bluuebunny/crossref_metadata_2025_split huggingface dataset:
Day‐to‐day glucose variability during pregnancy in women with Type 1 diabetes mellitus: glucose profiles measured with the Continuous Glucose Monitoring System
Authors: Kerssen Anneloes , de Valk Harold W. , Visser Gerard H.A. 
Published: August 2004

Objective  To observe day‐to‐day variability in glucose levels in pregnant women with Type 1 diabetes using the Continuous Glucose Monitoring System (CGMS) and to assess the usefulness of continuous glucose measurements for adjustment of insulin treatment.Design  A prospective observational study.Setting  The obstetrical outpatient clinic of the University Medical Centre Utrecht.Population  Pregnant women with Type 1 diabetes mellitus.Methods  Thirty‐one pregnant women with Type 1 diabetes used the CGMS for two consecutive days. Patients were classified in two groups (high vs low day‐to‐day variability) based on visual inspection of the glucose excursions. The relationship between day‐to‐day variability and the variables HbA1c, maternal age and body mass index (BMI), duration of diabetes, number of self‐monitored blood glucose levels, number of insulin injections, gestational age, nutrition, physical activity, White classification, living with children and method of insulin administration was determined. The two days of the first 20 CGMS measurements were separated and four physicians were asked to give recommendations on treatment adjustment for each separate day.Main outcome measures  Mean absolute difference (MAD) was calculated for each patient as measure of day‐to‐day variability.Results  Seventeen patients (55%) were classified as having low (MAD 0.92–2.33 mmol/L) and 14 (45%) as having high day‐to‐day variability (MAD 2.41–6.12 mmol/L). Of the variables measured, only the relation between MAD and HbA1c was significant (r= 0.58, P= 0.001). The difference in recommendation on treatment adjustment between the days of the CGMS measurement ranged from 29% to 48%. This percentage was significantly higher in the high day‐to‐day variability group (48 vs 33%, P= 0.01).Conclusion  Day‐to‐day glucose variability is high and the treatment of pregnant women with Type 1 diabetes is a problem. Fine‐tuning of insulin regimens based on two‐day measurements with the CGMS is not advisable.
Low concentrations of maternal thyroxin during early gestation: a risk factor of breech presentation?
Authors: Pop Victor J. , Brouwers Evelien P. , Wijnen Hennie , Oei Guid , Essed Gerard G. , Vader Huib L. 
Published: August 2004

Objective  To evaluate the relation between breech position at term (>37 weeks of gestation) and low maternal fT4 levels during gestation in women not suffering from overt thyroid dysfunction.Design  A prospective cohort study of pregnant women.Setting  Community‐based study.Population/Sample  At random selected pregnant women of the general population.Methods  At antenatal booking, based on thyroid function assessed at 12 weeks of gestation in a large cohort of pregnant women, two groups of participants were defined: women with low fT4 levels—below the 10th centile (n= 135) and women with fT4—between the 50th and 90th centiles at 12 weeks of gestation (n= 135). Women with clinical thyroid dysfunction (fT4 and TSH outside reference range) at 12 weeks of gestation were excluded. Maternal thyroid function (fT4 and TSH) was subsequently assessed at 24 and 32 weeks of gestation. Analysis refers to 204 women who met the inclusion and exclusion criteria and in whom all thyroid parameters were assessed.Main outcome measures  Fetal presentation (cephalic–breech) at delivery in women with term gestation (>37 weeks of gestation) in relation to maternal thyroid function at 12, 24 and 34 weeks of gestation.Results  Breech presentation at term delivery was independently related to fT4 levels <10th centile at 12 weeks of gestation (OR = 4.7, 95% CI 1.1–19 [but not to an fT4 level below the 10th centile at 24 and 32 weeks of gestation]) as well as primiparity (OR = 4.7, 95% CI 1.3–15).Conclusions  Women with hypothyroxinaemia (fT4 level at the lowest 10th centile) during early gestation but without overt thyroid function are at risk for fetal breech presentation at term (>37 weeks of gestation).
Improving the quality of cervical screening
Authors: George Samuel , Abrahams Yusuf , Karim Shakir Z. , Kothari Anjali 
Published: August 2004

