bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of maternal vascular pressure on the dimensions of the placental capillaries
Authors: Karimu A. L. , Burton G. J. 
Published: August 2005

ABSTRACTObjective
The study sought stereological evidence for the sluice flow phenomenon in the human term placenta.Design
Two series of experiments were conducted on Caesarian delivered placentae. In both, two fetal arteries were cannulated and perfused. In the first series, five placentae were perfusion‐fixed under arterial pressures of 40 mmHg and 60 mmHg, and an external pressure of 10 mmHg in the intervillous space. In the second series, five placentae were perfusion‐fixed at arterial pressures of 70 mmHg and 90 mmHg with an external pressure of 30 mmHg. Stereological estimates relating to the size of the capillaries and the thickness of the villous membrane were then made.Results
In each series, as the arterial pressure rose, there was an increase in the volume fraction and surface area of the fetal capillaries, and a concomittant decrease in the mean thickness of the villous membrane. These changes were negated as the external pressure rose, indicating the importance of the pressure differential between the capillary lumen and the intervillous space in determining the dimensions of the fetal capillaries.Conclusions
The study demonstrated that placental capillaries are elastic and hence deformable. If a sufficiently high pressure is generated in the intervillous space, they may therefore be compressed. This may explain the increase in umbilical vascular resistance demonstrated by doppler studies in pregnant women scanned in the supine position. In this situation the venous drainage from the intervillous space is believed to be impeded by the gravid uterus compressing the inferior vena cava.
Neonatal platelet reactivity and serum thromboxane B2production in whole blood: the effect of maternal low dose aspirin
Authors: Louden K. A. , Pipkin F. Broughton , Heptinstall S. , Fox S. C. , Tuohy P. , O'Callaghan C. , Mitchell J. R. A. , Symonds E. M. 
Published: August 2005

ABSTRACTObjectives
Concern has been expressed about possible neonatal side effects after the use of maternal anti‐platelet agents in pregnancy, particularly low dose aspirin treatment. We have studied neonatal platelet behaviour using whole blood techniques, and assessed the neonatal effect of the maternal ingestion of 60 mg aspirin daily.Design
Cross sectional and randomised, double‐blind, placebo‐controlled.Setting
University hospital.Subject
1. Eight normal women, studied before conception, and their infants. 2. Twenty‐four infants whose mothers had been randomised to receive either 60 mg aspirin daily, or placebo, in double‐blind fashion.Methods
The Clay Adams Ultra Flo 100 whole blood single platelet counter was employed to measure platelet aggregation in response to various agonists. The platelet release reaction was also measured in whole blood, and serum thromboxane B2 (TxB2) production was measured by radio‐immunoassay. Umbilical cord blood samples were obtained at delivery.Results
1. Neonatal platelet aggregation induced by adrenaline, ADP and platelet activating factor was reduced in comparison with their mothers (P < 0.01), whereas the neonatal platelet release reaction was reduced when stimulated by collagen and U46619 (a thromboxane mimetic) (P < 0.01). Serum TxB2 production was similar in mothers and babies. 2. Neonatal platelet aggregation, release reaction and serum TxB2 production were not significantly reduced in infants exposed to maternal aspirin in comparison with those neonates exposed to maternal placebo. This is in contrast to the effect on maternal platelets.Conclusions
Although only a small number of patients were studied, we interpret this as a relative sparing of neonatal platelet reactivity due to the presystemic action of low dose aspirin.
Induced abortion: an audit of reported current pracl among consultant gynaecologists in Scotland*
Authors: Penney Gillian C. , Templeton Allan 
Published: August 2005

