bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre‐eclampsia and intrauterine growth retardation
Authors: Harrington K. , Carpenter R. G. , Goldfrad C. , Campbell S. 
Published: August 2005

Objective
To evaluate the predictive value of transvaginal Doppler ultrasound studies of the uterine and umbilical arteries in early pregnancy, in identifying pregnant women at risk of subsequently developing pre‐eclampsia, or the delivery of a small for gestational age infant.Design
A multivariate logistic regression of Z scores of Doppler indices obtained from the uterine and umbilical arteries of 652 women with singleton pregnancies at 12 to 16 weeks of gestation. Measurements included the presence or absence of a notch, bilateral (right and left waveform) notching, vessel diameter, the resistance index, the pulsatility index, time averaged mean velocity (cm/s), maximum systolic velocity (cm/s), and volume flow (mL/min). Stepwise logistic regression and multivariate analysis of all the parameters measured was used to construct several scoring systems.Main outcome measures
Pre‐eclampsia, birthweight, preterm delivery.Results
In women that developed complications, there was a trend towards increased resistance and reduced velocity and volume flow. If bilateral notches were present there was an increased risk of pre‐eclampsia (odds ratio [OR] 21.99, 95% CI 6.55–73.79), premature delivery (OR 2.38, 95% CI 1.19–4.75), and the delivery of a small for gestational age baby (OR 8.63, 95% CI 3.95–18.84). Using multivariate analysis, a seven parameter model was selected (after removal of vessel diameter, uterine and umbilical resistance index). This model produces a scoring system with a sensitivity of 92.9% and a specificity of 85.1% for the prediction of pre‐eclampsia. A three parameter model (bilateral notches, uterine resistance index, umbilical pulsatility index) provides similar sensitivities, but lower specificities, when compared with the seven parameter model.Conclusion
These data indicate that there are differences in uterine and umbilical artery Doppler blood flow indices at 12 to 16 weeks, in pregnancies with a normal or complicated outcome. Scoring systems derived from multivariate analysis of Doppler indices demonstrate the potential of being able to identify, in early pregnancy, a group of women at increased risk of the subsequent development of pre‐eclampsia, premature delivery, or the birth of a small for gestational age baby.
Recombinant human relaxin as a cervical ripening agent
Authors: Brennand Janet E. , Calder Andrew A. , Leitch Craig R. , Greer Ian A. , Chou Min Min , MacKenzie Ian Z. 
Published: August 2005

Objective
The aim of this study was to investigate the efficacy and safety of recombinant human relaxin (rhRIx) as a cervical ripening agent in women with an unfavourable cervix before induction of labour at term.Design
A multi‐centre, double‐blind, placebo‐controlled trial performed in Edinburgh, Glasgow and Oxford. Women were treated with 0, 1, 2 or 4 mg of rhRIx in a gel vehicle administered intravaginally. Analysis of variance tests were performed on all continuous variables, and Cochran Mantel‐Haenszel tests employed for all discrete variables.Participants
Ninety‐six women at 37 to 42 weeks of gestation with a singleton pregnancy and a modified Bishop score of 4 were recruited.Results
There was no significant difference in the change in modified Bishop score between the four treatment groups. The lengths of the first and second stages of labour were similar in all 4 groups. PGE2 and oxytocin requirements were similar in all groups, as was the mode of delivery. There was no evidence that relaxin was absorbed systemically when given in this way.Conclusion
Recombinant human relaxin 1 to 4 mg, administered as an intravaginal gel, has no effect as a cervical ripening agent before induction of labour at term.
Routine oxytocin in the third stage of labour: a placebo controlled randomised trial
Authors: Nordström Lennart , Fogelstam Kerstin , Fridman Gunilla , Larsson Anita , Rydhstroem Hakan 
Published: August 2005

