bluuebunny/crossref_metadata_2025_split huggingface dataset:
A single cervical fetal fibronectin screening test in; population at low risk for preterm delivery: an improvement on clinical indicators?
Authors: Faron Gilles , Boulvain Michel , Lescrainier Jean‐Pol , Vokaer Alain 
Published: August 2005

Objective
To assess the accuracy of a single cervical fetal fibronectin test to predict spontaneous preterm delivery in an unselected antenatal population.Design
A prospective blind cohort study.Setting
Antenatal clinic of a teaching hospital in a Brussels semiurban area.Participants
An unselected group of 170 women followed at the antenatal clinic.Methods
A single cervical sample was obtained between 24 and 33 completed weeks of pregnancy. The fibronectin test was compared with clinical evaluation and their predictive properties were assessed.Results
Fifteen women were excluded from the analysis because of elective preterm delivery for medical indications or loss to follow up. Of the 155 remaining women, nine (7%) had a spontaneous preterm delivery. For a single fetal fibronectin test, the sensitivity was 26.7%, the specificity 95.7%, and the positive and negative predictive values 40.0% and 92.4%, respectively. The likelihood ratio of a positive was similar to that of clinical predictors of preterm birth (LR = 6.2; 95% CI 2.0–19.6). Sensitivities were low for both clinical criteria and the fetal fibronectin test.Conclusions
Because of low sensitivity in a low risk population, screening for preterm delivery should not be based on the result of a single fetal fibronectin test alone. However, due to its high specificity the test might be useful in avoiding unnecessary medical intervention.
Screening for Down's syndrome: changes in marker levels and detection rates between first and second trimesters
Authors: Berry Esther , Aitken David A. , Crossley Jennifer A. , Macri James N. , Connor J. Michael 
Published: August 2005

Objective
To monitor changes with gestation in levels of alpha‐fetoprotein (AFP), free beta human chorionic gonadotrophin (FβhCG) and pregnancy associated plasma protein‐A (PAPP‐A) in Down's syndrome pregnancies and to compare risks estimated in the first trimester with those obtained by routine screening in the second trimester for the same pregnancies.Design
In each of 47 Down's syndrome pregnancies two maternal serum samples were obtained, one in the first trimester and one in the second trimester. Comparison of marker levels with 10,600 first trimester controls and a smaller sample of second trimester controls allowed case identification criteria based on optimum marker combinations to be developed and compared directly between trimesters.Setting
Biochemical genetics laboratory.Results
FβhCG was an effective marker of Down's syndrome in both the first and second trimesters. PAPP‐A levels were significantly reduced in trisomy 21 pregnancies in the first trimester only. Using a population model, these two markers in combination with maternal age gave an overall detection rate of 55% for a 5% false positive rate in the first trimester. For the paired first and second trimester samples, three of six cases classified as low risk by routine second trimester screening were classified as high risk by the first trimester screening protocol of FβhCG/PAPP‐A/matemal age. However, fifteen cases identified as high risk by routine second trimester screening were classified as low risk in the first trimester, a net loss in detection of 12 cases by first trimester screening.Conclusion
The data suggest that first trimester detection rates for Down's syndrome using a combination of FβhCG and PAPP‐A may vary with gestation and will be lower than those currently obtained by routine second trimester screening with AFP/hCG.
Ampicillin‐metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial
Authors: Svare Jens , Langhoff‐Roos Jens , Andersen Lars Franch , Kryger‐Baggesen NieIs , Borch‐Christensen Hanne , Heisterberg Lars , Kristensen Jens 
Published: August 2005

Objective
To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity.Design
Randomised controlled double‐blind trial.Setting
Six obstetric departments in the Copenhagen area.Population
One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation.Methods
Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo.Main outcome measures
Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections.Results
Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42%versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40%versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity.Conclusions
Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.
Effects of magnesium sulphate on the noradrenaline‐induced cerebral vasoconstrictor and pressor responses in the goat
Authors: Perales Alfredo J. , Torregrosa German , Salom Juan B. , Barbera Maria D. , Jover Teresa , Alborch Enrique 
Published: August 2005

