bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for aneuploidy in the first trimester by assessment of blood flow in the ductus venosus
Authors: Mavrides Eleni , Sairam Shanthi , Hollis Brian , Thilaganathan Baskaran 
Published: December 2003

Objective
To assess the role of ductus venosus Doppler assessment in screening for fetal aneuploidy in pregnancies at 11–14 weeks of gestation.Design
Prospective observational study.Setting
In a tertiary referral fetal medicine unit.Population
Two hundred fifty‐six consecutive pregnancies between 11 and 14 weeks of gestation referred to our unit.Methods
Nuchal translucency was measured and colour Doppler imaging was used to assess normal (forward) or abnormal (absence/reversed) ductus venosus flow during atrial contraction.Main outcome measures
Fetal karyotype, structural abnormalities and pregnancy outcomes.Results
The nuchal translucency measurement was ≥95th centile in 90 (35.2%) pregnancies, and 123 (48.0%) had a nuchal translucency‐related risk of ≥1:300. There were 46 chromosomally abnormal pregnancies and six euploid pregnancies with adverse outcome. The prevalence of abnormal ductus venosus Doppler waveforms in normal pregnancies was 4.49% (95% CI 1.76–8.76%). The sensitivities of abnormal nuchal translucency measurement alone, ductus venosus velocimetry alone or nuchal translucency and ductus venosus combined for Down's Syndrome were 80.4%, 58.7% and 93.5%, respectively. The likelihood ratios for aneuploidy with abnormal nuchal translucency measurement alone, ductus venosus velocimetry alone or nuchal translucency and ductus venosus combined were 3.33, 9.83 and 3.48, respectively.Conclusion
There is clear association between abnormal flow in the ductus venosus and fetal aneuploidy. The use of ductus venosus velocimetry in combination with nuchal translucency is better than either test alone, since it increases the sensitivity in the detection of Down's Syndrome to 94% and decreases the likelihood ratio of a negative test to 0.08.
Randomised controlled trial of reflexology for menopausal symptoms
Authors: Williamson Jan , White Adrian , Hart Anna , Ernst Edzard 
Published: December 2003

Objective
Clinical experience suggests that reflexology may have beneficial effects on the symptoms occurring in menopausal women, particularly psychological symptoms. This study aims to examine that effect rigorously.Design
Randomised controlled trial with two parallel arms.Setting
School of Complementary Health in Exeter, Devon, UK.Sample
Seventy‐six women, aged between 45 and 60 years, reporting menopausal symptoms.Methods
Women were randomised to receive nine sessions of either reflexology or nonspecific foot massage (control) by four qualified reflexologists given over a period of 19 weeks.Main outcome measures
The Women's Health Questionnaire (WHQ), the primary measures being the subscores for anxiety and depression. Severity (visual analogue scale, VAS) and frequency of flushes and night sweats.Results
Mean (SD) scores for anxiety fell from 0.43 (0.29) to 0.22 (0.25) in the reflexology group and from 0.37 (0.27) to 0.27 (0.29) in the control group over the course of treatment. Mean (SD) scores for depression fell from 0.37 (0.25) to 0.20(0.24) in the reflexology group and from 0.36 (0.23) to 0.20 (0.21) in the control (foot massage) group over the same period. For both scores there was strong evidence of a time effect (P < 0.001) but no evidence of a time–group interaction (P > 0.2). Similar changes were found for severity of hot flushes and night sweats. In the control group, 14/37 believed they had not received true reflexology.Conclusion
Foot reflexology was not shown to be more effective than non‐specific foot massage in the treatment of psychological symptoms occurring during the menopause.
A randomised, double‐blind trial comparing raloxifene HCl and continuous combined hormone replacement therapy in postmenopausal women: effects on compliance and quality of life
Authors: Voss Simon , Quail Deborah , Dawson Alison , Bäckström Tjorbörn , Aguas Fernanda , Erenus Mithat , The Hok Sien , Bonnar John , De Geyter Christian , Hunter Myra , Nickelsen Thomas ,   for the Euralox Investigators Group
Published: December 2003

