bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histopathological findings in women with postmenopausal bleeding
Authors: Gredmark Thomas , Kvint Sonja , Havel Guillaume , Mattsson Lars‐Åke 
Published: August 2005

ABSTRACTObjective To investigate endometrial histopathology in a geographically defined population of women presenting with postmenopausal bleeding.Design Prospective study with collection of data during an 18–month period.Setting The health care county of Skaraborg, Sweden.Subjects Dilatation and curettage using general anaesthesia was performed on 457 postmenopausal women suffering from uterine bleeding. Women using hormone replacement therapy for climacteric complaints were not included in the investigation.Main outcome measures The frequency of bleeding was correlated to endometrial histopathology, and in relevant cases to pathological conditions in cervix and ovaries in a defined population of postmenopausal women.Results The incidence of postmenopausal bleeding decreased with increasing age while the probability of cancer as the underlying cause increased. The peak incidence of endometrial carcinoma was found in women between 65 and 69 years of age. Endometrial histopathology showed: atrophy (50%); proliferation (4%); secretion (1 %); polyps (9%); different degrees of hyperplasia (10 %); adenocarcinoma (8 %); not representative (14 %); other disorders (3 %). In six women a squamous carcinoma of the cervix was found, and eight proved to have ovarian tumours.Conclusions The histopathological finding of endometrial adenomatous hyperplasia or cancer in about 15% of the postmenopausal women with bleeding justifies a thorough examination. The probability of cancer as the underlying cause increased with age. The endometrium was atrophic in 50%. Eight women had ovarian tumours. These findings may imply that transvaginal ultrasound examination should be included in the evaluation of postmenopausal bleeding as occasionally endometrial biopsies of atrophic endometrium could be avoided and ovarian pathology detected.
Does early growth delay occur in diabetic pregnancy?
Authors: Steel Judith M. , Wu Patricia S. , Johnstone Frank D. , Muir Berenice B. , Sweeting Vicky M. , Hillier Stephen G. 
Published: August 2005

Objective To identify the date of ovulation in pregnant women with Type 1 diabetes in order to assess the validity of the concept of early growth delay.Design Identification of ovulation by measurement of urinary luteinising hormone and assessment of fetal growth using ultrasound scan.Setting Diabetic pre‐pregnancy and antenatal clinic in a teaching hospital.Subjects Twenty women with Type 1 diabetes who had attended a pre‐pregnancy clinic.Measures Urinary LH, by laboratory and kit methods, during conception cycles. Human chorionic gonadotrophin measured in early pregnancy. Early ultrasound scans by a single observer blind to menstrual and ovulation dates.Outcome Gestation calculated from ovulation date and gestation estimated from menstrual dates, compared with gestation at age indicated by early ultrasound scan.Results When the date of ovulation was identified in 20 women with Type 1 diabetes there was no evidence of growth delay in any pregnancy. When gestation was estimated from menstrual dates there was apparent early growth delay in six pregnancies.Conclusion This study, together with others discussed, indicates that early growth delay is probably an artefact of incorrectly estimated ovulation date.
A dose‐ranging study of the use of cyclical dydrogesterone with continuous 17β oestradiol
Authors: Burch D. J. , Spowart K. J. M. , Jesinger D. K. , Randall S. , Smith S. K. 
Published: August 2005

ABSTRACTObjective To establish the lowest dose of cyclical dydrogesterone that protects against endometrial hyperplasia induced by continuous 2 mg 17β oestradiol, and to study the dose effect on vaginal bleeding and side effects.Design Double‐blind, prospectively randomised dose‐ranging study.Setting Menopause clinics in the UK and The Netherlands.Subjects Three hundred and seventy‐one postmenopausal women with intact uteri, aged 40 to 60.Interventions Administration of six 28‐day treatment cycles of continuous daily micronised 178 oestradiol with a randomly allocated dose of 5 to 20 mg of dydrogesterone added for the last 14 days of each.Main outcome measures Histological assessment of adequate progestational endometrial response, bleeding patterns and adverse effects.Results The study was completed by 320 subjects (86 %). Endometrial transformation occurred in over 94 % of those talung 5 mg of dydrogesterone, and in over 97 % of those on hgher doses, without significant differences between the 10, 15 and 20 mg groups. Acceptable bleeding patterns were found at all doses, with the incidence of withdrawal bleeding rising with increasing dose. The day of onset of bleeding was predictable from cycle to cycle, and occurred later in the 20 mg group than in the others. The incidence of noncyclic bleeding was about 6 % at all doses. Withdrawal occurred in 3‐3% due to unacceptable bleeding and in 5‐4% due to side effects. There was no relation with dose.Conclusions A dydrogesterone‐17p oestradiol combination hormone replacement therapy confers endometrial protection with an acceptable bleeding pattern and few side effects. At least 10 mg of dydrogesterone for 14 days is required for acceptable endometrial protection.
Measuring sexual functioning in premenopausal women
Authors: Garratt Andrew M. , Torgerson David J. , Wyness Jjulie , Hall Marion H. , Reid David M. 
Published: August 2005