ABSTRACTObjective
To obtain an overview of current abortion practice in Scotland for comparison with agreed criteria for good quality care based on literature review.Design
Postal questionnaire survey.Subjects
All 132 consultant gynaecologists practising in the NHS in Scotland.Results
Response rate 92%. The survey revealed regional inequalities in the availability of services, particularly with regard to early medical abortion and second trimester procedures. It also revealed great individual variations in many areas of practice notably in screening for genital tract infection, the use of cervical predilatation, contraceptive provision, and follow up. Several aspects of practice compared poorly with the agreed criteria for good quality care.Conclusions
The postal questionnaire approach achieved a good response rate and has provided an informative overview of current practice on a national basis. Variations in the provision of services and in clinical practice, both among regions and among individual consultants, have been identified. Elements of abortion care in which great variations exist and in which current practice compares poorly with the agreed criteria have been highlighted as appropriate areas for the development of national guidelines and for educational initiatives. Such a questionnaire approach to assessing current practice can complement, and possibly replace, some aspects of casenote review audit.
Pelvic exenteration: a review of the Gateshead experience 1974–1992
Authors: Robertson Greg , Lopes Alberto , Beynon Gareth , Monaghan John M. 
Published: August 2005

ABSTRACTObjective
To examine morbidity and survival among women treated by pelvic exenteration for gynaecological malignancy.Design
Retrospective review by analysis of case records.Setting
Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK.Subjects
Eighty‐three consecutive patients referred from within the UK from 1974 to 1992 for initial treatment of advanced gynaecological malignancy or management of recurrent disease following unsuccessful initial therapy.Results
Overall five year actuarial survival was 41%, falling to 36 % at 10 years. Serious morbidity was low, and there were only three perioperative deaths.Conclusions
For patients with limited options for treatment of advanced primary or recurrent cancer, exenteration offers a reasonable prospect of survival with good quality of life.
Transvaginal sacrospinous colpopexy for vault and marked uterovaginal prolapse
Authors: Carey Marcus P. , Slack Mark C. 
Published: August 2005

ABSTRACTObjective
To assess the results of the sacrospinous colpopexy procedure for the treatment of vault prolapse following hysterectomy and marked uterovaginal prolapse.Design
A prospective study of all patients undergoing sacrospinous colpopexy for vault and marked uterovaginal prolapse between December 1991 and December 1992.Setting
Kent and Canterbury Hospital, Canterbury.Subjects
Forty women with vault prolapse following hysterectomy and 24 with marked uterovaginal prolapse.Interventions
All patients underwent posterior vaginal repair, enterocele sac obliteration and sacrospinous colpopexy. In 48 patients an anterior vaginal repair with suburethral buttressing sutures was also performed. A long‐needle bladder neck suspension operation (Raz procedure) was included for three women with coexistent stress incontinence. In 13 patients a vaginal hysterectomy was performed and in 11 the uterus was conserved. A postanal sacrorectopexy was performed on one patient with marked rectal prolapse.Results
The mean follow up period was five months. So far, there have been three failures in the group treated for vault prolapse. One of these underwent a successful repeat sacrospinous colpopexy and repair. The main long term complication was cystocele formation. One sexually active patient complained of dyspareunia following surgery.Conclusion
The sacrospinous colpopexy is effective in the treatment of vault prolapse and compares favourably with abdominal vault supporting procedures. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele. This procedure is also a useful adjuvant when treating marked uterovaginal prolapse.
Dexamethasone and fetal heart rate variation
Authors: Dawes G. S. , Serra‐Serra V. , Moulden M. , Redman C. W. G. 
Published: August 2005

