bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnetic resonance spectroscopy in pre‐eclampsia: evidence of cerebral ischaemia
Authors: Rutherford Jane M. , Moody Alan , Crawshaw Sarah , Rubin Peter C. 
Published: December 2003

ObjectiveTo establish whether there are changes in the maternal brain in pre‐eclampsia detectable by magnetic resonance angiography and spectroscopy.DesignA prospective, observational study.SettingObstetric and Radiology Departments, Queen's Medical Centre, Nottingham.SampleFourteen healthy, nulliparous non‐pregnant women, 9 healthy primiparous pregnant women and 10 women with pre‐eclampsia.MethodsMagnetic resonance angiography and proton magnetic resonance spectroscopy of the brain was performed on each woman. Non‐pregnant women were each studied twice. Healthy pregnant women were studied three times during pregnancy and once postnatally. Subjects with pre‐eclampsia were studied once antenatally and twice postnatally. Magnetic resonance angiograms were examined for signs of vessel narrowing. On magnetic resonance spectroscopy, the ratios of the dominant peaks of the spectrum:N‐acetyl aspartate (NAA), choline, creatine and lactate were compared.Main outcome measuresComparison of spectroscopic indices in non‐pregnant, normal pregnant and pre‐eclamptic women.ResultsOn magnetic resonance angiography, there was no evidence of vessel narrowing in any of the three groups. NAA/choline ratio was higher at all stages of pregnancy compared with the non‐pregnant group (P< 0.05) associated with lower choline. NAA/choline increased gradually during healthy pregnancy associated with a decrease in choline. NAA/choline was significantly lower in the pre‐eclampsia group compared with the healthy pregnant women at similar gestation (P< 0.01), associated with higher choline. There were no differences between the groups postnatally. Lactate was not detected. These changes are similar to those found in patients with carotid stenosis without cerebral infarction.ConclusionsNarrowing of vessels detectable on magnetic resonance angiography does not occur commonly in pre‐eclampsia. Magnetic resonance spectroscopy results suggest that there is relative cerebral ischaemia in pre‐eclampsia compared with healthy pregnancy.
Gene expression of nitric oxide synthase by human umbilical vein endothelial cells: the effect of fetal plasma from pregnancy with umbilical placental vascular disease
Authors: Wang Xin , Wang Jian , Trudinger Brian 
Published: December 2003

Objective
To determine whether endothelial cell injury would be produced by factor(s) released into the fetal circulation, manifested by altered messenger RNA expression of nitric oxide synthase.Design
Case–control study.Setting
University teaching hospital.Samples
Fetal plasma was collected from 34 normal pregnancies, 44 pregnancies with umbilical placental vascular disease identified by an abnormal umbilical Doppler and 11 pregnancies with maternal pre‐eclampsia but with normal umbilical Doppler studies.Methods
Aliquots from a common culture of human umbilical vein endothelial cells (HUVECs) were incubated with fetal plasma from the members of the three patient groups. The total RNA was extracted from the endothelial cells and mRNA for nitric oxide synthase was measured by reverse transcription and semi‐quantitative polymerase chain reaction (RT‐PCR). This was standardised by comparison of the amplified inducible nitric oxide synthase (iNOS) or endothelial constitutive nitric oxide synthase (ecNOS) to glyceraldehyde 3‐phosphate dehydrogenase (GAPDH).Main outcome measure
Endothelial cell gene expression of iNOS and ecNOS.Results
The mRNA expression of iNOS and ecNOS were significantly higher (P < 0.05) in HUVECs stimulated by fetal plasma from pregnancies with umbilical placental vascular disease [iNOS 1.12 (0.16); ecNOS 1.78 (0.18)] when compared with normal pregnancies [iNOS 0.56 (0.06); ecNOS 1.06 (0.10)]. In the maternal pre‐eclampsia group, the NOS expression [iNOS 0.76 (0.11); ecNOS 1.39 (0.26)] did not differ from normal pregnancy. In the vascular disease group, there was no difference in NOS expression between the subgroups with and without maternal pre‐eclampsia.Conclusions
Our study demonstrates that umbilical placental vascular disease is associated with a factor(s) in fetal plasma that produces an increase in the expression of iNOS and ecNOS mRNA by endothelial cells. Our findings raise the possibility that the release of factors causing an up‐regulation of iNOS and ecNOS in the endothelium in the fetal placenta may occur as part of an inflammatory response of the vascular endothelium to injury.
Cohort study of operative delivery in the second stage of labour and standard of obstetric care
Authors: Murphy Deirdre J. , Liebling Rachel E. , Patel Roshni , Verity Lisa , Swingler Rebecca 
Published: December 2003

