bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trial of labour after caesarean section in sub‐Saharan Africa: ameta‐analysis
Authors: Boulvain Michel , Fraser William D. , Brisson‐Carroll Gisèle , Faron Gilles , Wallast Elizabeth 
Published: August 2005

Objective To evaluate the safety and effectiveness of apolicy of trial of labour for women with a previous caes are an section, delivering in hospitals in sub‐Saharan Africa.Design Ameta‐analysis of 17 published reports. Setting Hospitals located in sub‐Saharan Africa.Main outcome measures The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical condition swere computed using an approach equivalent to a random effects model.Results The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI63–75%). Maternal mortality among all women with aprevious caesarean section was 1.9/1000 (95%CI0–4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95%CI1.0–3.2). Criteria used to select women foratrial of labour appeared to have a limited impact on the probability of vaginal delivery.Conclusions In hospitals in sub‐Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.
Outcome of pregnancy in women with Marfan's syndrome
Authors: Lipscomb Karen J. , Clayton Smith Jill , Clarke Bernard , Donnai Paul , Harris Rodney 
Published: August 2005

Objective
To improve life expectancy and prevent premature mortality in women with Marfan's syndrome.Methods
During the development of a regional genetic register for Marfan's Syndrome the outcome of 91 pregnancies in 36 women with this condition was established retrospectively and the cardiovascular and obstetric complications documented.Results
No patient had a significant cardiovascular abnormality limiting function before her pregnancy. Of 36 women, four had an aortic dissection relating to pregnancy and two others required aortic surgery following delivery. Thirty women had uncomplicated gestational histories. The incidence of obstetric complications did not exceed expectation.Conclusions
Women with Marfan's syndrome are at significant risk of aortic dissection in pregnancy even in the absence of preconceptional cardiovascular abnormality. Aortic root dilatation may be a predictor of risk but dissection may occur without significant dilatation. Guidelines for obstetric care are suggested and preconceptional assessment recommended.
A randomised controlled trial of Doppler ultrasound velocimetry of the umbilical artery in low risk pregnancies
Authors:   Doppler French Study Group
Published: August 2005

Objective
To evaluate the effect on management and outcome of pregnancy of routine umbilical Doppler examination in low risk populations.Design
Pragmatic randomised controlled trial.Setting
Twenty centres caring for low risk pregnant women.Participants
4187 women were randomly assigned to umbilical Doppler between 28 and 34 weeks of gestation or no routine umbilical Doppler. The women included were at low risk at 28 weeks of gestation denned by a normal ultrasonographic examination at the time of randomisation and no obstetric or medical complications during the first two trimesters of the pregnancy.Results
The general characteristics at inclusion were comparable for the two groups. Performance of umbilical Doppler led to a significant increase in the number of ultrasonographic and Doppler examinations subsequently conducted; there were no other effects on the management of the pregnancy. There was no significant difference in fetal distress during labour (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.70–1.33). There were three times fewer perinatal deaths in the Doppler group (three versus nine), but this difference was not significant (OR 0.33; 95% CI 0.06–1.33).Conclusion
Based on this trial routine use of umbilical doppler for low risk pregnancy cannot be recommended. More data are needed to reach a definite conclusion of the value of routine Doppler.
The case for stopping cervical screening at age 50
Authors: Cruickshank Margaret E. , Angus Valerie , Kelly Margaret , McPhee Susan , Kitchener Henry C. 
Published: August 2005

