bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated tissue plasminogen activator as a potential marker of endothelial dysfunction in pre‐eclampsia: correlation with proteinuria
Authors: Belo Luís , Santos‐Silva Alice , Rumley Ann , Lowe Gordon , Pereira‐Leite Luís , Quintanilha Alexandre , Rebelo Irene 
Published: December 2003

Objective
To clarify the role played by endothelial cell production of fibrinolytic factors in normal pregnancy and pre‐eclampsia.Design
A longitudinal study performed during normal pregnancy and a cross sectional study performed in healthy and pre‐eclamptic pregnant women in the third trimester of pregnancy.Setting
Department of Obstetrics and Gynaecology, University Hospital of S. João, Porto, Portugal.Population
Fourteen normal pregnant women followed through the three trimesters of gestation. Two groups of women (normal, n= 56; pre‐eclamptic, n= 37) evaluated at the third trimester of gestation.Methods
Measurement of platelet number, plasma levels of fibrinogen, tissue plasminogen activator (t‐PA) antigen, plasminogen activator inhibitor‐1 (PAI‐1) activity, and fibrin fragment D‐dimer.Main outcome measures
Pre‐eclampsia, proteinuria.Results
All the substances, except platelet count, increased significantly throughout normal pregnancy. Comparison of the values in the third trimesters of normal and pre‐eclamptic pregnancies showed similar values for the fibrinogen and platelet counts, and higher values of t‐PA (almost twice normal median value; P < 0.0001), PAI‐1 and D‐dimer in the pre‐eclamptic women. t‐PA correlated positively and significantly with the degree of proteinuria in pre‐eclamptic women (r= 0.575, P= 0.0002).Conclusion
These findings suggest that elevated t‐PA antigen may reflect endothelial disturbance in pre‐eclampsia, and may be a potential biomarker of risk.
Does fear of childbirth during pregnancy predict emergency caesarean section?
Authors: Johnson Rebecca , Slade Pauline 
Published: December 2003

Objective
Caesarean section rates are rising dramatically in the UK. It has been estimated that they have increased from 10% to 22% of all births over 15 years. A Swedish study has suggested that fear of childbirth during pregnancy may increase the risk of emergency caesarean section. The aim of this study is to identify whether fear of childbirth can predict the occurrence of emergency caesarean section in a UK sample.Design
A prospective design using between‐group comparisons.Setting
Sheffield, S. Yorkshire, UK.Sample
Four hundred and forty‐three pregnant women, recruited at 32 weeks of gestation, over 16 years of age.Methods
Participants completed self‐assessment, postal questionnaires assessing fear of labour and anxiety using the Wijma Delivery Expectancy Scale (W‐DEQ) and the Speilberger State Trait Anxiety Scale (STAI), together with their expectations about their mode of delivery. Delivery information was gathered via birth summary sheets.Main outcome measure
Mode of delivery.Results
Emergency caesarean section was associated with previous caesarean section, parity, age and a score reflecting medical risk, but not fear of childbirth or anxiety measures. There were no differences in fear between women experiencing spontaneous‐vertex, forceps/ventouse, emergency or elective caesarean deliveries. The W‐DEQ was factor analysed and was found to measure four distinct domains: fear, lack of positive anticipation and the degree to which women anticipate isolation and riskiness in childbirth. However, these individual factors also failed to contribute to the prediction of mode of delivery. Primiparous women in the UK sample showed highly elevated fear scores when compared with a Swedish sample. Such discrepancies were not found for the multiparous sample.Conclusions
Fear of childbirth during the third trimester is not associated with mode of delivery in a UK sample. Possible cross‐cultural differences are discussed.
Reproductive performance after hysteroscopic metroplasty in the hypoplastic uterus: a study of 29 cases
Authors: Barranger Emmanuel , Gervaise Amélie , Doumerc Séverin , Fernandez Hervé 
Published: December 2003

