bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section
Authors: Morrison John J. , Rennie Janet M. , Milton Peter J. 
Published: August 2005

ABSTRACTObjective To establish whether the timing of delivery between 37 and 42 weeks gestation influences neonatal respiratory outcome and thus provide information which can be used to aid planning of elective delivery at term.Design All cases of respiratory distress syndrome or transient tachypnoea at term requiring admission to the neonatal intensive care unit were recorded prospectively for nine years.Setting Rosie Maternity Hospital, CambridgeSubjects During this time 33,289 deliveries occurred at or after 37 weeks of gestation.Main outcome measures This information enabled calculation of the relative risk of respiratory morbidity for respiratory distress syndrome or transient tachypnoea in relation to mode of delivery and onset of parturition for each week of gestation at term.Results The incidence of respiratory distress syndrome at term was 2.2/1000 deliveries (95% CI; 1.7–2.7). The incidence of transient tachypnoea was 5.7/1000 deliveries (95% CI; 4.9–6.5). The incidence of respiratory morbidity was significantly higher for the group delivered by caesarean section before the onset of labour (35.5/1000) compared with caesarean section during labour (12.2/1000) (odds ratio, 2.9; 95% CI 1.9–4.4; P < 0.001), and compared with vaginal delivery (5.3/1000) (odds ratio, 6.; 95% CI 5.‐8.9; P < 0.001). The relative risk of neonatal respiratory morbidity for delivery by caesarean section before the onset of labour during the week 37+0 to 37+6 compared with the week 38+0 to 386 was 1.74 (95% CI 1.1–2.8; P < 0.02) and during the week 38+0 to 37+6 compared with the week 39+0 to 39+6 was 2.4 (95% CI 1.2–4.8; P < 0.02).Conclusions A significant reduction in neonatal respiratory morbidity would be obtained if elective caesarean section was performed in the week 39+0 to 39+6 of pregnancy.
Maternal serum hCG and fetal nuchal translucency thickness for the prediction of fetal trisomies in the first trimester of pregnancy
Authors: Brizot M. L. , Snijders R. J. M. , Butler J. , Bersinger N. A. , Nicolaides K. H. 
Published: August 2005

ABSTRACTObjective To compare the potential value of maternal serum total hCG and free β‐hCG in predicting the risk for fetal trisomies during the first trimester of pregnancy and to examine whether data on maternal hCG and fetal nuchal translucency thickness can be combined to derive risks.Methods Maternal serum total hCG and free β‐hCG were measured in samples from 83 singleton pregnancies with fetal chromosomal abnormalities (trisomy 21 (n= 41), trisomy 18 (n= 19), trisomy 13 (n= 8) sex chromosome aneuploidies (n= 1l), triploidy (n= 4)) and 394 chromosomally normal controls at 10 to 13 weeks gestation. In all cases, the fetal nuchal translucency thickness was measured at the time of fetal karyotyping.Results In the 249 chromosomally normal controls with fetal nuchal translucency less than 3 mm, total hCG and free β‐hCG decreased significantly with increased fetal crowt‐rump length. In 145 chromosomally normal fetuses with nuchal translucency 3 to 9 mm total hCG and free β‐hCG were not significantly different from the 249 with nuchal translucency less than 3 mm. In fetuses with trisomy 21, total hCG and free β‐hCG were significantly higher, whereas in trisomies 18 and 13 levels were lower than in chromosomally normal controls. When the cutoff levels for total hCG and free β‐hCG were selected to include 4% of chromosomally normal fetuses, the detection rates for trisomy 21 were 24% and 32%, respectively. There was no significant association between hCG and nuchal translucency thickness in either the chromosomally normal (r=–0.01) or abnormal group (r=–0.15).Conclusion An improved estimate of risk for fetal trisomies at 10 to 13 weeks gestation can be derived by combining data on maternal age, maternal serum total or free β‐hCG and fetal nuchal translucency thickness.
Increase in bone mass of older postmenopausal women with low mineral bone density after one year of percutaneous oestradiol implants
Authors: Holland E. F. Nigel , Leather Andrew T. , Studd John W. W. 
Published: August 2005

