bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetric practice and the prevalence of urinary incontinence three months after delivery
Authors: Wilson P. D. , Herbison R. M. , Herbison G. P. 
Published: August 2005

Objective
To examine the relation between obstetric factors and the prevalence of urinary incontinence three months after delivery.Design
2134 postal questionnaires sent between August 1989 and June 1991.Setting
Teaching hospital in Dunedin, New Zealand.Subjects
All women three months postpartum who were resident in the Dunedin area.Main outcome measure
Prevalence of urinary incontinence.Results
1505 questionnaires were returned (70.5% response rate). At three months postpartum 34.3% of women admitted to some degree of urinary incontinence with 3.3% having daily or more frequent leakage. There was a significant reduction in the prevalence of incontinence for women having a caesarean section, in particular in primiparous women with a history of no previous incontinence (prevalence of incontinence following a vaginal delivery 24.5%, following a caesarean section 5.2% P = 0.002). There was little difference between elective caesarean sections and those carried out in the first and second stages of labour. The odds ratios for women having a caesarean section were 0.4 (95% confidence interval (CI) 0.2–0.7) (all women and all primiparae) and 02 (95% CI 0.0–0.6) (primipara with no previous incontinence) in comparison with those having a normal vaginal delivery. The prevalence of incontinence was also significantly lower in women having had two caesarean sections (23.3%; P = 0.05) but similar in those women having three or more caesarean sections (38.9 YO) in comparison with those women who delivered vaginally (37.7%). Other significant independent odds ratios were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95% CI 0.4–09), parity ≥5 (2.2, 95% CI 1.0–4.9) and pre‐pregnancy body mass index (1.07, 95% CI 1.04–1.10).Conclusions
Adverse risk factors for urinary incontinence at three months postpartum are vaginal delivery, obesity and multiparity (2 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.
Impaired implantation after in vitro fertilisation treatment associated with hydrosalpinx
Authors: Fleming C. , Hull M. G. R. 
Published: August 2005

Objective
To study whether the presence of hydrosalpinx affected success after in vitro fertilisation (IVF) in women with inflammatory tubal damage.Design
Retrospective, nonrandomised study.Setting
University private IVF clinic with complete fertility services.Participants
Two study groups (79 women with hydrosalpinges and 198 women with inflammatory tubal damage but no hydrosalpinx) and a third group (22 sterilised, previously fertile women) for comparison.Main outcome measures
Clinical pregnancy and livebirth rates per embryo transfer cycle; implantation and live baby rates per individual embryo transferred.Results
The hydrosalpinx group had a significantly lower implantation rate per embryo (8.2%) and chance of a live baby per embryo transferred (5.6%), compared with the nonhydrosalpinx group (14.9% and 11.2%, respectively). The hydrosalpinx group also had a lower clinical pregnancy rate (23%) and live birth rate per transfer cycle (17%) compared with the nonhydrosalpinx group (30% and 26%), but these differences were not significant.Conclusions
The presence of a hydrosalpinx halves the chance of an embryo implanting, probably due to physical or toxic chemical effects of fluid draining from the hydrosalpinx into the uterine cavity. Women with hydrosalpinges may benefit from distal salpingostomy or salpingectomy as a drainage procedure before in vitro fertilisation treatment, even though such surgery may not increase the chances of natural conception.
Diet in pregnancy and the offspring's blood pressure 40 years later
Authors: Campbell D. M. , Hall M. H. , Barker D. J. P. , Cross J. , Shiell A. W. , Godfrey K. M. 
Published: August 2005

Objective
To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life.Design
A follow up study of men and women born during 1948–1954 whose mothers had taken part in a survey of diet in late pregnancy.Setting
Aberdeen, Scotland.Population
Two hundred and fifty‐three men and women born in Aberdeen Maternity Hospital.Main outcome measure
Systolic and diastolic blood pressure.Results
The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50 g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (P= 0.02)). At daily animal protein intakes above 50 g, lower Carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (P= 0.004)). These increases in blood pressure were associated with decreased placental size.Conclusion
Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.
A randomised controlled trial of early versus delayed use of amniotomy and oxytocin infusion in nulliparous labour
Authors: Cammu Hendrik , Van Eeckhout Eddy 
Published: August 2005

