bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of oscillometric blood pressure monitoring in pregnancy and pre‐eclampsia
Authors: Gupta Manish , Shennan Andrew H. , Halligan Aidan , Taylor David J. , de Swiet Michael 
Published: August 2005

Objective
To assess the accuracy of the Omron HEM 705 CP oscillometric device for the measurement of blood pressure in pregnancy and pre‐eclampsia.Setting
Two teaching hospitals.Participants
Eighty‐five pregnant women with a wide range of blood pressures, and 43 women with pre‐eclampsia.Methods
Evaluation was carried out according to the British Hypertension Society protocol, incorporating criteria of the Association for the Advancement of Medical Instrumentation (AAMI).Results
Mean differences (device minus observer) for systolic blood pressure were −0.9 mmHg (SD 10) in normal pregnancy, and −2 mmHg (SD 10) in the women with pre‐eclampsia. For diastolic blood pressure, Korotkoff phase V, the differences were −1.5 mmHg (SD 10), and −8 mmHg (SD 8) respectively; i.e. the device consistently under‐read the diastolic blood pressure in pre‐eclamptic women by a mean of 8 mmHg when compared with conventional sphygmomanometry. Korotkoff phase IV could not be accurately reproduced. According to the British Hypertension Society grading criteria, the device reached a ‘B’ grading in the 85 pregnant women. In pre‐eclampsia only a ‘C’ grade was reached for systolic blood pressure, and ‘D’ grade for diastolic blood pressure. Accuracy criteria stipulated by the AAMI were not met in any situation.Conclusion
The Omron HEM 705 CP does not reach acceptable accuracy criteria for blood pressure measurement when compared with trained observers in women with pre‐eclampsia, as judged by the British Hypertension Society Protocol. It also failed to meet the AAMI criteria, although the methodology stipulated by the AAMI may not be applicable to a pregnancy population.
The Stockholm Birth Centre Trial: maternal and infant outcome
Authors: Waldenstrom Ulla , Nilsson Carl‐Axel , Winbladh Birger 
Published: August 2005

Objective
To compare an in‐hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome.Background
The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midwives, restricted use of medical technology, and discharge within 24 h after birth.Methods
Of 1860 women meeting low risk medical criteria in early pregnancy and interested in birth centre care, 928 were randomly allotted birth centre care and 932 standard maternity care. Data were collected mainly from hospital records, and analysis was by intention‐to‐treat.Results
Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical differences were observed in maternal morbidity or in perinatal mortality, neonatal morbidity, Apgar score or infant admissions to neonatal care. Perinatal mortality, defined as intrauterine death after 22 weeks of gestation and infant death within seven days of birth, occurred in eight cases (0.9%) in the birth centre group and in two cases (0.2%) in the standard care group (OR 4.04, 95% CI 0.80 to 39.17; P= 0.11). Subgroup analysis showed that a larger proportion of first‐born babies in the birth centre group (15.6%) were admitted for neonatal care than in the standard care group (9.5%) (P= 0.003), whereas the converse was the case for the newborns of multiparous women: 4.7% and 8.4%, respectively (P= 0.04). The overall rates of operative delivery (e.g. caesarean section, vacuum extraction and forceps), 11.1% in the birth centre group and 13.4% in the standard care group, did not differ statistically (P= 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group.Conclusion
Birth centre care was associated with less medical interventions than standard care without any statistically significant differences in health outcomes. However, the excess of perinatal deaths and of morbidity in primigravidas’ infants in the birth centre group gives cause for concern and necessitates further studies.
Experience of Finnish women with Norplant insertions and removals
Authors: Ollila E. , Sihvo S. , Merilainen J. , Hcmminki E. 
Published: August 2005

