bluuebunny/crossref_metadata_2025_split huggingface dataset:
The performance of screening tests for ovarian cancer: results of a systematic review
Authors: Bell Ruth , Petticrew Mark , Sheldon Trevor 
Published: August 2005

Objective
To estimate the performance of currently available tests in detecting ovarian cancer in asymptomatic women.Methods
Systematic review of prospective screening studies.Results
Twenty‐five studies were identified: sixteen studied women at average risk and nine studied women at higher risk. Most studies evaluated only one screening method, were small, detecting few cancers, and gave few follow up details. Sensitivity estimates are therefore imprecise. In a typical larger study, reported sensitivity of ultrasound screening at one year was around 100% (95% CI 54%–100%), while the sensitivity of CA125 measurement followed by ultrasound (multimodal screening) was about 80% (95% CI 49%–95%). False positive rates ranged between 1.2% and 2.5% for grey scale ultrasound, between 0.3% and 0.7% for ultrasound with colour Doppler and between 0.1% and 0.6% for multimodal screening. This implies that, in annual screening of a population with an incidence of 40 per 100,000, and if no cancers were missed, between 2.5 and 60 women would undergo surgery for every primary ovarian cancer detected.Conclusions
Ultrasound and multimodal screening can detect ovarian cancer in asymptomatic women, but there is currently no evidence on whether screening improves outcome for women in any risk group. On‐going randomised controlled trials should establish the magnitude of any benefit of screening. The low prevalence of ovarian cancer in the population, and its rate of progression, may limit the potential cost‐effectiveness of screening.
A prospective intervention study of stopping smoking in pregnancy in a routine antenatal care setting
Authors: Wisborg Kirsten , Brink Henriksen Tine , Jørgen Secher Niels 
Published: August 2005

ObjectivesTo evaluate the effect of specific education of midwives on stopping smoking in pregnant women and to determine the effect of this programme on pregnancy outcome.DesignA prospective intervention study.SettingDepartment of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark.Population and methodsA group of midwives (9 out of 54) was taught the effects of smoking during pregnancy and instructed in various methods of educating women to stop smoking. All pregnant women who attended antenatal care from October 1994 to September 1995 were either in the intervention group (n = 527) or the control group (n = 2629). Pregnant women attending the specifically educated midwives were considered to be the intervention group. They were given individual advice about stopping smoking at the first antenatal visit at about 16 weeks of gestation and a leaflet on smoking and pregnancy.ResultsAt the first antenatal visit at about 16 weeks of gestation, 22% of the pregnant women smoked. Between the first visit and the routine visit at 30 weeks of gestation 51 (2%) stopped smoking and 56 (2%) started smoking. No differences were found between the intervention group and the control group in the rate of stopping smoking, validated by cotinine measurements. Mean birthweight, mean gestational age and the proportion of preterm birth in the two groups were similar.ConclusionEducation of midwives and integration of advice about smoking cessation at a low cost in routine antenatal care failed to affect smoking habits among pregnant women.
A randomised controlled trial of care of the perineum during second stage of normal labour
Authors: McCandlish Rona , Bowler Ursula , van Asten Hedwig , Berridge Georgina , Winter Cathy , Sames Lesley , Garcia Jo , Renfrew Mary , Elbourne Diana 
Published: August 2005

Objective
To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth.Design
Randomised controlled trial.Setting
Two English maternity care units.Sample
5471 women who gave birth between December 1994 and December 1996.Methods
At the end of the second stage of labour women were allocated to either the ‘hands on’ method, in which the midwife's hands put pressure on the baby's head and support (‘guard’) the perineum; lateral flexion is then used to facilitate delivery of the shoulders, or the ‘hands poised’ method, in which the midwife keeps her hands poised, not touching the head or perineum, allowing spontaneous delivery of the shoulders.Main outcome measure
Perineal pain in the previous 24 hours reported by women in self‐administered questionnaire 10 days after birth.Results
Questionnaires were completed by 97% of women at 10 days after birth. 910 (34.1%) women in the ‘hands poised’ group reported pain in the previous 24 hours compared with 823 (31.1%) in the ‘hands on’ group (RR 1.10, 95% CI 1.01 to 1.18: absolute difference 3%, 0.5% to 5%, P = 0.02). The rate of episiotomy was significantly lower in the ‘hands poised’ group (RR 0.79, 99% C1 0.65 to 0.96, P= 0.008) but the rate of manual removal of placenta was significantly higher (RR 1.69, 99% CI 1.02 to 2.78; P= 0.008). There were no other statistically significant differences detected between the two methods.Conclusion
The reduction in pain observed in the ‘hands on’ group was statistically significant and the difference detected potentially affects a substantial number of women. These results provide evidence to enable individual women and health professionals to decide which perineal management is preferable.
Increased large arterial stiffness and impaired acetylcholine induced skin vasodilatation in women with previous gestational diabetes mellitus
Authors: Hu Jie , Norman Mikael , Wallensteen Måna , Gennser Gerhard 
Published: August 2005