ABSTRACTObjective To assess the validity and reliability of a measure of sexual function for premenopausal women.Design A self‐administered sexual function questionnaire, derived from the Sabbatsberg Sexual Self‐Rating Scale, and other health measures were given to women who were randomly sampled from the community health index.Subjects One hundred and forty‐eight premenopausal women aged between 45 and 49 years.Main outcome measures The content validity, internal consistency and construct validity of the revised sexual rating scale.Results One hundred and thirty‐seven women (92 %) responded to the main questionnaire and 89 (60%) completed the sexual rating scale, which possessed a high level of internal consistency; scores on the sexual ratings scale had small to moderate correlations with the measures of health, two of which (depression and role limitations attributable to emotional problems) were sufficient to explain 25 % of the variation in the sexual functioning scores.Conclusion Questions derived from the Sabbatsberg sexual self‐rating scale have been used to construct a simple, acceptable, valid and reliable measure of sexual functioning for women in the 45 to 49 years of age group. Such a measure could be widely used as an adjunct to clinical and more general measures of health in order to assess the impact of interventions on sexual functioning within clinical trials.
The effect of cryopreservation in prevention of ovarian hyperstimulation syndrome
Authors: Thtinen Aila , Husa Lhsa‐Mari , Tulppala Maija , Simberg Niklas , Seppälä Markku 
Published: August 2005

ABSTRACTObjective To evaluate the effect of elective cryopreservation of all embryos in the prevention of severe ovarian hyperstimulation syndrome in women at increased risk, following superovula‐tion for in vitro fertilisation.Design Three hundred and ninety women undergoing superovulation for in vitro fertilisation between September 1991 and December 1992.Setting University Infertility Clinic, Helsinki, Finland.Interventions Twenty‐three women were considered to have an increased risk of developing ovarian hyperstimulation syndrome. They were characterised by more than 20 retrieved oocytes and/or by serum oestradiol levels exceeding 10000 pmol/l on the day of administration of human chorionic gonadotrophin. Instead of cancelling the cycle the oocytes were harvested and fertilised, and all good quality embryos were cryopreserved. The embryos were thawed and replaced during subsequent natural cycles.Main outcome measures Occurrence of ovarian hyperstimulation syndrome and pregnancy rate.Results One out of the 23 patients at increased risk developed a moderate degree ovarian hyperstimulation syndrome, while the others had only mild symptoms. Two of the remaining 367 women with no risk developed ovarian hyperstimulation syndrome, both during early pregnancy. Among the 23 patients at increased risk there have been 15 clinical pregnancies after transfer of two to three frozen‐thawed embryos in natural cycles, with a 32.6 % pregnancy rate.Conclusions Withholding embryo replacement and elective cryopreservation of the embryos is effective in preventing severe ovarian hyperstimulation syndrome. After subsequent replacement in natural cycles the implantation rate per embryo is good (22.7%).
Updating the clinical experience in endometriosis – the European perspective
Authors: Bromham D. R. , Booker M. W. , Rose G. L. , Wardle P. G. , Newton J. R. 
Published: August 2005

