bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy outcome in severe placental abruption
Authors: Kayani Salma Imran , Walkinshaw Stephen A. , Preston Carrol 
Published: December 2003

Objective
To determine the relationship between decision to delivery interval and perinatal outcome in severe placental abruption.Design
A case–control study.Setting
Large inner city teaching hospital.Methods
Retrospective case note review of pregnancies terminated following severe placental aburption and fetal bradycardia. One year paediatric follow up by case note review or postal questionnaire. The differences in outcome (death or cerebral palsy) were examined using non‐parametric and univariate analysis for the following time periods — times from onset of symptoms to delivery, onset of symptoms to admission, admission to delivery, onset bradycardia to delivery and decision to delivery interval.Main outcome measures
Prenatal death or survival with cerebral palsy.Results
Thirty‐three women with singleton pregnancies over 28 weeks of gestation, admitted with clinically overt placental abruption, where delivery was effected for fetal bradycardia. Eleven of the pregnancies had a poor outcome (cases), eight infants died and three surviving infants have cerebral palsy. Twenty‐two pregnancies had a good outcome (controls): survival with no developmental delay. No statistically significant relationship was found between maternal age, parity, gestation, or birthweight and a poor outcome. A statistically significant relationship between time from decision to delivery was identified (P= 0.02, Mann–Whitney U test). The results of a univariate logistic regression for this variable suggest that the odds ratio of a poor outcome for delivery at 20 minutes compared with 30 minutes is 0.44 (95% CI 0.22–0.86). Fifty‐five percent of infants were delivered within 20 minutes of the decision to deliver. Serious maternal morbidity was rare.Conclusion
In this small study of severe placental abruption complicated by fetal bradycardia, a decision to delivery interval of 20 minutes or less was associated with substantially reduced neonatal morbidity and mortality.
Cerebral palsy and clinical negligence litigation: a cohort study
Authors: Greenwood Catherine , Newman Sally , Impey Lawrence , Johnson Ann 
Published: December 2003

Objective
To compare the prevalence of criteria suggesting acute intrapartum hypoxia in children with cerebral palsy who have and have not been the subjects of clinical negligence legal claims.Design
Nested cohort study within a geographically defined cohort.Setting
The former Oxfordshire Health Authority.Population
Singleton children with cerebral palsy born between 1984 and 1993, excluding cases with a recognised postnatal cause for cerebral palsy.Methods
Retrospective review of medical records by blinded observer.Main outcome measures
Three ‘essential’ criteria defined by the International Cerebral Palsy Task Force which identify acute intrapartum hypoxia.Results
One‐fifth (27/138) of all singleton cerebral palsy children were the subject of a legal claim. The presence of all three criteria was significantly more likely to lead to a legal claim (P < 0.01), but in 74% (20/27) of claims, all three were not fulfilled and 36% (4/11) of those satisfying all three criteria did not claim. At least one of the three criteria was met in 82% (91/111) of the cases where there was no claim. Data on fetal or neonatal arterial blood gases were available in only 57% (78/138). Of the 27 claims, 12 were discontinued, 8 were settled and in 7 the legal process is still pending. The presence of the three essential criteria for acute intrapartum hypoxia did not increase the likelihood of a legal claim being settled.Conclusion
The prevalence of the ‘template essential’ criteria is high in all cases of cerebral palsy. Although the presence of all three essential criteria was more likely in the claims group, this did not appear to influence the outcome of a claim. It remains to be seen whether the existence of the template leads to change in the pattern of decisions made by the courts.
Avoidable stillbirths and neonatal deaths in rural Tanzania
Authors: Hinderaker Sven G. , Olsen Bjørg E. , Bergsjø Per B. , Gasheka Peter , Lie Rolv T. , Havnen Jakob , Kvåle Gunnar 
Published: December 2003