Objective
Gestational diabetes is associated with increased risk of developing noninsulin‐dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro‐ and microvascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes.Design
Cross‐sectional study.Setting
Vascular research laboratory in the obstetric unit of a university hospital.Participants
Seventeen nonpregnant, healthy women with a history of gestational diabetes and 20 nonpregnant control women of similar age without previous diabetes.Methods
For quantification of the mechanical properties in large arterial vessels the wall movements of the abdominal aorta and left common carotid artery were recorded with an ultrasonic tracking system. Microvascular perfusion in the skin of the hand and foot was recorded by a laser Doppler technique to assess the vasodilatory response induced by transcutaneous acetylcholine.Results
Women in the gestational diabetes group showed evidence of increased wall stiffness in the common carotid artery and a lower maximum incremental velocity of the pulsatile vessel diameter change in both aorta and carotid artery compared with controls. Acetylcholine induced vasodilatation in both hand and foot was lower in women with previous gestational diabetes compared with controls.Conclusion
Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalities might be early evidence of vascular complications associated with subsequent NIDDM.
Outcome of very preterm small for gestational age infants: the first nine years of life
Authors: Kok Joke H. , Lya den Ouden A. , Verloove‐Vanhorick S. Pauline , Brand Ronald 
Published: August 2005

Objective
To determine the influence of intrauterine growth retardation of preterm infants on mortality and cognitive development.Design
A nationwide study cohort of very preterm and/or small for gestational age infants (< 32 weeks and/or < 1500 g) born alive in 1983 in the Netherlands. Assessment on neuromotor and cognitive development at five years, and a parental questionnaire on school performance at nine years. Cognitive outcome is defined as handicap for mental and speech‐language development, and need for special education.Sample
134 small for gestational age infants (< 10th centile) and 410 appropriate for gestational age infants (between 25th and 75th centile) of all infants between 25 and 32 weeks of gestational age were identified; infants with congenital malformations and not of Caucasian race were excluded.Main outcome measures
Neonatal mortality, in‐hospital and five years mortality; Cognitive outcome at five years; School performance at nine years.Results
The mortality risk for small for gestational age compared with appropriate for gestational age infants was significantly higher, after adjustment for gestational age, sex, multiple pregnancy and mode of delivery (OR 2–56,95% CI 1.26–5.26). Small for gestational age infants showed more often gross motor and minor neurological dysfunction, but less cerebral palsy than appropriate for gestational age infants. Cognitive outcome at five years in small for gestational age infants was significantly worse than appropriate for gestational age infants stratified for mode of delivery OR 2.44 (95% CI 1.05–5.55). At nine years of age significantly more small for gestational age infants (1 6.4%) needed special education than appropriate for gestational age infants (11.9%).Conclusion
Intrauterine growth retardation increases the risk of mortality and of cognitive disorders.
Prolonged pregnancy: evaluating gestation‐specific risks of fetal and infant mortality
Authors: Hilder Lisa , Costeloe Kate , Thilaganathan Baskaran 
Published: August 2005

Objective
To evaluate gestation‐specific risks of stillbirth, neonatal and post‐neonatal mortality.Design
Retrospective analysis of 171,527 notified births (1989–1991) and subsequent infant survival at one year, from community child health records.Setting
Notifications from maternity units in the North East Thames Region, London.Main outcome measures
The incidence of births, stillbirths, neonatal and post‐neonatal deaths at each gestation after 28 completed weeks. Mortality rates per 1000 total or live births and per 1000 ongoing pregnancies at each gestation were calculated.Results
The rates of stillbirth at term (2.3 per 1000 total births) and post‐term (1.9 per 1000 total births) were similar. When calculated per 1000 ongoing pregnancies, the rate of stillbirth increased six‐fold from 0.35 per 1000 ongoing pregnancies at 37 weeks to 2.12 per 1000 ongoing pregnancies at 43 weeks of gestation. Neonatal and post‐neonatal mortality rates fell significantly with advancing gestation, from 15 1.4 and 31.7 per 1000 live births at 28 weeks, to reach a nadir at 41 weeks of gestation (0.7 and 1.3 per 1000 live births, respectively), increasing thereafter in prolonged gestation to 1.6 and 2.1 per 1000 live births at 43 weeks of gestation. When calculated per 1000 ongoing pregnancies, the overall risk of pregnancy loss (stillbirth + infant mortality) increased eight‐fold from 0.7 per 1000 ongoing pregnancies at 37 weeks to 5.8 per 1000 ongoing pregnancies at 43 weeks of gestation.Conclusion
The risks of prolonged gestation on pregnancy are better reflected by calculating fetal and infant losses per 1000 ongoing pregnancies. There is a significant increase in the risk of stillbirth, neonatal and post‐neonatal mortality in prolonged pregnancy. This study provides accurate data on gestation‐specific risks of pregnancy loss, enabling pregnant women and their carers to judge the appropriateness of obstetric intervention.
Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial
Authors: Vause S. , Congdon H. M. , Thornton J. G. 
Published: August 2005