Objective  To compare the adequacy of cervical cytology sampling by a newly designed cervical cell sampler (the implement) with a commonly used, extended tip cervical scraper, namely the Jordan's spatula, by assessing the quality of cervical smears obtained.Design  Prospective randomised controlled trial, with the approval of the local Ethics Committee after informing the Medical Devices Agency in the UK.Setting  Colposcopy Clinic in a District General NHS Trust Hospital in London.Population  Women attending the Colposcopy Clinic and having a good command of the English language (to avoid any misinterpretation of the information and enabling them to give informed consent) were invited to take part. Two hundred and twenty patients were recruited.Methods  The women were randomised into two groups, each of them having two smears at the same time, half of them having their first smear with the Jordan's spatula and the other half having the first smear with the new implement.Main outcome measure  Good quality smears, assessed by evidence of effective sampling of the transformation zone, including immature metaplastic cells and also endocervical cells.Results  Fifty‐four percent of smears taken by the new implement showed good quality smears, compared with 37% taken by Jordan's spatula, a statistically significant result with P value <0.001.Conclusion  A larger number of good quality smears, judged by evidence of sampling of transformation zone and presence of endocervical cells, were obtained with the new implement. The difference was statistically significant. This would enhance the ability to detect dyskaryosis and increase adequate smear rates, reducing unnecessary recall of patients for repeat smears.
A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence
Authors: Ankardal Maud , Ekerydh Anne , Crafoord Kristina , Milsom Ian , Stjerndahl Jan‐Henrik , Engh Marie Ellström 
Published: August 2004

Objective  To compare open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence.Design  Multicentre, prospective randomised trial.Setting  Departments of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Göteborg, Borås County Hospital and Örebro University Hospital, Sweden.Population  Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component were included, and were randomised to either open colposuspension (n= 120) or laparoscopic colposuspension (n= 120).Methods  Women were randomised to open colposuspension with sutures or laparoscopic colposuspension with polypropylene mesh and staples. Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared.Main outcome measures  Objective and subjective cure rates from 48‐hour frequency–volume chart, a 48‐hour pad test and a subjective assessment of the woman's incontinence and quality of life performed one year after surgery.Results  Objective and subjective cure rates were higher after open compared with laparoscopic colposuspension (P < 0.001). Quality of life was improved following surgery in both groups (P < 0.0001) and the improvement was significantly greater in the open colposuspension group (P < 0.05) with regard to physical activity. Performing an open colposuspension was less time consuming (P < 0.0001), resulted in more blood loss (P < 0.0001), longer catheterisation time (P < 0.01), greater risk of urinary retention (P < 0.01) and a longer hospital stay (P < 0.0001) compared with performing a laparoscopic colposuspension. The rate of serious complications was low in both groups.Conclusion  Open colposuspension had a higher objective and subjective cure rate one year after surgery but with a greater blood loss, greater risk of urinary retention and a longer hospital stay than laparoscopic colposuspension.
A prospective randomised comparison of sublingual and vaginal misoprostol in second trimester termination of pregnancy
Authors: Tang Oi Shan , Lau Winnie Nga Ting , Chan Carina Chi Wai , Ho Pak Chung 
Published: August 2004

