bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of heart disease diagnosed de novo in pregnancy in a West London population
Authors: Tan Jackie , de Swiet Michael 
Published: August 2005

Objectives
To determine the prevalence of heart disease diagnosed de novo in pregnancy in a West London population and to re‐examine the current role of routine cardiovascular examination in antenatal care in the UK.Design
Retrospective study.Setting
Obstetric medical clinics at Queen Charlotte's and Chelsea Hospital, University College Hospital and Northwick Park Hospital.Population
Three hundred and twenty women referred for cardiac evaluation during pregnancy.Results
The majority of the 139 women referred specifically for evaluation of murmurs during pregnancy were found to have physiological murmurs (97%). Only four women (3%) were found to have significant cardiac lesions de novo in their pregnancy. Three of these four women were immigrants who had no previous history of heart disease. The only woman from the UK was already known to have a murmur from childhood.Conclusions
Our study shows that heart disease diagnosed de novo in pregnancy in a West London population is an uncommon problem with low prevalence. It also appears to be a problem seen mainly in the immigrant population. The results emphasise the importance of taking a thorough medical history in all pregnant women. However, our results if they are confirmed, would suggest that only immigrants and those with significant symptoms or a known history of heart murmur or heart disease need undergo cardiovascular examination during pregnancy. These findings need to be confirmed in a larger group in other parts of the UK before further recommendations on selective cardiovascular examination can be made. This will have significant implications for midwifery‐led care.
Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy
Authors: Hope Peter , Breslin Sue , Lamont Linda , Lucas Alexandra , Martin Denis , Moore Isabella , Pearson James , Saunders Dawn , Settatree Ralph 
Published: August 2005

Objective
To use information collected by the Confidential Enquiry into Stillbirths and Deaths in Infancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia.Design
Review of casenotes by a multidisciplinary focus group.Sample
All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia.Main outcome measures
Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate.Results
Maternal obesity and big babies were over‐represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered.Conclusions Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome.
A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care
Authors: Slade P. , Heke S. , Fletcher J. , Stewart P. 
Published: August 2005

Objective
To investigate whether women having medical or surgical terminations of pregnancy differ in their emotional distress before or after the procedure. To evaluate whether choice of procedure occurs, the factors influencing type of procedure and the effect of choice on emotional responses and satisfaction with care.Design
A prospective comparative study.Setting
A termination of pregnancy unit in a University Teaching Hospital.Participants
Two hundred and seventy‐five women attending for medical or surgical first trimester termination of pregnancy.Methods
Interviews concerning choice and measures of emotional status were completed prior to terminations. Four weeks after termination emotional functioning was reassessed together with satisfaction with care.Results
Women having a surgical termination waited longer for the procedure and were at more advanced gestation than those having the medical termination. There were no differences in emotional responses related to type of procedure or gestation. One‐quarter remained highly anxious at four weeks. Medical and surgical groups did not differ in emotional status prior to termination. Those having the medical procedure rated it as marginally more stressful and experienced more post‐termination physical problems and disruption to life. Seeing the fetus was associated with more intrusive events (nightmares, flashbacks, unwanted thoughts related to the experience). One‐quarter of the medical and 67% of the surgical group reported having no choice in type of procedure. Only 53% of the medical group would choose the same procedure again compared with 77% of the surgical group.Conclusions
Termination method did not influence emotional adjustment. Many women were not offered genuine choice of procedure. Having choice was considered very important but was unrelated to emotional distress or satisfaction with care.
Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence?
Authors: King Jennifer K. , Freeman Robert M. 
Published: August 2005

