bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises
Authors: Reilly E.T.C. , Freeman R.M. , Waterfield M.R. , Waterfield A.E. , Steggles P. , Pedlar F. 
Published: December 2003

Objective
To test whether supervised pelvic floor exercises antenatally will reduce the incidence of postpartum stress incontinence in at‐risk primigravidae with bladder neck mobility, ultrasonically proven.Design
Single blind, randomised controlled trial.Setting
Antenatal clinic in a UK NHS Trust Hospital.Sample
Two hundred and sixty‐eight primigravidae attending an antenatal clinic at approximately 20 weeks of gestation with bladder neck mobility, on standardised valsalva, of 5mm or more linear movement. The median age was 28, ranging from 16 to 47 years.Intervention
Patients randomised to supervised pelvic floor exercises (n= 139) attended a physiotherapist at monthly intervals from 20 weeks until delivery. The exercises comprised three repetitions of eight contractions each held for six seconds, with two minutes rest between repetitions. These were repeated twice daily. At 34 weeks of gestation the number of contractions per repetition was increased to 12. Both the untreated control group and the study group received verbal advice on pelvic floor exercises from their midwives antenatally.Main outcome measures
Subjective reporting of stress incontinence at three months postpartum. Pelvic floor strength, using perineometry, and bladder neck mobility measured by perineal ultrasound.Results
Of the 268 women enrolled, information on the main outcome variable was available for 110 in the control group and 120 in the study group. Fewer women in the supervised pelvic floor exercise group reported postpartum stress incontinence, 19.2% compared with 32.7% in the control group (RR 0.59 [0.37–0.92]). There was no change in bladder neck mobility and no difference in pelvic floor strength between groups after exercise, although all those developing postpartum stress incontinence had significantly poorer perineometry scores than those who were continent.Conclusions
The findings suggest that antenatal supervised pelvic floor exercises are effective in reducing the risk of postpartum stress incontinence in primigravidae with bladder neck mobility.
Use of mifepristone as an example of conflicting and misleading medical information on the internet
Authors: Mashiach Roy , Seidman Guy I. , Seidman Daniel S. 
Published: December 2003

Objective
To evaluate the accuracy and reliability of medical information available on the internet regarding medical abortion using mifepristone, with special emphasis on the possible bias of the internet websites providing the information.Methods
A systematic search of the internet identified patient‐oriented websites distributing medical information about mifepristone. The sites were divided into three groups according to their views of the drug (i.e. in favour, against or indifferent).Results
Forty sites met the criteria for inclusion in our analysis: 15 sites (37.5%) were in favour of using mifepristone, 16 (40%) were against and nine (22.5%) were indifferent. Incorrect information, found in 12 sites (30%), was significantly more common (P < 0.006) in websites that opposed the use of mifepristone than in websites that favoured it, 56.3% and 6.7%, respectively. Websites against the use of mifepristone provided significantly more (P < 0.05) graphic descriptions (31.3%vs 0%) and significantly fewer (P < 0.03) links (18.8%vs 60%), than the sites in favour of the use of mifepristone.Conclusions
We found that information provided on the internet regarding the use of mifepristone was significantly less complete and accurate and included more graphic descriptions when the site opposed medical termination of pregnancy. These findings reinforce the concerns regarding the reliability and credibility of medical information on the internet and the need for quality control.
Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence
Authors: Stanwood Nancy L. , Grimes David A. , Schulz Kenneth F. 
Published: December 2003

Objective Assess the safety and efficacy of intrauterine contraceptive device (IUCD) insertion immediately after induced or spontaneous abortion.Design Systematic search for randomised trials that had at least one treatment arm that involved IUCD insertion immediately after an induced or spontaneous miscarriage using Medline, Popline, EMBASE, and review articles supplemented by correspondence with investigators.Population Women of any age or gravidity who had an IUCD inserted immediately after evacuation for spontaneous or induced abortion.Methods Articles were abstracted and the raw data from tables were analysed with RevMan 3.1 software. We focused on Tietze‐Potter gross life table probabilities with denominators of person‐time of exposure.Main outcome measures Rates of perforation, expulsion, pelvic inflammatory disease, contraceptive failure, and method continuation.Results Complication rates for immediate post‐abortal IUCD insertion were low. Perforation was rare with a rate of approximately one per 1000 insertions. One year gross cumulative expulsion rates ranged from 1.8% to 12.6%, pregnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. The net discontinuation rate due to pelvic inflammatory disease was low, ranging from 0.0 to 0.8 per 100 women at one year. Increasing gestational age at insertion was associated with increased expulsion rates.Conclusions Post‐abortal IUCD insertion is safe and effective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive failure were low and similar to those reported for interval insertion. Second trimester gestational age is associated with an increased risk of expulsion. Immediate insertion may have a higher expulsion rate than delayed insertion. However, these risks may be outweighed by the benefit of immediate contraception.
The relationship between cervical dilatation at initial presentation in labour and subsequent intervention
Authors: Holmes Paul , Oppenheimer Lawrence W. , Wu Wen Shi 
Published: December 2003

