bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burch colposuspension: a 10–20 year follow up
Authors: Alcalay Menachem , Stanton Stuart L. , Monga Ash 
Published: August 2005

ABSTRACTObjective
To review the outcome of women who underwent Burch colposuspension 10 to 20 years ago and to assess factors which affect long term success.Design
Longitudinal retrospective study.Setting
Urogynaecology Unit, St George's Hospital, London.Subjects
One hundred and nine women with genuine stress incontinence.Main outcome measures
Survival analysis of subjective and objective cure of stress incontinence.Results
Cure of incontinence following Burch colposuspension is time‐dependent, with a decline for 10 to 12 years when a plateau of 69% is reached. Factors adversely affecting cure are previous bladder neck surgery (logrank test P= 0.02), pre‐operative weight greater than 80 kg, intra‐operative blood loss more than 1000 ml and the development of post‐operative detrusor instability. Post‐operative complications included de novo detrusor instability (14.7%), long term complaints of voiding difficulty with objective recovery at the final follow up (22%) and recurrent urinary tract infection (4.6%).Conclusions
Long term follow up after colposuspension is necessary to assess sequelae. We suggest that new continence procedures should be followed up for 5 to 10 years.
Lack of analgesic effect of systemically administered morphine or pethidine on labour pain
Authors: Olofsson Ch. , Ekblom A. , Ekman‐Ordeberg G. , Hjelm A. , Irestedt L. 
Published: August 2005

Objective
To evaluate the true analgesic effect of morphine and pethidine on labour pain.Design
The analgesic and sedative effects of intravenous morphine or pethidine and their effect on anxiety were compared in a prospective, double‐blind, randomised dose‐response study.Setting
A Stockholm teaching hospital obstetric unit.Participants
Ten healthy nulliparous parturients in active labour were included in each group.Results
Even after repeated doses (up to 0.15 mgkg body weight morphine and up to 15 mag body weight pethidine) the findings were uniform, with very high pain scores maintained in each group as assessed with visual analogue scale. The parturients were all significantly sedated and several fell asleep but were awakened by pain during contractions.Conclusion
It is concluded that labour pain is not sensitive to systemically administered morphine or pethidine. These drugs only cause heavy sedation. It therefore seems unethical and medically incorrect to meet parturients' requests for pain relief by giving them sedation. Considering the well documented negative effects on newborn infants we also believe systemic pethidine should be avoided in labour.
Changes in maternal heart dimensions and plasma atrial natriuretic peptide levels in the early puerperium of normal and pre‐eclamptic pregnancies
Authors: Pouta Anneli M. , Räsänen Juha P. , Airaksinen K. E. J. , Vuolteenaho Olli J. , Laatikainen Timo J. 
Published: August 2005

Objective
To measure plasma atrial natriuretic peptide (ANP) in relation to maternal haemodynamics and body fluid balance in the early puerperium following uncomplicated pregnancy and pre‐eclampsia.Design
A longitudinal study from late pregnancy and into the early postpartum period (days 1 to 3 and days 4 to 6) compared with nonpregnant controls.Subjects
Eleven women with uncomplicated pregnancies, 12 women with pre‐eclampsia and 12 healthy, nonpregnant women.Main outcome measures
Maternal heart dimensions determined by M‐mode echocardiography, concentrations of ANP, and daily urine output and sodium excretion.Results
After delivery increases in left atrial dimensions, represented as mean (SEM), from 33.2 (1–6) to 37.7 (1.7) mm and ANP levels from 7.9 (1.1) to 19.0 (2.7) pmol/L were observed at 1–3 days postpartum in normal pregnant women, but we were not able to demonstrate a significant increase in diuresis and natriuresis. In the third trimester left atrial dimensions (38.4 (1.2) mm) and ANP levels (15.4 (2.2) pmol/L) were greater in pre‐eclampsia. ANP levels rose further in pre‐eclamptic women in the early puerperium (27.4 (7.4) pmol/L) with an increase in diuresis and natriuresis, while left atrial dimensions did not change significantly (39.4 (1.7) mm). A pericardial effusion was found in 11 pre‐eclamptic but in only three healthy pregnant women.Conclusions
A concommitant increase in left atrial dimensions and ANP in the early puerperium following uncomplicated pregnancies is consistent with the mechanism of atrial stretch as a stimulus for ANP release, although the biological significance of this finding remained unclear. A significantly higher release of ANP in the early puerperium after pregnancies complicated by pre‐eclampsia may be a mechanism which promotes the renal elimination of excessive body fluids and sodium.
Magnesium sulphate in the treatment of eclampsia and pre‐eclampsia: an overview of the evidence from randomised trials
Authors: Chien Patrick F. W. , Khan Khalid S. , Arnott Neil 
Published: August 2005