Objective
To compare intravenous oxytocin administration (Partocon® 10 IU) with saline solution in the management of postpartum haemorrhage in the third stage of labour.Design
A double‐blind, randomised controlled trial involving 1000 parturients with singleton fetuses in cephalic presentation and undergoing vaginal delivery, randomly allocated to treatment with oxytocin (n=513) or 0.9% saline solution (n=487).Setting
Labour ward at a central county hospital.Main outcome measures
Mean blood loss (total, and before and after placenta delivery); frequencies of blood loss > 800 mL, need of additional oxytocic treatment, postpartum haemoglobin < 10 g/dL; and duration of postpartum hospitalisation.Results
As compared with saline solution, oxytocin administration was associated with significant reduction in mean total blood loss (407 versus 527 mL), and in frequencies of postpartum haemorrhage > 800 mL (8.8%versus 15.2%), additional treatment with metylergometrine (7.8%versus 13.8%), and postpartum Hb < 10 g/dL (9.7%versus 15.2%), and a nonsignificant increase in the frequency of manual placenta removal (3.5%versus 2.3%). There was no group difference in the mean duration of postpartum hospitalisation (4.6 versus 4.5 days, respectively).Conclusions
Administration of intravenous oxytocin in the third stage of labour is associated with an approximately 22% reduction in mean blood loss, and approximately 40% reductions in frequencies of postpartum haemorrhage (> 500 mL or >800 mL) and of postpartum haemoglobin < 10 g/dL. Identification of risk groups for oxytocin treatment does not seem worthwhile. Oxytocin is a cheap atoxic drug and should be given routinely after vaginal delivery.
Gestational age and induction of labour for prolonged pregnancy
Authors: Gardosi Jason , Vanner Tracey , Francis Andy 
Published: August 2005

Objective
To examine the length of gestation according to menstrual and ultrasound scan dates, and the rate of induction of labour in a unit with a routine induction policy for prolonged pregnancy.Design
Retrospective analysis of computer files of 24,675 pregnancies delivered in a teaching hospital between 1988 and 1995, which had a record of the last menstrual period and a dating ultrasound scan. Detailed survey of 168 casenotes of consecutive inductions of labour to establish the indications given.Setting
Teaching hospital with policies of routine mid‐trimester ultrasound scan and routine induction for prolonged pregnancy at 290 to 294 days.Main outcome measures
Gestational age at delivery by menstrual history and ultrasound biometry in spontaneous and induced laboursResults
The single largest category of reasons given for induction of labour was prolonged pregnancy.‘Post‐term pregnancy’, from the date of expected delivery as recorded in the notes, together with ‘maternal request’ and ‘social factors’, were the reasons given for induction of labour in 71.3% of cases. Menstrual dates systematically overestimated gestational age at term when compared with scan dates. After 41 weeks, this difference exceeded the confidence limits for second trimester scan dating error, suggesting that most pregnancies which are considered ‘prolonged’ according to menstrual dates are in fact mis‐dated. The median gestational age for induced labours was 286 days by last menstrual period but only 280 days by scan, and most (71.5%) inductions done post‐term (> 294 days) according to menstrual dates were not post‐term if scan dates alone are used to calculate the gestational age. The average induction rate over the seven year study period was 16.6%. It was higher when there was any gestational age error in either direction (16.8%) compared with when menstrual and scan dates were in complete agreement (13.7%, OR 1.27, CI 1.09–1.47, P < 0.001). The induction rate was highest (up to 21.8%) in the cases where menstrual dates overstated gestational age without exceeding the usual limits for adjusting dates according to scan. Such over‐estimation within tolerance limits of 7, 10 or 14 days occurred in 37.1%, 45.8%, or 52.6% of all pregnancies, respectively.Conclusions
Most pregnancies undergoing post‐term induction are not post‐term when assessed by ultrasound dates. Regardless of whether prolonged pregnancy is considered to be a risk factor requiring intervention, the proportion of pregnancies considered ‘post‐term’ can be reduced considerably by a dating policy which ignores menstrual dates and establishes the expected delivery date on the basis of ultrasound dates alone.
Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence
Authors: Keane Declan P. , Sims Tevor J. , Abrams Paul , Bailey Allen J. 
Published: August 2005

