bluuebunny/crossref_metadata_2025_split huggingface dataset:
The surgical management of vaginal vault prolapse
Authors: CREIGHTON SARAH M. , STANTON STUART L. 
Published: August 2005

AbstractObjective— A review of the results of surgery for vaginal vault prolapse following hysterectomy.Design— A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital.Setting— St George's Hospital, London.Subjects— 28 women.Interventions— The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year.Main outcome measures— Pre‐ and post‐operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function.Results— The mean follow‐up time was 17.1 months for the colposacropexy an 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus.Conclusion— The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.
Second trimester amniotic fluid oestriol, dehydroepiandrosterone sulphate, and human chorionic gonadotrophin levels in Down's syndrome
Authors: CUCKLE H. S. , WALD N. J. , DENSEM J. W. , CANICK J. , ABELL K. B. 
Published: August 2005

AbstractObjective— To investigatc the rcason for low matcrnal scrum unconjugated oestriol (uE3) and raised human chorionic gonadotrophin (hCG) levels in Down's syndrome pregnancies.Design— Mcasurement of uE3, total oestriol (tE3), dehydroepiandrosterone sulphate (DHEAS), a precursor of oestriol, and hCG in 15–20 week amniotic fluid samples from pregnancies with and without Down's syndrome.Setting— The retrieval and use of stored amniotic fluid samples collected from women who had had an amniocentesis for antenatal diagnosis.Subjects— 45 women with a Down's syndrome pregnancy and 224 unaffected controls of the same gestational age.Results— The median level of amniotic fluid in affected pregnancies was low for uE3, tE3 and DHEAS but high for hCG: 0.50,0.46,0.35 and 1–58 multiples of the normal median, respectively.Conclusion— These results suggest that the abnormal maternal serum levels of uE3 and hCG in affected pregnancies are due mainly to abnormal feto‐placental synthesis, rather than feto‐maternal transfer.
Pulsatile umbilical venous flow and its clinical significance
Authors: NAKAI YUICHIRO , MIYAZAKI YOSHIHIKO , MATSUOKA YASUNAGA , MATSUMOTO MASAHIKO , OGITA MOTOHARUIMANAKA SACHIO 
Published: August 2005

ABSTRACTObjective
To determine the prevalence and significance of pulsatile waveforms from the umbilical vein.Setting
A tertiary referral clinic for high risk pregnancies.Subjects
209 fetuses from 24–41 weeks gestation.Main outcome measures
The presence of pulsatile waveforms in the umbilical vein and the pregnancy outcome.Results
9/209 fetuses demonstrated pulsatile waveforms and seven had severe growth retardation or congenital anomalies of the heart. Pulsatile flow and abnormalities of the inferior vena cava waveforms were observed in these seven but not in the two infants who were born at term. Double pulsations are described for the first time.Conclusion
Examination of the umbilical venous waveform for pulsatile flow is a useful test as it indicates the presence of asphyxial cardiomyopathy or congenital heart lesions.
Perineal video‐ultrasonography in the assessment of vaginal prolapse: early observations
Authors: CREIGHTON SARAH M. , PEARCE J. MALCOLM , STANTON STUART L. 
Published: August 2005

ABSTRACTObjective
To investigate the efficacy of perineal ultrasonography in the assessment of vaginal prolapse.Design
A prospective descriptive study.Setting
Urodynamic Unit, St. George's Hospital, London.Subjects
Six women, three of them were awaiting colposuspension and three had had a colposuspension.Interventions
Perineal ultrasound scans were performed on women with and without incontinence and prolapse, both before and after continence surgery. Movement of the bladder, urethra, uterus, vaginal vault and enterocele were observed during coughing and the valsalva manoeuvre.Main outcome measures
To assess reproducibility, six patients had six different measurements taken of bladder neck and prolapse position and movement relative to the symphysis. The measurements were plotted upon an X‐Y co‐ordinate axis. Each measurement was repeated three times and one way analysis of variance performed upon the readings.Results
Perineal ultrasonography clearly demonstrated movement of the whole pelvic floor. Minor degrees of both anterior and posterior vaginal wall prolapse could be seen and quantified. An increase in posterior vaginal wall mobility was noted in women after colposuspension. All measurements taken were found to be reproducible.Conclusions
Perineal ultrasonography is easy to perform and is reproducible. It may improve understanding of why some women develop posterior vaginal wall prolapse after colposuspension and, conversely, why some women develop incontinence following anterior repair for prolapse.
Plasma concentrations of motilin and somatostatin are increased in late pregnancy and postpartum
Authors: HOLST NICOLAI , JENSSEN TROND G. , BURHOL PER G. 
Published: August 2005