Objective
To examine the ability of magnesium sulphate to counteract the noradrenaline‐induced cerebral vasoconstrictor and pressor responses in goats by using both in vivo and in vitro techniques.Design
Cerebral blood flow was measured in vivo by means of an electromagnetic flow probe around the internal maxillary artery. Isometric tension was recorded in vitro from rings of goat middle cerebral artery maintained in an organ bath.Results
1. In vivo. Continuous infusion of noradrenaline (10 μg/min) directly into the cerebral arterial supply elicited sustained decrease in cerebral blood flow (61% [SEM 3] of control values) and increase in cerebral vascular resistance (178% [SEM 9] of control values). Magnesium sulphate, injected directly into the cerebral arterial supply (10–300 mg) or infused intravenously (0.3 g and 3 g during 15 min) at the noradrenaline‐induced steady state, increased cerebral blood flow by decreasing cerebral vascular resistance in a dose‐dependent manner. A similar result was obtained when intravenous magnesium sulphate (3 g/15 min) was tested against the cerebral vasoconstrictor and pressor responses induced by intravenous infusion of noradrenaline (30 ug/min). 2. In vitro. When compared with the response obtained in a control medium (1 mmol/L Mg2+), 10 mmol/L Mg2+significantly inhibited the maximum contraction elicited by noradrenaline (10−8 to 3 × 10−3 mol/L) from 45% [SEM 4] to 26% [SEM 4].Conclusions
Magnesium sulphate reverses the noradrenaline‐induced cerebral vasoconstrictor and pressor responses by a direct inhibitory action of Mg2+ on the actions of noradrenaline in the cerebral and peripheral vascular beds, which leads to a decrease in vascular resistance. These results could explain, at least in part, the beneficial effects of magnesium sulphate in the management of pre‐eclampsia and eclampsia.
Magnetic resonance imaging of the uterus after endometrial resection
Authors: Turnbull L. W. , Jumaa A. , Bowsley S. J. , Dhawan S. , Horsman A. , Killick S. R. 
Published: August 2005

Objective
Despite the increasing popularity of endometrial resection for the treatment of menstrual problems, the long term sequelae of this procedure are poorly recognised. As diagnostic hysteroscopy following endometrial resection is frequently unrewarding and transvaginal ultrasound is incapable of detecting subtle changes in endometrial morphology, magnetic resonance imaging was employed to evaluate the uterus.Design
Retrospective study of unselected post‐operative women.Methods
Fifty‐nine women, of whom 22 were amenorrhoeic, were studied a mean number of 34 months after endometrial resection, using a 1.5 Tesla magnetic resonance imaging system with a pelvic phased array coil for signal reception. T2‐weighted FSE images were acquired through the long and short uterine axis and volumetric assessment of each uterine layer performed using an ISG Allegro workstation.Main outcome measures
The location and volume of residual endometrium, the volume of junctional zone and myometrial tissue, and the presence of additional intrauterine and pelvic pathology were recorded.Results
Residual endometrium was demonstrated in all except three amenorrhoeic women, with a similar mean volume present in menstruating and amenorrhoeic groups. Additional findings included adenomyosis, haematometra, fallopian tube dilatation and free intraperitoneal fluid.Conclusions
The majority of amenorrhoeic and all menstruating women have residual endometrium after endometrial resection. The lack of communication of islands of residual endometrium with the uterine cavity results in haematometra formation, fallopian tube dilatation and possibly free intraperitoneal fluid.
A regional audit of perinatal and infant autopsies in Northern Ireland
Authors: Thornton C. M. , O'Hara M. D. 
Published: August 2005

Objective
To investigate the rate and quality of perinatal/infant autopsies and their contribution to the final diagnosis.Methods
The anonymised reports of autopsies performed on 174 of the 367 cases reported to the Northern Ireland Regional Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) coordinator in 1993 were reviewed. They were scored using a modification of the CESDI Pathology Audit Form 93 and, based on the score obtained, ascrined to one of three groups: good, adequate or inadequate. Based on the information obtained, they were also assessed as providing diagnostic, confirmatory, additional or no diagnostic data. The pre‐autopsy clinical extended Wigglesworth classification was compared with that based on autopsy findings.Results
The autopsy rate was 47.4% and included 18 late fetal losses, 70 stillbirths, 57 neonatal deaths and 29 post neonatal deaths. The Regional Paediatric Pathology Centre performed 34.5% of the autopsies. Of the total number of autopsies, 46.6% failed to reach an adequate standard. Only 4.9% of the inadequate autopsies were performed in the Regional Centre. The Wigglesworth classification was altered in 20.7% of cases following autopsy. The autopsy findings of 49 cases were diagnostic, 75 confirmatory, 23 yielded additional information and 27 were useful in only a negative sense.Conclusion
The autopsy rate for this region is well below the recommended level of 75%. With the exception of the Regional Centre, the quality of the perinatallinfant autopsy did not reach the standard suggested in the CESDI Pathology Audit form 93. Despite this the autopsy yielded valuable diagnostic, confirmatory or additional findings in 84.5% and resulted in alteration to the pre‐autopsy Wigglesworth classification in 20.7%.
A systematic review comparing continuity of midwifery care with standard maternity services
Authors: Waldenström Ulla , Turnbull Deborah 
Published: August 2005

