bluuebunny/crossref_metadata_2025_split huggingface dataset:
2308 second trimester terminations using extra‐amniotic or intra‐amniotic prostaglandin E2: an analysis of efficacy and complications
Authors: HILL N. C. W. , MACKENZIE I. Z. 
Published: August 2005

SummaryA total of 2308 mid‐trimester terminations using PGE2 extra‐amniotically (1608) or intra‐amniotically (700) has been analysed for efficacy and immediate and early morbidity. The mean induction‐to‐abortion intervals were similar for the two routes. Overall, 67% of the patients were in hospital for 1 night. Morbidity rates were similar for the two administration routes and were no higher than those reported for second trimester terminations using dilatation and evacuation. Minor side‐effects of vomiting occurred in 1006 (44%) and diarrhoea in 320 (14%). Forty (1·7%) lost more than 500 ml of blood during termination and 13 (0·6%) were transfused. Major complications were extremely rare and genital tract trauma only occurred in 4 (0·17%) and proven pelvic infection in 2 (0·08%) patients. Thirty‐three (1·4%) were readmitted and required a surgical evacuation of the uterus. Since long‐term complications have been assessed for this method of termination and found to be infrequent, we see no reason to consider a change in methods for second trimester terminations.
Delivery in an obstetric birth chair: a randomized controlled trial
Authors: CROWLEY P. , ELBOURNE D. , ASHURST H. , GARCIA J. , MURPHY D. , DUIGNAN N. 
Published: August 2005

AbstractObjective— To determine whether nulliparae whose second stage of labour is conducted in an obstetric birth chair have a lower incidence of instrumental delivery than those using a conventional delivery bed.Design— Randomized controlled trial using sealed, opaque envelopes for allocation.Setting— Delivery ward in a busy teaching hospital.Patients— 1250 nulliparae with a singleton live fetus with cephalic presentation, without epidural anaesthesia, who had achieved full dilatation.Intervention— Intention to conduct second and third stages of labour in either the Birth‐EZ chair or the conventional delivery bed, as randomly allocated.Main outcome measures— Primary measure: vaginal operative delivery; principal secondary measures: duration of second stage, perineal trauma, blood loss, women's views, and neonatal status.Results— Delivery in the birth chair did not result in a reduction in operative delivery, overall. However, there was a reduction in vaginal operative delivery for fetal heart rate abnormality. There was no beneficial effect on perineal trauma or puerperal perineal pain. Post‐partum haemorrhage was more frequent in the birth chair group.Conclusions— Delivery in the birth chair does not offer any obvious advantage to women over delivery on a bed.
Audit of workload in gynaecology: analysis of time trends from linked statistics
Authors: FERGUSON J. A. , GOLDACRE M. J. , HENDERSON J. , GILLMER M. D. G. 
Published: August 2005

AbstractObjective— To report on trends in workload patterns in gynaecology using linked statistical data.Design— Retrospective analysis of linked abstracts of hospital inpatient and day‐case records for patients treated in the National Health Service in gynaecology.Setting— Six health districts in the south of England covered by the Oxford record linkage study.Subjects— Records for hospital admissions to gynaecology (excluding obstetric admissions) from 1975 to 1985.Measurement and main results— Inpatient episodes increased by 23.5% and day case episodes increased by 13.1%. More people treated contributed about 90% and increased readmissions contributed about 10% to the increase in workload. The workload was decreased by strike action in 1975 and 1981–2. Average length of stay decreased substantially and consistently over the 11 years. Emergency readmissions increased annually by an average of 2.7%. Admission rates in 11 groups of surgical procedures accounting for 85% of all gynaecological inpatients are reported, and increases occurred in 10 of the 11 groups. For example, average increases in annual admission rates were 1.0% for sterilization, 1.9% for legal abortion and 8.2% for biopsy of the cervix, the rate for dilatation and curettage decreased by 1.4%.Conclusions— The increase in admission rates in gynaecology was almost entirely due to increases in numbers of people treated. The rise would have been even greater if the increase in private patients had been considered. The increase may reflect increased expectations on the part of patients and their doctors, advances in technology and increased bed availability due to declining lengths of stay.
Immunocytochemical localization of neutrophil elastase in term placenta decidua and myometrium in pregnancy‐induced hypertension
Authors: BUTTERWORTH B. H. , GREER I. A. , LISTON W. A. , HADDAD N. G. , JOHNSTON T. A. 
Published: August 2005