ABSTRACTObjective
To examine plasma levels of motilin and somatostatin throughout pregnancy.Design
Prospective observational study.Setting
University Hospital, Norway.Subjects
Eight healthy pregnant women (aged 24–38 years) six of them primi‐gravidae and eight healthy non‐pregnant women of similar age with ovulatory menstrual cycles.Interventions
In the pregnant women blood samples were obtained at 4‐week intervals from 8 weeks gestation throughout pregnancy and again at 5 days and 28 days postpartum. In the non‐pregnant controls blood samples were obtained on cycle days 4, 7, 10, 13, 14, 15, 18, 21 and 24.Main outcome measures
Plasma levels of motilin and somatostatin. Results Plasma concentrations of both motilin and somatostatin rose continuously during pregnancy, and motilin levels increased still further to a peak of 165.1 (SE 35.8) pmol/1 at 5 days postpartum. Plasma motilin levels were significantly higher during the third trimester and at 5 days postpartum compared with non‐pregnant controls (P<0.0001). The highest plasma somatostatin levels were found at 40 weeks gestation and at 5 days postpartum (mean 32.1 SE 1.1 pmol/1). Somatostatin levels were significantly higher during the second and third trimester and the postpartum period compared with levels in the follicular phase of the non‐pregnant controls (P<0.0001).Conclusions
Circulating levels of motilin cannot play a major role in the relaxation of the gut in pregnancy, but somatostatin may play a part in regulating motility.
Falling incidence of hypoxic‐ischaemic encephalopathy in term infants
Authors: HULL JEREMY , DODD KEITH L. 
Published: August 2005

ABSTRACTObjective
To examine trends in the incidence of hypoxic‐ischaemic encephalopathy over a 13‐year period.Design
A retrospective analysis of medical records of all infants admitted in the years 1976–1980 and 1984–1988.Setting
A large non‐teaching district health authority in central England.Subjects
Infants admitted to a district general hospital neonatal unit with clinical features of hypoxic‐ischaemic encephalopathy.Main outcome measures
Incidence of three grades of hypoxic‐ischaemic encephalopathy, handicap and mortality.Results
During the first 5‐year period the overall incidence of hypoxic‐ischaemic encephalopathy was 7.7 per 1000 live births with 2.6 per 1000 live births being severely affected (grades II and III). In the second 5‐year period the overall incidence was 4.6 per 1000 live births with 1.8 per 1000 live births being severely affected. The difference in the overall rate is statistically significant. Of the infants with severe encephalopathy 61 % had Apgar scores below 4 at 1 min and 60% were born by instrumental or operative delivery.Conclusions
The fall in incidence of hypoxic‐ischaemic encephalopathy has occurred during a period of falling perinatal mortality rate. It was instructive to find that infants born vaginally and without obstetric intervention formed a larger fraction of the severely affected infants in the later period.
Sweeping of the membranes is an effective method of induction of labour in prolonged pregnancy: a report of a randomized trial
Authors: EL‐TORKEY MOHAMED , GRANT JOHN M. 
Published: August 2005

ABSTRACTObjective
To determine whether sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy.Design
Randomized controlled trial.Setting
A district maternity hospital.Subjects
65 women attending an antenatal clinic; 33 randomized to sweeping of the membranes and 32 to a control group.Main outcome measure
Proportion of women achieving spontaneous labour.Results
Spontaneous labour occurred more often in the sweeping of the membranes group than in the control group (25/33 (76%) vs 12/32 (38%); odds ratio (OR) 4.65; 95% confidence interval (CI) 1.75 to 12.31; P= 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labour ward (16/33 (49%) vs 5/32 (16%); OR 4.39; 95% CI 1.56 to 12.32; P= 0.005). There were fewer maternal infections in the sweeping group (0/33 vs 4/32 (12%); OR 0.12; 95% CI 0.02 to 0.88; P= 0.04). There were no differences in the type of analgesia used in labour, the mode of delivery or neonatal outcome.Conclusions
Sweeping of the membrances is an effective method of induction of labour in women with prolonged pregnancy.
The modified Pereyra procedure: a clinical and urodynamic review
Authors: KARRAM MICKEY M. , ANGEL OSCAR , KOONINGS PAUL , TABOR BANNIE , BERGMAN ARIEH , BHATIA NARENDER 
Published: August 2005

