bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications of laparoscopy: a prospective multicentre observational study
Authors: Jansen Frank Willem , Kapiteyn Kitty , Trimbos‐Kemper Trudy , Hermans Jo , Trimbos J. Baptist 
Published: August 2005

Objective
To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands.Design
A nationwide prospective multicentre observational study.Methods
Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra‐operative or post‐operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published.Results
Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [%0]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3%0). In 83 cases (57%; 95% CI for approach = 49–65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7%0 for diagnostic laparoscopic procedures, 4.5%0 for sterilisation and 17.9%0 (χ2= 127; dF = 2; P <0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy.Conclusions
Most complications occurred during operative laparoscopic procedures (rate 17.9%0). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.
Transdermal oestradiol gel in the treatment of the climacterium: a comparison with oral therapy
Authors: Hirvonen E. , Lamberg‐Allardt C. , Lankinen K. S. , Geurts P. , Wilén‐Rosenqvist G. 
Published: August 2005

Objective
To compare two doses of a transdermal oestradiol gel (Divigel®/Sandrena®) plus oral sequential medroxyprogesterone acetate (MPA) with oral oestradiol valerate plus oral sequential MPA (Divina®/Dilena®).Design
Two‐year, randomised, open‐label, comparative study.Setting
Menopausal outpatient clinic in Helsinki.Subjects
Postmenopausal women with climacteric complaints or already using HRT.Interventions
(1) One gram gel containing 1 mg oestradiol for 3 months plus 20 mg oral MPA during the last 14 days; (2) 2 g gel containing 2 mg oestradiol for 21 days plus 10 mg oral MPA during the last 14 days; (3) 2 mg oestradiol valerate tablets for 3 weeks plus 10 mg oral MPA during the last 10 days. In all groups, each treatment period was followed by a 7‐day medication‐free interval.Main outcome measures
Climacteric complaints, bleeding control, bone mineral density, biomarkers of bone metabolism, lipid profile, tolerability and safety.Results
With each preparation, climacteric complaints were significantly reduced and good bleeding control was obtained. In addition, maintenance of bone mineral density as well as a reduction of bone turnover was achieved in all groups. Lipid parameters showed no unfavourable changes. Continuation rates were similar in all groups with overall 74% of patients completing the first year, whereas 94% of patients who elected to continue completed the second year. Tolerability of the gel was good: only 1.7% of patients discontinued treatment due to skin irritation.Conclusions
Transdermal oestradiol gel and oral oestradiol valerate tablets, used in combination with oral sequential MPA, are effective regimens of HRT in postmenopausal women. Transdermal oestradiol gel is an efficient, well‐tolerated form of HRT.
Maternal birthweight and diet in pregnancy in relation to the infant's thinness at birth
Authors: Godfrey K. M. , Barker D. J. P. , Robinson S. , Osmond C. 
Published: August 2005

Objective
To examine how maternal diet in pregnancy and parental body size and birthweight influence an infant's thinness at birth measured by a low ponderal index.Design
An observational study of newborn infants and their parents.Setting
Southampton, England.Population
Five hundred and thirty‐eight infants born at term.Main outcome measure
Ponderal index at birth.Results
Women who had a high intake of carbohydrate in early pregnancy and a low intake of dairy protein in late pregnancy tended to have infants that were thin at birth (P= 0.01 and P= 0.03, respectively, in a simultaneous analysis). Women who themselves had a low birthweight also tended to have thin infants, ponderal index falling from 28.3 kg/m3 to 26.2 kg/m3 as the women's birthweights decreased from more than 4.0 kg to 2.5 kg or less (P < 0.0001). Tall fathers had thin infants, but ponderal index was not related to the women's heights or the fathers’ birthweights.Conclusion
These associations may reflect constraints on placental development imposed by a woman's nutrition in pregnancy and during her own intrauterine life. Effects of the father's height may be mediated through genetic influences on skeletal growth.
Simultaneous effects of aneuploidy and oncogenic human papillomavirus on histological grade of cervical intraepithelial neoplasia
Authors: Monsonego Joseph , Valensi Pierre , Zerat Laurent , Clavel Christine , Birembaut Philippe 
Published: August 2005

