bluuebunny/crossref_metadata_2025_split huggingface dataset:
Charts of fetal size: 1. Methodology
Authors: Altman Douglas G. , Chitty Lyn S. 
Published: August 2005

ABSTRACT Objectives To discuss the features of study design and analysis which are necessary to derive valid reference centiles for fetal size. To describe a study which meets the stated criteria.Design
Prospective study of 663 fetuses.Results
The selection of the sample and adequate sample size are of great importance. Prospective collection of data specifically for the purpose of deriving centiles is recommended. It is essential to use statistical methods that take proper account of the increasing variation among fetuses as pregnancy proceeds; such methods are described and illustrated. A study is described which meets the stated criteria for design and analysis, and from which new fetal size centile charts have been derived and are presented in subsequent papers.Conclusions
Many published studies containing charts (standards) of fetal size are methodologically flawed. Research design and statistical analysis must adhere to sound principles for fitted centiles of size to be valid and so clinically relevant.
Charts of fetal size: 4. Femur length
Authors: Chitty Lyn S. , Altman Douglas G. , Henderson Annabel , Campbell Stuart 
Published: August 2005

ABSTRACTObjective
To construct a new size chart for fetal femur length.Design
A prospective, cross sectional study of fetuses scanned once only for the purpose of the study at gestations between 12 and 42 weeks.Setting
The routine ultrasound department of a London teaching hospital.Subject
The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days.Results
Femur length was measured on 649 of the 663 fetuses. A linear‐cubic regression model was fitted to estimate the mean and a separate linear regression to estimate the standard deviation. Gentiles were derived by combining these two regression models, assuming that the measurements have a normal distribution at each gestational age. A new chart for femur size is presented and compared with previously published data.Conclusions
We have constructed a new size chart for fetal femur length taking into consideration the increasing variability with increasing gestational age. We have compared our chart with other published data, and believe that the differences seen may be largely due to methodological differences.
The effects of dihydralazine, labetalol and magnesium sulphate on the isolated, perfused human placental cotyledon
Authors: Petersen Olav B. , Skajaa Kristjar , Svane Danny , Gregersen Hans , Forman Axel 
Published: August 2005

ABSTRACTObjective
To assess the effects of dihydralazine, labetalol and magnesium sulphate on the vascular tone in the isolated, perfused human placental cotyledon.Methods
In vitro perfusion of the fetal compartment of isolated, human placental cotyledons.Results
None of the drugs affected basal vascular tone. The thromboxane A2‐mimic U46619 and endothelin‐1 induced a concentration‐dependent increment in perfusion pressure, while 5‐ hydroxytryptamine induced a variable increase, and norepinephrine induced a small, transient increase in perfusion pressure. After preconstriction with U46619, magnesium sulphate (1.5×10−3 to 6.10−3 mol/1) induced a decrease in perfusion pressure, while dihydralazine (10−6to 10−4 mol/1) or labetalol (10−7 to 10−4 mol/1) enhanced the perfusion pressure. These effects of dihydralazine and labetalol were unaffected by treatment with indomethacin 10−6 mol/1, but could be reversed by addition of magnesium sulphate 6.10−3 mol/1. Labetalol 10−6 to 10−4 mol/1 also caused an increase in the perfusion pressure induced by endothelin‐1, but showed no effects after preconstriction with 5‐hydroxytryptamine. Pretreatment with labetalol 10−4 mol/1 inhibited the transient increase in perfusion pressure induced by norepinephrine 3.10−5 mol/1.Conclusions
The present data demonstrated that the commonly used vasodilating agents labetalol and dihydralazine do not produce vasodilatation in the human perfused cotyledon after vasoconstriction induced by agents of suggested importance for maintenance of fetal placental vascular tone, and that high concentrations of these drugs may even enhance vasoconstriction induced by thromboxane and endothelin‐1 in this area. Magnesium sulphate may show the potential to reverse such unwanted effects of dihydralazine and labetalol.
Roles of prostaglandins and intracellular free calcium mobilisation in epidermal growth factor‐induced proliferation of human amnion cells
Authors: Tahara Masahiro , Masumoto Nobuyuki , Mizuki Jirou , Kasahara Kanji , Tasaka Keiichi , Kurachi Hirohisa , Miyake Akira 
Published: August 2005