ABSTRACTObjective
To review the clinical and urodynamic outcome of treatment by the modified Pereyra procedure in 93 women with genuine stress incontinence.Design
Retrospective review.Setting
Harbor/UCLA Medical Center and Los Angeles County Women's Hospital, Los Angeles, California, USA.Main outcome measures
Clinical and urodynamic assessment one year after modified Pereyra procedure.Results
Overall 82% of patients were subjectively cured while only 63% were objectively cured. Women with failed surgery had significantly lower pre‐operative maximum urethral closure pressures. The procedure had a low operative and postoperative morbidity with no significant disturbance of voiding function noted at one year follow‐up.Conclusions
Our results with the modified Pereyra procedure for stress incontinence showed a significantly lower success rate than has been reported from many previous studies.
Randomized trial of amniotomy in labour versus the intention to leave membranes intact until the second stage
Authors: BARRETT JON F. R. , SAVAGE JOHN , PHILLIPS KEVIN , LILFORD RICHARD J. 
Published: August 2005

ABSTRACTObjective
To compare by randomized prospective clinical trial the outcome of labours which are managed with the intention to leave the membranes intact, compared with the practice of elective artificial rupture of the membranes (ARM) in early established labour.Design
Prospective randomized controlled trial of low risk women admitted in spontaneous labour, with intact membranes.Setting
The labour ward of St. James's University Hospital, Leeds, UK.Subjects
362 women in spontaneous labour with intact membranes and no evidence of fetal distress, between 37 and 42 weeks gestation. During the course of the trial it was found that some randomization cards could not be accounted for and a system of daily checks was instituted. The results were analysed for all recorded women (n= 362) and after institution of the more rigorous system (n= 120).Main outcomes measured
The duration of each phase of labour, epidural rate, prevalence of an abnormal cardiotocograph (CTG) (assessed blind), method of delivery and neonatal outcome.Results
178 of the 183 women (97%) in the ARM group had their membranes ruptured in early labour, and 83 (46%) of the 179 women allocated to non‐intervention had ARM performed at some stage. A significant decrease in the duration of labour (mean 8.3, SD 4.1 h vs mean 9.7, SD 4.8h, n = 156; P= 0.05) was found amongst primigravidae allocated to ARM when compared with non intervention. The duration of the second stage of labour was unaffected. In the ARM group the epidural rate was higher and labour was more often complicated by CTG abnormalities. There were no differences in the method of delivery, fetal condition at birth (cord blood lactate, Apgar score) or postpartum pyrexia between the ARM and non‐intervention groups. The same trends were observed when analysis was confined to women entered into the trial after the system of rigour was instituted.Conclusion
Routine ARM results in labour that is slightly shorter than if the membranes are allowed to rupture spontaneously but more epidurals are used suggesting that labour is more painful. There are fewer fetal heart rate abnormalities if the membranes are left intact but amniotomy has no effect on fetal condition at birth.
Fetal acidaemia, the cardiotocograph and the T/QRS ratio of the fetal ECG in labour
Authors: MACLACHLAN NEIL A. , SPENCER JOHN A.D. , HARDING KATE , ARULKUMARAN SABARATNAM 
Published: August 2005

