bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomised controlled comparison of betamethasone with dexamethasone: effects on the antenatal fetal heart rate
Authors: Magee L. A. , Dawes G. S. , Moulden M. , Redman C. W. G. 
Published: August 2005

Objective
To compare the effects of maternal administration of betamethasone and dexamethasone on fetal heart rate, using computerised numerical analyses, and to examine the association between changes in short term variation and the timing and indication for delivery.Setting
John Radcliffe Hospital, Oxford.Sample
Fifty‐nine women with singleton pregnancies, who were at risk of delivery before 34 weeks of gestation, had received no steroids in the preceding week and could give informed consent.Methods
Women were randomised on a double‐blind basis to receive either betamethasone or dexamethasone. The fetal heart rate was recorded (60‐minute duration at similar times of day) before steroid administration and on each of the following two days; changes were measured by computerised analyses.Main outcome measures
Changes in short term variation and long term variation of fetal heart rate or the number of fetal movements. Statistical analysis was nonparametric.Results
Betamethasone and dexamethasone had no differential effects on the computerised cardiotocography. However, both steroids decreased baseline fetal heart rate, increased long term variation, increased short term variation, and decreased fetal movements on the first day after steroid administration, and decreased high fetal heart rate variation and decelerations on the second day. Among 13 women who were delivered within one week of steroid administration, smaller rises in short term variation on day one were associated with delivery for fetal indications.Conclusions
Both betamethasone and dexamethasone produced transient, unexplained changes in the fetal heart rate over the two days following steroid administration. Larger changes in short term variation were associated with fetal wellbeing. It is important to recognise that such changes are a physiological response of the human fetus to steroid administration.
Urodynamics: prediction, outcome and analysis of mechanism for cure of stress incontinence by periurethral collagen
Authors: Monga Ash K. , Stanton Stuart L. 
Published: August 2005

Objective
To assess the role of urodynamics in the prediction and assessment of outcome and analysis of the mechanism of cure for stress incontinence using periurethral collagen as our treatment model.Design
Prospective longitudinal study.Setting
A teaching hospital tertiary referral centre.Patients
Sixty women with genuine stress incontinence.Results
The objective cure rate was 54% (n= 54) at 12 months. Subtracted cystometry, urethral electrical conductivity and bladder neck excursion measurements did not predict cure. A low pre‐injection maximum urethral closure pressure adversely affects outcome (31 cmH2O (success) vs 19 cmH2O (failure), P= 0.004); all women with a maximum urethral closure pressure > 39 cmH2O were rendered dry. Urethral pressure profilometry can analyse mechanism of cure. Total profile length, stress maximum urethral closure pressure, stress functional urethral length and pressure transmission ratio in the first quarter of urethral length were increased in successful cases (P < 0.05), and rest maximum urethral and maximum urethral closure pressures, area under rest profile and pressure transmission ratio in the second quarter of urethral length were increased in failed cases (P < 0.02).Conclusions
In successful cases the increased area and pressure transmission ratio in the first quarter of the functional urethral length suggest that collagen placement occurs at the bladder neck or proximal urethra. Cure appears to be due to prevention of bladder neck opening during stress and not obstruction. In addition the cephalad elongation of the urethra caused by collagen probably accounts for the increased abdominal pressure transmission in the first quarter of the urethra. In failures, there is an increased length and increased area to peak pressure suggesting collagen is deposited more distally. This study confirms the role of certain urethral pressure profilometry variables in the prediction and analysis of mechanism of cure.
The mythology of hormone replacement therapy
Authors: Hartmann Beda W. , Huber Johannes C. 
Published: August 2005

