bluuebunny/crossref_metadata_2025_split huggingface dataset:
Signal processing and display—cardiotocographs
Authors: Carter Michael C. 
Published: August 2005

ABSTRACTThe technology used in cardiotocographs limits the basic resolution of the recorded data. The limitations and errors generated by the data collection, signal processing (autocorrelation) and printing the fetal heart rate (FHR) are discussed. Although adequate for displaying baseline variability, present‐day cardiotocographs are incapable of displaying beat‐to‐beat changes in FHR.
The loss of a baby at birth: the role of the bereavement officer
Authors: Appleton Richard , Gibson Brenda , Hey Edmund 
Published: August 2005

ABSTRACTObjective
To illustrate and emphasise the role of the Bereavement Officer in the management of perinatal death, as recommended and envisaged by a report of the Royal College of Obstetricians and Gynaecologists in 1985.Design
A description of the training and responsibilities of the officer and an account of her involvement with all perinatal deaths within a given period.Setting
Perinatal deaths in the 12 months, 1 October 1989 to 30 September 1990 from a regional neonatal intensive care unit within a maternity hospital.Subjects
A total of 59 registerable deaths, three late terminations (severe fetal abnormality) and 12 late mid‐trimester miscarriages were dealt with by the Bereavement Officer in this 12 month period.Results
The introduction of this service to our unit has led to an improvement in our management of both perinatal and fetal deaths.Conclusion
The service has justified fully the recommendations made by the Royal College of Obstetricians and Gynaecologists. Reducing parents’ distress will facilitate their grieving and any subsequent bereavement counselling.
Screening for fetal distress in labour using the umbilical artery blood velocity waveform
Authors: Somerset D. A. , Murrills A. J. , Wheeler T. 
Published: August 2005

ABSTRACTObjective
To investigate the potential value of umbilical artery blood velocity waveform measurement as a screening test for intrapartum fetal distress on admission to the labour ward.Design
Prospective study drawn from the local population of pregnant women.Setting
The labour ward of the Princess Anne Hospital, Southampton, UK.Subjects
334 women with singleton pregnancies of at least 37 weeks gestation.Main outcome measure
Emergency caesarean section for fetal distress.Results
There was a twelvefold increase in the rate of emergency caesarean section for fetal distress (95% Confidence Interval (CI), 4.9‐29) among women with a systolic/diastolic (S/D) ratio 3.0, when compared to those with an S/D ratio of <3.0 (P < 0.00001). Measurement of the umbilical artery blood velocity waveform compared favourably with admission cardiotocography.Conclusions
Umbilical artery blood velocity waveform analysis may be used to screen for fetal distress in labour and appears to be particularly sensitive to problems of placental origin. However, it is not likely to confer benefit in labour wards whose fetal heart rate monitoring policy is determined by pregnancy risk factors and admission cardiotocography.
Low maternal serum levels of pregnancy associated plasma protein A (PAPP‐A) in the first trimester in association with abnormal fetal karyotype
Authors: Brambati B. , Macintosh M. C. M. , Teisner B. , Maguiness S. , Shrimanker K. , Lanzani A. , Bonacchi I. , Tului L. , Chard T. , Grudzinskas J. G. 
Published: August 2005

ABSTRACTObjective
To assess the relation between maternal serum pregnancy associated plasma protein A (PAPP‐A) in the first trimester and the outcome of pregnancy by karyotype.Design
A retrospective study of PAPP‐A levels in blood samples collected prior to chorionic villus sampling.Setting
Milan, Italy.Subjects
Five hundred twenty‐two women, aged 20 to 47, at 7 to 11 weeks gestation, prior to undergoing chorionic villus sampling. Four hundred forty‐five women had a pregnancy with a normal karyotype; in 30 pregnancies the karyotype was abnormal (including 14 cases of Down's syndrome and 7 of trisomy 18).Main outcome measures
Normal or abnormal fetal karyotype. Serum PAPP‐A at 6 to 11 weeks gestation measured by radioimmunoassay.Results
The median value of PAPP‐A in the abnormal group was 0.27 multiples of the normal median (MoM). This is significantly lower than the median value in the normal group (1.01 MoM) (95% CI for the difference 0.46–0.84 MoM; P<0.00001 Mann‐Whitney test).Conclusions
There is an association between low levels of PAPP‐A in the first trimester with chromosome anomalies. Screening by measurement of PAPP‐A might detect 60% of cases of Down's syndrome in the first trimester with a false positive rate of 5%.
The individualised birthweight ratio: a more logical outcome measure of pregnancy than birthweight alone
Authors: Wilcox Mark A. , Johnson Ian R. , Maynard Paul V. , Smith Sarah J. , Chilvers Clair E. D. 
Published: August 2005