AbstractObjective—The aim of the study was to determine whether there was evidence of elastase containing neutrophils at the materno‐fetal interface in women with pregnancy‐induced hypertension (PIH).Design—An observational prospective study.Setting—The Simpson Memorial Maternal Pavilion Edinburgh.Methods—Placentas were obtained at vaginal or abdominal delivery from 51 consecutive women, 23 had normal pregnancies (13 caesarean sections) and 28 had PIH (18 caesarean sections). An immunocytochemical technique was used to localize elastase containing neutrophils in the placenta, decidua and myometrium.Main outcome measures—The numbers of positively stained cells, estimated subjectively as minimal, moderate or heavy, in subchorionic plate, perivillous fibrin and decidua.Results—In both normal and PIH pregnancies neutrophils were absent from the myometrium. However, elastase containing neutrophils were located in areas of fibrin in the subchorionic plate and around the villi although there was no significant difference between the normal and PIH group. Neutrophils were also located in the fibrin of the decidua and in this case the number was significantly greater in the PIH group than in the normal group and correlated with plasma urate.Conclusion—The release of neutrophil elastase in the decidua could contribute to the vascular damage evident in PIH.
Cancer of the cervix in women under 40 years of age, a regional survey, 1975–1984
Authors: PEEL K. R. , KHOURY G. G. , JOSLIN C. A. F. , O'DONOVAN P. J. , MGAYA H. , KEATES G. , HEAD C. , THOROGOOD D. J. 
Published: August 2005

AbstractObjective— To review the method and results of treatment of carcinoma of the cervix in women <40 years old.Design— Retrospective review of all available case records.Setting— Yorkshire Regional Health Authority.Subjects— 428 women <40 years old treated for stage IB‐IV carcinoma of the cervix between 1975 and 1984 inclusive.Main outcome measures— Overall survival, by stage, effect of age, identifiable factors of prognostic significance, survival, grade 3 morbidity and pattern of recurrence in relation to treatment.Results— The 5‐year actuarial percentage survival by stage was 78–4 (IB), 54–4 (II), 18–4 (III) and 0 (IV). Identifiable factors of prognostic importance were stage, nodal metastases (P<0.001) and tumour grade (P<0.01).Conclusion— Primary surgical treatment for young women with early disease allows ovarian conservation and the avoidance of radiotherapy in 80% of them. Such treatment results in less local recurrence, particularly evident in patients with moderate or poorly differentiated tumours and a lower incidence of serious morbidity.
Pre‐eclampsia and offspring's blood pressure, cognitive ability and physical development at 17‐years‐of‐age
Authors: SEIDMAN DANIEL S. , LAOR ARIE , GALE RENA , STEVENSON DAVID K. , MASHIACH SHLOMO , DANON YEHUDA L. 
Published: August 2005

