bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subtotal abdominal hysterectomy: a surgical advance or a backward step?
Authors: Ewies A. A. A. , Olah K. S. J. 
Published: August 2005

Objective
To review the short and medium term outcomes of subtotal abdominal hysterectomy. We also describe the management of cervical stump complications by vaginal trachelectomy or large loop excision of the transformation zone.Design
Retrospective analysis.Setting
Warwick General Hospital, Warwickshire, UK.Sample
One hundred and fifty women underwent subtotal abdominal hysterectomy between 1993 and 1999. Five women had vaginal trachelectomy and another five had large loop excision of the transformation zone for complications relating to the cervical stump.Results
The prevalence of intra‐operative and early post‐operative complications was 4% and 7.3%, respectively. Twenty women (13.3%) had late complications, of whom 17 (11%) presented with symptoms directly related to the stump (two had also genuine stress incontinence). Three presented with genuine stress incontinence alone. The commonest problem was regular menstruation, which occurred in 12 women (8%). Ten of these women underwent vaginal trachelectomy or large loop excision of the transformation zone. None had intra‐operative or post‐operative complications.Conclusions
The high prevalences of cervical stump problems should be taken into account before a change in surgical procedure from total to subtotal hysterectomy is recommended. Further prospective studies with prolonged follow up are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Total hysterectomy, preferably by the vaginal route, remains the procedure of choice for most women. Should a problem develop, vaginal trachelectomy or large loop excision of the transformation zone by an experienced surgeon are the best options for these women.
Combined oral oestradiol valerate‐norethisterone treatment over three years in postmenopausal women: correlation between oestrogen levels and bone mineral density sites
Authors: Perry W. , Wiseman R. A. 
Published: August 2005

Objective
To compare trabecular and compact bone response and relationship to oestrogen status using continuous oestradiol valerate 2 mg and norethisterone 0.7 mg daily as hormone replacement and to determine the therapeutic range of 17 beta‐oestradiol.Design
Open label trial.Setting
Independent endocrine clinicSample
One hundred and thirty‐one patients were compared at point of entry and at 36 months.Methods
Postmenopausal women were assessed using a Lunar dual photon and single photon bone scanner, and bone mineral density of the lumbar spine, right hip and left forearm were annually correlated with 17 beta‐oestradiol and oestrone levels over three years. Total alkaline phosphatase was compared between improvers and decliners of bone mineral density.Results
Significant improvement in bone mineral density (P < 0.0001) occurred at all sites except the left forearm, where bone loss was prevented. There was no correlation between oestrogen levels and bone mineral density improvements at hip sites. However, in the lumbar spine larger improvements in bone mineral density occurred in women with 17 beta‐oestradiol levels > 185 pmol/L compared with those below, which were statistically significant for those with 17 beta‐oestradiol levels > 248 pmol/L. Bone turnover, as quanitifed by total alkaline phosphatase measurements, was suppressed in most patients, but there were no differences in the mean alkaline phosphatase levels between the best improvers and worst decliners for lumbar spine bone mineral density. Improvers had an age mean of 5.21 years greater than decliners (P= 0.01) and a mean duration difference since the menopause of 5.1 years compared with decliners (P= 0.007).Conclusion
This combined continuous preparation of hormone replacement therapy improves not only trabecular bone but prevents compact bone loss, and the data suggest that the therapeutic range of 17 beta‐oestradiol is between 200 pmol/L and 350 pmol/L.
Pregnancy testing prior to sterilisation
Authors: Kasliwal Asha , Farquharson Roy G. 
Published: August 2005

Objective
To determine the incidence of positive pregnancy test on the day of laparoscopic sterilisation.Design
Prospective longitudinal observational study.Setting
Gynaecology unit in a UK teaching hospital.Sample
Between 1 January 1997 and 31 December 1998, eight hundred and two consecutive women were admitted for laparoscopic sterilisation after assessment in the gynaecology clinic. On the day of planned surgery, all women had a pregnancy test performed on a urine sample taken that morning following overnight fasting, immediately prior to operation.Main outcome measures
A positive pregnancy test on the day of planned surgery.Results
Of 802 women tested, 21 (2.6%) were pregnant. A careful medical history taken before surgery revealed evidence of amenorrhoea and menstrual irregularity in 17 of the pregnant women. Of the 21 pregnant women, 11 underwent termination of pregnancy, six continued the pregnancy, four had a miscarriage and one had an ectopic pregnancy.Conclusion
The routine practice of pregnancy testing on the day of laparoscopic sterilisation introduced in our hospital should continue to be part of a thorough clinical assessment before surgery. This may help to reduce the considerable level of existing litigation in a high risk area of gynaecological practice.
Cardiac troponin I in pre‐eclampsia and gestational hypertension
Authors: Fleming Sean M. , O'Gorman Thomas , Finn Joseph , Grimes Helen , Daly Kieran , Morrison John J. 
Published: August 2005

