bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asymptomatic women at high risk of vertical HIV‐1 transmission to their fetuses
Authors: Tibaldi Cecilia , Tovo Pier A. , Ziarati Nahid , Palomba Elvia , Salassa Bernardino , Sciandra Mauro , D'Ambrosio Rosa , Ponti Antonio , Sinicco Alessandro 
Published: August 2005

ABSTRACTObjective
To identify how reliably CD4+ (helper) lymphocyte count and p24 antigenaemia can predict mother‐to‐infant transmission of human immunodeficiency virus type 1 (HIV‐1).Design
Prospective study.Setting
University of Turin Center for Intravenous Drug Users (IVDU) and/or HIV‐1 seropositive pregnant women.Subjects
Twenty‐nine infants born to asymptomatic seropositive women from November 1985 to June 1991.Results
Seven children (24%) developed symptomatic infection, while 22 healthy seronegative children at the age of 18 months were considered uninfected. A CD4+ lymphocyte count persistently <500/mm3 during pregnancy was associated significantly with the child's infection status with a relative risk (RR) of 11.4. (CI 1.58–82.05). A marked association (RR 13.6) (CI 1.93–95.72) was similarly detected between maternal antigenaemia and the risk of the child being infected. In a multivariate logistic analysis, crude and adjusted odds ratios (OR) of transmission were 27.0 (95% CI 2.5–291.2) and 35.6 (1.1–1159) for low CD4+ counts; 64 (3.2–1261) and 51.6 (2.5–1058) for p24 antigenaemia.Conclusions
Asymptomatic HIV positive women with a CD4+ count below 500/mm3 or p24 antigenaemia are about ten times as likely to transmit the virus to their children. CD4+ lymphocytes decrease during pregnancy and a low CD4+ cell count early in pregnancy remains low up to delivery. Therefore knowledge that they have a low CD4+ lymphocyte count early in pregnancy may help women to decide whether or not to continue their pregnancy.
Assisted conception using buserelin and human menopausal gonadotrophins in women with polycystic ovary syndrome
Authors: Wada I. , Matson P. L. , Troup S. A. , Lieberman B. A. 
Published: August 2005

ABSTRACTObjective
To compare the outcome of in vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) cycles in women with or without ultrasound features of polycystic ovary syndrome (PCOS).Design
A consecutive series from January to December 1989.Subjects
Twenty‐five women with PCOS scheduled for assisted conception. The controls were 139 women with normal ovaries.Setting
A single centre specialist fertility unit, Manchester, UK.Interventions
Pituitary desensitisation was with buserelin. In the PCOS group ovarian stimulation was with 1 ampoule (75 iu FSH) of hMG/day in 12 women (Group I) and two ampoules/day in 13 (Group II). The controls (Group III) were given two ampoules of hMG daily. Human chorionic gonadotrophin (hCG; 10 000 iu) was given when three follicles measured 20 mm diameter.Main outcome measures
Serum oestradiol (E2) concentrations, number of follicles, clinical pregnancies, features of the ovarian hyperstimulation syndrome (OHS).Results
Women with PCOS (Groups I or II) had more follicles 14 mm diameter on the day of the hCG injection (P<0.005), higher serum E2 concentrations on the day after the hCG (P<0.05) and more oocytes retrieved (P<0.05) than the controls. The OHS was more prevalent in those with PCOS (32% versus 6.5%; P<0.05). The clinical pregnancy rate per embryo transfer (27% versus 22%) or gamete transfer (25% versus 39%) and the rate of spontaneous miscarriage (33% versus 12%) were not statistically different.Conclusions
The pregnancy rate and outcome of pregnancy following IVF or GIFT in women with or without PCOS are similar. Women with PCOS are at a higher risk of developing OHS.
A paramedic based emergency domiciliary obstetric service: the South Glamorgan experience
Authors: Hibbard Bryan M. , Dawson Andrew , Boyce Janet , Oliver Mary , Goodall Keith , Organ Philip , Rookes Neville 
Published: August 2005

