bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales
Authors: Redburn J.C. , Murphy M.F.G. 
Published: December 2003

Objective
To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal.Design
Collation of available NHS and private sector information.Setting
England and Wales.Sample
NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage.Methods and Main Outcome Measures
NHS data by 5–year age group, year and operation type were collated for 1961–1995. non–NHS operations for 1981, 1986, and 1992/3 were back–projected. Hysterectomy incidence rates, 1961–95, were back–projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year.Results
When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55–59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25–64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing.Conclusions
True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.
Women's views on the practice of prenatal perineal massage
Authors: Labrecque Michel , Eason Erica , Marcoux Sylvie 
Published: December 2003

Objective
To determine how women who practised perineal massage during pregnancy assessed the technique.Design
Observational study within one arm of a randomised controlled trial.Setting
Five secondary and tertiary care hospitals in the Province of Quebec, Canada.Participants
Among 763 women randomised to the massage arm of a clinical trial of perineal massage during pregnancy, 684 (90%) who completed a questionnaire after delivery.Main
outcome measures A 20‐item questionnaire completed a few days after birth. The first 18 questions elicited opinions using a 6‐point Likert scale. Based on a factor analysis, 17 of these questions were classified into four categories: acceptability of perineal massage (8 items); preparation for birth (4 items); relationship with the partner (2 items); and effect of massage on delivery (3 items). Scores of each scale varied between 1 (highly negative assessment) to 6 (highly positive assessment). The last two questions asked whether women would perform the massage in their next pregnancy and whether they would recommend perineal massage to another pregnant woman. In addition, 262 also provided comments about their experience in the daily diary provided to record compliance during the trial.Results
On average, perineal massage was felt to be quite acceptable [mean (standard deviation) 4.09 (0.93)]. Pain and technical problems reported during the first week or two of massage tended to disappear after a few weeks. Women's assessment of the effect of massage on preparation for birth [4.34 (1.08)] and on delivery [4.18 (1.37)] was positive. Women's views about the effect on their relationship with their partner were either positive or negative [3.54 (1.74)] and were proportional to the partner's participation with the massage. Most women said they would massage again if they were to have another pregnancy (79%; 95% CI, 76%–82%) and would recommend it to another pregnant woman (87%; 95% CI 84%–90%).Conclusion
Overall, women's assessment of prenatal perineal massage is positive.
The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder
Authors: Steiner Meir , Romano Steven J. , Babcock Susan , Dillon Julia , Shuler Cathy , Berger Charlene , Carter Diana , Reid Robert , Stewart Donna , Steinberg Susanne , Judge Rajinder 
Published: December 2003

Objective
To determine the effectiveness of fluoxetine in alleviating physical symptoms of premenstrual dysphoric disorder.Design
Randomised, double‐blind, placebo controlled, parallel study.Setting
Canadian University based outpatient clinics.Participants
Four hundred and five subjects, of whom 320 with prospectively determined premenstrual dysphoric disorder were randomised.Methods
Randomised women were assigned to fluoxetine 20 or 60 mg/day or placebo. Common physical symptoms associated with premenstrual dysphoric disorder including breast tenderness, bloating, and headache were evaluated by visual analog scales and the self‐rated and observer premenstrual tension syndrome scales.Outcome measures
Luteal phase change from mean baseline scores to mean treatment scores for all scales.Results
Fluoxetine treatment was statistically superior to placebo, with no significant differences between the two fluoxetine dosages in their effects on physical symptoms.Conclusion
Daily fluoxetine treatment is superior to placebo in improving the most common physical symptoms associated with premenstrual dysphoric disorder.
Psychosocial characteristics of women and their partners fearing vaginal childbirth
Authors: Saisto Terhi , Salmela‐Aro Katariina , Nurmi Jari‐Erik , Halmesmäki Erja 
Published: December 2003

Objectives
To examine the personal characteristics and socio‐economic background of women and their partners fearing vaginal childbirth.Design
Questionnaire survey by the 30th week of pregnancy.Setting
Sixteen outpatient maternity centres in the capital area of Finland.Participants
Two hundred and seventy‐eight women and their partners.Main
outcome measures Personality traits, socio‐economic factors, life and partnership satisfaction and pregnancy‐ and delivery‐associated anxiety and fear.Results
The more anxiety, neuroticism, vulnerability, depression, low self‐esteem, dissatisfaction with the partnership, and lack of social support the women reported, the more they showed pregnancy‐related anxiety and fear of vaginal delivery. In multiple regression analyses psychological variables of the woman contributed most to the prediction of pregnancy‐related anxiety (increase in R2=0.20, P<0.001), the strongest predictor being general anxiety (beta = 0.28, P<0.001). Lack of support contributed most to the prediction of severe fear of vaginal delivery (increase in χ2= 13.66, P<0.01), the strongest predictor being dissatisfaction with the partnership (Wald 8.61, P<0.01). Life‐dissatisfaction reported by the partner contributed to pregnancy‐related anxiety and his dissatisfaction with the partnership contributed to the woman's fear of vaginal delivery.Conclusions
The personalities of a pregnant woman and her partner, and their relationship, influences the woman's attitude to her pregnancy and her forthcoming delivery.
Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous preterm birth
Authors: Vermeulen Gustaaf M. , van Zwet Anton A. , Bruinse Hein W. 
Published: December 2003