ABSTRACTObjective To evaluate the effect of 75 mg oestradiol implants on the bone mass of older postmenopausal women with osteoporosis.Design One year prospective‐controlled study.Subjects Thirty‐two postmenopausal women over 60 years of age and more than five years postmenopausal with low bone density were recruited. Thirty women completed treatment for one year with 75 mg oestradiol implants. The changes in bone density were compared with a control group of 14 women. The side effects with treatment were documented.Main outcome measures Dual energy X‐ray absorptiometry of the lumbar spine and proximal femur using Hologic 1000 QDR before treatment and at one year. Plasma oestradiol assays were performed before and after one year.Results The median percentage changes in the treated group after one year was 12.6% at the lumbar spine and 5.22 % at the total hip. The increase in vertebral bone density was greatest in women with low initial bone density (r = 0.35, P < 0.05) and those with highest treatment plasma oestradiol levels (r = 0.47, >P < 0.01). Side effects were common but most were transient and mild in nature.Conclusion 75 mg oestradiol implants significantly increase the bone mineral density at the spine and hip of older postmenopausal women with established osteoporosis.
Postnatal maternal morbidity: extent, causes, prevention and treatment
Authors: Glazener Cathryn M. A. , Abdalla Mona , Stroud Patricia , Templeton Allan , Russell Ian T. , Naji Simon 
Published: August 2005

ABSTRACTObjective To describe the prevalence and causes of postnatal maternal morbidity.Design Questionnaire survey of postnatal patients. Further data extracted from SMRl returns, case records and the Aberdeen Maternity and Neonatal Databank.Setting Postnatal care in a teaching maternity hospital, midwife delivery hospital, general practitioner maternity units and in the community.Subjects Twenty percent random sample of deliveries (1249 women) surveyed one week, eight weeks and 12 to 18 months after delivery.Main outcome measures Incidence of self reported maternal morbidity, treatment received, readmission rates and causes for readmission.Results Of mothers in the sample 85% (99% CI 82‐88%) reported at least one health problem in hospital, rising to 87% (84‐90%) of those at home; 76% (71‐81%) reported at least one health problem after eight weeks post‐delivery.Conclusions Maternal morbiditv is extensive and under‐recognised after delivery. Measures to reduce and alleviate it must be sought.
Three dimensional ultrasound: abnormalities of the fetal face in surface and volume rendering mode
Authors: Lee Andreas , Deutinger Joshp , Bernaschek Gerhard 
Published: August 2005

ABSTRACTObjective To evaluate three dimensional ultrasound in surface and volume rendering mode in fetal malformations of the face.Setting Day assessment unit in a university hospital.Subjects Four cases have been examined: two cases represented cleft lip, one case was a male with trisomy 13 (Patau syndrome) with proboscis, and one case represented a male fetus with unilateral anophthalmia.Conclusion A new technique of three dimensional ultrasound visualisation in fetal malformation using surface and volume rendering is presented. The equipment consisted of a commercially available ultrasound machine, a built‐in graphic workstation, and three dimensional software. Post‐processing of data required approximately 10 minutes of calculation. The application of three dimensional ultrasound in complex malformations of the face appears to provide reasonable value for prenatal diagnosis and may become clinically useful in the near future.
Immune dysfunction – a potential target for treatment in endometriosis
Authors: Gleicher N. 
Published: August 2005

ABSTRACTThe treatment approach towards endometriosis has been traditionally either surgical or hormonal in nature. Since endometriosis is, to a large extent, a microscopic disease, a surgical approach cannot be expected to eradicate the disease. Treatment is, therefore, generally attempted by hormonal manipulation, an approach based on the known oestrogen sensitivity of endometriosis.Hormonal manipulation can only temporarily affect endometriosis, and quite clearly does not address the underlying aetiology and/or pathophysiology of the disease. Since neither is, at present, well understood, one can only speculate as to the treatment approach that would, in fact, affect the pathophysiology of the condition.Endometriosis has, in recent years, been characterized by a large number of immunological abnormalities in the host. It is, therefore, very tempting to speculate that an immunological defect represents the basic abnormality which later leads to the occurrence of the disease. This assumption is supported by the observation that those immunological defects are already present in the mildest forms of the disease. In fact, if one believes that many cases of unexplained infertility represent undiagnosed microscopic endometriosis, then evidence suggests that this precursor stage of the disease is basically characterized by an identical immunological profile to that of endometriosis.An immunological aetiology and/or pathophysiology of endometriosis should lead to an immunological treatment approach toward the disease. Specifically, a number of non‐specific immunomodulators, presently utilized in a variety of medical conditions with immunological aetiologies, would seem to represent promising new therapeutic strategies to conquer endometriosis at its roots. A new treatment approach to endometriosis appears urgently needed since, at least with regard to the effects of endometriosis on fertility and pregnancy loss, present approaches have proven ineffective.
Reduction of menstrual blood loss in women suffering from idiopathic menorrhagia with a novel antifibrinolytic drug (Kabi 2161)
Authors: Edlund Mans , Andresson Kerstin , Rybo Goran , Lindoff Claes , ÅStedt Birger , Von Schoultz BO 
Published: August 2005