Objective
To evaluate the effectiveness of magnesium sulphate in the treatment of eclampsia and pre‐eclampsia by a systematic quantitative overview of controlled clinical trials.Design
Online searching of the MEDLINE database between 1966 and 1995, and scanning of the bibliography of known primary studies and review articles on the use of magnesium sulphate in eclampsia and pre‐eclampsia. Study selection, study quality assessment and data extraction were performed independently by two reviewers under masked conditions. Where possible outcome data from trials were pooled and summarised using the Mantel‐Haenszel method.Participants
One thousand seven hundred and forty‐three women with eclampsia and 2390 with pre‐eclampsia included in nine randomised trials that evaluated the effects of magnesium sulphate.Main outcome measures
Seizure activity and maternal death.Results
In eclampsia, recurrence of seizures was less common with magnesium sulphate therapy compared with phenytoin (odds ratio [OR] 0.27, 95% CI 0.17.0.45, P= 0.00) and diazepam (OR 0–41, 95% CI 0.30–0.57, P= 0.00). As indicated by the point estimate, there was a trend towards a reduction in maternal mortality with magnesium sulphate in eclampsia (OR 0.51,95% CI 0.24–1.07, P= 0.10versus phenytoin; OR 0.78, 95% CI 0.41–1.45, P= 0.52versus diazepam). When used for seizure prophylaxis in pre‐eclampsia, magnesium sulphate was found to be more effective than phenytoin (OR 0.15, 95% CI 0.03–0.72, P= 0.01).Conclusion
Magnesium sulphate is a superior drug in preventing the recurrence of seizures in eclampsia and in seizure prophylaxis in pre‐eclampsia.
Fetal telemedicine: six month pilot of real‐time ultrasound and video consultation between the Isle of Wight and London
Authors: Fisk Nicholas M. , Sepulveda Waldo , Drysdale Karen , Ridley David , Garner Paul , Bower Sarah , Kyle Phillips , Dhillon Harjeet , Carvalho Julene S. , Wootton Richard 
Published: August 2005

Design
Prospective audit of first six months.Setting
Referral from a district general hospital on the Isle of Wight to a comprehensive tertiary referral service, the Centre for Fetal Care at Queen Charlotte's Hospital 120 km away in London.Participants
Women whose pregnancy was suspected, or at risk, of fetal abnormality.Interventions
Remote consultation by transmitting ultrasound and video in real‐time over ISDN 30 telephone lines. Contemporaneous questionnaire to referring practitioner and patient.Main outcome measures
Frequency, indication, technical success and duration of consultation. Qualitative and semi‐quantitative image quality. Effect of teleconsultation on need for physical referral.Results
Twenty‐nine women underwent 39 teleconsultations, and image quality was sufficient for diagnosis in all but one. Fetal abnormalities were present in 76%. Referral in person was required for only four women, significantly fewer than the 13 the referring hospital indicated would have been physically referred in the absence of this service (P < 0.001). Most mothers were counselled by the specialist ‘face‐to‐face’ over the link, and 80% felt teleconsultation reduced their anxiety.Conclusions
A fetal telemedicine service is technically and clinically feasible. This demonstration suggests that such a service reduces the need for physical referral while increasing the rate of consultation, allowing better selection of patients who might benefit from referral. Further evaluation in a variety of clinical settings is now indicated, along with cost‐benefit analysis.
Voluntary universal antenatal HIV testing
Authors: Mercey Danielle , Helps Barbara A. , Copas Andrew , Petruckevitch Ann , Johnson Anne M. , Spencer John 
Published: August 2005

