bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy
Authors: MOODLEY J. , GOUWS E. 
Published: August 2005

ABSTRACTObjective
To compare the antihypertensive effects of epoprostenol sodium (pros‐tacyclin) with that of dihydralazine in acute hypertensive crises of pregnancy.Design
A prospective randomized study. A minimum of 20 patients per group was considered statistically acceptable (alpha = 0.05, power = 0.9).Setting
A large urban tertiary hospital.Subjects
Forty‐seven pregnant patients with diastolic blood pressures of >100 mmmHg were studied.Intervention
Lowering of high blood pressure with either dihydralazine (n= 25), the standard drug for this purpose, or epoprostenol (n= 22).Main outcome measure
A significant drop in high blood pressure was regarded as a fall of 15 mmHg diastolic and 30 mmHg systolic blood pressure.Results
There were no statistically significant differences in the antihypertensive effects between the two treatment groups. Epoprostenol infusion caused less tachycardia; the mean pulse rate changed from 81.77 beats/min, before treatment to 88.36 at stabilization, compared with a change from 80.96 beats/min to 102.68 in the group treated with dihydralazine (P= 0.0024).Conclusion
The place of epoprostenol in pregnancy might be in patients with severe hypertension and tachycardia and in those requiring acute control of severe hypertension on the operating table before general anaesthesia.
Determinants of pregnancy heartburn
Authors: MARRERO J. M. , GOGGIN P. M. , de CAESTECKER J. S. , PEARCE J. M. , MAXWELL J. D. 
Published: August 2005

ABSTRACTObjective
To study the prevalence and severity of reflux symptoms in pregnancy.Design
Self‐administered questionnaire detailing age, race, gestational age, parity, weight, height, symptoms and severity of gastro‐oesophageal reflux.Setting
An antenatal clinic in a teaching hospital.Subjects
607 consecutive women at various stages of pregnancy were recruited during attendance at antenatal clinic.Results
The prevalence of heartburn increased with gestational age (22% in the first, 39% in the second, and 72% in the third trimester; P<0.0001), as did severity of heartburn (P<0.0001). Pharyngeal regurgitation as a symptom showed little increase during advancing pregnancy. Symptoms of heartburn rapidly increased towards the end of the second trimester. The decrease in heartburn traditionally expected during the last three weeks of pregnancy (fetal head descent) was not observed. Logistic regression analysis showed increased risk of suffering heartburn with increasing gestational age (P<0.0001), pre‐pregnancy heartburn (P<0.0001), parity (P<0.0001) and inversely with maternal age (P<0.05) but not with body mass index before pregnancy, race, or weight gain in pregnancy.Conclusion
Heartburn, but less so pharyngeal regurgitation, increases in prevalence and severity with gestational age and parity. We speculate that hormone‐related impairment of distal oesophageal clearance mechanisms may have a crucial bearing on whether heartburn develops in those individuals at greatest risk.
The prognosis of adenosquamous carcinomas of the uterine cervix
Authors: BETHWAITE PETER , YEONG MEE LING , HOLLOWAY LINDA , ROBSON BRIDGET , DUNCAN GRAEME , LAMB DAVID 
Published: August 2005

ABSTRACTObjectivesFirstly, to identify a cohort of women with invasive adenosquamous carcinomas of the uterine cervix, including mucin‐producing squamous cell carcinomas. Secondly, to compare the biological characteristics and behaviour of a cohort of adenosquamous carcinomas with a cohort of non‐mucin‐producing squamous cell carcinomas.DesignHistological review, retrospective survival analysis.SettingRegional multidisciplinary gynaecological oncology service.Subjects161 cases of stage 1B and above invasive cervical carcinoma presenting between 1 January 1980 and 31 July 1987. Thirty nine women with adenosquamous carcinomas were compared with 103 women with non‐mucin‐producing squamous cell tumours.ResultsInclusion of routine stains for mucin in the assessment of histological material resulted in the reclassification of 38 (24%) of the cases, including the identification of 31 mucin‐producing squamous cell carcinomas. The survival with adenosquamous tumours was significantly worse than with squamous cell cancers (P= 0.006), 5‐year survival rates being 52% and 75% respectively. Multivariate analysis showed that this effect was explained by differences in clinical stage, pelvic lymph node metastasis and vascular invasion by tumour.ConclusionsThe application of routine mucin stains to cervical tumours identifies a group of previously unrecognized adenosquamous cancers. Tumours so identified are likely to pursue a more aggressive clinical course associated with a poorer survial when compared to non‐mucin‐producing squamous carcinomas.
Changes in decidual stromal cell function associated with labour
Authors: KHAN HAROON , ISHIHARA OSAMU , SULLIVAN MARK H. F. , ELDER MURDOCH G. 
Published: August 2005

