bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Down's syndrome: experience in an inner city health district
Authors: Saridogan E. , Djahanbakhch O. , Naftalin A. A. 
Published: August 2005

Objective
To review the experience of Down's syndrome screening in an inner city health district.Design
In this retrospective study the names of the women were obtained from the Regional Cytogenetic Laboratory and District Down's Syndrome Register. Antenatal notes of the mothers were studied. Maternal age during the affected pregnancy, screening test performed if any, gestational age at booking and at screening, screening test results, and pregnancy outcome were reviewed.Setting
An inner city health district.Population
Down's syndrome cases diagnosed prenatally and postnatally.Interventions
None.Results
Antenatal diagnosis of Down's syndrome was made in 15/45 women (33.3%); Edwards' syndrome was diagnosed antenatally in 2/5 women. Screening was not performed in eight women (17.8%) whose infants were affected by Down's Syndrome; it was also not performed in one woman whose baby was affected by Edwards' syndrome due to late presentation to the antenatal clinic or loss of the blood sample. Nineteen women (42.2%) with a Down's syndrome pregnancy and two women with a Edwards' syndrome pregnancy had had a negative screening test. Three women had had a positive screening test but declined amniocentesis. Among those who had a screening test, the overall detection rate of screening was 48.6% (18/37) for Down's syndrome and 50% (2/4) for Edwards' syndrome. The detection rates in different ethnic groups did not show significant difference. Four women chose not to have termination following diagnosis of Down's syndrome, giving a total reduction rate of 21 %.Conclusion
Screening programmes for Down's syndrome have not yet resulted in a substantial reduction in the number of affected babies. In addition to trials at developing screening programmes with better detection rates, efforts should be made to improve the provision of the screening service and the quality of antenatal care in general with emphasis on early presentation and optimal understanding of the implications of the tests.
A clinical analysis of 500 medico‐legal claims evaluating the causes and assessing the potential benefit of alternative dispute resolution
Authors: B‐Lynch Christopher , Coker Adeyemi , Dua John A. 
Published: August 2005

Objective
1. To evaluate the common causes of medico‐legal dispute in obstetrics and gynaecology. 2. To assess the potential benefit of early alternative dispute resolution.Design
A prospective analysis of over 500 cases submitted from over 100 solicitors between 1984 and 1994 for medical expert opinion on potential medico‐legal claims.Cases
Five hundred consecutive cases that met the inclusion criteria: 488 from the United Kingdom and 12 from abroad (Hong Kong, Republic of Ireland).Main outcome measures
The main principles underlining medico‐legal disputes and causes of such claimsResults
Analysis of 500 claims show 46% were misguided allegations, 19% incompetent care, 12% error of judgement, 9% lack of expertise, 7% failure of communication, 6% poor supervision and 1% inadequate staffing. Of the misguided allegations 119/225 cases (59%) were obstetric and 111/275 (40%) cases were gynaecological. The most common cause of obstetric dispute was ‘cerebral palsy’ (22%), while the commonest cause of gynaecological dispute was failed sterilisation (19%). Settled claims were under‐reported by solicitors.Conclusion
Because of the high percentage (46%) of misguided allegations, an alternative course of dispute resolution must be a realistic way forward. This course of action, combined with improved communication, could result in a major reduction in the costs of potential medical litigation. Early alternative dispute resolution should be considered in an attempt to reduce the escalating quantum of damages and costs. We recommend recruiting independent, experienced and unbiased consultants in active practice within the appropriate speciality to review such cases at the level of hospital complaints management as an in house review procedure, particularly for small and moderate‐sized claims, as a means whereby doctors can retain control of medico‐legal disputes, in contrast to control by the legal profession.
Non‐invasive prenatal diagnosis by isolation of both trophoblasts and fetal nucleated red blood cells from the peripheral blood of pregnant women
Authors: Durrant Lindy , McDowall Katherine , Holmes Rachel , Liu David 
Published: August 2005