Objective
To evaluate the literature on contraindications contained in pharmaceutical data sheets of five currently available oestrogen replacement preparations (HRT). These contraindications include cardiovascular disease, diabetes, liver diseases, otosclerosis, endometriosis, melanoma and hormone‐dependent tumours.Design
Systematic review.Interventions
Oestrogen replacement regimens.Results
The contraindications to the five HRT preparations have been taken uncritically from the data sheets of oral contraceptives. In some of these conditions not only is HRT not contraindicated, it is indicated. The data sheets for the HRT preparations all state that cardiovascular disease is a contraindication, but systematic review shows that ischaemic heart disease, hypertension and hyperlipidaemia are not contraindications, and in ischaemic heart disease HRT may actually be indicated. Similarly, systematic review shows that diabetes, chronic liver disease, endometriosis, some cases of treated cancer of the endometrium and breast, melanoma and otosclerosis are not contraindications to HRT.Conclusions
The information in the pharmaceutical data sheets of HRT regimens should be modified as more accurate information could influence how these preparations are prescribed by doctors as well as affect patient compliance.
Association of gestational diabetes with abnormal maternal vascular endothelial function
Authors: Knock Gregory A. , McCarthy Andrew L. , Lowy Clara , Poston Lucilla 
Published: August 2005

Objective
To evaluate vascular endothelial function in isolated small arteries from women with gestational diabetes.Methods
Small subcutaneous arteries (mean luminal diameter ∼ 250μm) were dissected from biopsies obtained at caesarean section in 14 normotensive women with gestational diabetes and in 18 normotensive nondiabetic pregnant women. Vascular function was determined after mounting the arteries on a small vessel myograph.Results
Pre‐constricted arteries from gestational diabetic pregnant women demonstrated poor relaxation to acetylcholine, an endothelium‐dependent vasodilator (pEC50, mean [SE], 6.98 [0.10] vs normal pregnant, 7.28 [0.08], P < 0.03; % maximum relaxation, median [range], 88.2 [42.4–994] vs normal pregnant 94.2 [71.8–100.0], P < 0.01). In the presence of indomethacin relaxation to acetylcholine was similar in both groups suggesting a deficiency in dilator prostaglandin synthesis in the arteries from the diabetic women. The nitric oxide synthase inhibitor N ‐monomethyl‐L‐arginine further reduced sensitivity of arteries to acetylcholine but to a similar degree in both normal pregnant and gestational diabetic women. Relaxation to sodium nitroprusside, an indicator of sensitivity of the vascular smooth muscle to nitric oxide, was similar in both groups.Conclusions
Maternal vascular endothelial dysfunction may contribute to the increased incidence of cardiovascular disorders in women with gestational diabetes.
Impact of percutaneous oestradiol gels in postmenopausal hormone replacement therapy on clinical symptoms and endometrium
Authors: Foidart Jean‐Michel , Beliard Aude , Hedon Bernard , Ochsenbein Edith , Bernard Anne‐Marie , Bergeron Christine , Thomas Jean‐Louis 
Published: August 2005

Objective
To compare the effects on endometrium, climacteric symptoms and the menstrual cycle, and the clinical and biological tolerance of two percutaneous oestradiol gels used as hormone replacement therapy.Design
A large open randomised multicentre study.Setting
France and Belgium.Participants
Two‐hundred and fifty‐four women with an intact uterus and who had experienced a natural menopause received either Oestrogel® (n= 126) or Estreva®, a new formulation of oestradiol gel (n= 128), (1.5 mg of oestradiol/day) for the 24 first days of each calendar month during six consecutive months. Nomegestrol acetate (Lutenyl®), a norprogesterone derivative, was administered (5 mg/day) from day 11 to day 24 of each oestradiol cycle.Main outcome measures
Examination of endometrial biopsies taken before treatment and between days 18 and 24 of the last treatment cycle, climacteric symptoms assessed using a modified Kupperman index, control of menstrual cycle evaluated by diary cards, and clinical and biological tolerance.Results
Both treatments lowered the frequency and intensity of hot flushes and the global Kupperman index. 96% of the cycles were followed by withdrawal bleeding. Breakthrough bleeding or spotting resulted in premature discontinuation of treatment in one volunteer. Mastodynia occurred in 20 women and contributed to the premature termination of treatment in three of them. Endometrial biopsies taken at the end of treatment showed identical histologies in both groups, with a secretory pattern in the majority of women, and absence of hyperplasia.Conclusions
This trial confirmed that, when the two oestradiol gels tested were administered cyclically with nomegestrol acetate to postmenopausal women, they were well tolerated, effective and suitable for the treatment of oestrogen deficiency syndrome.
Use of oral misoprostol in the prevention of postpartum haemorrhage
Authors: El‐Refaey Hazem , O'Brien Pat , Morafa Wale , Walder Jane , Rodeck Charles 
Published: August 2005