Objective
To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries.Design
A randomised controlled trial.Setting
The delivery suite at Leeds General Infirmary.Sample
One hundred and thirty‐five nulliparous women with an effective epidural in labour.Methods
The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner). epidural analgesia in labour reduces operative vaginal deliveries.Main outcome measure
Rate of instrumental vaginal delivery.Results
There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31,95% CI 0.62–2.78). No adverse effects were noted.Conclusion
Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.
A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection
Authors: Brocklehurst P. , Kinghorn G. , Carney O. , Helsen K. , Ross E. , Ellis E. , Shen R. , Cowan F. , Mindel A. 
Published: August 2005

Objective
To evaluate the efficacy and safety of a suppressive course of acyclovir in late pregnancy in women with recurrent genital herpes infection on the incidence of viral shedding, herpes lesion development and caesarean section for recurrent genital herpes.Design
Double‐blind, randomised placebo controlled clinical trial.Setting
Adepartment of genitourinary medicine in Sheffield and an antenatal clinic in London.Population
Pregnant women with recurrent genital herpes infection at < 36 weeks of gestation.Methods
Participating women were given acyclovir 200 mg four times a day (or matching placebo) from 36 weeks of gestation until the time of delivery. Women were seen weekly and viral cultures were obtained from the cervix and vulva. Decisions regarding mode of delivery were left to the discretion of the attending obstetrician.Main outcome measures
Delivery by caesarean section for recurrent genital herpes infection. Number of episodes of recurrent genital herpes infection and number of episodes of asymptomatic viral shedding during the treatment period. In addition blood was taken at two weekly intervals to determine acyclovir levels.Results
The total number of women recruited was 63 (3 1 received acyclovir and 32 received placebo). The number of women undergoing delivery by caesarean section for recurrent herpes at the time of delivery was 12 (19%). The odds ratio for delivery by caesarean section in women taking acyclovir, compared with those talung placebo, was 0.44 (95% CI 0.09–1.59). The odds ratio for clinical recurrences during treatment was 0.10 (95% confidence interval 0.00–0.86) and the odds ratio for clinical recurrence or asymptomatic shedding during treatment was 0.32 (95% CI 0.05–1.56).Conclusion
This trial was unable to demonstrate that acyclovir can significantly decrease the number of caesarean section deliveries; however, the number of clinical recurrences was significantly reduced. Two episodes of asymptomatic virus shedding both occurred in women taking acyclovir. At the present time there is little evidence to suggest that acyclovir should be used outside randomised controlled trials for the suppression of recurrent genital herpes infection during pregnancy.
A population based case‐control teratologic study of oral metronidazole treatment during pregnancy
Authors: Czeizel Andrew E. , Rockenbauer Magda 
Published: August 2005

Objective
To study human teratogenic risk of metronidazole.Design
A case‐control analysis of congenital abnormalities after oral metronidazole treatment during pregnancy grouped by months of gestation. The source of information concerning the use of drugs during pregnancy was the prospective data of the women's prenatal logbook and the retrospective data of a questionnaire filled in by mothers.Setting
The large population‐based dataset of the Hungarian Case‐Control Surveillance of Congenital Abnormalities, 1980–1991.Participants
The control group involved 30,663 pregnant women who had healthy babies; the response rate was 65%. The index group consisted of 17,300 pregnant women who had offspring with congenital abnormalities from the study pregnancy; data were available for 82% of these women.Results
Of 30,663 pregnant women in the control group, 1041 (3.4%) were treated with metronidazole, 162 (0.53%) in the second to third month of gestation. Of 17,300 pregnant women in the index group, 665 (3.8%) were treated with metronidazole, 104 (0.66%) in the second to third months. McNemar analysis for case‐matched control pairs indicated a somewhat higher maternal metronidazole treatment in the second‐third months of gestation in nine cases with cleft lip with or without cleft palate, but it was not possible to exclude the recall bias. In addition, this finding was not confirmed by the comparison of cases with cleft lip with or without cleft palate and the total control group.Conclusion
Treatment with oral metronidazole during pregnancy presents no clinically important association with congenital abnormalities.
Obstetric outcome in 232 ovum donation pregnancies
Authors: Abdalla Hossam I. , Billett Anne , Kan Andrew K. S. , Baig Sabah , Wren Marie , Korea Lena , Studd John W. W. 
Published: August 2005