ABSTRACTObjective
To compare the effect of Kabi 2161 (a prodrug of tranexamic acid) and placebo on the reduction of menstrual blood loss in women suffering from idiopathic menorrhagia and to evaluate tolerance and effectiveness in a two‐dose regimen.Design
A randomised, double blind parallel group study using double dummy technique.Setting
The departments of gynaecology at three medical centres in Sweden.Subjects
Ninety‐one outpatients visiting the gynaecological clinics from March 1991 to May 1992 were randomised into the study; 68 women fulfilled the study.Interventions
Two run‐in cycles, followed by administrations of Kabi 2161 (600 mg) tablets (1 four times daily or 2 twice daily) or placebo for the first five days of three menstrual cycles.Main outcome measures
Objective measurement of the change in menstrual blood loss during the treatment periods compared with menstrual blood loss during the run‐in periods.Results
A statistically significant reduction of menstrual blood loss was found for each treatment group, compared with the placebo group (P < 0.001). The mean reduction with 95% confidence interval (CI) was 33 % (24–40) in the group treated with 1 four times daily and 41 % (33–49) in the group treated 2 twice daily. The difference between the treated groups in reduction of menstrual blood loss is not significant. No significant differences were found in the frequencies of reported unwanted events during run‐in and during treatment between the different treatment groups. There were also no significant differences between the treatment groups and the placebo group.Conclusion
Kabi 2161 in a dosage of 2.4 g per day gave a statistically significant reduction in objectively measured menstrual blood loss in a two (41 %) as well as in a four (33 %) dosage regimen compared with placebo. Frequency of unwanted events did not differ from those during run‐in or from those in the placebo group. The optimal daily dosage needs to be further evaluated in a dose titration study.
Communication following a stillbirth or neonatal death: room for improvement
Authors: Crowther Mary E. 
Published: August 2005

ABSTRACTObjective
To assess the extent of knowledge which mothers had about a previous stillbirth or neonatal death, their satisfaction with the information and advice given them, and their degree of anxiety during a subsequent pregnancy.Design
Personal interview.Setting
Antenatal clinic of a British military hospital in Germany.Subjects
Forty‐eight Caucasian, pregnant women, 28 of whom had had a previous stillbirth (Group A) and 20 a neonatal death (Group B).Results
Over half (25/48) the women had a poor or confused knowledge of the events surrounding the death, only 29% were satisfied with the information they had received, and nearly 40% became pregnant within six months of the death despite medical advice against conceiving soon after such an event. The mothers of stillborn babies were significantly less likely to know the birthweight than the mothers of babies who died after birth (60%vs 95%), and 40% had not given the baby a name. Over a third of the mothers were admitted to hospital because of anxiety about the current pregnancy.Conclusions
Dissatisfaction with the quality of information given by hospital staff, rapid conception despite medical advice to the contrary, and anxiety in a subsequent pregnancy were common after a previous stillbirth or neonatal death. A poor or confused knowledge about the baby's death was more likely if the death had been intrauterine and unexplained, or associated with maceration, a lethal abnormality, an emergency delivery resulting in stillbirth, or a preventable cause.
Infertility and the seeking of infertility treatment in a representative population
Authors: Schmidt Lone , Münster Kirstine , Helm Peter 
Published: August 2005