ABSTRACTObjective
To investigate the mechanisms which regulate the growth of human amnion cells.Design
A prospective descriptive study.Subject
Women undergoing caesarean section at term before the onset of labour.Interventions
Amnion cells were cultured in monolayer.Main outcome measures
Cell cycle analysis, intracellular calcium levels, prostaglandin (PG) production rates.Results
Epidermal growth factor (EGF) stimulated intracellular Ca2+ mobilisation and PGE2 production in cultured amnion cells. The addition of a Ca2+ channel blocker (cobalt) or a Ca2+ chelator (EGTA) into the culture medium inhibited intracellular Ca2+ mobilisation and PGE2 production induced by EGF. The analysis of cell cycles showed that EGF induced the initiation of DNA synthesis and that the addition of cobalt or EGTA into the culture medium inhibited EGF‐induced DNA synthesis. The addition of a cyclo‐oxygenase inhibitor (indomethacin) inhibited PGE2 production and DNA synthesis induced by EGF without the effect on intracellular Ca2+ mobilisation. Moreover, the inhibitory effect of indomethacin on EGF‐induced DNA synthesis was attenuated by the addition of exogenous PGE2 or PGF2n.Conclusions
These data suggest that EGF induces an increase in intracellular Ca2+ levels and the rate of prostaglandin production which leads to proliferation of human amnion cells.
Episiotomies and the occurrence of severe perineal lacerations
Authors: Anthony S. , Buitendijk S. E. , Zondervan K. T. , van Rijssel E. J. C. , Verkerk P. H. 
Published: August 2005

ABSTRACTObjective
To investigate the relation between the use of mediolateral episiotomy and the occurrence of severe (third degree) perineal tears in hospital deliveries in the Netherlands.Design
An observational study.Subject
Data were derived from the Dutch National Obstetric Database (LVR) of 1990, from which 43 309 spontaneous, occipito‐anterior, vaginal deliveries of live, singleton infants were investigated.Intervention
Medio‐lateral episiotomy.Main outcome measure
The occurrence of severe perineal tears.Results
The severe tear rate was 1.4% in the total study group. Using multiple logistic regression to control for possible confounding variables, the use of mediolateral episiotomy was found to be associated with a more than fourfold decrease in risk of severe lacerations (odds ratio 0.22, 95% CI 0.17 to 0.29). Further, in a logistic model deliveries in hospitals with restrictive use of episiotomy (< 11%) were compared with those in hospitals with liberal use of episiotomy (≥ 50%). Liberal use of episiotomy was not associated with a lower frequency of severe perineal tears.Conclusion
Although a protective effect of mediolateral episiotomy on the occurrence of severe lacerations was found, liberal use of mediolateral episiotomy should be discouraged on the basis of our findings.
The individualised birth weight ratio: a new method of identifying intrauterine growth retardation
Authors: Sanderson David A. , Wilcox Mark A. , Johnson Ian R. 
Published: August 2005

ABSTRACTObjective
To assess the effectiveness of the newly developed individualised birthweight ratio in identifying growth retarded infants.Design
Prospective observational study.Setting
Obstetric unit, City Hospital Nottingham.Subjects
Two thousand eight hundred and thirty‐five women delivered between December 1991 and July 1992 and the infants of 616 of these selected by virtue of their birthweight for gestation and individualised birthweight ratio centile positions.Main outcome measures
Skinfold thickness and ponderal index measurements, occurrence of abnormal fetal heart rate patterns, operative delivery due to fetal distress and the need for neonatal resuscitation.Results
Using an individualised birthweight ratio less than the 10th centile as a cut‐off results in 25% of those less than the 10th centile of birthweight for gestation being reclassified as normally grown. A slightly larger group are reclassified as small; significantly more of these infants have abnormal ponderal indices and skinfold thicknesses, suffer abnormal fetal heart rate patterns, operative delivery for fetal distress and need neonatal resuscitation than do those who are reclassified as normally grown.Conclusion
The individualised birthweight ratio combines the simplicity of birthweight measurement with the accuracy of clinical measurements in the identification of the growth retarded baby.
Five year survival rate in endometrial carcinoma stages I‐II: influence of degree of tumour differentiation, age, myometrial invasion and DNA content
Authors: Lindahl Bengt , Ranstam Jonas , Willén Roger 
Published: August 2005