Objective
To investigate the use of the oral prostaglandin E1 analogue, misoprostol in the prevention of postpartum haemorrhage.Design
A prospective observational study.Setting
A university teaching hospital.Participants
Two hundred and thirty‐seven consecutive women undergoing vaginal delivery.Methods
All the women were given 600 μg oral misoprostol just after delivery.Main outcome measures
Rates of postpartum haemorrhage; need for therapeutic oxytocic drugs; retained placenta and length of the third stage of labour.Results
Postpartum haemorrhage occurred in 6% of the women; the need for therapeutic oxytocics in 5%, retained placenta in 2% and the median length of the third stage was 5 min. Vomiting and diarrhoea in the first hour after delivery occurred in 8% and 3% respectively and shivering in 60%.Conclusions
Misoprostol may be effective in the prevention of postpartum haemorrhage, and has few side effects. A double blind randomised trial is required.
The diagnostic accuracy of cervico‐vaginal fetal fibronectin in predicting preterm delivery: an overviev
Authors: Chien Patrick F. W. , Khan Khalid S. , Ogston Simon , Owen Philip 
Published: August 2005

Objective
To determine the accuracy with which cervico‐vaginal fetal fibronectin predicts preterm delivery using systematic quantitative overview of the available literature.Design
Online searching of MEDLINE database (1966 to April 1996), scanning of bibliography of known primary and review articles and review of recent journal issues. Study selection, assessment of study quality and data extraction were performed in duplicate under masked conditions. Likelihood ratios were generated in subgroups of symptomatic and asymptomatic pregnant women by pooling data from different studies. An LR of > 10 or < 0.1 indicated conclusive changes in the pretest probability of preterm delivery while an LR of 5–10 or 0.2–0.1 indicated only moderate changes.Participants
Seven hundred and twenty‐three symptomatic women with threatened preterm labour included in nine studies and 847 asymptomatic women (635 low risk and 212 high risk) included in six studies selected for meta‐analyses.Main outcome measures
Likelihood ratios for positive and negative test results using delivery at < 37 and < 34 weeks of gestation, and within one week of testing as outcome measures.Results
In symptomatic women a positive test predicted delivery < 37 weeks of gestation with a pooled likelihood ratio (LR) of 4.6 (95% CI 3.5–6.1) while a negative test had a pooled LR of 0.5 (95% CI 0.4–0.6). For delivery < 34 weeks of gestation, the pooled LR was 2.6 (95% CI 1.8–3.7) for a positive test and 0.2 (95% CI 0.1–0.5) for a negative test. For delivery within one week of testing, the pooled LR was 5.0 (95% CI 3.8–6.4) for a positive test and 0.2 (95% CI 0.1–0.4) for a negative test. In asymptomatic women at low risk of delivery < 37 weeks of gestation the pooled LR was 3.2 (95% CI 2.2–4.8) for a positive test and 0.8 (95% CI 0.7–0.9) for a negative test. In high risk asymptomatic women using delivery < 37 weeks of gestation as an outcome measure the pooled LR was 2.0 (95% CI 1.5–2.6) for a positive test and 0.4 (95% CI 0.2–0.8) for a negative test. For delivery < 34 weeks of gestation in high risk, asymptomatic women the pooled LR was 2.4 (95% CI 1.8–3.2) for a positive test and 0.6 (95% CI 0.4–0.9) for a negative test.Conclusion
The presence of fetal fibronectin in cervico‐vaginal mucus has limited accuracy in predicting preterm delivery as the likelihood ratios for positive and negative test results generated only minimal to moderate changes in the pretest probability of preterm birth.
Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy
Authors: Poen A. C. , Felt‐Bersma R. J. F. , Dekker G. A. , Devillé W. , Cuesta M. A. , Meuwissen S. G. M. 
Published: August 2005