ABSTRACTObjective
To determine the effect of maternal administration of dexamethasone on fetal heart rate and its variation.Design
Retrospective analysis of computerised data derived from cases studied over three years.Setting
High risk pregnancy unit, John Radcliffe Hospital, Oxford.Subjects
Twenty‐eight pregnant women, at 27 to 32 weeks of gestation, to whom dexamethasone was given to accelerate pulmonary maturation in the expectation of preterm delivery.Methods
Dexamethasone (two doses of 12 mg intramuscularly, 12 h apart) was given on 51 occasions at weekly intervals (one to four occasions per patient). Complete data were available for cardiotocograph analysis from computerised measurement of fetal heart rate variables for two days before and four days after dexamethasone and, in 19 women, measurements of umbilical arterial flow velocity waveforms before and after dexamethasone.Results
In 10 pregnancies without fetal distress there was a highly significant (P < 0.01) transient rise in short term fetal heart rate variation after dexamethasone administration, from means (SE) 6.4 (028) to 9.8 (0.4) ms. In 18 pregnancies with subsequent delivery for fetal distress (abnormal fetal heart rate pattern) and high umbilical arterial resistance index [mean 0.93 (0.06 SE)], the rise in short term fetal heart rate variation was less (P < 0.01), from mean (SE) 5.4 (0.26) to 6.1 (0.48) ms. In a further case of discordant twin pregnancy, the larger twin continued to respond to dexamethasone administrations with a rise in fetal heart rate variation for five weeks; the smaller twin, with maintained tachycardia and reduced umbilical arterial end‐diastolic flow velocity, failed to respond after the first two weeks.Conclusion
The results show that maternal dexamethasone administration normally causes a rise in fetal heart rate variation for up to a day. This rise is reduced in pre‐eclampsia or intrauterine growth retardation, associated with a reduction in umbilical flow, perhaps because of a consequential lower concentration of steroid in the fetus. The results contrast with those for betamethasone which has been reported to reduce fetal heart rate variation.
The quality of routinely collected maternity data
Authors: Cleary R. , Beard R. W. , Coles J. , Devlin H. B. , Hopkins A. , Roberts S. , Schumacher D. , Wickings H. I. 
Published: August 2005

ABSTRACTObjective
To assess the validity of clinical information held on a regional maternity database, the St Mary's Maternity Information System (SMMIS).Design
A retrospective review of 892 maternity case notes and matched SMMIS records, by a midwife trained in clinical coding techniques.Setting
Three maternity units in the North West Thames Region.Main outcome measures
Percentage agreement for 17 directly recorded SMMIS data items and equivalent data abstracted from the notes. Frequencies of diagnosis codes abstracted from case notes, as compared with those generated by SMMIS on the basis of directly recorded data.Results
A generally high level of agreement was observed between the abstracts of the notes and the SMMIS records. Of the 17 data items examined, 10 showed 95% agreement or better, and all but two exceeded 80% agreement. Little difference was found between the levels of agreement observed at the three sites. A greater number and range of diagnosis codes were abstracted from the notes than were generated by SMMIS.Conclusions
The directly recorded clinical data held on the SMMIS regional database is largely accurate and consistently recorded across a variety of units. The database can therefore be considered a valuable resource for the comparative audit of maternity practice. The SMMIS technique for deriving, on a semi‐automatic basis, diagnosis codes from the directly recorded fields, appears to work moderately well. We suggest that the direct method of data collection used in SMMIS could provide a model for other specialties in the National Health Service.
A randomised trial of routine versus selective counselling in perinatal bereavement from congenital disease
Authors: Lilford Richard J. , Stratton Peter , Godsil Susan , Prasad Anjali 
Published: August 2005

ABSTRACTObjective
To find out whether routine counselling improves psychological wellbeing after bereavement for fetal abnormality.Design
A randomised trial among bereaved couples who did not demonstrate any unexpected strain or psychopathology after bereavement.Setting
St. James's University Hospital, Leeds.Subjects
Fifty‐seven couples.Interventions
Independent counselling by an experienced psychotherapist.Main outcome measures
Self‐administered questionnaires measuring grief, anxiety and depression and a structured psychological interview 16 to 20 months after the loss. Anniversaries of a death or expected birth date were avoided.Results
There were no differences in outcome between women randomised to the study group or randomised to the control group with respect to grief, anxiety, depression or the results of the structured overview. Among those in the randomised study group, women who attended for counselling had a much better outcome than women who defaulted from counselling. Overall, women who underwent termination of pregnancy did slightly worse than those who had experienced stillbirth or neonatal death. On an informal basis, the clinician concerned believes that he was better able to help bereaved couples as a result of feedback and criticism from the independent counsellor.Conclusions
(1) The hypothesis that all couples should have independent counselling after prenatal loss for congenital abnormality is unproven, but it is likely that clinicians can benefit from feedback from a counsellor; (2) it is possible that termination of pregnancy is more psychopathogenic than other forms of fetal loss; (3) people who attend for their counselling sessions are probably inherently better able to adjust to bereavement; (4) trials of psychological intervention are feasible, but follow up is either difficult to achieve or expensive.
Expectant management of twin pregnancy with single fetal death
Authors: Santema Job G. , Swaak Astrid M. , Wallenburg Henk C. S. 
Published: August 2005

