bluuebunny/crossref_metadata_2025_split huggingface dataset:
Respiratory function in severe gestational proteinuric hypertension: the effects of rapid volume expansion and subsequent vasodilatation with verapamil
Authors: BELFORT M. A. , ANTHONY J. , KIRSHON B. 
Published: August 2005

AbstractObjectives— (1) To define the baseline respiratory function in untreated severe gestational proteinuric hypertension (GPH) and (2) to assess the effects of volume expansion with dextran (MW = 70 000 Dalton) and subsequent vasodilatation with the calcium antagonist verapamil on the baseline respiratory function in severe GPH.Design— Prospective descriptive study.Setting— Reproductive Research Unit, Groote Schuur Hospital, Cape Town, South Africa.Subjects— Six women with severe GPH undergoing stabilization and delivery.Interventions— Baseline haemodynamic and respiratory function was assessed using invasive monitoring. Patients then underwent volume expansion to a pulmonary capillary wedge pressure of 16 mmHg with dextran‐70, followed by vasodilatation with the calcium antagonist verapamil. Haemodynamic and respiratory variables were measured, before and after both the fluid load and the reduction (20%) in the mean arterial pressure.Main outcome measures— Mean arterial pressure, heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance, respiratory rate, blood gases, alveolar arterial oxygen difference, oxygen availability, oxygen consumption, pulmonary shunt fraction.Results— Baseline oxygen availability/delivery and oxygen consumption indices were consistent with severe tissue ischaemia. Volume loading with 400 ± 114 ml dextran‐70 normalized these variables, and subsequent vasodilatation with verapamil did not reduce these indices below the normal limits for pregnancy.Conclusions— These data support the theory that some of the complications of severe GPH may follow organ damage due to prolonged tissue ischaemia. They also support the appropriateness of controlled volume expansion in the management of this condition. We suggest, from these data, that the combination of volume expansion and verapamil vasodilatation lowers the blood pressure without compromising the maternal respiratory function.
Randomized controlled trial of antenatal social support to prevent preterm birth
Authors: BRYCE ROBERT L. , STANLEY FIONA J. , GARNER J. BARRY 
Published: August 2005

AbstractObjective— To test the effect of a programme of additional antenatal social support on the occurrence of preterm birth (a birth from 20 to 36 weeks gestation) in women at risk of preterm birth.Design— A prospective randomized controlled trial. The design was one of randomization before consent for a new treatment.Setting— Three public hospital antenatal clinics in Perth and the offices of 87 obstetricians and general practitioners in Western Australia.Subjects— 1970 pregnant women with poor obstetric histories entered the trial; 983 of these were randomly allocated to the programme group and 987 to the control group.Interventions— Normal antenatal care was provided for both groups. In addition, members of the programme group were offered an intervention aimed at providing expressive (emotional) social support, consisting of antenatal home visits and telephone calls by midwives. Of the women allocated to the programme group, 24 refused consent and 69 were not traced before completion of their pregnancies, the remaining 890 women (90.5%) agreed to enter the programme, and each received at least one intervention.Main outcome measures— Gestational age at completion of the pregnancy. A pregnancy ending before 20 weeks was labelled a miscarriage.Results— There were 126/981 (12.8%) preterm births in the programme group and 147/986 (14.9%) in the control group. The outcome data for two women in the programme group and one in the control group could not be found. The unadjusted odds ratio for preterm birth in the programme was 0.84 (95% CI 0.65–1.09). The observed relative reduction in preterm births associated with the programme was 13.8% (95% CI −8.2% to +31.5%) and the trial had a 60% power to exclude a true relative reduction of 25%.Conclusions— The results of this trial and those of other controlled clinical trials provide little evidence for the effectiveness of social support interventions in the prevention of preterm birth in women with poor obstetric histories.
Pre‐operative cervical preparation before first trimester vacuum aspiration: a randomized controlled comparison between gemeprost and mifepristone (RU 486)
Authors: HENSHAW R. C. , TEMPLETON A. A. 
Published: August 2005

