bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the intrauterine device appropriate contraception for HIV‐1‐infected women?
Authors: Morrison Charles S. , Sekadde‐Kigondu Christine , Sinei Samuel K. , Weiner Debra H. , Kwok Cynthia , Kokonya Donald 
Published: December 2003

Objective
To assess whether the risk of complications is higher in HIV‐1‐infected women compared with non‐infected women in the two years following insertion of the intrauterine contraceptive device.Design
Prospective cohort study.Population
Six hundred and forty‐nine women (156 HIV‐1‐infected, 493 non‐infected) in Nairobi, Kenya who requested an intrauterine contraceptive device and met local eligibility criteria.Methods
We gathered information on complications related to the use of the intrauterine contraceptive device, including pelvic inflammatory disease, removals due to infection, pain or bleeding, expulsions, and pregnancies at one, four, and 24 months after insertion by study physicians masked to participants’ HIV‐1 status. Cox regression was used to estimate hazard ratios.Results
Complications were identified in 94 of 636 women returning for follow up (14.7% of HIV‐1‐infected, 14.8% of non‐infected). The incidence of pelvic inflammatory disease was rare in both infected (2.0%) and non‐infected (0.4%) groups. Multivariate analyses suggested no association between HIV‐1 infection and increased risk of overall complications (hazard ratio=1.0; 95% CI 0.6‐1.6). Infection‐related complications (e.g. any pelvic tenderness, removal for infection or pain) were also similar between groups (10.7% of HIV‐1‐infected, 8.8% of non‐infected; P=0.50), although there was a non‐significant increase in infection‐related complications among HIV‐1‐infected women with use of the intrauterine contraceptive device longer than five months (hazard ratio=1.8; 95% CI 0.8‐4.4). Neither overall nor infection‐related complications differed by CD4 (immune) status.Conclusions
HIV‐1‐infected women often have a critical need for safe and effective contraception. The intrauterine contraceptive device may be an appropriate contraceptive method for HIV‐1‐infected women with ongoing access to medical services.
Perinatal outcome in SGA births defined by customised versus population‐based birthweight standards
Authors: Clausson Britt , Gardosi Jason , Francis Andre , Cnattingius Sven 
Published: December 2003

Objective
To determine whether customised birthweight standard improves the definition of small for gestational age and its association with adverse pregnancy outcomes such as stillbirth, neonatal death, or low Apgar score.Design
Population based cohort study.Population
Births in Sweden between 1992‐95 (n=326,377).Methods
Risks of stillbirth, neonatal death, and Apgar score under four at five minutes were calculated for the lowest 10% birthweights according to population‐based and customised standards, and were compared with the data from the group with birthweights over this limit. Population attributable risks for stillbirth using various birthweight centile cutoffs were calculated for the two standards.Outcome
measures Odds ratios and 95% confidence intervals for stillbirth, neonatal death and Apgar score under four at five minutes, and population attributable risks for stillbirth at different birthweight centiles.Results
Risks of stillbirth, neonatal death, and Apgar score under four at five minutes and population attributable risks of stillbirth were consistently higher if ‘small for gestational age’ was classified by a customised rather than by the population‐based birthweight standard. Compared with infants who were not small for gestational age by both standards, the odds ratio for stillbirth was 6.1 (95% CI 5.0‐7.5) for small for gestational age by customised standard only, whereas it was 1.2 (95 % CI 0.8‐1.9) for small for gestational age by population standard only.Conclusions
Compared with the population‐based birthweight standard, a customised birthweight standard increases identification of fetuses at risk of stillbirth, neonatal death and Apgar score under 4 at 5 minutes, probably due to improved identification of fetal growth restriction.
Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data
Authors: Bell Jacqueline S. , Campbell Doris M. , Graham Wendy J. , Penney Gillian C. , Ryan Mandy , Hall Marion H. 
Published: December 2003