ABSTRACTObjective
To provide a new outcome measure for pregnancy specifically related to the individual.Design
Computer analysis of physiological factors affecting birthweight.Setting
Two provincial teaching hospitals (University and City Hospitals, Nottingham) and an associated district general hospital (Derby City Hospital) serving a defined catchment area in the East Midlands.Subjects
All women delivering in the above hospitals since the start of computerised obstetric records: 31 561 women with gestational age verified by early pregnancy ultrasound scan data.Main Outcome Measures
Calculation of the predicted birthweight taking into account maternal and fetal physiological factors. Derivation of the individualised birthweight ratio (actual birthweight divided by predicted birthweight expressed as a percentage) for each individual baby.Results
The individualised birthweight ratio redefines as normally grown 41% of babies below the 10th centile of crude birthweight for gestation. Other babies previously regarded as normal are redefined as growth retarded. At the upper end of the distribution 46% of those above the 90th centile of birthweight for gestation are redefined as normally grown.Conclusions
The predicted birthweight can be calculated for an individual pregnancy at a given gestation. The standardised comparison between this predicted birthweight and the actual birthweight is a more logical reflection of the normality of intrauterine growth and therefore more logical as an outcome measure for pregnancy than crude birthweight for gestation.
Intravaginal misoprostol as a cervical ripening agent
Authors: Fletcher H. M. , Mitchell S. , Simeon D. , Frederick J. , Brown D. 
Published: August 2005

ABSTRACTObjective
To determine if misoprostol (exogenous prostaglandin E1 PGE1) used vaginally was of value in improving the Bishop score, leading to an early safe vaginal delivery in women in whom the cervix is unripe and delivery is indicated.Design
A double‐blind clinical trial.Setting
Antenatal and labour wards of the University Hospital of the West Indies, Jamaica.Subjects
Forty‐five women in the third trimester with various obstetric indications for induction of labour and with no contra‐indications to prostaglandins.Interventions
The women were randomly assigned to receive treatment or a placebo. The treated group had 100 μg misoprostol inserted vaginally while the placebo was similarly inserted.Main outcome measures
Efficacy of the misoprostol was measured by the increase in the Bishop score 12 h after giving the treatment, the time between insertion and delivery, the need for oxytocin, and the out‐come of the pregnancy.Results
The prostaglandin was superior to the placebo in ripening the cervix and inducing labour. The change in Bishop score was 5·3 in the misoprostol group compared with 1·5 in the placebo group (P < 0·001). The mean time from insertion to delivery was 15·6 h in the former while it was 43·2 h in the placebo group (P≤ 0·001). The need for oxytocin was also significantly less in the women receiving the prostaglandin compared with those who received the placebo (29%vs 62%, P < 0·02). There was no difference in the two groups in the delivery outcome in terms of complications, Apgar scores and mode of delivery.Conclusions
Intravaginal misoprostol is an effective and cheap method of inducing labour in the third trimester.
The design, effectiveness and acceptability of the arm sleeve for the prevention of body fluid contamination during obstetric procedures
Authors: Kabukoba Josaphat J. , Pearce J. Malcolm 
Published: August 2005