Objective
To determine the pattern of abnormal cervical cytology in women aged 50 to 60 years and to determine whether the development of cervical neoplasia in this age group is confined to women who have been inadequately screened.Design
Retrospective case analysis study.Population
An 11‐year birth cohort of women in Grampian Region born between 2/10/33 and 1/10/44, and those who had significant cytological abnormalities in the 5 year period 1/10/89 to 30/9/94.Main outcome measures
Cytological and histological outcome for women with significant cytological abnormalities between 50 to 60 years of age and the interval between three consecutive smears taken up to 50 years of age for those women.Results
Of 23,440 women aged 50 to 60 years ever screened in Grampian Region, 229 (1%) had significant cytological abnormalities. Seventy had CIN 3 and 15 had invasive disease of the cervix. Among approximately 9000 women with adequate smear histories prior to age 50, one case of CIN 3 and one case of invasion were detected. The prevalence of invasive disease in the whole cohort during this five year period was 59/100,000. Among the previously well screened women the prevalence was 11 /100,000.Conclusion
The incidence of preinvasive disease of the cervix is low over the age of 50 and is seen almost exclusively in inadequately screened women. There would appear to be little benefit in continuing cervical screening over the age of 50 in women who have had regular negative smears. The release of this low risk group from the cervical screening programme could alleviate anxiety and could enable reallocation of resources to target better high risk women who default from regular screening and to reduce screening intervals where necessary to three years.
Serum concentrations of cancer antigen 125, placental alkaline phosphatase, cancer‐associated serum antigen and free beta human chorionic gonadotrophin as prognostic markers for epithelial ovarian cancer
Authors: Ind Thomas , Iles Ray , Shepherd John , Chard Tim 
Published: August 2005

Objective
To investigate the prognostic significance of elevated levels of cancer antigen 125 (CA125), placental alkaline phosphatase (PLAP), free β human chorionic gonadotrophin (hCG) and cancer‐associated serum antigen (CASA) in women with primary epithelial ovarian carcinoma.Design
A two year follow up study of survival.Setting
A tertiary care gynaecological oncology unit.Participants
One hundred and eleven women with histologically confirmed epithelial ovarian cancer.Main outcome measures
Survival over a two year period.Results
Stage corrected log‐rank χ2 tests demonstrated a significant effect on survival for all four tumour markers (CA125 P= 0.0142; PLAP P < 0.0001; CASA P= 0.0098; hCG P= 0.0002). This was confirmed when each variable was fitted together with disease stage in Cox proportional hazard models. When fitted as multiple variables in a Cox proportional hazard model, the addition of free β‐ hCG and CASA to disease stage, PLAP concentrations and CA125 levels did not demonstrate further prognostic value.Conclusions
Levels of all four markers correlate with survival in patients with epithelial ovarian cancer. The combination of PLAP and CA125 concentrations together with disease stage may be used to predict survival but the addition of hCG and CASA levels do not give additional prognostic information.
A longitudinal study of umbilical artery Doppler waveforms in normal pregnancy: analysis using Laplace transform techniques
Authors: Brackley Karen J. , Ramsay Margaret M. , Pipkin Fiona Broughton , Rubin Peter C. 
Published: August 2005

Objective
To analyse umbilical artery Doppler waveforms using the Laplace transform analysis technique, an alternative method of waveform shape analysis, and to determine the normal ranges for the variables of this technique throughout normal pregnancy.Design
A prospective longitudinal study.Setting
Department of Obstetrics and Gynaecology, Nottingham University Hospital.Sample
A cohort of 17 healthy women investigated every four weeks from the end of the first trimester until term.Methods
Umbilical artery Doppler signals were recorded and analysed using the Laplace transform analysis technique. The median and interquartile ranges for each variable were determined and serial changes during pregnancy described.Results
Vessel wall tone decreases in the umbilical artery at the beginning of the second trimester. Alpha, the variable related to upstream flow conditions, also decreases at this stage of pregnancy but values are then comparatively stable from 24 weeks of gestation until term. A fall in downstream resistance within the fetoplacental circulation during pregnancy is detected using the C‐coefficient. Real pole appears to be of no value in the assessment of downstream resistance to flow in the fetus.Conclusions
The normal ranges for the Laplace transform analysis variables have been established for the umbilical artery longitudinally through normal pregnancy. Changes in fetal blood flow during complicated pregnancy can now be investigated using this technique.
Uterine thermal balloon therapy for the treatment of menorrhagia: the first 300 patients from a multi‐centre study
Authors: Amso Nazar N. , Stabinsky Seth A. , McFaul Peter , Blanc Bernard , Pendley Laura , Neuwirth Robert 
Published: August 2005