Objective
To review randomised controlled trials of alternative maternity services characterised by continuity of midwifery care.Methods
A systematic review of randomised controlled trials, analysed on an intention to treat basis, in which the study intervention was characterised by a midwife or small group of midwives providing care from early pregnancy to the postnatal period (defined as that provided on the postnatal ward); and the controls by standard maternity care as practised in the place where the trial was conducted. The seven trials identified included 9148 women. Main outcome measures were interventions during labour, maternal outcomes and infant outcomes.Results
The alternative models with continuity of midwifery care were associated with less use of obstetric interventions during labour (eg, induction, augmentation of labour, electronic fetal monitoring, obstetric analgesia, instrumental vaginal delivery and episiotomy). However, the caesarean section rate did not differ statistically between the trial groups (OR 0.91; 95% CI 0.78 to 1.05). The lower episiotomy rate in the alternative models of care (OR 0.69; 95% CI 0.61 to 0.77) was associated with a significantly higher rate of perineal tears in the pooled alternative groups (OR 1.15; 95% CI 1.05 to 1.26). The percentage of intact perineums was very similar for the two groups (OR 1.11; 95% CI 1.00 to 1.24). There was no maternal death, and rates of maternal complications based on unpooled estimates did not show any statistically significant differences. The proportion of babies with an Apgar score < 7 at five minutes after the birth was approximately the same in the pooled alternative groups as in the control groups (OR 1.13 95% CI 0.69 to 1.84). Admission to intensive care or special care baby unit was similar (OR 0.86; 95% CI 0.71 to 1.04). The difference in perinatal deaths was bordering on statistical significance (OR 1.60; 95% CI 0.99 to 2.59).Conclusion
Continuity of midwifery care is associated with lower intervention rates than standard maternity care. No statistically significant differences were observed in maternal and infant outcomes. However, more research is necessary to make definite conclusions about safety, for the infant as well as for the mother. This review illustrates the variation in the different models of alternative and standard maternity care, and thus the problems associated with pooling data from different trials.
Potentially avoidable perinatal deaths in Denmark, Sweden and Lithuania as classified by the Nordic‐Baltic classification
Authors: Langhoff‐Roos Jens , Larsen Steen , Basys Vytautas , Lindmark Gunilla , Badokynote Migle 
Published: August 2005

Objectives
To analyse which subgroups of perinatal deaths contribute most to the perinatal mortality rate in Lithuania compared with Denmar/Sweden.Design
Comparison of all perinatal deaths in Denmark/Sweden 1991 and Lithuania 1993–1994 by the common Nordic‐Baltic perinatal death classification, based on information from the medical records.Results
The doubled perinatal mortality in Lithuania compared with Denmark/sweden is mainly explained by a threefold increase of intrapartum and two‐ to fivefold increase in neonatal deaths of nonmalformed infants. The higher rate of malformed infants is partly explained by a four times higher mortality from neural tube defects.Conclusions
The use of a common perinatal death classification has identified categories mainly responsible for the higher rate of perinatal mortality, but further investigation of potentially avoidable factors requires further study.
A randomised trial of mode of delivery in women infected with the human immunodeficiency virus
Authors: Newell Marie‐Louise , Parazzini Fabio , Mandelbrot Laurent , Peckham Catherine , Semprini Augusto , Bazin Brigitte , Darbyshire Janet , Sanchez Emilia , Pardi Giorgio 
Published: August 2005