Objective
To assess the maternal and neonatal morbidity following operative delivery in the second stage of labour in relation to the standard of obstetric care.Design
Cohort study.Setting
Maternity units in two teaching hospitals in Bristol, United Kingdom.Population
Three hundred and ninety‐three women with term, singleton, cephalic pregnancies who required operative delivery in theatre at full dilatation between February 1999 and February 2000.Methods
Morbidity was compared for completed instrumental delivery, failed instrumental delivery and immediate caesarean section in relation to duration of second stage of labour, number of pulls at attempted instrumental delivery, number of instruments used and operator experience.Main outcome measures
Maternal trauma, admission to special care baby unit, neonatal trauma.Results
Failed instrumental delivery after a long second stage of labour was associated with increased maternal trauma (adjusted odds ratios [OR] 4.1, 95% confidence interval [CI] 1.1, 16.5). More than three pulls at attempted instrumental delivery was associated with increased neonatal trauma for completed (adjusted OR 4.2, 95% CI 1.6, 9.5) and failed deliveries (adjusted OR 7.2, 95% CI 2.1, 24.0). Babies delivered after failed instrumental delivery with more than three pulls were at increased risk of admission to special care baby unit (adjusted OR 6.2, 95% CI 1.6, 22.8) The use of multiple instruments was associated with increased neonatal trauma (adjusted OR 3.1, 95% CI 1.5, 6.8; adjusted OR 4.4, 95% CI 1.3, 14.4, for completed and failed deliveries, respectively). Excessive pulls and multiple instrument use were associated with an initial attempt at vaginal delivery by an inexperienced operator, 25/48 (52%) and 34/75 (45%).Conclusion
Guidelines for safe operative delivery in the second stage of labour should be developed and adhered to in order to reduce morbidity, particularly neonatal trauma.
The prognostic significance of HPV‐16 genome status of the lymph nodes, the integration status and p53 genotype in HPV‐16 positive cervical cancer: a long term follow up
Authors: Hernádi Zoltán , Szarka Krisztina , Sápy Tamás , Krasznai Zoárd , Veress György , Póka Róbert 
Published: December 2003

Objective
Prognostic evaluation of HPV‐16 genome status of the pelvic lymph nodes, the integration status of HPV‐16 and p53 codon 72 polymorphism in cervical cancer.Design
Prospective cohort study.Setting
Department of Gynaecological Oncology, University of Debrecen, Hungary.Sample
Thirty‐nine patients with HPV‐16 positive cervical cancer.Methods
Primary tumour specimens of 39 cervical cancer patients with HPV‐16 positive primary tumour were subjected to multiplex polymerase chain reaction using HPV‐16 E1/E2, E7 and p53 codon 72 allele‐specific primers. Pelvic lymph nodes of the same patients were also tested for the presence of HPV‐16 DNA and for its integration status using HPV‐16 E7 and E1/E2 ORF specific primers, respectively.Main outcome measures
Progression‐free survival.Results
Metastatic lymph nodes carried HPV‐16 DNA more frequently than nodes with no evidence of disease (100.0% vs 35.7%, P= 0.001). Cases with HPV‐16 positive nodes had higher recurrence rate than those with HPV‐16 negative nodes (42.9% vs 11.1%, P= 0.009). There was no difference between cases with and without histologically proven nodal disease with regard to integration status of HPV‐16 DNA in the primary tumour (integrated 90.9% vs 71.4%, episomal 9.1% vs 21.4%, mixed 0% vs 7.1%) and p53 codon 72 polymorphism (Arg/Arg 54.5% vs 67.9%, Pro/Pro 0 vs 7.1%, Arg/Pro 45.5% vs 21.4%).Conclusion
Regardless of the presence of nodal metastasis, HPV‐16 status of the nodes is a significant predictor of recurrent disease. HPV‐16 integration status and p53 codon 72 genotype do not seem to have a bearing on disease outcome in cervical cancer with HPV‐16 positive primary.
Laparoscopic colposuspension: a systematic review
Authors: Moehrer Birgit , Carey Marcus , Wilson Don 
Published: December 2003