Objective
To compare routine amniotomy and early intravenous oxytocin (active management of labour) with a more selective use of amniotomy and oxytocin in women in true labour who received comparable continuous supportive midwifery care.Design
Randomised controlled trial of nulliparous clinic patients in spontaneous labour at term. Setting Labour and delivery ward of a university teaching hospital.Participants
Three hundred and six parturients: 152 received active management of labour; 154 were more selectively managed.Interventions
1. Active management: early amniotomy, early use of oxytocin. 2. Selective intervention management: no routine amniotomy and more selective use of oxytocin.Outcome measures
Use of oxytocin and amniotomy. Labour duration, mode of delivery.Results
Maternal characteristics were comparable in both groups. Amniotomy was more often performed (91%versus 57%, P < 0.01) and oxytocin more often used (53%versus 27%, P < 001) in the active management group. The first stage of labour, however, was only shortened by half an hour in the active management group (254 min versus 283 min, P= 0.087). Caesarean section rate (3.9%versus 2.6%), spontaneous vaginal delivery rate (78%versus 79%) and neonatal outcome were not significantly different between groups.Conclusion
Within a set‐up of strict labour diagnosis and supportive midwifery care, routine amniotomy and early use of oxytocin offered no advantage over a more selective use of amniotomy and oxytocin in terms of mode of delivery and labour duration.
Blood folic acid and vitamin B12 in relation to neural tube defects
Authors: Wald N. J. , Hackshaw A. K. , Stone R. , Sourial Nefertiti A. 
Published: August 2005

Objective
To determine the relation between blood folic acid and serum vitamin B12 in neural tube defect pregnancies using data from the MRC Vitamin Study and a literature review of all studies.Design
Stored blood samples collected as part of a randomised trial of vitamin supplementation in the prevention of neural tube defects were retrieved from affected pregnancies (cases) and unaffected pregnancies (controls). Four controls were matched with each case by centre, maternal age and duration of storage of the blood sample. The samples had been collected from women at entry to the trial, immediately before the women became pregnant, and at around 12 weeks of pregnancy. Our results were combined with those already published from other studies to obtain an overall assessment of blood folic acid and vitamin B12 in relation to neural tube defects.Setting
Blood samples were collected as part of the MRC Vitamin Study. The collaborating centres were in the United Kingdom, Hungary, Israel, Australia, Canada and Russia.Participants
Twenty‐seven women with neural tube defect pregnancies and 108 matched controls with unaffected pregnancies.Results
Serum and red cell folic acid and serum vitamin B12 levels were lower in the cases than in controls at each of the three occasions when blood samples were collected, but no comparison was significant (P > 0.05). A systematic review of all studies from the literature showed that on average, during the 1st trimester of pregnancy, serum folic acid was 0.6 ng/ml lower in neural tube defect pregnancies (P < 0.01), red cell folic acid was 77 ng/ml lower (P < 0.001) and serum vitamin B12 was 38 ng/l lower (P < 0.001). A logistic regression showed no association between serum B12 and neural tube defects after allowing for serum folic acid.Conclusion
Our results are consistent with other evidence that folic acid and vitamin B12 levels are lower in women with neural tube defect pregnancies and consistent with evidence from randomised trials which showed that folic acid is protective.
Characterisation of a sperm coating auto‐antigen reacting with antisperm antibodies of infertile males using monoclonal antibodies
Authors: Poulton T. A. , Everard D. , Baxby K. , Parslow J. M. 
Published: August 2005

Objective
In a previous study a number of sperm‐specific antigens were identified which reacted with antisperm antibodies from both infertile and vasovasostomised males. To investigate the localisation and distribution of these antigens and their role in male fertility, monoclonal antibodies were raised against them; immunoblotting techniques were used to select only those antibodies which competed with human antisperm antibodies for these human auto‐antigens.Design
One antibody, NW21, reacted with an 18 kDa auto‐antigen present on epididymal sperm but absent from testicular sperm. Immunohistochemical studies showed that the antigen is produced in small basal cells between the columnar epithelium of the corpus epididymis, passes up into the tubule and then coats sperm passing along the epididymis. Sperm stored in the cauda epididymis and ductus deferens stain strongly for this sperm coating glycoprotein.Conclusions
The localisation of this antigen supports the suggestion that auto‐immune infertility may represent a response to epididymal rather than testicular sperm. Monoclonal antibodies raised to unique and immunologically accessible sperm coating proteins, produced in the epididymis rather than in the testis, would seem to present an excellent theoretical solution to male contraception.
Insulin‐like growth factor‐binding protein 1 and insulin‐like growth factor‐binding protein 3 in pre‐eclampsia
Authors: Wang Hsin‐Shih , Lee Jing‐Der , Cheng Bor‐Jen , Soong Yung‐Kuei 
Published: August 2005

