bluuebunny/crossref_metadata_2025_split huggingface dataset:
An objective and subjective assessment of uterine blood loss in postmenopausal women on hormone replacement therapy
Authors: SPORRONG TOMMY , RYBO GÖRAN , MATTSSON LARS ÅKE , VILBERGSON GUDJON , CRONA NILS 
Published: August 2005

ABSTRACTObjective
To determine the volume of withdrawal blood loss in women taking hormone replacement therapy (HRT).Design
Prospective randomized double blind cross‐over trial.Subjects
Twenty‐nine postmenopausal women, with climacteric symptoms.Interventions
The women were treated with cycles of 2 mg oestradiol valerate for 21 days combined with either 250 μg levonorgestrel or 10 mg medroxyprogesterone acetate, for the last ten days. Each woman was randomly allocated to one of the preparations and switched to the other after four months.Twenty‐nine postmenopausal women, with climacteric symptoms.Main outcome measures
Uterine blood loss was estimated by the alkaline haematin method. Bleeding patterns were recorded specifying the number of days with bleeding and subjective rating of the amount of blood lost.Results and conclusions
The mean uterine blood loss was 35.2 ml and was equivalent to the normal menstrual blood loss. There was no significant difference between therapies but the women themselves considered that they bled more heavily when taking the levonorgestrel combination. The intraindividual variation in blood loss was small, independent of preparation taken, but the variation between individuals was large. Withdrawal bleeding started 2–3 days earlier when the women used the medroxyprogesterone acetate compared to the levonorgestrel formulation.
Study of the birthweight of parents experiencing unexplained recurrent miscarriages
Authors: CHRISTIANSEN O. B. , MATHIESEN O. , LAURITSEN J. G. , GRUNNET N. 
Published: August 2005

ABSTRACTObjective
To examine birthweight and preterm birth rates in couples with unexplained recurrent miscarriages.Design
A case control study. Birth data of couples with recurrent miscarriages were obtained from midwife records. Time and sex‐matched births from the same records served as controls.Setting
A Regional Hospital in Denmark.Subjects
79 singleborn women with recurrent miscarriages and 60 of their male partners comprised the main study groups. Two control groups comprised 474 female and 360 male singleborn infants who survived day 7 postpartum.Main outcome measures
Mean birthweight in the two main study groups and in subgroups with histories of 3, 4 and ≥5 miscarriages.Results
The mean birthweight of the women with recurrent miscarriages was 3265 g (SE 70) and in female controls 3414 g (SE 23) (P<0.025). The 17 women with five or more miscarriages had a mean birthweight of 2991 g (SD 140) (P<0.001 compared with controls). Of the women in the study group 10.8% were born preterm compared with 2.9% of the controls (P= 0.01). The mean birthweight of the male partners in the study group, 3470 g (SE 68), did not differ significantly from that of 3504 g (SE 31) in the male controls (P<0.5).Conclusions
Women suffering unexplained recurrent miscarriages have on average had a significantly lower than normal birthweight themselves, whereas this was not observed in their male partners. This points towards the existence of a birthweight‐reducing trait associated with recurrent miscarriages, the trait being manifest only in the woman.
Leiomyosarcomas have a poorer prognosis than mixed mesodermal tumours when adjusting for known prognostic factors: the result of a retrospective study of 423 cases of uterine sarcoma
Authors: OLÁH K. S. , DUNN J. A. , GEE H. 
Published: August 2005

ABSTRACTObjectiveTo determine the survival data for the various tumour types of uterine sarcoma and determine the influence of various prognostic factors on survival.DesignRetrospective analysis of all uterine sarcoma cases registered in the 15 year period 1967–1981.SettingWest Midlands Regional Cancer Registry, serving a catchment area of 2.6 million women.Subjects423 women registered as having a uterine sarcoma; 367 of these were associated with the two main histological types, leiomyosarcomas (LMS) and mixed mesodermal tumours (MMT).Main outcome measuresDuration of survival was taken as the primary endpoint.ResultsThe overall 5‐year survival for uterine sarcomas in this series was 31%, with the major prognostic indicator being tumour stage. Survival for mixed mesodermal tumours is similar to other sarcomas despite a tendency towards less differentiation, wider dissemination and a greater age of the patient at diagnosis. Multivariate analysis shows that for cases with similar stage, age and grade, mixed mesodermal tumours have a better prognosis than leiomyosarcomas.ConclusionsThese results demonstrate the danger of considering each variable in isolation when the relation between variables can lead to spurious significance or lack of significance because of the imbalances in the numbers between groups of prognostic importance. This study underlines the need for an adequate inspection of the infra‐abdominal contents at the time of hysterectomy for uterine fibroids.
Higher multiple births and the modern management of infertility in Britain
Authors: LEVENE MALCOLM I. , WILD JENNIFER , STEER PHILIP 
Published: August 2005