Objective
To determine the effectiveness of laparoscopic colposuspension for the treatment of stress urinary incontinence.Design
Systematic review.Setting
Teaching hospitals.Population
Women with symptoms or urodynamic diagnosis of stress, urge or mixed incontinence.Methods
Randomised and ‘quasi‐randomised trials’ in women with symptoms or urodynamic diagnoses of stress, urge or mixed incontinence including laparoscopic surgery in at least one arm of the trial were identified from the Cochrane Incontinence Review Group's Specialised Register of Controlled Trials.Main outcome measures
Subjective cure, objective cure, quality of life measurements and surgical outcome measures.Results
Eight trials met the inclusion criteria. Five trials compared laparoscopic (n= 233) with open (n= 254) colposuspension. Risk of a positive stress test at follow up was significantly less in the open group (relative risk [RR] 0.89, 95% confidence interval [CI] 0.82 to 0.98). When one poor quality trial was excluded from the analysis, the relative risk was still less in the open group, but was no longer significant (RR 0.91, 95% CI 0.82 to 1.01). If considered as risk difference there is a 9% significantly higher risk of failure for laparoscopic colposuspension, however, excluding one poor quality trial, this risk of failure is non‐significant at 8%. Analysis of subjective cure showed no difference between the groups. A trend was shown towards a higher complication rate, less post‐operative pain, shorter hospital stay and time to return to normal function for laparoscopic compared with open colposuspension. Three trials compared different methods of laparoscopic colposuspension. Data from these trials could not be combined in view of the differences in the trials. Based on a single trial, two sutures were better than one. Sutures were as effective as mesh/staples. No conclusion could be drawn about the benefits of transperitoneal or extraperitoneal access.Conclusions
It is difficult to make valid conclusions as the evidence is limited by short term follow up and small numbers of trials and participants. However, it is possible that no difference exists between laparoscopic and open colposuspension for either objective or subjective cure. Further, well designed and adequately powered randomised controlled trials are required.
Perinatal mortality: clinical value of postmortem magnetic resonance imaging compared with autopsy in routine obstetric practice
Authors: Alderliesten Marianne E. , Peringa Jan , van der Hulst Victor P.M. , Blaauwgeers Hans L.G. , van Lith Jan M.M. 
Published: December 2003

Objective
To compare postmortem magnetic resonance imaging (MRI) with autopsy in perinatal deaths. To determine the acceptance and feasibility of postmortem perinatal MRI.Design
Cohort study.Setting
Large teaching hospital.Population
Fetuses and neonates from 16 weeks gestational age until 28 days after birth, stillbirths as well as intrapartum and neonatal deaths.Methods
MRI was performed prior to autopsy in a consecutive cohort of perinatal deaths after full parental consent. Agreement between MRI and autopsy was calculated. The consent rate for both examinations was recorded separately, as well as the time between the perinatal death and the MRI.Main outcome measure
Full agreement between MRI and autopsy.Results
Of 58 cases, 26 parents consented to both examinations (45%). Autopsy showed 18 major malformations, of which 10 were detected with MRI. The positive predictive value of MRI was 80% (4/5) and the negative predictive value was 65% (13/20). Additional consent for MRI was given in eight cases (14%). In 84%, the MRI could be performed within 48 hours.Conclusions
MRI is of value if autopsy is refused, but diagnostic accuracy is insufficient to recommend substitution of full autopsy. The acceptance rate of MRI only is better than that of autopsy.
Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping
Authors: Cederholm Maria , Haglund Bengt , Axelsson Ove 
Published: December 2003