Objective
To determine the causes of stillbirths and neonatal deaths in the community in rural Tanzania and to evaluate whether the deaths were avoidable under the prevailing circumstances.Design
Review of stillbirths and neonatal deaths.Setting
Rural northern Tanzania, Mbulu and Hanang districts.Sample
One hundred and nineteen stillbirth and neonatal deaths identified in a prospective cohort of antenatal attendees and 21 stillbirths and neonatal deaths identified retrospectively in a household survey in seven rural communities.Methods
Verbal autopsy was done to reach a diagnosis, in many cases supplemented with information from antenatal records and hospital records. The avoidability of deaths under the prevailing circumstances was assessed for each case. An account of risk factors detectable at antenatal clinic was done and compared with the woman's recall of the risk assessment and recall of being referred.Main outcome measures
Avoidability of stillbirths and neonatal deaths.Results
There were 60 stillbirths, 49 early neonatal deaths and 27 late neonatal deaths. Infection‐related deaths were most common (n= 53), followed by asphyxia‐related deaths (n= 32) and immaturity‐related deaths (n= 20). Malaria was the most common infectious agent observed (21 children and 20 mothers). Twenty‐one deaths (15%) were probably avoidable and 13 (10%) were possibly avoidable. A patient‐oriented avoidable factor was identified in 17 (51%) and a provider‐oriented avoidable factor was identified in 22 cases (65%). Twenty‐six of the 34 avoidable deaths had risk factors, but only two of the women were aware of it and only one recalled being referred to a hospital for the risk factor. There were eight deaths among the 133 mothers who experienced a perinatal death.Conclusions
Our data indicate that prevention and adequate treatment of infections and asphyxia in the newborn should have high priority in low‐income settings. The relatively low proportion of avoidable stillbirths and neonatal deaths may be partly due to accessible emergency obstetric care in the area. Future efforts should emphasise improving the communication between midwife and women at the antenatal clinics, preparing the women—and their families—for the delivery and to be ready for complications.
Pharmacokinetics of anti‐D IgG in pregnant RhD‐negative women
Authors: Bichler Johann , Schöndorfer Georg , Pabst Günther , Andresen Irmgard 
Published: December 2003

Objective
To assess the pharmacokinetics of anti‐D IgG in pregnant Rhesus D‐negative women after intramuscular and intravenous administration of 300 μg of Rhophylac.Design
An open, randomised, multicentre study.Setting
Seven gynaecological practices in Germany.Sample
Fourteen RhD‐negative pregnant women at risk of becoming Rhesus D immunised received study drug at 28th week of pregnancy either by intramuscular or intravenous route.Main outcome measures
Anti‐D IgG concentrations of serum samples obtained up to 11 weeks following antenatal Rhesus D prophylaxis were quantified by flow cytometry.Results
Mean anti‐D IgG concentrations after intravenous and intramuscular administration differed up to seven days post‐injection, from two weeks onwards they were comparable to each other. Irrespective of the administration route, anti‐D IgG in serum was detectable in all women up to at least nine weeks post‐administration.Conclusions
The serum concentrations of anti‐D IgG measured after administration of Rhophylac were very similar to those obtained with 300 μg of a different anti‐D immunoglobulin product.
Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy
Authors: Jacobsen Anne Flem , Qvigstad Erik , Sandset Per Morten 
Published: December 2003

Objective
To evaluate the effect and dose of dalteparin given to pregnant women with acute venous thromboembolism.Design
An observational study of pregnant women in Norway.Setting
Delivery and haematological departments in Norway.Population
Twenty women, aged 22–41 years, with acute venous thromboembolism verified by objective means.Methods
Patients were treated with dalteparin from diagnosis until delivery. Treatment was monitored with anti‐activated factor Xa (anti‐Xa) activity, and the dose was adjusted to achieve target 0.5–1.0 U/mL 2–3 hours post‐injection.Main outcome measure
Anti‐Xa activity and side effects.Result
None of the patients suffered recurrent venous thromboembolism or major bleeding complications. In 9 of 13 women starting with conventional dose of dalteparin (100 iu/kg bd), dose escalation was necessary to reach target anti‐Xa activity. None of the six women who started with 105–118 iu/kg bd required dose escalation. One woman who started with 133 iu/kg bd required dose reduction. Bioaccumulation of dalteparin was not observed.Conclusion
Our study suggests that dalteparin may be used for the treatment of acute venous thromboembolism in pregnancy. Approximately 10–20% higher doses of dalteparin may be needed as compared with non‐pregnant individuals.
Radioimmunoscintigraphy with Tc‐99m‐labelled SM3 in differentiating malignant from benign adnexal masses
Authors: Ali N. , Jan H. , van Trappen P. , Nasreen F. , Canizales A. , Carroll M.J. , Granowska M. , Jacobs I. , Britton K.E. 
Published: December 2003

