bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing severe loin pain in pregnancy
Authors: Irving Stuart O. , Burgess Neil A. 
Published: December 2003

Objective
To investigate whether the intravenous urogram used in an appropriate setting is a valuable investigation for managing severe loin pain in pregnancy.Design
Prospective obsevational study.Setting
University teaching hospital.Population
Fifteen pregnant women referred with severe loin pain.Methods
A prospective study collecting data over a 24‐month period was performed. Women with severe loin pain believed to be of renal origin that had failed to respond to conservative treatment were referred by their obstetricians. The intravenous urogram was performed that consisted of a two‐film series (plain film and a 20‐minute postmicturition film).Main outcome measures
Management of severe loin pain in pregnancy based on the findings of the intravenous urogram.Results
Over the two‐year period, 15 women had an intravenous urogram performed at a median gestation of 32 weeks (24–36 weeks). All women had undergone a prior urinary tract ultrasound examination within 24 hours of referral, which showed dilatation on the symptomatic side in 15/15 cases. The intravenous urogram confirmed dilatation on the ipsilateral side in 14/15 cases and revealed the level of dilatation in all of these cases. Delayed excretion of contrast was seen in all 14/15 cases. Three patients had obstructing ureteric calculi revealed by the intravenous urogram and one patient had a non‐dilated and non‐obstructed system.Conclusions
An intravenous urogram is a safe investigation in the appropriate setting. It allows for an accurate diagnosis to be made and for appropriate treatment to be instigated with joint decisions from urologic, obstetric and radiologic teams. This multidisciplinary approach care can be specifically tailored to the individual patient, which we feel is safer for both mother and baby.
Possible association between amniotic fluid micro‐organism infection and microflora in the mouth
Authors: Bearfield Caroline , Davenport Elizabeth S. , Sivapathasundaram Vythil , Allaker Robert P. 
Published: December 2003

ObjectiveTo determine whether oral bacteria are found in the amniotic cavity.DesignLaboratory based analysis of clinical samples.SettingRoyal London Hospital, Whitechapel.PopulationForty‐eight women attending for elective caesarean section.MethodsDental plaque, a high vaginal swab, amniotic fluid and chorioamnion tissue were taken from women with intact membranes.Main outcome measuresSamples were investigated using culture and microscopy for the presence of micro‐organisms. Amniotic fluid was analysed by polymerase chain reaction (PCR) for the presence of the ubiquitous 16S rRNA gene specific to most eubacteria. Samples were analysed using PCR genus and species specific primers directed to bacterial taxa found as part of the normal oral microflora (Streptococcusspp. andFusobacterium nucleatum). Levels of prostaglandinE2and cytokines were measured in amniotic fluid.ResultsAmniotic fluid was positive for universal bacteria PCR,Streptococcusspp. PCR andF. nucleatumPCR in 34/48, 20/48 and 7/48 of cases, respectively.Streptococcusspp. andF. nucleatumwere cultured from the dental plaque, vagina and amniotic fluid of 48/48, 14/48, 0/48 and 29/48, 6/48, 0/48 subjects, respectively. A significant association was found between detection of microbial DNA (universal andF. nucletum) and complications in previous pregnancies including miscarriage, intrauterine death, neonatal death, preterm delivery and premature rupture of membranes (P< 0.05 andP< 0.01, respectively). ProstaglandinE2and cytokine levels, with the exception of IL‐1α, were not significantly different between women with and without evidence of infection.ConclusionsThe results indicate thatStreptococcusspp. andF. nucleatumin the amniotic fluid may have an oral origin.
Endothelial function is preserved in pregnant women with well‐controlled type 1 diabetes
Authors: Ang Christine , Hillier Chris , Johnston Fiona , Cameron Alan , Greer Ian , Lumsden Mary Ann 
Published: December 2003