Objective  To compare the efficacy, side effects and acceptability of sublingual and vaginal misoprostol for second trimester medical abortion.Design  Prospective randomised controlled trial.Setting  Tertiary referral unit and a teaching hospital.Population  Two hundred and twenty‐four women at 12 to 20 weeks of gestation.Methods  The women were randomised to receive either sublingual or vaginal misoprostol 400 μg every 3 hours for a maximum of five doses. The course of misoprostol was repeated if the woman did not abort within 24 hours.Main outcome measures  The success rate at 48 hours, induction‐to‐abortion interval and the side effects.Results  There was no significant difference in the success rate at 48 hours (sublingual: 91%; vaginal: 95%). However, the success rate at 24 hours was significantly higher in the vaginal group (85%) compared with the sublingual group (64%). There was no difference in the median induction‐to‐abortion interval (sublingual: 13.8 hours; vaginal: 12.0 hours). Significantly more women in the sublingual group preferred the route to which they were assigned when compared with the vaginal group. The incidence of fever was also less in the sublingual group.Conclusion  The use of vaginal misoprostol for second trimester medical abortion resulted in a higher success rate than sublingual misoprostol at 24 hours but the abortion rate was similar at 48 hours. Vaginal misoprostol should be the regimen of choice but sublingual misoprostol is also an effective alternative.
The role of matrix metalloproteinases in vascular function: implications for normal pregnancy and pre‐eclampsia
Authors: Merchant Shaila J. , Davidge Sandra T. 
Published: August 2004

Objectives  (1) To investigate the effects of plasma from non‐pregnant, normal pregnant and pre‐eclamptic women on myogenic tone and endothelium‐dependent relaxation; (2) To investigate the role of matrix metalloproteinases (MMPs) in these parameters of vascular function.Design  Analysis of the effects of plasma from non‐pregnant, normal pregnant and pre‐eclamptic women on myogenic tone and endothelium‐dependent relaxation, and the effects of MMP inhibition on these parameters.Setting  University of Alberta, Edmonton, Alberta, Canada.Samples  Pooled plasma from non‐pregnant (n= 9), normal pregnant (n= 6) and pre‐eclamptic women (n= 12).Methods  Mesenteric arteries from virgin female C57BL/6J mice were exposed to pooled plasma from non‐pregnant, normal pregnant and pre‐eclamptic women in the absence and presence of GM6001 (5 μM; MMP inhibitor), and arterial function was assessed.Main outcome measures  Myogenic tone and endothelium‐dependent relaxation.Results  Plasma of women with pre‐eclampsia, and interestingly, plasma of non‐pregnant women, significantly enhanced myogenic tone at pressures ≥70 mmHg (P < 0.001) and blunted the maximum relaxation to methacholine (P < 0.001; P < 0.005) in isolated arteries. GM6001 altered response only in vessels exposed to the plasma of women with pre‐eclampsia; however, contrary to our hypothesis, this further enhanced myogenic tone and further abrogated relaxation.Conclusions  The strikingly similar vascular function profiles of vessels incubated in the plasma of non‐pregnant and pre‐eclamptic women suggest that pre‐eclampsia may be due, in part, to the lack of a necessary adaptation to pregnancy. Despite these similarities, however, there are differential effects of MMP inhibition, suggesting that MMPs play a greater role in the vasculature of women with pre‐eclampsia compared with non‐pregnant and normal pregnant women.
Early‐onset neonatal group B streptococcal infection in London: 1990–1999
Authors:   on behalf of the Health Protection Agency Group B Streptococcus Working Group, Mifsud Albert J. , Efstratiou Androulla , Charlett André , McCartney A. Christine 
Published: August 2004

Objective  To identify the incidence of early‐onset group B streptococcal infection and to describe the antecedent maternal risk factors, in order to provide data to inform the design of interventional strategies that could be introduced in the UK to reduce the burden of this infection.Design  A retrospective study with review of case notes of mothers and babies.Setting  Seven maternity units in London during 1990–1999.Population  All cases of proven early‐onset neonatal group B streptococcal infection.Methods  Identification of presence of risk factors that could be used to select women for the offer of intrapartum antibiotic prophylaxis.Main outcome measures Incidence and case‐fatality rate of invasive early‐onset group B infection.Results  One hundred and forty cases were identified among a birth cohort of 198,388 live births, an incidence of 0.71 per 1000 live births. Twenty‐two babies died, a case‐fatality rate of 15.6% or 1.1 per 100,000 live births. Women of black ethnic origin, and those who had had a previously affected infant, multiple pregnancy, preterm delivery, prolonged rupture of membranes or intrapartum fever all had a significantly increased risk of delivering an infected infant.Conclusions  These data suggest that the incidence of early‐onset group B streptococcal infection in these London centres is sufficiently high to warrant administration of intrapartum antibiotics to at‐risk women.
The economics of routine antenatal anti‐D prophylaxis for pregnant women who are rhesus negative
Authors: Chilcott Jim , Tappenden Paul , Lloyd Jones Myfanwy , Wight Jeremy , Forman Katie , Wray Julie , Beverley Catherine 
Published: August 2004