Objective
To determine whether the higher levels of obstetric intervention and maternity service use among older women can be explained by obstetric complications.Design
A retrospective analysis of routinely collected data from the Aberdeen Maternity and Neonatal Databank.Participants
All residents of Aberdeen city district delivering singleton infants at the Maternity Hospital 1988‐1997 (28,484 deliveries).Main outcome measures
Odds ratios for each intervention in older maternal age groups compared with women aged 20‐29. Interventions considered include obstetric interventions (induction of labour, augmentation, epidural use, assisted delivery, caesarean section) and raised maternity service use (more than two prenatal scans, amniocentesis, antenatal admission to hospital, admission at delivery of more than five days, infant resuscitation, and admission to the neonatal unit).Methods
Logistic regression was used to investigate the association between maternal age and the incidence of interventions. The odds ratios for each intervention were then adjusted for relevant obstetric complications and maternal socio‐demographic characteristics.Results
Levels of amniocentesis, caesarean section, assisted delivery, induction, and augmentation (in primiparae) are all higher among older women. Maternity service use also increases significantly with age: older women are more likely to have an antenatal admission, more than two scans, a hospital stay at delivery of more than five days, and have their baby admitted to a neonatal unit. Controlling for relevant obstetric complications reveals several examples of effect modification, but does not eliminate the age effect for most interventions in most groups of women.Conclusions
Higher levels of intervention among older women are not explained by the obstetric complications we considered.
Management of monoamniotic twin pregnancies: a case series and systematic review of the literature
Authors: Allen Victoria M. , Windrim Rory , Barrett Jon , Ohlsson Arne 
Published: December 2003

Objectives
To review the experience of the University of Toronto Perinatal Complex, Ontario, Canada concerning antenatally diagnosed monoamniotic twin pregnancies; and to compare our results with cases reported in the literature with respect to antenatal surveillance and perinatal outcome.Methods
A retrospective chart review of all twin gestations from 1993 to April 2000 was performed. A systematic review of the literature, 1966 to April 2000, of perinatal outcome in monoamniotic twin pregnancies was undertaken.Setting
All monoamniotic twin gestations at the University of Toronto.Results
Case‐series: 25 prenatally diagnosed monoamniotic twin pregnancies were identified. Seven pregnancies were affected by fetal anomalies. One fetus died at 29 weeks. Neonatal complications occurred below 33 weeks of gestational age and were related to immaturity. Systematic review of the literature: 49 studies met our selection criteria and reported 88 cases diagnosed antenatally. Fourteen pregnancies were affected by major congenital anomalies. Twenty fetuses died after 24 weeks of gestation. Neonatal complications varied widely in severity and depended on gestational age at birth. The risk of intrauterine fetal death was 10% at the University of Toronto and 12% in the review of the literature.Discussion
Our experience, the largest so far, suggests that regular fetal surveillance and appropriate steroid administration leads to a good perinatal outcome. The risk of fetal death (10%–12%) is lower than the previously quoted risk of 30%–70%. A careful review of obstetric interventions and further work examining outpatient surveillance of monoamniotic twin pregnancies are needed. The best treatment of monoamniotic twin pregnancies can only be determined by randomised trials.
Quantitative and qualitative assessment of women's experience of a one‐stop menstrual clinic in comparison with traditional gynaecology clinics
Authors: Abu Jafaru I. , Habiba Marwan A. , Baker Richard , Halligan Aidan W. F. , Naftalin Nicholas J. , Hsu Ronald , Taub Nicholas 
Published: December 2003

