bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased fetal nuchal translucency thickness at 10–14 weeks: is screening for maternal–fetal infection necessary?
Authors: Sebire N. J. , Bianco D. , Snijders R. J. M. , Zuckerman M. , Nicolaides K. H. 
Published: August 2005

Objective
To investigate the relation between increased fetal nuchal translucency thickness at 10–14 weeks of gestation and maternal–fetal infection.Design
Prospective study.Setting
Harris Birthright Research Centre for Fetal Medicine.Population
Four hundred and twenty‐six chromosomally normal pregnancies with increased fetal nuchal translucency thickness at 10–14 weeks of gestation and 63 with ‘unexplained’ second or third trimester fetal nuchal oedema or hydrops.Methods
Maternal serum infection screening and investigations for fetal infection in those with evidence of recent maternal infection.Main outcome measures
Maternal and fetal infection.Results
Evidence of recent maternal infection was present in six of the 426 pregnancies (1.4%) with increased fetal nuchal translucency thickness at 10–14 weeks, but in all cases a healthy infant was born with no evidence of infection. In contrast,‘unexplained’ second or third‐trimester fetal hydrops was associated with maternal infection in six of the pregnancies (9.5%) and in all cases there was evidence of fetal infection.Conclusions
Maternal–fetal infection is one of the causes of second or third trimester nuchal oedema or fetal hydrops. In contrast, the presence of increased nuchal translucency in the first trimester is not a marker of either maternal or fetal infection.
Management of twin pregnancies with fetal trisomies
Authors: Sebire Neil J. , Snijders Rosalinde J. M. , Santiago Carlos , Papapanagiotou George , Nicolaides Kypros H. 
Published: August 2005

Objective
To examine options of management and outcome of twin pregnancies affected by fetal trisomies.Design
Retrospective study.Setting
Research Centre for Fetal Medicine.Population
Twenty‐seven twin pregnancies affected by fetal trisomy.Methods
A computer search was made of our database for twin pregnancies concordant or discordant for trisomies. The data were reviewed for gestation at diagnosis of the chromosomal abnormality, management and pregnancy outcome.Main outcome measures
Pregnancy management and outcome in relation to type and gestation at diagnosis of the trisomies.Results
There were seven cases where both fetuses were trisomies and in these the parents opted for termination of pregnancy; termination was also performed in another pregnancy where one fetus had trisomy 18 and the chromosomally normal co‐twin had a major facial cleft. In 19 cases one fetus had either trisomy 21 (n= 14) or trisomy 18 (n= 5) and the other was normal. Selective fetocide was carried out in 13 of 14 pregnancies discordant for trisomy 21 and in one of the five with trisomy 18. In the four cases discordant for trisomy 18 that were managed expectantly, the trisomic baby died in utero or in the neonatal period, whereas the normal co‐twin was liveborn at 33 to 40 weeks (median 37). In the 14 cases of selective fetocide, the chromosomally normal co‐twin was live born at 24 to 41 weeks of gestation (median 38), and there was a nonsignificant inverse correlation between the gestation at fetocide and gestation at delivery.Conclusions
In twin pregnancies discordant for fetal trisomies the main determinant in deciding whether to perform selective fetocide or adopt expectant management is the degree of lethality of the chromosomal defect.
Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term
Authors: Johnson Nicholas , Lilford Richard , Guthrie Kate , Thornton James , Barker Margaret , Kelly Mike 
Published: August 2005

