bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancies complicated by placenta praevia: what is appropriate management?
Authors: Love Corinne D. B. , Wallace Euan M. 
Published: August 2005

Objective
To review the outcome of pregnancies complicated by placenta praevia over a three‐year period (1991–1993) and to describe in detail the antenatal course and the events leading to delivery, assessing retrospectively whether there are clinical features predictive of outcome and whether outpatient management would be reasonable.Design
A retrospective review of the case records of women with a pregnancy complicated by placenta praevia.Setting
A tertiary referral teaching hospital in Edinburgh.Results
There were 15,930 deliveries in the study period. Fifty‐eight women (0.4%) had a placenta praevia in the third trimester, 42 of whom (72%) had at least one episode of bleeding. Overall, 62% of the women had a major praevia with no differences in the grade of praevia between those women who did or did not have bleeding. Both diagnosis and delivery occurred significantly earlier in women with antepartum bleeding than in those without (median gestation at diagnosis 28.6 weeks versus 33.3 weeks (P < 0.01) and at delivery 36.0 weeks versus 37.1 weeks (P= 0.04), respectively). Delivery by emergency caesarean section was more common in women with bleeding (62%versus 38%). An increasing number of bleeding episodes experienced by individuals was not associated with significant differences in outcomes. Rapid emergency delivery for bleeding was necessary for three women, in none of whom could the bleeding have been predicted.Conclusions
The clinical outcomes of placenta praevia are highly variable and cannot be predicted confidently from antenatal events. Nonetheless, in the majority of cases with or without bleeding and irrespective of the degree of praevia, outpatient management would appear safe and appropriate.
Reliability of the recording of hysterectomy in the Saskatchewan health care system
Authors: Edouard Lindsay , Rawson Nigel S. B. 
Published: August 2005

Objective
To determine the validity of data pertaining to hysterectomy in the Saskatchewan health care utilisation datafiles.Design
Retrospective analysis of routinely collected data covering hospital discharge records and practitioner claims for reimbursement of services, together with a review of clinical charts.Setting
Province of Saskatchewan, Canada.Sample
All 1905 cases of hysterectomy in one calendar year for analysis of datafiles and a random sample of 227 clinical charts for review.Method
Information in the hospitalisation datafile was validated through an external comparison with data extracted from a review of clinical charts, as well as an internal comparison with independent data from the practitioner claims file. Corresponding context data on drug use and performance of related procedures were also analysed.Results
Concordance between hospital data and clinical charts was greater than 95% for those items of an administrative nature as well as type of hysterectomy and was around 85% for the diagnoses. When hospitalisation and practitioner claims data were compared, the concordance was 98% for type of hysterectomy but only 56% for diagnoses.Conclusions
The agreement between hospital data and clinical charts was excellent. The concordance between hospitalisation and practitioner claims data was almost exact for type of hysterectomy, while discrepancies in diagnoses between these files were mostly explainable on the basis of accepted clinical practice. Saskatchewan health care utilisation datafiles provide a source of valid data for research and evaluation studies.
Protective effect of depot‐medroxyprogesterone acetate on surgically treated uterine leiomyomas: a multicentre case‐control study
Authors: Lumbiganon Pisake , Rugpao Sungwal , Phandhu‐fung Surang , Laopaiboon Malinee , Vudhikamraksa Nara , Werawatakul Yuthapong 
Published: August 2005

Objective
To assess the protective effect of depot‐medroxyprogesterone acetate (DMPA) on uterine leiomyomas. DMPA has been widely used in Thailand for many years; uterine leiomyomas is the most common female tumour.Design
A multicentre hospital‐based case‐control study.Setting
University and regional hospitals.Patients
Cases were all newly diagnosed patients with pathologically proven diagnosis of uterine leiomyomas, who were admitted to eight hospitals in three regions of Thailand from January 1991; to June 1993;. Three controls matched with cases by sex, age within five years and date of admission within three months were recruited.Main outcome measures
Information on socio‐demographic factors, personal and family history, current disease, reproductive and contraceptive history was collected from cases and controls by interview.Results
There were 910 cases and 2709; controls. After univariate and unconditional multiple logistic regression analysis, risk factors associated positively with uterine leiomyomas are tubal ligation, family history of uterine leiomyomas, higher education, obesity and abortion. In contrast, DMPA, use of oral contraceptives, higher parity and smoking are associated with a lower relative risk suggesting that they have a protective effect against uterine leiomyomas. This causative relation is further strengthened by the strong duration‐response relation between DMPA and uterine leiomyomas. This protection may persist for more than 10 years after the last dose.Conclusion
We have demonstrated a strong, duration dependent protective effect of DMPA against uterine leiomyomas.
Counselling implications of chromosomal abnormalities other than trisomy 21 detected through a maternal serum screening programme
Authors: Sheridan E. , Williams J. , Caine A. , Morgan R. , Mason G. , Mueller R. F. 
Published: August 2005

