bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of fetal fibronectin as a predictor of preterm delivery in high risk asymptomatic pregnancies
Authors: Leeson S. C. , Maresh M. J. A. , Martindale E. A. , Mahmood T. , Muotune A. , Hawkes N. , Baldwin K. J. 
Published: August 2005

Objective
The study was designed to determine whether fetal fibronectin would predict delivery before 37 weeks in women at high risk of preterm delivery.Study methods
Forty‐three women considered at risk of preterm delivery were recruited antenatally into a blind longitudinal study. Quantitative assays of fetal fibronectin were obtained from sequential high vaginal swabs taken fortnightly from 24 to 34 weeks of gestation. Fibronectin concentrations of 0.05 μg/ml or more were considered as positive.Results
Results were calculated by swab and by subject. The sensitivity of an individual fibronectin swab in predicting preterm delivery within 14 days of testing was 71% and the specificity was 93Yo. The overall positive predictive value was 31% and the negative predictive value was 99%. The sensitivity of the fibronectin swab in predicting delivery before 37 weeks was 17% and the specificity was 93 Oh. The positive predictive value was 50% and the negative predictive value was 73%. For a woman who has had a positive swab the sensitivity in predicting preterm delivery within 14 days of testing was 80% and the specificity was 83 %; a woman was counted as positive only if the final swab was positive and preceded delivery by not more than 14 days. The positive predictive value was 36% and the negative predictive value was 97%. For a woman who has had a positive swab the sensitivity in predicting delivery before 37 weeks was 54%. The specificity, the positive predictive value and the negative predictive value were 85%, 64% and 79%, respectively. Women were counted as positive if any swab in the sampling sequence was positive. Fibronectin swabbing when calculated by patient did predict preterm delivery within 14 days of testing (P= 0.01) and before 37 weeks (P= 0.01). Analysis of the accuracy of predicting delivery from 7 to 28 days after sampling revealed that the best prediction for delivery was within the following 14 days.Conclusion
Serial fetal fibronectin assessment from 24 to 34 weeks of gestation anticipated preterm delivery within 14 days of testing and before 37 weeks for high risk asymptomatic women. Such testing should be performed every two weeks.
Maternal mortality in England and Wales 1970–1985: an analysis by country of birth
Authors: Ibison Judith M. , Swerdlow Anthony J. , Head Jenny A. , Marmot Michael 
Published: August 2005

Objective
To determine the risk of maternal mortality in immigrants to England and Wales. Design Analysis of death registrations, 1970–1985, by country of birth. Setting England and Wales.Population
Women dying in England and Wales during regnancy, childbirth or the puerperium, or dying fiom malignant tumour of the placenta.Main outcome measures
The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause‐specific death, adjusted for age, in immigrants compared with women born in England and Wales.Results
Women born in West Africa (relative risk 10.3; 95% CI 8.0–13.2) and the Caribbean (4.6; 3.8–5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3–2.0) and ‘Europe and the USSR’ (1.7; 1.2–2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the ‘Rest of the World’ and Scotland were at significantly elevated risk.Conclusions
An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non‐immigrants is required, and into whether this affects the risk of maternal mortality.
Peak systolic over protodiastolic ratio as an objective substitute for the uterine artery notch
Authors: Irion Olivier , Massé Jacques , Forest Jean‐Claude , Moutquin Jean‐Marie 
Published: August 2005

Objective
To measure the inter‐rater agreement for the identification of a uterine artery notch, as well as the association between an observed notch and the peak systolic over protodiastolic (A/C) ratio.Design
Cohort study.Setting
Tertiary care university hospital.Population and methods
Six hundred and sixty‐five nulliparous women in whom 1022 examinations of uterine artery velocity waveforms were performed by pulsed Doppler at 18 and at 26 weeks of gestation. Agreement between two independent raters was analysed using Cohen's kappa statistics. A/C ratios of flow velocity waveforms with or without a notch were compared. The agreement between A/C values and the presence of a notch was estimated by measuring the surface under the receiver operating characteristic (ROC) curve.Results
Inter‐rater agreement for the identification of a notch was 074 (95% CI 0.64–0.83) at 18 weeks and 0.72 (95% CI 0.64–0.80) at 26 weeks. NC ratios were higher when a notch was present (P < 0.0001). The area under the ROC curve was 0.86 (95% CI 0.81491) for the placental uterine artery and 0.93 (95% CI 0.90–0.96) for the nonplacental artery. An A/C value 2.5 in any uterine artery had a sensitivity of 88% and a specificity of 86% to detect a notch.Conclusion
Although there is no definitive definition of the notch, its detection is reproducible within a center. However, published prevalences between centers in unselected populations vary. The measure of the NC ratio can serve as an objective substitute.
Prevalence of fetal left ventricular hyperechogenic foci in a low risk population
Authors: Merati Roberto , Lovotti Massimo , Norchi Stefano , Teatini Alberto , Tenore Amedeo Carlo , Belloni Carlo 
Published: August 2005