Objective
To determine if differences exist in the collagen status of premenopausal nulliparous women with genuine stress incontinence compared with continent controls.Design
Thirty‐six premenopausal nulliparous women with urodynamically‐proven genuine stress incontinence were compared with 25 controls. All the women studied had a periurethral vaginal biopsy taken of approximately 30–50 mg in wet weight. This biopsy was then analysed to determine the collagen content, the type I:III collagen ratio and the collagen cross‐link content.Setting
A tertiary referral urodynamic unit.Results
The nulliparous women with genuine stress incontinence had significantly less collagen in their tissues (P < 0.0001) compared with the continent controls. In addition, there was a decreased ratio of type I to type III collagen (P= 0.0008), and the cross‐link content was also significantly reduced in the women with genuine stress incontinence (P < 0.0001).Conclusion
Genuine stress incontinence is present in a significant number of women before childbirth. The aetiology of their incontinence appears to be due to a defect in their connective tissue, with both a quantitative and qualitative reduction in their collagen.
Randomised trial of one versus two doses of prostaglandin E2 for induction of labour: 1. Clinical outcome
Authors: Mackenzie I. Z. , Burns Ethel 
Published: August 2005

Objective
To compare the outcome of induction of labour using a single versus two doses of prostaglandin E2 vaginal gel.Design
Prospective randomised trial comparing a single dose of prostaglandin E2 2 mg vaginal gel in the evening with two doses of prostaglandin E2 (2 mg), the second being given after six hours if labour had not started or the cervix was still unripe. Amniotomy and oxytocin titration were performed when necessary for both protocols. Nulliparae and multiparae were analysed separately by treatment intention.Setting
A maternity unit in a district general hospital annually delivering > 6000 women.Participants
Nine‐hundred and ninety‐five women with viable singleton pregnancies and cephalic presentation at term without previous history of caesarean section who were advised to have labour induced with prostaglandins.Main outcome measures
Need for formal amniotomy and oxytocin augmentation, use of epidural analgesia, rate of intrapartum interventions, mode of delivery and neonatal condition at birth.Results
For multiparae two prostaglandin doses resulted in a significant reduction in the need for formal amniotomy (15%vs 30%) and oxytocin augmentation (28%vs 38%) compared with those receiving a single dose; there was no significant difference for nulliparae. Other interventions during labour, length of labour, and mode of delivery were similar in both protocols. Failed induction occurred only in nulliparae and was similar in both protocols (1%). There was no discernible difference in fetal or neonatal outcome although passage of meconium was more common in labour if two doses had been given, as was neonatal admission to the special care baby unit.Conclusions
There was little clinical benefit from inducing labour with two doses of prostaglandin E2 at a six‐hour interval, compared with a single dose. There may be financial advantages with a two‐dose regimen.
Introducing external cephalic version at 36 weeks or more in a district general hospital: a review and an audit
Authors: Healey Martin , Porter Richard , Galimberti Andrea 
Published: August 2005

Objective
To audit the effect of introducing external cephalic version at 36 weeks on breech delivery rates and modes, and to assess factors that affect external cephalic version success rates.Design
A prospective unblinded study over 12 months of factors affecting external cephalic version success. A retrospective review of breech deliveries for 12 months before introducing external cephalic version and the first 12 months of practising external cephalic versions.Setting
Royal United Hospital, Bath.Population
One hundred and three women ( 36 weeks) with breech presentation booked for external cephalic version, and 324 women with a singleton breech presentation at delivery between November 1992 and October 1994.Methods
External cephalic version attempted on 89 women. Tocolysis was used on 41 of these women.Main outcome measures
External cephalic version success rate. Breech presentation rates (suitable for external cephalic version) at delivery. Delivery mode rates for breeches.Results
External cephalic version was successful in 39% of women. The breech presentation rate (external cephalic version suitable) at delivery fell from 2.7% to 2.4% of all deliveries. The vaginal breech delivery rate fell from 0.98% to 0.51%. The caesarean section rate was 63% for breeches (external cephalic version suitable) before external cephalic version introduction, and 47% among women who had an attempted external cephalic version.Conclusions
Attempted external cephalic version reduces the woman's risk of vaginal breech delivery and caesarean section. It provides individual women with a third management option and the possibility of avoiding a vaginal breech delivery or a caesarean section. To avoid one caesarean section takes 5.9 attempted external cephalic versions. This approach is expensive in operator time. Operator, placental site, position of fetal back and amniotic fluid index had a significant effect on the success of external cephalic version.
Maternal middle cerebral artery velocimetry in normal pregnancy and postpartum
Authors: Serra‐Serra Vicente , Kyle Phillipa M. , Chandran Ravi , Redman Christopher W. G. 
Published: August 2005

