bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of fetal exposure to danazol
Authors: BRUNSKILL PETER J. 
Published: August 2005

ABSTRACTObjective
To assess the consequences of exposure to danazol in utero. Additionally, by assessing the risk, to facilitate the counselling of pregnant women inadvertently exposed to danazol in early pregnancy.Design
Retrospective review of reported case histories.Subjects
129 women exposed to danazol during pregnancy were identified from individual case reports, data from the Australian Drug Reactions Advisory Committee and the United States Food and Drug Administration and from the reports of danazol exposure made directly to the manufacturers.Main outcome measures
Teratogenic effects of fetal exposure to danazol in relation to dosage and duration of exposure.Results
Of the 129 reported pregnancies, 12 miscarried and 23 were aborted. Of the 94 completed pregnancies, 37 resulted in the birth of normal males, 34 in non‐virilized females and 23 in virilized females. Virilization occurred in a proportion of female fetuses with a pattern of cliteromegaly, fused labia and urogenital sinus formation. Surgery to the genital tract was usually, but not always, required in childhood. The abnormality has not been reported where danazol therapy had been discontinued before the 8th week of pregnancy. Although more common in the higher dosages, virilization was reported in one case with a 200 mg daily dosage.Conclusions
Danazol should remain contraindicated in pregnancy and clinicians should give careful contraceptive advice to patients commencing or continuing danazol therapy. Nonetheless it is possible to be cautiously optimistic about the outcome of danazol‐exposed pregnancies, particularly if treatment is discontinued before 8 completed weeks gestation.
Standards in fetal monitoring—practical requirements for uterine activity measurement and recording
Authors: Steer P. J. 
Published: August 2005

ABSTRACTExternal monitoring of uterine contractility in human labour can record contraction frequency accurately, but cannot determine true intra‐uterine pressure reliably. It is therefore suitable for use in spontaneous labour where there is a need for a marker of contractions to aid in continuous fetal heart rate pattern interpretation. Intra‐uterine pressure measurement can provide quantitative information more reliably over intervals of 10–60 minutes. Although active pressure values for individual contractions can vary by up to 50% when measured simultaneously by two or more intra‐uterine catheters/transducers, this variation is not systematic and cumulative measures vary by less than 5%. The measurement of baseline tone is affected by variables not related to uterine activity and should therefore be excluded when quantitative measures are made.
The effect of anxiety and depression during pregnancy on obstetric complications
Authors: Perkin M. R. , Bland J. M. , Peacock J. L. , Anderson H. R. 
Published: August 2005

ABSTRACTObjective
To investigate the effects of anxiety and depression during pregnancy on obstetric complications using the data collected from the St George's Birthweight Study.Design
Prospective population study.Setting
District general hospital in inner London.Subjects
A consecutive series of 1860 white women booking for delivery were approached. Of these, 136 refused and 209 failed to complete the study for other reasons, leaving a sample of 1515.Main outcome measure
Data were obtained by research interviewers at booking, 17, 28, and 36 weeks gestation and from the structured antenatal and obstetric record. The predictor variables were the anxiety and depression scores measured using the General Health Questionnaire. The outcome variables were five obstetric complications: preterm delivery; nonspontaneous onset of labour; major analgesia in the first and second stages of labour; and nonspontaneous vaginal deliveries. The possible confounding effects of 35 socio‐economic, psychological and personal variables were investigated using logistic regression.Results
The factors that had the strongest relation with the outcomes were parity and maternal age. Depression during pregnancy was unrelated to the obstetric complications. Anxiety was weakly related to analgesia/anaesthesia in the second stage of labour (P= 0.04). However, anxiety accounted for only 0.1 % of the variance in use of major analgesia/anaesthesia. The most effective model, that for analgesia/anaesthesia in the first stage of labour, accounted for only 7.3% of the variance.Conclusions
In the general population of pregnant women, anxiety and depression during pregnancy, while undesirable in themselves, are of little importance in the evolution of obstetric complications.
Prediction of fetal acidaemia in intrauterine growth retardation: comparison of quantified fetal activity with biophysical profile score
Authors: Ribbert Lucia S. M. , Nicolaides Kypros H. , Visser Gerard H. A. 
Published: August 2005