ABSTRACTObjective
1. To design a device that would reduce contamination of staff during obstetric procedures. 2. To undertake clinical trials to assess the effectiveness and acceptability of such a device.Design
A prospective study. The arm sleeve is made of a nonwoven material laminated on polyethylene film making it waterproof. It has an elastomeric cuff with adhesive that ensures a watertight seal between it and the glove.Setting
Delivery suite in a teaching hospital.Methods
Doctors and midwives were requested to wear the sleeve on top of the standard gown and gloves. Each user was assessed for blood contamination at the end of the procedure and a questionnaire detailing the extent of contamination and the views of the user was completed.Results
Eighty questionnaires were completed. The contamination of arms and hands was 3.8% and 5%, respectively. Eighty‐nine percent thought the sleeve had served its purpose and 76% said they would use it regularly.Conclusions
The sleeve is an effective protective device which complements the glove and gown. We recommend that it should be used during all obstetric procedures.
Endometrial fibrinolytic enzymes in women with normal menstruation and dysfunctional uterine bleeding
Authors: Gleeson N. , Devitt M. , Sheppard B. L. , Bonnar J. 
Published: August 2005

ABSTRACTObjective
To study fibrinolysis in the endometrium in women with normal menstruation and dysfunctional uterine bleeding (DUB).Design
Tissue plasminogen activator activity (t‐PA) and antigen (t‐PAAg) and plasminogen activator inhibitor Type 1 antigen (PAI‐1) were measured in homogenates of endometrium sampled between 24 and 36 h after the onset of menstruation.Subjects
Women complaining of menorrhagia who had negative findings at clinical examination and curettage had their menstrual blood loss (MBL) measured from the third cycle after D&C. Those with MBL greater than 80 ml per cycle formed the DUB group.Measurements
Fibrinolytic enzyme antigen levels were measured with ELISAs. Tissue plasminogen activator activity was assayed by measuring the rate of conversion of Glu‐plasminogen to plasmin, using a chromogenic plasmin substrate.Conclusions
There is a strong positive correlation between endometrial t‐PA activity on the second day of menstruation and measured menstrual loss (P<0.05). Concentrations of endometrial t‐PAAg and PAI‐1 antigen are higher in women with DUB compared with normal women during menstruation.
Increased risk of aneuploidy in women having unsuccessful chorionic villus sampling procedures
Authors: Donnenfeld Lan E. , Librizzi Ronald J. , Weiner Stuart , Bolognese Ronald J. 
Published: August 2005

ABSTRACTObjective
To determine the incidence of fetal aneuploidy in women who had unsuccessful chorionic villus sampling (CVS) procedures.Design
Retrospective study.Setting
Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.Subjects
Two thousand six hundred and sixty‐eight women who underwent chorionic villus sampling, in 78 (2.9%) of whom villi could not be obtained.Interventions
Sixty‐nine of 78 (88%) women who had an unsuccessful CVS procedure underwent a subsequent amniocentesis later in the same pregnancy.Main outcome measures
The incidence of aneuploidy identified from amniotic fluid chromosome analysis in the 69 women who had an unsuccessful CVS procedure compared to the frequency of aneuploidy in women having a successful CVS procedure.Results
Of the 69 women who underwent a post‐CVS amniocentesis because of failure to obtain chorionic villi, six aneuploid pregnancies were identified (8.7%). The frequency of aneuploidy in the 2590 successfully sampled CVS patients was 2.5%. This difference was statistically significant (P= 0.009) by Fisher's exact test (two‐tailed).Conclusions
Women having an unsuccessful CVS procedure should be informed that they may be at increased risk for carrying an aneuploid fetus.
The adnexal mass: benign or malignant? Evaluation of a risk of malignancy index
Authors: Davies Ann Prys , Jacobs Ian , Woolas Robert , Fish Andrew , Oram David 
Published: August 2005

ABSTRACTObjective
To validate a risk of malignancy index incorporating menopausal status, serum CA 125 level and pelvic ultrasound features in the pre‐operative diagnosis of ovarian cancer.Design
A retrospective observational study.Setting
Department of Obstetrics and Gynaecology, The Royal London Hospital.Subjects
One hundred and twenty‐four women admitted consecutively to the gynaecology department for surgical exploration of an adnexal mass.Main outcome measures
The sensitivities and specificities of menopausal status, serum CA 125 level and ultrasound features, in isolation and combined (the risk of malignancy index (RMI)), for diagnosing ovarian cancer.Results
Tested on a new population of women, the RMI retained the high sensitivity for diagnosing ovarian cancer seen in the original report describing its derivation. The specificity, however, was lower. The study confirmed that the RMI is more accurate than the individual criteria in diagnosing ovarian cancer, and was comparable with other scoring systems.Conclusions
The risk of malignancy index is a simple scoring system for ovarian cancer. Application of the risk of malignancy index in clinical practice may provide a rational basis for specialist referral of patients with ovarian cancer before diagnostic surgery.
Electroencephalogram and computerised cerebral tomography findings in eclampsia
Authors: Moodley J. , Bobat S. M. , Hoffman M. , Bill P. L. A. 
Published: August 2005

