bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective miscarriage of Down's syndrome fetuses in women aged 35 years and older
Authors: Macintosh M. C. M. , Wald N. J. , Chard T. , Hansen J. , Mikkelsen M. , Therkelsen A. J. , Petersen G. B. , Lundsteen C. 
Published: August 2005

ABSTRACTObjective
To estimate the fetal loss of Down's syndrome fetuses between the time of chorionic villus sampling (10 weeks gestation) and the time of amniocentesis (16 weeks gestation) and term in women aged 35 years and older.Design
The age specific prevalence rates in the first trimester of Down's syndrome were estimated using the Danish cytogenetic register in combination with results from four published studies. These were compared with the reported prevalence at the time of amniocentesis and at birth.Subjects
5927 singleton pregnancies undergoing chorionic villus sampling (71 cases of Down's syndrome and 5856 unaffected cases). This was combined with published data on a further 231 cases of Down's syndrome and 16620 unaffected cases.Main outcome measures
Age specific prevalences at the time of chorionic villus sampling. Proportion of pregnancies lost between the time of chorionic villus sampling and the time of amniocentesis and term.Results
Thirty‐two percent of Down's syndrome pregnancies are lost between the time of chorionic villus sampling (10 weeks) and the time of amniocentesis (16 weeks) and 54% are lost by term.Conclusions
The high fetal loss rates of Down's syndrome between the time of chorionic villus sampling and term introduce problems when evaluating first trimester screening tests with respect to their effective detection rates at term. A recommendation for quoting term risks is made.
The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour
Authors: Aldrich C. J. , D'Antona D. , Spencer J. A. D. , Wyatt J. S. , Peebles D. M. , Delpy D. T. , Reynolds E. O. R. 
Published: August 2005

ABSTRACTObjective
To measure the effect of maternal pushing during the second stage of labour on fetal cerebral oxygenation and blood volume.Design
A prospective study comparing changes in the fetal cerebral concentrations of oxy‐haemoglobin, deoxyhaemoglobin and cerebral blood volume, before and during maternal pushing in the second stage of labour.Setting
Teaching hospital obstetric unit.Subjects
Ten term fetuses during labour.Results
Following the onset of maternal pushing, mean cerebral deoxyhaemoglobin concentration increased by a mean of 0.79 (SD 0.59) μmol.100 g‐1, (P < 0.01) without any consistent change in the oxyhaemoglobin concentration. These changes were associated with a significant decrease in the calculated mean cerebral oxygen saturation from a mean of 46.8% (SD 8.6) to 38.1% (SD 5.2) (P < 0.01). Pushing was also associated with a significant increase in the mean cerebral blood volume, which rose by a mean of 0.33 ml. 100 g‐1 (SD 0.37) (P < 0.05).Conclusion Maternal pushing during the second stage of labour leads to a significant decrease in fetal cerebral oxygenation, together with an increase in cerebral blood volume.
Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study
Authors: Clarke Aileen , Black Nick , Rowe Pam , Mott Sarah , Howle Karen 
Published: August 2005

ABSTRACTObjective
To describe the indications for total abdominal hysterectomy for women with nonmalignant disease and to determine the immediate (initial ten days) and medium term outcome.Design
A prospective cohort study.Setting
Three district general hospitals in shire counties, two in outer London and one London teaching hospital.Subjects
Three hundred and sixty‐six women undergoing total abdominal hysterectomy (with or without other procedures) for nonmalignant disease.Interventions
Self‐completed patient questionnaires before and ten days, six weeks and three months after surgery. Data extracted from patients' hospital case notes.Main outcome measures
Complications plus change in symptoms, urinary and bowel function, general health status, sexual function, activities of daily living and quality of life.Results
The principal indications were bleeding, pain or both. Symptoms were severe enough to be socially debilitating and have a major impact on lifestyle. Otherwise, the women were in good health. During the first ten post‐operative days the women suffered more pain, urinary discomfort, constipation and a reduction in their ability to perform activities of daily living. Urinary (25%) and wound (25%) infections were the commonest complications. At the same time, significant improvements in psychological health occurred. By six weeks, the principal symptoms had resolved for 95% of the women and early adverse effects on urinary and bowel function had settled. This was reflected in improvements in health status and quality of life including sexual activity. Despite this, these changes did not meet the pre‐operative expectations of some women.Conclusions
Most women reported substantial benefits from hysterectomy. However, women should be warned about early, transient adverse effects. These findings can serve as a benchmark for nonexperimental evaluations of the effectiveness of new treatment modalities.
The effect of uterine contractions on fetal oxygen saturation
Authors: McNamara Helen , Johnson Nicholas 
Published: August 2005