Objective
To evaluate the reproductive performance after hysteroscopic metroplasty performed for hypoplastic uterus.Design
Crossover study (15 patients) and descriptive analysis (14 patients).Setting
Tertiary care university hospital.Population
Twenty‐nine women (mean age: 31.4 years; range: 27–38.5 years) with a hypoplastic malformed uterus and a history of primary infertility and/or recurrent abortion and/or preterm delivery were included in this study. Fourteen women suffered from primary infertility and 15 women had previous pregnancies. Twenty‐three women had been exposed to diethylstilboestrol in utero.Methods
Women underwent hysteroscopic metroplasty between January 1996 and May 1999.Main outcome measures
Rate of pregnancies and live births, anatomical results.Results
The mean follow up was 40 months (range: 13–67 months). Twenty‐one women (72.4%) experienced 30 pregnancies. Thirteen women gave birth to 16 live infants. At the time of the follow up, four women were pregnant in the second trimester. Compared with previous pregnancies, the rate of deliveries increased from 3.8% to 63.2%. No complications occurred during metroplasty. The hysteroscopic anatomical results were good in all cases.Conclusions
Our results suggest that hysteroscopic metroplasty, with its simplicity and minimal post‐operative sequelae, seems to be an operation of choice in women with a hypoplastic malformed uterus and a history of severe infertility and/or recurrent pregnancy loss.
A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy
Authors: Bartley Julia , Baird David T. 
Published: December 2003

Objective
To compare the effectiveness of gemeprost and misoprostol as prostaglandins used in combination with mifepristone for induction of mid‐trimester termination.Design
Randomised trial.Setting
Scottish teaching hospital.Sample
One hundred women undergoing abortion between 12 and 20 weeks.Methods
Each woman received 200 mg mifepristone and 36–48 hours later either 1 mg gemeprost vaginal pessary every 6 hours for 18 hours or 4 × 200 μg misoprostol tablets vaginally followed by 2 × 200 μg misoprostol tablets orally every 3 hours for 12 hours. Success was defined as the percentage of women aborted within 24 hours of the first administration of prostaglandin.Main outcome measures
Prostaglandin–abortion interval and side effects.Results
There were no significant differences in median prostaglandin–abortion interval between gemeprost (6.6 hours 95% CI 6.0–10.7) and misoprostol (6.1 hours 95% CI 5.5–7.5) (P= 0.22). The cumulative abortion rates at 24 hours (96%vs 94%, respectively), the surgical evacuation rates (12% and 10%) and the incidence of vomiting, diarrhoea and pain were similar.Conclusion
Two hundred milligrammes of mifepristone followed 36–48 hours later by either vaginal gemeprost or misoprostol is a highly effective way of inducing abortion in the second trimester of pregnancy.
Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth
Authors: Frudinger Andrea , Halligan Steve , Spencer John A.D. , Bartram Clive I. , Kamm Michael A. , Winter Raimund 
Published: December 2003

Objective
To assess the relationship between the subpubic arch angle, anal sphincter and perineal trauma, and anal incontinence after childbirth in nulliparous women.Design
Prospective cohort study.Setting
University teaching hospital.Sample
One hundred thirty‐four low risk nulliparous women.Methods
Measurements of the bony pelvic outlet were made to calculate the subpubic arch angle. Endosonographic assessment of the perineum and anal sphincter was made before and after delivery. A specific bowel function questionnaire was completed before and after delivery.Main outcome measures
Perineal and anal sphincter trauma, and deteriorating anal continence after delivery.Results
Thirty‐two women with a subpubic arch angle of less than 90° had significantly prolonged first and second stages of labour when compared with 102 women whose subpubic arch was wider. Following delivery, anal continence deteriorated in more women with a narrow subpubic angle (69%vs 21%, P < 0.001) but this was unrelated to the incidence of anal sphincter and perineal trauma.Conclusions
A narrow subpubic arch is strongly associated with prolonged labour and postpartum anal incontinence in nulliparous women. However, perineal and anal sphincter trauma, assessed by ultrasound, does not account for the higher rate of postpartum anal incontinence in women with a narrow subpubic arch angle.
The management of symptomatic hydronephrosis in pregnancy
Authors: Fainaru Ofer , Almog Beny , Gamzu Ronni , Lessing Joseph B. , Kupferminc Michael 
Published: December 2003