Objective
To study changes throughout gestation and the puerperium of middle cerebral artery flow velocity waveforms obtained by transcranial Doppler ultrasound.Design
Prospective, observational study.Setting
John Radcliffe Maternity Hospital, Oxford, UK.Participants and Methods
Middle cerebral artery velocities were measured by transcranial Doppler ultrasound in 25 nonpregnant women, 22 women longitudinally followed throughout pregnancy and 21 women serially studied from delivery until the late puerperium.Main outcome measures
Transcranial Doppler changes in pregnancy and the puerperium.Results
The transcranial Doppler ultrasound measurements showed good reproducibility. Signals from one middle cerebral artery could not be obtained in 4.6% of the examinations, but otherwise readings were similar on both sides. Women in the second half of pregnancy had lower middle cerebral artery mean velocities than nonpregnant women. Velocities decreased with advancing gestation but increased in the immediate puerperium to levels comparable to those found in nonpregnant women.Conclusions
Transcranial Doppler ultrasound is a noninvasive technique suitable for studying maternal cerebral haemodynamics in pregnancy and postpartum. Middle cerebral artery mean velocity decreased with advancing gestation and increased to nonpregnant values in the immediate puerperium. These physiological changes need to be considered when comparing data with measurements taken in abnormal pregnancy states.
Does sweeping of the membranes reduce the need for formal induction of labour? A randomized controlled trial
Authors: Boulvain Michel , Fraser William D. , Marcoux Sylvie , Fontaine Jean‐Yves , Bazin Sylvie , Pinault Jean‐Jacques , Blouin Daniel 
Published: August 2005

Objective
1. To evaluate the effectiveness of sweeping of the membranes to reduce the need for a formal induction of labour; 2. to evaluate the side effects of this intervention.Design
A randomised controlled clinical trial.Setting
Three tertiary care hospitals of the province of Quebec, Canada.Population
Two hundred women for whom non‐ urgent induction of labour was medically indicated.Methods
Women were randomly allocated to sweeping of membranes, or vaginal examination for Bishop scoring only.Main outcome measures
1. Cumulative incidence and relative risk of induction of labour by either oxytocin, prostaglandins or amniotomy; 2. women's discomfort and side effects attributable to sweeping of the membranes.Results
Women allocated to sweeping of the membranes required formal induction of labour less frequently than women in the control group, but this difference was not statistically significant (49%vs 60%, RR 0.83, 95% CI 0.64–1.07). Pain during vaginal examination and other side effects were more frequently reported by women allocated to the sweeping group.Conclusions
The observed reduction in the need for formal induction of labour is smaller than in previous studies. Side effects and discomfort associated with sweeping of the membranes must be taken into account when counselling women who require induction of labour.
The role of ultrasonographic markers for trisomy 21 in women with positive serum biochemistry
Authors: Verdin Stuart M. , Economides Demetrios L. 
Published: August 2005