Objective
To identify counselling requirements, we reviewed the frequency and type of non‐trisomy 21 chromosome abnormalities found at amniocentesis after maternal serum screening for Down's syndrome.Design
The study involved a review of the cytogenetic results of amniocenteses performed because of a raised maternal serum screening risk.Setting
The maternal serum screening and amniocenteses were performed at hospitals in the Yorkshire region.Sample
1715 amniocenteses were performed as a result of a raised maternal serum screening risk for the period 1990 to 1993.Methods
The cytogenetic results were classified into the main categories of numerical and structural chromosomal abnormalities.Main outcome measures
The nature and frequency of abnormal cytogenetic results were identified in which parental samples were required in order to determine if the abnormal finding was de novo or familial and/or for which specialist genetic counselling was required.Results
Sixty‐nine pregnancies of 1715 amniocenteses were identified with a chromosomal abnormality (4.0%): 35 (2.0%) with trisomy 21 and 34 (2.0%) with another chromosomal abnormality. For 20 of these 34 abnormalities, parental karyotypes were required and in 29 of the 34 specialist genetic counselling was required.Conclusions
Women undergoing maternal serum screening and, in particular, those proceeding to amniocentesis, should be informed that there is an equal chance that a chromosomal abnormality other than trisomy 21 will be found at amniocentesis, the nature of which usually requires parental samples and specialist counselling.
A double‐blind randomised controlled trial of the effects of medroxyprogesterone acetate on bone density of women taking oestrogen replacement therapy
Authors: Adachi Jonathan D. , Sargeant Everett J. , Sagle Margaret A. , Lament David , Fawcett Paul D. , Bensen William G. , McQueen Matthew , Nazir Darius J. , Goldsmith Charles H. 
Published: August 2005

Objective
To assess the effects of medroxyprogesterone acetate on bone density in women who have had a hysterectomyDesign
Randomised, double‐blind, placebo‐controlled trial of medroxyprogesterone acetate 10 mg, 20 mg or placebo as an adjunct to oestrogen therapy.Participants
One hundred and twenty‐three women, aged 18 to 45 years and currently receiving daily oestrogen, who presented at a university‐based rheumatology practice.Interventions
The women were randomly assigned to receive either medroxyprogesterone acetate 10 mg, 20 mg or placebo daily beginning on day 15 of each month for one year. Forty‐one women were randomised into each group.Main outcome measure
The primary outcome measurement was the percentage of change from baseline in bone mineral density of the lumbar spine (L2–L4). Secondary outcome measures included differences in femoral neck bone density, cholesterol and triglyceride levels between groups.Results
At one year, change in bone mineral density did not differ between either the treatment or placebo groups. Medroxyprogesterone acetate 20 mg and 10 mg led to statistically significant reductions in very low density lipoprotein cholesterol, total triglycerides, and very low density lipoprotein triglycerides when compared with placebo. Medroxyprogesterone acetate 20 mg also led to a statistically significant reduction in high density lipoprotein cholesterol, high density lipo‐protein‐2 cholesterol, and high density lipoprotein‐2 triglycerides.Conclusions
Medroxyprogesterone acetate at either dose as an adjunct to oestrogen did not improve bone mineral density at one year when compared with placebo. Medroxyprogesterone acetate 10 mg may not adversely affect lipids. Medroxyprogesterone acetate 20 mg, however, did reduce high density lipoprotein cholestrol and therefore may increase cardiovascular risk.
Computerised estimation of the baseline fetal heart rate in labour: the low frequency line
Authors: Mongelli Max , Dawkins Robert , Chung Tony , Sahota Daljit , Spencer John A. D. , Chang Allan M. Z. 
Published: August 2005

Short Headline: Computerised FHR baseline estimationObjective
To develop and evaluate a computerised algorithm for the estimation of the fetal heart rate baseline (low frequency line) during labour.Design
Retrospective observational study.Methods
Fetal heart rate signals were obtained from women in labour using the Nottingham fetal ECG monitor. The computerised algorithm for the baseline estimation was developed for intrapartum applications and is based on averaging modal fetal heart rate values. Evaluation was carried out on sixty cardiotocographic recordings by 12 experts and by the computer. These estimates were compared with those obtained from the computerised system using paired differences and intraclass correlation.Results
The study showed that it is possible to produce a low frequency line from data obtained from intrapartum records. The system could not estimate the low frequency line in four records, whereas experts were also unable to estimate between one and seven tracings. The 95% CI for the paired differences between computer and experts was ‐12 to 15 bpm, whereas between the experts this was ‐10 to 10. With the exception of one expert, there was a high concordance between experts and between computer and experts (intraclass correlation > 0.9).Conclusions
The performance of this computerised algorithm cannot be distinguished from that of experienced clinicians. There were no significant differences between baseline values obtained by the computerised algorithm and those by the clinicians.
Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up
Authors: Loft Anne , Lidegaard Øjvind , Tabor Ann 
Published: August 2005