Objectives
To assess the uptake of universal voluntary named HIV testing of hospital booked antenatal women and to identify behavioural and demographic factors associated with testing. To identify the number of previously undiagnosed women detected by the new policy and to compare prevalence among those testing with that measured by unlinked anonymous monitoring.Design
Self‐completion questionnaire and data abstraction from structured booking forms and virology laboratory records.Setting
Central London teaching hospital antenatal clinic.Participants
One thousand three hundred and seventy‐four women booking with a hospital based midwife during the 49 weeks from 27 July 1993 to 1 July 1994.Results
Before the introduction of the new testing policy fewer than 10 women per year had an HIV test, and during the study this rose to 41% (548/1340). In univariate analysis, Caucasian and Mediterranean ethnic origin, fewer previous live births, and more than one lifetime sexual partner were associated with higher uptake of HIV testing. In a multivariate model only the number of previous live births and ethnic origin remained significantly associated with testing. Six women out of 828 (1%) who completed the question about nonprescribed drug use stated that they had injected drugs, and four of these women accepted a test. Two women, both with recognised major risk factors for HIV infection, were diagnosed HIV antibody positive (a prevalence in the tested women of 0.36%). A further three women were already known to be HIV antibody positive. During the 12 months from July 1993 seven women (0.24%) were found to be positive by unlinked anonymous testing.Conclusions
The introduction of a universal approach to antenatal HIV testing appears feasible: it increased the uptake of the test and detected previously unrecognised infections. Many women chose not to be tested, however, and cases remained undiagnosed. Further studies are required to examine different models of offering HIV testing, reasons for declining the test, and the cost–benefit of antenatal HIV screening.
VEGF mRNA levels in placentae from pregnancies complicated by pre‐eclampsia
Authors: Cooper Jason C. , Sharkey Andrew M. , Charnock‐Jones D. Stephen , Palmer Christopher R. , Smith Stephen K. 
Published: August 2005

Objective
To measure the mRNA levels of vascular endothelial growth factor and its receptor in the placenta following delivery after uncomplicated pregnancy and after pregnancies complicated by pre‐eclampsia.Setting
Rosie Maternity Hospital, Cambridge.Material
Placental biopsies were obtained following delivery by caesarean section in 23 cases of pregnancy presenting at a range of gestational ages with pre‐eclampsia. These were compared with biopsies from 20 appropriately matched women with uncomplicated pregnancies.Main outcome measure
mRNA levels of vascular endothelial growth factor (VEGF) and its receptor the fins‐like tyrosine kinase (flt), were quantified in total RNA isolated from placental biopsies using the RNAse protection assay. The amount of RNA was compared with that of the housekeeping gene glyceraldehyde 3–phosphate dehydrogenase (GAPDH), used as a standard. Results were expressed as arbitrary optical density units of VEGF/GAPDH and flt/GAPDH.Results
In both control and pre‐eclamptic women regression analysis showed that the level of mRNA encoding VEGF declined significantly with gestational age (P < 0.0001). However, levels of VEGF mRNA were significantly lower in the pre‐eclamptic women compared with the control women (P < 0.023).Conclusions
This study provides evidence of an abnormality of growth factor expression in the placenta during pregnancies complicated by pre‐eclampsia. Such placentae exhibit deficient growth and differentiation of terminal villi and reduced fetal capillary branching and reduced levels of VEGF could well account for these morphometric changes. This finding provides a molecular explanation for this abnormal placental development and points to VEGF as a factor in the aetiology of pre‐eclampsia and its complications.
Late selective termination of fetal abnormalities in twin pregnancies: a multicentre report
Authors: Lipitz Shlomo , Shalev Eliezer , Meizner Israel , Yagel Simcha , Weinraub Zvi , Jaffa Ariel , Shalev Joseph , Achiron Reuwen , Schiff Eyal 
Published: August 2005

Objective
To evaluate the outcome of late selective fetal termination based on combined data from eight tertiary perinatal centres.Design
Israeli law requires institutional committee approval for pregnancy termination. Moreover, after 24 weeks only a district superior committee can approve the termination. A total of 36 bichorionic twin pregnancies who underwent selective fetal termination after 24 complete gestational weeks were identified in eight Israeli centres.Results
In 23 women (63.9%) the indication for selective termination was structural anomaly, and in 13 (36.1%) the indication was chromosomal abnormality. The mean gestational age at the time of diagnosis was 24.1 ± 1.9 weeks. The termination procedure was performed at a mean gestational age of 25.5 ± 2.0 weeks (median 25, range 24–33 weeks). There was one case of immediate procedure‐related complication (i.e. amnionitis) and the unaffected infant died, which was the only perinatal death in this series. No evidence of coagulopathy was reported. Only five women (13.8%) delivered before 34 completed weeks. The mean gestational age at delivery was 36.9±2.9 weeks (28–41 weeks), and the mean procedure‐to‐delivery interval was 11.8±3.2 weeks (median 13, range 3–17 weeks).Conclusions
Late (> 24 weeks) selective termination in twin pregnancies is associated with favourable perinatal outcome of the healthy twin. In countries where the law permits late pregnancy termination, the parents should be informed of that possibility.
A comparative study of the cosmetic appeal of abdominal incisions used for hysterectomy
Authors: Currie I. , Onwude J. L. , Jarvis G. J. 
Published: August 2005