Objective To analyse alterations in the vaginal flora after 2% clindamycin vaginal cream or placebo administered for the prevention of preterm delivery in high risk women.Design Observational study during a randomised multicentre double‐blind placebo controlled trial.Setting Twelve city hospitals in The Netherlands.Participants One hundred and sixty‐eight women were enrolled. Alterations in the vaginal flora could be analysed in one hundred and twenty‐four women by comparing the Nugent score on entry to the trial and at 31 weeks’ gestation. The Nugent score was classified into normal, intermediate and bacterial vaginosis.Interventions Two percent clindamycin vaginal cream or placebo cream administered daily for seven days at week 26 of pregnancy.Main outcome Changes in the vaginal flora at week 31 of pregnancy.Results The placebo group consisted of 64 women and the clindamycin group of 60 women. At week 31 the vaginal flora was similar to week 26 with placebo cream but changed from normal vaginal flora to intermediate or bacterial vaginosis with 2% clindamycin vaginal cream.Conclusion Obstetricians should not prescribe 2% clindamycin vaginal cream to pregnant women with normal vaginal flora in order to reduce the incidence of preterm birth, because it has no beneficial effects and is actually harmful. 2% Clindamycin vaginal cream encourages the presence of bacterial vaginosis which is epidemiologically associated with preterm birth.
Growth hormone binding protein in normal and aneuploid pregnancy: a paradoxical decrease in trisomy 18
Authors: Wallace Euan M. , D'Antona Donato , Veveris‐Lowe Tara , Crossley Jennifer A. , Barnard Ross 
Published: December 2003

Objective To explore whether abnormalities in growth hormone binding protein (GHBP) may underlie the growth restriction associated with fetal aneuploidy.Design A retrospective casecontrol study.Setting Monash Medical Centre, Clayton, Victoria, Australia.Population Twenty‐one trisomy 18, and 30 trisomy 21 pregnancies, and 170 chromosomally normal pregnancies at 15–18 weeks of gestation representing three to five controls per case matched for source, gestation and duration of storage.Methods GHBP was measured using a ligand immunofunctional assayResults In the chromosomally normal pregnancies GHBP levels decreased slightly but significantly across the narrow gestational window studied. Compared with controls, levels of GHBP, expressed as median (95% CI) multiples of the median (MoM), in the trisomy 21 pregnancies were similar, 1.0 (0.92–1.39) MoM and 1.27 (1.04–1.50) MoM, respectively; P=0.061 (Mann‐Whitney U test) but were significantly reduced in the trisomy 18 pregnancies, 0.68 (0.51–0.84) MoM; P=0.0014 (Mann‐Whitney U test).Conclusions These data suggest that decreased levels of maternal growth hormone binding protein, and by implication growth hormone receptor complement, may underlie the early severe growth restriction that is characteristic of trisomy 18.
Does a second delivery increase the risk of anal incontinence?
Authors: Faltin Daniel L. , Sangalli Michel R. , Roche Bruno , Floris Lucia , Boulvain Michel , Weil Antoine 
Published: December 2003

Objective To evaluate the prevalence of anal incontinence and anal sphincter defects after a first vaginal delivery and assess the effect of a second delivery.Design Prospective cohort study using postal questionnaires assessing incontinence to flatus and stools at three and thirty months postnatally and anal endosonography at three months following delivery.Setting Recruitment was from the antenatal clinic at the University Hospitals of Geneva, Switzerland.Population One hundred women with a vaginal delivery of their first child.Main outcome measures Prevalence of anal incontinence and anal sphincter defects.Results Anal incontinence was reported by 16/92 (17%) of women at three months after delivery and by 11/77 (14%) at 30 months. At that time, 5/54 (9%) with no further delivery reported incontinence, compared with 6/23 (26%) of those who had had another delivery (RR 2.8, 95% CI 1.0‐8.3). Anal sphincter defects were diagnosed by endosonography in 46/87 (53%) women and were associated with reported incontinence at both three months (RR 1.9; 95% CI 1.4‐2.6) and 30 months (RR 1.9; 95% CI 1.3‐2.8) after delivery. The prevalence of anal incontinence at 30 months was highest (5/13, 39%) among those in whom a sphincter defect was diagnosed by endosonography after their first delivery and with a second delivery.Conclusion Anal incontinence after childbirth is associated with defects of the anal sphincter diagnosed by endosonography. Subsequent deliveries increase the risk of incontinence, particularly among women with a sphincter defect diagnosed after the first delivery.
Birthweight in liveborn twins: the influence of the umbilical cord insertion and fusion of placentas
Authors: Loos Ruth J. F. , Derom Catherine , Derom Robert , Vlietinck Robert 
Published: December 2003

