bluuebunny/crossref_metadata_2025_split huggingface dataset:
Down's syndrome births and pregnancy terminations in 1989 to 1993: preliminary findings
Authors: Alberman Eva , Mutton David , Ide Roy , Nicholson Amanda , Bobrow Martin 
Published: August 2005

ABSTRACTObjective
To investigate changes in the numbers of Down's syndrome births and terminations of pregnancies from 1989 to 1993.Design
Data from a national register of cytogenetic diagnoses of karyotypes associated with Down's syndrome were analysed to obtain observed numbers of births and terminations of pregnancies known to be affected. Allowance was made for those cases diagnosed prenatally for whom the eventual outcome of the pregnancies had not yet been ascertained.Results
There has been an increase over the study years in the number of cytogenetic diagnoses of Down's syndrome from 1063 in 1989 to 1137 in 1993, despite an overall fall in births in England and Wales. This is largely due to the increase in antenatal screening and diagnosis, but in part also due to the rise in numbers of pregnancies at increased maternal ages. The rise in prenatally diagnosed cases, of which 92% end in termination, has been accompanied by a fall in both the estimated numbers of affected live births, from 764 in 1989 to 615 in 1993, and the rate per 1000 total live births in the same years from 1.1 to 0.9.Conclusions
Better and speedier information on the outcome of prenatally diagnosed cases of congenital anomalies such as Down's syndrome would improve the quality of information available for those auditing genetic services or those planning for the care of survivors.
Elevated levels of insulin‐like growth factor binding protein‐1 in fetal distress
Authors: Crawford R. A. F. , Hills F. A. , Farkas A. , Chard T. 
Published: August 2005

ABSTRACTObjective
To investigate the association between fetal distress (abnormal cardiotocograph tracing and/or a low fetal pH) and the levels of fetal IGFBP‐1.Design
Prospective comparative study.Subjects and methods
Twenty‐two women in labour with evidence of fetal distress defined by FIGO criteria and 19 women in uncomplicated labour. The gestation range was 37 to 42 weeks and birthweight range was 2500 to 4240 g. IGFBP‐1 was determined by radioimmunoassay.Results
The umbilical levels of IGFBP‐1 were significantly higher in the study group compared with the control group (median 282.5 μg/l versus 128 μg/l, P= 0.0046; Mann‐Whitney U test). There was a significant inverse correlation between fetal IGFBP‐1 and cord pH (r = 0.58, P≤ 0.0001). There was no difference between the maternal serum levels of IGFBP‐1 in the two groups.Conclusion
Umbilical IGFBP‐1 is elevated in association with fetal distress.
Low incidence of primary infection with toxoplasma among women in Sheffield: a seroconversion study
Authors: Zadik P. M. , Kudesia G. , Siddons A. D. 
Published: August 2005

ABSTRACTObjective
To determine the incidence of primary toxoplasma infection in women of childbearing age.Design
A retrospective study of seroconversion on stored pairs of sera taken for routine antenatal testing.Setting
The antenatal clinics and general practices of Sheffield between July 1989 and October 1992.Subjects
One thousand six hundred and twenty‐one women on whom pairs of sera, separated by more than 500 days, had been received.Main outcome measure
Rate of primary infection determined by seroconversion as measured by the presence of antibody in the second serum and its absence in the first.Results
Of 1621 women, 160 (9.9%) were initially seropositive. One seroconversion was detected in 2966 woman years of observation for susceptibles. The projected rate for primary infections was 0.23 (95% CI 0.0059–1.3) per 1000 pregnancies.Conclusions
The rate is much lower than for earlier estimates of incidence in the UK but agrees with a more recent estimate from Sheffield and suggests a falling incidence.
Nitric oxide synthase activities in placental tissue from normotensive, pre‐eclamptic and growth retarded pregnancies
Authors: Mmorris Nicholas H. , Sooranna Suren R. , Learmont Jonathan G. , Poston Lucilla , Ramsey Bruce , Pearson JeremyD. , Steer Philip J. 
Published: August 2005