Objective
Norplant® and Norplant‐2® have been available for use by Finnish women since 1984 and 1986, respectively. The objective of this study was to explore Norplant users’ experiences of insertions, removals and medical treatments.Design
A questionnaire was sent to women who had received Norplant® or Norplant‐2® implants one to two years earlier (n= 262) in normal clinical settings; the response rate was 79%.Results
At insertion, problems were experienced by 9% and at least some pain by 23% of women. During the first year 20% of all users (14% of Norplant® and 33% of Norplant‐2® users) had their implants removed. Problems were experienced at removal by 33% of women and pain was experienced by 40%; nevertheless most users were satisfied with the device. Findings were similar for the two types of Norplant. Forty‐two percent of the women had received minipills containing levonorgestrel before Norplant insertions in an attempt to assess Norplant's suitability, and 8% had received drugs for adverse effects caused by Norplant.Conclusions
Studies including perspectives of Norplant users and the whole lifespan of Norplant (including removal) should be conducted in all clinical settings where Norplant is provided.
Automated blood pressure measurement as a predictor of proteinuric pre‐eclampsia
Authors: Halligan Aidan W. F. , Shennan Andrew , Lambert Paul C. , Bell Stephen C. , Taylor David J. , de Swiet Michael 
Published: August 2005

Objectives
To investigate the relation between antenatal clinic, obstetric day unit and 24‐hour ambulatory blood pressure measurements and 24‐hour proteinuria levels in hypertensive pregnancies.Design
An observational study.Participants
Forty‐eight women presenting with new hypertension after 20 weeks of gestation.Results
The closest relation was found between ambulatory blood pressure measurements and 24‐hour proteinuria levels. No significant relation was found between the conventional diastolic blood pressure threshold of 90 mmHg and 24‐hour proteinuria levels.Conclusions
Ambulatory blood pressure measurement gives better information about disease status in pre‐eclampsia as assessed by proteinuria than does conventional sphygmomanometry.
Medical abortion or vacuum aspiration? Two year follow up of a patient preference trial
Authors: Howie F. L. , Henshaw R. C. , Naji S. A. , Russell I. T. , Templeton A. A. 
Published: August 2005

Objective
To describe and compare health outcomes two years after medical abortion or vacuum aspiration in women recruited into a patient preference trial during 1990 to 1991.Design
Women recruited to the original, partially randomised study were contacted for assessment using a structured interview.Setting
Grampian region of Scotland, UK.Participants
One hundred and forty women who had participated in a partially randomised study of first trimester abortion two years previously.Intervention
Vacuum aspiration or medical abortion using mifepristone and gemeprost.Main outcome measures
Long‐term general, reproductive and psychological health; acceptability of procedure; perceived value of choice of method of termination.Results
There were no significant differences between women who had undergone medical abortion or vacuum aspiration two years previously in general, reproductive or psychological health. Almost all women placed a high value on the provision of choice of method of termination. There was a significant difference in perception of long term procedure acceptability among women who had been randomised to a method of termination.Conclusions
Women should have the opportunity to choose the method of termination. This opportunity will result in high levels of acceptability, particularly at gestations under 50 days of amenorrhoea.
Levator ani function before and after childbirth
Authors: Peschers Ursula M. , Schaer Gabriel N. , DeLancey John O. L. , Schuessler Bernhard 
Published: August 2005

Objective
To evaluate pelvic floor muscle strength before and after vaginal birth.Design
Prospective repeated measures study.Setting
Main district hospital.Population
Fifty‐five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group.Methods
Pelvic muscle strength was evaluated by palpation, perineometry and perineal ultrasound before childbirth in the 36th to 42nd week of pregnancy, three to eight days postpartum and six to ten weeks postpartum.Main outcome measures
Pelvic floor muscle strength on palpation, intravaginal squeeze pressure and vesical neck elevation during squeeze.Results
Pelvic floor muscle strength is significantly reduced three to eight days postpartum in women following vaginal birth but not in women after caesarean delivery. Six to ten weeks later palpation and vesical neck elevation on perineal ultrasound do not show any significant differences to antepartum values, while intravaginal pressure on perineometry remains significantly lower in primiparae, but not in multiparae.Conclusions
Pelvic floor muscle strength is impaired shortly after vaginal birth, but for most women returns within two months.
Perineal examination as a predictor of underlying external anal sphincter damage
Authors: Frudinger Andrea , Bartram Clive I. , Spencer John A. D. , Kamm Michael A. 
Published: August 2005