Objective
To assess the relation of umbilical cord insertion and fusion of placentas with birthweight in monozygotic monochorionic, monozygotic dichorionic, and dizygotic twins.Design
A prospective population study.Population
4529 liveborn twin pairs whose birthweight was recorded, placentas were examined, and site of umbilical cord insertion was determined after delivery.Results
Infants with a peripheral cord insertion weighed 150g less (P<0.001) than infants with a central cord insertion. Dizygotic infants had a significantly (P<0.001) higher incidence of central cord insertion (82%) than monozygotic dichorionic (65%) and monozygotic monochorionic (53%) infants. Monozygotic dichorionic infants with fused placentas and a peripheral cord insertion weighed on average 300g less (P<0.01) than infants with separate placentas and a central cord insertion. In dizygotic infants, fusion of the placentas did not affect birthweight.Conclusions
Umbilical cord insertion is associated with birthweight in all types of twins. Fusion of the placentas only affects the birthweight of monozygotic dichorionic, not that of dizygotic infants. This might be due to the greater proximity of implantation of monozygotic dichorionic twins. Dizygotic twins weighed more than monozygotic twins only when placentas were fused and cord insertion was peripheral. Hence, the difference between the mean birthweights of dizygotic, monozygotic dichorionic, and monozygotic monochorionic infants may originate from the least favourable antenatal situation, namely fused placentas with a peripheral cord insertion, which occurs most frequently in monozygotic twins.
Abnormal Doppler velocimetry and blood flow volume in the middle cerebral artery in very severe intrauterine growth restriction: is the occurrence of reversal of compensatory flow too late?
Authors: Konje Justin C. , Bell Stephen C. , Taylor David J. 
Published: December 2003

Objectives
To determine the time course of quantified volumetric flow and pulsatility index changes in the middle cerebral arteries of severe intrauterine growth restricted fetuses with absent or reversed end diastolic flow velocities (AREDFV) on umbilical artery Doppler with a view to defining the threshold for early intervention before the onset of reversal of adaptation.Setting
Fetal growth clinic of a large UK teaching hospital.Sample
Seventeen severe intrauterine growth restricted (AC<third centile for gestation and gender) fetuses with abnormal umbilical artery Doppler velocimetry and oligohydramnios (amniotic fluid index <third centile for gestation).Methods
One to three daily Doppler velocimetry and quantified volume flow of the middle cerebral artery Doppler velocimetry of the umbilical arteries and daily cardiotocography.Results
Reversal of adaptation occurred in eight fetuses, four of which ended as stillbirths and four as neonatal deaths. In two of these fetuses, this had already occurred before the diagnosis of intrauterine growth restriction. In the others, the onset was rapid and difficult to predict. Volume flow in the middle cerebral arteries decreased in those fetuses exhibiting reversal of adaptation but rose in the nine in which compensatory Doppler indices persisted. The decrease in volume flow occurred before the onset of reversal of adaptation in the pulsatility index. In the fetuses exhibiting reversal of adaptation, the rise in the pulsatility index was consistent over 48 hours compared with the physiological fluctuations in pulsatility index in some fetuses where the rise was only for 24 hours followed by a fall. Quantified volume flow fell in the fetuses before reversal of adaptation set‐in. The umbilical artery Doppler indices fluctuated between absent and reversed end diastolic velocities within the same fetus irrespective of the changes in the middle cerebral artery Doppler indices.Conclusion
Reversal of adaptation is of sudden onset and is associated with poor prognosis. Predicting its occurrence on Doppler indices is difficult as the changes may be very rapid. However, volume flow changes appear to be slower and of earlier onset than the pulsatility index changes. This may therefore be a more useful tool in predicting imminent reversal of adaptation and therefore early delivery.
Spontaneous contractions of myometrium from humans, non‐human primate and rodents are sensitive to selective oxytocin receptor antagonism in vitro
Authors: Wilson R.J. , Allen M.J. , Nandi M. , Giles H. , Thornton S. 
Published: December 2003