Objective
To isolate fetal trophoblasts and nucleated red blood cells from the peripheral blood of pregnant women.Design
Trophoblasts were isolated from whole blood of women in the first trimester of pregnancy by a specific monoclonal antibody, 340. Nucleated red blood cells were isolated by separating whole blood on a triple gradient, staining with ferromagnetic particles coated with an antitransferrin monoclonal antibody and separated on a mini magnetic activated cell sorting (MACS) column. Sorted cells were sexed using a nested polymerase chain reaction for a specific sequence on the Y chromosome and the sex was confirmed by karyotyping of chorionic villus samples.Participants
Patients between 10 and 14 weeks of pregnancy who were undergoing elective chorionic villus sampling for the detection of fetal aneuploidies.Main outcome measure
Fetal sex determined by polymerase chain reaction on fetal cells sorted from maternal blood.Results
When both trophoblasts and nucleated red blood cells were sorted, fetal sex was correctly predicted in 12/13 cases (92%), which included correct diagnosis of five of six male pregnancies. More importantly the two techniques were complementary, with only one male pregnancy being diagnosed on both trophoblasts and nucleated red blood cells, two being detected only with trophoblasts and two on nucleated red blood cells alone. No false positives (male signal from a female pregnancy) were diagnosed with either trophoblasts or nucleated red blood cells even with the highly sensitive nested polymerase chain reaction technique, which is very prone to contamination. This study also shows that it is possible to isolate both trophoblasts and nucleated red blood cells from the same sample of maternal blood.Conclusion
Fetal cells can be isolated from maternal blood at around 10 weeks of pregnancy.
Induction of labour: a randomised clinical trial of amniotomy versus amniotomy with oxytocin infusion
Authors: Moldin Per G. , Sundell Gunilla 
Published: August 2005

Objective
To compare two methods of induction of labour—amniotomy with oxytocin infusion versus amniotomy alone.Design
Prospective randomised clinical trial.Setting
The department of obstetrics in a Swedish central hospital.Participants
One hundred and ninety‐six pregnant women with indication for induction of labour at term and a favourable cervix (modified Bishop score ≥ 6).Interventions
The women were randomised to amniotomy followed by oxytocin infusion after 1 h (group A, n= 98) or amniotomy alone (group B, n= 98). If labour had not ensued on the following morning, after approximately 24 h, the women in group B were given an oxytocin infusion.Main outcome measures
Induction‐delivery interval, duration of labour, time spent in delivery ward, oxytocin use, maternal and neonatal clinical outcome.Results
Amniotomy combined with early oxytocin infusion resulted in shorter induction‐delivery interval (median 6.0 h; 95% confidence interval (CI) 5.0 to 6.5 h) than amniotomy alone (median 9.0 h; 95% CI 7.5 to 10.0 h). This was due to a shorter latent period in the former group (median 2.3 h; 95% CI 2.0 to 3.0 h) compared to the latter (median 4.3 h; 95% CI 3.0 to 5.5 h). The duration of labour stages 1 and 2 were similar in both groups. The time spent in the delivery ward was slightly reduced for women managed by amniotomy alone (median 5.0 h; 95% CI 4.5 to 6.0 h) compared with those managed by the combination of amniotomy and oxytocin infusion (median 6.0 h; 95% CI 5.0 to 6.5 h). Eighty‐seven percent in group A and 95% in group B were given oxytocin, and the total oxytocin infusion time was nearly five times longer in group A. No other important effect on maternal or fetal outcomes was demonstrated.Conclusion
With regard to safety the results do not warrant recommending either type of labour induction. The minor differences observed between the induction groups justify an individual management policy, with attention paid to both the indication for induction of labour and the woman's choice.
Hepatitis C virus infection in pregnancy
Authors: Floreani A. , Paternoster D. , Zappalà F. , Cusinato R. , Bombi G. , Grella P. , Chiaramonte M. 
Published: August 2005