Objective
To assess the relation between perineal inspection and sphincter integrity in parous women.Design
Prospective observational study.Setting
District general hospital.Population
Fifty‐seven consecutive parous women attending a gynaecology clinic for problems unrelated to the pelvic floor.Methods
A detailed history of bowel function and mode of delivery obtained; the perineum inspected to determine the presence and position of scarring, and anal endosonography performed.Results
In 19 women with an intact perineum on inspection, endosonography showed perineal scarring in five, with both perineal and sphincter scarring in three. Four had urge faecal incontinence. Three patients had a perineal tear only on inspection, but this group was too small for analysis and was discounted. Nine had an episiotomy scar only. Endosonography demonstrated perineal scarring in four, and combined perineal and sphincter scarring in two; one woman in this group had urge faecal incontinence. Twenty‐six women had episiotomy and perineal tears on inspection. Endosonography revealed underlying perineal scarring in five women, with combined perineal and sphincter scarring in 14; six women in this group had urge faecal incontinence and one passive incontinence for flatus. Sonographically the scarring was anterior and circumferential rather than radial, and mostly left‐sided, whereas on inspection episiotomy and perineal scarring were right sided.Conclusions
A normal perineum on clinical examination does not exclude underlying sphincter damage. The incidence of sphincter damage increases significantly when an episiotomy scar is associated with a perineal tear.
Women's health in midlife: the influence of the menopause, social factors and health in earlier life
Authors: Kuh Diana L. , Wadsworth Michael , Hardy Rebecca 
Published: August 2005

Objective
To describe the health symptoms of a large representative sample of British women at age 47 years, and to examine the influence of the menopause allowing for social factors and health in earlier adult life.Design
A national prospective birth cohort study. Information on health problems, menstrual cycle, use of hormone replacement therapy and life stress at 47 years was collected using a postal questionnaire. Information on health, smoking behaviour and educational attainment earlier in life had been collected at previous home visits.Setting
England, Scotland and Wales.Population
A general population sample of 1498 women, 84% of those sent a questionnaire.Main outcome measure
Twenty self‐reported health symptoms over the previous 12 months.Results
Women who had experienced an early natural menopause had a strongly raised risk of vasomotor symptoms (hot flushes or night sweats), sexual difficulties (vaginal dryness or difficulties with intercourse) and trouble sleeping. However, there was little or no excess risk of other somatic or psychological symptoms. In contrast, all types of symptoms were more common among women who had had a hysterectomy or were users of hormone replacement therapy. Women with the least education, stressful lives, or a previous history of poor physical and psychological health at age 36 also reported more symptoms at 47 years compared with other women, but adjustment for these factors in a logistic regression model did not affect the relations between symptoms and current menopausal status. For vasomotor symptoms, postmenopausal women had an adjusted odds ratio of 4.7 (95% CI 2.6–8.5) and perimenopausal women had an adjusted odds ratio of 2.6 (95% CI 1.9–3.5) compared with premenopausal women. Corresponding adjusted odds ratios for sexual difficulties were 3.9 (95% CI 2.1–7.1) and 2.2 (95% CI 1.4–3.2), and for trouble sleeping were 3.4 (95% CI 1.9–6.2) and 1.5 (95% CI 1.1–2.0).Conclusions
Specific symptoms were clearly associated with the natural menopause. More general health concerns were common among women in middle life, particularly among those with stressful lives, or those who had had a hysterectomy or started taking hormone replacement therapy before they were postmenopausal. Appropriate advice and support needs to be easily accessible.
Vaginal vault suspension for prolapse after hysterectomy using an autologous fascial sling of rectus sheath
Authors: Barrington J. W. , Calvert J. P. 
Published: August 2005

Objective
To evaluate the results of a modified rectus sheath fascial sling used as a treatment for vaginal.Design
Retrospective analysis of case records.Setting
District General Hospital in South Wales.Participants
Ten women who had had a hysterectomy 2 to 20 years previously (mean 8 years).Results
All the women were cured of symptoms related to vaginal vault prolapse. There were no intra‐operative complications. No new urinary symptoms have developed. One woman developed an enterocele which was corrected by the abdominal insertion of a prolene mesh.Conclusion
A modified rectus sheath fascial sling is a safe, simple effective abdominal operation for the surgical correction of vaginal vault prolapse after hysterectomy. vault prolapse after hysterectomy.
Significance of a diastolic notch in the uterine artery flow velocity waveform induced by uterine embolisation in the pregnant ewe
Authors: Ochi Hiroshi , Matsubara Keiichi , Kusanagi Yasuki , Taniguchi Humiaki , Ito Masaharu 
Published: August 2005