ABSTRACTObjective
To assess the potential benefits of using extended trained ambulance personnel (paramedics) as primary responders for domiciliary obstetric and gynaecological emergencies.Design
An observational study of performance and analysis of operational data in a newly established service.Setting
A mixed urban and rural population served by South Glamorgan Health Authority.Main outcome measures
Work load, response times, management and transfer of patients, efficiency of communications and appropriateness of training.Results
There was an initial increase in requests above that when a hospital‐based service operated. Targets for response times were met. The mean response time for providing appropriate skilled help was halved compared with the previous arrangements and a safe and efficient service was provided. Prompt transport and advance notice and preparation for reception in the delivery unit contributed to optimal management. Medical staff depletion in the delivery unit was minimised.Conclusion
An Emergency Domiciliary Obstetric Service based on primary response by specially trained ambulance service paramedics can beneficially replace traditional hospital‐based Obstetric Flying Squads.
Invasive carcinoma of the cervix following local destructive treatment for cervical intraepithelial neoplasia
Authors: Anderson M. C. 
Published: August 2005

ABSTRACTObjective
To investigate the occurrence of invasive carcinomas following local destructive treatment for cervical intraepithelial neoplasia (CIN) and to evaluate the factors responsible.Design
A multicentre retrospective study.Subjects
Forty‐nine women registered with the British Society for Colposcopy and Cervical Pathology from 24 centres throughout Great Britain between 1985 and 1992, who had been treated by local destructive methods for CIN and who subsequently developed invasive carcinoma of the cervix.Results
Of the 49 women whose details were submitted, 42 had squamous cell carcinoma, six adenosquamous carcinoma and one adenocarcinoma. Eight had microinvasive carcinomas (Stage Ia) at the time of diagnosis, 24 had Stage Ib tumours and eight Stages II to IV. Thirteen women have died. Thirty‐five women had been treated by laser vapourisation, ten by cold coagulator, two by diathermy and two by cryosurgery. In 19 women (39%) the diagnosis of invasive carcinoma was made on the first follow up visit or within one year of treatment. Five patients did not present with invasive disease until more than five years after treatment.Conclusions
The data presented suggest that many, but not all, of the invasive carcinomas presenting after local destructive treatment for CIN resulted from failure to recognise early invasive disease at the time of the initial assessment. The importance of thorough evaluation before undertaking these forms of treatment is emphasised. The use of excisional procedures should further reduce the small risk of invasive carcinoma developing after treatment for CIN.
Erythrocyte sodium lithium countertransport in normal and hypertensive pregnancy: relation to haemodynamic changes
Authors: Macphail Sheila , Thomas Trevor H. , Wilkinson Robert , Davison John M. , Dunlop William 
Published: August 2005

ABSTRACTObjective
To establish the changes in erythrocyte sodium lithium countertransport (SLC) with advancing normal pregnancy and to determine if these changes were different in pregnancy induced hypertension (PIH). The changes in both groups were assessed in relation to haemodynamic changes.Design
SLC, mean arterial pressure (MAP), cardiac output (CO) and total peripheral vascular resistance (TPVR) were determined serially during normal pregnancy and cross‐sectionally in PIH. Women were studied again 20 weeks after delivery where possible.Setting
Routine antenatal clinic and antenatal ward of a regional reference centre.Subjects
Fifty‐one normal primigravid women were studied serially and 41 primigravid women with PIH were studied at time of diagnosis.Results
During normal pregnancy SLC (mmol Li/h/l cells) increased from a nonpregnant value of 0.24 ± 0.02 (mean ± SEM) to 0.32 ± 0.02 at 14 weeks, and 0.37 ± 0.02 at 20 weeks gestation. This was maintained until 38 weeks (0.40 ± 0.02). The increase until 20 weeks occurred at the time of greatest change in CO (5.10 ± 0.18 to 6.79 ± 0.20 l/min) and TPVR (1327 ± 58 to 969 ± 33 dyn/s/cm−5). The decrease in TPVR with a rise in SLC is opposite to the relation reported in essential hypertension so that a functional relation is unlikely. However, the changes within pregnancy were positively correlated (r = 0.43, P<0.01). In hypertensive pregnancies TPVR was elevated compared with normotensive pregnancies (1543 ± 100 vs 1090 ± 37) but the SLC was not different from that found in normotensive pregnancies (0.43 ± 0.02 vs 0.40 ± 0.02).Conclusions
The changes in SLC activity suggest dynamic effects on erythrocyte membrane function during pregnancy. However, no differences could be found between normal and hypertensive pregnancy and SLC is unlikely to be of value as a marker of hypertensive risk during pregnancy.
The outcome of pregnancy after CO2 laser conisation of the cervix
Authors: Hagen Bjørn , Skjeldestad Finn Egil 
Published: August 2005