Objective
To compare continuous combined hormone replacement therapy (ccHRT) and raloxifene with respect to compliance and quality of life, which were predefined secondary endpoints of a large, prospective study designed to investigate the uterine effects of both treatments.Design
Double‐blind, randomised controlled trial of six‐month duration.Setting
One hundred and twenty‐nine gynaecology hospital departments, clinics or practices specialised in women's healthcare, located in Europe, South Africa and Israel.Population
Healthy postmenopausal women (n= 1008).Main outcome measures
Changes in quality of life using the Women's Health Questionnaire (WHQ) and compliance using a compliance questionnaire and pill count. Adverse event and early discontinuation rates and satisfaction with treatment using a visual analogue scale (VAS).Results
Women taking raloxifene reported greater satisfaction with their treatment as assessed on the VAS (P= 0.004),and a lower proportion, as compared with ccHRT, reported being worried by the treatment (9.6%vs 20.2%, P < 0.01). Women taking ccHRT reported greater deterioration in scores from the WHQ for depressed mood and menstrual symptoms than those taking raloxifene (P < 0.01). For memory, vasomotor symptoms and sexual behaviour, the ccHRT group reported significantly greater mean improvements (P < 0.05). Over half (58.8%) of those taking raloxifene noticed no effect, 37.7% felt better and 3.4% felt worse as measured using the compliance questionnaire. Fifty percent of the women taking ccHRT felt better, 37.8% noticed no effect but over 10% felt worse. More women on raloxifene (94.6%) than on ccHRT (85.9%) reported that they were taking their double‐blinded medication regularly (P < 0.01).Conclusions
A lower rate of adverse event‐related discontinuations, the lack of negative effects on quality of life and a smaller proportion of women being worried by the drug treatment were associated with higher treatment satisfaction and better compliance in postmenopausal women taking ccHRT or raloxifene.
In vitro study of tocolytic effect of rofecoxib, a specific cyclo‐oxygenase 2 inhibitor. Comparison and combination with other tocolytic agents
Authors: Doret Muriel , Mellier Georges , Benchaib Mehdi , Piacenza Jean Michel , Gharib Claude , Pasquier Jean Charles 
Published: December 2003

Objective
The aim of this work was to study and compare the tocolytic effects of rofecoxib with indomethacin, ritodrine, nicardipine and atosiban. We also studied the combination of rofecoxib with each agent.Design
In vitro animal experimental study.Setting
Non‐selective cyclo‐oxygenase (COX) inhibitors have potent tocolytic effect. However, they also have major fetal side effects that seem to be due to COX‐1 inhibition. A specific COX‐2 inhibitor could be a potent tocolytic agent with less fetal toxicity.Sample
Myometrial strips from pregnant Wistar rats at 18 days of gestation.Methods
Isometric tension was recorded from 112 pregnant rat myometrial strips in vitro. Strips were exposed to increase molar concentration of one drug or combination.Main outcome measures
Contractile activity was assessed by calculating the area under the curve, to obtain a dose–response curve of each drug. EC50 and mean maximal inhibiting concentration were compared using ANOVA. Chemical interaction was defined for each combination.Results
The in vitro tocolytic effect of rofecoxib was demonstrated. Contractile activity stopped at a concentration of 1.6 × 10−7 M. Effective concentrations were 1000 times less than for indomethacin and significantly lower than ritodrine and atosiban. Rofecoxib combined with ritodrine had a synergic effect. Other combinations only had an additive effect.Conclusions
Rofecoxib has a potent tocolytic effect in vitro. The high specificity and low effective concentrations of COX‐2 may result in low fetal toxicity. Animal fetal side effects need to be explored.
Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: a case series
Authors: Rodie V.A. , Thomson A.J. , Stewart F.M. , Quinn A.J. , Walker I.D. , Greer I.A. 
Published: December 2003

Objectives
To assess the use of low molecular weight heparin for the treatment of venous thromboembolism in pregnancy.Design
A prospective observational study.Setting
The maternity units in two university teaching hospitals and one district general teaching hospital.Population
Thirty‐six consecutive women presenting with objectively diagnosed venous thromboembolism during pregnancy and the immediate puerperium.Methods
Treatment with the low molecular weight heparin enoxaparin, approximately 1 mg/kg sc, twice daily, based on early pregnancy weight.Main outcome measures
Peak anti‐Xa activity (three hours post‐injection), alterations in treatment, side effects and the use of regional anaesthesia.Results
In 33 women, the initial dose of enoxaparin provided satisfactory peak anti‐Xa activity (median 0.8 u/mL, range 0.44–1.0 u/mL) and was continued. Three women required dose reduction since peak anti‐Xa activities were above the therapeutic range (1.2, 1.2 and 1.1 u/mL). No woman developed thrombocytopaenia, haemorrhagic complication or further thromboembolic episode. Two women developed allergic skin reactions on enoxaparin and were changed to tinzaparin. Fifteen women had regional anaesthesia for delivery, with a reduced dose of enoxaparin (40 mg once daily), all without complication.Conclusions
Enoxaparin is a safe and effective treatment for venous thromboembolism during pregnancy and confers a major advantage over unfractionated heparin through its simplified regimen of administration.
Corticosteroids and fetal vasculature: effects of hydrocortisone, dexamethasone and betamethasone on human umbilical artery
Authors: Potter S.M. , Dennedy M.C. , Morrison J.J. 
Published: December 2003