ABSTRACTObjective
To study the relation between quantified fetal movements and fetal activity assessed by the biophysical profile score and the pH in umbilical arterial blood at elective caesarean section.Design
Fetal activity was assessed within 24 h prior to caesarean section for decelerative fetal heart rate patterns both by quantification (% of time spent moving) and by applying the biophysical profile score (BPS) criteria.Setting
Department of Obstetrics, University Hospital.Subjects
Nineteen growth retarded fetuses.Main outcome measures
Fetal generalised movements (FGM%), fetal breathing movements (FBM%), total fetal activity (TFA%= FGM%+ FBM%); FGM, FBM and tone as assessed according the biophysical profile score (BPS); umbilical arterial pH.Results
In all 11 acidaemic fetuses (pH <7.20) TFA% was below the 10th centile for normal fetuses; nine had decreased FGM% and eight decreased FBM%. Absence of FGM or tone according to the biophysical profile score was only seen in two acidaemic fetuses.Conclusion
TFA% <11.7% was a better predictor of acidaemia at birth than either reduced FGM%, FBM%, or absence of FGM, FBM and tone as defined in the biophysical profile score. The two methods of assessing FBM were identical in predicting acidaemia, suggesting that in presence of acidaemia the decrease of FBM may be an all‐or‐none phenomenon. Furthermore, the data indicate that reduction in body movements may precede reduction in breathing movements.
Objectively measured tobacco exposure during pregnancy: neonatal effects and relation to maternal smoking
Authors: Bardy Ali H. , Seppälä Timo , Lillsunde Pirjo , Kataja J. Matti , Koskela Pentti , Pikkarainen Jarmo , Hiilesmaa Vilho K. 
Published: August 2005

ABSTRACTObjective
To measure quantitatively and objectively the maternal and fetal tobacco exposure during pregnancy and its neonatal effects.Design
Tobacco exposure was assessed from maternal serum samples, obtained during the first half of pregnancy and from umbilical serum samples obtained at delivery, by measuring the concentration of nicotine metabolite, cotinine. Data on the respective pregnancies and neonates were collected from the Finnish Medical Birth Registry.Setting
Finland.Subjects
One thousand two hundred and thirty‐seven pregnancies and newborns, representing all pregnancies resulting in a liveborn infant during one week in one country.Main outcome measures
Gestational age, birthweight and crown‐heel length of newborns.Results
Cotinine (>6 μg/l) was detected in either maternal or umbilical serum in 300 pregnancies, and these mothers and newborns were classified as exposed. Important differences occurred between measured exposure and reported smoking behaviour. Of the exposed mothers, 38% were nonsmokers and 3.4% of the nonexposed mothers were smokers. Tobacco exposure was associated with shorter gestational age, reduced birthweight and shorter crown‐heel length of the newborns. After correction for parity, gender, and gestational age, the exposed newborns were on average 188 g (95% confidence interval (CI) 123–253 g) lighter and 10 mm (95% CI7–13 mm) shorter than the nonexposed newborns. One μg/ml of cotinine in maternal serum resulted in a mean decrease of 1.29 g (95% CI 0.55–2.02 g) in birthweight and in a mean decrease of 0.059 mm (95% CI 0.035–0.083 mm) in birth length. Maternal cotinine concentrations better explained the neonatal findings than the reported smoking habits.Conclusions
There is a quantitative dose and effect relation between tobacco exposure and a decrease in the gestational age at birth and size of the neonate. The smoking habit reported by mothers themselves is not an accurate measure of fetal tobacco exposure.
Stereomicroscopic demonstration of chorionic villi: differentiation between miscarriage and ectopic pregnancy
Authors: Dæby Kristiansen John , Clausen Ingo , Nygaard Nielsen Majbrit , GRove Thomsen Sten 
Published: August 2005