ABSTRACTObjectiveTo measure nitric oxide synthase activity in tissues from the placenta, placental bed and umbilical cord at delivery in normal and complicated pregnancies.DesignA prospective blinded study.SettingThe obstetric departments of three London teaching hospitals.SubjectsSamples of whole placenta, dissected stem villous arteries, umbilical cord vessels and the placental bed of the uterus were collected at delivery and assayed for nitric oxide synthase activity. Samples of placenta were taken from ten normotensive, six pre‐eclamptic and eight growth retarded pregnancies, and stem villous arteries from a further seven normotensive pregnancies.ResultsThere was minimal placental bed nitric oxide synthase activity in each group. Placental villous homogenates from pregnancies complicated by pre‐eclampsia and fetal growth retardation had significantly lower activities of nitric oxide synthase than those from normotensive women with appropriately grown babies. There were no significant differences in calcium dependent or calcium independent nitric oxide synthase activities in the umbilical vein and artery in the normal or in the pre‐eclamptic groups. However, there was significantly more calcium dependent than calcium independent nitric oxide synthase in the umbilical veins in all groups.ConclusionsLocal nitric oxide production in the placental bed of the uterus is unlikely to contribute substantially to the low resting vascular tone in the uteroplacental circulation. However, a relative deficiency of placental nitric oxide in pregnancies complicated by fetal growth retardation and pre‐eclampsia may contribute to the development of the high impedance fetoplacental circulation found in these conditions.
Presentation and management of choriocarcinoma after nonmolar pregnancy
Authors: Tidy John A. , Rustin Gordon J. S. , Newlands Edward S. , Foskett Marianne , Fuller Sandra , Short Delia , Rowden Philippa 
Published: August 2005

ABSTRACTObjective
To ascertain the mode of presentation and treatment outcome for women with choriocarcinoma after a nonmolar pregnancy.Design
Retrospective analysis of case records between 1985 and 1994.Setting
A referral centre for trophoblastic disease.Subjects
One hundred women with choriocarcinoma: 62 after a live birth, six after a live birth preceded by a molar pregnancy and 32 after a nonmolar abortion.Results
Choriocarcinoma after nonmolar pregnancies represent 17% of the total gestational trophoblastic tumours requiring treatment. Vaginal bleeding was the commonest symptom in all groups, but symptoms from metastatic disease were important in the group presenting after a live birth. Metastatic disease was present in 31% of cases after live birth and 43% post‐abortion. The median interval between the antecedent pregnancy and choriocarcinoma was five and six months, respectively. High risk multi‐agent chemotherapy was required in 82% and 60% of cases, respectively. The mortality rate was significantly higher after a live birth than a nonmolar abortion (21%vs 6%).Conclusions
Treatment of choriocarcinoma after a live birth is associated with an unacceptably high mortality rate. Vaginal bleeding is an important early symptom and a pregnancy test should be performed if it persists after usual medical treatment.
Pregnancy with stillbirth of both twins
Authors: Rydhstroem Hakan 
Published: August 2005

Objective
To identify and evaluate clinical characteristics in pregnancy leading to stillbirth of both twins.Material and methods
All 68 twin deliveries in Sweden from 1973 to 1989 inclusive, where both twins were dead at birth, were identified by extracting information filed at the Medical Birth Registry (MBR), the National Board of Health and Welfare, Stockholm. Information in the MBR was used for analysis. A questionnaire was also distributed to each delivery unit to obtain information on ultrasound scan made before either or both twins died, and type of placentation.Results
The relative risk for like‐sexed (n= 66) vis‐à‐vis unlike‐sexed fetuses (n= 2) to suffer intrauterine death was 12.6 (95% confidence limits 4.3, 375). The rate of like‐sexed twins was 97.1%versus 72.2% for the general twin population; monochorionic placentation was identified in 50.0% of these pregnancies. In only seven was there a cause of death evident, including five pregnancies with lethal malformation. The median gestational duration was 33 weeks (range 26 to 41). For the smaller twin in the pair there was an obvious trend toward low birthweight and 16.1% were by definition small for gestational age, whereas the larger twins seemed to have a normal birthweight distribution. The proportion of pregnancies with both twins stillborn increased significantly with increasing discordance in weight (linear trend χ2= 4.5; P= 0.03). The interval between ultrasound examination showing two living fetuses and delivery was nine days or less in half the cases.Conclusion
The major risk factor for fetal deaths seems to be a like‐sexed pregnancy with a monochorionic placenta. About half of pregnancies with available information had no more than nine days between an ultrasound examination, confirming two living fetuses, and birth. The great majority of these twins did not show evidence of growth retardation, but birthweight discordance may be a risk factor for fetal death.
A population based survey of women's experience of the menopause
Authors: Porter Maureen , Penney Gillian C. , Russell Daphne , Russell Elizabeth , Templeton Allan 
Published: August 2005

