bluuebunny/crossref_metadata_2025_split huggingface dataset:
Folates in the periconceptional period: are women getting enough?
Authors: Mathews Fiona , Yudkin Patricia , Neil Andrew 
Published: August 2005

Objective
To examine the prevalence of folic acid supplementation prior to conception and in the first trimester of pregnancy, and to identify sociodemographic variables associated with the use of supplements.Design
Observational study.Setting
District general hospital in the south in England.Population
Nine hundred and sixty‐three randomly selected pregnant nulliparous Caucasian women recruited from May 1994 to February 1996 inclusive.Methods
Questionnaire administered at approximately 16 weeks gestation.Main outcome measures
Intakes of supplemental folic acid before conception and during pregnancy.Results
31.5% (303/963) (95% CI 28.5–34.4) of pregnant women reported using supplements containing folic acid prior to conception. The proportion using pre‐conceptional folic acid increased by approximately 1% per month during the 22 months of the study. 38.1% (367/962) (35.1 to 41.2) of women began taking folic acid only after the confirmation of pregnancy, and this proportion appeared constant over time. Young age, smoking and low educational attainment were statistically significant predictors of failure to use folic acid both before and during pregnancy.Conclusions
Use of folic acid before conception in nulliparous women is much higher than the 2% to 3% reported in earlier studies of all pregnant women, and appears to be increasing. However, many women still only begin taking folic acid after conception, despite current health education strategies. New approaches, focusing on women who are currently least likely to take folic acid ‐ those who are young, are of low educational backgrounds, and are smokers ‐ may now be required. Given the inevitably of unplanned pregnancies, efforts must also be made to increase the currently static uptake of folic acid immediately after the confirmation of pregnancy.
Nationwide maternal mortality in Surinam
Authors: Mungra A. , van Kanten R. W. , Kanhai H.H.H. , van Roosmalen J. 
Published: August 2005

Objective
To assess the magnitude, causes and associated factors of maternal mortality in Surinam.Methods
Nationwide confidential enquiry. Maternal deaths were identified using various methods and sources for the period 1991–1993. All cases were examined by a maternal mortality expert committee for substandard care analysis.Results
The national maternal mortality ratio was 226 per 100,000 live births, which is six times higher than the official maternal mortality ratio of 38 for the preceding three year period. The main causes of death were haemorrhage (30%) and pre‐eclampsia (20%). In 95% of analysed cases, substandard care factors which had contributed to the deaths were present at one or more levels of maternity care.Conclusions
Maternal mortality was found to be several times higher than had been officially reported for Surinam during the previous three decades. Improvement of maternity care services in Surinam is needed, and has to be addressed at all levels, from the community, health centre and hospital to the Conclusions highest level of organisation.
Activin A, inhibin A, inhibin B and parturition: changes of maternal and cord serum levels according to the mode of delivery
Authors: Florio P. , Benedetto C. , Luisi S. , Santuz M. , Di Carlo C. , Marozio L. , Genazzani A. R. , Petraglia F. 
Published: August 2005

Objective
To evaluate whether activin A, inhibin A, and inhibin B levels in maternal and umbilical artery serum change according to the mode of delivery.Design
Maternal and cord blood specimens were collected at term after spontaneous labour and vaginal delivery, or elective caesarean section.Setting
Universities of Pisa, Turin, Naples and Udine.Population
Forty–two healthy pregnant women, at 39–40 weeks of gestation, divided into two subgroups: group 1 vaginal delivery (n= 21), were delivered of 10 female and 11 male infants; group 2 elective caesarean section (n= 21), were delivered of 11 female and 10 male infants.Main outcome measures
Serum activin A, inhibin A, inhibin B concentrations in maternal and umbilical cord blood.Results
At vaginal delivery, maternal serum inhibin A and inhibin B levels were lower and activin A levels higher than at elective caesarean section. Maternal levels of activin A, inhibin A and inhibin B were constantly higher than in umbilical arterial blood, independent of the mode of delivery. No significant difference was observed in umbilical arterial serum levels of the three proteins between the two modes of delivery. Umbilical arterial serum activin A and inhibin A concentrations did not show a significant difference between male and female infants in either vaginal or caesarean section, but male infants showed inhibin B levels significantly higher than female, independent of the mode of delivery.Conclusions
In the presence of active labour, the human placenta secretes larger amounts of activin A and lesser amounts of inhibin A and inhibin B into the maternal circulation. Inhibin–related proteins in the fetal circulation do not show differences according to the mode of delivery, suggesting that they have a different method of production or metabolic rate compared with maternal activin and inhibins.
The possible use of colour flow Doppler in planning treatment in early invasive carcinoma of the cervix
Authors: Cheng Wen‐Fang , Wei Lin‐Hung , Su Yi‐Ning , Cheng Shao‐Pei , Chu Jan‐Show , Lee Chien‐Nan 
Published: August 2005