ABSTRACTObjective
To determine whether decidual cells produce altered levels of prostaglandins after labour.Design
Decidual stromal cells and macrophages were isolated before and after labour, and the production of prostaglandins E2 and F2α measured. Changes in the numbers of cyclooxygenase enzyme positive cells were assessed by immunocytochemistry.Results
Decidual stromal cells obtained after labour produced 30 times more prostaglandins E2 and F2α in culture than cells obtained before labour. The increased production persisted for up to 72 h of culture, and was associated with an increase in the numbers of cyclooxygenase‐positive cells from <5% to >95%. No changes in macrophage function were observed.Conclusion
Increased levels of prostaglandins E2 and F, a were released from decidual stromal cells after labour, suggesting that these cells may be an important source of prostaglandins in labour.
A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain
Authors: PETERS A. A. W. , TRIMBOS‐KEMPER G. C. M. , ADMIRAAL C. , TRIMBOS J. B. , HERMANS J. 
Published: August 2005

ABSTRACTObjective
To see whether surgical adhesiolysis would improve pelvic pain in women with pelvic adhesions.Design
Randomized clinical trial comparing surgery (adhesiolysis) with no surgery with final analysis of results after 9–12 months.Setting
Department of Gynecology, Leiden University Medical Center, the Netherlands.Subjects
48 women known by laparoscopy to have stage II‐IV pelvic adhesions.Interventions
Midline laparotomy and surgical adhesiolysis.Main outcome results
Pelvic pain assessed by the McGill pain score, subjective pain assessment and disturbance of daily activities.Results
24 women were randomly allocated to undergo surgical adhesiolysis and 24 to a control group who did not have surgery. After 9–12 months there were no significant differences between the two groups overall with regard to pelvic pain. A subgroup of women with severe, vascularized and dense adhesions involving bowel (stage IV) had significantly less pelvic pain after adhesiolysis for two of the three methods of assessment.Conclusions
Adhesiolysis for the treatment of pelvic pain is not indicated in women with light or moderate degree pelvic adhesions. It may be beneficial in those with severe adhesions involving the intestinal tract.
The effect of pH on release of PGE2 from vaginal and endocervical preparations for induction of labour: an in‐vitro study
Authors: JOHNSON T. A. , GREER I. A. , KELLY R. W. , CALDER A. A. 
Published: August 2005

ABSTRACTObjective To study the effect of pH and precoating with obstetric cream on the release of prostaglandin E2 (PGE2) from commercially available triacetin and starch based gels, lactose based vaginal tables and sustained release hydrogel polymer pessaries in‐vitro.Design
A prospective observational study.Methods PGE2 preparations held in dialysis bags were placed in Ringers lactate buffer and release of PGE2 into the buffer was measured over 8–12 h by radio‐immunoassay. The hydrogel polymer pessary was also assessed after precoating with obstetric cream.Main outcome measures
In‐vitro PGE2 release at pH 7.4, pH 5.4 and pH 3.4.Results The gel preparations provided rapid and reliable release, while the lactose based vaginal tablet provided much lower release of PGE2 with sudden and variable release occurring after 5–8 h, an effect which was enhanced at low pH. With the triacetin gel preparation, release of PGE2 was reduced at lower pH, while the starch based gel appeared to provide optimal release at pH 5.4. The hydrogel polymer pessaries provided linear release in‐vitro and this was reduced at pH 3.4. In addition, precoating the sustained release hydrogel polymer pessaries with obstetric cream virtually abolished release of PGE2.Conclusions As the vagina is normally acid, these results suggest that vaginal pH could influence PGE2 release and this may result in variable clinical responses. In view of this, pH should be taken into account in the development of preparations for clinical use. Furthermore, the use of obstetric cream should be avoided when administering PGE2 preparations for induction of labour.
The prognostic value of fetal ultrasonography before induction of labour
Authors: SAUNDERS NIGEL , AMIS SHAMIM , MARSH MICHAEL 
Published: August 2005