ABSTRACTObjective
To find out what happens to fetal arteriolar oxygen saturation during a uterine contraction.Design
Prospective observational study.Setting
Labour ward, St James's University Hospital, Leeds.Subjects
Eighteen women in normal labour monitored with a fetal scalp surface pulse oximetry sensor, an intrauterine pressure catheter, and a head to cervix force transducer.Methods
The effect of intrauterine pressure and head to cervix force on fetal arteriolar oxygen saturation was examined using time series analysis and a regression model of 159 contractions.Outcome measure
Fetal oxygen saturation during a contraction.Results
The average oxygen saturation drops after a contraction. The greatest drop in oxygen saturation is reached 92 s after the peak of a contraction and takes approximately 1 min 30 s to recover (P= 0.036).Conclusion
Uterine contractions during normal labour affect fetal oxygen saturation.
Screening for trisomy 21 in twin pregnancies by maternal age and fetal nuchal translucency thickness at 10–14 weeks of gestation
Authors: Sebire Neil J. , Snijders Rosalinde J. M. , Hughes Karen , Sepulveda Waldo , Nicolaides Kypros H. 
Published: August 2005

Objective
To determine the prevalence of increased fetal nuchal translucency thickness in twin pregnancies and to evaluate screening for trisomy 21 by a combination of translucency thickness and maternal age.Design
Prospective screening study at 10 to 14 weeks of gestation.Setting
Fetal Medicine Centre.Population
22,518 self‐selected pregnant women at 10 to 14 weeks of gestation, including 21,477 singleton and 448 twin pregnancies with live fetuses.Methods
Fetal nuchal translucency thickness was measured by ultrasound examination at 10–14 weeks. Sensitivity and false positive rates of screening for trisomy 21 by a combination of fetal nuchal translucency thickness and maternal age were calculated.Main outcome measures
Prevalence of increased nuchal translucency thickness and detection of trisomy 21.Results
In the 448 twin pregnancies the nuchal translucency thickness was above the 95th centile of the normal range (for crown‐rump length in singletons) in 65/896 fetuses (7.3%), including 7/8 (88%) with trisomy 21. Increased translucency was also present in four fetuses with other chromosomal abnormalities. In the chromosomally normal twin prebmancies the prevalence of increased nuchal translucency was higher in fetuses from monochorionic (8.4%; 16/190) than in those with dichori‐onic pregnancies (5.4%; 37/688). The minimum estimated risk for trisomy 21, based on maternal age and fetal nuchal translucency thickness, was 1 in 300 in 19.5% (175/896) of the twins including all eight of those with trisomy 21.Conclusions
In twin pregnancies the sensitivity of fetal nuchal translucency thickness in screening for trisomy 21 is similar to that in singleton pregnancies, but the specificity is lower because translucency is also increased in chromosomally normal monochorionic twin pregnancies.
Anal and urinary incontinence in women with obstetric anal sphincter rupture
Authors: Tetzschner Tine , Sørensen Michael , Lose Gunnar , Christiansen John 
Published: August 2005

Objective
To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk.Design
An observational study.Settings
Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark.Participants
Ninety‐four consecutive women who had sustained an obstetric anal sphincter rupture.Interventions
Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum. A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum.Main outcome measures
The frequency of anal and urinary incontinence and risk factors for the development of incontinence.Results
Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice.Conclusions
Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.
Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound
Authors: Naidu S. , Payne A. J. , Moodley J. , Hoffmann M. , Gouws E. 
Published: August 2005

Objective
To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO4) and phenytoin on cerebral circulation.Design
Prospective randomised study.Setting
High care obstetric unit, King Edward VIII Hospital, Durban, South Africa.Participants
Twenty‐four eclamptic patients: 13 received MgSO, and 11 phenytoin.Intervention
Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant.Results
Magnesium sulphate significantly reduced the pulsatility index (P= 0.002) and mean flow velocity (P= 0.02) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO, and phenytoin groups.Conclusion
These findings provide firm evidence that MgSO, relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.
Very preterm birth–a regional study. Part 1: Maternal and obstetric factors
Authors: Hagan R. , Benninger H. , Chiflings D. , Evans S. , French N. 
Published: August 2005