AbstractObjective— To compare the effectiveness of 200 mg mifepristone with 1 mg gcmeprost vaginal pessary in achieving cervical dilatation and softening (‘priming’) before late first trimester pregnancy vacuum aspiration.Design— A randomized, operator blind, placebo controlled trial.Setting— UK teaching hospital.Subjects— 90 primigravid women with 63–91 days amenorrhoea and ultrasonically confirmed single living fetus of correct size for gestational age.Interventions— The women were allocated to receive 200 mg mifepristone orally or an identical oral placebo 36 h before operation or 1 mg gemeprost vaginal pessary 3–4 h preoperatively.Main outcome measures— Onset of new symptoms following drug administration, a proven objective measure of the force required to dilate the cervix, and estimated intraoperative blood loss.Results— There were no significant diffcrences in the baseline cervical dilatation, the force required to dilate the cervix or the volume of intraoperative blood loss between the active treatment groups. Both drugs were significantly more effective than placebo. Significantly fewer women in the mifepristone group had adverse side effects than in the gemeprost group.Conclusions— Mifepristone is a highly effective cervical priming agent, and has the advantages of being an oral prcparation associated with few side effects.
A clinical comparison of sonographic hydrotubation and hysterosalpingography
Authors: MITRI F. F. , ANDRONIKOU A. D. , PERPINYAL S. , HOFMEYR G. J. , SONNENDECKER E. W. W. 
Published: August 2005

AbstractObjective— To assess the value of vaginal sonographic hydrotubation as a pre‐liminary test of uterine configuration and tubal patency in infertility inves‐tigation, and to compare this new test with hysterosalpingography.Design— A prospective blind comparison of the two tests in an unselected group of infertile women.Setting— Hillbrow Hospital, Johannesburg, South Africa.Subjects— Sixty women undergoing routine infertility investigations agreed to participate in the study. There were no refusals.Interventions— Within 4 weeks before or after hysterosalpingography sonographic hydrotubation was performed as follows: The uterus and tubes were identified using a 5 MHz vaginal ultrasound probe and between 10 and 20 ml of normal saline were injected into the uterine cavity through an endocervical catheter.Main outcome measures— The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before and after injection of saline and the presence of free fluid in the pouch of Douglas.Results— The sonographic and hystersalpingographic findings were similar in 82% of the women with respect to uterine assessment and in 72% with respect of tubal findings. In seven women (12%) found to have bipolar tubal disease on sonography and cornual block on hysterosalpingography, the sonographic diagnosis was confirmed at laparoscopy. Septate uterus in three women was diagnosed with greater certainty with sonographic hydrotubation.Conclusions— Sonographic hydrotubation is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and fallopian tubes. Its use will reduce the need for hysterosalpingography and in some cases laparoscopy.
Is genetic susceptibility to pre‐eclampsia conferred by homozygosity for the same single recessive gene in mother and fetus?
Authors: LISTON WILLIAM A. , KILPATRICK DAVID C. 
Published: August 2005

AbstractObjective— To determine whether any simple, purely genetic mechanism can account for susceptibility to pre‐eclampsia.Design— Six simple Mendelian models of inheritance were considered, and pre‐dictions concerning the incidence of pre‐eclampsia in various family members of index cases were calculated for each genetic model. Data were then extracted from published family studies in which a suitable disease definition had been used, and compared to our theoretical expectations.Results— Only one of the genetic models considered, in which both mother and fetus must express the same recessive gene to confer susceptibility, was consistent with the observed incidence values for relatives of index cases. This model was also consistent with the putative association with HLA‐DR4, but could not account for the comparative rarity of pre‐eclampsia in parous women.Conclusion— Homozygosity for a single recessive gene shared by mother and fetus, unlike five other genetic mechanisms tested, is consistent with published family studies in pre‐eclampsia, and should be considered the best working hypothesis at present.
The prevalence, aetiology and clinical significance of pseudo‐sinusoidal fetal heart rate patterns in labour
Authors: MURPHY KARL W. , RUSSELL VIRGINIA , COLLINS AMANDA , JOHNSON PAUL 
Published: August 2005