ABSTRACTObjective
To investigate lifetime prevalence of infertility, the seeking of infertility treatment and outcomes of treatment.Design
Cross‐sectional postal questionnaire study.Setting
County of Copenhagen, Denmark.Subjects
Three thousand, seven hundred and forty‐three women, 15 to 44 years old, selected at random were asked about infertility, their seeking of infertility treatment, diagnoses provided by their doctors and subsequent parenthood. Response rate was 78%, n= 2865. A random sample of non‐responders was interviewed by telephone.Main outcome measures
Fertility status, seeking of infertility treatment, subsequent deliveries and adoptions.Results
Of the women who had attempted to have a child, 26.2% had experienced infertility; 4.1% of the women aged 25 to 44 years were currently primarily infertile and 8.6% had involuntarily not delivered a first child; 47.4% of the infertile women had sought infertility treatment. Significant predictors for seeking infertility treatment were school education > 9 years and not having delivered a child. Of the infertile women 54.9% subsequently had a child. Only 30% of these reported that the successful delivery was treatment‐related.Conclusions
The health care system should see to it that infertile couples from lower social classes are offered information on the possibility of infertility treatment. High quality infertility treatment has to include both the “supply” of taking care of the infertile couple's psychosocial strain and the goal of ensuring successful pregnancies.
A clinico‐pathological classification of perinatal deaths in the Faroe Islands
Authors: Olsen Sjúröur F. , Samuelsen Steintora , Joensen Høgni D. 
Published: August 2005

ABSTRACTObjective
To highlight the causes of perinatal mortality in the Faroe Islands where perimortality is high according to Nordic standards.Design
Two systems were employed to classify perinatal deaths on the basis of clinico‐pathological findings, one focusing on obstetrical factors and the other on fetal‐neonatal factors.Setting
Faroe Islands. Data from Iceland were used for comparison since the two communities have many similarities, including similar birthweight distributions.Subjects
Birth and death certificates and medical and midwife files were recovered for 98 of the 102 officially recorded perinatal deaths in the Faroes during 1977–1986. Icelandic data for 1976–1985 were available in the literature.Results
The perinatal mortality rate was 13.7 per 1000 births. Obstetric factors were classified as unexplained, congenital anomaly, antepartum haemorrhage, pre‐eclampsia, mechanical causes, and maternal disorders and accounted for 43%, 18%, 15%, 11%, 6%, and 6% of the 98 cases, respectively. Fetal‐neonatal factors were classified as antepartum asphyxia, congenital anomaly, intrapartum asphyxia, hyaline membrane disease, pulmonary immaturity, and other causes, and these factors accounted for 43%, 18%, 15%, 9%, 5%, and 8%, respectively. The excess perinatal mortality rate of 4.1 cases per 1000 births in the Faroes, relative to Iceland, could mainly be attributed to an excess of 2.9 cases per 1000 births in the group classified as unexplained, as defined according to the obstetrics classification.Conclusions
No well defined cause was particularly common in the Faroes or could account for the excess perinatal mortality rate in the Faroes relative to Iceland.
Fertility and pregnancy outcome following large loop excision of the cervical transformation zone
Authors: Cruickshank M. E. , Flannelly G. , Campbell D. M. , Kitchener H. C. 
Published: August 2005

ABSTRACTObjective
To determine if large loop excision of the transformation zone affects subsequent fertility and pregnancy outcome.Design
A case‐control study.Setting
A teaching hospital serving a regional population.Subjects
One thousand women who had undergone large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN) between 1989 and 1991. Two controls were matched for each of the 149 women who had a singleton pregnancy progressing beyond 20 weeks of gestation following treatment, with regard to age, parity, height, husband's or partner's social class and smoking habits to account for common independent risk factors for adverse obstetric outcome and cervical intraepithelial neoplasia.Main outcome measures
Intention to conceive, number of pregnancies, gestation, low birthweight, mean birthweight, mode of delivery, and duration of labour.Results
Out of a cohort of 1000 women who underwent LLETZ for the treatment of CIN, 653 women replied to a postal questionnaire. When asked up to 54 months after treatment, 130 women (19.9%) had become pregnant and 47 (7.2%) had tried to become pregnant. A total of 199 pregnancies from 178 women was identified from the cohort of women.For the 149 women from the case cohort, the mean birthweight was 3380 g compared with 3373 g in the control group (P= 0.88). The incidence of low birthweight in pregnancies progressing to at least 37 weeks of gestation was 3.1% in the treated group, compared with 3.2% in the control group (P= 098). Following LLETZ, 94% of deliveries were preterm (< 37 weeks of gestation), compared with 50% in the control group (P= 0.12). There was no significant difference in mean gestation, mode of delivery, indication for caesarean section or duration of labour between the women who had undergone LLETZ and the controls.Conclusion When socio‐epidemiological factors associated with the development of cervical intraepithelial neoplasia are controlled for, LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy outcome.
European postcoital tests: opinions and practice
Authors: Guid Oei S. , Keirse Marc J. N. C. , Bloemenkamp Kitty W. M. , Helmerhorst Frans M. 
Published: August 2005