ABSTRACTObjective
To investigate the effect of laser conisation of the cervix on the outcome of subsequent pregnancy.Design
Case‐control study.Setting
Department of Obstetrics & Gynaecology, University Hospital, Trondheim, Norway.Subjects
Three hundred and fifty‐one women were treated for cervical intra‐epithelial neoplasia (CIN) by laser conisation of the cervix between 1 January 1983 and 31 December 1985. The 56 women among them who had been delivered of live infants beyond 22 weeks gestation after the conisation and before 1 January 1991 were studied for the outcome of their pregnancies. For each case, two controls of equal parity and age (±3 years) were selected.Main outcome measures
The length of gestation and birthweight of the infants.Results
The median (range) length of gestation was 39 weeks (26–43) in cases compared with 40 weeks (34–42) in controls (z=−4.0, P<0.001). The median (range) birthweight was 3330 g (1150–4940) in cases and 3630 g (1610–5080) in controls (z=−3.5, P<0.001). Overall 38% of cases were delivered preterm (≤37 weeks gestation), compared with 6% of controls (P<0.0001; odds ratio 9.0, 95% CI 3.7–21.7). A logistic regression analysis of a set of possible confounding factors revealed no significant risk factors in addition to conisation for the occurrence of preterm delivery. No correlation was found between the height of the cone and the occurrence of preterm delivery in subsequent pregnancy.Conclusion
Conisation with microsurgical laser technique increases the risk of preterm delivery in subsequent pregnancies. Laser conisation in young women should be restricted to those with high grade CIN or a lesion extending into the endocervical canal.
A comparison of bioelectrical and mechanical activity of the female urethra
Authors: Barnick C. G. W. , Cardozo L. D. 
Published: August 2005

ABSTRACTObjective
To determine the relationship between mechanical function and innervation of the urethra in order to clarify the effect of denervation and re‐ennervation on urethral function.Design
Prospective observational study.Setting
Tertiary referral urodynamics unit.Subjects
Thirty‐six women, 21 with urinary symptoms and urodynamically proven genuine stress incontinence and 15 without urinary symptoms.Interventions
All women underwent concentric needle electromyography of the urethral sphincter and urethral pressure profilometry at rest and during cough induced stress.Results
Significant correlations were found between variables indicating denervation and reinnervation and improved resting urethral function. No correlation was found between these variables and urethral function under stress.Conclusions
Our findings contradict current opinion that denervation of the urethral sphincter is associated with a reduction in the sphincteric function of the urethra, at rest or during stress, and suggest that denervation cannot therefore be a major aetiological factor in the development of genuine stress incontinence.
The predictive value of uterine artery flow velocity waveforms in miscarriage in older women
Authors: van den Elzen H. J. , Cohen‐Overbeek T. E. , Grobbee D. E. , Wladimiroff J. W. 
Published: August 2005

ABSTRACTObjective
To determine whether uterine artery blood flow velocity measurements can predict miscarriage in older women.Design
Prospective study.Subjects
Three hundred and ninety‐three women aged 35 years and older in the first trimester of pregnancy.Main outcome measures
Miscarriage, genetic abortion, pulsatility index (PI), maternal age, gestational age at intake.Results
Twenty women miscarried; 10 pregnancies were terminated because of chromosomal anomalies. Maternal age and gestational age at intake were significantly associated with miscarriage rate (P= 0.01 and P= 0.001, respectively). Uterine artery PI values declined significantly during the first trimester (P= 0.001). However, no association was found between uterine artery PI values and miscarriage rate. PI, maternal age and gestational age at intake were not essentially different between women who miscarried before or after chorionic villus sampling. No association was found between PI, maternal age, and gestational age at intake and genetic abortion rate.Conclusions
Uterine artery blood flow velocity waveforms, as expressed by the pulsatility index, bear no relation to miscarriage.
The assessment of clinical competence in obstetrics and gynaecology in two medical schools by an objective structured clinical examination
Authors: McFaul P. B. , Taylor D. J. , Howie P. W. 
Published: August 2005