Objective
To assess the contribution of constitutional factors, as demonstrated by antenatal bladder neck mobility, in the development of postpartum urinary stress incontinence.Design
A prospective investigational study.Setting
General district hospital.Population
One hundred and three primigravid women with no pre‐existing urinary incontinence or neurological disorder.Methods
Antenatal and postnatal measurement of bladder neck mobility using perineal ultrasound.Main outcome measure
Urinary stress incontinence at 10–14 weeks postpartum.Results
Women with postpartum urinary stress incontinence have significantly greater antenatal bladder neck mobility than those women continent postpartum. There were no significant differences in any labour or delivery variables, including mode of delivery, between the postpartum continent and incontinent women.Conclusions
There is evidence for a constitutional risk factor (eg. defective pelvic floor connective tissue in the development of postpartum stress incontinence).
Immediate and long term outcome of human parvovirus B19 infection in pregnancy
Authors: Miller Elizabeth , Fairley Christopher K. , Cohen Bernard J. , Seng Claude 
Published: August 2005

Objective
To estimate more precisely the risk of fetal loss and congenital abnormalities after maternal parvovirus B19 infection, and to assess the long term outcome for surviving infants.Design
Prospective cohort study of pregnant women with confirmed B19 infection with follow up of the surviving infants. The rate of fetal loss in the study cohort was compared with that in pregnant women with varicella.Setting
Cases reported by laboratories in England and Wales between 1985‐1988 and 1992–1995.Sample
Four hundred and twenty‐seven pregnant women with B19 infection and 367 surviving infants of whom 129 were followed up at 7–10 years of age.Methods
Questionnaires to obstetricians and general practitioners on outcome of pregnancy and health of surviving infants. Maternal infection confirmed by B19‐specific IgM assay and/or IgG seroconversion.Results
The excess rate of fetal loss in women with B19 infection was confined to the first 20 weeks of gestation and averaged 9%. Seven cases of fetal hydrops followed maternal infections between 9 and 20 weeks of gestation (observed risk 2.9%, 95% CI 1.2–5.9). No abnormalities attributable to B19 infection were found at birth in surviving infants (observed risk 0%, upper 95% CI 0.86%). No late effects were found at 7–10 years.Conclusions
Around 1 in 10 women infected before 20 weeks of gestation will suffer a fetal loss due to B19. The risk of an adverse outcome of pregnancy after this stage is remote. Infected women can be reassured that the maximum possible risk of a congenital abnormality due to B19 is under 1% and that long term development will be normal.
Ultrasound detection of vault haematoma following vaginal hysterectomy
Authors: Thomson A.J.M. , Sproston A.R.M. , Farquharson R.G. 
Published: August 2005

Objective
To assess whether ultrasound detection of vault haematoma can be used as a predictor of post‐ooperative morbidity following vaginal hysterectomy.Design
Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994.Sample
Two hundred and twenty‐three women having undergone vaginal hysterectomy.Methods
All women hadtransvaginal ultrasound examination by an independent observer on the third post‐operative day. Routine observations and clinical assessments were made by establishedmanagement protocol, by staff blinded to the ultrasound findings.Main out come measures
Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re‐admission rate and length of stay.Results
Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31%vs7%), post‐operative haemoglobin drop (2–5 g/dL vs1.6 g/dL), need for blood transfusion (145%vs1.2%), representation to hospital (25.5%vs5.4%)and length of hospital stay (8.87 days vs6.25 days) wereseen in the haematoma group.Conclusion
Ultrasound detection of vault haematoma following vaginal hysterectomy is a commonfinding associated with increased febrile morbidity, need for blood transfusion, longer hospital stayand higher re‐admission rate. In view of increasing demand for early discharge, driven by purchasersand patients, post‐operative ultrasound identifies a high risk population and is both convenient andnoninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trialof prophylactic antibiotics in this identified subset.
Low sodium diet and pregnancy‐induced hypertension: a multi‐centre randomised controlled trial
Authors: Knuist Marianne , Bonsel Gouke J , Zondervan Hans A , Treffers Pieter E 
Published: August 2005

