bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choosing options for ultrasound screening in pregnancy and comparing cost effectiveness: a decision analysis approach
Authors: Roberts Tracy , Mugford Miranda , Piercy James 
Published: August 2005

Objective
To compare the cost effectiveness of different programmes of routine antenatal ultrasound screening to detect four key fetal anomalies: serious cardiac anomalies, spina bifida, Down's syndrome and lethal anomalies, using existing evidence.Design
Decision analysis was used based on the best data currently available, including expert opinion from the Royal College of Obstetricians and Gynaecologists, Working Party and secondary data from the literature, to predict the likely outcomes in terms of malformations detected by each screening programme.Setting
Results applicable in clinics, hospitals or GP practices delivering antenatal screening.Main outcome measure
The number of cases with a ‘target’ malformation correctly detected antenatally.Results
There was substantial overlap between the cost ranges of each screening programme demonstrating considerable uncertainty about the relative economic efficiency of alternative programmes for ultrasound screening. The cheapest, but not the most effective, screening programme consisted of one second trimester ultrasound scan. The cost per target anomaly detected (cost effectiveness) for this programme was in the range £5,000‐£109,000, but in any 1000 women it will also fail to detect between 3.6 and 4.7 target anomalies.Conclusions
The range of uncertainty in the costs did not allow selection of any one programme as a clear choice for NHS purchasers. The results suggested that the overall allocation of resources for routine ultrasound screening in the UK is not currently economically efficient, but that certain scenarios for ultrasound screening are potentially within the range of cost effectiveness reached by other, possibly competing, screening programmes. The model highlighted the weakness of available evidence and demonstrated the need for more information both about current practice and costs.
Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care
Authors: Zondervan Krina T. , Yudkin Patricia L. , Vessey Martin P. , Dawes Martin G. , Barlow David H. , Kennedy Stephen H. 
Published: August 2005

Objectives
To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain.Design
Retrospective cohort analysis of the MediPlus UK Primary Care Database.Setting
One hundred and thirty‐six general practices in the UK.Study group
A cohort of 5051 incident cases of chronic pelvic pain.Methods
The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995.Main outcome measures
Duration of symptoms, frequency of diagnoses and referral rates.Results
A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (P < 0.001) from a median of 13.7 months in 13–20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty‐eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21–50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates.Conclusions
The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.
A comparison of fetal behaviour in breech and cephalic presentations at term
Authors: Kean L. H. , Suwanrath C. , Gargari S. S. , Sahota D. S. , James D. K. 
Published: August 2005

Objective
To evaluate fetal behaviour in breech and cephalic fetuses at term, using a computerised fetal behaviour program.Design
An observational study.Setting
Pregnancy Assessment Centre, University Hospital, Nottingham.Sample
Twenty‐six breech and 58 cephalic fetuses between 36 and 41 weeks.Methods
Behaviour (fetal heart rate and activity) was recorded with the use of Doppler ultrasound. The duration of recording was 60 minutes or more in all but four recordings (minimum 49 minutes).Main outcome measures
Behavioural criteria studied were 1. the relative percentage time spent in low and high variation fetal heart rate patterns; 2. the duration and recurrence of fetal activity; 3. the number of accelerations in low and high fetal heart rate variation; and 4. the number of fetal behavioural state transitions.Results
Breech fetuses differed from the cephalic group in that they were lighter than the cephalic fetuses (median 3105 g vs 3400 g; P < 0.01) and were born to older mothers (median maternal age 30 years vs 28 years; P < 0.01). No significant differences were found in rates of movement, numbers of accelerations and time exhibiting low and high fetal heart rate variation. However, breech fetuses exhibited significantly more state transitions (median 5.2h vs 3.69h; P= 0.01).Conclusions
This study shows that breech fetuses are neurologically different from their cephalic counterparts in otherwise healthy pregnancies, and that subtle behavioural differences can be demonstrated in utero using this computerised method.
The influence of 5,10 methylenetetrahydrofolate reductase genotypes on enzyme activity in placental tissue
Authors: Daly Sean F. , Molloy Anne M. , Mills James L. , Less Y. Jack , Conley Mary , Kirke Peadar N. , Weir Donald G. , Scott John M. 
Published: August 2005

