bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic laser coagulation in the management of severe twin‐to‐twin transfusion syndrome
Authors: Ville Yves , Hecher Kurt , Gagnon Alain , Sebire Neil , Hyett Jon , Nicolaides Kypros 
Published: August 2005

Objective
To assess the clinical effectiveness of endoscopic laser coagulation of placental vessels in theDesign
Prospective study.Setting
Three referral centres for the management of twin‐to‐twin transfusion syndrome.Population
One hundred and thirty‐two pregnancies complicated by severe twin‐to‐twin transfusion syndrome, reflected by polyhydramnios and enlarged bladder of one twin and oligoanhydramnios and collapsed bladder of the other twin, presenting before 28 weeks of gestation.Methods
Prospective collection of data on pre‐procedure assessment, the procedure and the follow up were collected prospectively. Laser coagulation of placental vessels crossing the intertwine membrane on the chorionic surface under sono‐endoscopic guidance, followed by amniodrainage.Main outcome measures
Maternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors.Results
Endoscopic laser was carried out at a median gestation of 21 weeks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%).Conclusions
The results of this multicentre study are similar to those in our original report on the first 45 cases. In comparison with serial amniodrainage, the survival rate may be similar, but the handicap rate in survivors appears much lower. This study stresses the need for a prospective study comparing treatment of severe transfusion syndrome threse two techniques.
A systematic review and meta‐analysis of family history and risk of ovarian cancer
Authors: Stratton John F. , Pharoah Paul , Smith Steven K. , Easton Doug , Ponder Bruce A. J. 
Published: August 2005

Objective
To estimate the relative risk and lifetime risk of ovarian cancer in women with various categories of family history.Design
A meta‐analysis of all published caseecontrol and cohort studies.Methods
Pooled relative risk estimates were calculated for the caseecontrol studies, using the Mantel‐Haenzel method. These estimates were combined with the relative risks from the cohort studies. The pooled estimates of relative risk were used to estimate lifetime risks of ovarian cancer from age 15 Up to age 75, for various categories of family history.Main outcome measures
Relative risks and lifetime risks of developing ovarian cancer were calculated for the categories of women with 1. an affected first degree relative; 2. an affected mother; 3. an affected sister; and 4. women with more than one affected relative.Results
The relative risk to first degree relatives is 3.1 (95% CI 2.6–3.7). There is some evidence that this relative risk declines with age. The relative risk to mothers of cases 1.1 (95% CI 0.8–1.6) was lower than the relative risks to sisters: 3.8 (95% CI 2.9–5.1), and daughters: 6.0 (95% CI 3.0–11.9); the explanation of this difference is unclear.Conclusions
Women with a family history of ovarian cancer have a substantially higher risk of developing ovarian cancer compared with women without such a history. However the risk is small for most categories of family history, except for the small number of individuals who have more than one affected relative.
Impact of surgery for stress incontinence on the social lives of women
Authors: Black N. A. , Bowling A. , Griffiths J. M. , Pope C. , Abel P. D. 
Published: August 2005

Objective
To assess the feasibility of collecting disease‐specific and generic data on the impact of surgery on the social lives of women with stress incontinence; to describe the social impact of surgery in a representative group; and to determine the effect of timing on the assessment of outcome.Design
Longitudinal study; questionnaires before and three, six, and twelve months after surgery.Setting
Eighteen hospitals in North Thames region.Participants
Four hundred and forty‐two women undergoing surgery for stress incontinence between January 1993 and June 1994.Main outcome measures
Post‐operative recovery time, stress incontinence symptom impact index, activities of daily living, and cost of protection.Results
Post‐operative recovery was uneventful for most women, but three months after surgery 24% of those in paid employment beforehand were still on sick or unpaid leave. Most women (75%) reported that stress incontinence had less adverse impact on their lives three months after surgery, though 18% reported no change, and 7% felt life was worse. The likelihood of improvement was similar regardless of whether pre‐operative urodynamic studies had been conducted. The extent of improvement was dependent on pre‐operative severity. Similar findings were obtained six and twelve months after surgery. After an initial slight but nonsignificant deterioration in their ability to carry out activities of daily living, women gained a slight benefit from surgery (proportion with no or only slight limitation rose from 72% to 82%; P= 0.0001). The mean cost of protection (pads and towels) fell from £8.59 a month before surgery to £2.99 a month one year after surgery, by which time 68% of women were not using protection. In contrast, 11% were still spending over £10 a month.Conclusions
It is possible to collect standard data on the impact of surgery on social functioning and, thus, provide women with better information on likely outcomes. The benefits of pre‐operative urodynamic investigations need to be assessed. The stability of the outcome measures over the first post‐operative year suggest that outcomes need to be assessed only once and at any time from three to twelve months after the operation.
Shedding of syncytiotrophoblast microvilli into the maternal circulation in pre‐eclamptic pregnancies
Authors: Knight Marian , Redman Christopher W. G. , Linton Elizabeth A. , Sargent Ian L. 
Published: August 2005