ABSTRACTObjective
To assess prospectively the number of triplet and higher multiple births born in 1989 and their methods of conception. To assess obstetric factors and the effect of these pregnancies on neonatal medical Services.Design
All consultant paediatricians received a monthly card asking whether they had been involved in the management of triplet and higher multiple pregnancies delivered after 22 weeks gestation. Detailed questionnaire sent to those giving a positive response.Setting
British Paediatric Surveillance Unit organized mailings to all members of the British Paediatric Association working in the British Isles.Subjects
156 pregnancies resulting in 482 babies (143 triplets, 12 quadruplets and l quintuplet set). These data were compared to nationally collected OPCS data.Main outcome measures
Method of conception, obstetric performance, neonatal outcome.Results
Of the 156 pregnancies, 47 (31%) were conceived naturally, 52 (34%) had ovarian Stimulation (usually with clomiphene or gonadotrophins) 37 (24%) had IVF and 17(11%) GIFT. All quadruplet and quintuplet pregnancies were established after assisted reproduction. Mothers who had had IVF were significantly older than those who had ovulation induction alone. The median gestation at birth was 33 weeks. Overall 181 (40%) of the babies required intensive care for a median duration of 5 days. The perinatal mortality of the triplets alone and quads and quins together was 70 and 104 per 1000 respectively.Conclusions
Assisted reproduction is the major cause of triplets and higher multiple births and ovarian Stimulation is the single most important technique currently in use. These babies are very likely to be born pre term and make consider‐able demands on neonatal intensive care facilities.
Cone biopsy: has endocervical sampling a role?
Authors: ANDERSON D. J. M. , STRACHAN F. , PARKIN D. E. 
Published: August 2005

ABSTRACTObjective
To investigate the sensitivity, specificity and predictive value of endocervical sampling in women with abnormal cervical smears.Design
A randomized study of two methods of endocervical sampling.Setting
Colposcopy clinic at Aberdeen Royal Infirmary.Subjects
100 women with abnormal cervical smears selected for cone biopsy according to current colposcopy criteria.Interventions
53 women were randomized to have endocervical sampling with the Kevorkian curette and 47 to have sampling with the Medscand endocervical brush.Main outcome measures
Cytology and histology results from endocervical sampling compared with cone biopsy histology.Results
The overall sensitivity of endocervical sampling was 56%, with a false negative rate of 44% and a negative predictive value of 26%.Conclusions
Endocervical sampling should not influence management when colposcopy is unsatisfactory.
Lack of relation between fetal blood gases and fetal blood flow velocity waveform indices found in rhesus isoimmunised pregnancies
Authors: LEGARTH JESPER , LINGMAN GORAN , STANGENBERG MAGNUS , RAHMAN FERYAL 
Published: August 2005

ABSTRACTObjective
To investigate the relation between umbilical vein blood gas components and the vascular resistance in four fetal arteries in Rh‐immunised pregnancies.Design
A prospective observational study over a 4‐month period.Setting
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.Subjects
Fifteen Rh‐isoimmunised pregnant women.Interventions
Pulsed Doppler examinations of the embilical artery, fetal internal carotid artery, thoracic aorta and abdominal aorta before transabdominal fetal blood sampling from the umbilical vein on 38 occasions.Main outcome measures
Doppler flow velocity pulsatility index (PI), systolic/ diastolic ratio (A/B) and resistance index (RI) in the four fetal arteries investigated were related to the umbilical vein blood gases and acid‐base status (PO2, PCO2, O2‐content, CO2‐content, HCO3, base excess and lactate concentration).Results
There were no correlations between the Doppler indices in any of the vessels studied and the blood gases components in the umbilical vein. The ratios between the corresponding Doppler indices in the different vessels were also independent of the blood gases and acid‐base status and there were no significant differences in the Doppler indices in the same vessel between fetuses with blood gas values over the 75th centile and those with values below the 25th centile.Conclusion
This study does not support a reduction in peripheral vascular resistance in the fetal cerebrum in relation to fetal hypoxia in Rh‐immunized pregnancies.
A comparison between computerised (mean range) and clinical visual cardiotocographic assessment
Authors: CHENG L. C. , GIBB D. M. F. , AJAYI R. A. , SOOTHILL P. W. 
Published: August 2005