Objective
To evaluate the safety and efficacy of thermal balloon therapy for menorrhagia.Design
Prospective, observational study.Setting
Fifteen centres in Canada and Europe.Population
Two hundred and ninety‐six eligible women for whom follow up data were available for three months or more. Eligible women included those for whom further fertility was not a concern, were not postmenopausal, suffered from intractable menorrhagia, had a normal uterine cavity, and who were fully informed regarding the investigational nature of uterine thermal balloon therapy.Methods
Three hundred and twenty‐one procedures of balloon endometrial ablation were performed using the same protocol between June 1994 and August 1996. Exclusion criteria included structural uterine abnormality or (pre) malignant lesions. Treatment entailed controlled heating of fluid in an intrauterine balloon. General anaesthesia was employed in the 61% of procedures while local anaesthesia with or without sedation was used in 39% of cases.Analysis
Follow up data at 3 and/or 6, and/or 12 months were required for inclusion in the analysis. A paired t test, Wilcoxon signed‐ranks test, and multiple and logistic regression analyses were used to evaluate the changes in bleeding and dysmenorrhoea patterns, and possible confounding variables, respectively. Success was defined as the subjective reduction of menses to eumenorrhoea or less.Results
No intra‐operative complications occurred, and post‐operative morbidity was minimal. Success of the procedure was constant over the year (range 88%–91%). Treatment led to a significant decrease in the duration of menstrual flow and severity of pain (P < 0.0001). Increasing age, higher balloon pressure, smaller uterine cavity, and a lesser degree of pre‐procedure menorrhagia were associated with significantly improved results. Pre‐treatment with gonadotrophin releasing hormone agonists increased amenorrhoea and spotting rates (P= 0.03), but was only used in 5% of cases.Conclusion
Thermal balloon endometrial ablation appears to be safe, as well as effective in properly selected women with menorrhagia and is potentially an outpatient procedure.
Fetal cardiac function and septal thickness in diabetic pregnancy: a controlled observational and reproducibility study
Authors: Macklon Nicholas S. , Hop Wim C. J. , Wladimiroff Jurly W. 
Published: August 2005

Objective
To determine the reproducibility of duplex Doppler waveform analysis and fetal cardiac interventricular septal thickness measurement and to compare these parameters in matched pregnancies with and without well‐controlled maternal Type 1 diabetes at 18–20 weeks of gestation.Design
A prospective blind twin cohort study and a blinded inter‐observer and intra‐observer agreement study.Setting
A tertiary referral prenatal diagnostic unit within a university hospital.Results
Good inter‐ and intra‐observer agreement was found for the measurement of transvalvular peak flow velocities and the duration of ventricular ejection in the fetal heart. Inter‐observer agreement for aortic flow acceleration rate was poor. M‐mode measurement of interventricular septal thickness showed moderate reproducibility. The mean (SD) width of the interventricular septum in the fetuses of well controlled diabetic women was 2.1 mm (0.2 mm), and was significantly greater (P= 0.01) when compared with the corresponding value in matched controls [1.9 mm (0.2 mm)]. No cardiac functional differences were evident.Conclusions
On‐screen video analysis of Doppler cardiac flow waveforms and M‐mode measurement of intraventricular septal thickness demonstrated good reproducibility. The fetuses of well controlled diabetic pregnancies demonstrated signs of altered cardiac morphology early in pregnancy, before any evident alterations in cardiac function.
Reduced fetal exposure to aspirin using a novel controlled‐release preparation in normotensive and hypertensive pregnancies
Authors: Regan Carmen L. , McAdam Brendan F. , McParland Peter , Boylan Peter C. , FitzGerald Garret A. , Fitzgerald Desmond J. 
Published: August 2005