Objective
To investigate whether syncytiotrophoblast microvilli (STBM) are shed into the maternal circulation in increased amounts in pre‐eclamptic pregnancies as a possible cause of maternal vascular endothelial dysfunction.Design
A time‐resolved fluoroimmunoassay was developed to measure STBM levels in peripheral and uterine venous plasma from normal pregnant and pre‐eclamptic women. Three colour flow cytometry was used to assess the microparticulate nature of the STBM in pregnancy plasma. The effects of these plasmas on endothelial cell proliferation was compared and a correlation with the levels of STBM detected was sought.Setting
A laboratory investigation using clinical samples obtained from an obstetric practice in a teaching hospital.Samples
Peripheral venous plasma from 20 women with established pre‐eclampsia, 20 normal pregnant women matched for age, gestation and parity, and 10 nonpregnant women of reproductive age. Paired uterine and peripheral venous plasma taken at caesarean section from 10 women with pre‐eclampsia and 10 unmatched normal pregnant women.Results
STBM were detected in the plasma of pregnant women by both flow cytometry and time‐resolved fluoroimmunoassay. Significantly higher levels of STBM were found in women with established pre‐eclampsia (P= 0.01). STBM concentrations were higher in uterine venous plasma than in concurrently sampled peripheral venous plasma, confirming their placental origin. A significant correlation was found between the amount of STBM in the plasma and endothelial cell inhibitory activity.Conclusions
STBM are shed into the maternal circulation (microvillous deportation) and are present in significantly increased amounts in pre‐eclamptic women. They may contribute to the endothelial dysfunction underlying the maternal syndrome of pre‐eclampsia.
The haemodynamic effects of ketanserin versus dihydralazine in severe early‐onset hypertension in pregnancy
Authors: Bolte Antionette C. , van Eyck Jim , Strack van Schijndel Rob J. M. , van Geijn Herman P. , Dekker Gustaaf A. 
Published: August 2005

Objective
To compare the haemodynamic efficacy of ketanserin (a selective serotonin2‐receptor blocker) with dihydralazine in the management of severe early‐onset hypertension in pregnancy.Design
Subgroup analysis within a randomised prospective multicentre trial to compare haemodynamic effects as measured by pulmonary artery catherization.Setting
Departments of Obstetrics and Gynaecology and Intensive Care Medicine, Free University Hospital, Amsterdam and Sophia Hospital, Zwolle.Participants
Thirty‐one women with a diastolic blood pressure > 110 mmHg and a gestational age between 26 and 32 weeks.Results
The antihypertensive efficacy of both drugs was comparable. Dihydralazine significantly increased cardiac output (P < 0.01), while ketanserin induced only minor changes in cardiac output. Systemic vascular resistance decreased in both groups, but the decrease was significantly more pronounced with dihydralazine compared with ketanserin. Ketanserin induced a significant but not clinically relevant increase in heart rate (P < 0.01, while dihydralazine caused marked tachycardia (P < 0.005). Left ventricular stroke work index was reduced to similar values in both groups.Conclusions
The antihypertensive profile of ketanserin is characterised by an early and gradual reduction of blood pressure in combination with a moderate decrease in systemic vascular resistance and no significant change in cardiac output. Dihydralazine causes market tachycardia resulting in a considerable increase in cardiac output.
Changes in the expression of the type‐2 but not the type‐1 cyclo‐oxygenase enzyme in chorion‐decidua with the onset of labour
Authors: Slater Donna , Allport Victoria , Bennett Phillip 
Published: August 2005

