bluuebunny/crossref_metadata_2025_split huggingface dataset:
Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding
Authors: HOFMEYR G. JUSTUS , NIKODEM V. CHERYL , WOLMAN WENDY‐LYNNE , CHALMERS BEVERLEY E. , KRAMER TAMI 
Published: August 2005

AbstractObjective— To measure the effects of supportive companionship on labour and various aspects of adaptation to parenthood, and thus by inference the adverse effects of a clinically orientated labour environment on these processes.Design— Randomized controlled trial.Setting— A community hospital familiar to most of the participants, with a conventional, clinically‐orientated labour ward.Subjects— Nulliparous women in uncomplicated labour.Intervention— Supportive companionship from volunteers from the community with no medical nor nursing experience, concentrating on comfort, reassurance and praise.Main outcome measures— Duration of labour, use of analgesia, perceptions of labour and breastfeeding success.Results— Companionship had no measurable effect on the progress of labour. Diastolic blood pressure and use of analgesia were modestly but significantly reduced. The support group were more likely to report that they felt that they had coped well during labour (60 vs 24%, P<0.00001). Their mean labour pain scores (26.4 vs 44.2, P<0.00001) and state anxiety scores (28.2 vs 37.8, P<0.00001) were lower than those of the control group. Compared with the control group (n= 75), at 6 weeks women in the support group (n= 74) were more likely to be breastfeeding exclusively (51 vs 29%. P<0.01); and to be feeding at flexible intervals (81 vs 47%, P < 0.0001).Conclusions— Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. These effects may be reduced by the provision of additional companionship during labour aimed to promote self‐esteem.
The effect of induced abortion on subsequent pregnancy outcome
Authors: FRANK PETER I. , McNAMEE ROSANNE , HANNAFORD PHILIP C. , KAY CLIFFORD R. , HIRSCH SYBIL 
Published: August 2005

AbstractObjective—To investigate the effect of induced abortion on the outcome of the next pregnancy.Design—Long‐term prospective controlled cohort study.Setting—Joint Royal College of General Practitioners/Royal College of Obste‐ tricians and Gynaecologists study based in general practice in England, Scotland and Wales.Subjects—1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non‐abortion group).Main outcome measures—Non‐viable outcome (spontaneous or missed miscar‐ riage, ectopic pregnancy or stillbirth), birthweight, length of gestation.Results—Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non‐abortion group the rela‐ tive risk of a non‐viable outcome in the abortion group was 1.01 (95% CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI −76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI −2–2 days to + 0.4 days) than in the non‐abortion group. Women who had their abortions in NHS premises had an increased risk of a non‐viable outcome (RR 2.55, 95% CI 1–31 to 4.94) and had babies with significantly lower mean birth‐ weight (− 119 g, 95% CI −233 g to +5 g) compared with those who obtained their operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non‐viable outcome. Although these differences remained after adjustment for a number of important variables, it is possible that factors not measured in the present study, such as economic status and occupation, played a contributory role.Conclusion—Overall, induced abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy.
The role of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of ectopic pregnancy in Gabon
Authors: VILLE Y. , LERUEZ M. , GLOWACZOWER E. , ROBERTSON J. N. , WARD M. E. 
Published: August 2005

AbstractObjective— To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae.Design— A prospective observational study with two comparison groups.Setting— A general hospital in Franceville, Gabon.Subjects— Forty‐five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation.Main outcome measures— Serum levels of IgG and IgA antibodies to C. trachomatis (L1 and rMOMP) and N. gonorrhoeae (pili) in all the women. In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied.Results— IgG and IgA antibodies to C. trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P<0.0001). IgG and IgA antibodies to N. gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy.Conclusions— Infection with chlamydia, and probably with N. gonorrhoeae, is an important factor in the causation of ectopic pregnancy in Gabon.
A comparison of perinatal outcome, antenatal and intrapartum care between England and Wales, and France
Authors: MASCARENHAS L. , ELIOT B. W. , MACKENZIE I. Z. 
Published: August 2005

ABSTRACTObjective
To compare the national statistics of England and Wales with the national statistics of France, and see if there are significant differences in obstetric care resulting in a significantly different perinatal outcome.Design
Retrospective analysis of national statistics 1970–1989 (latest available figures) relating to perinatal outcome, antenatal and intrapartum care.Setting
HIPE and DoH statistics (England and Wales); INSERM statistics (France).Subjects
Pregnant women residents of England and Wales, and of France.Interventions
Different aspects of obstetric care for which comparable data were available from national statistics.Main outcome measures
Perinatal mortality rate, incidence of low birth weight and preterm delivery; type of antenatal care, number of antenatal visits and in‐patient admission rate; induction of labour rate, incidence of acceleration of labour with oxytocin, incidence of spontaneous and operative deliveries and person undertaking delivery; episiotomy rate and postnatal in‐patient stay.Results
More antenatal intervention and marginally less intrapartum intervention in England and Wales as compared with France. No significant difference in the perinatal mortality rate, in the incidence of low birth weight or preterm delivery, with similar trends being observed over the two decades.Conclusion
Significant differences in obstetric practices between the two countries without a major difference in perinatal outcome.
A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)—a preliminary report
Authors: CULLIMORE J. E. , LUESLEY D. M. , ROLLASON T. P. , BYRNE P. , BUCKLEY C. H. , ANDERSON M. , WILLIAMS D. R. , WADDELL C. , HUDSON E. , SHAFI M. I. 
Published: August 2005