ABSTRACTObjective
To compare Computer cardiotocographic (CTG) analysis with clinical visual analysis.Design
A retrospective blind comparison of the two techniques of CTG assessment.Setting
Fetal Assessment Unit, King's College Hospital, London.Subjects
One hundred CTG traces of women referred to the unit were studied; the traces were taken after 32 weeks' gestation, within 10 days of delivery and where outcome was known.Interventions
The CTG traces were assessed both by the Computer (System 8000 computerised CTG analyser, Oxford Sonicaid Ltd) and visually, by one of us.Main outcome
Computer mean range from 0 to 80 in ms clinical visual CTG score from 0 to 80 (arbitrary units). A score <20 is ominous; suspicious when between 20 and 30; and normal when >30.Results
Therea was close correlation between the Computer mean range and clinical visual assessment (r= 0.78, n = 100, P= 0.001). However, there were 13 occa‐sions where the Computer classified the trace as abnormal when clinical visual assessment was normal, indicating Computer false positives. All these pregnancies had normal outcomes. There were no traces where Computer analysis was normal and clinical visual assessment abnormal.Conclusions
Computerised CTG analysis gives an objective assessment which agrees closely with experienced visual assessment. It also provides a number which can be used to assess the value of fetal heart rate analysis.
The risk of acute myocardial infarction after oestrogen and oestrogen‐progestogen replacement
Authors: FALKEBORN MARGARETA , PERSSON INGEMAR , ADAMI HANS‐OLOV , BERGSTRÖM REINHOLD , EAKER ELAINE , LITHELL HANS , MOHSEN RAWYA , NAESSEN TORD 
Published: August 2005

ABSTRACTObjective
To determine the relative risk of developing a first acute myocardial infarction after treatment with oestrogens alone or oestrogen‐progestogen combinations.Design
Prospective cohort study utilizing a prescription‐based and record linkage System for a follow‐up period from 1977 to 1983. Average individual observation time was 5–8 years.Setting
The entire female population of the Uppsala Health Care Region (14 million inhabitants), one‐sixth of the total Swedish population.Subjects
23 174 women aged 35 years and older, identified from pharmacy records as having been prescribed non‐contraceptive oestrogens during 1977–1980.Outcomes
Admissions to hospitals for first acute myocardial infarctions.Results
Overall, 227 cases of a first acute myocardial infarction were observed as against 281–l expected, RR=0.81 (95% confidence limits 0.71 to 0.92). Women who were younger than 60 years at entry into the study and prescribed oestradiol com‐pounds (1–2 mg) or conjugated oestrogens (0.625–1.25 mg) showed a significant 30% reduction of the relative risk (RR=0.69,0.54 to 0.86). Those prescribed a com‐bined oestradiol‐levonorgestrel brand also demonstrated a significantly lowered relative risk (RR=0.53, 0.30 to 0.87). The risk estimates were near unity during the first year of follow‐up but decreased during subsequent years. Exposure to the weak oestrogen oestriol did not alter the risk.Conclusion
Hormonal replacement therapy with oestrogens alone, and maybe also when cyclically combined with progestogens, can reduce the risk of acute myocardial infarction.
The efficacy of phenytoin in relation to serum levels in severe pre‐eclampsia and eclampsia
Authors: NAIDU S. , MOODLEY J. , BOTHA J. , McFADYEN L. 
Published: August 2005

ABSTRACTObjectives
To investigate the efficacy of phenytoin in relation to total and free serum levels in patients with severe pre‐eclampsia and eclampsia.Design
Prospective descriptive study.Setting
Labour Ward, King Edward VIII Hospital, Durban, South Africa. Tertiary referral centre serving an underprivileged community.Subjects
Eleven patients admitted with a hypertensive crisis. Four patients had eclampsia and 7 had impending eclampsia.Main outcome measures
Free and total phenytoin levels; efficacy of phenytoin as an anticonvulsant and side‐effects of therapy.Results
Although total phenytoin levels were within the therapeutic range, free phenytoin levels were abnormally high in all patients. Three patients (2 with eclampsia and 1 with imminent eclampsia) each had a seizure after phenytoin treatment had been initiated.Conclusion
Neither total nor free phenytoin levels were good predictors of seizure control. It is postulated that the poor performance of phenytoin as an anticonvulsant in severe eclampsia may relate to inadequate distribution of the drug to the brain as a result of cerebral oedema and poor cerebral perfusion rather than paradoxical seizure activity associated with high free phenytoin levels.
Differences between obstetricians in caesarean section rates and the management of labour
Authors: GUILLEMETTE JULIE , ERASER WILLIAM D. 
Published: August 2005