Objectives
To examine the fetal effects of a novel controlled‐release, low dose aspirin preparation in normal and hypertensive pregnancies.Design
Random double‐blind study. Participants assigned to receive conventional formulation aspirin (75 mg), controlled‐release low dose aspirin (75 mg), or matching placebo.Setting
National Maternity Hospital, Dublin.Participants
Eighteen women with an uncomplicated pregnancy and 18 women with preeclampsia.Main outcome measures
Urine was analysed for metabolites of thromboxane and prostacyclin by gas chromatography, mass spectrometry. Serum thromboxane B2, was determined in maternal and cord blood.Results
Both aspirin preparations reduced maternal serum thromboxane B2, by 95% and induced similar reductions in the urinary 11‐dehydro‐thromboxane B2, a major metabolite of thromboxane A2in vivo. In contrast, neither preparation altered urinary 2,3–dinor‐6‐keto PGF1α, the major metabolite of prostacyclin. Despite their similar effects in the mothers, the two aspirin preparations differed in their effects on the fetus. While both suppressed cord fetal thromboxane B2, this was significantly (P < 0.005) less for the controlled‐release preparation (210 ± 42 ng/ml for placebo vs 109 ± 22 ng/ml for controlled‐release aspirin and 44 ± 9 ng/ml for regular oral aspirin).Conclusions
At equivalent maternal suppression of serum thromboxane B2, a controlled aspirin release preparation results in lower fetal exposure than regular oral aspirin.
Two‐year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes
Authors: Cooper Kevin G. , Parkin David E. , Garratt Andrew M. , Grant Adrian M. 
Published: August 2005

Objective
To assess clinical status and changes in health related quality of life after two years in women randomised to medical management or transcervical resection of the endometrium (TCRE) for treatment of heavy menstrual loss.Design
Two‐year follow up using postal questionnaires and operative databank review.Setting
Gynaecology department of a large UK teaching hospital.Participants
Women who had joined a randomised comparison of medical treatment with TCRE for heavy menstrual loss two years previously.Main outcome measures
Women's satisfaction with treatment, gynaecological symptoms, changes in health related quality of life, and additional treatments received at two years.Results
Women allocated medical treatment were significantly less likely to be totally or generally satisfied (57%vs 79%, difference −22%, 95% CI −36, −9%), to find their management acceptable (77%vS 93%. difference −16%, 95% CI −26, A%), or to recommend their allocated treatment (24%vs 78%, difference −54%, 95% CI −61, −33%). In the medical cohort 59% of women had undergone TCRE, hysterectomy or both, whereas 17% in the TCRE cohort had undergone further surgery. Bleeding and pain scores were similar in the groups and highly significantly better than at recruitment. Short Form‐36 health survey scores were significantly improved from baseline for five of the eight health scores in the medical arm, and seven in the TCRE arm.Conclusions
The results at two years consolidate the findings and conclusions based on the four‐month follow up data. A policy of early TCRE is effective and safe and does not result in an increase in hysterectomies. It should not be routinely withheld in an effort to try alternative medical therapies.
Comparison of vaginal misoprostol and gemeprost as pretreatment in first trimester pregnancy interruption
Authors: Henry Aila‐Maija , Haukkamaa Maija 
Published: August 2005

Objective
To compare the effectiveness of vaginal misoprostol pretreatment with standard gemeprost pre‐treatment in first trimester pregnancy termination.Design
A prospective randomised study.Population
One hundred and ninety‐nine women scheduled for day case termination of pregnancy during the first trimester.Methods
Cervical priming with a vaginally applied 200 μg tablet of misoprostol for at least four hours, compared with a 1.0 mg vaginal suppository of gemeprost for at least three hours before vacuum aspiration.Main outcome measures
The prostaglandin effect on baseline cervical dilatation was the main outcome. Others were occurrence of pre‐operative pain and need for analgesia, pre‐operative side effects such as nausea, vomiting and diarrhoea, presence of blood in the vagina and blood loss during the operation.Results
There was no significant difference in the dilatation ability of misoprostol or gemeprost, nor in the preoperative use of analgesics. The frequency of nausea and diarrhoea was significantly less common in the misoprostol treated women.Conclusions
Vaginally applied misoprostol is as effective as gemeprost in cervical priming prior to first trimester vacuum aspiration. Misoprostol was associated with fewer side effects than gemeprost.
Review and assessment of selection criteria used when booking pregnant women at different places of birth
Authors: Campbell R. 
Published: August 2005