Objective
To investigate circulating levels of insulin‐like growth factor‐binding protein 1 (IGFBP‐1) and IGFBP‐3 in the mother and the fetus in pregnancies complicated by pre‐eclampsia, and the relationship between serum levels of IGFBPs and fetal birthweight.Design
A prospective study over an 18 month period.Setting
A tertiary care academic medical centre.Participants
Sixty‐six pregnant women with pre‐eclampsia (35 cases of mild/moderate pre‐eclampsia and 31 cases of severe pre‐eclampsia) and 78 nonpra‐eclamptic pregnant women of matched gestational weeks and maternal ages.Main outcome measures
Serum concentrations of IGFBP‐1 and IGFBP‐3 at the time of delivery.Results
In pre‐eclampsia associated with intrauterine growth retardation (IUGR), maternal and cord serum IGFBP‐1 levels at the time of delivery were elevated. By contrast, circulating IGFBP‐3 levels in both the mother and the fetus were lower in pre‐eclampsia with IUGR than in nonpre‐eclamptic pregnancy. However, there was no difference in serum IGFBP‐1 and IGFBP‐3 levels between pre‐eclampsia without IUGR and nonpre‐eclamptic pregnancy in both the mother and the fetus.Conclusions
In pre‐eclampsia, elevated concentrations of circulating IGFBP‐1 and decreased serum IGFBP‐3 levels were observed in both the mother and the fetus. However, these changes may simply reflect low birthweight in pre‐eclampsia.
The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses
Authors: Morssink L. P. , de Wolf B. T. H. M. , Kornman L. H. , Beekhuis J. R. , van der Hall T. P. J. , Mantingh A. 
Published: August 2005

Objective
To examine whether in women who are delivered of an extremely small for gestational age infant, raised levels of second trimester maternal serum alpha‐fetoprotein (MSAFP) or human chorionic gonadotrophin (MShCG) levels are related to the presence of placental pathology detected at birth.Design
Retrospective cross‐sectional study.Setting
Department of Obstetrics and Gynaecology, Antenatal Diagnosis Unit, Groningen University Hospital, The Netherlands.Participants
Eighty‐four women who were delivered of an extremely SGA infant (< 2.3rd centile) in whom the MSAFP and the MShCG levels were known and placental pathology reports were available (study group), and 8692 women in whom the MSAFP and MShCG levels were known and the pregnancy outcome was normal (control group). Pregnancies with congenital anomalies were excluded. Analyte levels were expressed in multiples of the median (MOM) for gestational age. Statistical analysis between groups was performed by ANOVA, after logarithmic transformation of the MOMS, to normalise their distribution.Main outcome measures
1. The means of the MSAFP and MShCG concentrations in the study group with and without placental lesions were compared with those in the control population. 2. The means of the MSAFP and MShCG levels in the study group with placental lesions were compared with those in the study group without placental lesions.Results
1. Comparison of study groups with controls: in the study group without placental lesions, the mean log MSAFP MOM (0.062), as well as the mean log MShCG MOM (–0.033), was not significantly different (P= 0.11 and P= 0.68, respectively) from the mean analyte levels in the control population (0.002 and 0.006, respectively). The mean logs of these analytes in the study group with placental lesions (0.162 and 0.129, respectively) were significantly higher compared with the MSAFP and MShCG levels in the control population (P < 0.001 for both analytes). 2. Comparison of study groups with each other: the mean log of the MSAFP level of 0.162 in the group with placental lesions was significantly different from the mean of 0.062 of the study group without placental lesions (P < 0.025). The higher mean log MShCG MOM of 0.129 in the group with placental lesions was significantly different from the mean log MShCG MOM of −0.033 in the study group without placental lesions (P < 0.025).Conclusions
Raised levels of second trimester MSAFP and MShCG in women who are subsequently delivered of an extremely small for gestational age infant are related to the presence of pathological changes in the placenta, detectable at birth. It is speculated that these placental pathological changes, which frequently accompany small for gestational age pregnancies, have their origin in the second trimester, when the normal physiological changes of the placenta occur.
A comparison of bladder and ovarian function two years following hysterectomy or endometrial ablation
Authors: Bhattacharya Siladitya , Mollison Jill , Pinion Sheena , Parkin David E. , Abramovich David R. , Terry Peter , Kitchener Henry C. 
Published: August 2005