ABSTRACTObjective
To define more clearly the neuropathophysiology of eclampsia.Design
A prospective study relating to computerised cerebral tomography (CAT) scan and electroencephalogram (EEG) findings in eclampsia.Setting
A large referral centre in a developing society.Subjects
Thirty‐two women with eclampsia.Main outcome measures
Abnormalities in EEG and CAT scan findings.Results
Approximately 45% of the women studied had CAT scan abnormalities, while 90% had EEG abnormalities. A burst suppression pattern on EEG examination was found in four women suggesting a temporary dissolution of cerebral function to the midbrain level as the cause of seizures.Conclusions
EEGs are probably more sensitive than CAT scans in detecting the extent of the pathology in the brain in women with eclampsia.
Fetal intracranial haemorrhage: clinical significance of in utero ultrasonographic diagnosis
Authors: Achiron R. , Pinchas O. Hamiel , Reichman B. , Heyman Z. , Schimmel M. , Eidelman A. , Mashiach S. 
Published: August 2005

ABSTRACTObjective
To review in utero detection of fetal intracranial haemorrhage.Design
Retrospective survey of pregnant women presenting to the ultrasonographic unit in whom the diagnosis of fetal intracranial haemorrhage was reached.Setting
The Chaim Sheba Medical Center in Ramat Gan, and Shaare Zedek Medical Center in Jerusalem; two large district general hospitals, each with 6000 maternity patients per year.Subjects
Five fetuses with gestational ages ranging from 26 to 36 weeks.Main outcome measures
Maternal complications, fetal monitoring, prenatal Doppler ultrasound studies, postnatal imaging studies, neonatal morbidity and mortality.Results
Transabdominal sonography showed hyperechoic lesions in the brain parenchyma, and the lateral ventricle in three of five fetuses. In the remaining two fetuses, transvaginal sonography enhanced the visualisation of ventriculomegaly with intraventricular haemorrhage in one and periventricular leukomalacia was identified in the second. Three fetuses were appropriate for gestational age, and two were severely growth retarded. In one woman severe pre‐eclamptic toxaemia may explain intracranial haemorrhage. Abnormal nonstress test and abnormal flow velocity waveforms in the umbilical and cerebral arteries were present in the two growth retarded fetuses, and in one who was appropriate for gestational age. The two growth retarded fetuses died shortly after birth. Of the three surviving infants, two had normal long term development, and one developed hydrocephalus with subsequent severe neurodevelopmental retardation, dying at the age of seven months.Conclusions
This small series shows that intracranial haemorrhage has a broad spectrum of manifestations with diverse prognosis. Following an antenatal diagnosis of intracranial haemorrhage, the obstetrician must give special consideration to electronic fetal heart monitoring and Doppler velocity waveforms. The prenatal diagnosis of intracranial haemorrhage has medico‐legal implications suggesting that neurological outcome may not necessarily be due solely to intrapartum events and management.
The coagulation system in placental insufficiency: a study in the fetal circulation
Authors: Wilcox Gavin R. , Trudinger Brian J. , Exner Thomas 
Published: August 2005