ABSTRACTObjective To evaluate the course and outcome of expectantly managed twin pregnancies with single fetal death in the second half of gestation.Design Case‐controlled study of 29 consecutive pregnancies from 1973 to 1993, with sonographic evidence of a twin at 20 weeks gestation with antenatal demise later in pregnancy, matched for maternal parity with 58 twin pregnancies without fetal death and delivered in the same year as the index case. Outcome measures included the incidence of complications of pregnancy, gestational age and mode of delivery, placentation, and perinatal outcome.Setting University Hospital Rotterdam.Results The frequency and severity of pregnancy‐induced hypertensive disorders was significantly higher in the study group than in controls. We found no differences between the study group and controls with regard to median gestational age at delivery (33 weeks versus 34 weeks) and median birthweight of liveborn infants (1880 g versus 2160 g). No consumptive coagulopathy was apparent in our 29 patients. The main cause of neonatal death was prematurity; multicystic encephalomalacia was not observed.Conclusions Our results support expectant management in twin pregnancies complicated by single fetal death.
The incidence of cervical intraepithelial neoplasia among women with renal transplant in relation to cyclosporine
Authors: Ter Haar‐van Eck Sylvia A. , Rischen‐Vos Jacqueline , Chadha‐Ajwani Savi , Huikeshoven Frans J. M. 
Published: August 2005

ABSTRACTObjective To evaluate the policy of an annual smear to screen renal transplant recipients for cervical intraepithelial neoplasia and invasive carcinoma and to determine the incidence of abnormal smears and CIN before and after the introduction of cyclosporine (1983).Design A retrospective study over the period 1971 to 1992.Subjects Postmenarchial women who received renal transplants and who were on immuno‐suppressive treatment for at least one month.Mean outcome measures Cytology and histology results.Results A total of 144 women who received renal transplantation were eligible for our study. Observation time varied from 1 to 227 months (median 59 months) with a mean for the group transplanted before 1983 (Group A) of 103 months, and for the group transplanted after 1983 (Group B) of 46 months. Of these women, 25 had an abnormal smear. Of these, 14 were confirmed by histology and repeated smears of the other 11 patients were negative. Within the 60 women in Group A with an abnormal smear, six had CIN I or CIN II, three had CIN III and one showed adenocarcinoma of the endometrium. Among the 84 women in Group B, four had CIN I or CIN II and none had CIN III. The overall incidence of abnormal cytology was 17.3%, with no invasive cervical carcinoma in this group.Conclusions Our policy of screening is adequate. With the introduction of cyclosporine the incidence of abnormal cytology and histology has a tendency to decrease. However, the duration of risk is not comparable yet.
A randomised double blind placebo controlled trial of fish oil in high risk pregnancy
Authors: Onwude J. L. , Lilford R. J. , Hjartardottir H. , Staines A. , Tuffnell D. 
Published: August 2005