Objective
To investigate whether ploidy and oncogenic human papillomavirus types can be correlated with the histological grade of cervical intraepithelial neoplasia (CIN) in the same tissue sections.Design
Histological data were obtained from 292 dysplastic lesions of the cervix and classified according to the CIN and the Bethesda terminologies. The samples were analysed using Feulgen‐stained image analysis cytometry for ploidy and Human papillomaviruses DNA typing by in situ hybridisation, respectively.Setting
Colposcopy Clinic at Alfred Fournier Institute, Paris.Population
Three hundred and forty women referred for an abnormal cervical smear.Results
The ploidy data strongly segregate high grade from low grade squamous intraepithelial lesions (aneuploidy 78%versus 21%; P < 0.0001). There was a significant association between aneuploidy and the severity of the lesions (94% for CIN 3, 55% for CIN 2 and 14% for CIN 1; P < 0.0001). Both classifications showed a significant association of histological grade with oncogenic human papillomavirus types (HPV 16–18–33: 20% in low grade and 78% in high grade squamous intraepithelial lesions, 31% and 75% in CIN 1 and CIN 3, respectively; P < 0.0001). The simultaneous effects of these viruses and ploidy demonstrate an association in aneuploid cells between the presence of oncogenic human papillomavirus types and histological grade (76% and 18% in high and low grade squamous intraepithelial lesions, respectively; P < 0.0001). Such an association was not observed in diploid cells (20% in both low and high grade squamous intraepithelial lesions).Conclusion
High risk human papillomavirus types do not exert an independent effect on the histological grade of cervical intraepithelial neoplasia.
Medical causes on stillbirth certificates in England and Wales: distribution and results of hierarchical classifications tested by the Office for National Statistics
Authors: Alberman Eva , Blatchley Nick , Botting Beverley , Schuman Jeremy , Dunn Alistair 
Published: August 2005

Objective
To produce a classification of stillbirths registered in England and Wales compatible with a previously described classification for neonatal deaths; to compare national data for intrapartum stillbirths with those for the remaining stillbirths; and to report on stillbirths with a gestational age of 24 to 27 completed weeks first made registrable on 1 October 1992.Design
Algorithms were developed and tested to derive hierarchical cause classifications making use of multiple causes mentioned on stillbirth certificates.Results
The additional information available since 1986 on cause and time of death of stillbirths, classified in a hierarchical fashion allows a more meaningful interpretation of the available information on the causes of stillbirth than was previously possible and does not perturb ongoing trends. Antepartum deaths without a classifiable cause contributed the majority: between 1992 and 1994 they accounted for 43% if mentions of asphyxial conditions are regarded as classifiable causes, and 82% if not considered as causal. Stillbirths described as occurring intrapartum are consistently of higher gestational age and birthweight than the remainder, lending validity to the time of death given.Conclusions
The national use of a classification including reported time of death of the fetus and mentions of asphyxial conditions is justifiable, providing a distinction is made between associated mentions and causal conditions. Better and more complete clinical information on stillbirth certificates will contribute further to understanding of their causes.
Randomised trial of one versus two doses of prostaglandin E2 for induction of labour: 2. Analysis of cost
Authors: MacKenzie I. Z. , Magill Patrick , Burns Ethel 
Published: August 2005

