bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delivery outcome after the use of acid‐suppressing drugs in early pregnancy with special reference to omeprazole
Authors: Källén Bengt 
Published: August 2005

Objective
To study delivery outcome after maternal use of acid‐suppressing drugs during early pregnancy.Design
Cohort study of women identified by interview in early pregnancy.Population
Sweden women giving birth from 1995 to early 1997.Methods
Comparison of infants exposed to acid‐suppressing drugs with all births in 1995–1996.Main outcome measures
Presence of congenital malformations.Results
Proton pump blockers were used by 275 women, H2 receptor antagonists by 255 women, and both categories of drugs by 20 women. No effect of the use of omeprazole or H2‐receptor antagonists on the rate of congenital malformations could be demonstrated.Conclusions
Though a teratogenic effect of these drugs cannot be completely ruled out, the individual risk after exposures during the first trimester seems to be negligible.
A randomised placebo controlled trial of oral misoprostol in the third stage of labour
Authors: Justus Hofmeyr G. , Cheryl Nikodem V. , de Jager Marinda , Gelbart Bradley R. 
Published: August 2005

Objective
To compare oral misoprostol 400 μg with placebo in the routine management of the third stage of labour.Design
A double‐blind placebo controlled trial.Setting
The labour ward of an academic hospital in Johannesburg, South Africa with 7000 deliveries per annum.Participants
Low‐risk women expected to deliver vaginally.Methods
Women in labour were randomly allocated to receive either misoprosto1 400 μg orally or placebo after the birth. Conventional oxytocics were given immediately if blood loss was thought to be more than usual. Postpartum blood loss in the first hour was measured by collection in a special flat plastic bedpan. Side effects were recorded.Main outcome measures
Measured blood loss ≥ 2 1000 ml within the first hour after birth. Use of additional oxytocics.Results
The groups were well matched. Measured blood loss ≥ 1000 ml occurred in 15/250 (6%) after misoprostol and 23/250 (9%) after placebo (relative risk 0.65; 95% confidence interval 0.35–1.22). The difference may have been reduced by the greater use of conventional oxytocics in the placebo group, which was statistically significant for intravenous oxytocin infusion (2.8% vs 8.4%, relative risk 0.33, 95% confidence interval 0.140.77). Shivering was more common in the misoprostol group (190/, vs 5%, relative risk 3.69; 95% confidence interval 2.05‐6.64).Conclusions
Shivering has been shown in this study to be a specific side effect of misoprostol administered orally in the puerperium. No serious side effects were noted. Misoprostol shows promise as a method of preventing postpartum haemorrhage. Because of the potential benefits for childbearing women, particularly those in developing countries, further research to determine its effects with greater certainty should be expedited.
Does an early postnatal check‐up improve maternal health: results from a randomised trial in Australian general practice
Authors: Gunn Jane , Lumley Judith , Chondros Patty , Young Doris 
Published: August 2005

Objectives
To investigate whether a visit to a general practitioner one week after discharge results in less depression, increased breastfeeding rates, improved patient wellbeing, fewer physical problems and greater satisfaction with general practice care than the traditional six week postnatal check‐up.Design
A randomised controlled trial.Setting
Rural and metropolitan Victoria, Australia.Population
Women giving birth at one rural and one metropolitan hospital between February and December 1995 inclusive.Methods
All women received a letter and appointment date to see a general practitioner for a check‐up: the intervention group for one week after hospital discharge, the control group for six weeks after birth. A mail‐out survey was conducted at three and six months after birth, including Edinburgh Postnatal Depression Scale and Short Form 36.Results
1017/1407 (72.3%) women giving birth at participating hospitals were eligible for the trial: 683 (67.2%) gave informed consent. The average response rate to postal follow up at three and six months was 67.5%. No significant differences were found between the groups in: Edinburgh Postnatal Depression and Short Form 36 scores; number of problems; breastfeeding rates; or satisfaction with general practitioner care. Women in the intervention group were less likely to attend for their check‐up (76.4%vs 88.4%; P=0.001), more likely to discuss labour and birth at their check‐up (OR=1.77, 95% CI 1.17–2.68), less likely to have a vaginal examination (OR = 0.51; 95% CI 0.34–0.77) or pap smear (OR = 0.34; 95% CI = 0.22–0.52) at their check; more likely to report difficulties with low milk supply (OR= 1.72; 95% CI = 1.12–2.66) and adjusting to the demands of a new baby (OR= 1.76; 95% CI 1.13–2.74), more likely to talk to a general practitioner about their baby (68.2%vs 58.0%; P= 0.02) and less likely to consult a hospital doctor about their baby (7.3%vs 14.0%, P = 0.02).Conclusions
To make clinically important improvements in maternal health more is required than early postnatal review.
Is cystic ovarian endometriosis an asymmetric disease?
Authors: Vercellini Paolo , Aimi Giorgio , De Giorgi Olga , Maddalena Silvia , Carinelli Silvestro , Crosignani Pier Giorgio 
Published: August 2005