Objective
To investigate the pathological significance of intra‐tumoural blood flow signals detected by colour Doppler ultrasound and their association with angiogenesis in cervical carcinoma.Design
A prospective cross‐sectional study.Setting
University hospital.Population
One hundred and four women with Stage IB‐IIA cervical carcinoma.Methods
All women underwent radical hysterectomy and pelvic lymph node dissection. Transvaginal colour Doppler ultrasound was performed before surgery to search for arterial blood flow signals within the tumours. Tumours with a measurable intra‐tumoural resistance index were defined as tumour with detectable blood flow and the others as tumour with undetectable blood flow. The microvessel density of the excised tumour was assessed immunohistochemically. The women's clinical and pathologic data were recorded.Results
There were 60 tumours (58%) exhibiting detectable intra‐tumoural blood flow signals. Tumours with detectable blood flow were larger, had deeper cervical stromal invasion, a higher incidence of parametrial invasion and pelvic lymph node metastases, and a higher microvessel density, when compared with those without detectable blood flow. Cervical cancers with deep cervical stromal invasion, parametrial invasion, and pelvic lymph node metastasis had higher microvessel density than those with superficial stromal invasion, no parametrial invasion, or no lymph node metastasis. Microvessel density correlated well with lymph node metastases and parametrial invasion by multiple regression analysis, while intra‐tumoural blood signals only showed correlation with parametrial invasion. In the prediction of pelvic lymph node metastases and parametrial invasion, colour flow Doppler had a sensitivity of 0.80 and specificity of 0.48 in predicting lymph node metastases, and sensitivity of 0–91 and specificity of 0.57 in predicting parametrial invasion.Conclusions
The characteristics of blood flow signals in cervical carcinoma detected by colour Doppler ultrasound are associated with tumour angiogenesis and could reflect the likelihood of parametrial invasion and lymph node metastases in cervical carcinoma. The intra‐tumoural blood flow signals might be used as a screening test in predicting parametrial invasion and pelvic lymph node metastases. These findings may be helpful in planning treatment for women with Stage I and II cervical carcinoma.
Intrinsic duodenal obstruction: trends in management and outcome over 45 years (1951–1995) with relevance to prenatal counselling
Authors: Murshed R. , Nicholls G. , Spitz L. 
Published: August 2005

Objective
To investigate the incidence of associated anomalies and document changes and progress in the management and outcome of intrinsic duodenal obstruction (atresia or stenosis) in a large series over a long time period with a view to providing comprehensive data for prenatal counselling.Design
A retrospective casenote review.Setting
A quaternary referral centre for paediatxic and neonatal surgery.Population
lbo hundred and seventy‐five infants born with duodenal obstruction between 1951 and 1995.Methods
For analysis of management and outcome data, the series was divided into three groups, each admitted over 15 year periods: Group A, 1951–1965; Group B, 1966–1980; Group C, 1981–1995.Main outcome measures
Primary: associated anomalies, complication rates and survival. Secondary: age at diagnosis, duration of hospital stay.Results
There were 136 males and 139 females. Seventeen of 30 cases (57%) presenting between 1991 and 1995 were diagnosed prenatally on ultrasound scan. The median age at diagnosis for atresia was 3–5 days (Group A); 2.2 days (Group B) and 1.8 days (Group C). The median age at diagnosis for incomplete obstruction was five days. Associated anomalies included Down's syndrome (n= 82, 30%); Down's plus cardiac malformation (n= 38, 14%); isolated cardiac (n= 64, 23%); and gastrointestinal problems (n= 116, 42%). Overall complication rates fell from 51% (Group A) to 18% (Group C) and survival increased from 51% to 95%. Median hospital stay also decreased from 35 days to 18 days.Conclusions
These data confirm a progressive improvement in the outcome of intrinsic duodenal obstruction over the past 45 years. It is important to note that they only relate to infants born with duodenal atresia and do not take into account possible ‘hidden’ mortality resulting from spontaneous abortion or termination.
Magnetocardiography in the diagnosis of fetal arrhythmia
Authors: van Leeuwen P. , Halier B. , Bader W. , Geissler J. , Trowitzsch E. , Grönemeyer D. H. W. 
Published: August 2005