AbstractObjective— To investigate the influence of maternal pre‐eclampsia on the blood pressure, physique and intelligence of the offspring at the age of 17 years.Design— Data obtained at the age of 17 during assessment for drafting to the Israel Defence Forces and from the records of the mothers' pregnancies from the Jerusalem Perinatal Study.Subjects— Study subjects were 145 girls and 283 boys whose mothers had had pre‐eclampsia and controls were 12 701 girls and 20 416 boys whose mothers did not have pre‐eclampsia.Main outcome measures— Systolic and diastolic blood pressure, weight, height and intelligence scores at the age of 17 were related to birthweight and the occurrence of pre‐eclampsia during their mothers' pregnancies.Results— Systolic blood pressure was >140 mmHg in 6.9 and 11.0% of the study girls and boys, compared with 2.9 and 9.9% of the control girls and boys. The study boys but not the girls had a higher mean body mass index than the controls (P<0.001). There were no differences in the intelligence scores. Using multiple logistic regression to allow for the confounding effects of body mass index, weight and birthweight, the odds ratio for the risk of a systolic pressure >140 mmHg was 2.30 (95% CI 1.80–4.46) for the study girls but was not significantly increased for the study boys.Conclusion— Maternal pre‐eclampsia does not impair growth and cognitive performance in the children who reach late adolescence but may be associated with hypertension.
Evaluating the quality of the maternity services—a discussion paper
Authors: PATERSON C. M. , CHAPPLE J. C. , FRCOG R. W. BEARD , JOFFE MICHAEL , STEER P. J. , WRIGHT C. S. W. 
Published: August 2005

AbstractObjective— A review of the use of computer collected audit data in assessing the quality of maternity services.Setting— All maternity units managed by the North West Thames Regional Health Authority.Recommendations— A system of audit must supply information that is both credible and of interest to clinicians managers and consumers. The information should be adjusted for differences in populations to allow valid comparisons between units. It needs to be presented in an easily digested form. One way of implementing audit would be to establish a regional group representative of clinicians, patients and managers who would initially interpret the data and make recommendations. A local group of similar composition would be asked to comment on and respond to these with a plan for the following year. Changes would be monitored by analysis of the routinely collected data.Conclusions— Medical audit in the maternity services requires new concepts if it is to influence the quality of clinical care and the use of resources available to provide that care. The appropriate balance needs to be found between the perspectives of clinicians, patients and managers. A major challenge is the collection of valid data. This has largely been overcome by the St Mary's maternity information system. The next stage is to devise a system of audit that is epidemiologically sound and is acceptable to those who will be asked to implement the lessons that emerge. Only then will it be possible to determine whether clinical practice and the use of resources can be altered to the benefit of patients.
The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow‐up over four years
Authors: HILTON P. , MAYNE C. J. 
Published: August 2005

AbstractObjective— To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding.Design— Uncontrolled observational study.Setting— Regional university gynaecological urology unit.Subjects— A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem.Treatment— A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site.Main outcome measures— Urodynamic reassessment 3 months after surgery and clinical follow‐up for up to 4 years, using life table methods. The median follow‐up was 27 months.Results— At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P<0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P<0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P<0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged.Conclusions— This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre‐operatively.
Platelet reactivity and serum thromboxane B2 production in whole blood in gestational hypertension and pre‐eclampsia
Authors: LOUDEN K. A. , PIPKIN F. BROUGHTON , HEPTINSTALL S. , FOX S. C. , MITCHELL J. R. A. , SYMONDS E. M. 
Published: August 2005

AbstractObjective— To determine the nature and extent of changes in platelet reactivity in gestational hypertension and pre‐eclampsia (using whole blood techniques which may be more physiological than those previously employed).Design— Cross‐sectional observational study.Subjects— 8 normal primigravidae, 16 women with gestational hypertension and 12 women with pre‐eclampsia, studied at around 36 weeks gestation.Results— Platelet reactivity (aggregation and release reaction) induced by stimulation with adrenaline was decreased in the pre‐eclamptic group. Serum thromboxane B2 production was unchanged in both hypertensive groups compared with the control group.Conclusions— In the context of evidence of platelet activation in pre‐eclampsia, our findings are interpreted as reflecting platelet exhaustion.
Erythropoietin levels in amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy
Authors: CAMPBELL JAMES , WATHEN NEVILLE , LEWIS MARK , FINGEROVA HELENA , CHARD TIM 
Published: August 2005