Objective
To investigate serum cardiac troponin I, a sensitive marker of cardiac myocyte damage, in normal pregnancy and pregnancies complicated by hypertension with and without significant proteinuria.Design
Prospective cross sectional study.Setting
University hospital delivery suite.Sample
Serum samples obtained from women in normal pregnancy and in pregnancies complicated by hypertension with and without significant proteinuria.Method
Women with hypertension in pregnancy (at least two readings of systolic blood pressure > 140 mmHg and diastolic blood pressure > 90 mmHg) (n= 26) and normotensive women (n= 43) were included in the study. Serum cardiac troponin I was measured using Beckman Access immunoassay.Main outcome measure
Serum cardiac troponin I level in the pregnancies complicated by hypertension (with and without significant proteinuria) compared with the levels measured in normotensive women.Results
The median serum cardiac troponin I level in pregnancies complicated by hypertension was 0.118 ng/mL (n= 26) which was significantly greater than that measured in samples obtained from normotensive women in pregnancy (0.03 ng/mL; n= 43) (P < 0.0001). There were higher median serum cardiac troponin I levels in hypertensive women with significant proteinuria (0.155 ng/mL; n= 6), compared with those without proteinuria (0.089 ng/mL; n= 20; P= 0.03).Conclusion
Serum cardiac troponin I is elevated in women with hypertensive disorders of pregnancy indicating some degree of cardiac myofibrillary damage in these disorders.
Factors influencing postnatal liver function tests
Authors: David Anna L. , Kotecha Manisha , Girling Joanna C. 
Published: August 2005

Objective
To investigate liver function tests (LFTs) changes in the puerperium and the influence of specific obstetric events on these changes.Design
A longitudinal observational study.Setting
West Middlesex University Hospital, Twickenham.Population
Ninety‐four women with uncomplicated pregnancy who delivered at term.Methods
Aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transferase (GGT), total bilirubin (Bilirubin) and alkaline phosphatase (ALP) were measured in early labour and on day 1, day 2, day 5 and day 10 postnatal.Main outcome measures
Peak enzyme concentration, time of peak enzyme concentration, the area under the curve for each enzyme and the rate of change of enzyme level from predelivery to peak concentration.Results
All LFTs were affected by delivery (P < 0.001), increasing by 88% (0.500%) on day 2 or day 5 for AST, 147% (0–1140%) on day 5 for ALT and 63% (0–450%) on day 5 or day 10 for GOT. Multiple linear regression showed that caesarean section and opioid administration was associated with a faster rise in AST (P= 0.001, P= 0.033 respectively). The mean peak GOT concentration was 39% higher in women having caesarean section compared with vaginal delivery (P= 0.015). Univariate analysis showed that perineal trauma, use of Entonox, maternal age at delivery and breastfeeding also influenced LFT concentration significantly.Conclusion
Liver enzyme levels change significantly in the puerperium and are affected by common obstetric events, particularly caesarean section. This study aids clinical interpretation of postnatal LFTs in women recovering from liver‐related illnesses, by facilitating the differentiation of physiological and pathological processes.
The impact of maternal serum screening on the birth prevalence of Down's syndrome and the use of amniocentesis and chorionic villus sampling in South Australia
Authors: Cheffins Tracy , Chan Annabelle , Haan Eric A. , Ranieri Enzo , Ryall Richard G. , Keane Rosemary J. , Byron‐Scott Rosemary , Scott Heather , Gjerde Elizabeth M. , Nguyen Anh‐Minh , Ford Judith H. , Sykes Stephen 
Published: August 2005