Objective
To examine the possible use of magnetocardiography in the diagnosis of fetal arrhythmias.Design
Investigation of routinely examined pregnant women, as well as women referred because of arrhythmias or other reasons.Participants
Sixty‐three women between the 13th and 42nd week of pregnancy.Methods
Recording of 189 fetal magnetocardiograms, of which 173 traces (92%) demonstrated sufficient fetal signal strength to permit evaluation. After digital subtraction of the maternal artefact, all fetal complexes were identified and the recording was examined for arrhythmic events.Results
Short bradycardic episodes, not associated with any pathological condition, were found in 26% of all recordings, usually in mid‐pregnancy. In 12 cases, isolated extrasystoles of no clinical importance could be identified. There were nine traces which revealed multiple arrhythmias including ventricular and supraventricular ectopic beats, bigeminy and trigeminy, sino‐atrial block and atrio‐ventricular conduction disturbances. Furthermore, two cases with tachycardia were found.Conclusion
Magnetocardiography offers a simple noninvasive method for examination of the fetal cardiac electrophysiological signal. It may thus be useful in the identification and classification of clinically relevant arrhythmia and aid in decisions concerning treatment.
Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia?
Authors: Cox Joanne , Cotzias Christina S. , Siakpere Obukohwo , Osuagwu Fiona I. , Holmes Emma P. , Paterson‐Brown Sara 
Published: August 2005

Objective
To assess whether an inflatable obstetric belt, synchronised to apply uniform fundal pressure during a uterine contraction, reduces operative delivery rates when used in the second stage of labour.Design
Randomised controlled trial.Methods
Five hundred nulliparae with a singleton cephalic pregnancy at term and with an epidural in labour were recruited during the first stage and randomised at full dilatation. Standard care involved one hour passive second stage and one hour active pushing after which instrumental delivery was performed if delivery was not imminent. Those randomised to the belt group, in addition to standard care, had the inflatable obstetric belt for the whole second stage of labour.Main outcome measure
Mode of delivery.Results
One hundred and eleven of the 260 women in the belt group (42.7%) compared with 94 of the 240 in the control group (39.2%) had a spontaneous vertex delivery (P= 0.423). The lift‐out instrumental delivery rate was similar between the two groups: 108 belts (41.5%), compared with 101 controls (42.1%) (P= 0.902), whereas rotational instrumental deliveries in the belt group were 26 belts (10%) compared with 36 controls (15%) (P= 0.09). Fifteen women (5.8%) in the belt group and nine women (34%) in the control group had a caesarean section in the second stage (P= 0.292). An intact perineum was more likely in the belt group (16.5% compared with 9–6%, P= 0.022) as was a third degree tear (6.5% compared with 0.4%, P= 0.001).Conclusion
The inflatable obstetric belt did not significantly reduce operative delivery rates when used in this clinical setting in the second stage of labour.
Second trimester prenatal screening for Down's syndrome using alpha‐fetoprotein and free beta hCG: a seven year review
Authors: Spencer Kevin 
Published: August 2005