Objective
To assess the cosmetic appeal of abdominal incisions used for hysterectomy.Design
A comparative study.Setting
St James's University Hospital, LeedsParticipants
One hundred women, including 50 consecutive women attending a gynaecology clinic for the first time and 50 hospital staff.Results
Sixty‐eight percent of women preferred a Pfannenstiel incision as the incision of first choice, while 31% chose the laparoscopic assisted vaginal hysterectomy incisions (LAVH). When women who had undergone previous abdominal surgery were compared with women with no previous surgery, there was a significant difference in their choice (80% Pfannenstiel, 18% LAVH compared with 54% Pfannenstiel, 45% LAVH).Conclusions
In gynaecological surgery there is already a cosmetically‐favoured incision. One cannot assume that if a gynaecologist uses a minimally invasive surgical technique at hysterectomy that this will be cosmetically acceptable to the woman. Gynaecologists should not use cosmetic appeal in counselling women for LAVH and should concentrate on the other proven benefits of minimally invasive surgery.
Serum levels of endometrial proteins during transcervical resection of the endometrium
Authors: Hahn Robert G. , Olsson Joel , Englund Katarina , Seppala Markku 
Published: August 2005

Objective
To study the potential for dissemination of endometrial tissue substances during transcervical resection of the endometrium (TCRE).Design
Prospective study.Setting
One university and two county hospitals.Participants
Forty‐eight women with dysfunctional bleeding.Interventions
The serum levels of two endometrial proteins, insulin‐like growth factor binding protein‐1 (IGFBP‐1) and placental protein 14 (PP14), were measured before and every 10 min during the operations. Blood loss was also measured by a photometer together with absorption of the irrigating fluid containing glycine 1.5% and ethanol 1% by expired‐breath tests, and serum sodium and volumetric fluid balances.Main outcome measures
Linear correlations between changes in IGFBP‐1 and PP14 during TCRE and operating parameters such as operating time, blood loss and fluid absorption.Results
The baseline levels of IGFBP‐1 were normal but PP14 could only be detected in one third of the patients, which was due, in part, to pre‐operative treatment with danazol. The highest levels of IGFBP‐1 and PP14 during surgery correlated positively with the baseline concentrations. Fluid absorption (median 405 ml, range 0–2177) was the only surgical factor associated with increasing serum levels of endometrial proteins.Conclusion
Absorption of the solution used to irrigate the uterus is associated with dissemination of endometrial products in the bloodstream during TCRE.
Routine obstetric ultrasound examinations in South Africa: cost and effect on perinatal outcome–a prospective randomised controlled trial
Authors: Geerts Lut T. G. M. , Brand Esther J. , Theron Gerhard B. 
Published: August 2005

Objective
To compare routine midtrimester with selective obstetric ultrasonography concerning the Health Service cost and the effect on perinatal outcome.Design
A randomised controlled trial.Setting
Urban area served by Tygerberg Hospital, a tertiary referral centre in South Africa.Participants
Pregnant patients without risk factors for congenital anomalies referred for ultrasonography between 18 and 24 weeks of gestation.Intervention
Between 18 and 24 weeks, a level one ultrasound examination was performed on study patients only. Except for the routine scan, both groups received the same antenatal care and could be referred later for additional scans as judged by their clinicians.Main outcome measures
Overall adverse perinatal outcome and use of antenatal and neonatal services.Results
The groups did not differ significantly in their use of antenatal and neonatal services except for a greater number of ultrasound scans in the study group. More suspected postdate pregnancies occurred in control patients, as well as more amniocenteses for confirmation of lung maturity. More babies of low birthweight were born in the study group. The incidence of overall or major adverse perinatal outcome was comparable. Routine ultrasonography was accompanied by a considerable increase in costs.Conclusion
Selective use of obstetric ultrasonography did not increase the use of antenatal and neonatal services. Not routinely performing ultrasonography has led to considerable Health Service savings without increasing the risk for adverse perinatal outcome. It saved 75% of selected patients a referral to an ultrasound unit. Specific problems related to inaccurate gestational age determination need to be addressed.
Antenatal diagnosis of congenital toxoplasmosis: evaluation of the biological parameters in a cohort of 286 patients
Authors: Pratlong F. , Boulot P. , Villena I. , Issert E. , Tamby I. , Cazenave J. , Dedet J.‐P. 
Published: August 2005

