bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient hyperthyroidism of hyperemesis gravidarum
Authors: Tan Jackie Y.L. , Loh Keh Chuan , Yeo George S.H. , Chee Yam Cheng 
Published: December 2003

Objective
To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum.Design
Prospective observational study.Setting
Hospital inpatient gynaecological ward.Population
Women admitted with hyperemesis gravidarum and found to have hyperthyroidism.Methods
Fifty‐three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation.Main outcome measures
Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes).Results
Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of >5% of their pre‐pregnancy weight was lower compared with those of women who did not (P= 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile.Conclusions
In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti‐thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non‐significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.
Efficacy of pre‐operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review
Authors: Lethaby Anne , Vollenhoven Beverley , Sowter Martin 
Published: December 2003

Objective
To evaluate the role of pretreatment with gonadotrophin releasing hormone (GnRH) analogues (GnRHa) prior to surgery for women with uterine fibroids.Design
A systematic review was undertaken of all randomised controlled trials assessing the efficacy of GnRHa treatment prior to surgery (myomectomy or hysterectomy) in women with fibroids.Setting
Secondary care.Sample
Premenopausal women with fibroids awaiting surgery attending hospitals or clinics.Methods
Electronic searches of Medline, EmBase, Current Contents, the Cochrane Library, National Research Register, NLM's Clinical Trials Register and the Cochrane group's Trials Register were performed, between 1980 and 2000. Twenty‐six randomised controlled trials were identified that compared GnRHa with no treatment, placebo or other medical treatment. The quality of the trials was assessed and data were extracted independently by two of the reviewers. Statistical analysis was performed in Revman according to Cochrane guidelines and where possible outcomes were pooled in a meta‐analysis.Main outcome measures
Pre‐operative assessment (reduction in uterine and fibroid volume, change in haemoglobin and haematocrit, change in patient's symptoms), intra‐operative assessment (duration of operation, blood loss, proportion with vertical incision, proportion undergoing vaginal rather than abdominal procedure, frequency of blood transfusions), post‐operative assessment (complications, duration of hospital stay, recurrence of fibroids).Results
Pre‐ and post‐operative haemoglobin and haematocrit were significantly improved by GnRHa therapy prior to surgery, and uterine volume, uterine gestational size and fibroid volume were all reduced. Pelvic symptoms were also reduced but some adverse events were more likely during GnRHa therapy. Hysterectomy appeared to be easier after pretreatment with GnRHa therapy; there was reduced operating time and a greater proportion of hysterectomy patients was able to have a vaginal rather than an abdominal procedure. Duration of hospital stay was also reduced. Blood loss and rate of vertical incisions were reduced for both myomectomy and hysterectomy. Evidence of increased risk of fibroid recurrence after GnRHa pretreatment in myomectomy patients was equivocal and few data were available to assess change in post‐operative fertility.Conclusions
The use of GnRHa for three to four months prior to fibroid surgery reduces both uterine volume and fibroid size. They are beneficial in the correction of pre‐operative iron deficiency anaemia, if present, and reduce intra‐operative blood loss. If uterine size is such that a midline incision is planned, this can be avoided in many women with the use of GnRHa. For women undergoing hysterectomy, a vaginal procedure is more likely following the use of these agents.
A scoring system for the assessment of bowel and lower urinary tract symptoms in women
Authors: Hiller L. , Bradshaw H.D. , Radley S.C. , Radley S. 
Published: December 2003

Objective
To develop a simple scoring system for a validated 22‐item questionnaire used to assess bowel and urinary dysfunction in women.Setting
A urogynaecology clinic, a functional bowel clinic, a district general hospital and a general practice.Population
One hundred and one women referred with functional bowel and/or urinary symptoms and 131 asymptomatic controls.Methods
A user manual has been prepared. Individual responses to questions are categorised into normal and abnormal and odds ratio tests applied to reflect their sensitivity.Results
Scoring methods have been detailed, and appropriate and sensitive cutoff points defined.Conclusions
The use of this validated questionnaire is now aided by a user manual, facilitating health care evaluation research into the effects of pelvic surgery on pelvic floor symptomatology. A simple scoring system is provided, making the questionnaire a valuable and accessible research tool.
Medical management of late intrauterine death using a combination of mifepristone and misoprostol
Authors: Wagaarachchi Prabhath T. , Ashok Premila W. , Narvekar Nitish N. , Smith Norman C. , Templeton Allan 
Published: December 2003