Objective
Pregnant women with diabetes mellitus have a higher incidence of adverse pregnancy outcomes. Vascular, and in particular, endothelial function may be significantly modified in diabetes resulting in impaired endothelium‐dependent relaxation. This study aims to investigate endothelium‐dependent relaxation in pregnant women with pre‐existing type 1 diabetes mellitus.Methods
Small arteries (mean luminal diameter ∼295 μm) were isolated from biopsies of subcutaneous fat from pregnant women with pre‐existing type 1 diabetes mellitus, non‐diabetic pregnant women, and non‐diabetic non‐pregnant women. Endothelial and smooth muscle function were determined using wire myography, and the contributions of nitric oxide, vasodilator prostanoid and endothelial hyperpolarisation were studied using specific inhibitors.Results
Arteries obtained from the diabetic pregnant women did not demonstrate any difference in either endothelial or smooth muscle function when compared with non‐diabetic pregnant women. The contribution of nitric oxide to endothelium‐dependent relaxation was ∼20% in the pregnant women regardless of whether they were diabetic, and ∼11% in the non‐pregnant women. Endothelial hyperpolarisation appeared to contribute largely to vasorelaxation in human subcutaneous arteries, and was at least twice that of nitric oxide in pregnant women and fivefold greater in non‐pregnant women.Conclusions
This study provides evidence that pregnant women with well‐controlled pre‐existing type 1 diabetes mellitus have both normal endothelial and smooth muscle function. Endothelium‐dependent hyperpolarisation appears to play a large role in vascular relaxation in human subcutaneous resistance arteries. This study suggests that the problems associated with diabetic pregnancies are unlikely to be due to vascular dysfunction.
Fertility results after conservative treatment of advanced stage serous borderline tumour of the ovary
Authors: Camatte Sophie , Morice Philippe , Pautier Patricia , Atallah David , Duvillard Pierre , Castaigne Damienne 
Published: December 2003

Objective
To assess the fertility of patients treated conservatively for a Stage II or III borderline ovarian tumour.Design
A retrospective study.Setting
Gynaecological oncology department in a French anti‐cancer centre.Population
Seventeen patients treated with conservative management for a Stage II (n= 6) or III (n= 11) borderline ovarian tumour were followed up. Fifteen patients underwent a unilateral salpingo‐oophorectomy (with contralateral cystectomy in six patients), one had unilateral cystectomy and one a bilateral cystectomy. Fourteen patients had non‐invasive implants and three had invasive implants.Main outcome measures
Pregnancy rates and outcome.Results
Eight pregnancies were observed in seven patients in a median delay of eight months following the surgical procedure. Six pregnancies were observed spontaneously, one occurred after an ovarian stimulation and one after an IVF procedure. None of these patients recurred under the form of invasive ovarian carcinoma on the spared ovary. Two patients (one with a non‐invasive disease and one with an invasive one) had recurrence in the form of evolutive invasive implants, but neither woman died.Conclusion
Spontaneous pregnancy can occur after conservative treatment of advanced stage borderline tumour of the ovary (with non‐invasive implants). Such management, performed in a close follow up of the patients, does not affect the overall survival. Conservative surgery could be proposed in patients with borderline tumour of the ovary and non‐invasive peritoneal implants.
Obstetric cholestasis, outcome with active management: a series of 70 cases
Authors: Kenyon Anna P. , Piercy C. Nelson , Girling J. , Williamson C. , Tribe R.M. , Shennan A.H. 
Published: December 2003

Objective
To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.Design
Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed.Setting
Antenatal population of three London hospitals between August 1999 and April 2001.Population
Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma‐glutamyl transpeptidase, alanine amino‐transferase, aspartate amino‐transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology.Methods
All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded.Results
Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4–39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21–40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty‐five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated.Conclusions
Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.
Secondary colposuspension: results of a prospective study from a tertiary referral centre
Authors: Thakar Ranee , Stanton Stuart , Prodigalidad Lisa , den Boon Jan 
Published: December 2003

Objective
To evaluate the results of secondary colposuspension in women with recurrent urinary stress incontinence.Design
Prospective cross sectional observational study.Setting
Tertiary referral urogynaecology unit.Population
Fifty‐six women with recurrent stress incontinence.Main outcome measures
Determine prognostic factors that may affect the outcome of surgery, long term subjective and objective success rates and identify complications of secondary colposuspension.Results
The mean age was 54 years (range 34–83) and the median parity was 3 (range 1–5). The median length of follow up was four years (range 1.01–7.07). Forty‐two (75%) women had genuine stress incontinence and 14 (25%) had mixed incontinence on subtracted cystometry. The subjective cure rate was 71% and the objective cure rate was 80% and, as per Kaplan–Meier life time analysis, 65% had not failed surgery five years after the operation. The complication rate was low. However at follow up, eight women had required a posterior colporrhaphy for rectocele and three had a sacrocolpopexy for vault prolapse. Another eight women required further treatment for stress incontinence (seven urethral bulking agents and one tension‐free vaginal tape). There was no correlation of the outcome to age, past hysterectomy, number of previous incontinence procedures, parity, body mass index or blood loss at operation.Conclusion
Colposuspension after failed continence surgery has a good outcome with a low complication rate, but many still require further surgery for prolapse.
Evaluation of distance interactive learning in obstetrics and gynaecology (DIALOG)
Authors: Jha Vikram , Duffy Sean , McAleer Sean 
Published: December 2003