Objective
To ascertain the demographic, pregnancy and obstetric factors associated with the delivery of a live born very preterm infant (< 33 weeks of gestation) and to investigate any differences in these factors between identifiable aetiological groups.Design
Cohort analytical study.Setting
King Edward Memorial Hospital for Women (KEMH), Western Australia.Main variables examined
Maternal demographic and obstetric history, primary complication associated with delivery, obstetric management and mode of delivery.Results
Six hundred and eight women who were delivered of 693 live born very preterm infants in Western Australia between 1.1.90 and 31.12.91, representing 1.22% of all women who were delivered of a live born infant in those years. Singleton pregnancy occurred in 517 (85%) and 541 (89%) were delivered in KEMH. Mean maternal age was 28 years with an excess of mothers less than 20 years of age and older than 34 years compared with the statewide perinatal data. Pre eclampsia (n= 128, 21.1 %), preterm prelabour rupture of membranes (n= 148, 24.3%), idiopathic preterm labour (n= 195, 30.4%) and antepartum haemorrhage (n= 111, 18.3%) were associated with 94.1% of deliveries. These proportions varied with plurality and period of gestation. Demographic details, use of antenatal steroids, exposure to labour and caesarean section delivery differed between mothers depending on the primary complication. Overall 322 (53.0%) received antenatal steroids and 297 (48.8%) were delivered by caesarean section. Factors associated with decreased use of steroids were gestational age of less than 27 weeks (odds ratio (OR) 0.54; 95% CI 0.36–0.83), preterm prelabour rupture of the membranes (OR 0.48; 95% CI 0.29–0.78) and idiopathic preterm labour (OR 0.56; 95% CI 0.35–0.91). Factors associated with increased use of steroids were multiple pregnancy (OR 1.70; 95% CI 1.02–2.41) and pre‐eclampsia (OR 1.87; 95% CI 1.09–3.19).Conclusions
These very preterm deliveries account for only a small proportion of all deliveries. There are differences in the mother's demographic history, obstetric management and delivery depending on the primary aetiological factor.
Serum screening for Down's syndrome between 8 and 14 weeks of pregnancy
Authors: Wald N. J. , George L. , Smith D. , Densem J. W. , Pettersonm K. ,   on behalf of the International Prenatal Screening Research Group
Published: August 2005

Objective
To determine the value of serum screening for Down's syndrome at 8–14 weeks of pregnancy using seven potential serum markers (alpha‐fetoprotein, unconjugated oestriol, total human chorionic gonadotrophin (hCG), free α‐hCG, free P‐hCG, pregnancy associated plasma protein A (PAPP‐A), and dimeric inhibin A).Design
Stored blood samples collected from women at about 10 weeks of pregnancy, prior to having a chorionic villus sampling procedure on account of advanced maternal age, were retrieved from pregnancies associated with Down's syndrome and from matched unaffected pregnancies.Setting
Twenty‐one obstetric centres in nine countries.Subjects
Seventy‐seven pregnancies associated with Down's syndrome each matched with five controls (except in two cases that were matched with four controls) for maternal age (same five year age groups), duration of storage of the serum sample (same calendar year), and gestational age (usually same week of pregnancy).Results
The levels of two potential markers differed between affected and unaffected pregnancies sufficiently to be of value in screening—free β‐hCG and PAPP‐A. The median free P‐hCG level in affected pregnancies was 1.79 times the median level for unaffected pregnancies, and the median PAPP‐A level was 0.43 times the normal median. These two markers were combined with maternal age to estimate a woman's risk of having a fetus with Down's syndrome. A screening programme that used a risk cutoff level of 1:300 would detect 63 % of affected pregnancies and also classify 5.5% of unaffected pregnancies as screen positive. None of the other five markers added more than 2 % detection for the same false‐positive rate.Conclusion
The performance of screening using maternal age and serum‐free β‐hCG and PAPP‐A at 10 weeks of pregnancy was better than the double test (alpha‐fetoprotein and hCG with maternal age) and similar to the triple test (alpha‐fetoprotein, unconjugated oestriol and hCG with maternal age) at 15–22 weeks.
Cardiac abnormalities in pulmonary oedema associated with hypertensive crises in pregnancy
Authors: Desai D. K. , Moodley J. , Naidoo D. P. , Bhorat I. 
Published: August 2005

Objective
To describe the cardiac abnormalities by two‐dimensional and Doppler echo‐cardiography (echo‐Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors.Design
A prospective observational study.Setting
King Edward VIII Hospital, Durban, South Africa.Participants
Sixteen patients with HCP complicated by pulmonary oedema over a six‐month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied.Results
Echocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25 %) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filling abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema.Conclusion
This study demonstrates the value of echo‐Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.
Is intrapartum vibratory acoustic stimulation a valid alternative to fetal scalp pH determination?
Authors: Irion Olivier , Stuckelberger Pierre , Moutquin Jean‐Marie , Morabia Alfredo , Extermann Philippe , Béguin Frangois 
Published: August 2005