Objective
To assess the value of particular markers detected by second trimester ultrasound examination among those women whose fetuses were shown to be at increased risk of Down's syndrome on the basis of biochemical screening.Design
A retrospective study of 459 pregnancies.Setting
Fetal Medicine Unit, Royal Free Hospital.Participants
Four hundred and fifty‐nine regnant women, including four twin pregnancies, registered at the Royal Free Hospital, who were considered screen positive (risk > 1: 250) based on the results of mid‐trimester biochemical markers (maternal serum free β human chorionic gonadotrophin and α fetoprotein).Main outcome measures
The ultrasound markers that were examined included structural defects, shortened femur length, echogenic bowel, dilation of the renal pelvis and choroid plexus cysts. The likelihood ratios for trisomy 21 for each of these markers were calculated.Results
Of the 463 fetuses which were screen positive, 449 (97%) had a normal karyotype detected by amniocentesis (n= 344) or postnatal follow up (n = 105). Fourteen fetuses had an abnormal karyotype including 11 (2.4%) with trisomy 21. Ultrasound markers were found in 9/11 (81.8%) fetuses with trisomy 21, compared with 44/449 (9.8%) with a normal karyotype. Detection of one or more ultrasonographic markers in a screen positive pregnancy increased the risk of trisomy 21 by a likelihood ratio of 8.4, and the absence of such markers decreased the risk by a likelihood ratio of 0.2. The risk was considerably increased when the presence of two or markers were detected (likelihood ratio 41). In trisomy 21 fetuses the two most commonly detected markers, shortened femur and dilation of the renal pelvis, had llkelihood ratios of 49.3 and 20.5, respectively. Choroid plexus cysts were detected in 27 of the normal karyotypic fetuses compared with none of those with trisomy 21.Conclusion
The presence or absence of abnormal ultrasonographic markers can significantly change the risk of Down's syndrome among pregnant women already found to have abnormal serum biochemistry. This data may be useful in counselling such women.
Treatment of menopausal keratoconjunctivitis sicca with topical oestradiol
Authors: Sator Michael O. , Joura Elmar A. , Golaszewski Thomas , Gruber Doris , Frigo Peter , Metka Markus , Hommer Anton , Huber Johannes C. 
Published: August 2005

Objective
To investigate the effect of 17β‐oestradiol ophthalmic drops in comparison with a traditionalDesign
Randomised prospective trial.Setting
Menopause clinic.Participants
Eighty‐four postmenopausal women suffering from keratoconjunctivitis sicca and necessitating a hormone replacement therapy (HRT) for general climacteric symptoms.Methods
The women were randomised into two groups and were given 17β‐oestradiol eye drops (n=42, group 1) or a tear substitute (n=42, group 2). Both groups received a systemic HRT.Main outcome measures
A Schirmer's test was performed immediately before the beginning of therapy and after four months. In addition, eye symptoms were assessed using a visual analogue scale.Results
A comparison of visual analogue scores at four months in the women who received 17β‐oestradiol eye drops versus those who received a tear substitute demonstrated a statistically significant difference in all observed ocular symptoms (P<0.0001) The Schirmer's test revealed a significant difference of results before and after treatment in the oestradiol group (P<0.0001) while in group 2 no significant difference was found.Conclusions
Our study demonstrates that topical oestrogen is successful in treating keratoconjunctivitis sicca while it seems that the blood‐eye barrier prevents systemic oestrogens from acting on the conjunctivae.
An audit of anti‐D sensitisation in Yorkshire
Authors: McSweeney Ellen , Kirkham Jan , Vinall Paul , Flanagan Peter 
Published: August 2005

Objective
To determine the likely factors that contribute to RhD sensitisation.Design
Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991.Setting
Leeds Blood Centre, National Blood Service, Yorkshire.Population
One hundred and forty‐seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed.Main outcome measures
Identification of potential immunising events and adherence with recommendations on anti‐D immunoglobulin administration.Results
Twenty‐eight women (22%) had immune anti‐D antibodies during their first pregnancy or at delivery and 50 (39%) in their second pregnancy. Overall, 98 potential immunising events were identified in 62 women, excluding delivery; 67 women (52%) had no events, other than delivery. Miscarriages and medical terminations of pregnancy accounted for 81% of all identified events. Iatrogenic failure to adhere to recommendations for the administration of anti‐D immunoglobulin occurred in a significant proportion of women who subsequently developed immune anti‐D antibodies. Anti‐D immunoglobulin failed to protect against immunisation despite adherence to the protocol in 20 events (20%), 13 of which involved miscarriages or termination of pregnancy < 20 weeks of gestation. Potentially, antenatal prophylaxis might have prevented 86% of immunisations that were identified during the first pregnancy.Conclusions
The introduction of antenatal administration of anti‐D immunoglobulin could significantly reduce the level of sensitisation in primigravidae, and adherence to recommendations for administration of anti‐D immunoglobulin could be improved. Consideration should be given to reviewing the current recommendation that a dose of 250 IU of anti‐D immunoglobulin is adequate following termination of pregnancy before a gestational age of 20 weeks.