Objective
To assess the efficacy and safety of mifepristone in combination with misoprostol in the management of late fetal death.Design
Observational study.Setting
Aberdeen Maternity Hospital, Aberdeen.Methods
A consecutive series of 96 women with intrauterine death after 24 weeks of gestation were studied. Each woman received a single dose of 200mg mifepristone orally, following which a 24–48 hour interval was recommended before administration of misoprostol. For gestations of 24–34 weeks, 200μg of intravaginal misoprostol was administered, followed by four oral doses of 200μg at three hourly intervals. Gestations over 34 weeks were given a similar regimen but a reduced dose of 100μg misoprostol.Results
The average induction to delivery interval was 8.5 hours. Ninety‐five women (98.9%) were delivered within 72 hours of administration of first dose of misoprostol, with 66.7%, 87.5%, 92.7% and 95.8% women delivering within 12, 24, 36 and 48 hours, respectively. No significant correlation was found between mean induction to delivery interval and maternal age, parity, Bishop's score, birthweight and mifepristone/misoprostol interval. The induction to delivery interval was shorter with increasing gestation (P= 0.04). Mild side effects were noted in eight (8.3%) women. Three (3.1%) women had treatment for presumed or proven pelvic sepsis. No cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.Conclusion
The combination of mifepristone and misoprostol for induction of labour following late fetal death is an effective and safe regimen. The induction to delivery interval with this regimen appears shorter than studies using mifepristone or misoprostol.
Reproductive risk factors, pregnancy characteristics and obstetric outcome in female doctors
Authors: Heinonen Seppo , Saarikoski Seppo 
Published: December 2003

Objectives
To compare maternal risk factors, pregnancy characteristics and outcome in female doctors, teachers, and the general obstetric population.Design
We analysed obstetric outcomes among 331 female doctors and 656 teachers with singleton pregnancies who gave birth at Kuopio University Hospital from March 1989 to December 2000. The general obstetric population (n= 21,997) was selected as the reference group and logistic regression analysis was used to assess pregnancy outcomes in each group separately.Results
Reproductive risk factors among female doctors and teachers were similar to those in the general obstetric population with the exception of advanced maternal age, number of previous terminations, marital status, maternal smoking, obesity, infertility treatment and pre‐eclampsia. Interestingly, the number of operative deliveries did not vary between the groups. Pregnancy outcome among doctors and teachers was comparable with that in the general population.Conclusions
Although doctors and teachers appear to represent a group of health‐conscious women, obstetricians do not vary their management of pregnant doctors and teachers during pregnancy and labour.
Loop diathermy excision compared with cervical laser vaporisation for the treatment of intraepithelial neoplasia: a randomised controlled trial
Authors: Dey P. , Gibbs A. , Arnold D.F. , Saleh N. , Hirsch P.J. , Woodman C.B.J. 
Published: December 2003

Objective
To determine whether loop diathermy excision of the transformation zone and laser vaporisation are equally effective in the treatment of cervical intraepithelial neoplasia.Design
Randomised controlled trial.Population
Women referred for evaluation of cytological abnormality who were considered suitable for outpatient local destructive treatment.Setting
Seven colposcopy units in the North West Region.Methods
Loop diathermy excision of the transformation zone and laser vaporisation.Main outcome measure
Smear reported as moderate dyskariosis or worse following treatment.Results
Of 289 women randomised, 285 had one or more smears following treatment. Women were more likely to have a smear reported as moderate dyskariosis or worse following laser vaporisation [hazard ratio 3.01 (95% CI 1.27 to 7.12)]. The cumulative risk of a smear reported as moderate dyskariosis or worse was 6.0% at six months and 12.1% at three years in those allocated laser vaporisation, and 2.0% at six months, and 3.3% at three years in those allocated loop diathermy excision of the transformation zone.Conclusions
Loop diathermy excision is a more effective treatment of cervical intraepithelial neoplasia than laser vaporisation.
The VALUE national hysterectomy study: description of the patients and their surgery
Authors: Maresh M.J.A. , Metcalfe M.A. , McPherson Klim , Overton C. , Hall V. , Hargreaves J. , Bridgman S. , Dobbins J. , Casbard A. 
Published: December 2003