Objective
To determine the relative expression of cyclo‐oxygenase (COX)‐1 and COX‐2 in the chorion‐decidual part of human fetal membranes following delivery at term and to identify any changes in expression associated with labour.Methods
Fetal membranes were collected from 12 term pregnancies before labour following elective caesarean section and from 12 spontaneous vaginal deliveries. Expression of COX‐1 and COX‐2 mRNA was measured using a previously validated quantitative RT‐PCR assay.Results
COX‐2 expression exceeded that of COX‐1 by approximately eight‐fold. COX1 expression did not change but COX‐2 expression was found to increase four‐fold with labour.Conclusions
Chorion‐decidua has the capacity to contribute to the increase in prostaglandin synthesis within the uterus associated with labour. As in the amnion, it is COX‐2 and not COX‐1 which is upregulated with labour. COX‐2 selective anti‐prostaglandins should therefore be as effective as nonselective drugs in inhibition of fetal membrane prostaglandin synthesis.
Colour Doppler energy insonation of placental vasculature in monochorionic twins: absent arterio‐arterial anastomoses in association with twin‐to‐twin transfusion syndrome
Authors: Denbow Mark L. , Cox Phillip , Talbert David , Fisk Nicholas M. 
Published: August 2005

Objective
To determine in vivo whether monochorionic pregnancies complicated by twin‐to‐twin transfusion syndrome are associated with absence of haemodynamically‐compensatory arterioarterial anastomoses.Design
Forty monochorionic pregnancies were prospectively recruited for an ultrasonographic survey of the chorionic plate using colour Doppler energy. Arterio‐arterial anastomoses were identified by their characteristic bidirectional interference pattern on spectral Doppler. Angioarchitecture was confirmed by postnatal injection study.Setting
Fetal medicine tertiary referral centre in London.Main Outcome measures
Presence of arterio‐arterial anastomoses, development of twin‐to‐twin transfusion syndrome, survival.Results
Arterio‐arterial anastomoses were detected by colour Doppler energy in 21 pregnancies (53%), and there were no false positives. An arterio‐arterial anastomosis was more commonly found in unaffected (n= 28) compared to pregnancies affected by twin‐to‐twin transfusion syndrome (n= 12), both by colour Doppler energy [20/28 (71%) vs 1/12 (8%); Δ= 63%, 95% CI 40%‐86%] and by postnatal injection study [25/28 (89%) vs 3/12 (25%); Δ= 64%, 95% CI 37%‐91%]. In pregnancies in which no arterio‐arterial anastomoses were detected, a diagnosis of twin‐to‐twin transfusion syndrome was made in 58%, and the perinatal loss rate was 40%, compared with one case of twin‐to‐twin transfusion syndrome (5%) (P < 0.001) and a loss rate of 12% (P = 0.005) in pregnancies in which an arterio‐arterial anastomosis was detected.Conclusion
Twin‐to‐twin transfusion syndrome is associated with an absence of functional arterio‐arterial anastomoses in vivo in monochorionic twin pregnancies. This contributes to our understanding of the pathophysiology of twin‐to‐twin transfusion syndrome and confirms ex vivo studies demonstrating that twin‐to‐twin transfusion syndrome is associated with a paucity of superficial anastomoses. Prospective studies are indicated to determine the utility of colour Doppler energy for arterio‐arterial anastomoses in predicting risk in monochorionic pregnancies.
Efficacy of minor analgesics in primary dysmenorrhoea: a systematic review
Authors: Zhang W. Y. , Li Wan Po A. 
Published: August 2005