Objective
To investigate the relation between placental embolisation and the diastolic notch in the uterine artery flow velocity waveform of pregnant ewes under general anaesthesia.Methods
Seven pregnant ewes at a gestation 16 to 17 weeks were anaesthesized and micro beads of gelfoam were injected into the uterine artery; changes in the uterine circulation were assessed by Doppler velocimetry.Results
Gelfoam embolisation reduced uterine blood flow in a dose‐dependent manner, from a mean (95% CI) of 568 mL/min (495–641) to 159 mL/min (131–187) after the injection of 30 mg of gelfoam, and increased the uterine vascular resistance from 135 mmHg mine L−1 (103–167) to 498 mmHg mino L−1 (422–574). A diastolic notch in uterine artery flow velocity waveform was observed after 20 mg to 25 mg of gelfoam in two ewes and after injection of 30 mg of gelfoam in all seven animals. Injection of 30 mg of gelfoam increased the pulsatility index to 2–4 (1.9–2.9) from 0.6 (0.5–0.7). The mean uterine vascular resistance at the time of the appearance of a diastolic notch was 414 mmHg mine L−1 (377–451).Conclusion
These findings suggest that an elevated pulsatility index and the presence of a diastolic notch in the uterine artery flow velocity waveform are indicators of increased uterine vascular resistance and impaired uterine circulation.
A prospective study of maternal serum insulin‐like growth factor‐I in pregnancies with appropriately grown or growth restricted fetuses
Authors: Holmes R. P. , Holly J. M. P. , Soothill P. W. 
Published: August 2005

Objective
To determine whether there is a relationship between maternal serum insulin‐like growth factor‐I and fetal growth, consistent with the hypothesis that insulin‐like growth factor‐I influences maternal constraint upon fetal growth by controlling placental transfer.Design
A prospective, observational study.Setting
Fetal medicine unit and antenatal clinic of a large teaching hospital.Population
One hundred and forty‐one pregnant women identified as having small or normally grown fetuses.Methods
Fetuses were scanned every two weeks with maternal venesection at each visit. Cases (birthweight < 5th centile) were assigned to two groups: fetal growth restriction due to placental dysfunction (umbilical artery Doppler, growth velocity pulsatility index > +2 SD; n= 25) and normal small‐for‐gestational‐age (normal Doppler, growth velocity and amniotic fluid; n= 27). Eighty‐nine controls had birthweights between the 5th and the 95th centiles, normal Doppler, growth velocity and amniotic fluid. Insulin‐like growth factor‐I was measured by radioimmunoassay, and its relationship to gestational age and birthweight was assessed by regression analysis. Comparisons between case groups were made by Student's t test or analysis of covariance to allow for the effect of birthweight.Outcome measure
The last insulin‐like growth factor‐I level before delivery within the different subgroups.Results
In controls, maternal insulin‐like growth factor‐I increased with gestational age (p= 0.40; P= 0.0001) but did not correlate with birthweight. Insulin‐like growth factor‐I was low in the mothers of growth restricted fetuses (‐1.56 SD; P= 0.0001), but not in those with small‐for‐gestational age fetuses.Conclusions
The control and small‐for‐gestational‐age data suggest that maternal insulin‐like growth factor‐I is not associated with endocrine control of normal placental function. Low insulin‐like growth factor‐I relates to poor placental transfer, as indicated by Doppler, rather than to low birthweight. Whether this is a regulatory mechanism, a cause or a consequence of placental dysfunction needs further study.
The influence of oral contraceptives on the risk of multiple sclerosis
Authors: Thorogood Margaret , Hannaford Philip C. 
Published: August 2005

