bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities
Authors: Ingemarsson Ingemar , Herbst Andreas , Thorngren‐Jerneck Kristina 
Published: August 2005

Objective
To study the outcome after acidaemia at term birth, and the relation to gender and duration of pathological fetal heart rate changes.Design
Population based study of 154 infants with umbilical artery pH < 7.05 at term birth. Neonatal outcome and the result of developmental screening at age four years were compared with a control group with pH > 7.10. Fetal heart rate traces in infants with acidaemia were reviewed, and the relation between duration of fetal heart rate changes and outcome was analysed.Results
Of the 154 newborns with acidaemia at birth, 10 had encephalopathy, of which two died and two developed cerebral palsy. Nine of these 10 infants were boys, and eight had pH < 7.00. Male newborns (n= 39) more often had pronounced acidaemia (pH < 7.00) than females (n= 22). Although few infants had severe impairment, infants born with acidaemia significantly more often had speech problems at follow up than controls (19/102 versus 8/98; P= 0.03). In infants with acidaemia, duration of abnormal fetal heart rate changes was significantly associated with neonatal encephalopathy and speech problems at age four years.Conclusions
Acidaemia at term birth was associated with neonatal encephalopathy and with speech problems at four years of age. Boys had more often pronounced acidaemia and a complicated course. A protracted abnormal fetal heart rate trace was associated with poor outcome.
Lipid peroxidation in cord blood: a randomised sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios
Authors: Wang Chi Chiu , Rogers Michael Scott 
Published: August 2005

Objective
To determine the efficacy of prophylactic intrapartum amnioinfusion in reducing cord arterial lipid peroxide levels in cases of intrapartum oligohydramnios.Design
Sequential randomised pairs trial.Setting
Delivery suite of a teaching hospital, the Chinese University of Hong Kong.Population
Women with singleton, term pregnancy, cephalic presentation, clear amniotic fluid and an amniotic fluid index 5 cm, with a normal intrapartum fetal heart rate tracing within 30 minutes of amniotomy.Methods
Selected patients were randomised either for prophylactic saline amnioinfusion or as control cases. Cord arterial lipid peroxide concentrations and acid base balance were determined at delivery.Main outcome measures
Operative intervention for fetal distress, cord arterial malondialdehyde and organic hydroperoxide levels, pH and base excess.Results
Amnioinfusion was associated with significant reductions in the incidence of operative delivery for fetal distress and in lipid peroxide levels, an increase hi base excess, but no significant alteration in pH.Conclusions
Oligohydramnios in labour is associated with high levels of lipid peroxidation, reflecting cellular damage by release of free radicals following hypoxia reperfusion. Prophylactic intrapartum saline amnioinfusion is an effective technique for the reduction of lipid peroxidation and of the incidence of operative intervention for fetal distress but has no significant effect on overall operative delivery rates.
Improved methods of assessing proteinuria in hypertensive pregnancy
Authors: Saudan Patrick J. , Brown Mark A. , Farrell Tanya , Shaw Loretta 
Published: August 2005

