bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of hypoglycaemia on fetal heart activity and umbilical artery Doppler velocity waveforms in pregnant women with insulin‐dependent diabetes mellitus
Authors: Björklund A. O. , Adamson U. K. C. , Almström N. H. H. , Enocksson E. A. , Gennser G. M. , Lins P.‐E. S. , Westgren L. M. R. 
Published: August 2005

Objective
To study the effect of induced hypoglycaemia on fetal wellbeing as indicated by fetal heart rate and umbilical artery flow velocity waveforms.Design
A prospective experimental investigation.Setting
High risk pregnancy unit and diabetes research unit at Karolinska Institutet, Danderyd Hospital, a university affiliated hospital.Participants
Ten women with insulin‐dependent diabetes mellitus in the third trimester of pregnancy.Interventions
The fetal heart rate, the blood flow velocity waveforms in the umbilical artery and the maternal catecholamine levels were investigated during a 150–minute hyperinsulinaemic hypoglycaemic clamp with induction and maintenance of an arterial blood glucose level of about 2.2 mmol/l.Main outcome measures
1. Fetal: changes of fetal heart rate pattern and pulsatility index of the umbilical artery flow velocity waveforms. 2. Maternal: levels of plasma adrenaline and plasma noradrenaline.Results
Maternal hypoglycaemia was associated with an increase in frequency and amplitude of fetal heart rate accelerations, a slight decrease in the pulsatility index of the umbilical artery and a rise in the maternal catecholamine levels.Conclusions
We speculate that the increased number of fetal heart rate accelerations reflects an increased sympathico‐adrenal activity during the hypoglycaemic clamp. No potentially harmful effects on the fetus were observed in the fetal heart rate or in the umbilical artery Doppler waveform analysis during hypoglycaemia.
Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers
Authors: Heslington K. , Hilton P. 
Published: August 2005

Objective
Ambulatory monitoring continues to gain acceptance and increasing clinical application. There remains, however, a sparsity of published data from asymptomatic Volunteers, particulary women. Our aim was, by study of such a group, to establish normal ranges for cystometric variables on ambulatory monitoring.Participants
We recruited 22 women from staff and gynaecological inpatients. A standard questionnaire of urinary complaints was administered and any woman with significant symptoms was excluded. Conventional cystometry and ambulatory monitoring were undertaken in all Volunteers in random order. Volunteers were asked to go about everyday activities and to keep a detailed event diary whilst undergoing ambulatory monitoring.Results
Using standard International Continence Society terminology, detrusor instability was found in 18% of volunteers on conventional cystometry and in 68% on ambulatory monitoring. Significant differences were found between ambulatory monitoring and conventional cystometry with respect to the detrusor pressure rise on filling (P < 0.001) and voided volumes (P < 0.001). A significant difference was also present with respect to voiding pressures (P < 0.001), although the absence of simultaneous flow rate measurement makes absolute separation of voiding pressure from post‐voiding after contractions difficult.Conclusions
Ambulatory monitoring detects a greater number of abnormalities based on conventional cystometric criteria of normality. Before we can usefully apply the method to symptomatic patients we must first define normal ranges for filling and voiding cystometry for the technique. This study moves towards this goal. (The addition of flow rate data will permit accurate identification and measurement of voiding pressures.)
Erythrocyte ion and water balance and membrane potential in the puerperium of normal pregnancy
Authors: Bolton L. M. , Thomas T. H. , Dunlop W. 
Published: August 2005