ABSTRACTIn a large, double‐blind, multicentre study, 269 patients with confirmed endometriosis were randomly allocated to receive either danazol (200 mg twice daily; n= 137) or gestrinone (2.5 mg twice weekly; n= 132) for 6 months. The two groups were comparable in terms of the staging of endometriosis by the American Fertility Society (1979) score. After the sixth month of treatment, repeat laparoscopy was performed. Clinical assessment, haematological and biochemical investigations were carried out during the 6 months of treatment and for a further 12 months' follow‐up and are compared between the two groups. A total of 15 patients from the gestrinone group, including four patients with hirsutism, and 17 patients from the danazol group, including six patients with headache, withdrew because of adverse symptoms. An additional 22 patients, including 10 from the gestrinone group and 12 from the danazol group withdrew because of lack of efficacy, pregnancy, elevated hepatic function tests or for reasons unrelated to the trial. Total American Fertility Society scoring showed an improvement of 73.3% in 101 patients receiving gestrinone and 72.7% in 99 patients receiving danazol. The results showed a significant reduction in the severity of dysmenorrhoea by the third month in the danazol group and at 6 months in both groups. There was a significant (P < 0.001) increase in weight observed in both groups during treatment. Overall, the tolerability of danazol and gestrinone was good; however, significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps. During the 12 months of follow‐up, mild, moderate or severe degrees of lower abdominal pain, dysmenorrhoea and deep dyspareunia all fluctuated, with no statistically significant increase in frequency in either group.
Updating the clinical experience in endometriosis – the Brazilian perspective
Authors: Halbe H. W. , Nakamura M. S. , Da Silveira G. P. G. , Carvalho W. P. C. 
Published: August 2005

ABSTRACTIn an open‐label, multicentre, randomized, parallel group study, 164 women with endometriosis were assigned to treatment. Out of these women, 81 received danazol (600 mg daily for 8 weeks, then 400 mg for 16 weeks) and 83 were given gestrinone (2.5 mg twice a week for 24 weeks). Five weeks before the start of treatment clinical evaluation and diagnostic laparoscopy were performed during the screening visit. Drug assignment and laboratory data assessment were carried out within 3 days of the estimated onset of the menstrual cycle at baseline visit. The response to treatment was assessed during visits at weeks 2, 4, 8, 12, 16, 20 and 24; at the last visit a second laparoscopy was performed. Therapeutic efficacy was evaluated by analysis of the laparoscopic scores assessed according to the revised American Fertility Society classification. Symptomatic response was measured by clinical scores and laboratory data. In one centre, bone mineral density was also recorded. One patient in the danazol group discontinued treatment due to a cutaneous rash as a probable adverse reaction at the beginning of the study. The therapeutic efficacy of danazol and gestrinone did not differ significantly when the revised American Fertility Society scores were compared. The symptomatic response also showed no statistical difference when clinical examination scores were analysed. There was no significant difference between the drugs in laboratory data, including bone mineral density, with respect to adverse events. Analysis of clinical scores showed that danazol was superior to gestrinone with respect to acne and irregular bleeding. Based on these data, we conclude that both danazol and gestrinone are reliable in the treatment of endometriosis and offer similar results.
Low dose aspirin in pregnancy and early childhood development: follow up of the collaborative low dose aspirin study in pregnancy
Authors:   CLASP Collaborative Group CLASP Coordinating Centre, Radcliffe Infirmary, Oxford
Published: August 2005

ABSTRACTObjectiveTo determine any benefits or risks, expressed in early childhood, of low dose aspirin treatment in pregnancies at high risk of complications due to pre‐eclampsia or intrauterine growth retardation.DesignA questionnaire‐based follow‐up at 12 and 18 months of age of cohorts of surviving children whose mothers participated in a large randomised, double‐blind placebo‐controlled trial of 60 mg aspirin.SettingUnited Kingdom and Ottawa, Canada.Subjects4168 children assessed at 12 months through information provided by general practitioners, and 4365 assessed at 18 months through a questionnaire to parents.Main outcome measuresHospital visits in the first 18 months for congenital malformations, motor deficit, developmental delay, respiratory problems or bleeding problems; height or weight below the third centile; and delayed acquisition of certain developmental skills.ResultsThere were no clear differences in any of the main outcome measures, although some confidence intervals were wide.ConclusionsAlthough an adverse effect can not be ruled out, these findings are reassuring about the safety of low dose aspirin started after the first trimester, at least in respect of congenital malformations, major motor deficit, and severe neuromotor or developmental delay identifiable in early childhood. They provide no clear evidence of benefit. Taking into account evidence from large randomised controlled trials, the place of low‐dose aspirin in pregnancy appears to be limited, although it may be beneficial for women at high risk of early onset pre‐eclampsia; for them, evidence suggesting that it is not harmful is important.
Blood pressure and renal function seven years after pregnancy complicated by hypertension
Authors: Nisell H. , Lintu H. , Lunell N. O. , Möllerström G. , Pettersson E. 
Published: August 2005