Objectives
To describe the impact of maternal serum screening on the birth prevalence of Down's syndrome and on the use of amniocentesis and chorionic villus sampling in South Australia.Design
A descriptive population‐based study.Setting
South Australia (population 1.48 million persons; approximately 20,000 births per year).Participants
Women who had births or terminations of pregnancy with Down's syndrome in 1982–1996, women who had maternal serum screening in 1991–1996, amniocentesis or chorionic villus sampling in 1986–1996.Methods
Analysis of data from multiple sources on maternal serum screening, amniocentesis and chorionic villus sampling, births and terminations of pregnancy.Main outcome measures
Total prevalence and birth prevalence of Down's syndrome each year in 1982–1996; proportion of pregnant women using maternal serum screening in 1991–1996, and proportion using amniocentesis and chorionic villus sampling by indication in 1986–1996, by age group.Results
Use of maternal serum screening for Down's syndrome increased from 17% when introduced in 1991 to 76% of women who gave birth in 1996. Between 1982 and 1986 and 1996, terminations of pregnancy for fetal Down's syndrome increased from 7.1% to 75% and the birth prevalence of Down's syndrome fell by 60% from 1.05 to 0.42 per 1,000 births, against the background of an increase in total prevalence due to increasing maternal age. The use of amniocentesis increased from 5.8% in 1991 to 10.1% in 1996 mainly due to the increase among women younger than 35 years with maternal serum screening as the main reason. The increasing chorionic villus sampling rate among younger women stabilised at 0.4%, while the rate among older women decreased from 11.0% to 7.4%.Conclusions
The introduction of maternal serum screening in South Australia has resulted in increased use of any prenatal testing for Down's syndrome from about 7% (mainly older women having amniocentesis or chorionic villus sampling) to 84% of women (about 8% having direct amniocentesis or chorionic villus sampling and 76% having maternal serum screening first). This has resulted in a significant fall in the birth prevalence of Down's syndrome, maternal serum screening was the first indication of Down's syndrome for about half the terminations of pregnancy for Down's syndrome in 1993–1996, including three quarters of those in younger women.
The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery
Authors: MacLennan Alastair H. , Taylor Anne W. , Wilson David H. , Wilson Don 
Published: August 2005

Objectives
To define the prevalence of pelvic floor disorders in a non‐institutionalised community and to determine the relationship to gender, age, parity and mode of delivery.Design
A representative population survey using the 1998 South Australian Health Omnibus Survey.Sample
Random selection of 4400 households; 3010 interviews were conducted in the respondents'homes by trained female interviewers. This cross sectional survey included men and women aged 15–97 years.Results
The prevalence of all types of self‐reported urinary incontinence in men was 4.4% and in women was 35.3% (P < 0.001). Urinary incontinence was more commonly reported in nulliparous women than men and increased after pregnancy according to parity and age. The highest prevalence (51.9%) was reported in women aged 70–74 years. The prevalence of flatus and faecal incontinence was 6.8% and 2.3% in men and 10.9% and 3.5% in women, respectively. Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery. Multivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5–4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4–4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8–6.6). The difference between caesarean and instrumental delivery was significant (P < 0.03) but was not for caesarean and spontaneous delivery. Other associations with pelvic floor morbidity were age, body mass index, coughing, osteoporosis, arthritis and reduced quality of life scores. Symptoms of haemorrhoids also increased with age and parity and were reported in 19.9% of men and 30.2% of women.Conclusion
Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.
Endocrinological and endometrial factors in recurrent miscarriage
Authors: Li T. C. , Spuijbroek Marleen D. E. H. , Tuckerman Elizabeth , Anstie Barbara , Loxley Martin , Laird Susan 
Published: August 2005

Objective
To investigate the endocrinological and endometrial factors in women with unexplained recurrent miscarriageDesign
Prospective, case studySetting
Recurrent miscarriage clinic, Jessop Hospital for Women, SheffieldParticipants
One hundred and forty‐four women with unexplained recurrent (≥ 3) miscarriagesMethods
A blood sample was obtained in early follicular phase (day 3–5) to measure follicle stimulating hormone, luteinising hormone, prolactin, androgens and thyroid function; daily blood/urine samples were obtained from mid‐follicular phase to measure luteinising hormone until the luteinising hormone surge was identified; endometrial biopsy and a further blood sample for progesterone measurement were obtained in the mid‐luteal phase. A transvaginal ultrasonography was performed to evaluate ovarian morphology.Results
Hypersecretion of luteinising hormone or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women, respectively. The free androgen index was elevated in 14.6% of subjects. In the mid‐luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid‐luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test.Conclusions
Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.
Hepatitis C virus load during pregnancy and puerperium
Authors: Lin Ho‐Hsiung , Kao Jia‐Horng 
Published: August 2005