Objective
To present and to evaluate the conservative and surgical management of hydronephrosis in pregnancy.Design
Retrospective analysis of an interventional cohort.Setting
A tertiary maternity ward.Sample
Of the 30,552 women delivering in our institution between January 1998 and June 2001, 56 women (0.2%) were admitted to the prenatal care unit due to symptomatic hydronephrosis.Methods
For each patient, renal sonography, urinalysis, serum creatinine levels, white blood cell counts and urine culture were obtained. All patients were treated conservatively by analgesics, intravenous fluids and antibiotics. Failure of these measures: non‐resolving infection, deteriorating renal function, absence of Doppler sonographic evidence of ureteral flow or intractable pain led to instrumental drainage of the affected kidney. A double pigtail polyurethane ureteric stent was passed under cystoscopic vision and sonographic guidance.Main outcome measures
Resolution of clinical symptoms.Results
Conservative treatment led to resolution in 52 women (92.9%), whereas four women (7.1%) failed to respond and were treated successfully and without complications by pigtail insertion. Early induction of labour was unnecessary and good perinatal outcome was the rule.Conclusions
Although the vast majority of cases of symptomatic hydronephrosis in pregnancy may be treated conservatively, pigtail insertion is an efficient and safe modality for the rare patient with refractory symptoms.
The effect of the publication of a major clinical trial in a high impact journal on clinical practise: the ORACLE Trial experience
Authors: Kenyon Sara , Taylor David J. 
Published: December 2003

Objective
To estimate the short term effect of the publication of a major clinical trial on clinical practise.Design
Questionnaire survey of clinical practise.Setting
UK.Population
All maternity units in the UK.Method
A self‐administered questionnaire completed by lead consultants on delivery suite of maternity units.Main outcome measures
Changes in antibiotic prescription.Results
Within six months of publication, approximately 50% of maternity units had changed their guidelines for the care of women with preterm prelabour rupture of the fetal membranes.Conclusion
Publication of a major clinical trial does impact on clinical practise but the impact is heterogeneous in terms of time and consistency.
Active management of term prelabour rupture of membranes with oral misoprostol
Authors: Shetty A. , Stewart K. , Stewart G. , Rice P. , Danielian P. , Templeton A. 
Published: December 2003

Objective
To compare the active management of term prelabour rupture of membranes with oral misoprostol with conservative management for 24 hours followed by induction with oxytocin or prostaglandin E2 (PGE2) gel.Design
A non‐blinded randomised controlled trial.Setting
Induction and labour wards, Aberdeen Maternity Hospital.Population
Sixty‐one women with confirmed prelabour rupture of the membranes at ≥36 weeks of gestation.Methods
The women were randomised to 50 μg of oral misoprostol repeated every 4 hours, if required, to a maximum of five doses (active group), or to induction of labour with PGE2 gel or oxytocin only if not in spontaneous labour 24 hours after prelabour rupture of membranes (conservative group).Main outcome measures
Number of women in active labour within 24 hours of the prelabour rupture of membranes, preference of women for any one particular method of management in any subsequent pregnancy with prelabour rupture of membranes.Results
93.3% of the active group and 54.8% of the conservative group were in spontaneous labour within 24 hours of the prelabour rupture of membranes (RR 1.7, 95% CI 1.2 to 2.4). Of those achieving a vaginal delivery, 72% of the active group did so within 24 hours of the prelabour rupture of membranes as compared with 26.9% of the conservative group (RR 2.7, 95% CI 1.4 to 5.3, P= 0.002). There were no significant differences in the neonatal or maternal outcomes. In the active group, 78% felt they would have the same method of induction as compared with 40% in the conservative group (RR 1.9, 95% CI 1.1 to 3.3, P= 0.03).Conclusions
Active management with oral misoprostol resulted in more women going into labour and delivering within 24 hours of the prelabour rupture of membranes with no increase in maternal or neonatal complications. Women tended to view active management of prelabour rupture of membranes more positively. Oral misoprostol might be an option to consider in those wishing active management.
A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence
Authors: Fitzpatrick Myra , Harkin Rosemary , McQuillan Katherine , O'Brien Conor , O'Connell P. Ronan , O'Herlihy Colm 
Published: December 2003