Objective
To investigate the direct effects of corticosteroids on human umbilical artery resistance, in vitro.Design
Prospective laboratory study.Setting
University teaching hospital.Samples and methods
Umbilical artery samples were obtained following normal, term deliveries (n= 50) and dissected rings were suspended for isometric recording under physiological conditions. The effects of hydrocortisone (10−9–10−4 M), dexamethasone (10−9–10−4 M) and betamethasone (10−9–10−4 M) on umbilical artery resistance were measured in vitro.Main outcome measures
Changes in umbilical artery resistance, in vitro.Results
Hydrocortisone (n= 12) exerted a vasodilatory effect on human umbilical artery at all concentrations studied compared with vehicle control experiments (n= 12) (P < 0.0001). The mean net relaxant effect of hydrocortisone ranged from 11.77% (10−9 M) to 57.01% (10−4). Both exogenous compounds, dexamethasone (n= 12) and betamethasone (n= 12), similarly exerted a significant relaxant effect on human umbilical artery tone (P < 0.05–0.01), compared with vehicle control experiments (n= 12). The mean net relaxant effect of dexamethasone ranged from 14.43% (10−9 M) to 38.12% (10−4) and that of betamethasone ranged from 6.02% (10−9 M) to 42.30% (10−4), in a cumulatively increasing fashion. There was a non‐significant trend towards a greater vasodilatory effect of dexamethasone than betamethasone at lower bath concentrations studied.Conclusion
Corticosteroids exert a direct and potent vasodilatory effect on human umbilical artery resistance in vitro, thus providing an explanation for the previously unexplained vascular effects associated with antenatal administration of corticosteroids.
A study of hormone replacement therapy in postmenopausal women with ischaemic heart disease: the Papworth HRT Atherosclerosis Study
Authors: Clarke S.C. , Kelleher J. , Lloyd‐Jones H. , Slack M. , Schofield P.M. 
Published: December 2003

Objective
To assess the possible benefit of hormone replacement therapy (HRT) in the secondary prevention of ischaemic heart disease.Design
A prospective randomised trial of transdermal HRT in women with definite ischaemic heart disease.Setting
A regional cardiac unit.Population
Postmenopausal women with angiographically ischaemic heart disease.Methods
A total of 255 postmenopausal women with angiographically proven ischaemic heart disease were recruited and randomised; 134 were treated with transdermal HRT and 121 acted as controls. The women were seen at six monthly intervals. The primary end points, which were determined by a blinded assessor, were admission to hospital with unstable angina, proven myocardial infarction or cardiac death. A total of 53 (40%) patients withdrew from the HRT group and eight (7%) from the control group. The mean duration of follow up was 30.8 months.Main outcome measures
Admission to hospital with unstable angina, proven myocardial infarction or cardiac death.Results
During follow up, there were 53 primary end‐point events in the HRT group and 37 in the control group. Using an intention‐to‐treat analysis, the primary end‐point event rate was 15.4 events per 100 patient years for the HRT group compared with 11.9 for the control group (event rate ratio 1.29 (95% CI 0.84–1.95, P= 0.24)). Using a per‐protocol analysis, there was an event rate ratio of 1.49 (0.93–2.36, P= 0.11) for the HRT arm compared with the control arm. Particularly during the first two years of follow up, the HRT group had a higher, but not statistically significant, event rate than the control group.Conclusion
Our findings suggest that transdermal HRT should not be commenced for the purpose of secondary prevention in postmenopausal women with angiographically proven ischaemic heart disease.
The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria
Authors: Okonofua F.E. , Larsen U. , Oronsaye F. , Snow R.C. , Slanger T.E. 
Published: December 2003

Objective
To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria.Design
Cross sectional study.Setting
Women attending family planning and antenatal clinics at three hospitals in Edo State, South–south Nigeria.Population
1836 healthy premenopausal women.Methods
The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women's socio‐demographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models.Main outcome measures
Frequency of self‐reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections.Results
Forty‐five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio‐economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26–0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51–2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11–2.14), yellow bad‐smelling vaginal discharge (OR = 2.81, 95% CI = 1.54–5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09–2.49) and genital ulcers (OR = 4.38, 95% CI = 1.13–17.00).Conclusion
Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.
A new method to determine the feto‐placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion
Authors: Hoogeveen M. , Meerman R.H. , Pasman S. , Egberts J. 
Published: December 2003