Objective
To describe and assess the selection criteria currently being used when booking women for different places of birth.Design
A cross‐sectional survey.Setting
The South and West region of England.Sample
The 27 NHS Trusts who provide maternity care in the South and West region of England.Main measures
Selection criteria used when booking pregnant women for different places of birth; length of time criteria in use; whether criteria applied individually or as part of a risk score; and method by which criteria developed.Results
The response rate was 81%; 128 different, individual criteria, used as the basis to select women for different places of birth, were identified. No single criterion appeared on all the sets of criteria. None of the trusts who responded used the criteria in order to calculate a risk score. In all but one case the criteria were being used to select women who might be suitable for birth outside a consultant‐led maternity unit. Only two trusts used sets of criteria which identified, to any extent, 1. outcomes for which women could be at risk and 2. strategies that should be implemented to reduce that risk. Over half the trusts were able to identify a rationale for the particular set of criteria which they used but in only two cases was any reference made to an evidence base.Conclusions
A large variety of criteria are being used as a basis on which to book women for different places of birth but they appear to be poorly focused on particular adverse outcomes. To be effective, selection criteria must identify quantifiable differences in the risk of particular preventable adverse outcomes for births booked at different locations. Furthermore, there must be evidence that the risk could be reduced by a selecting a particular location. A systematic review is required to determine which selection criteria, if any, should be employed at booking.
In vitro accuracy of a novel registration and targeting technique for image‐guided template production
Authors: Widmann Gerlig , Widmann Roland , Widmann Ekkehard , Jaschke Werner , Bale Reto Josef 
Published: August 2005

AbstractObjectives: The objective of this study was to evaluate the accuracy of a novel registration and targeting technique for image‐guided template production (IGTP) in a preliminary phantom study.Material and methods: Registration of four standard dental stone casts with integrated target pellets to the corresponding computed tomography (CT) data was performed via a vacuum mouthpiece and an external reference frame (Medical Intelligence GmbH, Germany). Using the Treon navigation system (Medtronic Inc., Minneapolis, MN, USA) a surgical path with the entry in the centre of the dental crown and the target in the centre of the target pellet was planned on the CT data. An aiming device was adjusted according to the planned trajectory and guided drillings into the dental stone casts. The accuracy was evaluated on postoperative 3D‐CT data.Results: The mean fiducial registration error as given by the registration software was 0.4 mm. One hundred and twelve navigated drillings showed a mean accuracy [xy] of 0.42±0.26 mm (maximum 1 mm). For the z‐axis, a mean accuracy [z] of 0.25±0.12 mm (maximum 0.6 mm) was found.Conclusions: Comparing the presented registration technique to existing registration methods in IGTP and burr tracking, no radiographic and registration templates are needed. The procedure is easy and requires only minimal effort. Navigation‐controlled drillings could be performed with an accuracy that approaches the intrinsic navigation system's accuracy, a fact that warrants its use for surgical template production. Further accuracy studies of template‐guided drillings are necessary before the presented registration technique can be implemented for patient treatment.
Control of Charge Dilution in Turbocharged Diesel Engines via Exhaust Valve Timing
Authors: Yilmaz Hakan , Stefanopoulou Anna 
Published: August 2005

Abstract
In this paper we extend an existing crank angle resolved dynamic nonlinear model of a six-cylinder 12 l turbocharged (TC) Diesel engine with exhaust valve closing (EVC) variability. Early EVC achieves a high level of internal exhaust gas recirculation (iEGR) or charge dilution in Diesel engines, and thus reduces generated oxides of nitrogen (NOx). This model is validated in steady-state conventional (fixed EVC) engine operating points. It is expected to capture the transient interactions between EVC actuation, the turbocharger dynamics, and the cylinder-to-cylinder breathing characteristics, although this has not been explicitly validated due to lack of hardware implementation. A nominal low order linear multi-input multi-output model is then identified using cycle-sampled or cycle-averaged data from the higher order nonlinear simulation model. Various low-order controllers that vary EVC to maximize the steady-state iEGR under air-to-fuel ratio (AFR) constraints during transient fueling demands are suggested based on different sensor sets. The difficulty in the control tuning arises from the fact that the EVC affects both the AFR and engine torque requiring coordination of fueling and EVC. Simulation results are shown on the full order model.