Objective
To examine the effectiveness of the standard policy in the Netherlands to prescribe a sodium restricted diet to prevent or to treat mild pregnancy‐induced hypertension.Design
Multi‐centre randomised controlled trial between April 1992 and April 1994.Setting
Seven practices of independent midwives and one university hospital.Participants
The experimental group comprised 184 women given a low sodium diet (≤ 50 mmol sodium/day) and a control group of 177 women given a normal diet. Eligible women for inclusion had had a rise of blood pressure, or excessive weight gain or oedema during the antenatal period. The 361 women in the trial were recruited from 2020 nulliparae, of whom 1512 (75%) gave informed consent at the beginning of their pregnancy to participate in the study.Main outcome measures
The difference between highest diastolic blood pressure after randomization and diastolic blood pressure at the moment of randomisation; referral and admission to hospital for hypertension.Results
There was no difference in increase of diastolic blood pressure after randomisation, the percentage of referral and admission to hospital for hypertension, or in obstetric outcome between the two groups. Urinary sodium excretion after randomisation in the normal diet group was significantly higher than in the low sodium group.Conclusion
Prescribing a sodium‐restricted diet to prevent or to treat mild pregnancy‐induced hypertension is not effective. Therefore there is no need to introduce a salt restricted diet in prenatal care, although increasing evidence shows that a low sodium diet prevents hypertension in non pregnant individuals.
The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair
Authors: Mackrodt Carolyn , Gordon Beverley , Fern Elizabeth , Ayers Sarah , Truesdale Ann , Grant Adrian 
Published: August 2005

Objective
To compare polyglactin 910 sutures with chromic catgut sutures for postpartum perineal repair.Design
A stratified randomised controlled trial, using a 2 × 2 factorial design.Setting
The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.Sample
1780 women who had sustained an episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery.Methods
Policies of repair with polyglactin 910 or chromic catgut were compared. Both groups were assessed by a research midwife completing questionnaires at 24 to 48 hours and at ten days postpartum, and by self‐completed questionnaires at three months after birth.Main outcome measures
1. 24 to 48 hours postpartum: perineal pain, healing; 2. ten days postpartum: perineal pain, healing and removal of sutures; 3. three months postpartum: perineal pain, removal of sutures, resuturing, dyspareunia, and failure to resume pain‐free intercourse.Results
Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. The two groups were similar at trial entry. Significantly fewer women allocated to the polyglactin 910 reported pain in the previous 24 hours at both 24 to 48 hours (59%vs 67%; RR 0.89, 95% CI 0.83–0.95; 2P < 0.01), and ten days (24%vs 29%; RR 0.81, 95% CI 0.69–0.95; 2P = 0.01). At three months postpartum there was no clear difference between the groups in terms of perineal pain, dyspareunia or failure to resume pain‐free intercourse. More women in the polyglactin 910 group reported that some suture material had been removed (12%vs 7%; RR 1.62,95% CI 1.19–2.21; 2P < 0.01). Three women in the polyglactin 910 group had required resuturing compared with ten in the chromic catgut group (RR 0.30; 95% CI 0.08–1.09; 2P=0.1).Conclusions
Using polyglactin 910 rather than chromic catgut for perineal repair leads to about one fewer women among every 20 having perineal pain and using analgesia ten days postpartum. Its only apparent disadvantage is that more women, again estimated as 1 in 20, report having material removed during healing. Data from this and other trials suggest that for every 100 women repaired with a polyglycolic acid‐based material, about one fewer will require resuturing.
Analysis of birthweight and gestational age in antepartum stillbirths
Authors: Gardosi Jason , Mul Theo , Mongelli Max , Fagan David 
Published: August 2005