Objective
To study the effects of heterozygosity and homozygosity for the C677T mutation of the 5,10 methylenetetrahydrofolate reductase (MTHFR) gene on the activity of this enzyme in placental tissue from pregnancies not affected by neural tube defect.Design
Placental tissue was genotyped for the C677T variants of MTHFR. Total enzyme activity and residual activity after heating to 46°C for 5 minutes was then measured.Setting
A teaching hospital.Sample
Placental samples (n= 200), one from each of 200 uncomplicated term deliveries.Main outcome measures
Total and residual enzyme activity for MTHFR.Results
Placentae heterozygous for the C677T mutation of the MTHFR gene had significantly lower total enzyme activity than those without the mutation; the lowest activity occurred in homozygotes for the mutation. The same pattern was seen in relation to enzyme activity after heating.Conclusion
This study demonstrates that reduced enzyme activity is associated with the C677T variant of MTHFX in placental tissue. This is an important metabolic step in folic acid metabolism and pro‐
Use of the disutility ratio in prenatal screening for Down's syndrome
Authors: van der Meulen Jan H. P. , Mol Ben W. J. , Pajkrt Eva , van Lith Jan M. M. , Voorn Wim 
Published: August 2005

Objective
To assess the value of the triple test incorporating individual differences in parental evaluation of outcomes of pregnancy.Design
Decision analysis.Sample
Monte Carlo simulation of triple test results in 25,000 women with a normal pregnancy and 25,000 women with a pregnancy affected by Down's syndrome.Methods
A decision model was developed for women who were 16 weeks pregnant. Three strategies were evaluated: 1. no prenatal testing; 2. amniocentesis; and 3. the triple test followed by amniocentesis if the risk of a pregnancy with Down's syndrome, based on maternal age and the triple test results (post‐test risk), was above the woman's threshold risk for amniocentesis.Main outcome measures
The outcomes considered were: 1. birth of a child without Down's syndrome; 2. birth of a child with Down's syndrome; and 3. pregnancy loss, either spontaneously, or as a result of termination. The values of these pregnancy outcomes were expressed on a disutility scale in units of ‘lost pregnancy equivalents’. The birth of a normal child brings no disutility. The disutility of the birth of a child with Down's syndrome is consequently specified by the ratio of the expected parental distress after the birth of a child with Down's syndrome to the expected parental distress after the loss of the pregnancy (disutility ratio).Results
The value of the triple test depends strongly on maternal age as well as on the individual evaluation of the outcome of pregnancy. The triple test is of considerable value for all women > 38 years; its value for women between 27 and 38 years depends on the disutility ratio, and it is of little value for women c 27 years.Conclusion
The value of the triple test depends on the parental evaluation of outcome of pregnancy for a large group of pregnant women. The disutility ratio, as introduced in this study, might be an instrument to elicit these values for individual women in clinical practice.
Fetal ultrasound biometry: 2. Abdomen and femur length reference values
Authors: Kurmanavicius Juozas , Wright Eileen M. , Royston Patrick , Zimmermann Roland , Huch Renate , Huch Albert , Wisser Joseph 
Published: August 2005

Objective
To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.Design
A prospective, cross‐sectional study.Setting
Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich.Sample
The study data were obtained from 6557 pregnant women.Methods
Only the first ultrasound examination between 12 and 42 weeks of each fetus with certainly established gestational age was used for analysis. No exclusions were made on the grounds of small‐for‐date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter.Results
A total of 5807 mean abdominal diameters and abdominal circumferences were derived from fetal transverse and anterio‐posterior fetal abdominal diameter measurements. Fetal femur length was measured in 5860 instances. The charts, tables and regression formulae of the biometrical measurements are presented. A comparison of our charts with others showed no significant difference. Only Merz's1 centiles for abdominal biometry were lower and for femur length higher than ours. An application to calculate 2 scores was developed using Excel (Microsoft Corporation, USA); the macros are presented in detail in the Figure 6 footnote.Conclusions
We have presented centile charts, tables and formulae for fetal abdominal diameter and circumference and femur length derived from a large and minimally selected sample size in a carefully designed cross‐sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented to use in computer‐aided evaluation of fetal ultrasound biometry.
Colposcopy and treatment of cervical intra‐epithelial neoplasia: are national standards achievable?
Authors: Semple David , Saha Arabinda , Maresh Michael 
Published: August 2005