Objective
To assess the effects of delayed vs immediate pushing in second stage of labour with epidural analgesia on delivery outcome, postpartum faecal continence and postpartum anal sphincter and pudendal nerve function.Design
Prospective, randomised, controlled trial.Setting
Tertiary referral maternity teaching hospital.Population
One hundred and seventy nulliparous women randomised at full dilatation to immediate or delayed pushing.Methods
A total of 178 nulliparous women, all with continuous epidural analgesia, were randomised at full cervical dilatation, but before the fetal head had reached the pelvic floor, to either immediate pushing or 1 hour delayed pushing. Labour outcome was analysed and all women underwent postpartum assessment of anal sphincter function, including anal manometry. Those women who had a normal delivery underwent neurophysiology studies, while those women who had an instrumental delivery underwent endoanal ultrasound.Main outcome measures
Mode of delivery; altered faecal continence.Results
Ninety women were randomised to immediate pushing and 88 to delayed pushing. The spontaneous delivery rate was 56% (50/90) in the immediate pushing group and 52% (46/88) in the delayed pushing group. Mean duration of labour for the immediate pushing group was 427 minutes compared with 480 minutes for the delayed pushing group (P= 0.005). Eighty‐four percent (76/90) of women in the immediate pushing group received oxytocin to augment labour, 21/76 (28%) in the second stage only. Eighty‐one percent (71/88) of women in the delayed pushing group received oxytocin to augment labour, 22/71 (31%) in the second stage only. Fetal outcome did not differ between the two groups. Episiotomy rates were 73% and 69% in the immediate pushing and delayed pushing groups, respectively. 26% (23/90) of the immediate pushing group and 38% (33/88) of the delayed pushing group complained of altered faecal continence after delivery (NS). Manometry, ultrasound and neurophysiology studies did not differ significantly between the two groups. Overall, 55% of women after instrumental delivery had endosonographic evidence of damage to the external anal sphincter, while 36% of women after spontaneous delivery had abnormal neurophysiology studies.Conclusions
Rates of instrumental delivery were similar following immediate and delayed pushing, in association with epidural analgesia. Delayed pushing prolonged labour by 1 hour but did not result in significantly higher rates of altered continence or anal sphincter injury, when compared with immediate pushing.
Olfactory modulation of nausea during early pregnancy?
Authors: Hummel T. , von Mering R. , Huch R. , Kölble N. 
Published: December 2003

Objectives
To investigate whether nausea and vomiting and olfactory sensitivity are correlated, we determined whether subjects with little or no nausea and vomiting are less sensitive to odours than subjects who indicate a high degree of nausea and vomiting, and whether subjects with relatively low olfactory sensitivity are less prone to nausea and vomiting than subjects with relatively higher olfactory sensitivity.Design
Cross sectional study.Setting
The Unit of Perinatal Physiology, Department of Obstetrics, University Hospital, Zurich, Switzerland.Population
Fifty‐three women in early pregnancy.Methods
Following a detailed history related to olfaction and nausea and vomiting, subjects filled in a nausea profile which provided a ‘general nausea score’ comprised of the factors ‘somatic distress’, ‘gastrointestinal distress’, and ‘emotional distress’. Olfactory function was assessed using pen‐like odour dispensing devices (‘sniffin’ sticks’). Tests included n‐butanol odour threshold, odour discrimination and odour identification.Main outcome measures
Olfactory function assessed by means of the sniffing sticks nausea profile.Results
Correlational analyses between results of olfactory sensitivity and scores from the nausea questionnaire were not significant. Further, when subjects were divided into groups with relatively low or relatively high overall scores in the nausea profile, olfactory sensitivity did not differ between groups. Similarly, other analyses did not indicate a modulation of nausea and vomiting through olfactory sensitivity.Conclusions
These findings do not support the hypothesis that higher olfactory sensitivity relates to an increase of nausea. However, they do support the idea that olfactory‐induced nausea is independent of subjectively perceived intensity. Olfactory‐induced nausea appears to be due to the cognitive processing of olfactory information which, in early pregnancy, is reported to be altered in an unsystematic fashion.
Side effects of oral misoprostol during the first 24 hours after administration in the third stage of labour
Authors:   For the WHO Collaborative Group to Evaluate Misoprostol in the Management of the Third Stage of Labour, Lumbiganon Pisake , Villar José , Piaggio Gilda , Metin Gülmezoglu A. , Adetoro Lekan , Carroli Guillermo 
Published: December 2003