Objectives
To describe hysterectomies practised in 1994 and 1995: the patients, their surgery and short term outcomes.Design
One of two large cohorts, with prospective follow up, recruited to compare the outcomes of endometrial destruction with those of hysterectomy.Setting
England, Wales and Northern Ireland.Population
All women who had hysterectomies for non‐malignant indications carried out during a 12‐month period.Methods
Gynaecologists in NHS and independent hospitals were asked to report cases. Follow up data were obtained at outpatient follow up approximately six weeks post‐surgery.Main outcome measures
Indication for surgery, method of hysterectomy, ovarian status post‐surgery, surgical complications.Results
37,298 cases were reported which is estimated to reflect about 45% of hysterectomies performed during the period studied. The median age was 45 years, and the most common indication for surgery was dysfunctional uterine bleeding (46%). Most hysterectomies were carried out by consultants (55%). The proportions of women having abdominal, vaginal or laparoscopically‐assisted hysterectomy were 67%, 30% and 3%, respectively. Forty‐three percent of women had no ovaries conserved after surgery. The median length of stay was five days. The overall operative complication rate was 3.5%, and highest for the laparoscopic techniques. The overall post‐operative complication rate was 9%. One percent of these was regarded as severe, with the highest rate for severe in the laparoscopic group (2%). There were no operative deaths; 14 deaths were reported within the six‐week post‐operative period: a crude mortality rate soon after surgery of 0.38 per thousand (95% CI 0.25–0.64).Conclusions
This large study describes women who undergo hysterectomy in the UK, and presents results on early complications associated with the surgery. Operative complications occurred in one in 30 women, and post‐operative complications in at least one in 10. Laparoscopic techniques tend to be associated with higher complication rates than other methods.
Intra‐operative haemorrhage by blunt versus sharp expansion of the uterine incision at caesarean delivery: a randomised clinical trial
Authors: Magann Everett F. , Chauhan Suneet P. , Bufkin Laura , Field Karen , Roberts William E. , Martin James N. 
Published: December 2003

Objective
To determine whether the method used to expand the uterine incision for caesarean delivery affects the incidence of intra‐operative haemorrhage.Design
A prospective randomised study of women undergoing a low segment transverse caesarean delivery. Participants were assigned to have their uterine incision either sharply or bluntly expanded.Participants
Between June 1998 and June 2000, 470 women drew assignments to the sharp expansion group and 475 to the blunt group.Results
The maternal demographics of age, race, nulliparity, and body mass index as well as pre‐operative haematocrit were similar between groups. Compared with the blunt group, the estimated blood loss (886 versus 843mL, P= 0.001), change in the mean haematocrit (6.1%versus 5.5%, P= 0.003), incidence of postpartum haemorrhage (13%versus 9%; relative risk = 1.23, 95% CI 1.03, 1.46) and need for a transfusion (2%versus 0.4%; relative risk = 1.65, 95% CI 1.25, 2.21) were significantly greater in the sharp group.Conclusion
In caesarean delivery, sharply expanding the uterine incision significantly increases intra‐operative blood loss and the need for subsequent transfusion.
A two‐centred pragmatic randomised controlled trial of two interventions of postnatal support
Authors: Reid M. , Glazener C. , Murray G.D. , Taylor G.S. 
Published: December 2003

Objectives
To establish whether providing additional postnatal support during the early postnatal months influences women's physical and psychological health and to identify health service benefits.Design
Pragmatic randomised controlled trial with a 2 × 2 factorial design with two interventions.Setting
Community centres, Ayrshire and Grampian, Scotland.Population
One thousand and four primiparous women, 83% completed the baseline questionnaire, 71% at six months.Methods
(1) An invitation to a local postnatal support group run weekly with a facilitator, starting two weeks postpartum. (2) A postnatal support manual, posted two weeks postpartum.Main outcome measures
Data regarding primary outcome postnatal depression (Edinburgh Postnatal Depression Scale, EPDS), secondary outcomes, general health measures (SF‐36), social support (SSQ6), use of health services and women's views of interventions were collected at two weeks postpartum and at three and six months.Results
There were no significant differences in EPDS scores between the control and trial arms at three and six months, nor were there differences in the SF‐36 and the SSQ6 scores. The 95% CI for the difference in EPDS effectively excluded a change in mean score of more than 10% with either intervention. There were no differences in health service attendances in primary or secondary care between the control and trial arms. Of those women who attended the groups, 40% attended six or more. Women reported favourably on the ‘pack’ with the majority reading it a few times and feeling that it was aimed at them.Conclusions
Wide‐scale provision by the National Health Service of either support groups or self‐help manuals is not appropriate if the aim is to improve measurable health outcomes.
Autofluorescence spectroscopy for the diagnosis of cervical intraepithelial neoplasia
Authors: Weingandt Helmut , Stepp Herbert , Baumgartner Reinhold , Diebold Joachim , Xiang Wei , Hillemanns Peter 
Published: December 2003