Objective
To determine the value and impact over a seven year period of a second trimester screening programme for trisomy 21 and trisomy 18, using the two maternal serum markers alpha‐fetoprotein and free beta human chorionic gonadotrophin.Design
Retrospective review.Setting
A biochemical screening laboratory serving three health districts with three antenatal clinics in both teaching and nonteaching hospitals.Population
67,904 pregnancies in women of all ages screened between 14 and 22 weeks of gestation between 1 April 1991 and 31 March 1998.Methods
All women booked into three major antenatal clinics were offered biochemical screening. Women at increased risk of trisomy 21 or trisomy 18 (≥ 1 in 250 at term) were offered an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was performed.Main outcome measures
Detection rate for trisomy 21 and trisomy 18, false positive rates, uptake of screening, uptake of amniocentesis in women identified at increased risk, prevalence of trisomy 21 at birth, detection and false positive rates by maternal age, fetal loss rate after amniocentesis, report turn around time, and identification of other anomalies.Results
Overall, 87% (67,904/78,501) of women underwent screening. The rate of detection of trisomy 21 was 75% (80/107; 95% CI 66 to 83) with a 5.1% false positive rate (3466/67,904; CI 4.9 to 5.3%). In women under 30 years of age the detection rate was 60% (18/30; CI 41 to 77) with a 2.6% false positive rate (956/36,371; CI 2.5 to 2.8). The rate of detection of trisomy 18 was 57% (8/14; CI 29 to 82) with a 0.7% false positive rate (475/67,904; CI 0.64 to 0.76). Uptake of amniocentesis was 83% (2912/3508). Women were 3–3 times more likely to refuse amniocentesis if the risk was close to the cutoff (1 in 250) than if the risk was ≥ 1 in 50. Fetal loss within 28 days of amniocentesis was 0.9% (25/2912). Prenatal screening identified 84 other anomalies in addition to 41 cases of impending fetal death.Conclusion
Second trimester prenatal screening for trisomy 21 and trisomy 18 using a simple two marker approach incorporating free beta hCG can achieve high detection rates over a long period of time. Health authorities who still have not introduced trisomy 21 screening should be encouraged by what can be achieved and should consider making such screening available to all women. Established second trimester detection rates of 75% for a 5% false positive rate will be the benchmark by which first trimester screening using nuchal translucency, PAPP–A and free beta hCG will be judged.
Teenage pregnancies and risk of late fetal death and infant mortality
Authors: Olausson Petra Otterblad , Cnattingius Sven , Haglund Bengt 
Published: August 2005

Objective
To estimate the effect of low maternal age on late fetal death and infant mortality and to estimate the extent of any increase in infant mortality attributable to higher rates of preterm birth among teenagers.Design
Population‐based cohort study.Setting
Births recorded in the nationwide Swedish Medical Birth Registry.Population
All single births to nulliparous women aged 13–24 years (n= 320,174) during 1973–1989.Methods
Using information recorded in the medical birth registry, linked to a national education register, the effect of low maternal age on adverse outcomes was estimated using logistic regression analysis.Main outcome measures
Late fetal death, neonatal and postneonatal mortality and preterm birth.Results
Compared with mothers aged 2CL24 years, adjusted risks of neonatal and postneonatal mortality were significantly increased among mothers aged 13–15 years (odds ratios = 2.7 and 2.6, respectively) and among those aged 16–17 years (odds ratios = 1.4 and 2.0, respectively), while mothers aged 18–19 years had a significant increase in risk of postneonatal mortality only (odds ratio = 1.4). Rates of very preterm birth (≤ 32 weeks), according to maternal age, were: 13–15 years, 5.9%; 16–17 years, 2.5%; 18–19 years, 1.7%; and 20–24 years, 1.1%. The high rates of very preterm birth among young teenagers almost entirely explained the increased risk of neonatal mortality in this group.Conclusions
The increased risks of neonatal and postneonatal mortality among young teenagers may be related to biological immaturity. The increase in risk of neonatal mortality is largely explained by increased rates of very preterm birth.
Effects of tocolytic treatment with ritodrine on cardiovascular autonomic regulation
Authors: Vesalainen Risto K. , Ekholm Eeva M. K. , Jartti Thomas T. , Tahvanainen Kari U. O. , Kaila Timo J. , Erkkola Risto U. 
Published: August 2005