ABSTRACTObjective
To investigate whether ultrasound examination of the fetus and amniotic fluid before induction of labour can provide useful prognostic information about the course of labour and mode of delivery.Design
A prospective observational study.Setting
The delivery suite of St Mary's Hospital, London.Subjects
101 women undergoing induction of labour.Measured variables
Biparietal diameter, head circumference, abdominal circumference, occipital position, amniotic fluid volume and umbilical artery Doppler velocimetry waveforms.Main outcome measures
The outcome of labour was assessed in terms of the induction delivery interval, the mode of delivery and the incidence of abnormal cardiotocograms in labour.Results
Seven women were delivered by emergency caesarean section early in the first stage of labour because of a significant abnormality of the fetal heart trace and these pregnancies were characterized by small fetal abdominal circumference measurements. Marked oligohydramnios was also noted in five of these seven subjects. Small or average size babies who were surrounded by an adequate volume of amniotic fluid tended to be born spontaneously, whereas the majority of operative deliveries for failure to progress in labour were associated with fetal abdominal circumference measurements ≥340 mm. The mean Bishop score of women before labour who delivered spontaneously was not significantly different from the scores of women who had a forceps delivery or caesarean section. Abnormal cord Doppler waveforms were observed in only one instance.Conclusions
In women undergoing induction of labour, the measurement by ultrasonography of two variables (fetal abdominal circumference and amniotic fluid volume) may allow the prospective identification of pregnancies at increased risk of fetal distress or dystocia. If these findings can be replicated in early spontaneous labour than more rational utilization of resources may be possible in hospital based obstetric practice.
Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin
Authors: HAMILTON‐FAIRLEY DIANA , KIDDY DEBORAH , WATSON HAZEL , PATERSON CATHERINE , FRANKS STEPHEN 
Published: August 2005

ABSTRACTObjective
To assess the effect of moderate obesity on the outcome of induction of ovulation with low dose gonadotrophin in women with polycystic ovary syndrome (PCOS).Design
Retrospective analysis of women with PCOS treated consecutively. An analysis of the impact of obesity on outcome of pregnancy using data from the North West Thames Regional (NWTR) obstetric database was included for comparison. Setting Induction of ovulation clinic at the Samaritan Hospital for Women (St. Mary's Hospital Group).Subjects
100 women with clomiphene‐resistant anovulation associated with PCOS. 75 were of normal weight (BMI 19–24. 9 kg/m2, lean group) and 25 were moderately overweight (BMI 25–27.9 kg/m2, obese group).Interventions
Induction of ovulation using low doses of gonadotrophins with small, stepwise increments in dosage as required.Main outcome measures
Rates of ovulation, pregnancy and miscarriage; daily and total doses of gonadotrophin required for induction of ovulation.Results
The proportion of ovulatory cycles was significantly greater in the lean group (77%) compared with the obese group (57%) (χ2 9.8, P<0.001). Obese women required larger doses of gonadotrophin to achieve ovulation (P <0.001). The proportion of women who achieved at least one pregnancy was similar in the two groups (39%vs 48%) but miscarriage was more frequent in the obese group (60%vs 27%; P<0.05). This difference was independent of the baseline and/or mid‐follicular luteinizing hormone (LH) concentration either before or during treatment. Analysis of data from the North West Thames Health Region obstetric database confirmed an increased risk of miscarriage in moderately obese women which was independent of maternal age.Conclusions
Moderate obesity in women with PCOS, treated with low dose gonadotrophin, is associated with an increased risk of miscarriage. This is reflected in the results of analysis of the effect of obesity on outcome of pregnancy in the general population. It is therefore important to encourage weight reduction in obese women with PCOS before considering therapy to induce ovulation.
Maternal serum screening for Down's syndrome: the effect of routine ultrasound scan determination of gestational age and adjustment for maternal weight
Authors: WALD N. J. , CUCKLE H. S. , DENSEM J. W. , KENNARD A. , SMITH D. 
Published: August 2005