Objective
Ultrasound scanning, serum CA125 and menopausal status have previously been combined in a risk of malignancy index for the differential diagnosis of adnexal masses. Although this approach has greater accuracy than either individual tests or clinical assessment, it has a significant false positive and false negative rate. Efforts have been directed at refining differential diagnosis and this study assessed the role of radioimmunoscintigraphy using the stripped mucin 3 (SM3) antibody that has a 17‐fold greater uptake in malignant than benign ovarian tumours in vitro.Design
Prospective study of patients with a pelvic mass using radioimmunoscintigraphy.Setting
Department of Nuclear Medicine of St Bartholomew's Hospital in collaboration with Cancer Network.Population
A total of 93 patients with pelvic masses were recruited for this study of which 32 had ovarian cancer and 61 had benign lesions.Methods
Radioimmunoscintigraphy was performed with Tc‐99m‐labelled SM3 (600 MBq), anterior and posterior pelvis imaged at 10 minutes and at 4 and 24 hours and evaluated with change detection analysis and probability mapping.Main outcome measures
Sensitivity and specificity of radioimmunoscintigraphy for ovarian cancer.Results
Radioimmunoscintigraphy had a sensitivity for ovarian cancer of 84% (27 true positive and 5 false negatives) and a specificity of 87% (53 true negatives and 8 false positives) giving a negative predictive value of 91%.Conclusion
These results suggest that radioimmunoscintigraphy could be used to reduce the number of false positive findings in a strategy to refine differential diagnosis of the pelvic mass.
Distribution of fetal erythroblasts in maternal blood after chorionic villous sampling
Authors: Al‐Mufti Raghad , Hambley Henry , Farzaneh Farzin , Nicolaides Kypros H. 
Published: December 2003

Objective
To investigate whether chorionic villus sampling (CVS) is associated with an increase in fetomaternal cell trafficking.Design
Prospective study.Setting
King's College London School of Medicine, King's College Hospital.Sample
Eighteen singleton pregnancies undergoing CVS for fetal karyotyping at 11–14 weeks of gestation and subsequently found to have chromosomal defects.Method
Maternal blood samples were obtained immediately before and at 3–14 (median 5) days after CVS. Fetal erythroblasts were isolated using triple density gradient separation and anti‐CD71 magnetic cell sorting techniques. The enriched erythroblasts were stained with Kleihauer–Giemsa and with fluorescent antibodies for the epsilon (ɛ) and gamma (γ) globin chains. The percentage of fetal cells positive for each stain was calculated. Fluorescence in situ hybridisation (FISH) for X‐ and Y‐chromosomes was also performed. Comparison was made in the proportion of enriched fetal cells between the pre‐CVS and post‐CVS samples.Main outcome measures
The proportion of fetal erythroblasts in maternal blood.Results
The percentage of erythroblasts enriched from maternal blood that stained positive for ɛ and γ globin chains and with Kleihauer–Giemsa was significantly higher in the post‐CVS samples compared with the pre‐CVS samples. FISH analysis for the Y‐chromosome confirmed the increase in fetal cell proportion in the post‐CVS samples. The percentage difference in fetal cells decreased significantly with time interval from CVS.Conclusion
CVS results in an increase in fetomaternal cell trafficking, which continues to be present for several days after the procedure.
Acceptability of a urinary continence promotion programme to women in postpartum
Authors: Chiarelli Pauline , Murphy Barbara , Cockburn Jill 
Published: December 2003