Objective
To study the acute effects of tocolytic treatment with intravenous ritodrine on cardiovascular autonomic regulation.Design
Validated methods to assess cardiovascular autonomic nervous function—heart rate and blood pressure variability and vagal cardiac baroreflex sensitivity—were measured before and during ritodrine infusion.Setting
Turku University Central Hospital, Turku, Finland.Sample
Twelve pregnant women admitted to hospital for threatened preterm labour.Methods
Electrocardiogram and continuous noninvasive finger blood pressure signals were recorded in each woman, resting in a supine position. Autoregressive spectrum analysis was used to quantify short term heart rate and blood pressure variability. Vagal cardiac baroreflex sensitivity was measured as the bradycardia response to an intravenous bolus injection of phenylephrine.Main outcome measures
Vagal cardiac baroreflex sensitivity and spectrum analysis indices of short term heart rate and blood pressure variability.Results
Ritodrine significantly decreased vagal cardiac baroreflex sensitivity as well as total (0.00–0.40 Hz), low frequency (0.04–0.15 Hz) and high frequency (0.15–4.40 Hz) power bands of the heart rate variability spectrum. Ritodrine significantly increased mean heart rate and the low frequency power band of the systolic blood pressure Variability spectrum.Conclusions
In pregnant women with threatened preterm labour intravenous administration of ritodrine decreases vagal cardiac baroreflex sensitivity and vagal modulation of heart rate, and increases sympathetically mediated blood pressure variability. Decreased baroreflex sensitivity and heart rate variability are known to be associated with a poor prognosis in some patient groups, so the effects of ritodrine tocolysis may be unfavourable in women with impaired circulatory homeostasis.
Maternal and fetal angiotensinogen gene allele sharing in pre‐eclampsia
Authors: Morgan L. , Crawshaw S. , Baker P. N. , Pipkin F. Broughton , Kalsheker N. 
Published: August 2005

Objective
To compare the angiotensinogen genotypes in normotensive and pre‐eclamptic pregnancies in maternal and fetal samples.Design
Prospective observational study.Setting
University Hospital, Queen's Medical Centre, Nottingham.Population
Forty‐three women with pre‐eclampsia and 84 normotensive pregnant women. Fetal samples were available for genotyping from 96% of the pregnancies.Methods
Maternal and fetal DNA was genotyped at angiotensinogen codon 235 and at a dinucleotide repeat polymorphism in the 3′ flanking region of the gene. Angiotensinogen and renin concentrations were measured in maternal plasma by radioimmunoassay.Results
In contrast to earlier studies, no association was demonstrated between the angiotensinogen 235 Thr variant and pre‐eclampsia. Normotensive pregnant women homozygous for this variant had significantly lower plasma angiotensinogen concentrations (median 2.2 ng AI/mL; IQR 1.8–3.0) than women homozygous for the 235 Met allele (3.6 ng AI/mL; IQR 2.5–4.1; P= 0.04). In pre‐eclamptic pregnancies, 79% (11/14) of mothers heterozygous for the dinucleotide repeat allele designated A9 transmitted this allele to the fetus, more frequently than would be expected by chance (P= 0.02). The A9 allele was associated with low plasma angiotensinogen concentrations (P= 0.001) and high renin concentrations (P= 0.02) in normotensive women.Conclusions
There is no evidence that the angiotensinogen 235 Thr allele is associated with pre‐eclampsia in the Nottingham population. The angiotensinogen 235 Thr allele is associated with low plasma angiotensinogen concentrations in normotensive pregnant women, in contrast to the high levels associated with this variant in non‐pregnant women, suggesting that regulation of angiotensinogen expression in normal pregnancy may differ significantly from that in the non‐pregnant state. There is preliminary evidence that maternal‐fetal transmission of an angiotensinogen allele associated with low plasma angiotensinogen concentrations is associated with pre‐eclampsia. Impaired generation of angiotensin II at the maternal‐fetal interface may be a factor in the pathogenesis of pre‐eclampsia.