Objective
To quantify the efficacy and safety of naproxen, ibuprofen, mefenamic acid, aspirin and acetaminophen (paracetamol) in the treatment of primary dysmenorrhoea through a systemic overview of randomised controlled trials.Methods
MEDLINE, EMBASE and the Science Citation Index were searched for randomised controlled trials. Efficacy was assessed by measurement of pain relief, requirement for rescue analgesics, restriction of daily life and absence from work or school. The rate ratios of side effects were used to assess safety.Results
Fifty‐six trials describing 55 comparisons of analgesics with placebo and 12 direct comparisons with other analgesics met our inclusion criteria. Women taking naproxen were over three times more likely to have at least moderate pain relief than those taking placebo. Ibuprofen, mefenamic acid and aspirin were also superior to placebo but acetaminophen was not. The requirement for rescue analgesics, restriction of daily life and absence from work or school were less frequent with naproxen and ibuprofen than placebo but not with aspirin or acetaminophen. Direct comparisons did not show any difference between naproxen and ibuprofen. Side effects occurred more frequently only with naproxen when compared with placebo.Conclusion
Naproxen, ibuprofen, mefenamic acid and aspirin are all effective in primary dysmenorrhoea. Ibuprofen appears to have the most favourable risk‐benefit ratio. Acetaminophen appears to be less effective than nonsteroidal anti‐inflammatory drugs, but there was only one trial meeting our inclusion criteria and further studies are required.
Obstetric risk factors for periventricular leukomalacia among preterm infants
Authors: Spinillo Arsenio , Capuzzo Ezio , Stronati Mauro , Ometto Alessandra , De Santolo Antonella , Acciano Salvatore 
Published: August 2005

Objective
To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants.Design
A cohort study of preterm singleton infants born between 25 and 33 weeks gestation.Setting
Pavia, Italy.Population
Three hundred and forty‐nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia.Method
The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders.Results
The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63–12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91–17‐07), and neonatal acidosis (PH < 7.2) at birth (OR 5–97; 95% CI 1.93–18.52). Meconium‐stained amniotic fluid (OR 3.95; 95% CI 1.42–10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28–5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium‐stained amniotic fluid (OR 4–06; 95% CI 1.65–10.0), long‐term ritodrine tocolysis (OR 2.56; 95% CI 1.38–4.72), maternal infection (OR 1.73; 95% CI 1.0–3.0), and acidosis at birth (OR 1.98; 95% CI 1.0–3.98).Conclusions
This study confirms that maternal infection, acidosis at birth, and meconium‐stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long‐term ritodrine use seems to increase the risk for transient echodense lesions.
Risk of myocardial infarction, angina and stroke in users of oral contraceptives: an updated analysis of a cohort study
Authors: Mant Jonathan , Painter Rosemary , Vessey Martin 
Published: August 2005

Objectives
To investigate risk of myocardial infarction, angina and stroke in users of contraceptive pills compared with users of other methods of contraception.Design
Prospective cohort study, with recruitment between 1968 and 1974 and annual follow up until the age of 45 years. After this age, only women who had never used oral contraception or those who had used it for eight or more years continued to be followed up annually until July 1994.Setting
Seventeen family planning clinics in England and Scotland.Population
17,032 women aged between 25 and 39 years at entry to the study.Main outcome measures
Occurrence of angina, myocardial infarction or stroke that was associated with either hospital admission or outpatient referral to hospital or death.Results
Increased risk of myocardial infarction in oral contraceptive users was observed only in women who were heavy smokers at entry to the study. In this subgroup the relative risk of a myocardial infarction was 4.2 (95% CI 1.4–16.6) in ever users of oral contraception compared with non‐users, 4–9 (1.2–23.6) in current users, and 4–0 (1.3–16.2) in ex‐users. In all current users the relative risk of angina was 0.5 (0.1–1.4), and the relative risk of ischaemic stroke was 2.9 (1.3–6.7). The increased risk of ischaemic stroke did not persist in ex‐users.Conclusions
Use of oral contraception is associated with increased risk of ischaemic stroke and increased risk of myocardial infarction (only in heavy smokers), but no increased risk of angina. These increased risks need to be considered within the context of the very low absolute risks of cardiovascular disease in this population. 5880 women need to take oral contraception for one year to cause one extra stroke, and 1060 women who are heavy smokers need to take it for one year to cause one extra myocardial infarction.
Risk of hysterectomy after 1000 consecutive endometrial laser ablations
Authors: Phillips Graham , Chien Patrick F. W. , Carry Ray 
Published: August 2005