Objective
To determine whether use of an automated urinalysis device will improve the accuracy of detecting proteinuria, and whether spot urine protein to creatinine ratio will provide accurate quantitation of proteinuria in hypertensive pregnant women.Design
Prospective studies assessing the accuracy of both detection and quantitation of proteinuria.Setting
Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia.Population
Hypertensive pregnant women admitted to hospital or day assessment unit for management of their hypertensive disorders.Methods
1. Routine dipstick urinalysis and 2. urinalysis by an automated device (Clinitek 100 Ames) on a midstream urine sample were compared with measurement of protein concentration on that sample (n= 103). In a third study, the protein:creatinine ratio on a midstream (spot) urine sample was compared with protein excretion over the subsequent 24 hours (n= 100).Main outcome measures
Relations between urine protein concentrations and 1. dipstick urinalysis and 2. automated urinalysis; 3. Positive and negative predictive values of spot protein: creatinine ratio for true proteinuria ( 300 mg/day).Results
Automated urinalysis improved the percentage of true positive urinalyses from 48% with visual urinalysis to 74% (P= 0.02). True negatives were 98% to 100% for both methods. Spot urine protein:creatinine ratio correlated well with subsequent 24‐hour urine proteinuria (r= 0.93, P < 0.001). A protein:creatinine ratio > 30 mg protein/mmol creatinine was the optimum discriminant value for true proteinuria, with sensitivity 93%, specificity 92%, positive predictive value 95% and negative predictive value 90%.Conclusions
Use of an automated urinalysis device improved accurate detection of proteinuria, particularly reducing false positive tests. A random urine protein:creatinine ratio provides an accurate and rapid quantitation of proteinuria in hypertensive pregnant women. This should improve clinical care, especially when managing hypertensive pregnant women as outpatients.
Single photon emission and cerebral computerized tomographic scan and transcranial Doppler sonographic findings in eclampsia
Authors: Naidu K. , Moodley J. , Corr P. , Hoffmann M. 
Published: August 2005

Objective
To define more clearly the neuropathophysiology of eclampsia utilising single‐photon emission computed tomography (SPECT), cerebral computerised tomography (CT) and transcranial Doppler (TCD) ultrasonography.Design
A prospective study.Setting
The obstetric unit in King Edward VIII Hospital, a large tertiary referral centre hi Kwa‐Zulu Natal, South Africa.Participants
Sixty‐five women with eclampsia.Interventions
Imaging and ultrasonographic investigations were performed within 48 hours postpartum. Unenhanced cerebral CT scans were performed in all the women and SPECT scans were performed on 63 women using Technetium‐99m‐hexamethylpropyleneamineoxime (99mTc‐HMPAO) as a tracer of regional cerebral blood flow. Middle cerebral artery blood flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach.Main outcome measures
Abnormalities in SPECT scan, CT scan and TCD ultrasound findings.Results
SPECT scanning revealed perfusion deficits in the watershed areas in all women, 75% of whom had concomitant deficits in the parieto‐occipital areas of the brain. Hypodensities (cerebral oedema) were reported in 38 CT scans (58.5%), with parieto‐occipital involvement in 97.4% of cases. Increased flow velocity measurements in the middle and posterior cerebral arteries were recorded in 36 (85.7%) women in whom TCD ultrasound was performed.Conclusion
The pathophysiological mechanism of eclamptic seizures is primary cerebral vasospasm with resultant ischaemia and cerebral oedema involving mainly the watershed areas and parieto‐occipital lobes of the brain. SPECT scanning has been shown to be superior to CT scanning and TCD ultrasonography in detecting neuropathophysiologic alterations in eclampsia. However, each of the three investigative tools provide its own unique information and all three are necessary research techniques to improve our understanding of the neuropathophysiological mechanism of eclamptic seizures.
The potential of serum levels of soluble tumour necrosis factor receptor I as a biochemical marker in cervical cancer
Authors: Sheu Bor‐Ching , Lin Ho‐Hsiung , Chang Daw‐Yuan , Ho Hong‐Nerng , Huang Su‐Cheng 
Published: August 2005