Objective
To examine the balance of erythrocyte ions and water during the rapid changes in plasma osmolality in the early puerperium, and during the subsequent period of sustained readjustment.Design
A serial study from the third trimester of pregnancy to 20 weeks after delivery.Participants
Thirty‐five primiparous women who had experienced no antenatal complications.Main Outcome Measures
Plasma osmolality, erythrocyte hydration, potassium, chloride and sodium were measured and nondiffusible ion content and erythrocyte membrane potential calculated. Plasma sodium, potassium and chloride were also measured.Results
During the first week after delivery plasma osmolality increased (280 (SEM 0.52)–289 (SEM 064) mosmol/kg; P < 0.001) but erythrocyte hydration did not decrease (2.060 (SEM 0.018)–2.067 (SEM 0.021) l/kg dry cells) because of an increase in total cell osmole content (577 (SEM 5.31)–597 (SEM 6.15) mosmol/kg dry cells; P= 0.001). This increase included nondiffusible anions, chloride and potassium. These changes in ionic balance did not affect membrane potential. After the first week of the puerperium and up to the 20th week, plasma osmolality was stable but erythrocyte osmole content and hydration both decreased. This was due to a decrease in nondiffusible anions and potassium with a smaller increase in chloride leading to a decrease in membrane potential (–14.31 (SEM 0.34) mV to −12.66 (SEM 0.28) mV; P < 0.001).Conclusions
A rapid increase in intracellular osmoles can occur in the mature erythrocyte and probably precedes the decrease in plasma osmolality in the puerperium. Changes in erythrocyte homeostasis in the first week of the puerperium can be accounted for by alterations in nondiffusible anions. After the first week of the puerperium it appears that the functional organisation of the membrane is changing.
A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant
Authors: Penn Zoe J. , Steer Philip J. , Grant Adrian 
Published: August 2005

Objective
To determine the optimum mode of delivery for women in preterm breech labour at a gestational age of 26 to 32 weeks.Design
A multicentre randomised controlled trial. Setting Twenty‐six hospitals in England, UK.Participants
Women with a singleton breech fetus in spontaneous preterm labour between 26 and 32 completed weeks of gestation, with no clear indication for a caesarean section or vaginal breech delivery.Intervention
Random allocation to either ‘intention to delivery vaginally’ or ‘intention to deliver by caesarean section’.Main outcome measures
Perinatal mortality, neonatal morbidity, maternal morbidity and gestation at delivery.Results
The trial was closed after 17 months because of low recruitment, by which time substantial numbers of women had been in the eligible gestation period. Thirteen women from six hospitals were recruited. One infant, randomised to and delivered vaginally, was stillborn. Three fetal presentations were cephalic at delivery despite a diagnosis of breech presentation at trial entry. No formal statistical analysis was performed due to the small numbers.Conclusions
No conclusions about the optimum mode of delivery for women in preterm labour with a fetus presenting by the breech can be drawn from this trial. The low accrual rate was due to clinicians' reluctance to randomise eligible women, reflecting the circumstances and nature of the trial.
Double‐blind evaluation of ritodrine sustained release for oral maintenance of tocolysis after active preterm labour
Authors: Holleboom C. A. G. , Merkus J. M. W. M. , van Elferen L. W. M. , Keirse M. J. N. C. 
Published: August 2005

Objective
To evaluate the effect of ritodrine sustained release capsules for maintaining uterine quiescence after successful treatment of active preterm labour.Design
Multicentre placebo‐controlled trial. Setting Five teaching hospitals in the Netherlands.Participants
Women (n= 95) at less than 35 weeks of gestation in whom active preterm labour had been stopped with intravenous ritodrine.Interventions
Women received either two 40 mg ritodrine sustained release capsules (n= 50) or identical placebo capsules (n= 45) three times a day for seven days.Results
The proportion of women who received another course of active treatment was significantly smaller with the sustained release than with placebo (1 of 50 versus 11 of 45: P= 0.003) as was the number delivering because of preterm labour during treatment (0 of 50 versus 4 of 45: P= 0.04). There were no other significant differences between the two groups.Conclusions
Maintenance treatment with ritodrine sustained release capsules after arrest of preterm labour reduces the risk of recurrences of preterm labour that necessitate treatment or precipitate delivery.
Smoking during pregnancy and preterm birth
Authors: Wisborg Kirsten , Henriksen Tine Brink , Hedegaard Morten , Jergen Niels 
Published: August 2005