Objective  To investigate the economics of routine antenatal anti‐D prophylaxis in the prevention of haemolytic disease of the newborn, in support of the NICE appraisals process.Design  Cost effectiveness analysis.Setting  UK NHS.Population/Sample  Pregnant women who are RhD‐negative.Methods  A model was constructed to estimate the incremental cost effectiveness and cost utility of: (1) offering routine antenatal anti‐D prophylaxis to all pregnant women who are RhD‐negative; (2) offering routine antenatal anti‐D prophylaxis to RhD‐negative primigravidae, compared with conventional management alone. Effectiveness estimates were derived from a meta‐analysis of two UK community‐based studies. Costs were derived from published sources and NHS product lists. Threshold analysis was conducted to reflect the social value of routine antenatal anti‐D prophylaxis through incorporating valuations of parental grief and fetal/neonatal loss.Main outcome measures  Cost per life year gained and cost per quality adjusted life year (QALY) gained.Results  The cost per life year gained is in the range £5,000–£15,000. The inclusion of long term neurodevelopmental problems results in a cost utility ranging between £11,000 and £52,000 per QALY gained. Threshold analysis suggests that if fetal loss, parental grief and subsequent high intervention pregnancy are valued at greater than 9 QALYs, the comprehensive policy would be more attractive than the primigravidae policy, assuming a maximum acceptable threshold of £30,000 per QALY.Conclusion  Routine antenatal anti‐D prophylaxis provides a cost effective intervention for preventing haemolytic disease of the newborn in the pregnancies of women who are RhD‐negative.
Randomised treatment trial of bacterial vaginosis to prevent post‐abortion complication
Authors: Miller Leslie , Thomas Katherine , Hughes James P. , Holmes King K. , Stout Suzannah , Eschenbach David A. 
Published: August 2004

Objective  To evaluate the efficacy of metronidazole to reduce post‐abortion complications among women with bacterial vaginosis.Design  A randomised, double‐blind placebo‐controlled trial.Setting  An American outpatient abortion facility between April 1999 and June 2000.Sample  Women presenting for surgical abortion were screened for bacterial vaginosis using a pH and amines card test.Methods  Women positive for elevated pH and amines on a self‐collected vaginal discharge sample were randomised to 1000 mg oral metronidazole before abortion followed by 500 mg twice daily or placebo. All randomised women were also dispensed 100 mg doxycycline to take twice daily for seven days.Main outcome measures  Data were collected by phone, daily diary or visit and scored from 0 to 7 for post‐abortion complications. Intention‐to‐treat analyses were completed prior to unblinding.Results  Of 1764 women screened by card test, 638 (36%) were positive. Of these, 393 were randomised. Follow up data were available for 253 (64%) of these women. A complication score of 3 or more occurred in 21% of women assigned to metronidazole, compared with 19% in those assigned placebo (RR 1.1, 95% CI 0.7–1.9). Among 153 women with Gram stain confirmation for bacterial vaginosis, there was a similar lack of benefit with treatment (RR 1.6, 95% CI 0.9–3.0). No individual symptom or sign was statistically different between groups even for second trimester procedures.Conclusion  Among women undergoing abortion and diagnosed with bacterial vaginosis, oral metronidazole, in conjunction with doxycycline, did not reduce post‐abortion complications.
Video monitoring of smear‐taking at colposcopy: relationship to cytology
Authors: Al‐Awadhi Rana M. , Mansell Elizabeth , Chong Swee , Chow Carl , Singer Albert , Coleman Dulcie V. 
Published: August 2004