Objective
A quantitative and qualitative evaluation of the views of patients attending two types of clinics for menstrual disorders.Methods
Semi‐structured qualitative interview and quantitative questionnaire.Setting
Five traditional general gynaecology clinics and a one‐stop menstrual clinic, where investigations are performed and results given to patients on the same day.Participants
Two hundred and thirty‐nine women (126 from the gynaecology clinic and 113 from the menstrual clinic) were recruited into the quantitative study; 18 and 26 patients from the gynaecology and the menstrual clinic, respectively, were interviewed for the qualitative study.Main
outcome measures Women's views about their care and progress towards resolution of their problem.Results
Following the initial consultation, 106 (84%) of the gynaecology clinic, and 98 (87%) of the menstrual clinic patients completed the first part of the questionnaire. Of those, 75 (71%) and 79 (81%) patients from the two types of clinic, respectively, completed a follow up questionnaire one year later. There were statistically significant differences in all the components of the first part of the questionnaire (information, continuity, waiting, organisation, and limbo) in favour of the one‐stop menstrual clinic. After one year, there was a statistically significant difference in one of the components, patient centeredness, but not in overall process co‐ordination. The interviews showed that patients attending the menstrual clinic appreciated getting the results of their investigations on the same day. They also found the organisation of the one‐stop menstrual clinic more closely suited to their needs and as a result were more likely to feel they were making progress.Conclusion
Women were consistently more positive about their experience in the one‐stop clinic. One‐stop clinics organised to meet the needs of patients might be appropriate for other clinical conditions. The combination of quantitative and qualitative methods is an effective method of assessing patients’ views of health services.
Endothelial function in myometrial resistance arteries of normal pregnant women perfused with syncytiotrophoblast microvillous membranes
Authors: Van Wijk Marja J. , Boer Kees , Nisell Henry , Smarason Alexander K. , Van Bavel Ed , Kublickiene Karolina R. 
Published: December 2003

Objective
To investigate the effects of syncytiotrophoblast microvillous membranes (STBM) in concentrations, found in vivo in women with pre‐eclampsia, on endothelial function in isolated resistance arteries.Setting
Department of Obstetrics and Gynaecology, Huddinge University Hospital, Stockholm.Sample
Twenty‐nine myometrial resistance arteries isolated from biopsies of healthy term pregnant women, obtained during caesarean section.Methods
The myometrial arteries were mounted in a pressure arteriograph and perfused intraluminally for three hours with STBM (20 to 2000ng/mL) or with erythrocyte membranes or physiological salt solution as controls, all substituted with 0.5% bovine serum albumin. Bradykinin concentration‐response curves were performed before and after perfusion.Main outcome measures
The bradykinin concentrationresponse curves were fitted to the Hill equation and maximal dilation and the pEC50 values were determined from these fits. Differences within groups were analysed with a paired Student's t test. Electron microscopic evaluation of the endothelium was performed.Results
Neither STBM nor erythrocyte membrane perfusion affected maximal dilation or the pEC50 values of the bradykinin concentration‐response curves at any concentration. Examination by electron microscopy showed no obvious damage to the endothelium after perfusion with STBM or erythrocyte membranes.Conclusion
Perfusion with STBM in concentrations up to 100 times those reported in pre‐eclampsia has no significant effect on bradykinin‐mediated dilation in isolated myometrial arteries.
Secondary postpartum haemorrhage: incidence, morbidity and current management
Authors: Hoveyda Fatemeh , MacKenzie I.Z. 
Published: December 2003

Objective
To determine the incidence, risk factors, presentation, treatment and morbidity associated with secondary postpartum haemorrhage.Design
Analysis of 132 consecutive women presenting with secondary postpartum haemorrhage occurring over a three‐year period.Setting
The maternity unit in a district general teaching hospital serving an annual delivery rate of around 6500 women.Main
outcome
measures Factors associated with the cause of the haemorrhage and the resulting morbidity.Results
Most women presented during the second week after delivery. A history of primary postpartum haemorrhage (OR 9.3; 95% CI 6.2‐14.0) and manual removal of placenta (OR 3.5; 95% CI 1.6‐7.5) were the only significant risk factors identified. There was a high associated morbidity, with 84% requiring hospital admission, 63% surgical evacuation, 17% blood transfusion, with three women suffering a uterine perforation, one managed by hysterectomy. In women undergoing evacuation only, 37% had retained placental tissue confirmed after surgery; pre‐operative ultrasound examination did not provide a better discrimination over clinical assessment for this finding.Conclusions
Secondary postpartum haemorrhage occurs in just under 1% of women, is associated with primary postpartum haemorrhage and retained placenta, and may result in significant maternal morbidity. This problem deserves more attention than it has received in recent years.
Titrated oral misoprostol solution for induction of labour: a multi‐centre, randomised trial
Authors: Hofmeyr G.J. , Alfirevic Z. , Matonhodze B. , Brocklehurst P. , Campbell E. , Nikodem V.C. 
Published: December 2003