Objective
To describe the prevalence of, and degree of distress caused by, 15 symptoms commonly attributed to the menopause among a random sample of women aged 45 to 54, selected from the total population of a geographically defined area.Design
Postal questionnaire survey.Setting
Grampiane Health Board area.Participants
Eight thousand women, aged 45 to 54, randomly selected from the Grampian Community Health Index.Main outcome measures
Self‐reported symptoms, including depression, and use of hormone replacement therapy (HRT) among women of differing menopausal status.Results
The response rate was 78%; 57% of respondents had experienced one or more of the 15 symptoms listed, but only 22% had found such symptoms a problem. Women's experience of classic vasomotor and atrophic symptoms varied according to menopausal status but experience of general somatic and psychological symptoms did not. Users of HRT and women whose menopause was iatrogenic found more symptoms a problem.Conclusions
Symptoms attributed to the menopause are common among women in the age group studied but often are not perceived as a problem. Among nonusers of HRT, only vasomotor and atrophic symptoms vary with menopausal status. Other somatic and psychological symptoms experienced by middle‐aged women cannot be regarded as part of the same ‘menopausal syndrome’.
A new method for measuring menstrual blood loss and its use in screening women before endometrial ablation
Authors: Gannon Michael J. , Day Philip , Hammadieh Nahed , Johnson Nicholas 
Published: August 2005

Objective
1. To develop and validate a method for measuring menstrual blood loss in a routine setting, and 2. To assess the value of measuring menstrual blood loss before endometrial ablation.Design
A prospective, observational study.Setting
Four Yorkshire hospitals: The General Infirmary at Leeds, St James's University Hospital, Leeds, St Luke's Hospital, Bradford and The Friarage Hospital, Northallerton.Participants
Three hundred and seventy‐two women who had been offered endometrial ablation for menorrhagia.Measurement
Sanitary material was washed with a nonioriic detergent in a known volume of water. The haemoglobin in a sample of solution was measured by mixing with sodium carbonate for spectrophotometric analysis.Interventions
The menstrual blood loss result was revealed to each woman. Electrosurgical endometrial ablation was performed for those who decided to have surgery.Main outcome measures
Proportion of women with normal menstrual blood loss ( 80 mL) who avoided surgery. Comparison of endometrial ablation outcome in women with and without genuine menorrhagia.Results
Thirty‐six women (10%) with normal menstrual blood loss who declined surgery continued to avoid surgery after a mean of 27 months. Two hundred and ninety‐two women were followed up for one year after endometrial ablation. Those with genuine menorrhagia (n= 122) were less likely to be dissatisfied (9%vs 18%) (OR 23, 95% CI 1.1–4.7) or to require hysterectomy (4%vs 7%) (OR 1.8, 95% CI 06–52) than women with normal menstrual blood loss (n= 170).Conclusions
The objective diagnosis of menorrhagia can be undertaken in a routine setting and may provide some women, who have a normal menstrual blood loss, sufficient reassurance to refrain from surgery. Women with genuine menorrhagia have a better outcome after endometrial ablation than those with normal menstrual blood loss.
Comparison of Gram‐stained smears prepared from blind vaginal swabs with those obtained at speculum examination for the assessment of vaginal flora
Authors: Morgan D. John , Aboud Catherine J. , McCaffrey I. Mary B. , Bhide Supriya A. , Taylor‐Robinson David , Lamont Ronald F. 
Published: August 2005