ABSTRACTObjective
The aim was to measure erythropoietin levels in amniotic fluid and extraembryonic coelomic fluid from 7–12 weeks’ gestation.Subjects
Twenty healthy women with ultrasonographically normal first trimester pregnancies prior to surgical termination.Methods
Paired samples of amniotic fluid and extraembryonic coelomic fluid were collected by transvaginal ultrasound guided needling. Erythropoietin was measured in both pregnancy fluids using a radioimmunoassay.Results
There was a highly significant difference between erythropoietin levels in extraembryonic coelomic fluid (median level 15.45 mU/ml; range 6.8–32.1 mU/ml) and those in amniotic fluid (median 5.0 mU/ml; range <5.0–5.8 mU/ml) (P<0.0001; Mann‐Whitney U‐test). The levels of erythropoietin in maternal serum (median 15.4 mU/ml; range 5.6–29.4 mU/ml) were similar to those in the extraembryonic coelom (P= 0.81; Mann‐Whitney U‐test). No relation was demonstrated between erythropoietin levels in amniotic fluid or coelomic fluid and stage of gestation.Conclusion
High levels of erythropoietin in coelomic fluid suggests that the hormone is involved in the process of human extraembryonic erythropoiesis. The exact regulatory role remains unknown.
Home visits for pregnancy complications and management of antenatal care: an overview of three randomized controlled trials
Authors: BLONDEL BEATRICE , BREART GERARD 
Published: August 2005

ABSTRACTObjective
To examine whether a policy of home visits reduces the amount of antenatal care provided by hospital maternity units.Design
A meta‐analysis of three randomized controlled trials. Setting 9 maternity units in France.Subjects
1410 women with pregnancy complications.Intervention
1 or 2 home visits a week by a midwife.Main outcome measures
Admission rate and length of stay in hospital.Results
The home‐visiting system did not affect the hospital admission rate (typical odds ratio = 0.9; 95% CI = 0.7–1.2). In each trial, the length of hospital stay did not differ between the intervention and the control groups.Conclusions
The home‐visiting system did not greatly alter the practice of antenatal hospital admission in the maternity units studied. The results question the way the health services were used and suggest that a better integration of hospital and home services is needed to make a more rational use of health care resources.
Gammaglutamyltransferase, aspartate and alanine aminotransferases and their ratio, mean cell volume and urinary dolichol in pregnant alcohol abusers
Authors: HALMESMÄKI ERJA , ROINE RISTO , SALASPURO MIKKO 
Published: August 2005

ABSTRACTObjective
To study the activities of serum gammaglutamyltransferase (GGT), aspartate and alanine aminotransferases (AST, ALT), and their ratio (AST/ALT), mean erythrocyte cell volume (MCV) and urinary dolichol output in alcohol‐abusing pregnant women, and compare the results to those of abstinent pregnant women.Design Prospective descriptive study.Setting Special outpatient clinic for pregnant problem‐drinkers in the department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland.Subjects 25 pregnant women referred to the special clinic at between 12 and 24 weeks gestation, they consumed at least 150 g of ethanol weekly, and a control group of 20 abstinent pregnant women matched for age, parity and smoking habits.Interventions The women were encouraged to visit the clinic at 2–4 week intervals. At each visit blood and urine samples were obtained, and the women were interviewed on their alcohol consumption during the previous weeks and encouraged to abstain in the future.Mean outcome measures Neonatal condition, fetal alcohol effects (FAE) in the newborn. Serum activities of GGT, AST and ALT, the AST/ALT ratio, the MCV, and the urinary concentration of dolichol in alcohol‐abusing women with either healthy or FAE infants, compared with those of abstinent women with healthy infants.Results
Of the 25 alcohol‐abusing women 13 gave birth to infants with FAE and 12 to healthy infants. All the women in the control group gave birth to healthy infants. GGT, AST and ALT activities were increased in all alcohol‐abusing women, regardless whether the infant had FAE or not. GGT was the best of these markers, GGT activities above the 95th normal centile were found in 33% of the samples from all alcohol‐abusing women. The AST/ALT ratio, MCV and urinary dolichol concentration were poor indicators of abusive drinking.Conclusions
Maternal alcohol abuse is difficult to assess by laboratory tests. Of the commonly used and easily available tests, GGT proved to be the best in our study.
A randomized placebo‐controlled study of the effect of low dose aspirin on platelet reactivity and serum thromboxane B2 production in non‐pregnant women, in normal pregnancy, and in gestational hypertension
Authors: LOUDEN K. A. , PIPKIN FIONA BROUGHTON , SYMONDS E. M. , TUOHY P. , O'CALLAGHAN C. , HEPTINSTALL S. , FOX SUSAN , MITCHELL J. R. A. 
Published: August 2005