AbstractObjective— To investigate the prevalence of sinusoidal and pseudo‐sinusoidal fetal heart rate (FHR) patterns in labour and the relation between the characteristics of the FHR pattern and fetal outcome.Design— A prospective observational study over a 6 month period in which all women who had continuous FHR monitoring in labour had their intrapartum cardiotocographs (CTGs) scrutinized for the presence of sinusoidal or pseudosinusoidal FHR patterns.Setting— John Radcliffe Hospital, Oxford.Subjects— 1520 women who had fetal monitoring during labour for various reasons.Main outcome measures— Both internal (electrocardiographic) and external (ultrasound) recordings of the FHR were analysed. Abnormal FHR patterns were related to obstetric characteristics and fetal outcome in terms of Apgar scores, umbilical artery pH and admission to the special care unit.Results— No true sinusoidal FHR patterns were observed, but pseudoinusoidal FHR patterns were found in 230 of the 1520 CTGs examined (15%) Of these, 219 were classified as minor (amplitude 5–15 beatdmin) and 11 as intermediate (amplitude 16–24 beatdmin). Major pseudo‐sinusoidal FHR pat‐terns (amplitude >24 beats/min) were not observed. Minor pseudo‐sinusoidal FHR patterns had a mean duration of 21 (SD 13) min and typically occurred once or twice early in labour. Using logistic regression analysis a significant, independent relation was demonstrated between the presence of minor pseudo‐sinusoidal FHR patterns and the use of pethidine (RR 1.84,95% CI 1.3 to 2.59, P < 0.0001) and epidural analgesia (RR 1.85,95% CI 1.24 to 2.76, P < 0.001). Intermediate pseudo‐sinusoidal FHR patterns were found in association with both in utero fetal sucking and transient episodes of fetal hypoxia such as that caused by periodic umbilical cord compression.Conclusion— Pseudo‐sinusoidal FHR patterns in labour will usually be associated with a normal fetal outcome but a careful fetal assessment is mandatory.
Self‐reported long‐term outcomes of hysterectomy
Authors: SCHOFIELD M. J. , BENNETT A. , REDMAN S. , WALTERS W. A. W. , SANSON‐FISHER R. W. 
Published: August 2005

AbstractObjectives— –To investigate women's perceptions of and satisfaction with the long‐term outcomes from a hysterectomy performed between 2 and 10 years ago and to determine whether satisfaction is related to demographic factors, factors associated with the hysterectomy, and the number or type of perceived benefits and problems associated with the hysterectomy.Design— Retrospective survey by telephone interview and postal questionnaire of 236 women who had a hysterectomy between 2 and 10 years ago.Setting— Women who had had a hysterectomy were identified from a community survey in the Hunter Region of NSW, Australia.Subjects— Two hundred and thirty‐six women who self‐reported having had a hysterectomy between 2 and 10 years ago.Main outcome measures— Perceived benefits resulting from the hysterectomy; perceived physical and psychological problems caused by the hysterectomy; satisfaction with care.Results— Relief from heavy bleeding was the most frequent benefit (57%) and the most important benefit (32%). Most of the women reported improvements in symptoms experienced before hysterectomy but more than half the women had symptoms which they believed had been worsened or caused by the hysterectomy. Despite this, high levels of satisfaction with the operation were reported.Conclusion— The results highlight the need to examine more closely decision‐making about treatment for menstrual symptoms such as heavy bleeding.
Relations between the fetal circulation and pituitary‐thyroid function
Authors: THORPE‐BEESTON J. GUY , NICOLAIDES KYPROS H. , SNIJDERS ROSALINDE J. M. , FELTON CARL V. , VYAS SANJAY , CAMPBELL STUART 
Published: August 2005

AbstractObjective— To study the relation between changes in the fetal thyroid hormone and thyroid stimulating hormone (TSH) concentrations and alterations in the fetal circulation as assessed by Dopplcr ultrasound.Design— A cross‐sectional study of small for gestational age (SGA) and red‐cell isoimmunized fetuses undergoing cordocentesis and Dopplcr studies for the assessment and determination of fetal karyotype, acid‐base balance and hac‐moglobin concentration.Setting— Harris Birthright Research Centre for Fetal Medicine, King's College, London.Subjects— 38 growth retarded and 38 red‐cell isoimmunised fetuses.Interventions— Cordoccntesis.Main outcome measures— Serum TSH total and free thyroxine (T4, FT4) and total and free triiodothyronine (T3, FT3) concentrations; middle cerebral artery (MCAVm) and dcsccnding thoracic aorta (AoVm) mean blood velocities; fetal Po2 and haemoglobin concentration (Hb).Results— Delta values (8) calculated as the number of SDs from the respective normal mean for gestation were used to compare the results with those from a previous study of normal fetuses. Mean AoVm was increased in the isoimmu‐nized fetuses (P < 0.001) but decreascd in the SGA fetuses (P < 0.001). Mean MCAVm was increascd in both groups (P < 0.01; P < 0.001). There were signifi‐cant associations between the gestational age adjusted values for TSH and MCAVm (r = 0.23, P < 0.05) and between T4, FT4 or FT3 and AoVm (r = 0.41, P < 0.01; r = 0.50, P < 0.001; r = 0.36, P < 0.01 respectively). In addition, T4 and FT4 were associated with 8Po2 and 8Hb.Conclusion— In the hypoxaemic hypoxia of growth retardation and the anaemic hypoxia of rhesus disease there are significant associations between changes in fetal thyroid hormone concentrations and changes in fetal blood flow as assessed by Dopplcr. Irrespective of whether altercd blood flow is the cause or cffect of changes in thyroid hormone concentrations, the observed changes could have beneficial effects for fetal survival, in the presence of a hostile intrauterine environment.
Erythrocyte hydration in normal human pregnancy
Authors: MACPHAIL S. , THOMAS T. H. , WILKINSON R. , DUNLOP W. , DAVISON J. M. 
Published: August 2005