Objective
To evaluate the clinical aspects of hepatitis C virus (HCV) liver disease in anti‐HCV + ve mothers, both during pregnancy and six months after delivery, and to assess the outcome of pregnancy.Setting
Obstetric department for high risk pregnancies of the University of Padova, Italy.Participants
Seventeen hundred consecutive pregnant women were studied.Methods
Each woman underwent the following: 1. serological screening for hepatitis surface antigen (HBsAg), antibodies to HCV (anti‐HCV), antibodies to human immunodeficiency virus type 1 (HIVI) within the first trimester of pregnancy; and 2. clinico‐biochemical assessment in order to ascertain previous or active liver disease and risk factors for viral infections.Results
Twenty‐nine (1.7%) of the 1700 women were found anti‐HCV positive. Eight of them had an associated positivity for HIV infection. HCV‐RNA was positive in 64.2% of anti‐HCV positive women. Liver function tests (included transaminases) were within the normal range in 27 mothers (both during and six months after delivery). Only 2/29 women had a slight increase in AST/ALT; liver biopsy in these cases was compatible with mild chronic active hepatitis. In all women the outcome of pregnancy was favourable (12/29 anti‐HCV positive mothers underwent caesarean delivery for causes independent from HCV infection).Conclusions
A substantial proportion of anti‐HCV positive pregnant mothers, even if asymptomatic, have circulating HCV‐RNA. The pregnancy does not induce a deterioration of liver disease, and vice versa, HCV infection does not increase the risk of obstetric complications.
A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy
Authors: Ayton Rosemary A. , Darting Giselle M. , Murkies Atice L. , Farrell Elizabeth A. , Weisberg Edith , Statistician Ingemar Selinus , Fraser Ian S. 
Published: August 2005

Objective
To compare the safety, efficacy and acceptability of a continuous low dose oestradiol releasing vaginal ring with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy.Design
An open, parallel, comparative multicentre trial.Setting
Sydney and Melbourne, Australia.Participants and Interventions
One hundred and ninety‐four postmenopausal women with symptoms and signs of urogenital atrophy were randomised on a 2:1 basis to 12 weeks of treatment with an oestrogen vaginal ring versus an oestrogen cream.Main outcome measures and results
Equivalence (95% CI) was demonstrated between the two treatments for relief of vaginal dryness and dyspareunia, resolution of atrophic signs, improvement in vaginal mucosal maturation indices and reduction in vaginal pH. No significant difference was demonstrated in endometrial response to a progestogen challenge test and equivalence was demonstrated in the incidence of intercurrent bleeding episodes. The vaginal ring was significantly more acceptable than the cream (P < 0.0001), and was preferred to the cream (P < 0.001).Conclusion
With equivalent efficacy and safety and superior acceptability to vaginal cream, the low dose oestradiol vaginal ring is an advance in vaginal delivery systems for the treatment of urogenital atrophy.
Vulvar intraepithelial neoplasia: long term follow up of treated and untreated women
Authors: Herod J. J. O. , Shafi M. I. , Rollason T. P. , Jordan J. A. , Luesley D. M. 
Published: August 2005

Objective
To investigate the long term outcome of patients with vulvar intraepithelial neoplasia.Design
A retrospective study using information obtained from patient casenotes.Sample
One hundred and thirty‐three women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15‐year period.Results
The diagnosis of vulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P≤ 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or symptomatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Recurrence was more common following laser vapourisation than after local excision (75%vs 40%; P≤ 001). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three from gynaecological malignancies of the lower genital tract.Conclusions
Patients with vulvar intraepithelial neoplasia require long term follow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possible to safely manage patients by more conservative methods.
Irrigating fluid absorption from the intact uterus
Authors: Olsson J. , Berglund L. , Hahn R. G. 
Published: August 2005