Objective
To investigate whether asymmetry exists in the left‐ and right‐handed distribution of ovarian cystic lesions in a large series of women with endometriosis.Design
Retrospective evaluation of a case series.Setting
Tertiary care and referral academic centre for the study and treatment of endometriosis.Population
A total of 1054 consecutive women undergoing first‐line surgical treatment for endometriosis in an eight‐year period.Methods
Data were collected on indication for the intervention, age at surgery, parity and disease stage as well as side and size of ovarian endometriomas.Main outcome measure
Frequency of left‐ and right‐sided ovarian endometriomas.Results
Histologically confirmed endometriotic ovarian cysts were present in 561 women, which were on the left side in 255 instances, on the right in 148, and bilateral in 158. In the patients with unilateral endometriomas, the observed proportion of left cysts (255/403, 63%; 95% confidence interval, 58% to 68%) was significantly different from the expected proportion of 50% (χ21, 28.41, P < 0.001). Including also the bilateral endometriotic cysts gave a total of 413/719 (57%) left‐sided and 306/719 right‐sided endometriomas. The magnitude of these proportions did not vary appreciably during the eight years considered. The difference in proportion of left‐ and right‐sided endometriotic cysts was virtually similar in subgroups of women with different indications for surgery. Cyst side was not related to age, parity or cyst diameter.Conclusions
The finding of a lateral asymmetry in the occurrence of ovarian endometriotic cysts is compatible with the anatomical differences of the left and right hemipelvis and supports the menstrual reflux theory.
Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders
Authors: Stead Maxine L. , Crocombe William D. , Fallowfield Lesley J. , Selby Peter , Perren Timothy J. , Garry Ray , Brown Julia M. 
Published: August 2005

Objective
To assess the feasibility and acceptability of including sexual activity questionnaires in gynaecological clinical trials.Design
A longitudinal quality of life study during the Maintenance Interferon Trial and the EVALUATE Hysterectomy Trial.Setting
Gynaecology clinics and women's homes.Sample
Ninety‐six women with advanced ovarian cancer participating in the Maintenance Interferon Trial and 542 women undergoing a hysterectomy in the EVALUATE Hysterectomy Trial.Methods
Quality of life questionnaires, including the sexual activity questionnaire, were completed by women prior to randomisation and periodically after randomisation.Main outcome measures
Compliance rates of the sexual activity questionnaire, both overall and with respect to the level of sexual functioning and age of the women. Attitudes of the women towards completing the questionnaire, and suitability of using the sexual activity questionnaire in clinical trials.Results
Compliance rates of over 80% were achieved in both trials, both overall and for each questionnaire completed. The age of the woman did not appear to influence the completion of the questionnaire, nor did her level of sexual functioning. Women were supportive of the research and did not find the questionnaire intrusive.Conclusions
It is feasible to include sexual activity questionnaires in gynaecological clinical trials requiring repeated assessment of quality of life over a long period of time. The sexual activity questionnaire is an appropriate tool to carry out investigations of sexual functioning and is worth considering for use in future clinical trials.
Selective deficit of angiogenic growth factors characterises pregnancies complicated by pre‐eclampsia
Authors: Reuvekamp Alida , Velsing‐Aarts Francien V. , Poulina Indira E. J. , Capello Jaques J. , Duits Ashley J. 
Published: August 2005