ABSTRACTObjective
To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN).Design
A multicentre prospective cohort study.Setting
CRC Clinical Trials Unit, Birmingham.Subjects
84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study.Intervention/Protocol
Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy.Main outcome measures
Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy.Results
Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow‐up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3.Conclusions
Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.
A randomized prospective study comparing delivery with metal and silicone rubber vacuum extractor cups
Authors: CHENOY RASHNA , JOHANSON R. 
Published: August 2005

ABSTRACTObjective
To determine the relative benefits and complications of assisted vaginal delivery with metal and silicone rubber vacuum extractor cups.Design
Prospective randomized controlled study.Setting
A busy referral maternity hospital in Kathmandu, Nepal.Subjects
101 women were assigned to delivery with the Silc‐cup and 98 to delivery with the metal cup.Main outcome measures
Success rate at achieving delivery with the assigned Instrument and incidence of neonatal trauma. Analysis was by ‘intention to deliver’ with women remaining in their original group regardless of the eventual mode of delivery.Results
Randomization resulted in two groups of women similar in respect of age, parity, gestation and indication for delivery. The overall success rate was similar for the two instruments (Silc‐cup 85% and metal cup 87%). The Silc‐cup was more likely to fail if there was excessive caput (seven failures compared with one in the metal cup group). The frequency of clinically significant maternal trauma was low in both groups. There were fewer babies with clinically significant scalp trauma in the Silc‐cup group (22%), compared with the metal cup group (37%).Conclusions
The data indicate a greater tendency for the Silc‐cup to fail when excessive caput is present but that metal cups are associated with increased scalp injuries.
An economic evaluation of daycare in the management of hypertension in pregnancy
Authors: TWADDLE SARA , HARPER VALERIE 
Published: August 2005

ABSTRACTObjective
To evaluate the efficiency of daycare in the management of hypertension in pregnancy compared with inpatient management with prior domiciliary visits.Design
Comparative study.Setting
Two maternity teaching hospitals, Glasgow Royal Maternity Hospital which has an established daycare unit and Aberdeen Maternity Hospital with no day‐care unit.Main outcome measures
Pregnancy outcomes in terms of maternal hypertensive complications, gestation at delivery, mode of delivery, birthweight, Apgar scores, admission rates and length of admission to special care baby unit.Results
There was no significant difference in any of the measured pregnancy outcomes between the two hospitals. The average cost of treating a woman with mild hypertension was £154.91 in Glasgow and £136.59 in Aberdeen. The average cost of treating women with a single episode of hypertension and women with a past history of hypertension was £88.65 and £214.12 in Glasgow and £31.18 and £28.28 in Aberdeen, respectively. If these two groups are excluded, the average cost of treating women with mild hypertension was £172.32 in Glasgow and £201.13 in Aberdeen. The majority of women were willing to attend daycare five times per week to avoid admission.Conclusion
Daycare management of hypertension in pregnancy is more efficient than inpatient care with prior domiciliary visits for most women, but less efficient for women with transient or previous hypertension. It is very acceptable to women. Domiciliary checking of women with hypertension found at outpatient clinics would reduce resource use.
Sonographic estimation of fetal weight in diabetic pregnancy
Authors: PEDERSEN J. F. , MØLSTED‐PEDERSEN L. 
Published: August 2005

ABSTRACTObjective
To investigate whether fetal weight estimation by ultrasound in diabetic pregnancy might be based upon fetal abdominal circumference (AC) alone.Design
A retrospective study.Setting
Diabetes Center, Rigshospitalet and Ultrasound Laboratory, Glostrup Hospital, Copenhagen.Subjects
Eighty‐six diabetic pregnant women who had an ultrasound study within 2 days before delivery.Results
We assessed in 73 fetuses various formulas based upon biparietal diameter and AC against formulas based upon AC alone, and these were only marginally less effective than the more complex ones. In 86 fetuses an AC was available. These fetuses were divided into a study population and a test population. The linear model was customized for the study population. Evaluation on the test population showed that the relative error (error as a percentage of birthweight) in predicting birthweight had a Standard deviation of 7–8%. The efficacy of AC in detecting fetuses >4000 g was examined in the test population; If AC>36–0 cm was chosen as riterion for macrosomia the positive and negative predictive values were 80% (8/10) and 91% (30/33), respectively.Conclusion
Formulas for estimating fetal weight in diabetic pregnancy based on AC alone are almost as effective as more complex ones. We recommend a simple linear formula of fetal weight as a function of AC.
Detection of hydatidiform mole in maternal serum screening programmes for Down's syndrome
Authors: CUCKLE H. S. , DENSEM J. W. , WALD N. J. 
Published: August 2005