Objective
To evaluate the association between smoking during pregnancy and preterm birth.Design
A follow up study.Setting
Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark.Participants
Four thousand one hundred and eleven nulliparous women with singleton pregnancies who returned questionnaires about smoking habits at 16 weeks of gestation.Results
The overall rate of preterm delivery was 4.3 %. Smokers had a 40 % higher risk of preterm birth compared with nonsmokers. A dose response relationship was found between smoking and risk of preterm birth. Adjustment for women's height, prepregnancy weight, age of the mother, marital status, education, occupational status, and alcohol intake did not change the results. Among women with an intake of less than 400 mg of caffeine per day no difference in the risk of preterm birth between smokers and nonsmokers was found. However, among women with an intake of more than 400 mg of caffeine per day, the risk of preterm birth was increased almost threefold among smokers compared with nonsmokers. Furthermore, among women with a high intake of caffeine a dose‐response relationship was found; women smoking one to five cigarettes per day had no increased risk of preterm birth compared with nonsmokers with the same intake of caffeine, women smoking six to ten cigarettes per day had almost three times higher risk of preterm birth, and women smoking more than 10 cigarettes per day had almost five times higher risk of preterm birth compared with nonsmokers with the same intake of caffeine.Conclusions
Smoking increases the risk of preterm birth. The association between smoking and preterm birth was only present among women with a high intake of caffeine. However, whether smoking alone influences the risk of preterm birth among heavy consumers of caffeine needs further investigation.
Laparoscopic sterilisation: opinion and practice among gynaecologists in Scotland
Authors: Penney Gillian C. , Souter Vivienne , Glasier Anna , Templeton A. A. 
Published: August 2005

Objectives
1. To produce a list of evidence‐based criteria for good quality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Scotland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria.Design
1. Agreement with criteria assessed by questionnaire survey; 2. Overview of current practice obtained by questionnaire survey and by casenote review.Setting
Scotland.Sample
1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals.Results
The response rate to the questionnaire survey was 94%. A list of 15 evidence‐based criteria was produced, covering patient selection, information and counselling, techniques of tubal occlusion and timing of sterilisation. All 15 suggested criteria gained an overall balance of support among responding gynaecologists. Similar impressions of current practice were gained from the questionnaire survey and from the casenote review. Aspects of practice which measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes included clear documentation that women had been counselled regarding failure rate and intended permanency; 88% of sterilisations were performed, or directly supervised by, a gynaecologist of consultant or senior registrar status; and only 2% of sterilisations were undertaken in combination with induced abortion. Aspects of practice which compared poorly with the agreed criteria, and for which recommendations for change have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists indicated that they provide locally produced information leaflets as an adjunct to counselling; four methods of tubal occlusion (including unipolar diathermy) were in use; and there were wide variations among hospitals in the use of day‐case care, ranging from 19% to 99%.Conclusions
A list of criteria for good quality care in relation to sterilisation has been validated by agreement among Scottish gynaecologists. Current practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for change in practice have been made. Following dissemination of these results and recommendations, re‐audit will be undertaken in order to identify any changes.
Lipid peroxidation in cord blood: the effect of amniotic fluid volume
Authors: Wang Chi Chiu , Rogers Michael Scott 
Published: August 2005

Objective
To assess the effect of amniotic fluid volume on umbilical cord arterial lipid peroxide levels in relation to intrapartum events.Design
Prospective observational study.Setting
Delivery suite of a teaching hospital, the Chinese University of Hong Kong.Population
Women with singleton, term, cephalic presentation, and an initially normal fetal heart rate tracing.Methods
All pregnancies had amniotic fluid index assessments before and after amniotomy and cord arterial lipid peroxide determination at delivery. Multiple regression analysis.Main outcome measures
Cord arterial malondialdehyde and organic hydroperoxide levels.Results
In 247 cases following amniotomy levels were inversely correlated with intrapartum amniotic fluid index. Amniotic fluid index during labour was an independent determinant of cord arterial lipid peroxide concentration, along with duration of second stage, absence of epidural, presence of tight nuchal cord entanglement and evidence of fetal distress.Conclusions
Oligohydramnios during labour is associated with high levels of lipid peroxidation in the fetus, reflecting an increase in hypoxic cellular damage by free radicals.
Seizure prophylaxis in hypertensive pregnancies: a framework for making clinical decisions
Authors: Khan Khalid S. , Chien Patrick F. W. 
Published: August 2005