Objective
To evaluate the side effects of 600 μg misoprostol orally during the first 24 hours after administration in the third stage of labour.Design
Double blind randomised controlled trial.Setting
Tertiary care hospitals in Nigeria and Thailand.Sample
All women participating in the WHO Misoprostol trial in these two hospitals between January 1, 1999 and June 17, 1999.Methods
All women were followed up during the first 24 hours postpartum to evaluate the occurrence of shivering, nausea, vomiting, diarrhoea and other misoprostol‐related side effects.Main outcome measures
Rates of shivering, nausea, vomiting, diarrhoea and pyrexia within 1 hour and in the intervals 2–6, 7–12, 13–18 and 19–24 hours after delivery.Results
A total of 1686 women were enrolled. Women who received misoprostol had higher incidence than the oxytocin group of ‘any’ shivering in the first hour (RR 6.4, 95% CI 3.9 to 10.4) and the period covering 2–6 hours following delivery (RR 4.7, 95% CI 1.9 to 11.2). Pyrexia was also more common in the misoprostol group in both the same time intervals (RR 2.8, 95% CI 1.4 to 5.3 and RR 6.3, 95% CI 3.7 to 10.8, respectively). Diarrhoea was not present in the first hour in either group but appeared in the second time period (2–6 hours) and third time period (7–12 hours) more frequently in the misoprostol group than with oxytocin.Conclusion
The increased incidence of shivering and pyrexia that occurs with postpartum use of misoprostol persists up to 6 hours following delivery. Approximately 5% of women experience diarrhoea that starts after 1 hour and subsides within 12 hours.
Fetal fibronectin—how useful is it in the prediction of preterm birth?
Authors: Leitich Harald , Kaider Alexandra 
Published: December 2003

Objective
To determine the value of cervicovaginal fetal fibronectin as a marker for preterm delivery, a previously published meta‐analysis was updated.Study design
Selection criteria confined the analysis to English‐language original reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. For the outcomes of delivery <37 or <34 weeks' gestation or delivery within 7, 14, or 21 days after fibronectin sampling, we calculated sensitivity and specificity rates for each study, for subgroups of studies, and for all studies combined.Results
A total of 40 studies were included. Statistical heterogeneity was seen in the majority of calculations of combined results and a random‐effects model was used in these cases. For the outcomes of delivery <37 and <34 weeks' gestation, overall sensitivity rates were 52% and 53%, and overall specificity rates were 85% and 89%, respectively. For the outcomes of delivery within 7, 14, and 21 days, we calculated sensitivity rates of 71%, 67%, and 59% and specificity rates of 89%, 89%, and 92%, respectively. For the subgroup of women with symptoms of preterm labour, sensitivity rates for delivery <37 and <34 weeks' gestation or delivery within 7, 14, and 21 days of 54%, 63%, 77%, 74%, and 70% and specificity rates of 85%, 86%, 87%, 87%, and 90% were calculated.Conclusion
Cervicovaginal fetal fibronectin is an effective short‐term marker of preterm delivery, especially in women with symptoms of preterm labour. Because results appear to be heterogeneous in different studies, caution should be taken when they are applied to a specific population.
Massive perivillous fibrinoid causing recurrent placental failure
Authors: Bane A.L. , Gillan J.E. 
Published: December 2003

Objective
To establish the incidence, recurrence rate and consequences of massive perivillous fibrinoid.Design
Retrospective analysis of the histology of all placentas with a diagnosis of massive perivillous fibrinoid between 1991 and 1998, together with the maternal case records.Setting
The histopathology department of the Rotunda Hospital, Dublin, Ireland.Population
A relatively homogeneous group of pregnant women in the northern part of Dublin City, which is the catchment area for the Rotunda Hospital, delivered between 1991 and 1998.Methods
Retrospective review of archival placental pathology and maternal charts.Main outcome measures
The incidence of massive perivillous fibrinoid, perinatal outcome and recurrence rate.Results
The incidence of massive perivillous fibrinoid was 0.028%, with a recurrence rate of approximately 18%. All the infants suffered intrauterine growth restriction; there was a 31% fetal loss rate and a 33% preterm delivery rate.Conclusions
Massive perivillous fibrinoid is associated with intrauterine death, intrauterine growth restriction and preterm delivery. It has a significant recurrence rate and both the clinical findings of intrauterine growth restriction and the postmortem findings imply a syndrome of chronic placental insufficiency.