Objective
To ascertain the prevalence and clinical significance of small hyperechogenic foci detected in the fetal left ventricle in routine ultrasound screening of pregnant women attending our hospital.Population and methods
From April 1994 to April 1995, 1135 consecutive pregnant women examined at the obstetric ultrasound unit of our hospital were studied prospectively. A postnatal cardiologic examination was performed when signs of cardiopathy were observed at the prenatal ultrasound investigation or the neonatal examination.Results
Congenital heart disease was detected in 10/1148 infants born (0.9%); eight diagnoses were made prenatally (detection rate 80%). The prevalence of left ventricular hyperechogenic foci was 3.2% (37/1148 fetuses). In 35 cases (94.6%) the foci were no longer observed at the routine third trimester examination. Only in two cases (5.4%) did foci persist at the postnatal examination but without clinical signs of cardiopathy or karyotype anomalies. No association was observed between foci and major structural abnormalities. The foci were single in 32 cases (86.5%). Four foci (10.8%) were located at the interventricular septum, five (13.5%) bilaterally at the papillary apparatus of the mitral valve, and the others at the ventricular wall. No focus was associated with incompetence of the affected valve, whereas five (13.5%) were associated with a fetal disorder.Conclusions
The prevalence of intracardiac hyperechogenic foci in our general population considered at low risk was more than five times greater than that reported in the literature. Foci were not associated with structural heart defects or chromosomal abnormalities. Persistence during the third trimester and postnatal life was rare and without evident signs of heart disease.
Sigmoid colon vaginoplasty: a modified method
Authors: Franz R. C. 
Published: August 2005

Objective
To assess the technical feasibility and functional results of sigmoid colon vaginoplasty using a modified technique.Design
Retrospective descriptive analysis.Setting
Referral centre.Patients
A method for creating an artificial vagina was applied in 13 women for the following indications: true hermaphrodite (n= l), gender dysphoria (n= 2), Müllerian dysgenesis (n= 10).Interventions
A method for sigmoid vaginoplasty was devised whereby transection of the inferior mesenteric artery proximal to the first sigmoid branch provides immediate mobility for the sigmoid colonic segment to reach the introitus (with adequate nourishment from the middle and inferior rectal vascular systems).Main outcome measures
Assessment of sexual function after a follow up period of 1 to 19 years.Results
Twelve women reported a satisfactory result. Three of these were lost to follow up after one year, and the others report for regular assessment. Mild stenosis at the muco‐cutaneous anastomosis, which may occur after failed perineal procedures, appears to be amenable to daily dilatations until the women become sexually active. In one woman the prosthesis had to be removed on account of severe pelvic floor fibrosis as a result of previous abdomino‐perineal surgery at the age of seven. Another woman presented with a postcoital vesico‐vaginal fistula after a previous McIndoe procedure; the tear at the base of the bladder was repaired and buttressed with a sigmoid vagina which is now functioning satisfactorily after 19 years.Conclusion
The creation of a sigmoid vagina which is vascularised by the middle and inferior rectal arterial systems appears to be an acceptable procedure for vaginal agenesis, acquired vaginal loss or sexual reassignment.
The costs of treating miscarriage: a comparison of medical and surgical management
Authors: Hughes Jenny , Ryan Mandy , Hinshaw Kim , Henshaw Richard , Rispin Rachel , Templeton Allan 
Published: August 2005