ABSTRACTObjective To determine whether n‐3 fatty acid (EPA/DCHA) prophylaxis is beneficial in high risk pregnancies.Design A randomised, double blind, placebo controlled trial.Setting Antenatal clinic of St James's University Hospital, Leeds.Subjects Two hundred and thirty‐three pregnant women at high risk of developing proteinuric or nonproteinuric pregnancy induced hypertension or asymmetrical intrauterine growth retardation.Intervention Active treatment was 2.7 g of MaxEpa daily (1.62 g of eicosapentaenoic acid and 1.08 g of docosahexaenoic acid). Placebo were matching air‐filled capsules.Main outcome measures Occurrence of proteinuric, nonproteinuric pregnancy induced hypertension or birthweight < 3rd centile.Results There was no difference in an intention to treat analysis between the placebo and active treatment groups for occurrence of proteinuric pregnancy induced hypertension (relative risk (RR) = 0.88;95% CI 0.47–1.66), nonproteinuric pregnancy induced hypertension (RR = 0.89; 95% CI0.48–1.64), birthweight < 3rd centile (RR = 0.89; 95% CI 0.48–1.64), or the duration of pregnancy (difference of mean durations = 0.1 days; 95% CI ‐4.8 to 4.9 days). Analyses stratified by use of tobacco, and analyses excluding known major protocol violators gave essentially identical results.Conclusion There is no evidence from ths study for any useful effect of fish oil supplementation for women at high risk of adverse outcomes from a pregnancy, but a small protective effect remains a possibility.
Temporising management of severe pre‐eclampsia with and without the HELLP syndrome
Authors: Visser Willy , Wallenburg Henk C. S. 
Published: August 2005

ABSTRACTObjective To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre‐eclampsia receiving temporising haemodynamic treatment does not depend on the presence or absence of the syndrome of haemolysis, elevated liver enzymes, and a low platelet count (HELLP).Design A case‐controlled study.Setting High risk obstetric unit, University Hospital Rotterdam‐Dijkzigt, Rotterdam.Subjects One hundred and twenty‐eight consecutive pre‐eclamptic patients with HELLP, ges‐tational age less than 34 weeks, matched for maternal and gestational age with 128 pre‐eclamptic patients without HELLP.Intervention Both groups were treated with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring with the aim of prolonging gestation and enhancing fetal maturity.Main outcome measures Maternal and perinatal outcome in patients with and without HELLP.Results Except for variables pertaining to HELLP, clinical and laboratory data and median prolongation of pregnancy did not differ between both groups. Complete reversal of HELLP occurred in 43% of patients. Perinatal mortality was 14.1% in HELLP patients and 14.8% in patients without HELLP. No maternal complications occurred.Conclusion We cannot reject the null hypothesis. Our data do not support a general recommendation of prompt termination of pregnancy in HELLP. Temporising treatment may improve fetal and neonatal as well as maternal outcome.
Corticotrophin‐releasing hormone and corticotrophin‐ releasing hormone binding protein in normal and pre‐eclamptic human pregnancies
Authors: Perkins A. V. , Linton E. A. , Eben F. , Simpson J. , Wolfe C. D. A. , Redman C. W. G. 
Published: August 2005

ABSTRACTObjective To measure the plasma levels of corticotrophin‐releasing hormone and corticotrophin‐releasing hormone binding protein in normal pregnancy and in pregnancies complicated by pre‐eclampsia.Setting John Radcliffe Hospital, Oxford and St Thomas's Hospital, London.Subjects One hundred and twenty pregnant women sampled prospectively throughout gestation, of whom 91 experienced a normal pregnancy and eight developed pre‐eclampsia; in a second study, 10 women with severe pre‐eclampsia, presenting at a range of gestational ages, were sampled once and compared with appropriately matched normal pregnant women.Main outcome measure Plasma levels of corticotrophin‐releasing hormone determined by immunoradiometric assay. Plasma levels of corticotrophin‐releasing hormone binding protein measured by direct radioimmunoassay.Results In the prospective study, plasma samples from women with pre‐eclampsia exhibited higher (390.2 versus 292.7 pmol/l at 36 weeks) levels of corticotrophin‐releasing hormone and significantly lower (5.24 versus 8.14 nmol/l at 36 weeks, P 0.002) levels of corticotrophin‐releasing hormone binding protein than normal controls. In the second, single time point study a significant elevation in CRH (P < 0.002) and reduction in CRH‐BP (P < 0.001) was found in pre‐eclamptic pregnancies compared with controls.Conclusions In human pregnancies complicated by pre‐eclampsia there is an elevated level of corticotrophin releasing hormone whilst there is less corticotrophin‐releasing hormone binding protein; therefore there is a net increase in free potentially bioactive hormone which may play a role in the pathology of the disease.