Objective
During the pilot phase of a trial to evaluate the effectiveness of caesarean section delivery compared with vaginal delivery in reducing mother‐to‐child transmission of human immunodeficiency virus (HIV) infection, the feasibility of randomisation to mode of delivery was assessed.Design
At 36 weeks of pregnancy, women infected with HIV were randomly allocated to either caesarean section delivery at 38 weeks or vaginal delivery. Information was also collected on the reasons why women were not enrolled, either because they refused or had a contraindication.Setting
Fifty‐one centres in six European countries. Population Pregnant women with confirmed HIV1 infection Main outcome measures Randomisation.Results
Three‐hundred and thirty‐nine women had been randomised by the end of 1996, the large majority from Italy (n= 250) and France (n= 54), with 22 from South Africa, three from Sweden, nine from Barcelona and one from London. A further 150 women were eligible but had not been randomised. Forty‐eight women (14%) were not delivered according to the arm to which they were randomised; the majority (n= 44) were changed from vaginal to caesarean section delivery. There is wide variation between European countries in the acceptability and adherence to the mode of delivery trial.Conclusion
The pilot phase of this trial has shown that in some settings randomisation to mode of delivery is feasible and acceptable, but that in other setttings clinicians and pregnant women are more reluctant to be randomised. Pending further information on transmission rates and accrual, enrollment into the trial continues.
Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility
Authors: Li T. C. , Saravelos H. , Chow M. S. , Chisabingo R. , Cooke I. D. 
Published: August 2005

Objective
To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.Design
A retrospective study.Setting
A specialist infertility clinic based at a teaching hospital in England.Population
One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995.Main Outcome measures
Ovulation and pregnancy rate.Results
The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre‐operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the preoperative levels were the main determinants of the outcome.Conclusion
Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre‐operative level was more than 10 IU/L reached 79%.
A comparative study using two dose regimens (200 μg or 400 μg) of vaginal misoprostol for pre‐operative cervical dilatation in first trimester nulliparae
Authors: Fong Y. F. , Singh Kuldip , Prasad R. N. V. 
Published: August 2005

Objective
To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre‐operative cervical dilatation.Design
Prospective double‐blind randomised study.Setting
Fertility Control Centre, National University Hospital, Singapore.Methods
Women were randomly allocated to either the 200 μg or the 400 μg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre‐operative and intra‐operative blood loss, and associated side effects.Results
For the 200 μg misoprostol group, only seven (23.3%) achieved a dilatation of ≥ 8 mm compared with 29 women (96.7%) in the 400 μg misoprostol group. The odds ratio was 95.3 (95% CI 10.9–830.9) for 400 pg misoprostol for successful pre‐operative cervical dilatation of ≥ 8 mm. The mean cervical dilatation for 400 μg and 200 μg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 pg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated.Conclusion
This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 μg misoprostol for at least three hours is optimal for pre‐operative cervical dilatation before vacuum aspiration in first trimester nulliparae.
The rise in caesarean section rate: the same indications but a lower threshold
Authors: Leitch C. R. , Walker J. J. 
Published: August 2005

Objective
To investigate the reasons for the rise in caesarean section rate and note any change in Design A retrospective, descriptive study comparing the years 1962 and 1992.Setting
A large city centre teaching hospital.Results
There was an overall increase in the caesarean section rate from 6.8% in 1962 to 18.1% in 1992. No single cause contributed more than 30% towards this increase. The main indications in both years were similar: failure to progress (42.2%vs 36.7%) and fetal indications (18.1%vs 18.9%). The largest relative increases were in the malpresentation group (10.8%vs 16%) and previous caesarean section (4.5%vs 15.2%).Conclusions
These results suggest that there has been a lowering in the overall threshold concerning the decision to carry out a caesarean section rather than changes in obstetric management. Obstetricians and the women in their care have to decide whether the current balance between risk and benefit is acceptable or whether they wish to alter the underlying philosophy if any significant reduction is to be sustained. indications.
Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycaemic clamp technique
Authors: Stanley Katharine , Fraser Robert , Bruce Christine 
Published: August 2005

Objective
To perform measurements of insulin resistance serially in pregnancy and after childbirth in normal women.Design
Longitudinal study.Setting
Teaching hospital.Methods
Ten normal women were studied using the hyperinsulinaemic euglycaemic clamp technique before pregnancy, at 16, 26 and 36 weeks gestation, and 8 weeks after delivery. All women breastfed their infants. Insulin resistance was measured by the glucose infusion rate required to maintain the plasma glucose at 4.5 mmol/l.Results
There was a progressive increase in insulin resistance in all women as pregnancy progressed. The increase in resistance was most marked between 16 and 26 weeks of gestation, with only minimal progression thereafter. Lactation does not alter insulin resistance.Conclusion
The timing and extent of changes in insulin resistance are of physiological importance because they affect all classes of maternal and fetal substrates.