Objective
To compare two management policies: rupture of the fetal membranes when women are in normal labour or leave them intact as long as feasible.Setting
The labour ward of a city university hospital.Design
Automated randomised clinical trial.Participants
1540 women in uncomplicated term labour. Data on labour duration, blood loss, oxytocin use and fetal condition were collected from 1132 women. Some data from nulliparous women has been presented earlier by the UK Amniotomy Group.Main outcome measures
Duration of labour, Apgar score, fetal morbidity and maternal morbidity including perineal injury, mode of delivery, epidural rates and the total number of vaginal examinations in the first stage of labour after amniotomy.Interventions Amniotomy at the next vaginal examination or amniotomy only if indicated. The median cervical dilatation at membrane rupture was 2 cm greater in the first group.Results
A policy of routine amniotomy in labour had no measurable advantage over selective amniotomy for parous women (difference = 4 min) but shortened labour in nulliparous women by 1 h (Mann‐Whitney U test: P < 0.05). There was a suggestion of a higher caesarean section rate (OR 1.9; 95% CI 0.9–3.5), and there were more vaginal examinations after membrane rupture in the group allocated routine amniotomy. There were no measurable differences in oxytocin use, fetal condition at birth, retained placenta rates, blood loss, pain or analgesia requirements.Conclusion
Routine amniotomy may shorten the first labour but not subsequent ones. There is a suggestion that routine surgical interference may be harmful by increasing the risk of caesarean section, and this agrees with data from other trials (common odds ratio 1.2; 95% CI 0.92–1.6).
Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials
Authors: Goffinet François , Paris‐Llado Josefa , Nisand Israel , Bréart Gérard 
Published: August 2005

Objective
Meta‐analysis of data from controlled trials performed in populations at high risk have shown that umbilical artery Doppler velocimetry (umbilical Doppler) can reduce perinatal mortality. The individual published trials among unselected or low risk populations have found no beneficial effect. Our objective was to evaluate the effect of routine use of the umbilical Doppler in unselected or low risk pregnancies by reviewing all published and unpublished randomised controlled trials.Study design
Systematically reviewing published and unpublished trials, we selected trials for the overview only if they were completed randomised trials of umbilical Doppler in unselected or low risk pregnancies. Of the seven trials examined, three were not included in the meta‐analysis because of methodological problems or because they did not meet the inclusion criteria. We therefore included four trials: two in unselected and two in low risk populations. These four groups were comparable in their degree of maternal and perinatal risk. Using the Mantel‐Haenzel statistical method and pooling the data, we considered 11,375 women in the meta‐analysis.Results
Systematic use of the Doppler umbilical artery velocimetry had no statistically significant effect on perinatal deaths in unselected populations (odds ratio [OR] 1.28; 95% confidence interval [CI] 0.61–2.67), low risk populations (OR 0.51; 95% CI 0.20–1.29) or overall for the four trials (OR 0.90; 95% CI 0.50–1.60); nor was there any significant effect on stillbirths (global OR 0.94; 95% CI 0.42–1.98). However, the number of participants remain insufficient and further information is required to arrive at a definite conclusion on the absence of effect. The meta‐analysis showed no significant difference between the Doppler groups and the control groups for antenatal hospitalisation, obstetric outcome or perinatal morbidity.Conclusion
Based on the results of the published trials, routine use of the umbilical Doppler cannot be recommended.
A meta‐analysis of low dose aspirin for the prevention of intrauterine growth retardation
Authors: Leitich Harald , Egarter Christian , Husslein Peter , Kaider Alexandra , Schemper Michael 
Published: August 2005

Objective
To determine more precisely the effect of prophylactic low dose aspirin on intrauterine growth retardation and perinatal mortality.Design
Meta‐analysis of 13 published randomised clinical trials.Methods
We searched 18 medical databases, including MEDLINE since 1964 and EMBASE since 1974, review articles and the references from each retrieved report to identify all studies evaluating the effect of aspirin in pregnancy and including both intrauterine growth retardation and perinatal mortality as outcome measures.Results
Among 13,234 women from 13 studies between 1985 and 1994, aspirin showed a significant reduction in intrauterine growth retardation (IUGR) (OR 0.82; 95% CI 0.72–0.93; P= 0.003) and a nonsignificant reduction in perinatal mortality (OR 0.84; 95% CI 0.66–1.08; P= 0.18). Subgroup analyses revealed that aspirin was effective at lower doses between 50 and 80 mg/day (IUGR: OR 0.87; 95% CI 0.76–0.99; mortality: OR 0.90, 95% CI 0.70–1.16), but that the preventive effect was greater at higher doses between 100 and 150 mg/day (IUGR: OR 0.36, 95% CI 0.22–0.59; mortality: OR 0.40, 95% CI 0.16–0.97) and among women entered before the 17th week of gestation (IUGR: OR 0.35, 95% CI 0.21–0.58; mortality: OR 0.43, 95% CI 0.17–1.06). We did not identify any specific subgroup of women most likely to benefit from aspirin treatment.Conclusion
The results of this meta‐analysis showed that early aspirin treatment reduced the risk of intrauterine growth retardation. Low dose aspirin should not be used routinely in pregnant women until those most likely to benefit from aspirin treatment have been clearly identified.
Effects of SR 49059, an orally active V1a vasopressin receptor antagonist, on vasopressin‐induced uterine contractions
Authors: Bossmar Thomas , Brouard Rémi , Döberl Anton , Åkerlund Mats 
Published: August 2005