ABSTRACTObjective
To compare and assess clinical competence among final year students in two British medical schools using a standardised objective structured clinical examination (OSCE) in obstetrics and gynaecology.Design
A comparative study of an OSCE with stations designed to test student abilities in history‐taking, physical examination, interpretation of data or results, interpersonal skills, practical procedures, as well as factual knowledge.Subjects
Two groups of final year medical students from two British medical schools.Methods
An OSCE of 26 stations.Results
The standardised OSCE was simple to organise and conduct once the content had been decided. Analysis of the results revealed significant differences in mean marks between the two sets of students in six stations, and in eight stations the mean score was less than five for one or other sets of students. The reasons for the differences between the medical schools and the poor performance of the students at some stations were investigated and possible causative factors identified.Conclusions
We have shown that an OSCE is suitable for testing clinical competence of students within and across medical schools, is able to highlight differences in standards between institutions, and can identify areas where teaching methods and/or course content are deficient.
Doppler ultrasound screening as part of routine antenatal scanning: prediction of pre‐eclampsia and intrauterine growth retardation
Authors: Bower Sarah , Schuchter Katharina , Campbell Stuart 
Published: August 2005

ABSTRACTObjective
To assess the value of incorporating continuous wave Doppler ultrasound of the uterine arteries into the routine scan as a screening test in an unselected population.Design
A cross sectional study by multiple operators using continuous wave Doppler ultrasound to obtain flow velocity waveforms (FVW) from both uterine arteries of all women attending for routine anomaly scan at 18 to 22 weeks over a period of 12 months. An abnormal FVW in either uterine artery was used to predict intrauterine death, antepartum haemorrhage and three different degrees of severity of preeclampsia and growth retardation, singly and in combination.Setting
King's College Hospital, London.Subjects
Two thousand, four hundred and thirty women attending for routine anomaly ultrasound scan.Results
A total of 2430 women were scanned with a 90% follow up rate. The results demonstrate higher sensitivities than previous studies, but with a high proportion of false positive tests. By including an early diastolic notch in the definition of an abnormal FVW the prediction of pre‐eclampsia is markedly improved; the relative risk to a woman with an abnormal waveform of developing moderate or severe pre‐eclampsia is increased 24‐fold. Although the positive predictive value for babies less than the 5th centile for gestation is only 15%, those at risk of neonatal complications may be identified.Conclusion
This simple test can be performed at a routine visit and a group of women can be identified for further assessment and possible therapeutic intervention.
A loading model for ritodrine administration in preterm labour
Authors: Holleboom C. A. G. , Merkus J. M. W. M. , van Elferen L. W. M. , Keirse M. J. N. C. 
Published: August 2005

ABSTRACTObjective
To develop a ritodrine infusion scheme for preterm labour that avoids plasma levels above those needed for tocolysis, requires only one rate adjustment, and is easy to apply in practice.Design
Prospective study of tocolytic effect and plasma ritodrine concentrations during application of the infusion scheme.Setting
High risk labour ward.Subjects
Consecutive series of 31 women in labour at less than 36 weeks' gestation.Intervention
Loading dose ritodrine infusion followed, as soon as tocolysis is reached, by a decrease in the infusion rate calculated on the basis of the interval between start of treatment and tocolysis.Results
Overall, steady state ritodrine levels were nearly identical to those at the time of tocolysis and correlated well with levels anticipated on the basis of our calculation (n= 30; r= 0.91; P <0.001). Adjustments during steady state were made in 12 women (40%), but in only two of them within 12 h after tocolysis had been reached. Delivery was postponed for more than 48 h in 29 women (93.5%) and beyond 37 weeks' gestation in 19 (61.3%).Conclusion
The loading model is easy to apply, avoids relative overdoses, requires few adjustments, is well tolerated, uses smaller quantities of ritodrine, and results in lower plasma ritodrine concentrations than the conventional infusion scheme.
Classifying perinatal death: experience from a regional survey
Authors: Settatree Ralph S. , Watkinson Michael 
Published: August 2005