Objective
To assess the acceptability to postpartum women of a physiotherapist‐delivered urinary continence promotion programme.Design
A survey of women participating in a randomised controlled trial where women received the intervention (which involved training in pelvic floor exercises and incorporated adherence‐enhancing strategies) or usual postpartum care.Setting
Postpartum wards of three tertiary teaching hospitals in the Hunter Region, NSW, Australia.Sample
Women were eligible to participate in the trial if they had a forceps/ventouse assisted delivery and/or delivered a higher birthweight baby (≥4000 g). This study is based primarily on data obtained for 348 women in the intervention group.Methods
Baseline hospital‐based interview; eight‐week follow up appointment with physiotherapist; three‐month follow up telephone interview.Main outcome measures
Comparative dropout rates for intervention and control groups; reasons for non‐participation; attendance at hospital follow up; self‐reported acceptability of and embarrassment about per vaginum examination; utilisation and perceived usefulness of intervention components; self‐reported adherence with recommended pelvic floor exercise regime.Results
There was no significant difference in dropouts between intervention (5.9%) and control groups (6.3%). Only 14% of women gave not wanting the per vaginum assessments as their main reason for not participating in the study. Eighty‐eight percent of women participated in the eight‐week postpartum follow up visit with the physiotherapist, with two‐thirds of these women attending the hospital for this; 72.2% of women reported no embarrassment, and 22.5% just a little embarrassment about per vaginum assessment. The information components of the intervention were well received. At the eight‐week follow up visit, 83.9% reported performing pelvic floor exercises at adequate frequency.Conclusions
The postpartum period provides an ideal opportunity for pelvic floor muscle testing and the delivery of continence promotion advice.
Screening for trisomy 21 in twins using first trimester ultrasound and maternal serum biochemistry in a one‐stop clinic: a review of three years experience
Authors: Spencer Kevin , Nicolaides Kypros H. 
Published: December 2003

Objective
To evaluate the performance of screening for fetal trisomy 21 in the first trimester of twin pregnancies by a combination of maternal serum biochemistry and ultrasonography.Design
Three year retrospective review of screening performance.Setting
District General Hospital maternity unit.Population
All women booked to receive routine antenatal care at Harold Wood Hospital between 1 June 1998 and 30th September 2001. The population included 13,940 women of all ages presenting with pregnancies between 10 weeks 3 days and 13 weeks 6 days gestation. Of these, 230 had a twin pregnancy.Methods
Women booked into the clinic were offered screening using a combination of maternal serum free β‐hCG and pregnancy‐associated plasma protein‐A (PAPP‐A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 13/18 (≥1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out. For women who on examination were at 14 weeks of gestation or greater, or for women presenting as late bookers beyond 14 weeks, screening was performed in the same time frame using only maternal serum free β‐hCG and α‐fetoprotein.Main outcome measures
The first trimester detection rate for trisomy 21 and all aneuploides, false positive rate, uptake of screening, uptake of invasive testing in women identified at increased risk and fetal loss rates after invasive testing.Results
Overall, 97.4% of the women with twins (224/230) accepted first trimester screening. The rate of detection of trisomy 21 was 75% (3/4). Fetal death at presentation was found in 3.4% of fetuses (16/460). Of women who accepted screening, 4.3% (10/230) presented too late for fetal nuchal translucency measurement and 10.0% of women (23/230) presented too early. A risk for trisomy 21 was calculated for each fetus based on the individual fetal nuchal translucency thickness and the maternal biochemistry. The false positive rate among those eligible for first trimester screening was 9.0% (19/206) of pregnancies and 6.9% of fetuses (28/412). Uptake of invasive testing was 59% (10/17) with chorionic villus sampling in eight cases and amniocentesis in two. No fetal loss occurred within 28 days of chorionic villus sampling and no loss occurred after amniocentesis. One case of trisomy 21 was identified for every three invasive procedures.Conclusion
First trimester screening for trisomy 21 in twin pregnancies is both theoretically possible and practically achievable using a combination of nuchal translucency thickness and maternal serum biochemistry. However, dilemmas for the mother and health professionals when both nuchal translucency thickness measurements are normal might suggest that greater reliance be placed on the nuchal translucency thickness risk alone when counselling women about invasive testing.
Maternal and neonatal hair mercury concentrations: the effect of dental amalgam
Authors: Lindow S.W. , Knight R. , Batty J. , Haswell S.J. 
Published: December 2003