ABSTRACTObjective
To evaluate direct peroperative stereomicroscopic examination of endometrial curettings in the differentiation between miscarriage and ectopic pregnancy.Design
A prospective consecutive controlled study.Setting
Odense University Hospital, Odense, Denmark.Subjects
One hundred and fifty‐nine women with vaginal bleeding and/or abdominal pain in early pregnancy and no fetus seen on ultrasound.Main outcome measures
The results of stereomicroscopy were compared with the histological diagnoses.Results
There was 90% (95% CI, 84–94%) agreement between the stereomicroscopic and histological examinations. Fifteen per cent had an ectopic pregnancy. The sensitivity of stereomicroscopy as a marker of ectopic pregnancy was 92% (73–99%), the specificity 94% (88–97%). The predictive value of a positive test was 73% (54–88%) and that of a negative test 98% (94–100%).Conclusion
Direct peroperative stereomicroscopy of endometrial curettings is a valuable diagnostic tool for immediate differentiation between miscarriage and ectopic pregnancy.
Validation of the SpaceLabs 90207 ambulatory blood pressure monitor for use in pregnancy
Authors: Shennan Andrew H. , Kissane Jenny , de Swiet Michael 
Published: August 2005

ABSTRACTObjective
To determine the accuracy of the SpaceLabs 90207 ambulatory blood pressure monitor in pregnant women.Design
Prospective observational study.Setting
Queen Charlotte's and Chelsea Hospital for Women.Subjects
One hundred and twenty‐two pregnant women from the antenatal population of Queen Charlotte's Hospital.Methods
Evaluation was carried out according to the British Hypertension Society (BHS) Protocol.Results
The mean difference between observer and device for systolic blood pressure was 3 (SD 4) mmHg. For diastolic blood pressure the difference was 5 (SD 6) mmHg for Phase IV (muffling of Korotkoff sound), and 4 (SD 4) mmHg for Phase V (disappearance of Korotkoff sound). According to the BHS grading criteria, the device reached a B grading for systolic blood pressure. B grading was also reached for diastolic blood pressure (Phase V) but grade C for diastolic blood pressure (Phase IV). The accuracy criteria stipulated by the Association for the Advancement of Medical Instrumentation (AAMI) were also met for both systolic and diastolic blood pressure.Conclusion
The SpaceLabs 90207, when compared with trained observers, is accurate in determining both systolic and diastolic blood pressure for clinical purposes, as judged by the BHS Protocol in pregnancy.
Anti‐D concentrations in fetal and maternal serum and amniotic fluid in rhesus allo‐immunised pregnancies
Authors: Economides Demetrios L. , Bowell Peter J. , Selinger Mark , Pratt Geoffrey A. , Ferguson Jane , Mackenzie I. Z. 
Published: August 2005

ABSTRACTObjective
To investigate the relation between anti‐D concentrations in maternal serum, fetal serum and amniotic fluid, and the development of fetal anaemia.Design
Observational cross sectional and longitudinal study.Setting
Regional referral centre.Subjects
Sixty‐one women undergoing fetal blood sampling at 19 to 36 weeks' gestation for fetal blood and haematocrit estimation for the management of Rh (D) allo‐immunisation. Thirty‐eight pregnancies (7 with an Rh (D) negative fetus) were tested only once but the rest had two to five fetal blood samplings.Interventions
Ultrasound guided fetal blood sampling and amniocentesis, and automated analysis of anti‐D antibody quantitation.Results
There were strong correlations between maternal serum, fetal serum and amniotic fluid anti‐D concentrations. Analyses of both longitudinal and cross sectional data demonstrated a decrease of the maternal/fetal serum anti‐D ratio with gestation. In pregnancies with Rh (D) negative fetuses the maternal/fetal anti‐D ratio was significantly lower (P<0.0001) than in those with Rh (D) positive fetuses. The degree of fetal anaemia (delta haematocrit) was correlated with maternal serum and amniotic fluid anti‐D concentrations (r=−0.55, n= 54, P<0.0001; r=−0.57, n= 44, P<0.0001, respectively) but there was a weaker correlation with fetal serum anti‐D (r= 0.37, n= 54, P<0.01).Conclusion
Anti‐D concentrations in maternal serum, fetal serum and amniotic fluid are correlated with fetal anaemia. The decrease in maternal/fetal anti‐D ratio with gestation suggests an increase in placental permeability for anti‐D with advancing pregnancy.
The effect of placental syncytiotrophoblast microvillous membranes from normal and pre‐eclamptic women on the growth of endothelial cells in vitro
Authors: Smárason Alexander K. , Sargent Ian L. , Starkey Phyllis M. , Redman Christopher W. G. 
Published: August 2005