Objective
To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention.Design
Retrospective case–control study.Setting
A teaching hospital in The Netherlands.Participants and methods
One hundred and twenty cases of vaginal delivery complicated by third degree perineal tear and 702 uncomplicated vaginal deliveries were compared, with respect to possible risk factors.Results
In a multivariate model high birthweight, forceps delivery, induced labour, epidural anaesthesia and parity were risk factors for anal sphincter tear. In addition, mediolateral episiotomy was associated with fewer sphincter injuries. Separate analysis of nulli‐ and multiparous women demonstrated that high birthweight and epidural anaesthesia (increased risk) and mediolateral episiotomy (decreased risk) were factors associated with anal sphincter tear only in nulliparous women.Conclusions
We found several risk factors for anal sphincter tear. Nulliparous women are at higher risk than multiparous women. Mediolateral episiotomy may be sphincter‐saving especially in nulliparous women and therefore prevent them from chronic faecal incontinence.
Significance of low birthweight for gestational age among very preterm infants
Authors: Spinillo Arsenio , Capuzzo Ezio , Piazzi Gaia , Baltaro Federica , Stronati Mauro , Ometto Alessandra 
Published: August 2005

Objective
To estimate the risk of specific adverse neonatal events resulting from the combined effects of prematurity and low birthweight in very preterm infants (delivered at 24–31 weeks of gestation)Design
A cohort study of specific adverse neonatal events in preterm infants born at between 24 and 31 weeks of gestation.Setting
Pavia, Italy.Population
Two hundred and thirty singleton infants with sonographically confirmed gestational age, delivered at 24 to 31 weeks of gestation.Methods
To evaluate the impact of a lower than expected birthweight on selected neonatal events independently of gestational age, we calculated birthweight standard deviation scores (differences between actual birthweight and fitted birthweight divided by fitted standard deviation) for each week of gestation.Results
After adjustment for gestational age and other confounders, there was a significant linear trend relating a decreasing birthweight SDS to an increased likelihood of neonatal death, intraventricular haemorrhage, severe respiratory distress syndrome, and acidosis. Compared with infants with SDS 0 ( 50th centile of birthweight), infants with birthweight SDS < −1 (< 16th centile) had increased odds for neonatal death [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.42–9.6], grade III‐IV intraventricular haemorrhage (OR 17.5, 95% CI 4.04–75.9), and neonatal acidosis (OR 3.22, 95% CI 1.41–7.4). The significance of birthweight SDS as a predictor of neonatal outcome, however, was lower than that of gestational age.Conclusions
A lower than expected birthweight affects the likelihood of several adverse neonatal events in very preterm infants. However, a decreasing birthweight SDS affects neonatal outcome less than decreasing gestation does.
Antioxidants in the treatment of severe pre‐eclampsis an explanatory randomised controlled trial
Authors: Gülmezoǧlu A. Metin , Hofmeyr G. Justus , Oosthuisen Mathys M. J. 
Published: August 2005