Objective
To evaluate the biological parameters obtained by cordocentesis and amniocentesis in the antenatal diagnosis of congenital toxoplasmosis.Design
Nine‐year retrospective study.Setting
Parasitology Laboratory, Department of Obstetrics and Gynaecology and Department of Paediatrics, Centre Hospitalo‐Universitaire, Montpellier, France.Participants
Two hundred and eighty‐six pregnant women infected with toxoplasmosis between 7 and 34 weeks of gestation.Methods
Detection of abnormalities by ultrasound examination. Detection in fetal blood of Toxoplasma, of specific IgM and IgA and of nonspecific biological markers. Detection in amniotic fluid of Toxoplasma.Results
Out of 286 antenatal diagnoses, 211 were negative (1st group), 40 were positive (2nd group) and led to 8 medical abortions, and 35 were uncertain (3rd group). In the 1st and 3rd groups respectively, 7 (3.3 %) and 5 (14.3 %) cases of congenital toxoplasmosis were observed. Overall, 52 cases of congenital toxoplasmosis were detected: 12 were clinically apparent, 36 subclinical (of which 12 were in groups 1 and 3) and 4 were lost to follow up.Conclusion
There is substantial importance in making the diagnosis of toxoplasmosis antenatally in order to limit the number of medical abortions. In our series, the most accurate predictor was the detection of the fetal antibody response (specific IgM and IgA) to Toxoplasma.
Treatment with a gonadotrophin releasing hormone agonist before endometrial resection: a multicentre, randomised controlled trial
Authors: Vercellini Paolo , Perino Antonio , Consonni Roberto , Trespidi Laura , Parazzini Fabio , Giorgio Pier 
Published: August 2005

Objective
To ascertain whether treatment with a gonadotrophin releasing hormone agonist before endometrial resection reduces absorption of distension fluid and operating time and facilitates the procedure.Design
A multicentre, prospective, randomised controlled study.Participants
Seventy‐one premenopausal women with established menorrhagia.Interventions
Eight weeks of goserelin depot treatment before endometrial resection of immediate surgery in the early proliferative phase of the cycle.Main outcome measures
Irrigation fluid deficit, operating time and degree or difficulty of the procedure.Results
After randomisation eight women withdrew from the study, leaving 33 women in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) min in the goserelin group versus 16.9 (9.5) min in the controls; mean difference † 1.8 min, 95% CI, −2.9 to + 64. Mean (SD) distension medium deficit was, respectively, 422 (287) ml versus 564 (291 ml); mean difference + 142 ml, 95 % CI‐4 to + 288. The goserelin effect was restricted to the 29 women with adenomyosis as the mean (SD) fluid deficit was considerably less in the 19 treated women than in the 10 controls (299 (206) ml versus 597 (135) ml; mean difference + 298 ml, 95YO CI +149 to + 447). The surgeons classified the intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1.Conclusions
Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in women with adenomyosis and may facilitate intrauterine operating conditions.
Differentiation of growth retarded from normally grown fetuses and prediction of intrauterine growth retardation using Doppler ultrasound
Authors: Bates Jane A. , Evans J. Anthony , Mason Gerald 
Published: August 2005

Objective
To assess the hypothesis that infants exhibiting catch‐up growth as an indicator of intrauterine growth retardation (IUGR) have a higher incidence of predelivery abnormal Doppler results.Setting
Obstetric unit, St James's University Hospital, Leeds.Participants
One hundred and ninety‐six women with singleton pregnancies at high risk of IUGR, delivered between October 1992 and August 1993.Main outcome measures
Postnatal catch‐up growth during the first seven months.Results
Forty‐six of the 196 infants demonstrated catch‐up growth and were therefore classified as growth retarded; 85% of this group had had abnormal Doppler results prior to delivery, compared with 14% of the normally grown group. However, there is considerable overlap in birthweight ratio distribution between the two groups.Conclusion
This study confirms the existence of a population of IUGR infants of average birthweight ratio. Doppler appears to distinguish IUGR (as defined by catch‐up growth) from normal growth more successfully in infants with an average birthweight ratio than in infants with a low birthweight ratio and is a better predictor of IUGR than SGA.