ABSTRACTObjective
To compare the prognostic capability of clinical stage, tumour differentiation, myometrial invasion, age and DNA content in endometrial carcinoma. Then to use the results to identify a small, high risk group suitable for more intensive adjuvant therapy.Design
A prospective five year follow up between June 1980 and June 1987.Setting
Department of Oncology, gynaecological section, University Hospital, Lund, Sweden. Endometrial tissue was obtained immediately prior to treatment for flow cytometric DNA analysis.Subjects
Two hundred and fifty‐one patients referred for treatment.Interventions
None.Results
Age, myometrial invasion of greater than 50%, and number of DNA populations (ploidy) were the only significant parameters related to survival. By combining myometrial invasion and number of DNA populations, we divided the patients into four groups. A very small high risk group was identified (7%) with a low survival rate (61%). Two intermediate groups with either myometrial invasion exceeding 50% or with more than one DNA population present constituted 34% of the patients and these had an overall survival rate of 75% and a relatively large low risk group of 59% of the patients (with a survival rate of 95%) was constructed out of those without deep myometrial invasion and demonstrating only one DNA population.Conclusions
These data suggest that number of DNA populations and depth of myometrial invasion could be combined to identify a small high risk group (7%) with a low survival rate (61%) suitable for adjuvant therapy.
First trimester maternal serum alpha‐fetoprotein in fetal trisomies
Authors: Brizot M. L. , Kuhn P. , Bersinger N. A. , Snijders R. J. M. , Nicolaides K. H. 
Published: August 2005

ABSTRACTObjective To evaluate the potential value of maternal serum alpha‐fetoprotein concentration in the detection of fetal trisomy at 10 to 13 weeks gestation and to examine the possible association between maternal serum alpha‐fetoprotein and fetal nuchal translucency thickness.Design Cross‐sectional study.Setting Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London.Subjects and methods Maternal serum alpha‐fetoprotein concentration was measured at 10 to 13 weeks gestation in samples from 57 pregnancies with fetal trisomies (trisomy 21 (n= 35), trisomy 18 (n= 16), and trisomy 13 (n= 6)) in 228 matched controls in whom the fetal nuchal translucency was < 3 mm and in 114 chromosomally normal fetuses with translucency ≥3 mm.Results In the control group maternal serum alpha‐fetoprotein increased significantly with fetal crown‐rump length (r= 0.451). In this group, the median maternal serum alpha‐fetoprotein was not significantly different from that in the groups with trisomy 21 (median = 0.84 MOM), trisomy 18 (median = 0.86 MOM), or trisomy 13 (median = 0.94 MOM), respectively. Neither in the control group nor in the group with trisomic fetuses was maternal serum alpha‐fetoprotein significantly associated with fetal nuchal translucency thickness (r= 0.01 and r= 0.03).Conclusion Measurement of maternal serum alpha‐fetoprotein concentration in the first trimester of pregnancy is not likely to be useful in the prediction of fetal trisomies.
The effects of maternal betamethasone administration on the fetus
Authors: Derks Jan B. , Mulder Eduard J. H. , Visser Gerard H. A. 
Published: August 2005

