bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colposcopically directed punch biopsy: a potentially misleading investigation
Authors: BUXTON E. J. , LUESLEY D. M. , SHAFI M. I. , ROLLASON M. 
Published: August 2005

AbstractObjective— To determine the relation between the histology of an initial colposcopically directed punch biopsy and a subsequent diathermy loop excision biopsy of the transformation zone, and the effect of lesion size on this relation.Design— Prospective observational study of loop diathermy excision biopsies of the cervical transformation zone.Setting— Academic unit colposcopy clinics at The Birmingham and Midland Hospital for Women and Dudley Road Hospital, Birmingham.Subjects— 243 women managed by colposcopy and directed punch biopsy followed by loop diathermy excision.Outcome measures— The histology of the punch biopsy and the excised transformation zone and the size of the abnormal lesion.Results— In 132 (54%) of the 243 women the histology of the punch biopsy and loop excision specimen did not agree. In 62 (47%) of these 132 women a more severe lesion was found in the excised transformation zone, including three unsuspected adenocarcinoma in situ and one stage Ia1 cancer. In 39 (41%) of the 96 women in whom a lesion of CIN 3, or greater severity, was found in the loop excision specimen, the paired punch biopsy had suggested a lesion of lesser severity. In small area lesions, the punch biopsy was more likely to show more severe disease than the loop excision specimen (P= 0.0014).Conclusions— The results suggest that directed punch biopsy is an inadequate endpoint by which to judge the severity of an epithelial lesion. The findings have important implications for patient management and the design of trials and cast doubt on the results of studies using punch biopsy as an endpoint.
Passive maternal smoking and birthweight in a South Indian population
Authors: MATHAI MATTHEWS , VIJAYASRI R. , BABU SANDHYA , JEYASEELAN L. 
Published: August 2005

ABSTRACTObjective
To determine the effects of passive maternal smoking on birthweight.Design
Cohort of consecutive singleton live births.Setting
Teaching hospital in South India.Subjects
994 infants and their mothers.Main outcome measure Birthweight.Results
All the women were themselves non‐smokers; 520 (52%) were passive smokers while the remainder were not exposed to tobacco smoke. Infants born to passive smokers were on the average 55 g lighter than those born to non‐smokers. Passive smoking was associated with a decrease in birthweight of 63 g (95% CI 12–114 g) even after adjusting for other variables known to affect birthweight.
Neonatal and maternal morbidity in relation to the length of the second stage of labour
Authors: SAUNDERS NIGEL ST. G. , PATERSON CATHERINE M. , WADSWORTH JANE 
Published: August 2005

ABSTRACTObjective
To investigate the relation between the duration of the second stage of labour and subsequent early neonatal and maternal morbidity.Design
Retrospective analysis of a regional obstetric database.Setting
17 maternity units in the North West Thames Health Region.Subjects
Selected from 36 727 consecutive singleton deliveries in 1988. The analysis was confined to the 25 069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour.Main outcome measures
The relative risk of early maternal morbidity, postpartum haemorrhage (PPH) and postpartum infection, and neonatal morbidity, as judged by low Apgar scores or admission to the special care baby unit (SCBU), in relation to anthropomorphic characteristics (parity and birthweight), interventions (epidural analgesia, episiotomy and operative delivery), signs of fetal compromise (meconium staining of the amniotic fluid or abnormal cardiotocography (CTG)), maternal morbidity in labour (pyrexia) and the duration of the second stage of labour.Results
The duration of the second stage of labour had a significant independent association with the risk of both PPH and maternal infection after adjustment for other factors. However, there was a similar or greater risk of PPH in association with operative delivery or a birthweight greater than .4000 g. Both maternal pyrexia in labour and primiparity were associated with a greater risk of post partum maternal infection than was the duration of the second stage, although all these factors were statistically significant. In contrast, the duration of the second stage was not significantly associated with the risk of a low Apgar score or admission to SCBU after adjustment for other factors.Conclusions
The duration of the second stage of labour has a positive independent association with early maternal morbidity. We could show no such relation between time spent in the second stage of labour and the frequency of low Apgar scores or the rate of admission to SCBU. With current management approaches, in the absence of factors suggesting fetal compromise, second stage labours of up to 3 h duration do not seem to carry undue risk to the fetus.
Abdominal irradiation in childhood; the potential for pregnancy
Authors: CRITCHLEY H. O. D. , WALLACE W. H. B. , SHALET S. M. , MAMTORA H. , HIGGINSON J. , ANDERSON D. C. 
Published: August 2005