Objective
To evaluate maternal and fetal hair mercury levels in relation to the placement of dental amalgam tooth restorations.Design
Cross sectional study involving women who never had dental amalgam restorations placed, women who had amalgam restorations placed before pregnancy and women who had restorations placed during the index pregnancy.Setting
North of England Maternity Hospital.Sample
Fifty‐three healthy women who delivered healthy babies at term.Methods
Maternal and fetal hair was collected in a standardised manner in the first few days following delivery.Main outcome measures
Maternal and neonatal hair mercury concentrations.Results
When compared with women without restorations, there was a significant increase in the maternal hair mercury concentration in women who had dental amalgam placed outside of the index pregnancy and also in women who had dental amalgam placed during the index pregnancy. The fetal hair mercury concentration was significantly higher in babies when mothers had been exposed to dental amalgam either before pregnancy or during pregnancy compared with unexposed babies. There was no difference in the maternal or fetal hair mercury levels in the groups of patients who had dental amalgam placed before or during pregnancy.Conclusion
Maternal and fetal hair mercury levels were significantly higher in women who previously had dental amalgam restorations placed. There was no evidence that placement of dental amalgam restorations in pregnant women who had already similar restorations increased the maternal or fetal hair mercury level.
Anatomical and functional changes in the lower urinary tract following spontaneous vaginal delivery
Authors: Wijma Jacobus , Potters Annemarie E. Weis , de Wolf Ben T.H.M. , Tinga Dick J. , Aarnoudse Jan G. 
Published: December 2003

Objective
To assess the incidence of urinary incontinence in pregnancy and after spontaneous vaginal delivery and its relation with changes in the static and dynamic function of the pelvic floor.Design
The second part of a prospective longitudinal study.Setting
University Hospital Groningen and Martini Hospital Groningen, the Netherlands.Population
A cohort of 62 women before and after spontaneous vaginal delivery at term and 27 nulliparous non‐pregnant controls.Methods
Urinary incontinence was measured by a questionnaire and by a 24 hour pad test. The position and mobility of the urethrovesical junction were measured by perineal ultrasound and related to simultaneously measured abdominal pressure changes. Serial investigations were done at 38 weeks of gestation and at 6 weeks and 6 months after delivery.Main outcome measures
Urinary incontinence and its relation with the position of the urethrovesical junction at rest and with the mobility of the urethrovesical junction during Valsalva and during coughing, indicated by the displacement/pressure coefficient and with obstetric variables.Results
After delivery, reported urinary incontinence was reduced from 26% at 38 weeks of gestation to 16% and 15% at 6 weeks and 6 months after delivery, respectively. Even lower rates were measured by the 24 hour pad test, which revealed a decrease from 14% at 38 weeks to 10% and 5% at 6 weeks and 6 months postpartum, respectively. Six weeks and six months after delivery, the angle of the urethrovesical junction at rest was significantly increased compared with the non‐pregnant control women. Compared with the antenatal measurements, the displacement/pressure coefficients during coughing and during the Valsalva manoeuvre were significantly increased six weeks after delivery. Six months after delivery, only the coefficient for coughing was still significantly greater than the antenatal value and the value in the non‐pregnant control group. No relations were found between urethrovesical junction measurements and obstetric variables and subjective or objective urinary incontinence parameters.Conclusion
Although pregnancy and spontaneous vaginal delivery significantly increased the degree of bladder neck descent during coughing, urinary incontinence, quite common during pregnancy, occurs less frequently postpartum.