ABSTRACTObjective
To determine if interobstetrician variation in caesarean section rates was associated with different approaches to the management of labour.Design
A retrospective cohort study.Setting
A tertiary care teaching hospital in Quebec, Canada.Subjects
546 nulliparae in spontaneous labour at term were grouped according to the rate of caesarean sections for dystocia of their obstetrician (high: women of two obstetricians with rates of 13.2% and 15.0%; and low: women of three obstetricians with rates of 6.0%, 6.2% and 6.5%).Main outcome measures
Frequency and timing of oxytocin, epidural, amniotomy, forceps.Secondary outcome measures
Indicators of neonatal asphyxia and trauma.Results
No difference between groups was observed in the frequency or timing of use of oxytocin or epidural analgesia. Amniotomy was practised earlier by the obstetricians in the high group. Differences in section rates for dystocia were greatest in the second stage (low—24%, high—7.9%). Obstetricians in the low group intervened earlier with forceps or vacuum extractor. Nine babies (all in the low group), 8 of whom had had an instrumental vaginal delivery, suffered trauma (5 clavicular fractures, 4 facial palsies) (Fisher's exact test, P= 0.0139).Conclusion
The practice patterns of the two groups are distinguished by differences in management of the second stage. Although lower section rates were associated with an increase in mild neonatal trauma, this appears to have been mediated by the earlier use of forceps in this group.
Prenatal microbiological risk factors associated with preterm birth
Authors: McDONALD H. M. , O'LOUGHLIN J. A. , JOLLEY P. , VIGNESWARAN R. , McDONALD P. J. 
Published: August 2005

ABSTRACTObjective
To study the vaginal flora of pregnant women at 22–28 weeks gestation to determine whether the presence of specific micro‐organisms is significantly associated with preterm birth and prelabour rupture of the membranes.Design
A comprehensive descriptive prospective study of the vaginal micro‐flora of women between 22–28 weeks gestation comparing those who gave birth preterm (<37 weeks) with those who gave birth at term. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Tri‐chomonas vaginalis. Multiple logistic regression analysis was used to account for confounding obstetric and demographic variables.Setting
The Queen Victoria Hospital, Adelaide, South Australia.Subjects
135 women who gave birth preterm compared to 651 women who gave birth at term.Main outcome measure
Preterm birth and preterm prelabour rupture of membranes (PROM)Results
The prevalence of Gardnerella vaginalis between 22–28 weeks was significantly higher in women who gave birth preterm compared to women who gave birth at term (23%vs 15%; multiple logistic regression odds ratio (OR) 1.8, 95% confidence intervals (CI) 1.01–3.2, P<0.05. Ureaplasma urealyticum was also found in a higher proportion of women who gave birth preterm (49% vs 32% OR 1.7, 95% CI 1.1–2.6, P<0.0005). Preterm PROM occurred in 42% of whom 60% were carriers of U. urealyticum between 22–28 weeks, compared with 32% in the term group (OR 3.2, CI 1.7–6.1, f<0.0005). When women who received antibiotics between the mid‐trimester swab and labour were excluded, G. vaginalis was also significantly associated with preterm PROM (OR 2.7, CI 1.1–6.5, P<0.05). The presence of vaginal enteropharyngeal bacteria (E. coli, Klebsiella spp., Haemophilus spp., Staph. aureus) in the midtrimester was not predictive of preterm birth, but when these organisms were found in labour, they appeared to have been acquired later in the pregnancy.Conclusion
Women carrying G. vaginalis or U. urealyticum during the midtrimester had nearly twice the risk of preterm birth, while women positive for U. urealyticum had more than a threefold risk of preterm PROM.
Can out‐of‐hours work by junior doctors in obstetrics be reduced?
Authors: McKEE MARTIN , PRIEST PATRICIA , GINZLER MARIA , BLACK NICK 
Published: August 2005