ABSTRACTObjective
To determine how frequently hydatidiform mole will be detected in a maternal serum Down's syndrome screening programme.Design
Affected pregnancies were identified using a national register. Unconjugated oestriol (μE3) and human chorionic gonadotrophin (hCG) were measured in stored serum samples and alphafetoprotein (AFP) levels were available from previous neural tube defect screening at 15–20 weeks gestation.Subjects
Ten pregnancies with a complete mole (i.e., hydropic placenta without a fetus), nine with stored serum samples and one with an AFP level only.Results
The median values were 0.08, 0.13 and 1–83 multiples of the normal median for AFP, uE3 and hCG respectively. Six out of nine (67%) tested for all three markers had a high risk of Down's syndrome given maternal age and the marker levels.Conclusion
Many molar pregnancies that have not presented clinically before 15 weeks will be detected through Down's syndrome screening.
Erythrocyte membrane composition in pregnancy‐induced hypertension: evidence for an altered lipid profile
Authors: ANCESCHI M. M. , COATA G. , COSMI E. V. , GAITI A. , TROVARELLI G. F. , DI RENZO G. C. 
Published: August 2005

ABSTRACTObjective
To investigate whether the increased membrane fluidity postulated as a possible contributing factor to the hypertensive states of pregnancy is related to the lipid composition of the erythrocyte membrane.Design
An observational case control study.Subjects
30 women with pregnancy induced hypertension, 26 normotensive pregnant women matched for gestational age, and 10 normotensive non pregnant nulliparous women.Interventions
Erythrocyte membranes were prepared from venous blood samples obtained from all the women.Main outcomes measures
Lipid analysis, including cholesterol to phospholipids ratio, distribution of phospholipid classes and fatty acid composition of total phospholipids in erythrocyte ghosts.Results
The cholesterol/phospholipid ratio was significantly higher in the women with pregnancy induced hypertension compared with the normotensive pregnant women (mean 1.24, SD 0.31, 95% CI 1.12 to 1.35 vs mean 0.90, SD 0.09, 95% CI 0.86 to 0.94; P <0.01). Normotensive non‐pregnant erythrocyte membrane cholesterol/ phospholipid ratio was 0.88 (SD 0.11, 95% CI 0.79 to 0.96). The percentage distribution of different phospholipid classes and fatty acid composition was similar in all the four groups.Conclusions
The increased cholesterol/phospholipid ratio of the erythrocyte membrane found in pregnancy‐induced hypertension represents one factor involved in the pathophysiology of this condition and a possible biochemical marker of the disease.
Distribution of renin‐containing cells in the developing human kidney: an immunocytochemical study
Authors: GRAHAM P. C. , KINGDOM J. C. P. , RAWEILY E. A. , GIBSON A. A. M. , LINDOP G. B. M. 
Published: August 2005

ABSTRACTObjective
To characterize the pattern of renin containing cells (RCC) within the human kidney between 20 weeks of gestation and 6 months of postnatal life.Design
Descriptive study using paraffin‐embedded blocks of kidney stored following postmortem examination.Methods
Sections of kidney were stained immunocytochemically using an antibody to human renin; the proportion of RCC within each of three zones (superficial, middle and deep) of the cortex, and their anatomical relation to individual glomeruli were determined. The cases were divided into five groups for analysis to gestational or postnatal age.Results
Fetal RCC were usually at the vascular pole of the most mature glomeruli within the deeper areas of the cortex and were occasionally located within glomeruli. This distribution persisted until birth, even when the kidney was histologically mature. By contrast there were fewer RCC in neonatal and infant kidneys and, as in adult kidneys, these were located predominantly in the superficial cortex.Conclusion
The change in RCC distribution around the time of normal birth may relate to the transition to independent renal function. The location and density of RCC during fetal life may influence renal perfusion and amniotic fluid production.
Clinical assessment of fetal electrocardiogram monitoring in labour
Authors: MURPHY KARL W. , RUSSELL VIRGINIA , JOHNSON PAUL , VALENTE JANE 
Published: August 2005