Objective
To compare serum levels of angiogenic growth factors vascular endothelial growth factor (VEGF), placental growth factor (PIGF) and angiogenin in pre–eclamptic women and matched controls.Design
Retrospective analysis of −70°C stored serum of women who developed pre‐eclampsia and matched controls.Setting
Department of Gynaecology and Obstetrics, St Elisabeth Hospital, Curaqao, Netherlands Antilles.Sample
Thirty women with pre‐eclampsia and 30 normotensive controls matched for age and gestation.Results
VEGF and PIGF serum levels were significantly lower in pre–eclamptic pregnancies, compared with controls (VEGF 0.31 ± 1.20 vs 18.30 ± 24.97 pg/mL, P= 0.0004; PIGF 54.19 ± 32.05 vs 497.95 ± 340.51 pg/mL, P < 0.0001). Matched couple analysis showed VEGF serum concentrations to be lower in the majority of pre–eclamptic women and PIGF concentrations to be lower in all pre–eclamptic women. Angiogenin serum levels showed no statistical significant difference between pre–eclamptic pregnancies and controls (523.68 ± 367.55 vs 670.41 ± 251.54 ng/mL, P= 0.058), with matched couple analysis showing no clear pattern.Conclusions
Decreased serum levels of VEGF and PIGF characterise, and therefore seem to be of importance during (the development of), pre‐eclampsia. This selective deficit of angiogenic growth factors might in part explain the shallow placentation found in this pregnancy complication.
Elevated mid‐trimester maternal corticotrophin‐releasing hormone levels in pregnancies that delivered before 34 weeks
Authors: Leung T. N. , Chung T. K. H. , Madsen Gemma , McLean Mark , Chang A. M. Z. , Smith Roger 
Published: August 2005

Objective
To test whether maternal corticotrophin‐releasing hormone levels are elevated in the mid–trimester for those women who subsequently had spontaneous preterm delivery and to assess the clinical utility of the measurement in the prediction of preterm delivery.Design
A prospective observational study.Setting
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.Population
1047 low risk pregnant women recruited at 15–20 weeks of gestation.Methods
Venous samples were assayed for levels of corticotrophin‐releasing hormone. The investigators responsible for the laboratory assay were blinded to the obstetric outcome.Main outcome measures
Incidence of preterm, term and post‐term pregnancies.Results
Those who were delivered spontaneously at a preterm gestational age (before 34 weeks) had significantly higher corticotrophin–releasing hormone levels in the mid–trimester, compared with those who were delivered at term or post–term. There was a trend towards lower corticotrophm–releasing hormone levels with more advanced gestational age at delivery. When the measurement of corticotrophin–releasing hormone was used to predict delivery before 34 weeks, the best cut off was 1.9 MoM, which produced a sensitivity of 72.7% and specificity of 78.4%. This translated to a positive predictive value of 3.6%, negative predlctive value of 99.6% and relative risk of 9.4 when the background prevalence of spontaneous preterm delivery before 34 weeks was 1.1%. The likelihood ratio was 3.4.Conclusions
Mid‐trimester maternal corticotrophin‐releasing hormone levels are elevated in pregnancies destined to deliver preterm before 34 weeks. When used alone in a low risk population, the measurement has a low predictive power for preterm delivery. However, the likelihood ratio of 3.4 implies that in high risk populations the test may be considerably more valuable.
Comparison of treatment outcomes of imipramine for female genuine stress incontinence
Authors: Lin Ho‐Hsiung , Sheu Bor‐Ching , Lo Mei‐Chen , Huang Su‐Cheng 
Published: August 2005