Objective
To estimate the risk of developing ovarian cancer after abdominal (total or subtotal) hysterectomy on benign indication.Design
Prospective historical cohort study with 12.5 years of follow up. Setting Denmark, nationwide.Population
All Danish women (aged 0 to 99 years) having undergone hysterectomy with conservation of at least one ovary for a benign indication from 1977 to 1981 (n= 22,135). Follow up was conducted from 1977 to 1991. The reference group included all Danish women who had not undergone hysterectomy, age‐standardised according to the hysterectomy group (n= 2,554,872).Methods
Registry data derived from the Danish National Register of Patients (diagnoses and operation codes) and the Civil Registration System (information about general population, including time of death).Main outcome measures
Incidence rate of ovarian cancer, lifetime risk of ovarian cancer, relative risk of ovarian cancer.Results
Seventy‐one women developed ovarian cancer on average 7.0 years after hysterectomy and 10,659 women in the reference group had ovarian cancer diagnosed after on average 6.4 years. The incidence rate of ovarian cancer was 0.27 per 1000 person‐years in the group that had undergone hysterectomy and 0.34 per 1000 person‐years in the general population (age‐standardised). The extrapolated lifetime risk of developing ovarian cancer was 2.1% after hysterectomy and 2.7% in the general population (RR 0.78; 95% CI0.60–0.96).Conclusions
The risk of ovarian cancer is lower among women who have undergone hysterectomy compared with those who have not. The protection seems to decrease with time.
A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study
Authors: Overton Christopher , Hargreaves Janet , Maresh Michael 
Published: August 2005

Objectives To study the frequency of complications of endometrial resection and ablation for menstrual disturbances and the influence of the experience of the operators.Design Prospective survey with additional retrospective reporting by theatre staff.Setting 300 National Health Service and independent hospitals in the United Kingdom (excluding Scotland).Population 10,686 women registered by 690 doctors (1–222 cases/doctor) from April 1993 to October 1994.Methods Mailings were sent to relevant medical and non medical staff at every hospital to ascertain who performed the operations. These doctors were asked to complete a questionnaire detailing their previous experience. Completed patient registration forms were returned each month. Theatre contacts returned lists of cases reported in theatre registers.Main outcome measures Perioperative, post‐operative and delayed complications by method of surgery and experience of operator.Results Two directly related deaths were reported. Laser and rollerball ablations were associated with least operative and post‐operative complications. Combined loop and rollerball diathermy was associated with a higher rate, but with fewer immediate operative complications than loop resection alone. Endometrial thinning agents were not associated with decreased complications. Fibroids were associated with increased operative haemorrhage. Early post‐operative complication rates ranged from 0.77% to 1.51%. Six‐week follow up in 82.5% of the women revealed few complications (1.25% to 4.58%). Increasing operative experience was associated with fewer uterine perforations in the loop resection alone group χ2 for trend, P < 0.001), but had no effect on operative haemorrhage in any group.Conclusions These procedures were used widely in 1993 to 1994 with low morbidity and mortality. The techniques may be relatively easily learned in the apprenticeship system without compromising safety. Combined diathermy resection appears safer than loop resection alone, but laser and rollerball ablation were safest.
Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo controlled trial
Authors: McDonald H. M. , O'Loughlin J. A. , Vigneswaran R. , Jolley P. T. , Harvey J. A. , Bof A. , McDonald P. J. 
Published: August 2005