Objective  To investigate the reasons why cervical smears occasionally fail to reflect the underlying pathology in the cervix even when the smear is taken at colposcopy.Design  A randomised study of three different smear‐taking devices.Setting  A colposcopy clinic.Population  Women attending the colposcopy clinic.Methods  A smear was taken from 172 nulliparous and 100 multiparous women at colposcopy and the procedure was monitored on a video‐imaging system. The cytological findings were compared with the biopsy report in 147 nulliparous and 85 multiparous women.Main outcome measures  Accuracy of cytology and the effect of a range of variables on the accuracy of cytology.Results  Sampling of the transformation zone was incomplete in 15% of nulliparous women and 8% of multiparous women. Univariate analysis of a range of variables including parity, type of sampling devices, completeness of sampling of the transformation zone, size of the transformation zone, size of the lesion (aceto‐white area) and location of the squamo‐columnar junction showed that the accuracy of cytology was influenced by all these factors except for parity and smear‐taking devices. Multivariate analysis showed that the location of the squamo‐columnar junction, the size of the transformation zone area, the size of the aceto‐white area and the ratio of the aceto‐white area to the area of the transformation zone influenced the accuracy of cytology.Conclusions  Women with large transformation zone areas (>30.03 mm2) and/or small aceto‐white lesions (<7.01 mm2) are more likely to have an inaccurate cytology reports than women with small transformation zone and women with larger aceto‐white areas. A ratio of the aceto‐white area to the area of the transformation zone of 0.22 or less increases the risk of disagreement between the cytological and histological findings.
A prospective study of pregravid oral contraceptive use in relation to fetal growth
Authors: Mucci Lorelei A. , Lagiou Pagona , Hsieh Chung‐Cheng , Tamimi Rulla , Hellerstein Susan , Vatten Lars , Adami Hans‐Olov , Cnattingius Sven , Trichopoulos Dimitrios 
Published: August 2004

Objective  Because oral contraceptives are so widely used, any health consequences may have substantial public health implications. Whether pregravid oral contraceptives could affect subsequent pregnancies has not been adequately studied. The study objectives were to examine whether pregravid oral contraceptive use affects fetal growth and pregnancy hormone levels.Design  A prospective study of pregnant women followed through pregnancy.Setting  A major teaching hospital in Boston, USA.Population  Two hundred and sixty Caucasian pregnant women, with a mean age of 31, and a parity of no more than two. Seventy‐nine percent of the women were pregravid oral contraceptive users.Methods  Exposure and covariate data were collected through structured questionnaires. Blood was drawn for hormonal analysis during the 16th and 27th gestational week. Information on pregravid oral contraceptive use included duration and recency of use, and oral contraceptive formulation. Multivariate regression models were used to examine the effect of pregravid oral contraceptive use on birth outcomes and the studied pregnancy hormones.Main outcome measures  Birthweight, placental weight, gestational age, pregnancy hormone levels of oestriol and progesterone at 16th and 27th gestational week.Results  Adjusting for confounders, pregravid oral contraceptive use increased birthweight (mean difference =+207.3 g, 95% CI =+77.6 to +337.1) and placental weight (mean difference =+64.9 g, 95% CI =+13.0 to +116.9) compared with never use. Women with prior oral contraceptive use had higher levels of serum progesterone (P= 0.002) and oestriol (P= 0.12) at the 27th gestational week measurement. The effect on birthweight, placental weight and hormones was stronger among those using oral contraceptives in the previous year and those using a high progestin/high oestrogen potency preparation.Conclusions  Pregravid oral contraceptive use is positively associated with fetal growth, and this effect may be mediated through oestriol and progesterone.