ABSTRACTObjective
To relate the T/QRS ratio of the fetal electrocardiogram (ECG) to the cardiotocogram (CTG) and fetal pH during labour.Design
Prospective data collection from selected monitored labours. Setting A postgraduate teaching hospital delivery suite.Subjects
113 women in labour at term.Main outcome measures
Correlation of fetal T/QRS ratio values with pH values at the time of fetal blood sampling and at birth (umbilical artery blood). Comparison of the predictive values of raised T/QRS ratio and a pathological CTG for fetal acidaemia.Results
Complete data sufficient for analysis was available for 51 fetal scalp blood samples and 93 umbilical artery pH samples. The median (range) of T/QRS ratio values before birth of 88 babies not requiring admission to the neonatal unit was 0.13 (0.00–0.32) with a 97.5th centile value of 0.28. T/QRS ratios did not correlate with fetal scalp pH values. Fetal scalp acidaemia (pH<7.20) was detected with rates of 50 and 13% respectively by a pathological CTG and by a T/QRS ratio above 0.28, the positive predictive values being 40% and 50%, respectively. There was a significant correlation between increasing T/QRS ratio and falling pH. Detection rates (sensitivities) for umbilical artery acidaemia (pH<7.12) were 76% and 29% whereas positive predictive values were 38% and 71% respectively for a pathological CTG and a T/QRS ratio above 0.28.Conclusion
A raised T/QRS ratio (<0.28) had a considerably lower detection rate for fetal acidaemia during labour than a pathological CTG.
Pre‐eclampsia and trisomy 13
Authors: TUOHY JEREMY F. , JAMES DAVID K. 
Published: August 2005

ABSTRACTObjective
To assess the reported association between field trisomy 13 and maternal pre‐eclampsia.Design
A retrospective case‐control study.Subjects
Twenty‐five women who gave birth to trisomy 13 infants in southwest England between 1971 and 1989; 38 women who gave birth to trisomy 18 infants in the same region over the same time and 50 women with normal karyotype infants matched for age, parity, and date of delivery with the trisomy 13 group.Main outcome measures
The medical records of all the women in the three groups were analysed for evidence of pre‐eclampsia. Four different thresholds of pre‐eclampsia were used. The incidence of pre‐eclampsia was compared between the three study groups and analysed separately for primigravid and multigravid women.Results
The incidence of pre‐eclampsia in pregnancies complicated by trisomy 13 was significantly higher than the incidence in the trisomy 18 and the normal karyotype control groups. This association was more pronounced in primigravid pregnancies.Conclusions
This, the largest survey of trisomy 13 and pre‐eclampsia to date, suggests an association between the two conditions. It also supports the argument for a fetal factor in the pathogenesis of pre‐eclampsia. We speculate on how genes encoded on chromosome 13 may be responsible.
Randomised comparative study in 217 women of three disposable plastic IUCD thread retrievers
Authors: BOUNDS W. , HUTT S. , KUBBA A. , COOPER K. , GUILLEBAUD J. , NEWMAN G. B. 
Published: August 2005

ABSTRACTObjective
To assess the relative efficacy of three disposable plastic instruments in the retrieval of ‘missing’ IUCD threads.Design
A prospective randomised comparative single centre study.Setting
Family Planning Clinic in London, UK.Subjects
217 of 350 IUCD users referred to the research team with ‘missing’ IUCD threads entered the study.Intervention
All women initially underwent exploration of the endocervical canal with Spencer Wells forceps. When this procedure did not retrieve the threads, the patients were entered into the study. A maximum of two randomly chosen plastic IUCD thread retrievers were then used in any one patient to explore the uterine cavity and capture the ‘missing’ threads. The order in which the two retrievers were employed was also determined at random. Four separate entries into the uterine cavity were permitted with each instrument, the endocervical canal being explored with Spencer Wells forceps after each retraction of the instrument to identify the possible descent of the threads.Main outcome measures
Threads brought down beyond the external cervical os, or threads brought to within the endocervical canal and then grasped by Spencer Wells forceps.Results
In approximately 40% of all patients, the threads were retrieved with Spencer Wells forceps alone and a further 40% with the disposable plastic retrievers. About 5% had no retrievable threads, and only 2.5% of the referred patients required general anaesthesia for removal of their IUCD. The analysis of the comparative trial was confined to the 197 patients with retrievable threads which could not be brought below the external os with Spencer Wells forceps. The first plastic retriever used was successful in 50% of patients. The Retrievette (59%) and the Emmett (53%) performed better than the Mi‐Mark Helix (37%) in this study. The difference was statistically significant (P=0.03) and the 95% confidence interval for the difference of the Mi‐Mark Helix from the other two retrievers was 4% to 33%. This retrieval rate for the Mi‐Mark Helix was much worse than in previously reported studies, though one doctor did have a better success rate with this retriever. The success rates, using a second plastic retriever randomly chosen from the two not used in the first attempt, were almost identical to those observed with the first retrievers: 63%, 56% and 36%. The success rate did not appear to be influenced by the length of thread, day of cycle, device type or parity. The success of the second retriever tried did not seem to be influenced by the retriever that had failed previously.Conclusions
Based on our experience, the initial exploration of the endocervical canal with Spencer Wells forceps is invaluable. If this simple manoeuvre fails to retrieve the ‘missing’ threads, either the Retrievette or the Emmett thread retrievers are useful tools in general practice or in the family planning clinic setting.
Second trimester amniocentesis in twin pregnancies: maternal haemoglobin as a dye marker to differentiate diamniotic twins
Authors: BEEKHUIS J. R. , DE BRUIJN H. W. A. , VAN LITH J. M. M. , MANTINGH A. 
Published: August 2005