Objective
To study the obstetric outcome of ovum donation pregnancies.Design
A retrospective analysis of 232 ovum donation pregnancies in the six years from 1988 to 1993.Setting
Infertility clinic in a private hospital.Participants
All ovum donation recipients that achieved pregnancy in the clinic during the stated time period.Main outcome measures
Percentages of live birth and miscarriages and ectopic pregnancies; number of sacs identified in the uterus at early (four weeks after transfer) and later scans; incidence of antepartum and postpartum haemorrhage; incidence of pregnancy‐induced hypertension; incidence of preterm, low birthweight and small‐for‐gestational age babies; and incidence of operative deliveries.Results
Of 232 pregnancies, 151 babies were born (live birth rate of 20%); and 81 were lost (57 before eight weeks, 17 after eight weeks and seven ectopic pregnancies). In nine cases there were no intrauterine sacs at the early scan (two ‘chemical pregnancies’ and seven ectopic pregnancies). In 169 cases there was initially one intrauterine sac, ending with 102 singleton deliveries (60%); in 47 cases there were initially two intrauterine sacs, ending with 11 singleton deliveries (23%) and 32 twin deliveries (68%); in the seven cases where three sacs were identified initially, there were no singleton deliveries, three twin deliveries (one selective fetal reduction) and three triplet deliveries. Women with premature ovarian failures had a significantly higher pregnancy rate compared with those with functioning ovaries (P < 0.02). However, in the former group, the miscarriage rate was also significantly higher (P < 0.03) so that the number of term births was similar. The incidence of vaginal bleeding was 12% in the first trimester, 1.5% in the second trimester, and 2% in the third trimester. The incidence of postpartum haemorrhage was 12%. Thirty‐two women had pregnancy induced hypertension (23% of all deliveries). This occurred in 22/105 singletons (21%), 7/32 twins (22%) and in all three (100%) of the triplets. In the singleton group 13% of infants were preterm, 18% had a birthweight < 2.5 kg and 15% were < 3rd centile for birthweight at delivery (small‐for‐gestational age). Ovarian function was found to be the only factor that significantly influenced the incidence of small‐for‐gestational age babies (odds ratio 8.84; 95% confidence interval 1.1–70.0; P= 0.007). The overall operative delivery rate was 85% with the caesarean section rate being 69%.Conclusions
Women who become pregnant following oocyte donation should be considered obstetrically as high risk, especially those with ovarian failure because of the increased incidence of small‐for‐gestational age infants in these pregnancies. They are also at higher risk of pregnancy induced hypertension and postpartum haemorrhage.
Progesterone resistance in women who have had breast cancer
Authors: Simpson H. W. , McArdle C. S. , Griffiths K. , Turkes A. , Beastall G. H. 
Published: August 2005

Objective
To investigate whether certain physiological responses to luteal progesterone are normal in women previously treated for breast cancer.Design
Salivary progesterone concentrations, basal body temperatures, and breast blood flow changes (surface temperature method) were all recorded daily for one natural menstrual cycle.Setting
Participants in the study made saliva collections and temperature measurements at home under semi‐standardised conditions with supervisory visits by a project nurse.Participants
Twenty‐five controls were compared with 30 women with previous breast cancer; all but three participants were parous and the average ages were 39 years (range 28–48) and 40 years (range 29–46), respectively. On average the women with previous breast cancer had had surgery 2.4 years previously; the operation was usually mastectomy, leaving the contralateral breast for study.Results
Follicular phase (day 1–14) oral temperature averages were statistically indistinguishable between women in the control group and those with previous breast cancer. Luteal progesterone profiles were considered in the normal range for the controls and patients. However, the women with previous breast cancer, on average, exhibited a significantly smaller rise in the luteal phase basal body temperature. Follicular phase breast surface temperature was significantly higher in the breast cancer group (+0.30°C). This group showed a highly significant reduction of the luteal heat cycle in their breasts.Conclusions
Two progesterone‐mediated physiological mechanisms have been found to be significantly less responsive in women with previous breast cancer than controls. The literature has been reviewed. Progesterone resistance could be a clinical entity and could be important in carcinogenesis.
Induced abortion in the first trimester of pregnancy and risk of miscarriage
Authors: Parazzini Fabio , Chatenoud Liliane , Tozzi Luca , Di Cintio Elisabetta , Benzi Guido , Fedele Luigi 
Published: August 2005

Objective
To analyse the relation between induced abortion and risk of subsequent miscarriage.Design
Case‐control study conducted between February 1990 and May 1995.Participants
Case group included 782 women (median age 32 years, range 1446) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14–45) were interviewed.Results
A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8–1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4–1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage.Conclusions
This study did not find any strong association between induced and spontaneous abortion.