Objective
To examine the risk of multiple sclerosis in users of combined oral contraceptives.Design
Cohort study conducted between 1968 and 1996 using diagnostic data supplied by general practitionersSetting
General practices throughout the United Kingdom.Population
Royal College of General Practitioners' Oral Contraception Study cohort of initially 46,000 women recruited during the late 1960s.Methods
Directly standardised incidence rates of multiple sclerosis were calculated for current, former and never‐users of oral contraceptives using first ever cases of multiple sclerosis reported by the general practitioners. The standardisation variables were age, parity, social class and smoking history. Five‐year survival rates in the different contraceptive groups were calculated using standard life table techniques.Results
One hundred and fourteen first ever cases of multiple sclerosis had been reported by November 1996 during 564,000 woman‐years of observation. The incidence rate in both current and former users was not materially different to that in never‐users. Although based on limited evidence there was no suggestion that the five‐year survival was affected by a woman's use of combined oral contraceptives.Conclusions
These findings do not suggest a greatly elevated risk of multiple sclerosis during, or after, use of combined oral contraceptives.
The management of squamous cell vulval cancer: a population based retrospective study of 411 cases
Authors: Rhodes Catharine A. , Cummins Carole , Shafi Mahmood I. 
Published: August 2005

ObjectiveTo audit the epidemiology, management and outcome of vulval cancer in the West Midlands.DesignA retrospective population based study using information obtained from Cancer Intelligence Unit records.SettingThe West Midlands Health Region.SampleFive hundred and six women with vulval carcinoma notified to the Cancer Intelligence Unit, during two three‐year periods: 1980–1982 and 1986–1988; 411 women had a proven histological diagnosis of squamous cell carcinoma of the vulva.ResultsHistology was available for 4541506 women (90%); 411/454 women (91%) had squamous cell carcinoma: these formed the study population. The women were treated at 35 hospitals, 16 of which averaged one case or less per year. The median age at diagnosis was 74 years. Presentation was delayed by more than one year in 631284 women with data (22%), and 971284 cases (34%) had more than one symptom. A biopsy was taken in 268 women (65%) and surgery was the primary treatment in 344/411 cases (84%). Fifteen different operations were used. Simple vulvectomy (35%) and radical vulvectomy with bilateral inguinal lymphadenectorny (34%) were the commonest surgical procedures; 190/344 (55%) had a lymphadenectorny; of these 102 women had negative node histology and 78 women had nodal metastases, with results not recorded in 10 cases. Overall, only 46% of all women (190/411) studied had a lymphadenectomy. Recurrence was recorded in 123/411 women (30% of the total). Univariate analysis showed significantly worse five‐year survival for older age, advanced stage, incomplete excision, poor differentiation, lack of lymph node resection, positive lymph node pathology and treatment in a hospital with less than 20 cases in total. A multivariate analysis using Cox proportional hazards model identified the first five factors as independent predictors of five year survival. Omission of lymphadenectorny was independently associated with poorer survival (RR 2.17,95% CI 1.53–3.07).ConclusionsThere is wide variation in the management of vulval cancer with inadequate usage of lymphadenectorny and many centres treating few cases. Survival analysis shows prognostic variables as expected; omission of lymphadenectomy adversely affects survival.
A randomised controlled trial of antibiotic prophylaxis for vesico‐vaginal fistula repair
Authors: Tomlinson A. John , Thornton James G. 
Published: August 2005

Objective
To test the hypothesis that intravenous antibiotics given intra‐operatively reduce the failure rate of vesico‐vaginal fistula repair.Design
A single blind, randomised controlled trial.Setting
A district hospital in Benin, West Africa.Population
Seventy‐nine women undergoing repair of an obstetric vesico‐vaginal fistula by a single surgeon at Hopital Evangelique; two women had repeat operations.Methods
Participants in the treatment group (n = 41) received ampicillin 500 mg intra‐operatively. Controls (n = 40) received no prophylactic antibiotics.Main outcome measures
Failure of fistula closure and objective incontinence (a positive pad test) at hospital discharge. Secondary outcomes included febrile morbidity, other antibiotic use and urinary infection.Results
Antibiotic prophylaxis did not reduce the odds of failed repair (OR 2.1 95% CI 0.75–6.1) or of objective incontinence (OR 1.9; 95% CI 0.72–5.1). The women in the antibiotic prophylaxis group received less post‐operative antibiotics and had less urinary infections at day 10.Conclusions
Prophylactic antibiotics should not be used in vesico‐vaginal fistulae repair in the developing world outside randomised controlled trials.