Objective
To study the characteristics of birthweight and gestational age of third trimester fetal deaths which occurred before the onset of labour.Design
Review of computerised confidential perinatal mortality records. Data originated from the 1992 Trent Region Perinatal Mortality Survey.Sample
One hundred and forty‐nine antepartum stillbirths of at least 24 weeks of gestation confirmed by early ultrasound scan. Congenital abnormalities and multiple pregnancies were excluded.Main outcome measures
Reported causes of stillbirth, weight‐for‐gestational age centiles based on a standard derived from normal pregnancies; pregnancy characteristics compared with the local maternity population.Results
Of 149 stillbirths, 83 (56%) were preterm and 66 were at term, and the majority (126; 85%) occurred from 31 weeks. Most of the deaths (97; 65%) were reported as ‘unexplained’ even though post‐mortems had been carried out in 60% of all cases. Using a gestational age‐specific fetal weight standard derived from normal, term live births, 41% of all cases of stillborn infants were small‐for‐ gestational age (< 10th centile; OR 6.2; 95% CI 3.3–11.5); 39% of which had been classified as unexplained were small for gestational age (OR 5.6; 2.6–12.0). This excess of small stillbirths was most pronounced between 31 and 33 weeks, where the weights of 63% of all stillbirths and 72% of unexplained fetal deaths were < 10th centile. Overall, a higher proportion of preterm (< 37 weeks) than term stillbirths were small for gestational age: 53%vs 26% (OR 3.3; 1.6–6.5). However, at term there were also more subtle differences in weight deficit, with more fetuses with a weight between the 10th and 50th centiles than between 50th and 90th (36 vs 11; OR 3.3; 1.4–7.8). Mothers of pregnancies ending in stillbirth were similar in age, size, parity and ethnic group to mothers of live born babies, but were more likely to be smokers (37 vs 27%, OR 1.6; 1.2–2.3).Conclusions
Many stillborn babies are small for gestational age. In the absence of significant differences in physiological pregnancy characteristics, this is unlikely to be a constitutional smallness, but represents a preponderance of intrauterine growth restriction. For a full appreciation of the strength of this association, appropriate weight standards and classifications need to be applied in perinatal mortality surveys. Many antepartum stillbirths which are currently designated as unexplained may be avoidable if slow fetal growth could be recognised as a warning sign.
Antenatal corticosteroid therapy and risk of osteoporosis
Authors: Ogueh Onome , Khastgir Gautam , Studd John W. W. , Jones Julia , Alaghband‐Zadeh Jamshid , Johnson Mark Richard 
Published: August 2005

Objective
To assess the risk of maternal osteoporosis associated with antenatal corticosterioid administration for neonatal respiratory distress syndrome prophylaxis.Design
Prospective longitudinal study.Setting
Maternity unit of Chelsea and Westminster Hospital, London.Population
Fourteen pregnant women who received dexamethasone therapy for fetal lung maturation in anticipation of delivery before 34 completed weeks of gestation.Methods
Blood samples were collected before dexamethasone administration, 24 hours and 48 hours after the course of dexamethasone, and within 24 hours of delivery. Serum levels of carboxy terminal pro‐peptide of type I pro‐collagen (PICP) were measured to monitor the rate of bone formation, and serum levels of cross‐linked carboxy terminal telopeptide (ICTP) were measured as a marker of bone resorption.Main outcome measures
Changes in the markers of bone turnover following dexamethasone administration.Results
Serum PICP levels dropped 24 hours after dexamethasone therapy (P= 0.001), but partially recovered by 48 hours (P= 0.014) to reach higher than pre‐therapy levels at delivery (P= 0.044). Although there were no corresponding changes in the serum levels of ICTP after 24 and 48 hours of therapy, levels increased from pretherapy to delivery (P= 0.006).Conclusion
Antenatal corticosteroid therapy leads to a transient suppression of, followed by an increase in, bone formation without any significant alteration in the pattern of bone resorption expected during pregnancy.
Randomised comparative trial of the intrauterine system and norethisterone levonor gestrel for treatment of idiopathic menorrhagia
Authors: Irvine G. A. , Campbell‐Brown M. B. , Lumsden M. A. , Heikkilä A. , Walker J. J. , Cameron I. T. 
Published: August 2005