Objective
To describe a framework for generating therapeutic recommendations using seizure prophylaxis in hypertensive pregnancies as an example.Design
A decision‐making framework was built using: 1. evidence of therapeutic benefit, with number needed to treat as the effect measure; 2. baseline rates of the target disorder that the treatment was designed to prevent; and 3. a treatment threshold, determined by weighting the potential risks against the potential benefits of the treatment.Methods
Evidence of therapeutic benefit (i.e. reduction in eclamptic seizures associated with magnesium sulphate therapy in hypertensive pregnancies) was determined by a systematic quantitative overview of controlled clinical trials. Baseline rates of seizures without magnesium sulphate therapy were derived from a recent cohort study. A treatment threshold was generated using estimates of treatment associated morbidities which were weighted against the potential reduction in seizures from magnesium sulphate therapy considering the relative values assigned to these outcomes by obstetricians practising in our hospital.Results
The number of hypertensive women needed to be treated with magnesium sulphate to prevent a single case of eclamptic seizures varied in a curvilinear fashion dropping from 1000 to 14 as the baseline rate of seizures increased from 0.1% to 10%. The treatment threshold as measured by number needed to treat was 64 (range 57–77). The number needed to treat for nonproteinuric hypertension was 1000 (95% CI 180–40,000), whereas it was 32 (95% CI 20–57) for proteinuric hypertension. Considering the uncertainty in estimation of the numbers needed to treat and treatment threshold, magnesium sulphate therapy may be recommended for women at high risk of eclampsia (e.g. severe pre‐eclampsia) while it should be withheld in cases at low risk (e.g. nonproteinuric hypertension and mild pre‐eclampsia).Conclusion
While awaiting further research obstetricians intuitively make decisions about seizure prophylaxis in hypertensive pregnancies. Our decision‐making framework generated therapeutic recommendations by explicit consideration of the available evidence.
Antenatal corticosteroid prescribing: setting standards of care
Authors: Wallace Euan M. , Chapman Janet , Stenson Ben , Wright Sherry 
Published: August 2005

Objective
Despite widespread recognition that prenatal administration of corticosteroids dramatically reduces perinatal mortality and morbidity, clinical practice in this area remains less than ideal. We therefore reviewed our practice to identify reasons for this and to determine attainable standards of care.Design
Retrospective case record review.Setting
Level three maternity unit in Edinburgh, UK.Population
All women admitted at gestations of 24 to 34 weeks and 6 days inclusive, and all women receiving corticosteroids in one institution, over a 10‐month period.Main outcome measures
The number and clinical features of women delivering before and after 35 weeks of pregnancy who had received corticosteroids.Results
Seven hundred and two women were admitted during the study period; case records were available for 688 of these. One hundred and ninety‐two women (28%) delivered before 35 weeks of gestation, of whom 123 (64%) had received dexamethasone. Of 69 women who received no steroids 30 (43%) were in hospital for more than 24 hours before delivery. Overall, 29% of women receiving dexamethasone delivered after 35 weeks of gestation and 42 (24%) women treated with dexamethasone received more than one course. While the grade of admitting doctor did not affect prescribing, there were other significant differences that may help guide future practice.Conclusions
This study provides some guidance for optimising corticosteroid prescribing and for the development of clinical practice guidelines. Approximately 80% of women should be able to receive at least some corticosteroids prior to delivery before 35 completed weeks of pregnancy.
Port‐site recurrences following laparoscopic operations for gynaecological malignancies
Authors: Kadar Nicholas 
Published: August 2005