Objectives
To investigate the significance of serum levels of soluble tumour necrosis factor receptor I (sTNF‐RI) as a potential biochemical marker in women with cervical cancer.Design
A prospective, case‐controlled study.Participants
Seventy‐one women with cervical cancer and 33 women with myoma were enrolled in this study.Methods
Pre‐operative serum levels of sTNF‐RI were measured with a standard enzyme‐linked immunosorbent assay utilising murine monoclonal antibody against sTNF‐RI.Main outcome measures
All data in both groups were evaluated and correlated with the pre‐operative serum levels of sTNF‐RI. Data analysis was carried out using ANOVA with multiple comparison and linear regression.Results
The mean serum level of sTNF‐RI in the cervical cancer group was significantly lower than that in the myoma group (P < 0.001). The sTNF‐RI levels decreased sequentially with disease progression from Stage Ia to IIb in women with cervical cancer. The mean serum level of sTNF‐RI was also significantly lower in women with positive lymph node (P < 0.05) or recurrent cancer (P < 0.001). A negative correlation was observed between serum levels of sTNF‐RI and tumour size (r=−0.622, P < 0.0001).Conclusions
Decreased pre‐operative serum levels of sTNF‐RI are observed in women with cervical cancer. The results do not support that the use of sTNF‐RI as a biochemical marker for cervical cancer.
Observer variability among colposcopists from the West Midlands region
Authors: Etherington I. J. , Luesley D. M. , Shafi M. I. , Dunn J. , Hiller L. , Jordan J. A. 
Published: August 2005

Objective To assess variation in diagnoses and management decisions among colposcopists when presented with cervical images; to see the impact of the referral cytology report on diagnostic accuracy.Design A two‐part video questionnaire study.Participants Colposcopists from West Midlands RegionMethods Twenty cervical images displaying a range of transformation zones from normal through varying abnormalities up to cervical intraepithelial neoplasia (CIN) grade 3 were shown on video tape together with basic patient information. Two sets of videos were made, the second being identical to the first other than including the referral cytology. Participants recorded their diagnoses and management decisions on prepared questionnaires. The two sets of videos were viewed several weeks apart.Results Completed questionnaires to both videos were received from 30 colposcopists. Diagnostic accuracy improved with knowledge of the cervical cytology result in cases of CIN 2/3 (x2= 19.45, P < 0.0001) but not where the histology was CIN 1 or less (x2= 2.64, P= 0.10). Overall inter‐observer agreement improved slightly from K = 0.169 to K = 0.212 when the cytology was revealed. While only 2.6% of cases of CIN 2/3 would have been under‐managed after the second questionnaire, 37.5% cases where the abnormality did not amount to CIN would have been over‐treated.Conclusion There is considerable inter‐observer variability and variation in diagnostic accuracy in scoring cervical images particularly at the lower end of the spectrum of abnormality which has the potential to lead to over‐treatment. We rely considerably on the cervical cytology result in forming a diagnosis. We recommend that a see‐and‐treat approach be abandoned when the referral smear shows minor abnormalities. The study has implications for both training and audit in colposcopy
Video colpography: a new technique for secondary cervical screening
Authors: Etherington I. J. , Dunn J. , Shafi M. I. , Smith T. , Luesley D. M. 
Published: August 2005

Objective
To assess the diagnostic accuracy of a new technique of cervical imaging and to consider its potential as a secondary cervical screening method.Design
A prospective cross‐sectional study with each case acting as its own control, comparing video colpography with colposcopy.Setting
University of Birmingham colposcopy clinics, City Hospital and Birmingham Women's Hospital.Participants
Fifty women referred for colposcopy.Interventions
The women had a video colpogram recording made prior to colposcopy.Main outcome measures
The proportion of technically suitable colpograms obtained and the level of agreement between colposcopist and video screener.Results
The images were satisfactory or good in 94% cases, and there was a very high level of agreement between colposcopist and video screener (K = 0.79). If the technique had been used in a primary health care setting as a secondary screening method for women with low grade cervical smear abnormalities, 61% would have avoided referral for colposcopy.Conclusions
Video colpography is an accurate, portable and quick method of cervical imaging. It combines the simplicity of a video camera with the versatility of computerised digital imaging and has great potential in the fields of teaching, audit and screening of low grade smear abnormalities.
Serum screening for Down's syndrome: how much do health professionals know?
Authors: Sadler Michael 
Published: August 2005