ABSTRACTObjective To examine prospectively the effects of maternal betamethasone administration on fetal heart rate variation, body, breathing and eye movements and the rest‐activity cycle.Design Thirty‐one women on 38 occasions were at risk of premature delivery and received two doses of betamethasone 24 h apart. Gestational age ranged between 26 and 32 weeks. Fetal heart rate was monitored on each of five successive days (0–4) and fetal body, breathing and eye movements were recorded on days 0, 2 and 4.Results Compared with the control day before steroid administration (day 0), both long term and short term fetal heart rate variation were reduced on days 2 and 3 (P < 0.01). In one‐third of the cases, fetal heart rate variation fell transiently below the lower normal range for gestational age. Body movements were reduced on day 2 by 50% (P 0.01) due to prolonged periods of inactivity (P < 0.01). Breathing movements were largely absent on day 2 (P < 0.01), but the occurrence of eye movements remained unchanged after betamethasone administration. All values returned to baseline on day 4, indicating that no fetal deterioration had occurred during the course of the study period. Similar responses to betamethasone were observed in five fetuses when studied at re‐presentation two weeks later.Conclusions Maternal betamethasone administration causes a considerable but transient reduction in fetal body movements and activity periods, breathing and heart rate variation, without affecting fetal eye movements. Knowledge of this phenomenon is important when assessing the fetal condition. The effect may be due to a glucocorticoid receptor mediated process in the fetal brain.
Mortality after gynaecologic operations in Finland, 1986–1991
Authors: Virtanen H. S. , Mäkinen J. I. 
Published: August 2005

ABSTRACTObjective To study the current in‐hospital, 30–day and 42–day mortality after conventional gynaecologic procedures in Finland, with special reference to hysterectomy.Design Nationwide six‐year annual study.Setting Data were from the Finnish Population Register Centre, the Finnish Cause‐of‐Death and Hospital Discharge Register, and the Register for Legal Abortions and Sterilisations.Subjects Gynaecologic operations (n= 299257) performed between January 1986 and December 1991.Main outcome measures The overall and age‐adjusted mortality rates during the initial hospitalisation, as well as 30 and 42 days after the operations. Age‐adjusted probability of dying withn 42 days after hysterectomy compared with the overall probability of age‐matched Finnish female control population.Results Overall mortality rates per 10000 hysterectomies increased gradually from 6.0 during initial hospitalisation to 9.1 and 12.9 when calculated 30 and 42 days post‐operatively. The overall 42–day mortality rates of radical hysterectomy, curettage and laparoscopy (other than sterilisation) exceeded the post‐hysterectomy mortality rate, while the rates after caesarean section, legal abortion and laparoscopic sterilisation did not. No deaths occurred after laparoscopic sterilisation (n= 40346). The patients who died after radical hysterectomy, curettage and for other laparoscopy than sterilisation were old, and the great majority of them died of cancer.Conclusions The mortality rates after gynaecologic procedures in Finland are currently very low and have clearly decreased in recent decades. Patients may be reassured that conventional gynaecologic operations are safe.
Obstetricians' views on prenatal diagnosis and termination of pregnancy: 1980 compared with 1993
Authors: Green Josephine M. 
Published: August 2005

ABSTRACTObjective To examine the attitudes of obstetricians in England and Wales concerning prenatal diagnosis and termination of pregnancy and to compare these with a similar survey carried out in 1980.Methods Postal questionnaires, based on those used in 1980, were sent to a random sample of 555 nonacademic consultant obstetricians, 71% of whom replied.Results The proportion of consultant obstetricians with a conscientious objection to termination of pregnancy was the same in both surveys, although virtually all conscientious objectors said that they made an exception for serious fetal abnormality. A major change was in the proportion saying that they generally required an undertaking to terminate an affected pregnancy before proceeding with amniocentesis: 75% in 1980 compared with 34% in 1993. As in 1980, lower priority is given to telling women of negative test results than of positive. More obstetricians in 1993 are prepared to consider terminations later in pregnancy, both for fetal abnormality and for social reasons, than was the case in 1980, but many are not prepared to recommend termination as late in pregnancy as the law allows. In some cases this is due to misapprehensions about what is legal. There are particular problems concerning terminations for fetal anomalies that not all would consider serious. One in seven of the 1993 sample would not recommend termination for cystic fibrosis at any gestation. Only 13 % would recommend termination for Down's syndrome beyond 24 weeks. There is a need not only for clarification of the law, but also of obstetrician's willingness to implement it.
The chronically symptomatic vulva: aetiology and management
Authors: Fischer Gayle , Spurrett Brian , Fischer Arthur 
Published: August 2005