Objectives
(1) To calculate the feto‐placental volume (FPV), using the haematocrit (Ht) values and the percentages of fetal haemoglobin (HbF), before and after red blood cell transfusion. (2) To estimate the transfusion‐induced loss of plasma fluid.Design
Retrospective analysis of data of 42 anaemic fetuses at the first transfusion [gestational age (GA) 19–36 weeks].Setting
Department of Obstetrics, Leiden University Medical Centre, The Netherlands.Sample
Fifteen hydropic and 27 non‐hydropic fetuses.Methods
Donor blood volume (Vdonor) and Ht (Htdonor), fetal pre‐ and post‐transfusion Ht values (Htinitial, Htfinal) and percentages of HbF (HbFinitial and HbFfinal) were used to calculate the FPV. The total red cell volume after transfusion (RCVfinal) and Htfinal were used to estimate the plasma fluid loss.Main outcome measures
Feto‐placental blood volume and loss of plasma fluid.Results
The equations that use Htfinal over‐estimate the FPV when the formula does not account for the difference between donor and post‐transfusion Ht (FPVHt= 21.36 * GA − 390; r= 0.89). FPV is under‐estimated (FPVHt= 9.90 * GA − 172; r= 0.84) when the blood volume increases with a volume less than the added donor blood volume. The calculation of FPV, using HbF percentages and the initial fetal RCV, is independent of volume changes (FPVHbF= 15.10 * GA − 279; r= 0.85). Comparing RCVfinal and Htfinal values showed that 31.1 ± 14.5% of the transfused volume was lost. Results of the hydropic fetuses did not differ from those of the non‐hydropic fetuses.Conclusions
FPV values based on Ht values are less reliable than those based on RCV and HbF findings. When, for practical reasons, Ht values have to be used, we propose an adapted equation for the calculation of the necessary volume of donor blood: Vdonor= FPVHbF* (Htfinal− Htinitial) / (Htdonor− 0.70 * Htfinal).
Infertility, blood mercury concentrations and dietary seafood consumption: a case–control study
Authors: Choy Christine M.Y. , Lam Christopher W.K. , Cheung Lorena T.F. , Briton‐Jones Christine M. , Cheung L.P. , Haines Christopher J. 
Published: December 2003

Objective
To compare blood mercury concentrations of infertile couples with those of fertile couples in Hong Kong, and to examine the relationship between blood mercury concentrations and seafood consumption.Design
Case–control study.Setting
In vitro fertilisation (IVF) Unit and Antenatal Unit of a university teaching hospital.Sample
One hundred fifty‐seven infertile couples attending IVF treatment and 26 fertile couples attending antenatal care without known occupational exposure to mercury.Methods
Mercury concentrations in whole blood were measured by cold vapour atomic absorption spectrophotometry. A dietitian recorded the quantity of seafood consumption among infertile couples via a food‐frequency questionnaire. Blood mercury concentrations and quantity of seafood consumption were compared between infertile and fertile couples.Main outcome measures
Whole blood mercury concentrations, quantity of seafood consumption.Results
Infertile couples had higher blood mercury concentrations than fertile couples. ‘Infertile males with abnormal semen’ and ‘infertile females with unexplained infertility’ also had higher blood mercury concentrations than their fertile counterparts. Blood mercury concentrations were positively correlated with quantity of seafood consumption. Infertile subjects with elevated blood mercury concentrations consumed a larger amount of seafood.Conclusion
Higher blood mercury concentration is associated with male and female infertility. Higher seafood consumption is associated with elevated blood mercury concentrations in our infertile population.
A double‐blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour
Authors: Scheepers Hubertina C.J. , Thans Marion C.J. , de Jong Pieter A. , Essed Gerard G.M. , Le Cessie Saskia , Kanhai Humphrey H.H. 
Published: December 2003

Objective
Although there has been much debate on whether women should be allowed to eat and drink during labour, little scientific data are available on the effects of caloric intake on the course of labour.Design
Double‐blind, randomised, placebo controlled.Setting
Leyenburg Hospital, The Hague, The Netherlands.Population
Two hundred and one consecutive nulliparous women, pregnant of a single fetus in cephalic presentation.Methods
All women were included in early labour (2cm–4cm of cervical dilatation) and were allowed to drink at will.Main outcome measures
The duration of labour, the need for augmentation and pain medication and the incidence of abdominal and vaginal instrumental deliveries.Results
Drinking of carbohydrate solutions was well tolerated, but did not show any beneficial effects regarding labour outcome when compared with the control group. In the carbohydrate group, a higher caesarean section rate was observed (RR 2.9, 95% CI 1.29–6.54).Conclusions
Women in the carbohydrate group had worse labour outcome. It is unclear whether a statistical coincidence, a negative effect of the carbohydrate intake or an incorrect carbohydrate intake strategy is responsible for these results. Further studies are necessary before any definite conclusion can be drawn.