Objective
Absorption of irrigating fluid may occur through severed blood vessels during endometrial resection. We studied whether irrigating fluid can also be absorbed through the undamaged uterus.Participants
We studied 25 women, aged 28–46 years (mean 38 years), who underwent elective laparoscopic sterilisation under general anaesthesia.Interventions
In 15 women blue‐stained irrigating fluid containing glycine 1.5% and ethanol 1% was applied to the uterine cavity under increasing pressure. Laparoscopy was employed to see when fluid emerged from the Fallopian tubes. Another 10 women had their Fallopian tubes clamped before the fluid pressure was raised, and systemic absorption was detected by measuring the serum glycine concentration.Results
Passage of fluid through the Fallopian tubes occurred in 14 of the 15 patients at a utero‐abdominal pressure gradient of 40 mmHg (n= 4), 80 mmHg (n= 4), 120 mmHg (n= 3), and 160mmHg (n= 3), respectively. The fluid passage rate ranged between 0.5 and 13 (mean 6.4) ml min−1. Of the women with clamped Fallopian tubes, 8 of 10 showed an increase in the serum glycine level of 60% at a pressure gradient of 160 mmHg, and of 120% at 200 mmHg.Conclusions
Uterotubal and transendometrial passage of small to moderate amounts of irrigating solution occurred frequently at the intrauterine fluid pressures normally used during endometrial resection.
Prediction of pre‐eclampsia by abnormal uterine Doppler ultrasound and modification by aspirin
Authors: Bower Sarah J. , Harrington Kevin F. , Schuchter Katharina , McGirr Cathy , Campbell Stuart 
Published: August 2005

Objective
To assess the effect of low dose aspirin on severe pre‐eclampsia when given to women identified as high risk by abnormal uterine artery Doppler ultrasound.Design
Women with abnormal uterine artery flow velocity waveforms were recruited to the CLASP trial at 24 weeks. Abnormal uterine artery waveforms, with a high resistance index or an early diastolic notch, were identified at the 18–22 week anomaly scan and confirmed at 24 weeks. Of those women with persistently abnormal waveforms, 63 agreed to enter the CLASP trial. Three women were lost to follow up and five did not comply. Thus, 60 were randomised: 29 to placebo and 31 to low dose aspirin (60 mg daily) and analysis by intention to treat is reported.Results
There were nine cases (29%) of pre‐eclampsia in the aspirin group and twelve (41%) in the placebo group (odds ratio (OR) 0.58, confidence interval (CI) 0.2–1.69, P = 0.32). Severe pre‐eclampsia developed in four women in the aspirin group and eleven women in the placebo group (OR 0.24, CI 0.07–0.88, P = 0.03) and intrauterine growth retardation occurred in eight cases in the aspirin group and twelve in the placebo group (OR 0.49, CI 0.17–1.47). The mean birthweight and gestation at delivery were 2.69 kg and 38.5 weeks in the aspirin group and 2.38 kg and 37.4 weeks in the placebo group, neither of which were statistically significant using the unpaired t test; P = 0.09 and P = 0.23, respectively.Conclusions
In high risk pregnancy low dose aspirin commenced at 24 weeks may reduce the incidence of severe pre‐eclampsia.
The effects of the antihormones RU486 and tamoxifen on fetoplacental development and placental bed vascularisation in the rat: a model for intrauterine fetal growth retardation
Authors: Sadek Saher , Bell Stephen C. 
Published: August 2005

Objective
To examine the effect of administration of the antihormones RU486 and tamoxifen in early pregnancy during the period of maximal decidual development in the rat upon fetoplacental and placental bed development.Design
Case‐control study in an experimental animal model.Setting
Academic department of obstetrics and gynaecology in a UK medical school.Animals
Small laboratory animal—the rat—exhibiting haemochorial placentation.Intervention
Administration of antiprogesterone or antioestrogen (RU486 and tamoxifen respectively) during early pregnancy.Main outcome measures
Weight of the whole pregnancy implant, fetus, mesometrial decidua and placenta; incidence of intrauterine fetal death; and histological changes in the placental bed.Results
RU486 produced resorption of all implants when administered above a threshold dose, below which it had no effect upon subsequent fetoplacental development. Tamoxifen treatment on days 9 to 11 resulted in significant reduction of decidual weight (35.1% on day 12 of pregnancy, P < 0.001). This was associated with a higher rate of implants or fetuses weighing below the 10th centile (59.6% and 5.7% on day 12, P < 0.001; 42.9% and 7% on day 16, P < 0.001; 25.4% and 7.6% on day 20, P < 0.001 in treated and control animals, respectively). This was also associated with a higher rate of intrauterine fetal death (30.7% on day 16 compared with 4.5% in controls, P < 0001; 47.8% on day 20 compared to 0.83% in controls, P < 0.001). Histologically, the placental bed of treated animals failed to develop a dilated uteroplacental artery although trophoblast cells migrated endovascularly to a level equivalent to untreated animals.Conclusions
RU486 had an all or none dose‐dependent effect on fetoplacental development, resulting in either abortion or normal development of pregnancy. Tamoxifen produced significant impairment of decidual development, which was associated with altered blood vessel transformation in the placental bed, impaired fetoplacental development and higher incidence of growth retarded fetuses and fetal death.
The effect of maternal epidural analgesia on fetal oxygen saturation
Authors: Johnson Nick , van Oudgaarden Elisabeth , Montague Imogen A. , McNamara Helen 
Published: August 2005