Objective
To assess whether consensus based national standards for colposcopy and treatment of cervical intra‐epithelial neoplasia are achievable in practice.Design
Identification of 100 consecutive cases of first assessment colposcopy from each gynaecological unit in the former North West region from 1 January 1994 and follow up of their outcome after one year.Setting
All 19 gynaecological colposcopy clinics in the former North West region.Sample
In one hospital data were available on only 39 women and therefore information was analysed on 1839 women.Main outcome measures
Waiting times for colposcopy, different modalities of treatment used for pre‐malignant conditions of the cervix and type of anaesthesia used for treatments. With regard to follow up, time of occurrence, whether or not colposcopy was performed and efficacy of treatment as judged by cervical cytology.Results
Waiting times for colposcopy varied in the individual hospitals studied, but overall 56% of patients were seen within eight weeks. Diathermy loop excision was the most popular treatment modality accounting for 44% of cases. At six months after treatment, 9.98% of patients had a smear of mild dyskaryosis or worse. Colposcopy, as well as cytology, was used at the first follow up visit in 43% of cases.Conclusion
At a local level individual hospitals can identify areas where improvements in the service they provide need to be made. The practicality of the current guidelines in today's health service needs questioning.
A controlled comparison of ovarian response to controlled stimulation in first generation Asian women compared with white Caucasians undergoing in vitro fertilisation
Authors: Lashen H. , Afnan M. , Sharif K. 
Published: August 2005

Objective
To compare ovarian response to controlled stimulation among Asian women from the Indian sub‐continent and white Caucasian women undergoing in vitro fertilisation (IVF).Design
Nested case‐control study.Setting
Assisted Conception Unit, Birmingham Women's Hospital.Sample
One hundred and eight first generation Asian patients (born in the Indian sub‐continent) and 216 white Caucasian controls, all of whom received IVF treatment in the period 1994 to 1997, were selected for the study. The two groups were matched for age to within one year, early follicular phase follicle stimulating hormone, indication for treatment, gonadotrophin dose and year of treatment. The outcome of treatment was not known when the controls were selected.Results
There was no statistically significant difference between the two groups in the duration of stimulation, egg number, number of embryos produced, fertilisation rate, clinical pregnancy rate, miscarriage rate, cycle cancellation rate and implantation rate.Conclusion
Under the same IVF protocol Asian women's response to controlled ovarian stimulation and IVF outcome are comparable to their white Caucasian peers.
Perioperative ultrasonography of lymph nodes in patients with gynaecological malignancy
Authors: Helin Hanna‐Leena , Penttinen Jorma , Kirkinen Pertti 
Published: August 2005

Objective
To examine the accuracy of perioperative ultrasonography in detecting pelvic and para‐aortic lymph nodes, and to compare the ultrasonographic findings with those observed in histology.Participants
Forty women with gynaecological malignancy were examined by ultrasonography during their operations before surgical exploration of the lymph nodes; 182 specimens were taken for histological analysis.Main outcome measures
Ultrasonographic findings were compared with histological diagnoses of lymph node biopsies.Results
Suspicious lymph nodes (diameter > 5 mm) were found in 31 lymph node regions. Seventeen histologically malignant lymph nodes were found. The sensitivity, specificity, and accuracy of finding metastatic lymph nodes by ultrasonography were 7 1 %, 88%, and 87%, respectively. The frequency of false negative ultrasonographic findings was 29%.Conclusions
Perioperative ultrasonographic examination can be of use in localising pelvic and para‐aortic lymph nodes, especially in laparoscopic operations, where tactile palpation of the retroperitoneal space is not possible. The negative predictive value of the method is high, but the relatively poor sensitivity limits its diagnostic value.
Effects of corticotrophin releasing hormone on contractile activity of myometrium from pregnant women
Authors: Simpkin James C. , Kermani Faiz , Palmer Anna M. , Campa Juan S. , Tribe Rachel M. , Linton Elizabeth A. , Poston Lucilla 
Published: August 2005