Objectives
1. To determine whether DIALOG, a multimedia interactive CD‐ROM designed for postgraduate education, was achieving its educational aim; 2. to assess DIALOG as a computer‐assisted learning tool by evaluating its design, presentation, usability, effective use of multimedia and interactions and availability; 3. to measure end user satisfaction and the impact of DIALOG in achieving an improvement in clinical practice as an index of educational value.Methods
Postal questionnaires were sent out to 150 users of DIALOG. A combination of the CIPP model, the CRISIS criteria and Kirkpatrick's model was used to design the evaluation questionnaire.Results
There was a 61.3% response rate to the questionnaire. Overall, 86.9% of respondents were happy with the use of DIALOG, 60.8% had a positive comment on the concept of distance learning using DIALOG and computer‐assisted learning, 50% agreed that it had helped sharpen their analytic skills and 45.6% reported an improvement in clinical practice after using DIALOG.Conclusion
This assessment proved to be a useful formative assessment of DIALOG. It has provided feedback on the availability and use of DIALOG and has highlighted the potential areas of improvement for future issues.
Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks
Authors: Salamalekis E. , Thomopoulos P. , Giannaris D. , Salloum I. , Vasios G. , Prentza A. , Koutsouris D. 
Published: December 2003

ObjectiveTo develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings.DesignRetrospective off‐line analysis of cardiotocogram and FSpO2recordings.SettingThe Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens.PopulationSixty‐one women of more than 37 weeks of gestation were monitored throughout labour.MethodsMultiresolution wavelet analysis was applied in each 10‐minute period of second stage of labour focussing on long term variability changes in different frequency ranges and statistical analysis was performed in the associated 10‐minute FSpO2recordings. Self‐organising map neural network was used to categorise the different 10‐minute fetal heart rate patterns and the associated 10‐minute FSpO2recordings.Main outcome measuresUmbilical artery pH of ≤7.20 and Apgar score at 5 minutes of ≤7 formed the inclusion criteria of the risk group.ResultsAfter usingk‐means clustering algorithm, the two‐dimensional output layer of the self‐organising map neural network was divided into three distinct clusters. All the cases that mapped in cluster 3 belonged in the risk group except one. The sensitivity of the system was 83.3% and the specificity 97.9% for the detection of risk group cases.ConclusionsA relationship between the fetal heart rate variability in different frequency ranges and the time in which FSpO2is less than 30% was noticed. Fetal pulse oximetry seems to be an important additional source of information. Computerised analysis of the fetal heart rate monitoring and pulse oximetry recordings is a promising technique in objective intrapartum diagnosis of fetal hypoxia. Further evaluation of this technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate recordings.
Enhancement of the perception of systemic pain in women with vulvar vestibulitis
Authors: Granot Michal , Friedman Michael , Yarnitsky David , Zimmer Etan Z. 
Published: December 2003

Objective
The aim of this study was to determine whether the characteristics of systemic pain perception and anxiety differ between women with vulvar vestibulitis and healthy women.Design
Case control study.Setting
Tertiary care hospital.Population
Forty‐four women with vulvar vestibulitis and 41 healthy women participated in the study.Methods
First, the women's state and trait anxiety was evaluated. Thereafter, heat pain stimuli were applied to the women's forearm and the pain and unpleasantness thresholds, as well as magnitude estimation of perceived intensity and unpleasantness of suprathreshold stimuli, were assessed. Finally, blood pressure was measured before, during and after a heat stimulus of 46°C.Main outcome measures
Pain threshold and suprathreshold, and anxiety levels of women with vulvar vestibulitis.Results
Women with vulvar vestibulitis had a higher anxiety state (40.0 [12.8] vs 34.1 [10.8], P= 0.044), a higher anxiety trait (42.1 [10.2] vs 35.6 [7.5], P= 0.005), a lower pain threshold (42.2°C [2.5] vs 43.6°C [1.9], P= 0.006), a lower unpleasantness threshold (40.2°C [2.9] vs 41.7°C [2.3], P= 0.023), a higher magnitude estimation of suprathreshold pain at 47°C (88.3 [14.9] vs 70.8 [14.9], P= 0.0001) and at 48°C (96.1 [7.3] vs 84.6 [14.8], P < 0.0001), a higher scoring of tonic pain perception (65.2 [17.3] vs 53.0 [18.6], P= 0.006) and a higher increase in systolic blood pressure during tonic pain stimuli (4.6 [9.6] vs−2.1 [8.7] mmHg, P= 0.005).Conclusion
Women with vulvar vestibulitis have an enhanced systemic pain perception and are more anxious.
Microvascular changes in the peripheral microcirculation of women with chronic pelvic pain due to congestion
Authors: Foong L.C. , Gamble J. , Sutherland I.A. , Beard R.W. 
Published: December 2003