Objective
To investigate whether amniocentesis and chorionic villus sampling increase the risk of bleeding, placental abruption, complications related to amniotic cavity and membranes, abnormal labour, operative deliveries and to investigate the impact of gestational length at the time of the procedure.Design
A population‐based cohort study.Setting
Sweden, 1991–1996.Population
All women, 35 to 49 years old, with single births (N= 71,586). The women were classified as exposed to amniocentesis (N= 21,748) or chorionic villus sampling (n= 1984) or not exposed (N= 47,854).Methods
Maternal outcomes were collected from the Swedish Medical Birth Register and the Swedish Hospital Discharge Register. With Logistic regression analyses odds ratios were calculated.Main outcome measures
Crude and adjusted odds ratios of bleeding, complications related to amniotic cavity and membranes, abnormal labour and operative deliveries. Women exposed to amniocentesis or chorionic villus sampling were compared with women non‐exposed.Results
Neither amniocentesis nor chorionic villus sampling was associated with severe pregnancy complications such as placental abruption or placenta praevia. Women in the amniocentesis group had a lower chance of normal delivery (OR = 0.93, 95% CI 0.90–0.97), an increased risk of complications related to amniotic cavity and membranes (OR = 1.15, 95% CI 1.06–1.24) and hypotonic uterine dysfunction (OR = 1.12, 95% CI 1.06–1.18). The risks were higher for amniocentesis before 15 weeks of gestation. Women in the amniocentesis group were more often delivered by forceps or vacuum extractions (OR = 1.11, 95% CI 1.03–1.19) and elective caesarean sections (OR = 1.09, 95% CI 1.02–1.16). For the chorionic villus sampling group, no significant associations were found.Conclusions
Among women aged 35–49 years, amniocentesis is not associated with important adverse outcomes such as abruption or placenta praevia. Minor associations were found for other maternal complications when amniocentesis was performed before 15 weeks of gestation. Improved methods to identify women with increased risk of chromosomally abnormal pregnancies might minimise the number of women exposed to invasive procedures.
Aspirin (100 mg) used for prevention of pre‐eclampsia in nulliparous women: the Essai Régional Aspirine Mère–Enfant study (Part 1)
Authors: Subtil Damien , Goeusse Patrice , Puech Francis , Lequien Pierre , Biausque Serge , Breart Gérard , Uzan Serge , Marquis Pierre , Parmentier Dominique , Churlet Alain ,   Essai Régional Aspirine Mère–Enfant (ERASME) Collaborative Group,   Collaborators and participating centres are listed at the end of the report
Published: December 2003

Objective
To reduce the incidence of pre‐eclampsia in nulliparous women, in accordance with the suggestion of a recent meta‐analysis that low dose aspirin might decrease this incidence by more than half if used early enough in and at a sufficient dose during pregnancy (more than 75 mg).Design
Multicentre randomised double‐blinded placebo‐controlled trial.Setting
Twenty eight centres in Northern of France and one in Belgium.Population
Three thousand and two hundred ninety‐four nulliparous women recruited between 14 and 20 weeks.Methods
Randomisation to either 100 mg aspirin or placebo daily from inclusion through 34 weeks.Main outcome measures
Preeclampsia was defined as hypertension (≥140 and or 90 mmHg) associated with proteinuria (≥0.5 g/L).Results
The aspirin (n= 1644) and placebo (n= 1650) groups did not differ significantly in the mothers' incidence of pre‐eclampsia (28 of 1632 [1.7%] vs 26 of 1637 [1.6%]; relative risk, RR, 1.08, 95% CI 0.64–1.83), hypertension, HELLP syndrome or placental abruption, or in the children's incidence of perinatal deaths or birthweight below the 10th centile. The incidence of babies with birthweight below the third centile was significantly higher in the aspirin group, with no explanation. The incidence of maternal side effects was higher in the aspirin group, principally because of a significantly higher rate of haemorrhage.Conclusions
Aspirin at a dose of 100 mg does not reduce the incidence of pre‐eclampsia in nulliparous women. Aspirin (100 mg) is associated with an increase in bleeding complications.
Postnatal morbidity after childbirth and severe obstetric morbidity
Authors: Waterstone Mark , Wolfe Charles , Hooper Richard , Bewley Susan 
Published: December 2003