ABSTRACTObjective
To assess differences in opinion and practice with regard to the postcoital test in Europe.Design
Multilingual questionnaire survey among heads of departments of obstetrics and gynaecology with large fertility clinics in 16 European countries.Subjects
Of 203 heads of departments, each responsible for 882 infertility cases per year (95% CI 657–1107) 145 (71%) responded.Information sought
Use of the postcoital test: its timing in relation to cycle and coitus, methodology used for the test, cut‐off level of normality and treatments applied for abnormal test results.Results
The postcoital test is used in 92% (and routinely in 68%) of departments. There are large differences in timing of the test in relation to menstrual cycle and coitus, in microscopic magnification used, and in cut‐off levels of normality. More than 10 different treatments are applied for abnormal test results.Conclusion
Guidelines of the World Health Organisation are not followed and divergence in practice and opinion is wide enough to question whether infertile couples are better off with than without the test.
The application of flow cytometric DNA analysis in detecting the presence of malignant cells in ovarian carcinoma peritoneal fluids
Authors: Kehoe S. , Ward K. , Luesley D. , Chan K. K. 
Published: August 2005

ABSTRACTObjective
To compare flow cytometric detection of malignant cells with standard cytological evaluation in patients with ovarian carcinoma.Setting
The City Hospital Trust, The Women's Hospital and CRC Trials Unit, Birmingham.Subjects
Forty‐three patients with histologically proven ovarian carcinoma and positive cytology, and a control population of 20 patients undergoing surgery for benign gynaecological conditions.Methods Prospective, blinded study examining ascitic fluid or peritoneal washings obtained at primary surgery by flow cytometric DNA analysis and cytological examination.Results
Flow cytometry detected aneuploid cells in 27/43 (63%) of malignant and 7/20 (35%) of benign fluid specimens. In malignant samples the mean aneuploid count was 38.5% (range 1–98%) with a mean S‐phase fraction of 5.2% (range 0–33.9%). In benign specimens the mean aneuploid count was 30.4% (range 14.5–66.4%). Based on these results, the overall sensitivity of cytometric detection of malignant cells was 714Y0, specificity 65%, with a positive predictive value of 85.1%. False positivity was found mainly in patients with benign ovarian cysts. Further examination revealed four false negative and four false positive results, where the peritoneal fluid and ovarian tissue DNA ploidy status concurred. Assuming such results to be correct increased the sensitivity of the test to 88.5YO and specificity to 85%.Conclusions
Although flow cytometry can glean information beyond the capabilities of cytological assessment, using the premise that aneuploid cells alone indicate malignancy, it remains secondary to cytology in the detection of malignant cells in peritoneal fluids.
The effects of gemeprost on the second trimester fetus
Authors: Lazda E. J. , Sams V. R. 
Published: August 2005

ABSTRACTObjective
To determine whether the use of gemeprost is associated with histological changes in the second trimester fetus.Setting
Histopathology department of a university hospital.Design
Retrospective comparison of histological features in fetuses aborted following maternal administration of gemeprost, with those in fetuses after spontaneous miscarriage.Outcome measures
Degree of tissue fragmentation; other histological abnormalities.Results
Significantly greater fragmentation of the liver was found in fetuses exposed to gemeprost (P= 0–046). Nonsignificant effects were found for brain (P= 0.082) and heart (P= 0.183), and no effect was seen on the kidney, adrenal and lung. No other significant histological differences were found between the two groups.Conclusions
This study is the first to document an effect of gemeprost on the fetus, but confirmation is required in further studies. Other implications are discussed.