ObjectivesTo determine the hysterectomy rate after endometrial laser ablation, allowing for variable follow up times, and to evaluate the factors that might predict outcome.DesignObservational cohort study.SettingSpecialist minimal access gynaecology unit in a district general hospital.MethodsData were obtained from case notes, theatre records, and follow up postal questionnaires. The risk of hysterectomy following endometrial laser ablation was assessed using survival curve estimates. Proportional hazards regression analysis was used to identify the predictor(s) of this outcome.ResultsA single endometrial laser ablation was carried out on 746 patients (85.4%); 124 patients (14.2%) underwent one repeat procedure and three (0.4%)) underwent two repeat ablative procedures. The cumulative rate of return of the postal questionnaires was 87.3% (762/873 patients). Survival curve analysis showed that the overall hysterectomy rate projected over a follow up period of 6.5 years was 21% (95% CI 16%‐27%). The age of the patient at endometrial ablation, uterine cavity length, operative time, volume of fluid absorbed, the presence or absence of dysmenorrhoea, premenstrual syndrome and the method of endometrial preparation prior to surgery did not contribute significantly to the regression model. Having a repeat endometrial ablation procedure increased the risk of having a subsequent hysterectomy (RR = 2.93; 95% CI 1.59–5.40;P= 0.0015), whereas the presence of intrauterine pathology (eg, polyps, fibroids and uterine shape abnormalities) decreased the risk of this outcome (RR = 0.26; 95% CI 0.08–0.86;P= 0.0082) after adjustment for confounding due to patient's age and dysmenorrhoea prior to surgery.ConclusionsEndometrial laser ablation is a safe and effective treatment for menstrual dysfunction. Repeat ablative procedures significantly increased, and the presence of intrauterine pathology decreased, the risk of subsequent hysterectomy. variable follow up times, and to evaluate the factors that might predict outcome.
Severe acute maternal morbidity: a pilot study of a definition for a near‐miss
Authors: Mantel Gerald D. , Buchmann Eckhart , Rees Helen , Pattinson Robert C. 
Published: August 2005

Objective
To test the application of a clinical definition of severe acute maternal morbidity.Design
A one‐year prospective descriptive multi‐centre study.Setting
Kalafong and Pretoria Academic hospitals, catering for the delivery of indigent women in the Pretoria Health Region.Methods
A ‘near‐miss’ describes a patient with an acute organ system dysfunction, which if not treated appropriately, could result in death. The case notes of women fitting this definition and all maternal deaths were analysed and compared.Outcome measure
Determine the primary obstetric factors and the organ systems that failed. Identification of episodes of sub‐standard care and missed opportunities.Results
One hundred and forty‐seven near misses and 30 maternal deaths were identified. The commonest reasons for a near‐miss were: emergency hysterectomy in 42 women (29%); severe hypotension in 40 (27%); and pulmonary oedema in 24 (16%). The most common initiating obstetric conditions were hypertension in 38 women (26%); haemorrhage in 38 (26%); and abortion or puerperal sepsis in 29 (20%). The primary obstetric factors amongst the maternal deaths were: hypertension (33%); sepsis (27%); and maternal medical diseases (17%) in 10, 8 and 5 women respectively. Sub‐standard care was identified in 82 cases. Breakdown in the health care administration was identified in 33, and patient‐orientated missed opportunities on 34 occasions.Conclusions
The definition of severe acute maternal morbidity identified nearly five times as many cases as maternal death. This definition allows for an effective audit system of maternal care because it is clinically based, the definition is robust and the cases identified reflect the pattern of maternal death.
Do routine antibiotics after loop diathermy excision reduce morbidity?
Authors: Foden‐Shroff J. , Redman C. W. E. , Tucker H. , Millinship J. , Thomas E. , Warwick A. , Jones P. W. 
Published: August 2005

Objective
To evaluate whether routinely giving an antibiotic after loop diathermy excision of the cervical transformation zone reduced post‐operative vaginal loss.Design
Prospective, randomised, double‐blind placebo controlled parallel study.Participants
Five hundred women undergoing loop diathermy excision in a colposcopy clinic.Intervention
Administration of either ofloxacin 400 mg (2 × 200 mg) once daily for 5 days or an identical placebo.Main outcome measure
Vaginal loss, assessed using a pictorial chart.Results
No significant difference in post‐operative vaginal loss was found.Conclusion
Routine antibiotic prophylaxis after loop diathermy excision is not justified.