ABSTRACTObjective
To investigate the impact of premature ovarian failure due to whole abdominal radiotherapy (DXT) in childhood on uterine physical characteristics and blood flow and measuring the uterine response to exogenous sex steroid replacementDesign
A comparative observational studySubjects
10 women with premature ovarian failure due to treatment with whole abdominal irradiation in childhood. A comparison group of 22 women with premature ovarian failure who had not received whole abdominal DXT.Main outcome measures
Uterine length and uterine blood flow measurement plus serial assessment of endometrial thickness during a cycle of exogenous sex steroid replacement.Results
Uterine length was significantly less (P<0.01) in women who had been exposed to whole abdominal DXT in childhood (mean 4.1 cm, 2SE 0.8) compared with a mean of 7.3 cm (2SE 0.6) in the comparison group. The three women in the DXT group who were studied serially had no increase in endometrial thickness in response to physiological sex steroid replacement therapy and most of the 10 irradiated women had no detectable uterine blood flow with Doppler ultrasound.Conclusions
Uterine musculature and blood flow are irreversibly affected by high dose irradiation in childhood. Non‐invasive assessment of this nature may predict potential for pregnancy following ovum donation and embryo transfer.
Calcium homeostasis in pregnancy during long‐term heparin treatment
Authors: DAHLMAN T. , SJÖBERG H. E. , HELLGREN M. , BUCHT E. 
Published: August 2005

ABSTRACTObjectiveTo investigate the effect of subcutaneous heparin treatment on calcium homeostasis in pregnancy.DesignA longitudinal case‐control observational study.SettingDepartment of Obstetrics and Gynaecology, Karolinska Hospital, Stockholm, Sweden.Subjects36 pregnant women with previously verified thromboembolic complications and 23 healthy pregnant control women similar in age, parity, weight, and smoking habit.InterventionsThromboprophylaxis during pregnancy and 6 weeks post partum was given with subcutaneous heparin twice daily to the 36 women with a history of thromboembolic complications, 16 received an average dose of 24 500 IU/day and 20 a mean dose of 17 300 IU/day. Venous blood and urine samples were obtained every 4 weeks.Main outcome measuresSerum concentrations of total calcium, ionized calcium, calcitonin and urinary calcium.ResultsWomen on high‐dose heparin treatment showed significantly higher concentrations of total and ionized calcium and of calcitonin in serum and significantly lower concentrations of calcium in urine than did 23 normal pregnant controls. The differences were most pronounced in the third trimester. The results obtained in the low‐dose heparin group were between those in the high‐dose and the control groups. At 8 weeks postpartum there were no significant differences between the heparin‐treated women and the controls. No significant differences were found during pregnancy in haematocrit, liver or renal function, serum levels of albumin, phosphate, magnesium, alkaline phosphatase, parathyroid hormone or urinary cyclic AMP.ConclusionsHeparin treatment during pregnancy results in changes in calcium homeostasis and a dose‐dependent response is suggested.
Length and variation in the menstrual cycle—a cross‐sectional study from a Danish county
Authors: MÜNSTER KIRSTINE , SCHMIDT LONE , HELM PETER 
Published: August 2005