Objectives
To determine whether: 1. oxytocin receptor antagonists influence spontaneous contractions of myometrium from humans, non‐human primates and rodents (in vitro), and 2. vasopressin V1a receptor antagonism is important for inhibition of spontaneous contractions in human myometrium.Design
In vitro pharmacology of spontaneous contractions of myometrium from humans and animals.Setting
The research laboratories of a university department of obstetrics and gynaecology and a pharmaceutical industry research centre.Interventions
Samples of human myometrium were obtained at caesarean section. Tissue strips were suspended in organ baths for isometric force recording. Cumulative concentration effect curves to a selective oxytocin receptor antagonist (L‐371,257) and a mixed oxytocin/vasopressin V1a receptor antagonist (atosiban) were obtained. The effect of L‐371,257 was also determined in myometrium from non‐pregnant rats and marmosets.Main
outcome measures The inhibition of spontaneous myometrial contractions in vitro.Results
L‐371,257 and atosiban significantly inhibited spontaneous activity of human myometrium in a concentration‐related manner (P<0.05), although the effect was more pronounced with L‐371,257. Spontaneous contractions of myometrium from non‐pregnant rats and marmosets were also inhibited by L‐371,257 (atosiban was not tested).Conclusions
Spontaneous contractions of myometrium from humans, marmosets and rats are, at least in part, dependent on oxytocin receptor activity, in vitro. L‐371,257 and atosiban may be inverse agonists. Selective non‐peptide oxytocin receptor antagonists may be effective tocolytics.
The selenium status of women with a history of recurrent miscarriage
Authors: Al‐Kunani A.S. , Knight R. , Haswell S.J. , Thompson J.W. , Lindow S.W. 
Published: December 2003

Objective
To assess the relationship between selenium levels in human blood and hair, and the risk of recurrent miscarriages.Design
Case–control study.Participants
Two groups of non‐pregnant women: 18 women with one or more successful pregnancies and no history of miscarriage (control group); 26 women with a history of recurrent miscarriage (≥ 3) with no subsequent successful pregnancies (study group).Methods
Samples of venous blood and scalp hair were collected and the selenium content analysed by inductively coupled plasma mass spectrometry.Results
No significance difference was found between the level of selenium in the blood samples of the women in each group. There was a significant reduction in the mean hair selenium level in the recurrent miscarriage group compared with the control group (0.14μg/g vs 0.34μg/g). Further analysis of the recurrent miscarriage group revealed no relationship between levels of serum or hair selenium with parity. There was a significantly greater proportion of women in the control group who ate cereals, vitamin supplements, and liver or kidney.Conclusion
There was evidence of selenium deficiency in women with recurrent miscarriages compared with a control group of women with a good reproductive performance. This difference was seen in hair samples but not serum samples and therefore may not represent a simple nutritional deficiency. The importance of selenium deficiency in miscarriage has still not been determined.
Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology
Authors: Develioglu Osman H. , Askalli Cenk , Uncu Gurkan , Samli Billur , Daragenli Omer 
Published: December 2003

Objective
To study the value of creatine kinase in ectopic pregnancy with reference to tubal histopathology.Design
Prospective controlled study.Setting
Academic tertiary‐care institution.Population
Thirty‐two women with ectopic pregnancy and 20 controls with intrauterine pregnancies.Methods
Creatine kinase and β‐hCG levels were measured on admission. Ectopic pregnancies were removed at surgery and examined histologically.Main outcome measures
Tubal localisation and integrity of ectopic pregnancies as judged at surgery and later histologically, and placental growth patterns in unruptured ectopic pregnancies classified as intraluminal, extraluminal or mixed as determined histologically.Results
Creatine kinase levels were higher in isthmic than ampullary ectopic pregnancies (P= 0.011), and higher in ruptured than in unruptured cases (P= 0.003) and normal pregnancies (P < 0.0001). A creatine kinase value >120iu/L was 65% sensitive and 87% specific in discriminating ruptured from unruptured ectopic pregnancies. Creatine kinase levels were above this cutoff in two of five unruptured ampullary ectopic pregnancies with invasive trophoblastic growth, yet in none of nine cases with intraluminally confined placentation (P= 0.04). Creatine kinase was positively correlated with gestational age in ruptured (P= 0.007), but not in unruptured ectopic pregnancies or normal pregnancies.Conclusions
Serum creatine kinase may help in discriminating ruptured from unruptured ectopic pregnancies, while it is not useful for the primary diagnosis of ectopic pregnancy. An increase in creatine kinase levels accompanying muscular damage in ectopic pregnancy probably antedates tubal rupture, and may be related to trophoblastic growth patterns.