Objective
To identify the impact of pregnancy and childbirth, and severe obstetric morbidity on outcome 6 to 12 months postpartum.Design
Questionnaire assessment of postnatal outcome in a cohort study.Setting
South East Thames, UK.Population
All women resident in South East Thames and delivering between 1st March 1997 and 28th February 1998.Methods
Questionnaire study of a cohort of women who experienced a severe obstetric morbidity during pregnancy or labour (cases), compared with a cohort of women who did not (controls).Main outcome measures
Assessment of postnatal depression risk [Edinburgh Postnatal Depression Scale (EPDS)], general health [Short Form 36 (SF‐36)], sexual activity and use of health services between 6 and 12 months postpartum.Results
There were 331 cases and 1339 controls out of 48,262 deliveries. Six to 12 months after delivery, 77 (23.3%) of cases and 272 (20.5%) of the controls were at risk of postnatal depression (P= 0.25; 95% CI for difference −2.2% to 7.9%), 43.1% of cases were having problems with sexual relations compared with 18.7% of controls (P < 0.001; 95% CI for difference 8.9% to 21.9%). There was evidence of poorer general health in cases. Some 31.5% of cases attended outpatients in the first six months and 9.4% required emergency admission to hospital compared with 17.0% (P < 0.001; 95% CI for difference 9.1% to 19.9%) and 3.7% (P < 0.001; 95% CI for difference 2.4% to 9.0%), respectively, in controls.Conclusion
Both control pregnancy and childbirth and severe obstetric morbidity are associated with significant postnatal morbidity. A severe obstetric morbid event significantly influences women's sexual health and wellbeing and increases health services utilisation. Prevention and appropriate management of severe obstetric morbid events may reduce these outcomes.
Changes in nuchal translucency thickness in normal and abnormal karyotype fetuses
Authors: Zoppi Maria A. , Ibba Rosa M. , Floris Marcella , Manca Fabiola , Axiana Carolina , Monni Giovanni 
Published: December 2003

Objective
To investigate the dynamic trend of the nuchal translucency thickness between fetuses with normal and abnormal karyotype.Design
Prospective observational study.Setting
Ospedale Microcitemico, Cagliari, Italy.Population
A cohort of 305 first trimester fetuses.Methods
Fetuses with a nuchal translucency greater than or equal to the 95th centile were invited for a second nuchal translucency measurement. The finding of an ‘increased or unchanged’ or ‘diminished’ thickness was compared in fetuses with normal and abnormal karyotype.Main outcome measures
Nuchal translucency and karyotype.Results
Median maternal age was 35 years (min 17, max 44) and median crown–rump length at first visit was 50 mm (min 38, max 80). A second nuchal translucency measurement was carried out in 292 fetuses, resulting in increased or unchanged values in 95 cases and decreased nuchal translucency in 197 cases. Two hundred and twenty‐six (77.4%) fetuses had normal karyotype and 66 (22.6%) had abnormal karyotype (44 trisomies 21, 10 trisomies 18, 5 trisomies 13, 4 cases of 45 X0, 1 case of 47,XXY, 1 case of 47,XXX and 1 translocation). In the 66 chromosomally abnormal fetuses, the second nuchal translucency measurement was enlarged or unchanged in 37 (56%), and diminished in 29 (44%), while in the 226 normal fetuses the second nuchal translucency measurement was enlarged or unchanged in 58 cases (25%) and diminished in 168 (75%) (relative risk 2.6, 95% confidence interval 1.7–4.0).Conclusion
In fetuses with abnormal karyotype, the second nuchal translucency measurement tends to be increased or unchanged, while in normal cases the size of nuchal translucency is generally reduced.
Maternal serum activin A levels in association with intrauterine fetal growth restriction
Authors: Wallace Euan M. , Schneider‐Kolsky Michal E. , Edwards Andrew , Baker Lesleigh , Jenkin Graham 
Published: December 2003

Objective
To assess maternal serum activin A as a potential marker of fetal growth restriction.Design
A cohort study.Setting
A maternal–fetal medicine unit, university teaching hospital.Population
Fifty‐seven women with a small fetus (less than 10th centile for gestation) referred for assessment of fetal size by ultrasound biometry.Methods
At the time of presentation for fetal biometry, maternal blood was collected for activin A measurement. The case records of each woman were independently reviewed after delivery and the pregnancy grouped into one of three groups: constitutionally small fetus, intrauterine growth restricted (IUGR) fetus or IUGR fetus and maternal pre‐eclampsia (IUGR–pre‐eclampsia). Activin A levels in the three groups were compared.Main outcome measures
Maternal serum activin A levels.Results
Sixteen of the 57 pregnancies were classified as constitutionally small, 17 as IUGR and 24 as IUGR–pre‐eclampsia. Expressed as multiples of a normal median (MoMs), the median (95% CI) activin A level in the constitutionally small pregnancies was 1.12 (0.72–1.39) MoMs significantly lower than the level in both the IUGR pregnancies, 3.00 (1.84–4.11) MoMs, and the IUGR–pre‐eclampsia pregnancies, 7.96 (5.73–10.62) MoMs (P= 0.002 and 0.0001 for IUGR vs constitutionally small and IUGR–pre‐eclampsia vs constitutionally small, respectively).Conclusions
Maternal serum activin A may be useful in the assessment of the small for gestational age fetus.