Objective
Pelvic venous congestion is a common finding in women with chronic pelvic pain. While the pathophysiology of this condition is poorly understood, there are clear indications that it involves vascular dysfunction. The present studies sought abnormalities in microvascular function in these patients.Design
Prospective longitudinal study.Setting
A teaching hospital tertiary referral.Population
Eighteen women with pelvic congestion and 13 nomal women.Methods
Parameters of microcirculatory function were measured in the calves of women using venous congestion plethysmography during the midfollicular and midluteal phases of the menstrual cycle. The women with pelvic congestion were studied again after treatment for the condition.Main outcome measures
Isovolumetric venous pressure, microvascular filtration capacity and limb blood flow.Results
Of the measured parameters of microvascular function, only isovolumetric venous pressure (Pvi) was significantly higher in women with congestion when compared to the controls during the same phase of the cycle. There were no menstrual cycle related differences in any of the other measured parameters in either patients or controls. Following successful treatment for the condition, values of Pvi in women with pelvic congestion were significantly reduced, achieving a level similar to that observed in the controls.Conclusion
The observed changes in Pvi suggest that this parameter is intimately associated with the pathophysiology of pelvic congestion. The increase in Pvi, without alterations in other measured microvascular parameters, may be attributable to systemic increases in postcapillary resistance secondary to neutrophil activation. These findings support the notion of systemic microvascular dysfunction in these women.
Sublingual compared with oral misoprostol in term labour induction: a randomised controlled trial
Authors: Shetty Ashalatha , Mackie Lisa , Danielian Peter , Rice Pat , Templeton Allan 
Published: December 2003

Objective
To compare the efficacy and patient acceptability of 50 μg of sublingual misoprostol with 100 μg of oral misoprostol in the induction of labour at term.Design
Non‐blinded randomised comparative trial.Setting
Tertiary level UK Hospital.Sample
Two hundred and fifty women at term with indications for labour induction.Methods
Fifty micrograms of sublingual misoprostol or 100 μg of oral misoprostol was administered every four hours after random allocation, to a maximum of five doses.Main outcome measures
Number of patients delivering vaginally within 24 hours of the induction, mode of delivery, neonatal outcomes and patient acceptability.Results
There was no significant difference in the number of women delivering vaginally within 24 hours of the induction in the sublingual group as compared with the oral group (62.8%vs 59%, RR 1.1, 95% CI 0.6–2.1), or in the mean induction to delivery time (21.8 vs 24.1 h, mean difference 2.3 h 95% CI −2.2 to +6.7). There was no difference in the uterine hyperstimulation rates (1.6% in both groups), operative delivery rates or neonatal outcomes. In the sublingual group, 92.6% found the induction acceptable with 15.8% finding the tablets with an unpleasant taste, while in the oral group it was 96.9% and 4%, respectively. More patients in the oral group thought that they would consider the same method of induction again as compared with the sublingual group (58.6%vs 40%, RR 1.4, 95% CI 1.04–1.9).Conclusion
Fifty micrograms of sublingual misoprostol every four hours has the same efficacy and safety profile as compared with 100 μg orally, but the oral route might be preferred by women.
A comparison of outpatient hysteroscopy with saline infusion hysterosonography
Authors: Rogerson Lynne , Bates Jane , Weston Mike , Duffy Sean 
Published: December 2003

Objectives
To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy.Design
Prospective, parallel, blinded comparative study.Setting
Outpatient hysteroscopy clinic in a large university teaching hospital.Population
All women referred for outpatient hysteroscopy in a 15‐month period.Interventions
Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result.Main outcome measures
The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test.Results
One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy.Conclusions
Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.