility were three times more likely to have BV than women with endometriosis, male factor or unexplained infertility. These findings support the association between BV, pelvic inflammatory disease (PID) and tubal damage but do not help distinguish between cause and effect. Women with anovulation were also three times more likely to have BV than women with endometriosis or male factor infertility, supporting suggestions of hormonal influence on vaginal flora.