Objective
To determine the association between fetal heart rate accelerations, whether spontaneous or induced by vibratory acoustic stimulation, and subsequent scalp pH values in presence of a suspicious intraparturn fetal heart rate tracing, and thereby assess the ability of accelerations to predict a concurrent normal fetal scalp blood pH.Design
Prospective observational study of 253 labours involving 421 pH samples.Setting
Tertiary care university hospital of Geneva.Intervention
Vibratory acoustic stimulation through the maternal abdominal wall for five seconds prior to fetal blood sampling.Main outcome measures
Spontaneous fetal heart rate reactivity (accelerations) in the 10 min preceding vibratory acoustic stimulation, vibratory acoustic‐induced reactivity prior to fetal blood sampling, and scalp pH value.Results
The positive predictive value of a reactive fetal heart rate response after vibratory acoustic stimulation was 78% (95% CI 73–84%) and 97% (95% CI 94–99%) for scalp pH values of > 7.25 and ≥ 7.20, respectively. Similar observations occurred with spontaneous reactivity. Of concern, 7 out of 31 (23%) occasions where the scalp blood pH was less than 7–20 appeared to be associated with a normal fetal heart rate response to vibratory acoustic stimulation.Conclusions
Fetal heart rate acceleration induced by vibratory acoustic stimulation was significantly associated with a normal scalp blood pH higher than 7.25. However, vibratory acoustic stimulation offers no advantage over observation of spontaneous fetal heart rate tracings and cannot safely replace fetal blood sampling during labour.
Is there any value in the long term follow up of women treated for endometrial cancer?
Authors: Owen* Philip , Duncan Ian D. 
Published: August 2005

Objective
To evaluate the clinical benefit of routine follow up of women after treatment for endometrial adenocarcinoma.Design
Retrospective case analysis.Participants
All cases diagnosed and treated for endometrial adenocarcinoma in Tayside, Scotland during 1982 to 1984 inclusive.Methods
Case‐note and cancer registration document review.Results
Of 102 patients, 97 had complete follow up for 10 years or until death. Recurrent disease was diagnosed in 17 women, only six of whom were asymptomatic at the time of diagnosis. There was no difference in survival between cases with symptomatic and asymptomatic recurrences. No recurrences were diagnosed more than six years after initial diagnosis.Conclusions
The diagnosis of asymptomatic recurrent endometrial carcinoma was not associated with improved long term survival. This small study showed no evidence of improved survival from the current practice of routine clinical review following treatment for endometrial adenocarcinoma. The effect of follow up on patient anxiety remains to be assessed.
Clinical and ultrasound prediction of macrosomia in diabetic pregnancy
Authors: Johnstone Frank D. , Prescott Robin J. , Steel Judith M. , Mao J. H. , Chambers Sarah , Muir Nicé 
Published: August 2005

Objective
To study prospectively the prediction power, at different gestations, of clinical and ultrasound measurements for fetal size in diabetic pregnancy.Setting
A large combined obstetric diabetic clinic in a teaching hospital.Participants
One hundred and eighty‐one pregnancies in which women had scans at least two of three specific time points and who were delivered of singletons after 34 weeks: 73% were pre‐gestational insulin‐dependent diabetics, the others were pre‐gestational White class A or gestational diabetics.Interventions
Clinical estimates of fundal height and fetal size and ultrasound estimates of abdominal circumference and head circumference were routinely carried out at gestational ages of 28, 34 and 38 weeks or before delivery.Main outcome measures
Standardised birthweight, corrected for gestation and parity. The relation with clinical and ultrasound measurements was investigated using multiple linear regression and the capability of the measurements to predict macrosomic births (>95th centile of normals) using receiver‐operator characteristic curves.Results
All measurements are poor predictors of eventual standardised birthweight. Prediction improves with closeness to delivery. Prediction is significantly improved by adding ultrasound to clinical information, but at 34 weeks or later this only contributes 8 % of the variance. There is no difference in the prediction power for macrosomia between clinical and ultrasound measurements.Conclusions
Even regular serial scanning and clinical examination will not always diagnose the macrosomic fetus in diabetic pregnancy. In our hands, clinical examination is as predictive as ultrasound measurements. Ultrasound does add to clinical prediction power but only to a small extent. Ultrasound should be used in a selected way, as defined by clinical findings, and with recognition and understanding of the errors and biases involved.