Objective To examine the relationship between the cervical dilatation at which women present in labour and the subsequent likelihood of caesarean section.Design Retrospective cohort study.Setting University teaching hospital.Population 3220 women met the entry criteria from 14,050 deliveries between January 1995 and December 1999.Methods Women meeting the following criteria were identified: those in spontaneous labour with a singleton pregnancy and a cephalic presentation at 37–42 weeks of gestation; all women delivering within 36 hours of first presentation were included. Women who had spontaneous rupture of the membranes before first attendance were excluded.Main outcome measures The primary outcome was the rate of caesarean section. Secondary outcomes were operative vaginal delivery, fetal weight, cord pH, five minute Apgar score, length of labour, labour augmentation with oxytocin and epidural analgesia.Results The risk of caesarean section decreased with increasing cervical dilatation at presentation. This was true for nulliparous (n=1168) and parous women (n=2052). The caesarean section rate of nulliparous women presenting at 0–3cm (n=812) was 10.3%, compared with 4.2% for those presenting at 4cm–10cm (n=356), and the mean duration of labour before presentation was 2.0 hours versus 4.5 hours, respectively (P=0.0001). For parous women the caesarean section rates were 5.7% and 1.3%, respectively (P=0.0001). There were significantly greater frequencies of use of oxytocin and epidural analgesia by women presenting earlier in labour. The caesarean section rate of 185 nulliparae (15.8%) who were initially allowed home was no different from those admitted immediately (9.2%vs 8.2%, P=0.67). Similarly, 196 (9.5%) of multiparae went home and had a caesarean section rate of 3.6%, compared with 3.1% if admitted immediately (P=0.76).Conclusions Women who present to hospital at 0–3cm spend less time in labour before presentation and are more likely to have obstetric intervention than those presenting in more advanced labour. Outcomes were similar whether or not the woman was initially allowed home.
Pregnancy and the erythrocyte sedimentation rate
Authors: van den Broek N.R. , Letsky E.A. 
Published: December 2003

Objectives To determine the range of erythrocyte sedimentation rate values obtained in healthy pregnant women. To examine the effect of gestational age and haemoglobin concentration on erythrocyte sedimentation rate.Setting Queen Charlotte's Hospital, London, UK.Design Cross sectional descriptive study.Population Healthy pregnant women attending for routine outpatient antenatal visits at Queen Charlotte's Hospital in London.Methods Erythrocyte sedimentation rate was determined by the Westergren method, haemoglobin concentration by automated cell counter and gestational age by ultrasonography. The median and 95% reference range was determined for erythrocyte sedimentation rate values obtained. Linear regression analysis was used to determine the influence of haemoglobin concentration and gestational age on erythrocyte sedimentation rate.Results For 1019 women examined, the range of erythrocyte sedimentation rate values obtained was 4–112 mm/h. Gestational age and haemoglobin concentration both significantly influenced erythrocyte sedimentation rate. (P<0.0001). For non‐anaemic women the 95% reference range rose from 18–48 mm/h in the first half of pregnancy to 30–70 mm/h in the second half of pregnancy. For anaemic women the corresponding reference ranges were 21–62 mm/h and 40–95 mm/h, respectively.Conclusion For the correct interpretation of erythrocyte sedimentation rate values obtained during pregnancy gestational age and haemoglobin concentration must be taken into account.
Seasonal variation in the occurrence of pre‐eclampsia
Authors: Magnus Per , Eskild Anne 
Published: December 2003

Objective To obtain evidence for seasonal variability in pre‐eclampsia using the assumption that environmental factors may have a role in the causal mechanisms.Design Cross sectional population‐based study.Population All 1,869,388 deliveries in Norway in the years 1967 to 1998.Method For each month, the percentage of births complicated by pre‐eclampsia was calculated. The relative risks of pre‐eclampsia by month of delivery were estimated as odds ratios using the month with lowest risk as the reference category.Results Mothers of children born in August had the lowest risk of pre‐eclampsia, and the risk was highest in the winter months (for December adjusted OR: 1.26, 95% CI 1.20–1.31). This pattern was independent of parity, maternal age, year and place of living.Conclusion The finding may provide a new clue for understanding the causes of pre‐eclampsia. Environmental factors that show a similar seasonal variation should be investigated as possible causes.
Impaired vascular function in women with pre‐eclampsia observed with orthogonal polarisation spectral imaging
Authors: Vollebregt Karlijn C. , Boer Kees , Mathura Keshen R. , de Graaff Jurgen C. , Ubbink Dirk Th. , Ince Can 
Published: December 2003