AbstractObjective— To determine whether the fall in plasma osmolality in normal human pregnancy resulted in cellular overhydration.Design— The changes in erythrocyte hydration, potassium and total osmoles in response to a decrease in osmolality in vitro and associated with the fall in plasma osmolality in normal pregnancy were determined.Subjects— Fifty‐one women were studied serially during pregnancy and again 20 weeks after delivery.Results— Erythrocytes from pregnant women exposed in vitro to a 29.9% osmolality decrement had a 28.5% increase in cell hydration. At 14 weeks gestation although plasma osmolality was lower than after delivery (281.1 vs 291.6 mosmol/kg; P < 0.01) both erythrocyte hydration (1.83 l/kg dry weight cells) and potassium (264 mmol/kg) contents were reduced from the nonpregnant values (1.88 l/kg; P < 0.001). For the remainder of pregnancy plasma osmolality remained at this lower level but cell hydration and potassium both increased to values at 38 weeks gestation that were greater than in the nonpregnant state (1.92 vs 1.88 1/kg; 287 vs 272 mmol/kg).Conclusions— These findings suggest that a loss of cell osmoles may be a primary event affecting cell hydration in pregnancy and plasma osmolality is then reduced to maintain normal cell hydration. Subsequent changes in cell hydration were led by changes in intracellular osmole content.
Is oral contraceptive use still associated with an increased risk of fatal myocardial infarction? Report of a case‐control study
Authors: THOROGOOD MARGARET , MANN JIM , MURPHY MICHAEL , VESSEY MARTIN 
Published: August 2005

AbstractObjective— To investigate the association between fatal myocardial infarction and use of modern low‐dose oral contraceptives.Design— A case‐control study.Setting— General practices throughout England and Wales.Subjects— 161 women aged under 40 dying from myocardial infarction during 1986–1988. Living controls (2 per case), matched for age and marital status, were chosen from general practice lists. Information was collected during structured interviews with general practitioners, and from postal questionnaires sent to surviving partners of the cases and to control women.Main outcome measures— Mortality from myocardial infarction in relation to many risk factors, notably oral contraception, as measured by relative risk.Results— After allowing for the confounding effects of medical risk factors and for surgical sterilization, the overall relative risk associated with both current and past use of oral contraceptives was estimated to be 1–9 (95% CI 0–7 to 4–9, and 1–0 to 3–5 respectively). The relative risk associated with current use of preparations containing 50 μg of oestrogen, however, was estimated to be 4–2 (0–5 to 39.2). At least some of the relative risk associated with oral contraceptive use is likely to be attributable to the confounding effect of cigarette smoking, but it is impossible to estimate how much from the available data.Conclusions— If there was an increased risk of fatal myocardial infarction associated with oral contraceptive use in 1986–1988 it is likely to have been less than two‐fold; in this study risks were slightly, but not significantly, elevated with both current and previous use. It may be that any increase in risk is associated solely with the older combined preparations containing 50 μg of oestrogen.
Assessment of urinary symptoms in early pregnancy
Authors: CUTNER A. , CARDOZO L. D. , BENNESS C. J. 
Published: August 2005