Objective
To test the effect of SR 49059, an orally active, nonpeptide, selective and specific antagonist of the vasopressin V1a receptors in humans.Design
A placebo‐controlled, double‐blind, cross‐over trial.Setting
The Department of Obstetrics and Gynaecology, Lund University Hospital, Sweden.Participants
Twelve healthy women, who had previously been sterilised by tubal ligation.Interventions
The women participated on days 1, 2 or 3 of two menstrual cycles, with intrauterine pressure recordings and intravenous bolus injections of 10 pmol/kg body weight of lysine vasopressin given 1 h before and at 1,2 and 3 h after oral administration of 300 mg of the study drug or of placebo.Main outcome measures
The area between the recording curve and zero level of pressure. Vital signs, safety parameters and drug plasma concentrations were also measured.Results
The spontaneous uterine activity as well as the response to lysine vasopressin injections before administration of the test drugs were almost identical at the two experiments. Following intake of SR 49059 the area under the recording curve (0–10 min) after the second, third, and fourth injection of lysine vasopressin were reduced by 57, 42, and 66%, respectively, compared with placebo. Trough plasma concentrations of lysine vasopressin were markedly higher and systolic blood pressure slightly lower after antagonist administration than after placebo, whereas no significant difference between treatments was observed in diastolic pressure, heart rate or plasma osmolality.Conclusions
This study demonstrates for the first time a biological effect of an orally active vasopressin V1a antagonist in humans in vivo and the results support the importance of vasopressin in uterine activation. The differences between study drug and placebo treatments in lysine vasopressin levels and systolic blood pressure, but lack of difference in osmolality indicate that SR 49059 antagonises the effect of lysine vasopressin on the vasopressin V1a receptor, but not that on the vasopressin V2 one. It is suggested that SR 49059 be explored therapeutically in dysmenorrhoea.
The effect of nifedipine and methyldopa on maternal cerebral circulation
Authors: Serra‐Serra Vicente , Kyle Phillipa M. , Chandran Ravi , Redman Christopher W. G. 
Published: August 2005

Objective
To study how the treatment of severe gestational hypertension affects maternal middle cerebral artery velocimetry.Design
Prospective, clinical, descriptive study.Setting
John Radcliffe Maternity Hospital, Oxford, England.Participants
Pregnant and puerperal women who required acute or chronic antihypertensive treatment with nifedipine (n= 46) or methyldopa (n= 26), respectively.Methods
Transcranial Doppler ultrasound examinations of maternal middle cerebral arteries were performed before and 45 min after nifedipine; and before and 48 hours after the onset of methyldopa therapy. Blood pressure and heart rate were also recorded.Main outcome measures
Clinical and transcranial Doppler changes induced by the antihypertensive medication.Results
Blood pressure and middle cerebral artery velocities decreased significantly following both short‐ and long‐acting antihypertensive therapy. Nifedipine‐induced changes were more pronounced and uniform than those found after methyldopa (16.7% and 6.4% decrease in middle cerebral artery mean velocity, respectively). The middle cerebral artery mean velocity decrease was independent of changes in the blood pressure or heart rate.Conclusions
Maternal cerebral haemodynamics are influenced by antihypertensive treatment. The reduction of middle cerebral artery flow velocities following administration of nifedipine and methyldopa may suggest that cerebral vasodilatation is occurring, which is consistent with the concept that cerebral vasospasm is present in women with pre‐eclampsia. The cerebral vasodilatation could result from a direct effect of the medication on the arteries in question.
Steady‐state pharmacokinetics of oestradiol gel in post‐menopausal women: effects of application area and washing
Authors: Järvinen A. , Granander M. , Nykänen S. , Laine T. , Geurts P. , Viitanen A. 
Published: August 2005