Objective To ascertain whether metronidazole treatment of women with a heavy growth of Gardnerella vaginalis during mid‐pregnancy would reduce the risk of spontaneous preterm birth.Design A multicentre, randomised, placebo‐controlled trialSetting Four metropolitan hospitals.Participants Eight hundred and seventy‐nine singleton women with a heavy growth of G. vaginalis or Gram stain indicative of bacterial vaginosis at 19 weeks of gestation.Interventions Oral metronidazole (400 mg) or placebo twice daily for two days at 24 weeks of gestation, and at 29 weeks if G. vaginalis found in test‐of‐cure swab four weeks after treatment.Main outcome measures Spontaneous preterm birth less than 37 weeks.Results Intention‐to‐treat analysis showed no difference between metronidazole and placebo groups in overall preterm birth (31/429 [7.2%] vs 32/428 [7.5%]) or spontaneous preterm birth (20/429 [4.7%] vs 24/428 [5.6%]). Among the 480 women with bacterial vaginosis, treatment had no effect on spontaneous preterm birth (11/242 [4.5%] vs 15/238 [6.3%]). In the subset of 46 women with a previous preterm birth, women in the metronidazole group showed a significant reduction in spontaneous preterm birth (2/22 [9.1%] vs 10/24 [41.7%], OR 0.14, 95%CI 0.01–0.84). A treatment effect was also found in compliant women with a previous preterm birth and bacterial vaginosis (0/14 [0%] vs 6/17 [35.3%], OR 0.0,95%CI 0.0–0.94).Conclusion Metronidazole treatment of women with a heavy growth of G. vaginalis or bacterial vaginosis did not reduce the preterm birth rate. Among women with a previous preterm birth, treatment reduced the risk of spontaneous preterm birth. Further studies are required to confirm these findings.
A randomised controlled trial evaluating a novel cytotoxic drug delivery system for the treatment of cervical intraepithelial neoplasia
Authors: Sidhu Harmini Kaur , Price John H. , McCarron Paul A. , McCafferty Dermot F. , Woolfson A. David , Biggart Denis , Thompson William 
Published: August 2005

Objective
To investigate the efficacy of a novel method for the treatment of cervical intraepithelial neoplasia. A cytotoxic drug delivery system using a bilaminar bioadhesive polymeric film was applied directly to the cervix. This cytotoxic drug delivery system allowed the dose, the site and the duration of application of the cytotoxic drug (5‐fluorouracil) to be controlled.Design
A prospective, double‐blind randomised controlled trial.Setting
The Departments of Obstetrics and Gynaecology and Pathology of Belfast City Hospital and The Queen's University of Belfast, and the Department of Pharmacy of The Queen's University of Belfast.Participants
One hundred and four patients who had been referred to the colposcopy outpatient clinic because of abnormal cervical cytology were recruited into the trial. They were assessed colposcopically and biopsies for histopathology were obtained. Only patients with cervical intraepithelial neoplasia lesions Grades 1 and 2 were recruited.Interventions
All patients were re‐assessed one, three, and six months after application of the cytotoxic drug delivery system by colposcopy. Clinical endpoints were noted.Main outcome measures
Pre‐treatment histopathological biopsy results were compared with those obtained after treatment.Results
The cytotoxic drug delivery system fulfilled the requirements for treatment of cervical intraepithelial neoplasia without causing any architechtural damage, but the chemotherapeutic agent, 5‐fluorouracil, did not provide effective treatment of disease.Conclusions
This study showed that the delivery system was effective, and further studies using this mechanism are now possible.
Incontinence in elderly women: is periurethral collagen an advance?
Authors: Stanton Stuart L. , Monga Ash K. 
Published: August 2005

Objective
To determine whether periurethral collagen is an effective, safe and practical day‐case procedure to control genuine stress incontinence (urethral sphincter incompetence) in the elderly female.Design
Prospective longitudinal study using subjective and objective outcome measures with long term follow up.Setting
A teaching hospital tertiary referral centre.Sample
Thirty‐two women over 65 years of age with a urodynamic diagnosis of genuine stress incontinence.Results
At one year, 22 women (79%) were subjectively cured or improved, and 14 (50%) were objectively cured; at two years, 18 (69%) and 14 (54%), respectively. Symptoms of urgency, urge incontinence, frequency and nocturia improved, while voiding difficulty remained unchanged. Brief urinary retention was encountered in seven women. No long term side effects or complications were encountered. Urodynamic studies suggest that collagen works by preventing premature bladder neck opening through physical stress, rather than by obstruction. This would account for the slight increase in functional urethral length.Conclusion
Contigen collagen is a simple and effective day case procedure as an alternative to major surgery and is without significant morbidity or complication. It is ideal for the elderly.
Transcutaneous electrical nerve stimulation in labour pain: a systematic review
Authors: Carroll Dawn , Tramèr Martin , McQuay Henry , Nye Bethany , Moore Andrew 
Published: August 2005

Objective
To review the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) for labour pain.Design
A systematic review of randomised controlled trials of TENS in pain during labour.Sample
Eight reports involving 712 women were included; 352 women received active TENS and 360 acted as controls.Methods
Reports were sought by searching MEDLINE and the Oxford Pain Relief Database.Main outcome measures
Analgesic and adverse effect outcomes.Results
Evidence for reduced pain using TENS in labour was weak. Additional analgesic interventions may be less likely with TENS (odds ratio 0.57; 95% CI 0.34–0.96), number‐needed‐to‐treat 14 (95% CI 7.3–119).Conclusions
Randomised controlled trials provide no compelling evidence for TENS having any analgesic effect during labour. Weak positive effects in secondary (analgesic sparing) and tertiary (choosing TENS for future labours) outcomes may be due to inadequate blinding causing overestimation of treatment effects.