Objective
To compare the impact upon maternity unit resources and finances of two protocols for induction of labour using prostaglandins.Design
A prospective randomised trial comparing a single dose of prostaglandin E2 (2 mg) in the evening with two doses of prostaglandin E2 (2 mg), the second being given after six hours if labour had not started or the cervix was still unripe, followed if necessary by formal induction of labour by amniotomy and oxytocin infusion 14 to 20 hours after the initial prostaglandin E2 dose. Outcome for nulliparae and multiparae were analysed separately, by treatment intention.Setting
A maternity unit in a district general hospital delivering > 6000 women annually.Participants
Nine hundred and fifty‐five women with viable singleton pregnancies and cephalic presentation at term without previous history of caesarean section who were advised to have labour induced with prostaglandins.Main outcome measures
Costs incurred in managing all aspects of labour, including time spent on the antenatal ward and, in the delivery unit; costs associated with formal induction, augmentation of labour and epidural analgesia; costs of intrapartum maternal morbidity, mode of delivery and immediate neonatal care. Costs of postpartum hospital stay were estimated from unit statistics.Results
The overall mean cost of induction of labour was £5.00 and £7.22 less per woman for nulliparae and multiparae, respectively, if the two dose regimen was used. The main reason for the differences was due to delivery suite costs from the slightly greater rate of assisted deliveries in the single treatment groups. In contrast, costs for neonatal care were marginally lower if only one prostaglandin dose was used.Conclusions
The increased drug costs providing two prostaglandin E2 doses when required were off‐set by reductions in the costs of other intrapartum interventions for both nulliparae and multiparae. The advantages of less time spent on the antenatal ward for multiparae when two prostaglandin E2 doses were used may be eliminated if amniotomy and oxytocin infusion was commenced six hours after the initial prostaglandin dose had been given if labour had not started.
The changing pattern of eclampsia over a 60‐year period
Authors: Leitch C. R. , Cameron A. D. , Walker J. J. 
Published: August 2005

Objective
To determine changes in the incidence and pattern of eclampsia within the same geographical area over a 60‐year period.Design
A retrospective, descriptive study of 1259 consecutive women classified, at the time, as having had an eclamptic convulsion between the years 1931 and 1990.Setting
A large city centre teaching hospital and the surrounding catchment area.Main outcome measures
The changes in the incidence and timing of the convulsion and the outcomes for the mother and baby.Results
Over the study period, the incidence of eclampsia fell by more than 90%, from 74.1/10,000 in the 1930s to 7.2/10,000 in the 1980s. Most of the reduction occurred over the first four decades, with little change in the last 20 years. Overall, 44% of the cases of eclampsia occurred in the antenatal period, 33% intrapartum and 23% postpartum. Since the biggest decreases were seen in the incidence of antenatal and particularly intrapartum eclampsia, there has been a relative increase in the proportion of eclampsia occurring postpartum. Maternal death from eclampsia occurred in 15.1% of cases between 1931 and 1940, 13.4% between 1941 and 1950, but fell dramatically to 3.9% after 1950. There has been no maternal death since 1964. Apart from the first decade, postpartum eclampsia was associated with significantly less risk of death to the mother throughout the study period. Perinatal death rate has fallen steadily from 432.6/1000 cases of eclampsia between 1931 and 1940 over the first three decades, to 168.7/1000 between 1961 and 1970. There has been little change since, although a lower proportion of neonatal deaths occurred as stillbirths.Conclusions
We found a significant reduction in both the incidence of eclampsia and associated morbidity in this population over the last 60 years. This has occurred in association with the introduction of the National Health Service, widespread antenatal care for all and a general improvement in health and welfare. Any further reduction in the incidence in the UK may be difficult to achieve. Since the incidence of eclampsia is now low, efforts should perhaps be directed at minimising the morbidity associated with severe pre‐eclampsia rather than prevention of convulsions.
A study of the quality of perinatal autopsy in the former Northern Region
Authors: Wright C. , Cameron H. , Lamb W. ,   on behalf of the Northern Perinatal Mortality Survey Steering Group
Published: August 2005