Objective
To compare the efficacy and acceptability of the levonorgestrel intrauterine system and norethisterone for the treatment of idiopathic menorrhagia.Design
A randomised comparative parallel group study.Setting
Gynaecology outpatient clinic in a teaching hospital.Participants
Forty‐four women with heavy regular periods and a measured menstrual blood loss exceeding 80 ml.Methods
Twenty‐two women had a levonorgestrel intrauterine system inserted within the first seven days of menses, and 22 women received norethisterone (5 mg three times daily) from day 5 to day 26 of the cycle for three cycles.Main outcome measures
The main outcome measure was the change in objectively assessed menstrual blood loss after three months of treatment.Results
When menstrual blood loss at three months was expressed as a percentage of the control, the levonorgestrel intrauterine system reduced menstrual blood loss by 94% (median reduction 103 ml; range 70 to 733 ml), and oral norethisterone by 87% (median reduction 95 ml; range 56 to 212 ml). After three cycles of treatment 76% of the women in the levonorgestrel intrauterine system group wished to continue with the treatment, compared with only 22% of the norethisterone group.Conclusions
Both the levonorgestrel intrauterine system and oral norethisterone in this regimen provided an effective treatment for menorrhagia in terms of reducing menstrual blood loss to within normal limits. The levonorgestrel intrauterine system was associated with higher rates of satisfaction and continuation with treatment, and thus offers an effective alternative to currently available medical and surgical treatments for menorrhagia. norethisterone for the treatment of idiopathic menorrhagia.
Effective analgesia following perineal injury during childbirth: a placebo controlled trial of prophylactic rectal diclofenac
Authors: Searles Jayne A. , Pring David W. 
Published: August 2005

Objective
To determine if diclofenac suppositories administered prophylactically produce effective.Design
A randomised double blind placebo controlled trial.Setting
York District Hospital.Population
One hundred women sustaining objective perineal injury (second degree tear or episiotomy) during spontaneous vaginal delivery at term.Methods
Suppositories were administered at the time of repair and approximately 12 hours later. The suppositories were randomised prior to issue by the pharmacy department and contained either 100 mg diclofenac or placebo.Main outcome measures
Pain scores assessed at 12, 24, 48 and 72 hours after delivery using a six point numerical scoring system and the use of additional analgesia and local treatments to the perineum.Results
The mean pain score was significantly reduced in the diclofenac group at 24, 48 and 72 hours after delivery (0.86, 0.7 and 0.59, respectively) compared with the control group (1.64, 1.31 and 1.5; P < 0.005). In addition there was less supplementary analgesia required (eight women only at 72 hours compared with 15 in the control group) and this was limited to paracetamol or topical treatments to the perineum.Conclusion
Prophylactic rectal diclofenac provides effective analgesia after perineal repair and its effect appears to be maintained into the second and third postpartum days. and lasting analgesia following perineal injury.
Placental hormones during induced hypoglycaemia in pregnant women with insulin‐dependent diabetes mellitus: evidence of an active role for placenta in hormonal counter‐regulation
Authors: Björklund A. O. , Adamson U. K. C. , Carlström K. A. M. , Hennen G. , Igout A. , Lins P.‐E.S. , Westgren L. M. R. 
Published: August 2005

Objective
To study the effect of induced hypoglycaemia on serum levels of the placental hormones oestriol, human placental lactogen, placental growth hormone and progesterone in the third trimester of pregnancy.Design
A prospective experimental investigation.Setting
High risk pregnancy unit and diabetes research unit at Karolinska Institutet Danderyd Hospital, a university hospital.Participants
Ten women with insulin‐dependent diabetes mellitus in the third trimester of pregnancy.Methods
Venous blood samples were collected every 15 minutes for analyses of oestriol, progesterone, human placental lactogen and placental growth hormone, during the 150 min of a hyperinsulinaemic hypoglycaemic clamp, which maintained arterial blood‐glucose level of about 2–2 mmol/l.Main outcome measures
Levels of analysed placental hormones during hypoglycaemia.Results
A statistically significant increase was observed in placental growth hormone during hypoglycaemia (P < 0.0001), whereas the placental hormones progesterone, human placental lactogen and oestriol did not show changes of clinical significance.Conclusions
The increase in placental growth hormone indicates that the placenta is an endocrine organ which may take an active part in acute metabolic processes, such as here in the hormonal counterregulation of hypoglycaemia.