ABSTRACTObjective
To investigate the current epidemiology of menstrual patters among women of fertile age.Design
Cross‐sectional postal questionnaire study.Setting
County of Copenhagen, Denmark.Subjects
3743 women, aged 15–14, selected at random from a Danish county, who were asked to provide information on menstrual pattern during the preceding year, 1981. The response rate was 78%. Information from non‐responders was obtained via telephone interviews.Results
In women with regular menstrual cycles, the 5th–95th centile range of usual cycle length decreased from 23–35 days in the 15–19 years age group to 23–30 days in the 40–44 years age group. Only 0.5% of regular menstruating women had a usual cycle length of <21 days and 0.9% had a usual cycle length of >35 days. At least one cycle length of <21 days was experienced by 18.6%, whereas 29.5% had at least one cycle of >35 days. Menstrual cycle variation of >14 days was present in 29.3% of all women. Cycle length variation of > 14 days was 2.7 times more frequent in women from lower social groups (controlled by age).Conclusion
The study confirmed the normally used definitions of polymenorrhoea (cycle length <21 days) and oligomenorrhoea (cycle length between 36 and 90 days), as these very short or long menstrual cycle lengths were very seldom recorded for a longer period. However, the high frequency in a normal population of large menstrual cycle length variation challenges the view that an intra‐individual variation of >5 days should be regarded as a sign of disease in the woman.
Management of prelabour rupture of the membranes in term primigravidae: report of a randomized prospective trial
Authors: GRANT JOHN M. , SERLE ELISABETH , MAHMOOD TAHIR , SARMANDAL PURNIMA , CONWAY DAVID I. 
Published: August 2005

ABSTRACTObjective
To compare a conservative and an active policy (immediate oxytocin infusion) of management of prelabour rupture of the membranes in term primigravidae.Design
Randomized trial involving 444 women.Setting
District maternity hospital.Main outcome measures
Caesarean section rate in each group; also the rate of forceps deliveries, spontaneous deliveries, length of labour, number of vaginal examinations, type of analgesia, pyrexia in labour or the puerperium and antibiotic use in the mother and the infant in each group. The caesarean section rate for the whole trial where the latent period was > 12 h was compared to that where the latent period was s=12h.Results
There were fewer caesarean sections in the conservative group (odds ratio (OR) 0.60,95% confidence interval (CI) 0.35 to 1.02; P= 0.06). There was a similar number of forceps deliveries (OR 0.79; 95% CI 0.52 to 1.19; P= 0.26) but more spontaneous deliveries (OR 1.57; 95% CI 1.08 to 2.29; P= 0.02) in the conservative group. More women managed conservatively required inhalational analgesia only for pain relief in labour (OR 2.88; 95% CI 1.46 to 5.68; P= 0.003), a similar number required pethidine (OR 1.29; 95% CI 0.85 to 1.94; P = 0.23), and fewer required epidural analgesia (OR 0.57; 95% CI 0.39 to 0–84; P= 0.005). The number of vaginal exminations was less in the conservative group (difference between means 0.53; 95% CI 0.25 to 0.80; F<0.001). Fewer women managed conservatively experienced four or more vaginal examinations in labour (OR 0.58; 95% CI 0.39 to 0.86; P= 0.007). There were no differences in the lengths of labour, the proportions of women who developed pyrexia in labour or the puerperium or who required antibiotics or in the proportions of infants who required antibiotics.Conclusions
These results argue in favour of a conservative policy in managing primigravidae at term with prelabour rupture of the membranes.
Biochemical composition of amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy
Authors: CAMPBELL JAMES , WATHEN NEVILLE , MACINTOSH MARY , CASS PETER , CHARD TIM , MAINWARING‐BURTON RICHARD 
Published: August 2005

ABSTRACTObjective
To determine the biochemical composition of amniotic fluid and extra‐embryonic coelomic fluid between 8 and 12 weeks gestation.Design
Prospective observational study.Subjects
40 women with a normal pregnancy between 7 and 12 weeks gestation having termination of pregnancy.Interventions
Before termination the women had a transvaginal ultrasound guided amniocentesis. Pure samples of amniotic fluid and extraembryonic coelomic fluid were obtained from each woman and standard biochemical variables were measured in each fluid sample immediately after collection.Results
Levels of sodium, potassium and bicarbonate were significantly higher in amniotic fluid whilst chloride, urea, bilirubin, protein, albumin, glucose, creatinine, calcium and phosphate were present in higher concentrations in extraembryonic coelomic fluid. All differences in concentration were significant (P <0.05; unpaired Mest). No relation was demonstrated between electrolyte concentrations in amniotic fluid or coelomic fluid and stage of gestation.Conclusions
Amniotic fluid and extraembryonic coelomic fluid have a widely differing biochemical composition. The biological significance of these differences remains unexplained.
CIN 3: the role of lesion size in invasion
Authors: TIDBURY PENELOPE , SINGER ALBERT , JENKINS DAVID 
Published: August 2005