Objective
To determine the frequency of port‐site recurrences following laparoscopic surgical treatment of gynaecological malignancies metastatic at the time of surgery.Design
Retrospective review of metastatic primary and recurrent gynaecological malignancies.Results
Twenty‐five women were studied. Twenty‐four had metastatic disease at the time of laparoscopic surgery, 22 in association with a primary malignancy (cervix: n= 12, ovary: n= 7, endometrium: n= 3), and two in association with recurrent ovarian cancer; all received pelvic or extended field radiation or chemotherapy after surgery. One woman with Stage IHC ovarian cancer, disease‐free at the completion of neoadjuvant chemotherapy following laparotomy by a general surgeon, was included; she developed scalene node metastases 18 months after definitive laparoscopic surgery. Seventy‐one 5 mm trocars and fifty 10 mm trocars (total n= 121) were used for surgery; thirty‐one 10 mm trocar sites and forty‐four 5 mm sites (total n= 75) received post‐operative treatment with chemotherapy (n= 49) or radiation (n= 26). Four women (16%) developed recurrences in association with endometrial (n= 2) and cervical (n= 2) cancer at six trocar sites. All recurrences were associated with abdominopelvic and/or distant metastases, and all occurred at untreated 5 mm trocar sites. The difference in recurrence rates between 5 mm and 10 mm trocar sites (χ2= 6; P < 0.025), and between treated and untreated trocars (χ2= 5; P < 0.05) were both statistically significant (McNemar's test), but the effects of treatment and trocar size on the port‐site recurrence rate were confounded.Conclusions
Port‐site recurrences are local manifestations of disseminated disease that result from the enhancement of tumour growth characteristic of healing tissues and can be prevented by appropriate post‐operative therapy.
Antenatal serum screening for genital herpes: a study of knowledge and attitudes of women at a central London hospital
Authors: Vonau Barbara , Low‐Beer Naomi , Barton Simon E. , Smith J. Richard 
Published: August 2005

Objective
To evaluate the knowledge and attitudes of women regarding genital herpes and specifically serum screening for prevention of vertical transmission.Setting
Antenatal clinic at the Chelsea and Westminster Hospital, London.Population
Randomly selected women at their first antenatal visit.Methods
A questionnaire focussing on the women's knowledge of, and their attitudes about, genital herpes was completed. The results were analysed using the Statistical Package for Social Sciences (SPSS).Results
One hundred women were surveyed over six weeks. The majority (80%) were aware that genital herpes was a sexually transmitted disease and 60% were aware that it can be transmitted to the baby in pregnancy. Only 34% thought that genital herpes is always symptomatic and 56% believed that they would know for certain if they had herpes. Sixty percent thought they would know whether their partners had ever been infected. Eighty percent of our sample population were prepared to be screened, and 76% would also encourage their sexual partner to have a blood test.Conclusion
This study shows that the study population had a good knowledge about genital herpes and that there would be acceptance of antenatal testing. Whether serum screening is cost‐effective must still be evaluated. The impact of such a screening on a couple's relationship is potentially deleterious and needs to be assessed carefully before a screening programme for genital herpes is actually introduced. The next phase of our study will address this issue.
The effect of carotid sinus denervation on fetal heart rate variation in normoxia, hypoxia and post‐hypoxia in fetal sheep
Authors: Kozuma Shiro , Watanabe Takanori , Bennet Laura , Green Lucy R. , Hanson Mark A. 
Published: August 2005

Objective
To investigate whether carotid sinus nerve reflexes are linked to the increase in heart rate variation in acute (one hour) hypoxia in late gestation fetal sheepDesign
Comparison of short term variation between intact and carotid sinus denervated fetuses in normoxia, hypoxia and post‐hypoxia.Subjects
Sixteen chronically catheterised pregnant sheep in late gestation.Results
There was no significant difference in short term variation between intact and denervated fetuses in normoxia. In intact fetuses short term variation increased significantly in hypoxia. In denervated fetuses it tended to increase in hypoxia, but this was not statistically significant. During the post‐hypoxia period, short term variation increased significantly in denervated fetuses, although at this time it was decreasing in intact fetuses. When the decrease in pH was small intact fetuses showed a significantly greater increase in short term variation than denervated fetuses in hypoxia. In contrast, short term variation increased similarly in both groups when the pH decrease was greater (> 0.03 in early hypoxia and > 0.05 in late hypoxia).Conclusions
Carotid sinus nerve reflexes have an important influence on heart rate variation in hypoxia and post‐hypoxia. It appears that other mechanisms (e.g. a rise in circulating catecholamines) are linked to an increase in heart rate variation when mild acidemia occurs in hypoxia.