Objective
To assess the quality of perinatal autopsy.Design
Review of all reports of post mortem examinations carried out following perinatal deaths from January 1994 to June 1994.Population
Former Northern Region of England.Methods
Assessment of post mortem reports concerning their content and interpretation, the assessment carried out by panel comprising a pathologist, obstetrician and paediatrician.Results
Reports were available for all 104 cases where post mortem examinations had been undertaken, of which 53 (51%) met the minimum standards for such autopsies proposed by the Royal College of Pathologists. Interpretative comments were judged to be adequate in 51 (49%).Conclusions
The quality of perinatal autopsies is frequently poor. Improvement requires increased awareness of the potential value of the autopsy, and more consultation between pathologists, obstetricians and paediatricians.
Lactate compared with pH analysis at fetal scalp blood sampling: a prospective randomised study
Authors: Westgren M. , Kruger K. , Ek S. , Grunevald C. , Kublickas M. , Naka K. , Wolff K. , Persson B. 
Published: August 2005

Objective
Fetal scalp blood sampling is a widely used method for assessing fetal condition in the event of ominous fetal heart rate patterns. The purpose of this randomised trial was to compare the value of fetal scalp blood lactate and pH management in cases of abnormal intrapartum fetal heart rate tracings.Methods
Of 341 cases of ominous fetal heart rate patterns, 169 were randomly assigned to pH analysis, and 172 to lactate measurements. Lactate was measured using a lactate card requiring 5 μL of blood and yielding the result within 60 seconds. pH analysis was performed with an ABL 510 acid‐base analyser requiring 35 μL of blood and yielding the results within 47 seconds.Results
Unsuccessful fetal blood sampling procedures (no result or an unreliable result) occurred significantly more often in the pH subgroup than in the lactate subgroup (OR 16.1 with 95% CI 5.8‐44.7). In the pH subgroup the failure rate was inversely related to the degree of cervical dilatation. Compared with the pH subgroup, the lactate subgroup was characterised by fewer fetal scalp incisions per blood sampling attempt (median 1.0 [interquartile range (IQR) 1‐11 vs 2.0 [IQR 1‐21]), and significantly less time required for the sampling procedure (median 120 s [IQR 90‐147] vs 230 s [IQR 180‐3001). The groups did not differ in mode of delivery, neonatal outcome and umbilical artery acid–base balance and lactate levels.Conclusion
This trial showed the levels of lactate and pH in fetal scalp blood to be comparable in predicting perinatal outcome, but the procedure to measuring lactate was more successful than that for pH. Owing to its simplicity of performance, lactate analysis is an attractive alternative for intrapartum fetal monitoring.
First trimester ultrasonographic diagnosis of fetal structural abnormalities in a low risk population
Authors: Economides Demetrios L. , Braithwaite Jeffrey M. 
Published: August 2005

Objectives
Ultrasonographic screening between 12+01 and 13+6 weeks for fetal structural abnormalities using transab dominal sonography and, where necessary, transvaginal sonography in a low risk population.Design
A prospective observational studySetting
London teaching hospitalMethods
Pregnant women with a total of 1632 low risk viable fetuses between 12+0 and 13+6 weeks of gestation were scanned using transabdominal and, where necessary, transvaginal sonography (40%). If the anatomical survey was normal, the women underwent routine 18‐20 week anomaly scans. Pregnancy outcomes were obtained from radiological and neonatal computerised databases, and postal or telephone patient enquiry.Results
Seventeen (1.0%) major structural abnormalities were diagnosed in the study group. Of these, 11 (64.7%) were diagnosed at the 12‐13 week scan, three diagnosed in the mid‐trimester and three postnatally. Of the fetal abnormalities diagnosed antenatally, 78.6% were diagnosed in the first trimester. The sensitivity of abnormality detection by the combination of both first and second trimester scans was 82.3%. In addition, a significant number of missed abortions (n= 36) were also diagnosed by the first trimester scan.Conclusion
This study has demonstrated the potential of screening a low risk population for fetal abnormalities at 12‐13 weeks of gestation using transabdominal sonography and, where necessary, transvaginal sonography. Larger studies are required to establish the clinical value of the first trimester scan.
First trimester sonographic detection of chromosomal abnormalities in an unselected population
Authors: Economides Demetrios L. , Whitlow Barry J. , Kadir Rezan , Lazanakis Michael , Verdin Stuart M. 
Published: August 2005