Objective
To determine whether corticotrophin releasing hormone plays a role in the regulation of tone in tern nonlabouring human myometrium.Setting
A teaching hospital research laboratory.Sample
Thirty‐seven women undergoing elective nonlabour caesarean section under regional anaesthesia.Methods
Human corticotrophin releasing hormone (1, 10, 100 nmol/L) was added to strips of term, nonlabouring myometrium mounted in an organ bath, and the effect on spontaneous, oxytocin (1 nmol/L) or prostaglandin F2α (100 nmol/L) stimulated contractions determined. Cyclic adenosine monophosphate (CAMP) content of the tissue was also determined by enzyme immunoassay.Results
Corticotrophin releasing hormone did not affect myometrial tension development in any of the experimental protocols. cAMP increased transiently after addition of corticotrophin releasing hormone (166.7 ± 12.7% at 1 minute) but this was not reflected by any change in tension.Conclusions
This study suggests that despite high maternal plasma concentrations of corticotrophin releasing hormone in pregnancy at term, this peptide is unlikely to play a direct role in the control of myometrial contractility in nonlabouring myometrium.
Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study
Authors: Howells R. E. J. , Dunn P. D. J. , Isasi T. , Chenoy R. , Calvert E. , Jones P. W. , Shroff J. Foden , Redman C. W. E. 
Published: August 2005

Objective
To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual by providing information.Design
Prospective randomised study.Setting
Colposcopy clinic of a large district general hospital.Sample
Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis.Methods
Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a Statenrait Anxiety Inventory (StAVTrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six‐month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet.Main outcome measures
Differences of anxiety and psychosexual scores between leaflet and control groups.Results
The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant.Conclusions
This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.
Fetal heart rate variability changes during brief repeated umbilical cord occlusion in near term fetal sheep
Authors: Westgate Jenny A. , Bennet Laura , Gunn Alistair J. 
Published: August 2005

Objective
To determine whether changes in fetal heart rate variation during repeated umbilical cord occlusions reflect evolving cardiovascular compromise in near term fetal sheep.Design
Fetal heart rate variation, fetal mean arterial pressure, electroencephalogram (EEG) and acid‐base status were measured during one minute umbilical cord occlusions, repeated either every five minutes (1 : 5 group) or every 2.5 minutes (1 : 2.5 group) for four hours or until mean arterial pressure fell below 20 mmHg for two successive occlusions.Sample
Fourteen chronically instrumented fetal sheep, mean gestation 126.3 (2.6) days.Results
Cord occlusion caused variable decelerations with initial sustained hypertension. In the 1:5 occlusion group mean arterial pressure remained elevated throughout, with little change in acid‐base status (pH = 7.34 (0.07), base deficit = 1.3 (3.9) after 4 hours) and no significant change in fetal heart rate variation. In contrast, in the 1:2.5 group from the third occlusion there was progressive hypotension during occlusions, severe progressive metabolic acidaemia (pH 6.92 (0.1), base deficit 17.0 mmol/L (4.7) after the last occlusion) and marked EEG suppression (P < 0.01). Fetal heart rate variation increased with the onset of occlusions (P < 0.05) and then progressively fell with continued occlusions. During the last 30 minutes of occlusions, fetal heart rate variation was severely suppressed in four, but increased in two fetuses, while all six fetuses developed overshoot‐instability of fetal heart rate and mean arterial pressure following each occlusion.Conclusions
Acute progressive asphyxia was typically associated with an immediate, transient increase in fetal heart rate variation. Subsequently variation became suppressed in only two‐thirds of fetuses during terminal acidaemia and hypotension. Fetal heart rate overshoot‐instability may be a useful marker of fetal decompensation following variable decelerations.
Oral contraceptive use and risk of endometriosis
Authors:   Italian Endometriosis Study Group
Published: August 2005

Objective
To analyse the association between use of oral contraception and risk of pelvic endometriosis.Design
We compared use of oral contraception in women with and without endometriosis.Participants
Eligible for the study were women with primary or secondary infertility (n= 393) or chronic pelvic pain (n= 424). requiring laparoscopy, consecutively observed between September 1995 and January 1996 in 15 obstetrics and gynaecology departments in Italy.Results
Out of the 817 women included in the study, 345 had a diagnosis of endometriosis; 164 (47.5%) women with endometriosis and 139 (29.4%) without the disease reported ever using oral contraception. In comparison with never users the estimated odds ratios (OR) of endometriosis were 1.8 (95% CI 1.0–3.3) in current users and 1.6 (95% CI 1.1–2.4) in exusers. No clear relation emerged between duration of oral contraceptive use and risk of endometriosis. In comparison with never users, the OR was 1.8 (95% CI 1.1–3.0) for women reporting their last use of oral contraception < 5 years before interview and 1.5 (95% CI 0.9–2.5) for those reporting their last use >5 years before interview.Conclusions
The study suggests that oral contraception is associated with an increased risk of endometriosis but this finding is based on a selected population and cannot generalised to all women with endometriosis.