Objective
To assess knowledge about serum screening for Down's syndrome in health professionals involved in antenatal care.Design
Postal questionnaire survey of knowledge of performance and interpretation of serum screening. Setting Portsmouth and South East Hampshire health district.Population
All health professionals likely to be involved in antenatal care.Methods
Questionnaires were sent to all general practitioners (n= 288), hospital midwives (n= 129), community midwives (n= 71), and obstetricians (n= 29) working in the district.Main outcome measures
Total number of correct responses given to eight factual questions and percentage of correct responses to each individual question.Results
Responses were received from 434 health professionals (84%). Fifty‐nine percent of health professionals correctly answered only a half or less of the factual questions on serum screening. Questions relating to the sensitivity, specificity, and positive predictive value were particularly poorly answered. Obstetricians scored most highly. General practitioners scored significantly less than the other groups.Conclusions
Women need accurate information to give informed consent to serum screening. Most health professionals likely to be involved in antenatal care in this district do not fully understand the test and are thus unlikely to provide such information. Changes in the provision of maternity services following Changing Childbirth may increase the input of midwives and general practitioners. Training of professionals about serum screening should be reviewed.
The deep venous system in the puerperium: an ultrasound study
Authors: Macklon Nicholas S. , Greer Ian A. 
Published: August 2005

Objective
To study the vessel wall diameter and blood flow velocity within the proximal deep venous system of the leg in the puerperium and to compare these measures with respect to the left versus right leg, 4th versus 42nd postnatal day, and vaginal versus caesarean delivery.Design
A combined longitudinal and cross‐sectional observational study.Setting
The ultrasound department of a teaching maternity hospital.Results
A reduction in vessel diameter and an increase in flow velocity was observed between the 4th and 42nd postnatal day. Vessel diameter was greater and flow velocity was reduced in the left compared to the right leg. In those delivered by caesarean section, a trend towards reduced flow velocity in the proximal deep leg veins was observed when compared with those delivered vaginally.Conclusions
These data suggest possible physiological mechanisms behind previous clinical observations relating to the period of greatest risk of deep vein thrombosis in the puerperium, the relative preponderance of left sided deep vein thrombosis and the risk of deep vein thrombosis associated with caesarean section.
Human placental syncytiotrophoblast microvillous membranes impair maternal vascular endothelial function
Authors: Cockell Anna P. , Learmont Jonathan G. , Smárason Alexander K. , Redman Christopher W. G. , Sargent Ian L. , Poston Lucilla 
Published: August 2005

Objective
To investigate the hypothesis that, should there be an increase in deported syncytiotrophoblast microvillous membrane fragments in pre‐eclampsia, it may cause maternal vascular endothelial dysfunction.Design
Syncytiotrophoblast microvillous membrane (STEM) vesicles, prepared from normal term placentae, were perfused through small subcutaneous arteries isolated from fat biopsies obtained at caesarean section. Endothelial function of these arteries was studied by determining acetylcholine‐induced relaxation after preconstriction with noradrenaline. As controls, physiological buffer or red blood cell membranes in physiological buffer were used and endothelial function similarly estimated. Transmission electron microscopy was performed on arteries after perfusion.Sample
STBM vesicles, isolated from the placentae of three healthy women undergoing elective caesarean section for reasons unrelated to pre‐eclampsia, were suspended in physiological buffer. Subcutaneous fat arteries were obtained from a separate group of 13 normotensive pregnant women, also undergoing elective caesarean section at term.Results
Perfusion with red blood cell membranes or physiological buffer had no significant effect on the concentration dependent relaxation in arteries preconstricted with noradrenaline. However, after 2 h perfusion with STBM vesicles, arteries showed a significant reduction in relaxation to acetylcholine, indicative of altered endothelial function. Transmission electron microscopy of arteries perfused with STBM vesicles confirmed endothelial disruption.Conclusions
STBM vesicle perfusion specifically altered the relaxation response of preconstricted maternal subcutaneous fat arteries to acetylcholine, suggesting an alteration in endothelial dependent relaxation. Deported microvilli may therefore be capable of producing endothelial cell damage and endothelial dysfunction observed in the maternal syndrome of pre‐eclampsia.
Prevalence and characteristics associated with use of hormone replacement therapy in Britain
Authors: Moorhead Timothy , Hannaford Philip , Warskyj Maria 
Published: August 2005