ABSTRACTObjective
To assess the occurrence of chronic hypertension and renal disorder after gestations complicated by pregnancy induced hypertension or pre‐eclampsia and to define background factors and laboratory analyses at follow up examination which discriminate between women who remain normotensive and those who develop hypertension.Setting
Swedish university hospital.Subjects
Women with pregnancy induced hypertension (PIH) (n= 49), pre‐eclampsia (n= 45) or a normotensive pregnancy (n= 44) during 1986.Design
Subjects were reviewed in 1993 with regard to chronic hypertension and renal disorder. Plasma concentrations of creatinine, urea, uric acid, calcium and albumin were measured, and urine was examined for the presence of microalbuminuria and erythrocyte excretion rate. Those with and without hypertension at follow up were compared with regard to the renal function tests and possible features in the history which might predict chronic hypertension.Results
Women with a history of pregnancy induced hypertension or pre‐eclampsia had an increased risk, relative to controls, for hypertension at follow up (37% and 20%vs 2%; P < 0.001), microalbuminuria (14% and 20%vs 2%; P < 0.05) and demonstrated increased plasma levels of albumin corrected calcium (2.41 [SE 0.021 and 2.40 [0.01] vs 2.32 [0.01] mmol/l; P < 0.001). The only factors significantly associated with hypertension at follow up were the presence of microalbuminuria (P= 0.0008) and having had a delivery prior to the index pregnancy (P= 0.0017).Conclusions
The risk for chronic hypertension seven years after a pregnancy complicated with pregnancy induced hypertension or pre‐eclampsia is considerably increased. The presence of hypertension at follow up is closely related to residual renal disorder.
Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age
Authors: Spinillo Arsenio , Capuzzo Ezio , Stronati Mauro , Ometto Alessandra , Orcesi Simona , Fazzi Elisa 
Published: August 2005

ABSTRACTObjective
To evaluate the impact of preterm premature rupture of membranes on the neurodevelopmental outcome of infants, assessed at two years of age.Design
A prospective observational study of surviving preterm infants born after premature rupture of membranes and of infants born after spontaneous preterm labour with intact membranes. The study was carried out in the period 1986 to 1991.Setting
Pavia, Italy.Subjects
One hundred and forty singleton infants born prematurely after premature rupture of membranes between 24 and 34 weeks of gestation and 120 controls of similar gestational age born after spontaneous preterm labour with intact membranes.Main outcome measures
Infant neurodevelopmental outcome at two‐year follow up.Results
After adjustment, by logistic analysis for the effect of gestational age and birthweight, infants born after premature rupture of membranes were more likely to have severe neurodevelopmental impairment (spastic tetraplegia and/or Bayley mental developmental index < 71) than controls (adjusted OR 5.75, 95% CI 1.22–27.18). Multivariate analysis of linear trend showed a statistically significant relation of duration of membrane rupture to occurrence of severe intraventricular haemorrhage, cystic periventricular leucomalacia and moderate to severe infant neurodevelopmental impairment.Conclusion
Infants born after prolonged premature rupture of membranes are at higher risk of subsequent moderate to severe neurodevelopmental impairment than those born after spontaneous labour with intact membranes.
Receptor‐mediated uterine effects of vasopressin and oxytocin in nonpregnant women
Authors: Bossmar Thomas , ÅKerlund Mats , Szamatowicz Jacek , Laudanski Tadeusz , Fantoni Guido , Maggi Mario 
Published: August 2005