Objective
To investigate the effect of cutaneous application area on oestradiol absorption using an oestradiol gel for transdermal use. Furthermore, the effect of washing of the application site on oestradiol pharmacokinetics was studied.Design
Open‐label, randomised, three‐way cross‐over study.Setting
A clinical pharmacokinetic research unit.Subjects
Sixteen healthy postmenopausal volunteers.Interventions
During three treatment periods, subjects were treated with 1 mg oestradiol (1.0 g Divigel®/Sandrena® 0.1% gel), applied on the thigh to a skin area of 200 cm2,400 cm2, or on an area ‘as large as possible’. Blood samples were drawn during steady‐state (on days 14–15) immediately before application and at regular time intervals thereafter.Main outcome measures
Serum oestradiol levels were measured for determination of peak concentration (Cmax), time to peak concentration (tmax) and bioavailability using the area under the time concentration curve (AUC0–24).Results
Bioavailability from a 200 cm2 area was 2‐fold higher than that from the largest possible area ((P<0.05)). Oestradiol peak plasma concentration from a 200 cm2 area was higher than from the two larger areas ((P<0.05)), which did not differ significantly from each other. Washing of the application site 30 min after application reduced the bioavailability from both the 200 cm2 and 400 cm2 application areas ((P<0.01)), but peak plasma concentration from the 200 cm2 area only ((P<0.01)). Time to reach peak plasma concentrations was significantly reduced with all three application areas by washing.Conclusion
A higher oestradiol absorption was achieved from a smaller application area. No marked differences were observed in the pharmacokinetics between 200 cm2 and 400 cm2 application areas, which are those recommended for this oestradiol gel preparation.
24‐hour blood pressure monitoring to evaluate the effects of nifedipine in pre‐eclampsia and in chronic hypertension in pregnancy
Authors: Benedetto Chiara , Zonca Marina , Giarola Maurizio , Maulà Vincenza , Chiarolini Luciano , Carandente Franca 
Published: August 2005

Objective
To investigate the effect of 7 to 14 days of therapy with nifedipine (sustained‐release preparation) on the 24‐hour blood pressure patterns of pregnant women with pre‐eclampsia or chronic hypertension, and to test the utility of blood pressure monitoring in modulating the timing and dosage of the drug.Design
24‐hour automatic blood pressure monitoring of pregnant women with pre‐eclampsia or chronic hypertension before and after nifedipine treatment.Setting
Centre for Prevention, Diagnosis and Treatment of Hypertension in Pregnancy, University of Turin, Italy.Population
Sixteen pregnant women with pre‐eclampsia and 17 with chronic hypertension.Methods
24‐hour blood pressure monitoring was performed before the beginning of the therapy and after 7 to 14 days of treatment with sustained‐release nifedipine.Main outcome measures
Chronobiological analysis of systolic and diastolic blood pressure values was performed; MESOR, amplitude, acrophase, hyperbaric index, percent time elevation and significance of rhythm were calculated before and after treatment.Results
6336 blood pressure measurements were analysed. Systolic and diastolic MESOR values were significantly decreased after nifedipine treatment both in pre‐eclampsia and in chronic hypertension. However, the antihypertensive effect of nifedipine in pre‐eclampsia was especially pronounced during evening and night, while in chronic hypertension it was more constant during the 24‐hour period. 24‐hour blood pressure monitoring allowed adjustment, when necessary, to the timing and dosage of nifedipine in accordance with the blood pressure patterns of each patient, using the hyperbaric index and percent time elevation as objective parameters for the evaluation of treatment efficacy.Conclusions
24‐hour blood pressure monitoring is a good method to optimise treatment, and confirms that nifedipine is useful for the control of maternal blood pressure in pregnancy.
Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial
Authors: Shipman M. K. , Boniface D. R. , Tefft M. E. , McCloghry F. 
Published: August 2005