Objective To investigate in vivo the function of the microcirculation of the skin in pregnancy and pregnancy complicated with pre‐eclampsia.Design Case–control study.Setting Academic Medical Centre.Participants A group of 10 women with pre‐eclampsia and a healthy control group of 10 pregnant women.Methods The microcirculation of the skin of the finger at rest and during venous occlusion was studied with laser Doppler fluxmetry and orthogonal polarisation spectral imaging. By inflating a cuff around the upper arm to a pressure of 50mmHg, causing venous occlusion, the local sympathetic veno‐arteriolar reflex was provoked. With laser Doppler fluxmetry the blood flow of the skin at a depth of 1–2mm was measured at rest and during venous occlusion. Orthogonal polarisation spectral imaging was used to assess red blood cell velocity at rest and during venous occlusion of the nutritive capillaries of the skin.Results Laser Doppler fluxmetry showed no significant difference between the normotensive group and the group with pre‐eclampsia. Using orthogonal polarisation spectral imaging, venous occlusion produced a significantly greater decrease in red blood cell velocity in the control group than in the women with pre‐eclampsia: (84% (81–88)(median and interquartile range) vs 58% (45–88), P=0.0029). No differences in absolute red blood cell velocities were observed between groups either at rest or during venous occlusion.Conclusion This study shows an impaired local veno‐arteriolar reflex in pre‐eclampsia at the nutritive, but not at the thermoregulatory, level of the microcirculation of the skin.
A randomised placebo‐controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea
Authors: Ziaei S. , Faghihzadeh S. , Sohrabvand F. , Lamyian M. , Emamgholy T. 
Published: December 2003

Objective To determine whether vitamin E is effective in the treatment of primary dysmenorrhoea.Design A randomised placebo‐controlled trial.Participants One hundred girls, aged 16–18 years old who suffered from primary dysmenorrhoea, among 1000 students attending a public high school in Region 5 in the Greater Tehran Municipality.Methods Fifty girls were given 500 units of vitamin E (five tablets) per day, and 50 were given five placebo tablets per day. The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain before and after the treatment was studied. Treatment in both groups was carried out in two consecutive menstrual periods.Results The severity of pain in the two groups was reduced after treatment, but the reduction was greater in the group treated with vitamin E. These differences were maintained in the second month of therapy.Conclusion Both placebo and vitamin E are effective in relieving symptoms due to primary dysmenorrhoea, but the effects of vitamin E are more marked.
Serum cystatin C reflects glomerular endotheliosis in normal, hypertensive and pre‐eclamptic pregnancies
Authors: Strevens Helena , Wide‐Swensson Dag , Grubb Anders , Hansen Alastair , Horn Thomas , Ingemarsson Ingemar , Larsen Svend , Nyengaard Jens R. , Torffvit Ole , Willner Julian , Olsen Steen 
Published: December 2003

Objective
To study the correlation between serum cystatin C levels and renal structural changes in normal, hypertensive and pre‐eclamptic pregnancy to evaluate it as a marker of the degree of renal involvement in pre‐eclampsia.Design
An observational prospective study.Setting
University Hospital of Lund, Sweden.Sample
Thirty‐six women with hypertensive disease in pregnancy and 12 healthy pregnant women in the third trimester recruited from maternal health care centres in the catchment area of the hospital.Methods
Renal biopsy samples were obtained from all participants and the degree of endotheliosis as well as the mean glomerular volume was evaluated by light microscopy in silver methenamin‐stained sections. Serum cystatin C levels were measured and correlated to the structural changes.Main outcome measures
Correlation among degree of glomerular endotheliosis, glomerular volume andserum cystatin C.Results
Serum cystatin C levels differed between the different degrees of endotheliosis, showing a highly significant increasing linear trend. They also correlated significantly with glomerular volume (r = 0.60, P < 0.001). Mean serum urate and creatinine levels also increased with the degree of endotheliosis, but not above the reference interval for normal term pregnancy, even in pre‐eclamptic women.Conclusion
Serum cystatin C may be used as a marker, not only for impaired renal function, but also for the degree of glomerular endotheliosis and increase in glomerular volume in pregnancy. It may be of value in the monitoring of pregnancies complicated by pre‐eclampsia.
The differential expression of oestrogen receptors, progesterone receptors, Bcl‐2 and Ki67 in endometrial polyps
Authors: Taylor Lydia J. , Jackson Tracy L. , Reid Janet G. , Duffy Sean R.G. 
Published: December 2003