Objective
To determine whether Gram‐stained smears obtained from blind vaginal swabs could be used reliably for the assessment of the vaginal flora.Design
A prospective, blind comparative study.Setting
The antenatal clinic of a district general hospital.Participants
Eighty‐eight women examined and screened for the presence of bacterial vaginosis during their first antenatal clinic visit. Two smears were obtained for each woman, the first prepared from a vaginal swab taken blindly and the second at speculum examination. The smears were Gram‐stained and classified according to the Nugent score: Grade 1 (normal), Grade 2 (intermediate), Grade 3 (bacterial vaginosis).Results
Eight of the 88 pregnant women were identified as having bacterial vaginosis on the basis of the smear taken at speculum examination, and these were correctly identified as having bacterial vaginosis by smears prepared from the blindly taken swab. This gives the blind vaginal swab technique for detecting bacterial vaginosis a sensitivity and specificity of 100% when compared with swabbing at speculum examination. The flora of two women were graded as intermediate, and of 75 as normal by both techniques. Only in three cases was there a disparity between the two techniques, a difference that was not statistically significant (kappa = 0.8546,95% CI 0.6945 to 1.0).Conclusions
Vaginal smears prepared from correctly taken blind vaginal swabs can be used to assess the vaginal flora and screen for bacterial vaginosis. This method could be used in epidemiological studies of bacterial vaginosis in the general population and for screening antenatal populations for abnormal vaginal flora.
A randomised comparison of oral and vaginal misoprostol for cervical priming before suction termination of pregnancy
Authors: Lawrie Alasdair , Penney Gillian , Templeton Nan 
Published: August 2005

Objective
To assess the effectiveness and acceptability of oral misoprostol, self‐administered 12 h before surgery, as a cervical priming agent prior to day case suction termination of pregnancy.Design
Randomised trial comparing oral misoprostol with the local standard regimen of vaginal misoprostol.Subjects
Sixty consecutive women scheduled for day case suction termination in one gynaecology unit.Interventions
Cervical priming with misoprostol 400 mg orally, 12 h prior to surgery or 800 mg vaginally, two to four hours prior to surgery.Main outcome measures
Basal cervical dilatation, cumulative force required to dilate the cervix to 9 mm, operative blood loss and side effects (nausea, vomiting, diarrhoea, abdominal pain and vaginal bleeding).Results
There were no significant differences between the oral and vaginal treatment groups in relation to basal dilatation, cumulative force to achieve 9 mm dilatation or gastrointestinal side effects. However, those in the oral group experienced more severe pain and heavier pre‐operative bleeding. Two patients in the oral group experienced incomplete abortion at home after taking misoprostol and a further patient required early admission because of heavy bleeding.Conclusions
Because of the unpredictability of action of oral misoprostol, with incomplete abortion or heavy bleeding occurring prior to admission in three patients, we cannot recommend the dosage schedule evaluated here for routine clinical use.
Sexual risk behaviour in women carriers of Mycoplasma hominis
Authors: Elshibly Salaheldin , Kallings Ingegerd , Hellberg Dan , Mårdh Per‐Anders 
Published: August 2005

Objective
To study the sexual behaviour of women harbouring Mycoplasma hominis in the vagina. Setting Two family planning clinics and a youth clinic for contraceptive advice.Methods
The vaginal flora of 996 women were investigated microbiologically, including culturing for M. hominis from the posterior vaginal fornix. Cultures and tests were also made to diagnose genital Chlamydia trachomatis infections, gonorrhoea, genital herpes, cervical human papillomavirus infection, trichomoniasis, genital warts and human immunodeficiency virus. The sexual behaviour of these women was investigated by structured in‐depth personal interviews.Results
Of the 996 women, 123 (12.3%) harboured M. hominis in the vagina. The remainder (87.7%), who had a negative M. hominis culture, served as a reference group. Those with M. hominis were significantly more likely to have had more than 10 partners during their lifetime, had a greater frequency of more than one sexual partner during the preceding month and the last six months, and reported more frequent experience of ‘casual sex’, including casual ‘travel sex’. More of them also had experience of group sex and were more likely to have been sexually abused than the women in the reference group. Fewer women with M. hominis had a current steady partner and were less often cohabitors, but more had had sexual intercourse during the previous week than those in the reference group. There was an association between the occurrence of M. hominis and bacterial vaginosis and genital chlamydia1 infection. Adjustment in multifactorial regression analyses therefore changed the results only marginally.Conclusions
Women with M. hominis have almost the same sexual risk behaviour as women with classic sexually transmitted diseases.
Impact of the introduction of new medical methods on therapeutic abortions at the Royal Infirmary of Edinburgh
Authors: Cameron Sharon T. , Glasier Anna F. , Logan Janet , Benton Lauri , Baird David T. 
Published: August 2005