Objective
To assess the efficacy of imipramine as a treatment of genuine stress incontinence and to explore the possible determining factors for treatment success and failure.Design
A prospective study.Setting
University department of obstetrics and gynaecology.Participants
Forty women with genuine stress incontinence were enrolled.Methods
Each woman was treated with 25 mg imipramine three times a day for three months.Main outcome measures
Each woman had a 20‐minute pad test and urodynamic study including uroflowmetry, both filling and voiding cystometry, and stress urethral pressure profile before and after treatment.Results
After treatment, 35% (n= 14) were cured, 25% (n= 10) improved by 2 50% and in the remaining 40% (n= 16) treatment failed. The efficacy of successful treatment was 60% (95% CI44.8–75.2). The median age and parity, as well as menopausal status, showed no statistical differences between the two groups. The pre‐treatment data including pad weight, functional urethral length, maximal urethral pressure, bladder compliance at urgency, bladder capacity, and average and maximal flow rates showed no statistical differences between the two groups except urethral closure pressure (P= 0.001). Besides, the functional urethral length and urethral closure pressure were significantly improved in the treatment success group. After medication, the median functional urethral length was 3 cm (intraquantile range [IQR] 2.3–3) in the treatment success group vs 2.3 cm (IQR 2–3) in the treatment failure group (P= 0.028). The urethral closure pressure was 77 cmH, O (IQR 61–105) for the treatment success group vs 40 cmH, O (IQR 34–53) in the treatment failure group (P < 0.0001).Conclusions
The efficacy of imipramine for genuine stress incontinence was 60% (95% CI 44.8–75.2). The pre‐treatment high urethral closure pressure may serve as a predictor for treatment success.
Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients
Authors: Junor E. J. , Hole D. J. , McNulty L. , Mason M. , Young J. 
Published: August 2005

Objective
To determine whether specialist gynaecological surgeons improved survival in women with ovarian cancer when compared with general gynaecologists.Design
Retrospective case note review.Population
All women diagnosed with ovarian cancer in Scotland in 1987, 1992, 1993 and 1994.Methods
Data on prognostic factors and surgical and post‐operative management was extracted from case notes. Surgeons were classified as specialist gynaecologists, general gynaecologists or general surgeons by an independent committee with no knowledge of an individual's outcome. Cox's proportional hazards model was used to determine the relative risk of a patient dying, if managed by specialist and general gynaecologists, after adjustment for age, histology, tumour differentiation, presence of ascites and socio‐economic status. Analysis was performed separately for each FIGO stage.Main outcome measures
Relative hazard ratios for survival up to three years.Results
Survival benefit for specialists varied according to the stage of the disease. The greatest benefit was observed among women with Stage III disease (44% of women presented at this stage) where there was a 25% (relative hazard ratio = 0.75, P= 0.005) reduction in the rate of dying for women operated on by specialist gynaecologists, compared with women operated on by general gynaecologists. Differential use of platinum chemotherapy did not explain this survival advantage. Specialist gynaecologists more often debulked tumour to c 2 cm than general gynaecologists in Stage III cases (36.3%vs 28.7%, P= 0.07). In women with Stage III carcinoma with > 2 cm remaining, survival was significantly improved for women treated by specialist gynaecologists (relative hazard ratio = 0.71, P= 0.007). No significant differences were observed for patients with Stages I, II and IV disease, although there were fewer deaths in women with early stage disease.Conclusions
Specialist gynaecologists improve survival for some women with ovarian cancer.
Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database
Authors: Zondervan Kina T. , Yudkin Patricia L. , Vessey Martin P. , Dawes Martin G. , Barlow David H. , Kennedy Stephen H. 
Published: August 2005

Objectives
To estimate the prevalence and incidence in primary care of chronic pelvic pain in women in the UK.Design
Cross‐sectional analysis of MediPlus UK Primary Care Database. Setting One hundred and thirty‐six general practices in the UK.Population
From 284,162 women aged 12–70 who were registered on the database and who had a general practice contact in 1991,24,053 chronic pelvic pain cases were identified between 1991 and 1995.Methods
Chronic pelvic pain was defined as pelvic pain lasting for at least six months, and cases were identified on the basis of contacts with general practice. Pain due to malignancy, chronic inflammatory bowel diseases or pregnancy, or which occurred only during menstruation or sexual intercourse, was excluded.Main outcome measures
Prevalence and incidence rates of chronic pelvic pain in primary care by age and region.Results
Monthly prevalence and incidence rates of chronic pelvic pain were 21.5/1000 and 1.58/1000, respectively, with an annual prevalence of 38.3/1000. Monthly prevalence rates increased significantly with age (P < 0.001) from 18.2/1000 in 15–20 year olds to 27.6/1000 in women older than 60, as symptoms persisted longer in older women. Prevalence and incidence rates varied significantly between regions (P < 0.001), with the lowest monthly prevalence in Scotland (16.0/1000) and the highest in Wales (29.4/1000).Conclusions
Chronic pelvic pain is a common condition in the UK, with a prevalence in primary care comparable to migraine, back pain, and asthma. Its prevalence in the general population is likely to be considerably higher.
Pure stress leakage symptomatology: is it safe to discount detrusor instability?
Authors: James Mark , Jackson S. , Shepherd A. , Abrams P. 
Published: August 2005