Objectives
To determine the effects of titrated oral misoprostol solution, compared with vaginal dinoprostone.Study design
Open, randomised clinical trial.Setting
Academic hospitals in South Africa and Liverpool, UK.Methods
Women undergoing induction of labour after 34 weeks of pregnancy were allocated by randomised, sealed opaque envelopes, to induction of labour with titrated oral misoprostol solution, or two doses of vaginal dinoprostone (2mg) administered six hours apart. Failure to deliver within 24 hours of randomisation was the primary outcome on which the sample size was based. The data were analysed by intention‐to‐treat.Results
Six hundred and ninety‐five women were randomly allocated: 346 to oral misoprostol and 349 to vaginal dinoprostone. There were no significant differences in substantive outcomes. Vaginal delivery within 24 hours was not achieved in 38% of women in the oral misoprostol group and 36% in the vaginal dinoprostone group (RR 1.08; 95% CI 0.89‐1.31). The caesarean section rates were 16% and 20%, respectively (RR 0.80; 95% CI 0.58‐1.11). Hyperstimulation with fetal heart rate changes occurred in 4% of women in the oral misoprostol group and 3% after vaginal dinoprostone (RR 1.32, 95% CI 0.59–2.98). The response to induction of labour in women with unfavourable cervices was somewhat slower with misoprostol when membranes were intact, and with dinoprostone when membranes were ruptured. There were no differences in neonatal outcome between the two groups.Conclusions
This new approach to oral misoprostol administration was successful in minimising the risk of uterine hyperstimulation, which has been a feature of misoprostol use for induction of labour, at the expense of a somewhat slower response in women with intact membranes and unfavourable cervices. Misoprostol is not registered for use in pregnant women, and further research is needed to confirm optimal and safe dosages.
The use of nuchal translucency measurement and second trimester biochemical markers in screening for Down's Syndrome
Authors: Michailidis G.D. , Spencer K. , Economides D.L. 
Published: December 2003

Objective
To assess the effectiveness of antenatal screening for trisomy 21 by first trimester sonography followed by second trimester biochemical screening.Design
Retrospective five‐year review.Setting
Maternity unit of a university hospital.Population
An unselected group of 7447 pregnant women who had a first trimester scan and nuchal translucency measurement in our unit after January 1995 and had an estimated date of delivery before 1 January 2000. 11.9% were ≥ 37 years old. A subgroup (n=4864) also had second trimester biochemical testing by alpha‐fetoprotein and free β‐human chorionic gonadotrophin.Main
outcome measures Prenatal and postnatal diagnosis of trisomy 21.Results
There were 23 fetuses affected with trisomy 21. The overall prenatal detection rate was 87% (20/23; 95% CI 66% to 97%) and we performed invasive procedures in 8.5% of our population. First trimester sonography identified 74% (95% CI 51.6% to 89.8%) of affected fetuses. Second trimester biochemical screening detected half of the fetuses with trisomy 21 which were missed by first trimester screening, increasing the sensitivity to 90.5% (19/21; 95% CI 69.6% to 98.8%) for an invasive procedure rate of 4.2% performed in screened positive women. However, the positive predictive value of the biochemical test was very low (0.5%). In screen negative women, karyotyping for advanced maternal age did not detect any affected fetuses.Conclusion
First trimester nuchal translucency measurement is an effective screening test for the prenatal detection of fetuses with Down's Syndrome. Although the measurement of biochemical markers in the second trimester can detect additional affected fetuses this may be outweighed by the delay in diagnosis, the extra visits and cost so that the right time for biochemical screening is most likely to be in the first trimester.
Operative intervention in delivery is associated with compromised early mother‐infant interaction
Authors: Rowe‐Murray Heather J. , Fisher Jane R.W. 
Published: December 2003