ABSTRACTObjective
To investigate the effect of using a routine ultrasound estimate of gestational age and maternal weight adjustment on maternal serum alpha‐fetoprotein (AFP), unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) levels in antenatal screening for Down's syndrome.Design
Women with a singleton pregnancy without Down's syndrome were screened using the three serum markers and an estimate of gestational age based on ‘dates’ (time since first day of the last menstrual period) and one based on an ultrasound scan examination was recorded together with maternal weight.Setting
Women attending the Homerton Hospital, Hackney, for their antenatal care between February 1989 and January 1990.Subjects
2113 women with a singleton pregnancy without Down's syndrome.Results
The use of ultrasound to estimate gestational age (usually based on the biparietal diameter of the fetal skull) led to a significant reduction in the variance of each marker at a given week of pregnancy. The level of each marker was negatively associated with maternal weight, so that adjustment for weight also led to a reduction in variance. These data on gestational age and maternal weight, taken together with published data on pregnancies associated with Down's syndrome, indicate that the routine use of ultrasound to estimate gestational age will increase the detection rate from 58% to 67% while maintaining the false‐positive rate at 5%, or reduce the false‐positive rate from 5.7% to 3.1% while maintaining the detection rate at 60%. Routine maternal weight adjustment for the serum marker levels was much less useful, increasing the detection rate by about 0.5% for a given false‐positive rate, or reducing the false‐positive rate about 0.1% for a given detection rate.Conclusion
An ultrasound gestational age estimate available at the time of Down's syndrome screening confers a substantial advantage to screening performance with a further small benefit resulting from maternal weight adjustment, which is worth adopting if it can be done without difficulty or extra cost.
Measurement of uterine activity in labour—clinical aspects
Authors: Gibb D. M. F. 
Published: August 2005

ABSTRACTIntra‐uterine pressure measurement remains the most objective way of measuring uterine activity in labour, and in this respect is superior to clinical assessment or external tocography. However there is little evidence to show that improving the assessment of uterine activity in labour is associated with an improvement in the outcome of labour for mother or fetus. It seems logical that use of intra‐uterine pressure monitoring will provide additional safety in women with a scarred uterus, breech presentation, high parity, or apparent failure of response to induction or augmentation of labour with the usual dose rates of oxytocics, but this has not been established by appropriately sized clinical trials. Further research to establish the role of uterine activity measurement in labour is urgently needed.
Prostaglandin prophylaxis and bladder function after vaginal hysterectomy: a prospective randomised study
Authors: Bergman Arieh , Mushket Yaron , Gordon David , David Menahem P. 
Published: August 2005

ABSTRACTObjective
To assess the efficacy of prostaglandins in enhancing bladder function after vaginal hysterectomy.Design
Prospective randomised study of women who underwent vaginal hysterectomy between November 1989 and August 1990.Setting
Sackler School of Medicine Tel Aviv University Medical Center, Department of Obstetrics and Gynaecology ‘B’.Subjects
24 women who underwent vaginal hysterectomy and anterior and posterior colporrhaphy for prolapse.Intervention
Administration of prostaglandin F2α 5 mg intravesically or E2 3 mg intravaginally versus 100 ml saline intravesically (control) daily, starting on the first post operative day, until adequate spontaneous voiding was established.Results
Women receiving either PGF2 or PGE2 resumed spontaneous bladder function earlier, required significantly fewer days catheterisation and had significantly less febrile morbidity compared to women in the control group.Conclusions
Prostaglandins, either intravesical or intravaginal, are beneficial in enhancing bladder function after vaginal hysterectomy.
Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery
Authors: Corney R. H. , Crowther M. E. , Everett H. , Howells A. , Shepherd J. H. 
Published: August 2005