ABSTRACTObjective
To define the relation between the size of a CIN 3 lesion (measured histologically) and invasive squamous carcinoma.Design
Measurement of CIN 3 by computerized planimetry of histological sections from 39 cone biopsies containing microinvasive cancer. Comparison with previous measurements of CIN lesions, associated with different grades of dyskaryosis.Results
Microinvasive carcinoma of the cervix is associated with extensive CIN 3 on the surface and in endocervical crypts. The mean size of CIN 3 lesions showing microinvasion is seven times greater than that for severe dyskaryosis without invasion, (P<0.0001) and a 100‐fold greater than with mild dyskaryosis (P<0.00001).Conclusion
Invasive squamous carcinoma of the cervix arises in large CIN 3 lesions and these are associated usually with severe dyskaryosis. We propose a model for the development of high‐grade precancer as a small focus within low grade pre‐cancer which then undergoes expansion in size, accompanied by apparent progression in cytological grade.
The role of partial colpectomy in the management of persistent vaginal neoplasia after primary treatment
Authors: CURTIS PAUL , SHEPHERD JOHN H. , LOWE DAVID G. , JOBLING TOM 
Published: August 2005

ABSTRACTObjective
To describe and assess the technique of partial colpectomy for the treatment of persistent vaginal neoplasia.Setting
Gynaecological oncology unit of a London teaching hospital.Subjects
12 women with persistent vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia (CIN) or for benign disease.Technique
Partial colpectomy using a vaginal approach assisted by a Schuhardt incision to improve access.Results
Assessment of patients between 9 and 99 (mean 55) months after partial colpectomy for VAIN showed no recurrence of disease in ten patients (83%).Conclusion
This technique of partial colpectomy is an effective procedure, associated with minimal morbidity which should be considered as primary treatment for patients suffering from persistent vaginal disease after hysterectomy or other procedures.
A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis
Authors: NEZHAT CAMRAN , NEZHAT FARR 
Published: August 2005

ABSTRACTObjective
To describe optimal procedures and preliminary results for videolaparo‐scopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea.Design
Observational study with follow up for at least one year.Setting
Subspecialty practice: Endometriosis Clinic and Centre for Special Pelvic Surgery.Subjects
Eighty five women (18–4–5 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded.Interventions
Excision and vaporization of endometriotic pathology was followed by presacral neurectomy.Outcome measures
During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively.Results
There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief.Conclusions
Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.
Genital tract infections associated with the intrauterine contraceptive device can be reduced by inserting the threads into the uterine cavity
Authors: PAP‐ÅKESON MARGARETHA , SOLHEIM FOLKE , THORBERT GUNNAR , AKERLUND MATS 
Published: August 2005