Objective
To test the hypothesis that at two years bladder and ovarian function function are no different following either simple hysterectomy or endometrial ablation (transcervical resectiodlaser ablation).Design
Randomised controlled trial comparing hysterectomy with endometrial ablation. Two years after trial entry bladder and ovarian function were evaluated subjectively by means of questionnaires and objectively by means of cystometry and estimation of serum follicle stimulating hormone respectively.Setting
Aberdeen Royal Infirmary.Participants
Two hundred and four women with dysfunctional uterine bleeding who, when recruited to the initial study two years previously, were aged less than 50 years, weighed less than 100 kg, and who would otherwise have undergone hysterectomy.Results
Of the 204 women originally recruited, 101 re‐attended the clinic and underwent cystometry and follicle stimulating hormone estimation. These, together with a further 59 women, completed postal questionnaires (79% of original cohort). Rates of stress incontinence (44%vs 44%, 95% CI of difference −16% to +15%), urge incontinence (21% vs 19% 95% CI of difference −11% to +14%), and hot flushes (30%vs 44%, 95% CI of difference −25% to +7%) were similar in the hysterectomy and endometrial ablation groups, respectively. Cystometry revealed 14 (31%) cases of bladder dysfunction after hysterectomy and 17 (35%) after hysteroscopic surgery (95% CI of difference −23% to +15%). Serum follicle stimulating hormone levels > 40 mIu/L were found in three (6%) women following hysterectomy and five (10%) of women after endometrial ablation.Conclusion
This study suggests that in comparison with endometrial ablation, simple hysterectomy for dysfunctional uterine bleeding does not compromise bladder or ovarian function, at least at two years after the operation. Due to lack of power the estimates of any differences are imprecise, and clinically significant effects cannot be ruled out.
Maternal and fetal levels of methionine and homocysteine in early human pregnancy
Authors: Steegers‐Theunissen Régine P. M. , Wathen Neville C. , Eskes Tom K. A. B. , van Raaij‐Selten Bertie , Chard Tim 
Published: August 2005

Objective
To investigate methionine metabolism during normal human embryonic development by measuring levels of methionine and total homocysteine in samples of maternal serum, extra‐embryonic coelomic fluid, and amniotic fluid.Design
Cross‐sectional observational study.Setting
Collaboration between St Bartholomew's Hospital, London, and the University Hospital of Nijmegen in The Netherlands.Participants
Twenty‐three women with uncomplicated pregnancies between 8 and 12 weeks of gestation before surgical termination of an ultrasonographically normal fetus.Methods
Maternal serum samples were collected prior to surgery. Samples of extra‐embryonic fluid and amniotic fluids were obtained by transvaginal ultrasound‐guided coelocentesis and amniocentesis. Methionine was measured using an aminoacid analyser and total homocysteine by high performance liquid chromatography.Results
Levels of methionine were four times higher in extra‐embryonic coelomic fluid and twice as high in amniotic fluid compared with maternal serum. In contrast, the total homocysteine concentrations were much lower in both extra‐embryonic coelomic fluid and amniotic fluid than in maternal serum. All differences were significant (P 0.01).Conclusions
The comparatively high concentrations of methionine in extra‐embryonic coelomic fluid and amniotic fluid, and the concomitant low levels of total homocysteine in these fluids, suggest a role for methionine metabolism during early human pregnancy.
Preventing Rhesus D haemolytic disease of the newborn by giving anti‐D immunoglobulin: are the guidelines being adequately followed?
Authors: Howard Helen L. , Martlew Vanessa J. , McFadyen Iain R. , Clarke Cyril A. 
Published: August 2005

Objective
To ascertain whether anti‐D immunoglobulin is being administered to Rhesus D negative women in accordance with the 1991 recommendations for its use to cover all events which may result in fetomaternal haemorrhage.Design
The notes of women delivered in 1994 were examined for compliance with the 1991 recommendations.Setting
Seven maternity units using a central antenatal screening service.Participants
Nine hundred and twenty‐two Rhesus D negative women delivered in these seven hospitals.Main outcome measures
The prescription, dosage and indications for administration of anti‐D immunoglobulin to women during pregnancy and in the puerperium.Results
Postnatal anti‐D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti‐D immunoglobulin. The 1991 recommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosage of 250 IU was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes poorly understood, with a ‘negative’ result interpreted as a reason not to give anti‐D immunoglobulin.Conclusion
Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immunisation below the current 1%. It is suggested that more careful application of the recommendations should be evaluated before considering either routine antenatal prophylaxis, or the European recommendation of a larger dose (1000–1500 IU), both of which would increase the requirements for this limited resource.
GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up
Authors: Khullar V. , Cardozo L. D. , Abbott D. , Anders K. 
Published: August 2005

Objective
To determine the efficacy of GAX collagen in the treatment of elderly women with genuine stress incontinence.Design
A single centre prospective study.Setting
A London teaching hospital.Participants
Thirty‐four women older than 60 years of age with genuine stress incontinence diagnosed on videocystourethrography.Interventions
Up to three paraurethral injections of GAX collagen.Main outcome measures
Subjective and pad test assessments performed pre‐operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre‐operatively, after three months and one year.Results
There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre‐treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size.Conclusion
GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.