Objective
To observe fetal arteriolar oxygen saturation during maternal epidural analgesia. Design An observation study of 27 epidural top‐ups.Setting
Labour ward, St James's University Hospital and Leeds General Infirmary, Leeds University, UK.Sample
Seventeen fetuses in uncomplicated labour monitored with a N400 fetal pulse oximeter. Outcome measure A change in fetal pulse oximetry reading following epidural analgesia.Results
There is no change in fetal oxygen saturation following an uncomplicated epidural top‐up (F = 0.93; df 35 and 784).Conclusion
An uneventful maternal epidural has no measurable effect on fetal oxygen saturation measured with a N400 pulse oximeter.
Obstetric outcome of pregnancies resulting from embryos biopsied for pre‐implantation diagnosis of inherited disease
Authors: Soussis Iakovos , Harper Joyce C. , Handyside Alan H. , Winston Robert M. L. 
Published: August 2005

Objective
Pre‐implantation diagnosis of inherited disease is now a viable option for some couples at risk of transmitting inherited disorders to their children. Since the pregnancy begins knowing that the embryo is not at risk, the need for repeated terminations is eliminated. Up to 25 % of the embryo is removed during the procedure, and so it is important to study the resulting pregnancies. Here we report on the obstetric outcome of our first 16 pregnancies resulting from embryo biopsy and preimplantation diagnosis of inherited disease.Setting
Teaching hospital.Sample
The first 16 pregnancies (12 singletons and 4 twins) following pre‐implantation diagnosis.Results
Three singleton pregnancies were lost in the first trimester. Of the remaining pregnancies, two had no prenatal diagnosis, six cases of X‐linked disease had the sex confirmed by ultrasound and chorionic villus sampling was performed in the remaining five. All the singleton pregnancies had an uneventful antenatal course and the birthweights and Apgar scores of the babies were normal. The twin pregnancies presented obstetric complications but these were not unusual.Conclusions
Fifteen healthy infants were born, but for the foreseeable future pre‐implantation diagnosis pregnancies should be closely followed up.
Childhood growth and age at menarche
Authors: Cooper Cyrus , Kuh Diana , Egger Peter , Wadsworth Michael , Barker David 
Published: August 2005

Objective
To study the influence of birthweight, and weight and height at age seven years, on menarcheal age in a national sample of 1471 girls in England, Scotland and Wales.Methods
We studied 1471 girls included in the MRC National Survey of Health and Development. During medical examinations carried out by school doctors in this cohort, born in the first week of March 1946, the mothers of girls were asked whether their daughters had started to menstruate, and if so, the month and year when this happened. Anthropometric measurements at birth and at age seven years were also obtained.Results
Girls who were heavier at age seven years had menarche at an earlier age. The average age at menarche of those in the highest fifth of the distribution of weight at seven years was 7.3 months less than that of those in the lowest fifth of the distribution. In contrast, girls who were heavier at birth had menarche at a later age. The average age at menarche of those in the highest fifth of the birthweight distribution was 2.2 months more than those in the lowest fifth. These opposing trends of birthweight and weight at seven years on age at menarche were observed across the distribution of each variable, and exerted statistically significant (P < 0.001) independent effects in a multivariate model.Conclusions
These observations are consistent with the hypothesis that menarcheal age is linked to programmed patterns of gonadotrophin release established in utero, when the fetal hypothalamus is imprinted, and is subsequently modified by weight gain in childhood.