ABSTRACTObjective
To investigate the effect of 60 mg aspirin daily on platelet reactivity and prostaglandin production in various groups of patients. Similar regimens, which are thought to act through inhibition of platelet thromboxane production, are currently undergoing clinical assessment for the prevention of pre‐eclampsia and intrauterine growth retardation.Design
A prospective randomized placebo controlled study.Setting
University Hospital, Nottingham.Subjects
12 non‐pregnant female volunteers, 18 normal primigravidae before 16 weeks gestation and 16 pregnant women admitted with gestational hypertension (GH) at a mean gestation of 38 weeks.Interventions
In the non‐pregnant women blood samples were taken before and after a 10‐day course of 60 mg aspirin daily. The primigravidae had blood samples taken at 16 weeks and then they were randomized to receive either 60 mg aspirin daily or a matched placebo. Further blood samples were obtained at 28, 32 and 36 weeks.Main outcome measures
Changes in platelet reactivity and release reaction, and serum thromboxane production, were estimated in whole blood.Results
60 mg aspirin daily significantly inhibited cyclo‐oxygenase dependent platelet aggregation, release reaction and serum thromboxane production in non‐pregnant and pregnant women, and in women with GH (P<0.01). When adrenaline was used as the aggregating agent, the cyclo‐oxygenase pathway was recruited in the increased reactivity seen in the third trimester of normal pregnancy, and was sensitive to inhibition by low dose aspirin.Conclusion
Low dose aspirin would appear to be an appropriate agent for the inhibition of platelet reactivity associated with hypertensive pregnancy.
The characteristics of the second stage of labour in 25 069 singleton deliveries in the North West Thames Health Region, 1988
Authors: PATERSON CATHERINE M. , SAUNDERS NIGEL ST. G. , WADSWORTH JANE 
Published: August 2005

ABSTRACTObjective
To define the contemporary characteristics of the second stage of labour in one Health Region.Design
Retrospective analysis of a regional obstetric database.Setting
Seventeen maternity units in the North West Thames Health Region.Subjects
Selected from 36 727 consecutive singleton deliveries in 1988. The analysis was confined to the 25 069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour.Main outcome measures
Second stage duration, obstetric intervention and maternal and fetal morbidity.Results
The duration of the second stage and the use of operative intervention were strongly negatively associated with parity and positively associated with the use of epidural analgesia. Maternal age, fetal birthweight and maternal height were also independently associated with the duration of the second stage. There were small but significant differences in the characteristics of women using epidural analgesia and those using alternative methods of pain relief. Parous women using epidural analgesia behaved in a similar manner to nulliparae without epidurals. Despite the longer second stages observed in women using epidural analgesia there appeared to be no significant increase in fetal morbidity. Within the region the epidural rate in individual units positively correlated with the overall forceps rate, the rate of caesarean section in the second stage of labour and the duration of the second stage.Conclusions
In our study the duration of the second stage in women not using epidural analgesia was similar to previous findings, but in those using epidural analgesia, the duration of the second stage was longer than has been reported previously, possibly reflecting a more conservative approach to operative intervention. Survival analysis indicates that in multiparae not using epidural analgesia the likelihood of spontaneous vaginal delivery after 1 h in the second stage was low, but in those multiparae using epidural analgesia and in all nulliparae there was no clear cut‐off point for expectation of spontaneous delivery in the near future; they continue to give birth at a steady rate over several hours. While maternal and fetal conditions are satisfactory, intervention should be based on the rate of progress rather than the elapsed time since full cervical dilatation.