Objective
To describe trends in the prevalence of hormone replacement therapy (HRT) use among women living in Britain between 1981 and 1990, and to determine whether women who receive HRT are different from those who do not.Design
Population‐based, prospective, observational study.Setting
Fourteen hundred general practices throughout the United Kingdom contributing data to the Oral Contraception Study of the Royal College of General Practitioners (RCGP).Population
Prevalence of use: women still under general practitioner observation in the Oral Contraception Study at the end of December 1981 (n= 19,949), 1984 (n= 18,037), 1987 (n= 16,063), 1990 (n= 13,379). Characteristics of users: 3806 HRT users and 3806 never‐users matched for age, hysterectomy status and duration of observation in the Oral Contraception Study.Main outcome measure
Ever‐use of hormone replacement therapy.Results
Between 1981 and 1990 there was a threefold increase in HRT use among women both among those who had and those who had not had a hysterectomy. Increasing trends were apparent in all age groups. By December 1990, 19% of all women (36% of those who had had a hysterectomy and 16% of those who had not had a hysterectomy) had ever used HRT; 9% were classified as current users. Forty‐one percent of women using HRT who had had a hysterectomy received combined (oestrogen and progestogen) preparations; 31% of those who had not had a hysterectomy received at least one prescription for unopposed oestrogen. Among those who had had a hysterectomy, HRT was more likely to be prescribed in women with a history of smoking, nonpsychotic psychiatric illness, hot flushes, other menopausal symptoms, oophorectomy, migraine or headache. Women with breast cancer were less likely to receive HRT. In women who had not had a hysterectomy, smoking, nonpsychotic psychiatric illness, hot flushes, other menopausal symptoms, migraine, headache and previous use of oral contraceptives increased the chances of HRT being used; a history of breast cancer, ischaemic heart disease or diabetes mellitus reduced the chances. Weaker associations of reduced risk were also found for hypertension and lower social class. The influence of hot flushes and other menopausal symptoms appeared to be stronger in women who used HRT before the age of 50, than in older women.Conclusions
HRT use increased dramatically within the cohort during the nine year period. HRT users are different from nonusers in a number of ways which could have opposing effects on a woman's risk of cardiovascular disease.
Sexual function after childbirth: women's experiences, persistent morbidity and lack of professional recognition
Authors: Glazener Cathryn M. A. 
Published: August 2005

Objective
To describe the sexual behaviour of postnatal women, including time of restarting intercourse, problems encountered, use of contraception and related use of available services.Design
Longitudinal survey using postal questionnaires following discharge from hospital, and at eight weeks and twelve to eighteen months postnatally.Setting
The questionnaires referred to postnatal care received in a teaching hospital and general practitioner delivery units, and in the community.Population
Randomly selected one in five sample of women who were delivered in the Grampian Region of Scotland over a 12‐month period.Main outcome measures
Times to restarting intercourse and contraception; problems related to intercourse and their relation to perineal pain, tiredness and method of infant feeding; and perceived need for and adequacy of help.Results
The median times to restarting intercourse and contraception were each six weeks. Problems with intercourse were reported by 569/1075 (53%, 95% CI 50–56) of women in the first eight weeks after delivery, and by 215/435 (49%, 95% CI 45–54) in the subsequent year. Women who reported perineal pain, depression or tiredness experienced problems related to intercourse more often than those who did not. Women who breastfed their infants were significantly less interested in intercourse than those who bottlefed, irrespective of tiredness or depression, but this effect did not persist in the long term. The need for help with problems was expressed by 7% to 13% of women, but a quarter of these had not sought it.Conclusions
Postnatal sexual problems are common. Health professionals ought to educate and prepare patients antenatally; be trained to identify problems; and be competent to deal with them openly and sympathetically.