Objective
To determine whether antioxidant therapy alters the disease process in severe early onset pre‐eclampsia, in support of the hypothesis that increased lipid peroxides and reactive oxygen species production play an important role in the pathogenesis of the disease.Design
Randomised, double‐blind, placebo controlled trial.Setting
Two tertiary care, referral hospitals in Johannesburg, South Africa.Participants
Women with severe pre‐eclampsia diagnosed between 24 and 32 weeks of gestation.Intervention
Combined antioxidant treatment with vitamin E (800 IU/day), vitamin C (1000 mg/day), and allopurinol (200 mg/day).Main outcome measures
Primary outcomes: 1. prolongation of pregnancy and 2. biochemical assessment of lipid peroxides and antioxidants. Secondary outcomes: data on maternal complications, side effects of treatment, infant outcomes and regular assessment of haematologic and renal parameters.Results
The proportion of women delivered within 14 days in the antioxidant group was 52% (14/27) compared with 76% (22/29) in the placebo group (relative risk 0.68, 95% confidence interval 0.45–1.04). One woman in each group had eclampsia. Eleven women (42%) in the antioxidant and 16 (59%) in the placebo group required two antihypertensives for blood pressure control. Trial medications were well tolerated with few side effects. Lipid peroxide levels were not significantly altered in the antioxidant and placebo groups. Serum uric acid levels decreased and vitamin E levels increased significantly.Conclusion
The results of this explanatory randomised trial do not encourage the routine use of antioxidants against pre‐eclampsia. However, further research with modified strategies such as earlier initiation of therapy or different combinations seem worthwhile.
Predictors of successful external cephalic version at term: a prospective study
Authors: Lau T. K. , Lo Keith W. K. , Wan D. , Rogers Michael S. 
Published: August 2005

Objective
To investigate clinical and ultrasonographic predictors of outcome of external cephalic version at term.Design
Prospective observational study.Setting
University obstetric unit.Population
All external cephalic versions performed over two years (n=243).Methods
Nineteen different clinical and ultrasonographic variables were recorded before each procedure. The ability of each of the 19 variables to predict the success or failure of external cephalic version was assessed by univariate analysis. The study population was then divided into two subgroups of 129 and 114 patients by random allocation using computer generated numbers. Logistic regression was performed in each subgroup to assess the relative importance and independence of the important variables. The derived regression models were then applied to the other subgroup of patients to assess accuracy and reproducibility.Results
The overall success rate of the procedure was 69.5%. Both regression models identified the same three variables as independent predictors of failed versions: 1. presenting part engaged; 2. difficult to palpate the fetal head, and 3. a tense uterus on palpation. The two models correctly predicted 75.2% and 84.2% of outcomes in the other subgroup. If uterine tone, which was assessed after administration of tocolytic, was excluded from the analysis, the other two factors remained in the models, with the addition of nulliparity as a significant predictor of failed external cephalic version. The chance of success of external cephalic version in the original 243 women was found to be < 20% if two of these variables were present, 0% if all three were present, and 94% if none were present.Conclusions
The outcome of external cephalic version can be predicted by easily available clinical parameters.
Sweeping of the membranes at 39 weeks in nulliparous women: a randomised controlled trial
Authors: Cammu Hendrik , Haitsma Vera 
Published: August 2005

Objective
To determine whether weekly sweeping of the membranes from 39 weeks of gestation results in a reduction in the number of women reaching 41 completed weeks and subsequently in a reduction of the number of women who will need induction of labour.Design
Randomised controlled trial.Participants
Two hundred and seventy‐eight nulliparous women, who were seen at the antenatal clinic of a university teaching hospital, were randomly allocated at 39 weeks of gestation to receive on a weekly basis either sweeping of the membranes (n=140) or a routine pelvic examination (n=138).Main outcome measures
The time interval between randomisation and delivery, the incidence of prolonged pregnancy (i.e. > 41 completed weeks), and the incidence of induction of labour.Results
In 24 women (17%) sweeping of the membranes was not possible. Fifty‐three women (38%) in the sweeping group and 50 women (36%) in the control group were delivered within one week after randomisation. Women allocated to sweeping showed a trend towards having a shorter randomization‐delivery interval: 9.4 days versus 10.6 days in the controls (P= 0.087). Sweeping had no statistically significant effect on the mean duration of pregnancy (282.8 days in the sweeping group versus 283.8 days in the control group, P= 0.127). The need for induction of labour was significantly reduced in those women who underwent sweeping (11%versus 26%, P= 0.004), merely as a result of a decrease in the number of women that exceeded 41 weeks (19%versus 33%, P= 0.016).Conclusion
Sweeping of the membranes weekly from 39 weeks does not increase the number of women who will deliver within the first week but significantly decreases the number that will reach 41 weeks. Induction of labour then becomes less necessary.