ABSTRACTObjective
To examine the hypothesis that Doppler‐defined umbilical placental insufficiency is associated with intravascular coagulation in the fetal circulation.Design
A prospective, descriptive, single centre study.Setting
The University of Sydney, Department of Obstetrics at Westmead Hospital.Subjects
Ninety‐one infants were classified on the basis of the systolic: diastolic (SD) ratio of the umbilical artery flow velocity waveforms into severe (SD > 99.9th centile), moderate (SD >95th centile) or control groups.Intervention
Blood was collected from the umbilical vein at delivery.Main outcome measures
The coagulation variables measured were the plasma concentrations of thrombin‐antithrombin, fibrinopeptide A and fibrinogen, the antithrombin III activity, the prothrombin time and the activated partial thromboplastin time.Results
There were no differences in activated partial thromboplastin time, antithrombin III activity, fibrinopeptide A or thrombin‐antithrombin complex concentrations between fetuses with placental insufficiency and those with no placental disease. Fetuses with severe and moderate placental insufficiency had a statistically significant prolongation of their mean prothrombin time compared to controls (23.7 ± 0.8, 23.6 ± 1.6, and 19.9 ± 0.6 s, respectively). Infants in the severe group had a lower plasma fibrinogen concentration than control fetuses (1.66 ± 0.09 and 1.94 ± 0.09 g/l, respectively). The activated partial thromboplastin time and antithrombin III activity were both highly dependent on gestational age.Conclusions
These results do not support the hypothesis that Doppler‐defined umbilical placental insufficiency is associated with activation of coagulation in the fetal circulation.
An audit of general practitioner requests for pelvic ultrasound: analysis of referral patterns and outcome
Authors: Skillern L. H. , Pearce J. M. 
Published: August 2005

ABSTRACTObjectives
1. To assess the information supplied by general practitioners on the gynaecological ultrasound request form and to determine how this information influences the interpretation of scans; and 2. To examine the influence of scans on the subsequent management of patients both by general practitioners and, where relevant, by hospital gynaecologists.Design
Retrospective analysis of gynaecological ultrasound requests made by general practitioners. Postal questionnaire and assessment of outcome according to general practitioners' records and, where appropriate, the hospital notes.Setting
A London teaching hospital gynaecological ultrasound department and associated general practices.Subjects
Four hundred ninety‐eight women referred by general practitioners for a gynaecological ultrasound scan over a one year period (1990).Results
The 498 requests for gynaecological ultrasound scans included 472 primary diagnostic referrals. Seventy‐one percent of general practitioners replied to the questionnaires. Overall, 46% of the scans were normal, but the proportion of normal scans fell to 21% if the date of the last menstrual period and a pregnancy test result were included on the form. Forty per cent of women scanned subsequently were referred for hospital care.Conclusions
General practitioners would appear to use the ultrasound service in a rational way and therefore there can be no justification for not allowing them open access. The positive diagnostic yield can be further improved if time is taken to supply simple relevant information which may be facilitated by a specific request form.
A randomised trial of 45 minutes and 15 minutes incremental oxytocin infusion regimes for the induction of labour in women of high parity
Authors: Orhue A. A. E. 
Published: August 2005

ABSTRACTObjective
To investigate whether in women of high parity induction of labour using a regimen of intravenous oxytocin, increasing incrementally at 45 min intervals, is safer than one increasing at 15 min intervals.Setting
University of Benin Teaching Hospital, Department of Obstetrics and Gynaecology, Benin City, Nigeria.Design
Randomised controlled trial.Subjects
Ninety women of parity 5 or more requiring induction of labour by infusion of oxytocin were randomly allocated to incremental increases at either 45 min intervals (experimental group) or 15 min intervals (control group).Main outcome measures
Mode of delivery; complications of labour and delivery (uterine rupture, precipitate labour, hyperstimulation, postpartum haemorrhage, perineal tears, puerperal pyrexia); number of days spent in hospital.Results
The 45 min incremental regimen resulted in longer induction–delivery intervals (estimate of difference in population medians 2 h, 95% confidence interval (CI) 1‐4 h); less precipitate labour (odds ratio (OR) 0.09,95% CI 0.03–0.30); less uterine hyperstimulation (OR 0.23, 95% CI 0.09–0.59); and a reduced length of hospital stay (estimate of difference in population medians 3 days, 95% CI 2–5 days). With the 45 min interval regimen there was a reduction in the occurrence of uterine rupture, postpartum haemorrhage, perineal tears and puerperal pyrexia, but these differences did not reach statistical significance.Conclusion
For the induction of labour in women of high parity the infusion rate of oxytocin should be increased every 45 min rather than every 15 min until contractions occur three times in 10 min and this infusion rate of oxytocin is maintained until delivery.