Objective
To assess the impact of the introduction of new medical methods on the provision of therapeutic abortions at the Royal Infirmary Edinburgh.Design
A review of the total number of abortions performed by medical and surgical means between 1989 and 1995 (inclusive); a prospective survey of the terminations of pregnancy (5 9 weeks of gestation) performed over the six‐month period of January to June 1994; and a questionnaire of the reasons why women chose a particular method.Setting
Large teaching hospital in Scotland.Subjects
One thousand and seven women seeking early pregnancy termination between January and June 1994.Main outcome measures
Proportion of pregnancies terminated by medical means; comparison of complete abortion rate, incidence of complications and morbidity following both medical and surgical methods (5 9 weeks of gestation); reasons for preference of the method of abortion.Results
Since 1991 there has been a progressive increase in the number of medical abortions performed at the Royal Infirmary of Edinburgh, and by 1994 the majority of women (57%) seeking abortion at ≤ 9 weeks chose a medical method. Women who chose medical abortion had more years at full‐time education and were less likely to smoke (P < 0–04). Both medical and surgical methods were highly effective (> 96% complete abortion) with a low incidence of complications and morbidity. However, women who had chosen the medical method were less likely to receive antibiotics for suspected endometritis than their surgical counterparts (χ2, P= 0.0001).Conclusions
If this trend towards medical methods in Edinburgh is repeated elsewhere, it will inevitably have an impact on gynaecological services by releasing staff and operating time for other purposes.
The standard primipara as a basis for inter‐unit comparisons of maternity care
Authors: Cleary R. , Beard R. W. , Chapple J. , Coles J. , Griffin M. , Joffe M. , Welch A. 
Published: August 2005

Objective
To assess the suitability of the standard primipara (a subset of the obstetric population that has relatively low risk or intervention and of adverse outcome) for making inter‐unit comparisons of indicators of the process and outcome of maternity care.Design
Inter‐unit comparison of 10 indicators of obstetric intervention and adverse outcome derived from routinely collected computerised data held on the St Mary's Maternity Information System.Setting
Fifteen maternity units in the former North West Thames Region.Participants
15,463 primiparae who were delivered in 1992.Main outcome measures
Proportion of primiparae within the standard definition; degree to which standard primiparae are associated with lower rates of intervention and adverse outcome, as compared to other primiparae.Results
Within the database, 42.6% of all primiparae were found to be standard, with rates varying between units from 25.9% to 57.7%. As expected, the standard primiparous woman is at less risk of intervention or adverse outcome than other primiparae. All but one component variable of the standard definition is a significant risk factor for at least four of the 10 indicators. Statistically significant differences in indicator rates are seen between standard and nonstandard primiparae within units. Within the standard group, significant differences in rates of intervention and adverse outcome are seen between units. Units with relatively high levels of intervention within the higher risk nonstandard group also have relatively high levels of intervention within the standard group.Conclusions
Use of the standard primipara, rather than the whole obstetric population, as the basis for inter‐unit comparisons of maternity care will control for the substantial difference in case mix seen in different units, thereby increasing the validity of those comparisons. The technique has the additional benefit of clarifying the relationship between everyday clinical decision making and a unit's performance in comparative indicator reports. The approach must be combined with a separate study of the other groups in the case mix, such as multiparae and high risk primiparae. Additional nonoverlapping groups, homogeneous in terms of risk factors, should be defined and used to extend the basis on which comparisons may be made.