Objective
To assess the feasibility of autofluorescence spectroscopy in the diagnosis of cervical intraepithelial neoplasia (CIN) using broadband light excitation.Design
Feasibility study.Setting
Colposcopy clinic of an university hospital.Population
Sixty‐eight patients at risk for CIN.Methods
After excitation with a broadband light between 375 and 440 nm, spectral distribution of native tissue fluorescence (autofluorescence) was acquired from 685 cervical sites for the localisation and differentiation of CIN, and compared with colposcopically directed biopsy and human papillomavirus (HPV) DNA testing.Main outcome measure
Detection of CIN.Results
The evaluation of spectral measurements revealed significantly lower autofluorescence values for CIN 3 lesions compared with normal tissue (P < 0.001), and compared with CIN 1 or CIN 2 (P < 0.002). High grade CIN lesions (CIN 2/3) presented with a significant reduced autofluorescence compared with CIN 1 (P < 0.002). Patients with a positive HPV DNA testing showed a significantly lower autofluorescence than patients tested negative for HPV DNA (P < 0.05). Severe inflammation such as chronic cervicitis may lead to false positive results.Conclusions
Autofluorescence spectroscopy represents an interesting approach for the detection of cervical neoplasia. Using an excitation wavelength band between 375 and 440 nm, significant differences between normal and precancerous lesions of the cervix can be seen.
Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention‐to‐treat
Authors: Zimmermann Roland , Durig Peter , Carpenter Robert J. , Mari Giancarlo 
Published: December 2003

Objective
To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B‐mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops.Design
Prospective study on an intention‐to‐treat basis.Setting
Multicentre study in five large tertiary referral centres.Population
One hundred twenty‐five fetuses with maternal alloantibodies known to cause immunological hydrops.Methods
If peak systolic velocity and B‐mode scan were reassuring the pregnancy was monitored at 7–14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced.Main outcome measure
Moderate to severe anaemia at delivery.Results
Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks.Conclusions
Middle cerebral artery peak systolic velocity is a highly sensitive non‐invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non‐invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.
What is a reasonable time from decision‐to‐delivery by caesarean section? Evidence from 415 deliveries
Authors: MacKenzie I.Z. , Cooke Inez 
Published: December 2003

Objective
To determine how long it takes from the decision to achieve delivery by non‐elective caesarean section (DDI), the influence on this interval, and the impact on neonatal condition at birth.Design
Twelve months prospective data collection on all non‐elective caesarean sections.Methods
Prospective collection of data relating to all caesarean sections in 1996 in a major teaching hospital obstetric unit was conducted, without the knowledge of the other clinicians providing clinical care. Details of the indication for section, the day and time of the decision and the interval till delivery were recorded as well as the seniority of the surgeon, and condition of the baby at birth.Results
The mean time from decision‐to‐delivery for 100 emergency intrapartum caesarean sections was 42.9 minutes for fetal distress and 71.1 minutes for 230 without fetal distress (P < 0.0001). For 22 ‘crash’ sections the mean time from decision‐to‐delivery was 27.4 minutes; for 13 urgent antepartum deliveries for fetal reasons it was 124.7 minutes and for 21 with maternal reasons it was 97.4 minutes. The seniority of the surgeon managing the patient did not appear to influence the interval, nor did the time of day or day of the week when the delivery occurred. Intrapartum sections were quicker the more advanced the labour, and general anaesthesia was associated with shorter intervals than regional anaesthesia for emergency caesarean section for fetal distress (P < 0.001). Babies born within one hour of the decision tended to be more acidaemic than those born later, irrespective of the indication for delivery. Babies tended to be in better condition when a time from decision‐to‐delivery was not recorded than those for whom the information had been recorded.Conclusion
Fewer than 40% intrapartum deliveries by caesarean section for fetal distress were achieved within 30 minutes of the decision, despite that being the unit standard. There was, however, no evidence to indicate that overall an interval up to 120 minutes was detrimental to the neonate unless the delivery was a ‘crash’ caesarean section. These data thus do not provide evidence to sustain the recommendation of a standard of 30 minutes for intrapartum delivery by caesarean section.