ABSTRACTObjectives
To determine if placental syncytiotrophoblast microvillous (STBM) membranes contain factors which could cause the maternal endothelial cell disturbance thought to be central to the pathophysiology of the maternal syndrome of pre‐eclampsia.Design
STMB membranes isolated from pre‐eclamptic or normal placentae were added to cultures of endothelial cells and their effect on the proliferation (measured by 3H‐thymidine incorporation), viability (measured by 51Cr release) and growth as a monolayer of these cells was determined. Membranes prepared from red blood cells, and nonendothelial adherent and nonadherent cell lines were used as specificity controls.Subjects
STBM membranes were isolated from the placentae of primigravid women, 10 having caesarean sections for breech presentations and 10 for pre‐eclampsia.Results
STBM membranes from the placentae of normal and pre‐eclamptic women suppressed endothelial cell proliferation to a similar extent and disrupted the cell monolayer to form a honeycomb‐like pattern. This change in morphology was seen before significant endothelial cell death occurred. Red blood cell membranes had no effect on either endothelial cell proliferation, viability or monolayer integrity. Endothelial cells from human umbilical arteries and bovine adrenal capillaries were similarly suppressed, but comparable concentrations of STBM membranes had no effect on nonendothelial cell lines.Conclusions
Syncytiotrophoblast microvillous membranes specifically interfered with endothelial cell growth in vitro. Our results demonstrate that there are trophoblast products which could cause the maternal syndrome of pre‐eclampsia through endothelial cell damage.
Plasma oestrogens in postmenopausal women with endometrial cancer
Authors: Nyholm Henrik C. J. , Nielsen Anette L. , Lyndrup Jens , Dreisler Anne , Hagen Claus , Haug Egil 
Published: August 2005

ABSTRACTObjective
To study plasma levels of oestrogens and androgens, sex hormone‐binding globulin (SHBG) and follicle stimulating hormone (FSH) in postmenopausal patients with endometrial cancer.Design
Patients and controls were matched for age, body mass index, parity and years since menopause.Setting
Department of Obstetrics and Gynaecology, Hvidovre Hospital, Denmark.Subjects
Fifty postmenopausal patients with endometrial cancer and 54 matching controls.Measurements
Plasma levels of SHBG, FSH, oestrone, oestradiol, oestrone‐sulphate, dehydro‐epiandrosterone sulphate, testosterone, and androstenedione were measured by radio‐immunoassays. Free fractions of oestradiol and testosterone were calculated according to levels of SHBG and albumin.Results
The levels of oestradiol, free oestradiol, and oestrone were elevated (P<0.001) in patients compared with controls (oestradiol: 51 (45–59) vs 37 (34–41) pmol/1; free oestradiol: 0.69 (0.59–0.80) vs 0.48 (0.42–0.54) pmol/1; oestrone: 180 (159–204) vs 119 (107–133) pmol/1 (mean values (95% CI) in patients vs controls)). Furthermore, an increased oestrone:androstenedione ratio (0.095 vs 0.072, P<0.01) was found in patients. SHBG correlated negatively (P<0.001) with body mass, while the free fractions of oestradiol and testosterone correlated positively (P<0.01) with body mass, in both patients and controls. Multiple regression analysis showed that the differences in oestrogen levels between the two groups persisted when controlling for the effect of body mass, age, years since menopause, parity, and levels of SHBG and FSH.Conclusion
Patients with endometrial cancer exhibit increased plasma levels of oestradiol and oestrone. Speculatively, these oestrogens may result from an increased oestrone conversion from androstenedione, an increased ovarian and adrenal secretion of androstenedione, or alternative oestrogen production routes. The present findings support the hypothetical role for oestrogens in the aetiology of endometrial cancer.
Flow cytometric studies of ploidy and proliferative indices in the Yorkshire trial of adjuvant progestogen treatment of endometrial cancer
Authors: Thornton J. G. , Ali S. , O'Donovan P. , Griffin N. , Wells M. , Macdonald R. R. 
Published: August 2005