Objective
To study the effects of antenatal perineal massage on subsequent perineal outcomes at delivery.Design
A randomised, single‐blind prospective study.Setting
Department of Obstetrics and Gynaecology, Watford General Hospital.Participants
Eight hundred and sixty‐one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995.Results
Comparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no‐massage group and 69.0% in the massage group (P= 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P= 0.094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P= 0.024 and P= 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30.Conclusion
Antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.
Is conservative surgery for tubal pregnancy preferable to salpingectomy? An economic analysis
Authors: Mol Ben W. J. , Hajenius Petra J. , Engelsbel Simone , Ankum Willem M. , Hemrika Douwe J. , van der Veen Fulco , Bossuyt Patrick M. M. 
Published: August 2005

Objective
The traditional treatment of ectopic pregnancy is salpingectomy, while conservative surgery aims to save the function of the uterine tube. This study compares the effectiveness and the economic costs of salpingectomy and conservative tubal surgery in women with a tubal pregnancy.Methods
Salpingectomy and conservative tubal surgery were compared economically, based on a combined retrospective and prospective cohort study and a review of the literature. A model was developed in which conservative surgery and salpingectomy with in vitro fertilisation and embryo‐transfer (IVF‐ET) were compared with salpingectomy alone.Participants
One hundred and fifteen consecutive women treated laparoscopically for tubal pregnancy.Main outcome measures
Complete removal of the tubal pregnancy; subsequent intrauterine pregnancy rate; economic analysis.Results
Tubal pregnancy was always treated successfully by both methods, sometimes with additional treatment for persistent trophoblast. In the short term costs per patient were £1554 (95% confidence interval [CI] £1501–£1656) for salpingectomy and £1787 (95% CI £1683–£1930) for conservative surgery. The mean difference between costs of salpingectomy and costs of conservative surgery was £233 (95% CI £80–£371). Concerning subsequent intrauterine pregnancy, conservative surgery is slightly more effective than salpingectomy but is more expensive. Costs per subsequent intrauterine pregnancy are £4063. If IVF‐ET is performed in all women who are not pregnant within three years after salpingectomy, costs per subsequent intrauterine pregnancy are £15,629.Conclusions
Salpingectomy is the treatment of choice in women not desiring future pregnancy. Salpingectomy seems less effective than conservative surgery when future pregnancy is desired, but is less costly. Conservative surgery seems more cost effective than salpingectomy with additional IVF‐ET.
Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects
Authors: Peschers Ursula M. , DeLancey John O. L. , Schaer Gabriel N. , Schuessler Bernhard 
Published: August 2005

Objective
To describe the sonographic appearance of normal anal sphincter anatomy and sphincter defects evaluated with a conventional 5 MHz convex transducer placed on the perineum.Design
Prospective, single‐blind study.Setting
Department of Obstetrics and Gynecology, University of Michigan Medical Center, USA.Population
Twenty‐five women with symptoms of faecal incontinence, 11 asymptomatic nulliparous women, and 32 asymptomatic parous women.Methods
A convex scanner was placed on the perineum with the woman in lithotomy position. Images were taken at three levels of the sphincter canal. Pictures were evaluated by two examiners who were blinded to the case history of the women and to the results of each other for the presence or absence of sphincter defects.Main outcome measures
Description of anal sphincter appearance on endoanal ultrasound. Reproducibilty of the evaluation of sphincter defects.Results
The internal anal sphincter is visible as a hypoechoic circle; the external anal sphincter shows a hyperechoic pattern. Proximally the sling of the puborectalis muscle is visible. Sphincter defects were detected in 20 women. In all five women who subsequently underwent surgery, the presence and location of the defect was confirmed at the time of surgery. Examiners were in agreement 100% of the time on the presence or absence of internal defects. They disagreed in one patient on the presence of an external defect.Conclusion
Exoanal ultrasound provides information on normal anatomy and on defects of the anal sphincter.