ABSTRACTObjective
To assess the prevalence and severity of psychosexual dysfunction in women treated for cancer of the cervix and vulva by radical vulvectomy, Wertheim's hysterectomy and pelvic exenteration; and to identify the risk factors for sexual morbidity and ways in which it might be reduced.Design
Retrospective study of patients by questionnaire and semistructured interview, 6 months to 5 years following surgery.Setting
Gynaecology–Oncology Unit of a general hospital.Patients
105 English speaking women with gynaecological cancer.Results
90% of the women in relationships had been sexually active prior to surgery. Of this group, 24% had no sexual difficulties post‐operatively; 66% of the latter still had problems more than 6 months later, and 15% of the latter never resumed intercourse (excluding those with a colpectomy). 82% of those aged less than 50 years who had had radiotherapy suffered sexual dysfunction. Lack of desire was the commonest problem, and half the women felt that their sexual relationship had deteriorated, yet only 16% felt that their marriage had worsened. Younger women were more likely to attribute personal and marital distress to their sexual problems. More information on sexual matters would have been liked by 28% of the women.Conclusions
Sexual dysfunction is common following radical pelvic surgery and tends to remain a chronic problem. As well as organic causes there is a strong psychogenie element brought about by loss of fertility, disfigurement, depression and anxiety about one's desirability as a sexual partner. The presence of a stable relationship before the diagnosis of cancer helps women cope better, and young single women are a very vulnerable group. Patients want more information on sexual matters and the provision of sexual counselling may improve outcome in the future.
Postpartum haemorrhage in Zimbabwe: a risk factor analysis
Authors: Tsu Vivien D. 
Published: August 2005

ABSTRACTObjectives
To identify risk factors associated with postpartum haemorrhage (PPH) in order to improve the effectiveness of antenatal screening.Design
A population‐based case control study.Setting
Harare, Zimbabwe.Subjects
Two groups of women, one group consisting of those with postpartum haemorrhage after a normal vaginal delivery and the other of women with normal unassisted vaginal delivery without PPH.Method
Data abstracted from the medical records; relative risks were estimated by multivariate logistic regression.Results
Low parity, advanced maternal age, and antenatal hospitalisation were among the strongest risk factors, with more modest associations for history of poor maternal or perinatal outcomes and borderline anaemia at the time of booking. No association with grand multiparity was found.Conclusions
These findings confirm the importance of previously recognised factors such as low parity, poor obstetric history, anaemia, and prolonged labour, but call into question the significance of grand multiparity. Previously undocumented factors such as maternal age greater than 35 years and occiput posterior head position emerged as predictors worthy of further investigation.
Polycystic ovaries and levels of gonadotrophins and androgens in recurrent miscarriage: prospective study in 50 women
Authors: Tulppala Maija , Stenman Ulf‐Håkan , Cacciatore Bruno , Ylikorkala Olavi 
Published: August 2005

ABSTRACTObjective
To compare the serum levels of gonadotrophins and androgens, as well as ovarian morphology, in 50 women with a history of recurrent miscarriage and in 20 healthy controls.Design
Prospective study on women with a history of at least three consecutive miscarriages in Department I and II of Obstetrics and Gynecology, University Central Hospital of Helsinki, Finland.Results
The recurrent miscarriage group as a whole exhibited gonadotrophin and androgen levels comparable to those seen in the controls. Ultrasound examination revealed polycystic ovaries (PCO) in 22 patients (44%) and in four control women (20%, P=0.06) but no differences in the levels of gonadotrophins and androgens emerged between the patients with or without PCO. During follow up, 33 (66%) women with a history of recurrent miscarriage who became pregnant; 16 miscarried again (48.5%), whereas 17 (51.5%) succeeded. The presence of PCO did not predict miscarriage, but the patients who miscarried had higher levels of total testosterone, free testosterone and dehydroepiandrosterone sulphate than RSA women with continuing pregnancies.Conclusions
PCO and hyperandrogenism may be associated with repeated miscarriage.