ABSTRACTObjective
To study the influence of the position of the threads of an intrauterine contraceptive device (IUCD) on the development of genital tract infection.Design
A multicentre randomized controlled trial. Subjects Women requesting an IUCD.Interventions
The women were randomized to be fitted with an IUCD either with the threads contained in the uterine cavity (threads‐up group) (n= 208) or passing through the cervix to the vagina in the usual way (threads‐down group) (n= 237). Multiple centre study with follow‐up at three months, 1 and 2 years. At the final visit ‘missing’ threads were retrieved using a disposable instrument (RetrievetteR).Main outcome measures
The occurrence of infection in the lower or upper genital tract.Results
63 women in the threads‐up group and 78 in the threads‐down groups dropped out. Previous gynaecological infection was reported by 21 and 48 women in the threads‐up and threads‐down group, respectively (odds ratio 0.44, 95% CI 0.24 to 0.79), 21 and 53 subjects had signs of infection at gynaecological examination (odds ratio 0.39,95% CI 0.21 to 0.69) and a wet‐smear was pathological in 33 and 79 (odds ratio 0.38, 95% CI 0.23 to 0.61). In the threads‐up group the vaginal pH was also lower at the final check up after 2 years. Spontaneous descent of the threads occurred in 11% of the threads‐up group and in six women in the threads‐down group the threads were in the cervix. In 93 women the threads were easily retrieved by means of the RetrievetteR, four women insisted on the threads remaining in the uterus and in 18 thread removal was performed under local or general anaesthesia.Conclusions
Infectious complications in women using an IUCD are more frequent if the threads lead from the uterine cavity to the vagina. This problem can be reduced by inserting the threads so that they remain entirely within the uterine cavity, a feasible procedure now that an effective instrument for IUCD thread retrieval is available.
Normal amniotic pressure throughout gestation
Authors: FISK N. M. , RONDEROS‐DUMIT D. , TANNIRANDORN Y. , NICOLINI U. , TALBERT D. , RODECK C. H. 
Published: August 2005

ABSTRACTObjective
To characterize amniotic pressure (AP) in pregnancies with normal amniotic fluid volume.Design
Observational study, mainly cross‐sectional.Setting
Fetal medicine unit within a tertiary referral hospital.Subjects
Patients undergoing transamniotic invasive procedures in whom amniotic fluid volume was subjectively assessed as normal on ultrasound. Those beyond 16 weeks with a deepest vertical pool on ultrasound <3.0 or >8.0 cm were excluded. Overall 194 pregnancies were studied on 232 occasions between 7 and 38 weeks gestation.Interventions
Manometry readings referenced to the top of the maternal abdomen were obtained via a fluid‐filled line from the needle hub and either connected to a pressure transducer (n= 190) or held vertically against a ruler (n−42).Main outcome measures
AP in mm Hg, AP corrected for gestational age (z scores), semi‐quantitative ultrasonic indices of amniotic fluid volume, clinical variables.Results
AP in singleton pregnancies increased with advancing gestation (P<0.001), and the sigmoid‐shaped regression curve plateaued in the mid‐trimester. AP z scores were not influenced by volume‐related phenomena such as twin gestation, the deepest vertical pool, or amniotic fluid index, nor by maternal age, parity, gravidity, fetal sex, or subsequent spontaneous preterm delivery.Conclusions
These findings suggest that AP is not principally determined by intrauterine volume. We speculate that AP, which reflects change in uterine tension as a function of radius, may instead be determined by gestation‐specific anatomical and hormonal influences on gravid uterine musculature. A reference range for AP has been constructed for use in amnioinfusion and amnioreduction procedures.
Intergenerational studies of human birthweight from the 1958 birth cohort. 1. Evidence for a multigenerational effect
Authors: EMANUEL IRVIN , FILAKTI HAROULLA , ALBERMAN EVA , EVANS STEPHEN J. W. 
Published: August 2005

ABSTRACTObjective
To investigate possible multigenerational influences on birthweight.Design
Data from the longitudinal study of one week's births in 1958 up to the age of 23 years, the British National Child Development Study, were utilized. These pro‐vide socio‐biological information on the parents of the cohort, on the cohort members from birth onwards, and on the pregnancies and the birthweight of any babies born to the cohort members.Main outcome measure
The main outcome was the birthweight of babies born to the cohort members, for whom complete intergenerational data were available for 1638 firstborn. Multiple regression modelling was used to investigate any associ‐ations between their birthweight and characteristics of their parents and grandparents.Results
Significant positive associations were found between babies' birthweight and parental birthweight but not gestational age. For the babies born to female cohort members additional findings included associations between their birthweight and the height of the maternal grandmother and the social class of the maternal grandfather, even after adjustment for such strong predictors of birthweight as maternal weight, smoking habit in pregnancy and baby's sex and birth order.Conclusion
These results thus offer support for a multigenerational influence on birthweight passed through the maternal line.