Objective
To investigate the role of first trimester sonography in detecting chromosomal abnormalities in an unselected obstetric population.Methods
2281 women (mean maternal age 30 years [range 16‐47]; mean gestational age 12+3 weeks [range 11‐14]) underwent transabdominal scanning to assess fetal structure and, if anatomical survey was considered to be incomplete (31% of cases), transvaginal sonography was also performed. Measurement of nuchal translucency was included and karyotyping performed as considered appropriate.Results
There were 16 chromosomal abnormalities; 13 (81%) were diagnosed at 11‐14 weeks either because of a nuchal translucency greater than or equal to the 99th centile for gestational age (7/16; 44% [95% CI 25‐63]) or due to the presence of structural abnormalities (6/16; 38% [95%CI 14.2–61.81). Seventy‐five percent of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency greater than or equal to the 99th centile (5/8; 63%) or due to the presence of a structural abnormality (1/8; 13%).Conclusions
A significant proportion of fetal chromosomal abnormalities can be detected by first trimester sonographic screening to assess fetal structural appearance. The sensitivity of detection can be improved by combining measurement of nuchal translucency with detailed examination of fetal anatomy.
The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review
Authors: Zondervan Krina T. , Yudkin Patricia L. , Vessey Martin P. , Dawes Martin G. , Barlow David H. , Kennedy Stephen H. 
Published: August 2005

Objective
Toobtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data.Design
Systematic review of published papers.Setting
The general population or hospitals in the United Kingdom.Population
Women participating in relevant community surveys or control women participating in hospital‐based studies.Methods
Papers were retrieved by systematically searching the databases MEDLINE, EMBASE and PsycLit, and by hand searching. Studies were included if they 1. were community‐based and reported prevalence rates of chronic pelvic pain, dyspareunia, dysmenorrhoea, or abdominal pain, or 2. referred to a clinical population but reported prevalence rates in a disease‐free control group.Main outcome measures
Prevalence rates for chronic pelvic pain including any overlap with dyspareunia, dysmenorrhoea and abdominal pain.Results
No community‐based study has been performed that provides an estimate of the prevalence of chronic pelvic pain in the general UK population. A rate of 39% was reported in women undergoing laparoscopy for sterilisation or investigation of infertility in the single study from the United Kingdom investigating chronic pelvic pain unrelated to menstruation or intercourse. Prevalence rates for dyspareunia, dysmenorrhoea, and abdominal pain found in UK community‐based studies were 8%, 45%, to 97%, and 23% to 29%, respectively, but definitions used varied greatly.Conclusions
Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community‐based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.
Insulin sensitivity in pre‐eclampsia
Authors: Roberts Ralph N. , Erik Henriksen Jan , Hadden David R. 
Published: August 2005

Objective
To investigate whether pre‐eclampsia is associated with an exaggeration of the insulin resistance seen in normotensive pregnancy.Design
Minimal model analysis of a frequently sampled intravenous glucose tolerance test to assess insulin sensitivity.Setting
Royal Maternity Hospital, Belfast.Participants
Eleven women with pre‐eclampsia and 11 matched normotensive pregnant women.Results
Insulin sensitivity (SI) was increased in the group with pre‐eclampsia compared with the normotensive women (mean [±SEM]: 2.6 [0.4] vs 1.6 [0.2] 10−4 min−1 per mU/L; P= 0.028). This was accompanied by a decrease in glucose effectiveness (SG) (1*1 ±0.1 vs 1.7 ±0.1 10−2 mid, P= 0.006) in the pre‐eclamptic women. In the normotensive group there was a significant inverse correlation between S, and mean arterial blood pressure (Y=−0.65; P= 0.03), but no such relation existed in the group with pre‐eclampsia.Conclusions
As with other forms of secondary hypertension, and unlike essential hypertension, the pathophysiology of pre‐eclampsia is not associated with insulin resistance.