ABSTRACTObjective
To assess the potential clinical value of fetal electrocardiographic (ECG) monitoring in labour.Design
Descriptive study of the use of ECG waveform analysis during labour and its correlation with other indices of fetal and neonatal well‐being.Setting
Teaching hospital in Oxford.Subjects
86 high risk pregnancies.Main outcome measures
Suitability of ST Segment Analyser (Cinventa, Sweden) for clinical use; relation between the T/QRS ratio during labour (an index of ST segment and T wave elevation) and intrapartum cardiotocography, umbilical artery pH at birth and Apgar scores; T/QRS ratio trends in labour.Results
The system was robust and user‐friendly. No statistically significant relation was found between T/QRS ratios in labour and FHR abnormalities in the cardiotocograph. There was a weak relation between T/QRS ratios and umbilical artery acidosis: at a cervical dilatation of 4 cm, the Spearman rank correlation of the mean T/QRS ratio with umbilical artery actual base deficit was r =−0.31, 0.05<P<0.01. The correlation of T/QRS with the umbilical artery pH was not statistically significant, although a trend was present (Spearman rank: r=−0.26, P<0.05). Correlation of the T/QRS ratio with Apgar scores at 1 and at 5 min was not statistically significant. Only 3 of 16 infants with an Apgar score of <7at 1 min had a mean T/QRS ratio above 0.25 at any time during labour.Conclusions
Further research is necessary before a decision can be made whether this new method of fetal monitoring should be introduced into clinical practice.
In‐utero sound levels when vibroacoustic stimulation is applied to the maternal abdomen: an assessment of the possibility of cochlea damage in the fetus
Authors: ARULKUMARAN S. , TALBERT D. , HSU T. S. , CHUA S. , ANANDAKUMAR C. , RATNAM S. S. 
Published: August 2005

ABSTRACTObjective
To measure sound pressure level in utero while a vibro acoustic stimulator is applied to maternal abdomen and to calculate whether the estimated effect on fetal cochlea cilia vibration would be hazardous.Design
Prospective descriptive study.Setting
Labour ward, National University Hospital, Singapore.Subjects
Eight women undergoing induction of labour.Intervention
A hydrophone was introduced via the cervix into the uterus and placed under ultrasound guidance near the fetal ear. Sound pressure was recorded when a vibroacoustic stimulator was applied directly to the maternal abdomen and also when separated by 2 cm of air.Main outcome measures
Sound pressure levels in utero.Results
The sound level recorded from the vibrator diaphragm in air was 107 dB at 2 cm and 74 dB at 1 m. The mean sound pressure level in utero was 90.7 dB (range 75–96 dB) when the vibrator was in contact with the abdominal wall and 80.1 dB (range 70–88 dB) when separated by 2 cm of air.Conclusions
Analysis of factors affecting displacement of cochlear sensing cilia in utero show that, for equal sound pressures, sound intensity and sound vibration are about 4000 times less in amniotic fluid, compared to that produced in air. Further protection is provided by viscous and hydrodynamic features of the ear. The estimated effect on cilia vibration by the mean sound pressure registered in utero, about 90 dB, corresponds to that produced postnatally by an airborne sound registering about 40 dB, which would not be hazardous.
Evidence against a pathogenetic role for endothelin in pre‐eclampsia
Authors: BENIGNI ARIELA , ORISIO SILVIA , GASPARI FLAVIO , FRUSCA TIZIANA , AMUSO GIUSEPPE , REMUZZI GIUSEPPE 
Published: August 2005

ABSTRACTObjective
To assess whether increased placental or systemic endothelin synthesis has a pathogenic role in pre‐eclampsia (gestational proteinuric hypertension).Design
Prospective observations study.Subjects
19 women with pre‐eclampsia and 10 healthy pregnant women were studied. All were in the last trimester.Main outcome measures
Preproendothelin‐1 gene expression by Northern blot analysis and generation of endothelin‐1 precursor, big‐endothelin‐1, and endothelin isoforms, namely endothelin‐1, 2 and 3, were assessed by specific radioimmunoassays, in placental tissue. Plasma endothelin‐1 levels and urinary excretion of big‐endothelin‐1 and endothelin‐1 were measured.Results
Placental preproendothelin‐1 gene expression and immunoreactive bigendothelin‐1 and endothelin‐1, 2 and 3, were comparable in placental tissue from pre‐eclamptic and normal pregnant women. Plasma levels of endothelin‐1 did not differ between pre‐eclamptic and normal pregnancies. In contrast, urinary excretion of endothelin‐1, which is likely to reflect the renal synthesis of the peptide, was significantly decreased in pre‐eclamptic, as compared with normal pregnant women. This was not due to a decreased renal generation of endothelin‐1 precursor, since urinary excretion of big‐endothelin‐1 did not differ between pre‐eclamptic and normal pregnancies. These data suggest an increased renal endothelin‐1 breakdown in pre‐eclampsia.Conclusions
Endothelin is unlikely to play a role in the pathogenesis of pre‐eclampsia. Instead, an increased renal breakdown may have a role in limiting the negative effects of other vasoactive factors on the renal circulation.