Objective
To investigate the effects of mode and place of delivery on first mother–infant contact and maternal emotional wellbeing.Design
A prospective, longitudinal study.Participants
A sociodemographically representative sample of 203 consecutive primiparous women was recruited, of whom 81% (n=164) were followed up.Setting
Four metropolitan hospitals, including one accredited baby friendly hospital, in Melbourne, Australia, 1997.Methods
During the postnatal hospital stay women were interviewed and medical records were inspected. Participants completed two self‐report psychometric measures: the Edinburgh Postnatal Depression Scale (EPDS) and the Profile of Moods States (POMS). Follow up at eight months postpartum comprised completion of a postal questionnaire and repeat administration of the standardised self‐report psychometric mood questionnaires.Results
The First Contact Index provides a measure of the first contact between a mother and her baby after the birth. Two‐way analysis of variance revealed significant differences in First Contact Index between three modes of delivery groups: spontaneous, instrumentally‐assisted, and caesarean section (P<0.001) and four hospital of delivery groups (P<0.001), but there was no significant interaction effect (P=0.55). Significant negative correlations existed between the First Contact Index and both the POMS and EPDS scores at two days postpartum (POMS, r = ‐0.339, 95% CI ‐0.46 to ‐0.22; EPDS, r = ‐0.279, 95% CI ‐0.41 to ‐0.16), even within delivery groups, and these were still present at eight months postpartum (POMS, r = ‐0.298, 95% CI ‐0.44 to ‐0.14, EPDS, r = ‐0.206, 95% CI ‐0.36 to ‐0.03).Conclusion
Instrumental and surgical delivery exert a negative impact on first postnatal contact between a mother and her baby which has persistent adverse maternal emotional correlates. Hospital practices associated with obstetric intervention in delivery also varied and are amenable to change, enabling optimal first mother–baby interaction regardless of mode of delivery.
Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey
Authors: Henriet Laurence , Kaminski Monique 
Published: December 2003

Objective
To study the impact of previous induced abortions on preterm delivery, small for gestational age and low birthweight in subsequent pregnancies.Design
Survey of a national sample of births in France in 1995.Setting
All public and private maternity hospitals in France.Population
12,432 women who had a singleton live birth during one week.Methods
Data were collected during the women's postpartum stay in hospital, partly obtained by interview and partly abstracted from hospital medical records. Rates of preterm delivery, small for gestational age and low birthweight were compared according to existence and number of previous induced abortions. Maternal age, parity, history of previous adverse pregnancy outcome, maternal weight before pregnancy, marital status, educational level, maternal employment status during pregnancy, nationality, smoking during the third trimester of pregnancy and antenatal care were controlled for using multiple logistic regression and polytomous logistic regression.Results
Twelve percent of women reported one previous induced abortion, and 3% two or more. Previous induced abortion was associated with an increased risk of preterm birth (OR 1.4; 95% CI 1.1–1.8); the risk of preterm delivery increased with the number of previous induced abortions (OR 1.3; 95% CI 1.0–1.7 for one previous abortion and OR 1.9; 95% CI 1.2–2.8 for two or more). The relationship was the same for very preterm and moderately preterm deliveries and for spontaneous and indicated preterm deliveries. After controlling for potential confounders, the association between previous induced abortions and small for gestational age and low birthweight infants was no longer significant.Conclusion
This study suggests that a history of induced abortion increases the risk of preterm delivery, particularly for women who have had repeated abortions. The respective role of the surgical and medical techniques used for induced abortions needs to be explored.