ABSTRACTObjective
To review the use of a membrane‐free haemolysate prepared from maternal blood to distinguish the amniotic sacs at amniocentesis in twin gestation.Setting
University Hospital, Groningen.Method
Haemoglobin solution prepared from maternal blood.Subjects
63 twin pregnancies having amniocentesis.Results
The fetal loss before 28 weeks was 4%. There was no perinatal mortality. Dye was detected in the second sac in 9 of 24 women tested before 1985 and none of the 39 women since, no malformations could be ascribed to the use of the haemolysate.Conclusion
The use of the membrane‐free haemolysate is safe, but the technique will probably gradually become redundant because of improved ultrasound.
Doppler umbilical artery flow velocity waveforms in diabetic pregnancy
Authors: JOHNSTONE FRANK D. , STEEL JUDITH M. , HADDAD NABIL G. , HOSKINS PETER R. , GREER IAN A. , CHAMBERS SARAH 
Published: August 2005

ABSTRACTObjective
To assess the effect of uncomplicated diabetes on umbilical artery flow velocity waveforms (FVWs); to investigate the relation between glycaemic control and FVWs and the predictive value of umbilical artery FVWs for antenatal fetal compromise.Design
Prospective descriptive study.Setting
A large diabetic pregnancy clinic in a teaching hospital.Subjects
128 pregnancies complicated by diabetes mellitus. 170 non diabetic women with no pre‐existing or pregnancy complications.Interventions
In diabetic pregnancies, umbilical artery resistance index (RI) Doppler recordings and glycosylated haemoglobin were measured every 2 weeks from 28 weeks.Main outcome measures
Umbilical artery RI and antenatal fetal compromise defined as a non reactive, decelerative cardiotocograph and/or a biophysical profile score persistently <6 and leading to immediate caesarean section.Results
Uncomplicated diabetic pregnancies had FVW values similar to those in the non‐diabetic range. Glycaemic control was unrelated to umbilical artery FVW values. Abnormal umbilical artery RI was found in nine pregnancies, these were more likely to show evidence of fetal compromise and to be associated with birth weights of <50th centile. In seven pregnancies there was evidence of fetal compromise, but only three of these pregnancies had abnormal FVW values.Conclusions
The non‐diabetic range of umbilical artery RI values is appropriate for diabetic pregnancies. Long‐term glycaemic control, within the range in this study, does not seem to affect umbilical artery RI. Abnormal umbilical artery RI is a significant predictor of fetal compromise in diabetic pregnancy, but fetal compromise can occur in association with normal RI values. Undue reliance should not be placed on normal FVW values in diabetic pregnancies.
Objective measurement of anxiety in hypertensive pregnant women managed in hospital and in the community
Authors: CARTWRIGHT W. , DALTON K. J. , SWINDELLS H. , RUSHANT S. , MOONEY P. 
Published: August 2005

ABSTRACTObjective
To determine whether pregnant hypertensives women are more anxious when monitored in hospital or at homes.Design
Prospective randomized controlled trial.Setting
Rosie Maternity Hospital and women's homes.Subjects
Ninety‐nine pregnant hypertensive women: 50 had their blood pressure measured telemetrically from home, and 49 had it measured in hospital.Main outcome measures
Number of episodes of monitoring, duration of monitoring, mean blood pressure during monitoring, gestational age at delivery, trait and state anxiety levels.Results
There were no significant differences in anxiety levels, or in any other outcome measure, between the home and hospital groups.Conclusion
When blood pressure is being monitored serially in pregnant hypertensive women, there is no measurable difference in their anxiety levels, whether they are in hospital or at home.