ABSTRACTObjective
To estimate whether flow cytometric indices provide independent measures of prognosis or predict response to prophylactic progestogens in endometrial cancer.Design
Endometrial tumour specimens were retrieved and analysed by flow cytometry from 257 women who had been randomly allocated in a previous trial to receive prophylactic progestogen in addition to conventional therapy for endometrial carcinoma.Setting
Fourteen district and two teaching hospitals in West Yorkshire.Subjects
Women developing primary endometrial cancer between 1975 and 1983.Main outcome measures
Tumour ploidy status and proliferative indices and the relation of these to tumour stage and grade, to prognosis and to response to progestogens.Results
Ploidy status and proliferative indices were related to tumour stage, grade and patient survival but were not independent predictors of survival. They did not predict patients who would respond to progestogens although there was a nonsignificant trend towards patients with diploid tumours surviving longer after progestogen treatment.Conclusions
Flow cytometry adds little to established prognostic indicators for endometrial cancer.
Does elective cryopreservation of all embryos from women at risk of ovarian hyperstimulation syndrome reduce the incidence of the condition?
Authors: Wada I. , Matson P. L. , Troup S. A. , Morroll D. R. , Hunt L. , Lieberman B. A. 
Published: August 2005

ABSTRACTObjectives
To analyse the incidence and factors associated with the ovarian hyper‐stimulation syndrome (OHS) in our IVF/GIFT programme before and after the introduction of a strategy to cryopreserve all embryos from women judged to be at risk.Design
Two hundred forty‐one consecutive IVF/GIFT cycles from January to December 1989.Setting
Specialist fertility unit, Manchester, UK.Interventions
Pituitary suppression was effected by a daily subcutaneous injection of buserelin (500 μg) beginning 7 days before the expected menses. The ovarian stimulation was with variable amounts of human menopausal gonadotrophin. Ovulation was induced with 10 000 i.u. human chorionic gonadotrophin (hCG). From January to May (period A), gametes/embryos were replaced and 2000 i.u. hCG given, irrespective of the serum oestradiol (E2) concentration. From June to December (period B), all the embryos from women with an E2>3500 pg/ml on the day of ovulatory trigger were electively cryopreserved.Main outcome measures
Serum E2, features of moderate or severe OHS, clinical pregnancies.Results
The OHS occurred in 10/105 (9.5%) and 12/136 (8.8%) cycles in periods A and B, respectively. Fewer women (6% versus 60%, P<0.05) who had their embryos cryopreserved developed severe OHS compared with women with an E2 >3500 pg/ml who became pregnant after gamete/embryo transfer in period A. The main factors associated with the development of OHS were serum E2 concentrations >3500 pg/ml, whether gamete/embryos were replaced and the additional hCG given, the occurrence of a pregnancy and the presence of polycystic ovary disease.Conclusion
The elective cryopreservation of all embryos from women with high E2 levels reduced the severity, but not the incidence of symptomatic OHS.
Vaginal delivery after previous caesarean section: is X‐ray pelvimetry necessary?
Authors: Thubisi M. , Ebrahim A. , Moodley J. , Shweni P. M. 
Published: August 2005

ABSTRACTObjective
To determine whether antepartum X‐ray pelvimetry (XRP) reliably identified women suitable for a trial labour or repeat elective caesarean section after one previous section.Design
A prospective controlled trial in which women were randomly allocated to either an antepartum XRP group who had XRP at 36 weeks gestation to determine mode of delivery, or a control group who had a trial labour without antepartum XRP. Following delivery, all controls had postpartum XRP.Setting
Department of Obstetrics and Gynaecology, King Edward VIII Hospital, Durban, South Africa.Subjects
Three hundred‐six women with a history of one previous caesarean section.Main outcome measures
Mode of delivery, birthweight and maternal and perinatal mortality and morbidity in the two groups.Results
In the antepartum XRP group, 23 of 144 (16%) of women delivered vaginally compared with 60 of 144 (42%) controls (P<0.0001). Of the 84 women with adequate antepartum XRP only 23 (27.7%) delivered vaginally. In the control group, 33 of 60 (55%) women who had vaginal deliveries had inadequate postpartum XRP and would have had a caesarean section if this information was known in the antepartum period; 62 of 84 (74%) caesarean sections in the control group had adequate postpartum XRP. Birthweight of the infants was similar in the two groups. There were no maternal or perinatal deaths. Maternal morbidity was similar in the two groups. Neonatal morbidity was minimal.Conclusion
Antepartum XRP is not necessary prior to a trial labour in women with one previous caesarean section. It increases the caesarean section rate and is a poor predictor of the outcome of labour.