ABSTRACTObjective
Against a background of concerns about the hours of work of junior doctors, this study examines how the night‐time work of junior staff in obstetrics may be reduced by giving greater responsibility to midwives.Design
In the first phase of the study, the tasks undertaken at night in four hospitals were identified. In the second phase a nominal group technique was used to seek the extent of agreement among professionals about the appropriateness of postponing surgery to the following day in certain circumstances.Results
There were considerable variations between hospitals in the rate of obstetric intervention and the division of tasks between doctors and midwives. The panel concluded that many tasks currently performed by senior house officers could be undertaken by midwives.Conclusion
This study suggests that there scope for reducing the workload of junior obstetricians at night through the adoption of an extended role by midwives.
The multidisciplinary management of a family with epithelial ovarian cancer
Authors: CRUICKSHANK D. J. , HAITES N. , ANDERSON S. , MATHESON H. , HALL M. H. , MILNER B. , AH‐SEE A. , GUNN I. , EREMIN O. , GILBERT F. , JOHNSTON A. W. 
Published: August 2005

ABSTRACTObjective
To describe the management of a family with an inherited predisposition to ovarian and breast cancer. Particular attention is paid to the problems of contraception, screening, prophylactic surgery and hormone replacement therapy.Setting
The multidisciplinary Grampian Familial Epithelial Overian Cancer Study Group.Subjects
162 members of a family extending over five generations. In the third generation, five of the 10 women died with epithelial ovarian cancer. Three women in generation IV have developed premenopausal breast cancer. There are now 78 family members in the fifth generation aged between 2 and 22 years.Interventions
Counselling of female family members is started at the age of 18 years. The combined oral contraceptive pill is advocated to suppress ovulation. Gynaecological follow‐up after the age of 28 includes yearly pelvic examination, transvaginal ultrasonography and serum CA125 estimation. Laparoscopy with peritoneal cytology is indicated if any part of this yearly assessment is abnormal. Prophylactic oophorectomy is advised between the ages of 35 and 40 years after the family is complete. In generation IV, 20 of the 29 women have undergone prophylactic oophorectomy. Oestrogen hormone replacement therapy with a cyclical progestogen is recommended after prophylactic oophorectomy. Breast cancer screening starts at the age of 25 and involves annual clinical breast examination augmented by mammography and breast ultrasound.Conclusions
Only by the careful questioning and recording of family history, including at least third degree relatives (cousins), will similar groups with familial ovarian/breast cancer be identified. When predisposing genes are characterized it will be possible to identify carriers within the family and concentrate clinical effort on them while offering appropriate reassurance to those with decreased risk.
Renal sodium retention does not occur during the luteal phase of the menstrual cycle in normal women
Authors: BISSON D. L. , DUNSTER G. D. , O'HARE J. P. , HAMPTON D. , PENNEY M. D. 
Published: August 2005

ABSTRACTObjective
To determine whether weight gain due to renal sodium and water retention occurs in the luteal phase of the normal menstrual cycle.Design
Prospective observational study.Setting
Research laboratory installed with modified spa bath.Subjects
Ten normal healthy women.Intervention
Each subject underwent two experiments, one in each phase of the menstrual cycle, involving 3 h head‐out water immersion and a pre‐ and post immersion control hour. 25 ml blood samples were obtained every hour before, during and after water immersion.Main outcome measures
Renal and hormonal responses to water immersion during the luteal and proliferative phases of the cycle.Results
There was no change in weight, creatinine clearance, basal sodium excretion or plasma atrial natriuretic peptide between the two phases of the cycle. There was a significant rise in basal progesterone, plasma aldosterone and plasma renin activity in the luteal phase of the ovulatory cycles. Renal and hormonal responses to immersion including sodium and calcium excretion, elevation of atrial natriuretic peptide (ANP) and suppression of plasma aldosterone and plasma renin activity were identical in the two phases of the menstrual cycle.Conclusion
We found no evidence to support the hypothesis that renal sodium and water retention occurs in the luteal phase of the normal menstrual cycle.
Litigation and the cardiotocogram
Authors: Symonds E. M. 
Published: August 2005

ABSTRACTThe extent of the liability in obstetric litigation is discussed. Arguments between experts reveal the lack of agreed standards in cardiotocography. This paper discusses the problems which need to be addressed when defning what constitutes an abnormal cardiotocogram (CTG), how long it needs to abnormal before it is significant, the contribution made by inadequate equipment and the question of whether it is defensible to decide positively not to monitor. Records need to be archived for a minimum of 25 years.