ABSTRACTObjective
To examine problems encountered in classifying perinatal death using the systems proposed by Hey et al. (1986) and Cole et al. (1986).Subjects
451 deaths from a regional perinatal mortality survey of which 293 had a post mortem examination.Methods
Documents from each death were reviewed by four assessors, one from each discipline, selected randomly from a pool of obstetricians, paediatricians, general practitioners and midwives. Each assessor classified the cause of death blind to the others. The degree of agreement between assessors was calculated for the full and shortened obstetric and fetal‐neonatal classifications using the kappa statistic for inter‐rater agreement.Results
The kappa statistic, which is a measure of the proportion of agreement above chance, gave a value of 0.55 for the full obstetric classification and 0.58 for the full fetal and neonatal classification when all four assessors made an assignment. An assignment was omitted in 6.2%, but the kappa value of zero for these omissions suggested that this was a nonsystematic result due to random protocol violations. The grouped (shortened) classifications generated a higher kappa value of 0.62 for the nine point obstetric system and 0.67 for the six point fetal and neonatal (New Wigglesworth) system. Post mortem had little effect on agreement. The best agreement levels observed were for congenital anomaly.Conclusion
This survey highlighted the complexity of the 22 and 24 point classifications, the uneven distribution of deaths within their categories, and the variable levels of agreement between professionals classifying deaths, thus questioning the validity of individual maternity units of health districts generating local data in this degree of detail for comparative purposes in regional and national statistics. Grouping the original categories led to greater agreement particularly for the New Wigglesworth classification. The role of post mortems in clarifying the cause of fetal and neonatal death needs further investigation.
Randomised comparison of routine versus highly selective use of Doppler ultrasound in low risk pregnancies
Authors: Mason G. C. , Lilford R. J. , Porter J. , Nelson E. , Tyrell S. 
Published: August 2005

ABSTRACTObjective
To help answer the question: should Doppler ultrasound of the umbilical circulation be made available to all pregnant women as part of their routine antenatal care?Design
A randomised trial.Setting
St James's University Hospital, Leeds.Subjects
2025 low risk primigravid women.Main outcome measures
Obstetric intervention rates and short term neonatal morbidity.Results
The incidence of abnormal Doppler was low (1.7%) with complete absence of end diastolic flow in only 0.3% of cases. No significant differences could be demonstrated between control and study women in any of the outcomes measured.Conclusion
This study did not demonstrate any benefit or harm from Doppler ultrasound as a routine screening test for all low risk women, whereas our previous studies have suggested that it is useful in high risk pregnancies. Any marginal returns on extending access to Doppler ultrasound from high risk to all women must be small. Since this test has excellent performance characteristics (sensitivity and specificity) for the prediction of fetal hypoxia and acidosis our results call into question the cost to benefit ratio of all tests designed to predict these outcomes in low risk women.
Early discharge following vaginal hysterectomy
Authors: Hancock Karl W. , Scott James S. 
Published: August 2005

ABSTRACTObjective
To assess the feasibility of discharging selected patients home within 72 h of vaginal hysterectomy.Design
Women for whom vaginal hysterectomy was planned and who were invited to take part. Those who accepted were visited at home by a staff nurse experienced in gynaecology to assess home conditions and family support. If these were suitable, the general practitioner was informed and invited to comment. If the operation was uneventful women were discharged on the third post operative day and visited at home by the nurse until the seventh day.Setting
Leeds Western Health Authority.Main outcome measures
The number of minor complications requiring treatment by the general practitioner, the readmission rate and the acceptability to the woman and her family.Results
For 11 out of 61, home conditions proved unsuitable for early discharge. In six of the remaining 50, abdominal hysterectomy proved preferable to vaginal. Thirty women were discharged home on the third day after vaginal hysterectomy, five on the fourth and seven on the fifth. Two developed urinary tract infections, treated by their general practitioners. Two required readmission to hospital. Twenty‐eight of 30 discharged on the third post operative day and nine of 12 discharged on the fourth or fifth post operative day were enthusiastic about the scheme.Conclusions
Early discharge following uncomplicated vaginal hysterectomy in selected patients appears to be a safe procedure, appreciated by the majority of women. Its adoption as a routine procedure would enable the surgical throughput in a unit to be maintained on a smaller bed complement.