Objective
To assess whether pregnancy and delivery influence serum levels of hepatitis C virus (HCV) in carrier mothers.Design
A prospective study.Setting
University department of obstetrics and gynaecology.Participants
Ten pregnant HCV carriers (group A) and 8 nonpregnant HCV carriers (group B).Methods
Serum samples were collected for group A at first and third trimesters, delivery, postpartum 1,3,6,9 and 12 months, and at every three months for 1 year for group B.Main outcome measures
Each serum sample was tested for serum alanine aminotransferase (ALT), anti‐HCV titre and HCV‐cDNA concentration by a competitive polymerase chain reaction (PCR) with a sensitivity of 250 copies/mL serum.Results
In group A, the HCV levels remained unremarkably changed during pregnancy and delivery. However, all women had decreased HCV levels 1 and 3 months after delivery. Two women had undetectable serum HCV level postpartum and thereafter. Serum ALT values in 3 women were sporadically elevated, but did not correlate with decreased serum HCV levels. Anti‐HCV titres remained unchanged during the study period. In two women from group B, the serum HCV levels were undetectable during follow up. Other 6 women showed fluctuations in the serum HCV levels but all were above 250 copies/mL. Serum ALT values were normal and anti‐HCV titres remained stationary in all 8 nonpregnant carriers.Conclusion
Serum HCV levels are decreased 1 and 3 months after delivery. This fact might suggest that puerperium is an optimal time for antiviral therapy in HCV carrier mothers.
Altered peripheral vascular response of women with and without pelvic pain due to congestion
Authors: Foong L. C. , Gamble J. , Sutherland I. A. , Beard R. W. 
Published: August 2005

Objective
To test the hypothesis that women with pelvic venous congestion have a reduction of reactivity of their peripheral circulation.Design
Comparison was made between 20 women with chronic pelvic pain due to congestion and a control group of 15 pain‐free women matched for age, parity and body weight. A comparison of these results was made with those from six postmenopausal women taking hormone replacement therapy.Methods
Study and control groups were investigated during the mid‐follicular phase of the menstrual cycle (days 5–9) and the mid‐luteal phase (days 19–23). The study group was also investigated during the fifth month of treatment with suppression of ovarian activity with leuprorelin or medroxyproges‐terone acetate or six months after hysterectomy and bilateral salpingo‐oophorectomy. Head‐up tilt sufficient to increase intra‐vascular pressure in the toe by a standard 40 mmHg was used as a means of raising venous pressure in the lower limb. Skin capillary red blood cell velocity (flux) was measured using a laser Doppler flow probe placed over the pulp of the big toe. Heart rate and blood pressure were also recorded. The change in skin blood flow following head‐up tilt was expressed as a percentage of baseline flow in the supine position.Main outcome measures
Percentage change in skin red blood cell flux, heart rate and blood pressure in response to 40° head‐up tilt.Results
In the control group the median response to head‐up tilt in the follicular phase was one of a reduction in flux, whereas in the luteal phase it was more variable ranging from an increase to a decrease in flux. The responses in the pelvic congestion group in both the follicular and luteal phases were similar to those of the control group in the luteal phase. A small but significant increase in heart rate in response to tilt in the pelvic pain group, compared with the control group, was interpreted as being due to a fall in venous return. Treatment of the pelvic congestion group by medical suppression of ovarian activity or total hysterectomy with bilateral salpingo‐oophorectomy resulted in a significant change in response to head‐up tilt from the variable type of luteal response to one of a more constant reduction in flux, similar to that of the control group in the follicular phase. A reduction in flux was also found consistently in postmenopausal women.Conclusion
The study confirms the hypothesis that women with pelvic pain due to congestion show a change in peripheral vascular reactivity which returns to normal after suppression of ovarian activity. It seems likely that some alteration of normal ovarian function is responsible for the observed changes in peripheral blood flow in response to a rise in venous pressure in women with pelvic congestion.
Women's sexual health after childbirth
Authors: Barrett Geraldine , Pendry Elizabeth , Peacock Janet , Victor Christina , Thakar Rance , Manyonda Isaac 
Published: August 2005

Objective
To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.Design
Cross‐sectional study using obstetric records, and postal survey six months after delivery.Setting
Department of Obstetrics and Gynaecology, St George's Hospital, London.Population
All primiparous women (n= 796) delivered of a live birth in a six month period.Methods
Quantitative analysis of obstetric and survey data.Main outcome measures
Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.Results
Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre‐pregnancy levels of 38%. Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P= 0.01) and previous experience of dyspareunia (P= 0.03). At six months the association with type of delivery was not significant (P= 0.4); only experience of dyspareunia before pregnancy (P < 0.0001) and current breastfeeding were significant (P= 0.0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.Conclusions
Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.