ABSTRACTObjective
To study in nonpregnant women myometrial actions of vasopressin and oxytocin and the involvement in these effects of specific uterine receptors.Subjects
Twenty‐eight women undergoing hysterectomy for benign gynaecological disorders.Interventions
Intrauterine pressure recordings. Intravenous bolus injections of 10 pmol/kg body weight of vasopressin and oxytocin. Repeated blood sampling for measurement of vasopressin and oxytocin concentrations in plasma. Recording of effects of vasopressin and oxytocin on isolated myometrium. Estimation of myometrial concentrations of vasopressin V1a and oxytocin receptors. Measurement of plasma oestradiol and progesterone.Main outcome measures
Vasopressin‐ and oxytocin‐induced increases of the area under the in vivo recording curve over 10 minutes and EC50 concentrations of dose‐responses in vitro. Concentrations of vasopressin V1a and oxytocin receptors.Results
Vasopressin was on average four times more potent than oxytocin in vivo. The effect of vasopressin premenstrually was more pronounced than in women under oestrogen influence only (proliferative phase‐hyperproliferation; P= 0.02), and tended to be more marked than in those in the luteal phase (P = 0.07). No significant variation in oxytocin response with the hormonal state was observed. EC50 concentrations of vasopressin were more than 20 times lower than those of oxytocin. The median concentration of the vasopressin V1a receptor was 208 (range 139–343) fmol/mg protein and that of the oxytocin receptor 49 (38–87) fmol/mg protein. Vasopressin receptor concentrations and in vivo effects of this peptide did not correlate, whereas for those of oxytocin a significant correlation was observed (P= 0.02).Conclusion
The high potency of vasopressin in nonpregnant women, particularly premenstrually, firmly supports an aetiological importance of this peptide in the uterine hyperactivity of primary dysmenorrhoea. Oxytocin seems to be less important in this condition in view of its much smaller potency and the absence of increase in effect premenstrually. Vasopressin appears to influence both the oxytocin and the vasopressin Vla receptor sites in the uterus, whereas oxytocin acts specifically on its own receptor.
The sensitivity of ultrasound and serum alpha‐fetoprotein in population‐based antenatal screening for neural tube defects, South Australia 1986–1991
Authors: Chan Annabelle , Robertson Evelyn F. , Haan ERIC A. , Ranieri Enzo , Keane Rosemary J. 
Published: August 2005

ABSTRACTObjective
To determine the sensitivity of antenatal screening methods for neural tube defects in population‐based screening in South Australia in 1986–1991, and whether ultrasound can replace serum alpha‐fetoprotein screening in terms of achieving an equivalent level of sensitivity.Design and setting
Ascertainment of all births and terminations of pregnancy with neural tube defects from multiple sources for 1986–1991 in South Australia. Serum and amniotic fluid alpha‐fetoprotein results were obtained from the only laboratory performing the tests as a Statewide antenatal screening programme, and information on ultrasound screening from case notifications, hospital case records and medical practitioners who cared for the women.Subjects
All 243 births and terminations of pregnancy with neural tube defects in South Australia in 1986–1991.Main outcome measures
The sensitivity of individual screening methods and of all methods used, particularly for spina bifida.Results
For pregnancies with neural tube defects screened by any method (serum alpha‐fetoprotein, ultrasound or amniocentesis), 86YO sensitivity was achieved. Ultrasound screening for anencephaly achieved 100 % sensitivity even in low risk pregnancies, compared with 92 % for serum alpha‐fetoprotein. For spina bifida, the sensitivity of ultrasound screening increased with the level of risk in pregnancy: it was 60% in low risk pregnancies, which was equivalent to that of serum alpha‐fetoprotein screening (64%); 89% in high risk pregnancies and 100% for women referred for confirmation of a suspected spina bifida by another ultrasonographer (×12 for trend = 23.49, P < 0.0001). Ultrasound screening in high risk pregnancies for spina bifida achieved higher sensitivity in teaching hospitals compared with other ultrasound services in the State (97%vs 65%), but sensitivity was equivalent for low risk pregnancies. It is estimated that, had the serum screening programme not been in place, the level of sensitivity achieved for spina bifida by ultrasound and amniocentesis would have been 62% compared with the actual situation of 76% with the programme in existence, a difference of nearly 15% (95% CI 2.5 to 267) (×12= 5.45, P= 0.02).Conclusions
Antenatal screening for neural tube defects in South Australia achieved a higher level of sensitivity with the maternal serum alpha–fetoprotein programme in place. We conclude that the serum screening programme should continue in South Australia pending a significant improvement in the sensitivity of routine ultrasound screening for spina bifida.