ABSTRACTObjective
To determine the causes and management of chronic vulval symptoms and to compare the findings in patients first presenting to a gynaecologist with those in patients first presenting to a dermatologist.Design
A prospective study of 144 patients, approximately half each being referred to a gynaecologist and a dermatologist. Diagnosis was based on clinical history, vulvoscopy, vulval biopsy and bacteriology. Biopsies were examined by a histopathologist experienced in dermatopathology and gynaecological pathology.Results
The two patient groups were similar in both range and frequency of conditions. The commonest cause of chronic vulval symptoms was dermatitis, which was found in 64% of our patients. Dermatitis occurred alone in 55% and was found in association with histological evidence of human papilloma virus (HPV) in a further 9%. These patients responded to simple dermatological methods, mainly topical corticosteroids. Histopathological evidence of HPV was encountered in only 23% of our patients, and of these 36% also demonstrated dermatitis on biopsy. Most responded to topical corticosteroids. Another 7% had lichen sclerosus, and all responded to potent topical corticosteroid. The remaining 15% demonstrated a range of diagnoses, including psoriasis, dysaesthetic vulvodynia, vulval intraepithelial neoplasia (VIN) and chronic candidiasis. The majority of patients had a corticosteroid responsive dermatosis rather than a gynaecological condition.Conclusions
The majority of patients with a chronically symptomatic vulva who present to either a gynaecologist or a dermatologist have a dermatological condition that responds to simple dermatological treatments. We believe that the presence or absence of the human papilloma virus is not relevant to most patients with a chronically symptomatic vulva and treatments should not be aimed at eradicating this virus. Histopathologists and gynaecologists who have focused on gynaecological disorders have often missed simple dermatological conditions that are easily treatable.
The prediction of fetal acidosis at birth by computerised analysis of intrapartum cardiotocography
Authors: Chung T. K. H. , Mohajer M. P. , Yang Z. J. , Chang A. M. Z. , Sahota D. S. 
Published: August 2005

ABSTRACTObjective
To assess the capability of a computer software interpretation program, using intrapartum fetal heart rate and intrauterine pressure as recorded in a cardiotocogram to predict fetal acidosis at birth.Design and subjects
A retrospective analysis of digitised fetal heart rate and uterine activity values obtained from 73 high risk women in labour.Setting
Two university teaching hospitals.Methods
A computer software program was constructed to analyse the digitised data and predict acidosis. The results of the analysis were compared with actual umbilical arterial blood pH and base excess at delivery.Results
The software cardiotocogram interpreter was able to predict a pH of less than 7.15 with an accuracy of 77%, a sensitivity of 88% and specificity of 75% in this set of data. It was able to predict a base excess of less than –8 mmol/1 with an accuracy of 81%, a sensitivity of 76% and specificity of 82%.Conclusions
A computerised method of analysing fetal heart rate and uterine activity using a simple algorithm has demonstrated a capability to predict fetal acidosis at the time of delivery. Further research in this area is warranted.
Reducing the induction to abortion interval in termination of second trimester pregnancies: a comparison of mifepristone with laminaria tent
Authors: Ho P. C. , Tsang S. S. K. , Ma H. K. 
Published: August 2005

ABSTRACTObjective
To determine whether mifepristone (RU486) is more effective than laminaria tent in shortening the induction‐abortion interval in termination of second trimester pregnancies with gemeprost.Design
Prospective randomised comparative trial.Setting
Department of Obstetrics and Gynaecology in a University teachng hospital.Subjects
Sixty‐two women undergoing termination of pregnancy in the second trimester.Interventions
The women were allocated at random to one of the two treatment groups. The first group received 600 mg of mifepristone 36 h before administration of gemeprost. In the second group, a medium‐sized laminaria tent was inserted 12 h before gemeprost. The pregnancies in both groups were terminated with vaginal gemeprost, 1 mg every 3 h up to a maximum of 5 mg/day.Main outcome measures
Induction‐abortion intervals, amount of gemeprost required, and incidence of side effects.Results
The median induction‐abortion interval in the mifepristone group (75 h) was significantly shorter than that in the laminaria tent group (11 h) and significantly fewer gemeprost pessaries were required. There was no significant difference in the amount of narcotic analgesics required or the incidence of side effects between the two groups.Conclusions
Mifepristone is more effective than laminaria tent in shortening the induction‐abortion interval in termination of second trimester pregnancies.