Objective
To determine whether the combination of a urological history and urinary diary, with rigorous selection criteria, can be used to define a group of women on whom urodynamic assessment is unnecessary prior to offering surgery for urinary stress incontinence.Design
Retrospective review of the urodynamic records of women attending for assessment between January 1992 and December 1996.Setting
Urodynamic Department, Southmead Hospital, Bristol.Population
5193 women who attended the urodynamic clinic during the five year study period.Methods
Self‐completion of a urinary diary in the preceding week before urodynamic assessment and a detailed urological history before undergoing cystometry by all women in the study period. Data were entered onto a computer database. Women reporting stress incontinence in the absence of bladder filling symptoms, with a normal urinary diary showing daytime frequency of seven times or less and nocturia of no more than once, had the results of their filling cystometry analysed.Results
Of 5193 women, 555 had symptoms of pure stress incontinence and a normal urinary diary. Incontinence was confirmed objectively in 81%, with 9% having incontinence secondary to detmsor instability; 5% had detrusor instability as the sole cause of their incontinence with 4% having a mixed picture of detrusor instability incontinence and urethral sphincter weakness.Conclusion
Genuine stress incontinence cannot be diagnosed reliably from a urological history, even when rigorous selection criteria are used in combination with a normal urinary diary. Without cystometry, incontinence secondary to detmsor instability will be missed.
Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial
Authors: Crowther Caroline A. , Kornman Louise , O'Callaghan Stephen , George Korula , Furness Margaret , Willson Kristyn 
Published: August 2005

Objectives
To assess the efficacy of an ultrasound scan at the first antenatal visit.Design
Randomised clinical trial.Setting
Women's and Children's tertiary level hospital, Adelaide, Australia.Population
Six hundred and forty–eight women attending for their first antenatal visit at less than 17 weeks of gestation who had no previous ultrasound scan in the pregnancy, who were expected to give birth at the hospital, and for whom there was no indication for an ultrasound at their first visit.Methods
Eligible consenting women were enrolled by telephone randomisation into either the ultrasound at first visit group, who had an ultrasound at the time of their first antenatal visit, or the control group in whom no ultrasound assessment was done at their first antenatal visit. Both groups of women completed a questionnaire at the end of the first visit on their feelings towards the pregnancy and anxiety levels. Data were collected on details of any ultrasound assessments, including the 18 to 20 weeks morphology scan, and pregnancy outcome. All primary analyses were on an intention–to–treat basis.Main outcome measures
The number of women who needed adjustment in dates of 10 days or more on the basis of their 18 to 20 weeks ultrasound morphology scan, who were booked for their morphology scan at sub–optimal gestations, who had a repeat of their maternal serum screening test, or who felt worried about their pregnancy at the end of the first antenatal visit.Results
Fewer women (9%) in the ultrasound at first visit group needed adjustment of their expected date of delivery as a result of the 18 to 20 week ultrasound, compared with 18% of women in the control group (RR 0–52,95% CI 0.34–0.79; P= 0.002). The number of women who had the 18 to 20 week ultrasound assessment timed suboptimally was similar to that in the control group (16% vs 21%), as was the number of women who had a repeat blood sample taken for maternal serum screening (6 vs 6%). Fewer women in the ultrasound at first visit group reported feeling worried about their pregnancy (RR 0.80, 95% CI 0.65–0.99; P= 0.04) or not feeling relaxed about their pregnancy (RR 0.73, 95% CI 0.56–0.96; P= 0.02), compared with women in the control group.Conclusions
A routine ultrasound assessment for dating offered to women at the first antenatal visit provides more precise estimates of gestational age and reduces the need to adjust the estimate of the date of delivery in mid–gestation. Women who had an ultrasound at the first visit reported more positive feelings about their pregnancy, compared with women in the control group at that time.