AbstractObjectives— To determine the correlation between lower urinary tract symptoms and urodynamic findings in early pregnancy.Setting— The termination clinic and gynaecology ward at King's College Hospital.Design— Observational study.Subjects— 47 women before termination of pregnancy at between 6 and 15 weeks.Interventions— Women filled in symptom questionnaires and then had urodynamic investigations, consisting of uroflowmetry and subtracted provoked cystometry.Main outcome measures— The occurrence of lower urinary tract symptoms and their association with urodynamic findings.Results— Lower urinary tract symptoms were fairly common but there was poor correlation with the urodynamic findings.Conclusions— The findings suggest that lower urinary tract symptomatology alone is insufficient to study lower urinary tract dysfunction in pregnancy.
A randomised placebo controlled trial of labetalol in the treatment of mild to moderate pregnancy induced hypertension
Authors: PICKLES C. J. , BROUGHTON PIPKIN F. , SYMONDS E. M. 
Published: August 2005

ABSTRACTObjective
To determine the need for, and efficacy of, treatment with labetalol in women with mild‐to‐moderate pregnancy induced hypertension (PIH).Design
Prospective double‐blind randomised placebo controlled study.Setting
Maternity units of five hospitals in the Trent Region.Subjects
144 women (86 primigravid) who developed PIH after 20 weeks gestation.Interventions
Treatment with oral labetalol up to 600 mg daily or placebo with subsequent care of treatment failures in accordance with the attending obstetrician's practice.Main outcome measures
Number of days spent as an antenatal inpatient; the development of proteinuria; the perceived need for induction of labour or elective caesarean section; and gestation age at delivery.Results
Labetalol significantly lowered the blood pressure and reduced the incidence of proteinuria. However, neither the number of days spent as an antenatal inpatient, nor the perceived need for induction of delivery or elective caesarean section, nor the gestation age at delivery differed significantly between the two treatment groups. Post‐randomisation consideration of early (≤32 weeks) and late (>32 weeks) onset groups showed the placebo treated early‐onset group (n= 15) to have more patients with severe hypertension (>150/110 mmHg) and a greater requirement for additional antihypertensive therapy prior to labour than the group treated with labetalol (n= 16).Conclusion
Anti‐hypertensive intervention therapy in pregnancy induced hypertension has been examined using a placebo controlled randomised double‐blind trial of labetalol in pregnancy. The maximum blood pressure prior to labour and the incidence of proteinuria was reduced in women on active therapy. However, the length of gestation was not significantly prolonged and indices of clinical outcome were not significantly altered. The appropriateness of pharmacological therapy for late‐onset PIH may be questioned.
Early teenage pregnancies in Hull
Authors: KONJE JUSTIN C. , PALMER ALAN , WATSON ALAN , HAY DOUGLAS M. , IMRIE ALASTAIR , EWINGS PAUL 
Published: August 2005

ABSTRACTObjectives
To determine the pattern, obstetric outcome and factors that predispose to pregnancies in young teenagers in Hull.Design
Retrospective study of case records of pregnancies from 1977 to 1988 in girls aged 16 years or less and in a control group of nulliparous women aged 20–24 years.Setting
Hull health district hospitals.Subjects
660 pregnant teenagers and 3 576 nulliparas aged 20–24 years.Main outcome measures
Ages at pregnancy, number of pregnancies per year, gestational age at booking and delivery, antenatal complications, mode of delivery, utilization of contraceptives and some social factors.Results
Of the 1 660 pregnancies in the young adolescents, 59.6% were terminations. The youngest girl was 11. The average annual incidence of early teenage pregnancies was 10.5 per 1 000 girls aged 10–16 compared to 6.4 per 1 000 in England and Wales. Physical characteristics and pattern of antenatal care were similar in the study and control groups. Anaemia was 2.53 times as common in teenagers (95% CI 2.19–2.9; P<0.0001) while hypertension alone was 1.7 times as frequent (95% CI 1.28‐2.4; P= 0.002). Pre‐eclampsia and proteinuric disorders were similar in the two groups. Apart from prolonged pregnancy, which was significantly less common in the index group, other gestational ages at delivery and birth weights were the same in both groups. The caesarean section rate in the index group was 0.56 times that in the control group (95% CI 0.4–0.75; P<0.0001) but forceps deliveries were 2.37 times as common in the index group (95% CI 1.80–3.12; P <0.0001). The uncorrected perinatal mortality rates were 13.6/1000 and 15.7/1000 in the index and control groups respectively.Conclusion
Early teenage pregnancies are common in Hull and, contrary to previous reports, are physically well tolerated by the early adolescents who book early and attend antenatal clinics regularly. Ineffective utilization and ignorance of contraceptive methods are contributory factors. We recommend that emphasis should be placed on providing contraceptive services for teenagers and adopting a more purposeful and holistic approach to sex education.