Objective
To obtain a greater understanding of the pathogenesis of endometrial polyps and to gain insight into which factors play a pivotal role in their growth.Design
Retrospective analysis of archived paraffin‐embedded specimens.Setting
St James's University Hospital.Sample
Thirty secretory phase endometrial samples, 10 secretory phase endometrial polyps, 8 proliferative phase endometrial samples and 10 proliferative phase endometrial polyps.Methods
Immunohistochemistry was used to characterise the expression of oestrogen and progesterone receptors, Bcl‐2 and Ki67 in cycling endometrium and phase‐matched endometrial polyps. Patterns of expression were compared between the polyps and the endometrium.Main outcome measure
The expression of oestrogen receptors, progesterone receptors, Bcl‐2 and Ki67.Results
Three significant differences were found between the endometrium and the polyps. Polyps taken from the proliferative phase of the cycle displayed significantly elevated expression of Bcl‐2 and weak or no expression of progesterone receptors. Secretory phase polyps displayed an elevated expression of oestrogen receptors.Conclusion
A localised increase in Bcl‐2 expression and consequential decline or cessation of apoptosis is an important mechanism underlying the pathogenesis of endometrial polyps. Elevated Bcl‐2 expression results in failure of the polyp tissue from undergoing normal cyclical apoptosis during the late secretory phase. This may mean the polyp is not shed along with the rest of the endometrium during menstruation.
A randomised trial comparing local versus general anaesthesia for microwave endometrial ablation
Authors: Wallage S. , Cooper K.G. , Graham W.J. , Parkin D.E. 
Published: December 2003

Objective
To compare the acceptability of microwave endometrial ablation using a local anaesthesia/sedation regime or general anaesthesia. To compare recovery following treatment with each type of anaesthetic.Design
Prospective randomised controlled trial with follow up of women who declined randomisation.Setting
The gynaecology department of a large teaching hospital in the UK.Population
All women referred for microwave endometrial ablation at the Aberdeen Royal Infirmary between July 1999 and September 2000 without a medical reason to favour one or other type of anaesthetic.Methods
191 women were equally randomised to undergo microwave endometrial ablation under general or local anaesthesia. Details were also collected for women not randomised because of an anaesthetic preference. All procedures were undertaken in an operating theatre.Main outcome measures
Data collected by questionnaire including the woman's view of treatment acceptability, operative details and post‐operative recovery.Results
Sixty‐nine percent of eligible women would consider treatment under local anaesthesia. Ninety‐one percent of microwave endometrial ablation procedures that started under local anaesthesia were completed without conversion to general anaesthesia. Anaesthetic type and allocation by randomisation or preference made no significant difference to the proportion of women describing treatment as totally or generally acceptable at two weeks. Neither parity nor cavity size predicted acceptability. Women allocated general anaesthesia were more likely to describe the procedure as totally acceptable and to choose the same anaesthetic again. There was no significant difference between anaesthetic groups regarding post‐operative pain, nausea or recovery time.Conclusions
Microwave endometrial ablation under local anaesthesia was acceptable to the majority of women referred for treatment. There was no recovery advantage from local anaesthesia and almost 1 in 10 women who starting treatment under local anaesthesia needed a general anaesthetic because of discomfort. The incidence of post‐operative pain and nausea means that treatment with this local anaesthetic/sedation regime remains a day case rather than an outpatient procedure.
The cost of microwave endometrial ablation under different anaesthetic and clinical settings
Authors: Seymour Janelle , Wallage Sarah , Graham Wendy , Parkin David , Cooper Kevin 
Published: December 2003

Objective
To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting.Design
The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting.Setting
Department of Gynaecology, Aberdeen Royal Infirmary, Scotland.Sample
One hundred and twenty‐seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic.Methods
Health and non‐health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting.Main outcome measures
Health and non‐health service costs.Results
There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non‐health cost of microwave endometrial ablation was £440 and £120, respectively, under general anaesthetic and £428 and £125 per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be £432 per treatment; however, this varied from £389 to £491 in the sensitivity analysis.Conclusion
There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re‐admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model.