Objective
To estimate and compare the costs of surgical and medical treatment of miscarriage to the National Health Service.Design
A patient‐centred, partially randomised trial.Setting
A teaching hospital in Scotland.Participants
Four hundred and thirty‐seven women with a proven first trimester miscarriage.Main outcome measures
The cost per patient of surgical and medical management of miscarriage plus the extra cost per patient of introducing medical management of miscarriage under three different scenarios are calculated.Results
The average cost of surgical treatment was £397 compared with £347 for medical treatment. Sensitivity analysis showed that the extra cost of introducing the medical management of miscarriage ranged from a cost saving of £71 per patient to an additional cost of £37 per patient.Conclusions
Our analysis showed that it may be possible to generate cost savings by introducing medical methods in the management of early miscarriage. However, the savings assume that costs associated with theatre use can be fully realised.
Children whose mothers had second trimester amniocentesis: follow up at school age
Authors: Finegan Jo‐Anne K. , Sitarenios Gabriel , Bolan Pamela L. , Sarabura Angeline D. 
Published: August 2005

Objective
To explore potential long term consequences of second trimester amniocentesis.Design
Children exposed to second trimester amniocentesis have been followed prospectively from birth to school age and compared with children whose mothers declined the test.Setting
The Hospital for Sick Children, Toronto.Sample
Eighty‐six children exposed to amniocentesis and 44 children whose mothers declined the test.Interventions
Second trimester amniocentesis for the late maternal age indication.Main outcome measures
Standardised tests of intelligence, academic achievement, speech articulation, visual‐perceptual‐motor ability and fine motor coordination were administered. Parents reported on child behaviour using standardised measures of behaviour problems, social competence, hyperactivity and temperament. Physical growth was also measured, and parents reported on child health.Results
Group differences were not observed.Conclusions
Second trimester amniocentesis does not appear to compromise child development, behaviour, growth or health.
A randomised prospective trial comparing laparoscopic and abdominal hysterectomy
Authors: Olsson Jan‐Henrik , Ellström Marie , Hahlin Mats 
Published: August 2005

Objective
To compare short term clinical results in a prospective randomised trial of laparoscopic hysterectomy compared with abdominal hysterectomy.Methods
One hundred and forty‐three women scheduled for total abdominal hysterectomy, with or without salpingo‐oophorectomy and with a maximum uterine width of less than 11 cm, were prospectively randomised to undergo the procedure by laparoscopic hysterectomy (n= 71) or abdominal hysterectomy (n= 72). During laparoscopic hysterectomy, the uterine arteries as well as the upper portion of the cardinal ligaments were transected laparoscopically. The perioperative and post‐operative courses of the groups were compared.Results
The number of women with a complication did not differ significantly between laparoscopic hysterectomy (27%) and abdominal hysterectomy (33 %) groups. The post‐operative fall in erythrocyte volume fraction was significantly greater following abdominal hysterectomy (5.6% compared with 4.1 % median value, P 0.001). Post‐operative pain, assessed by the patients two days after surgery on a visual analogue scale, was significantly higher following abdominal hysterectomy (4.2 compared with 3.6 units median value, P < 0.05). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value, P < 0.001), the women undergoing this procedure had a shorter post‐operative time in hospital (two compared with four days median value, P < 0.001) and a shorter convalescence (16 compared with 35 days median value, P < 0.001).Conclusions
Laparoscopic hysterectomy is a safe procedure for selected patients scheduled for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post‐operative pain, shorter time in hospital and shorter convalescence time.
Evaluation of a rapid diagnostic test for bacterial vaginosis
Authors: O'Dowd T. C. , West R. R. , Winterburn P. J. , Hewlins M. J. 
Published: August 2005

Objective
To evaluate a new rapid diagnostic test for bacterial vaginosis.Design
Comparison of a new biochemical diamine test with low technology tests and microbiological culture.Setting
General practice, family planning clinic.Participants
Patients attending a general practice with vaginal symptoms, women consulting for family planning and cervical smears, and women invited for health checks.Main outcome measures
Comparison of the new diamine test with microbiological culture for Gardnerella vaginalis, with clue cells, and with the amine test.Results
Two hundred and twenty‐nine vaginal swabs were assayed quantitatively by the new diamine test. When compared with microbiological culture of Gardnerella vaginalis, the sensitivities and specificities were 86% and 81%, respectively. When compared with clue cell findings, the sensitivities and specificities were 97% and 83%, respectively. In the third comparison with the amine test the sensitivity was 94% and the specificity 84%. Since microbiological diagnosis of organisms related to bacterial vaginosis is difficult, the new test and existing sideroom tests may be more sensitive to the condition and the true frequency of false positives may be less than the specificity in this study suggests.Conclusions
The new diamine test is accurate, sensitive and specific, and provides the basis for the rapid diagnosis of bacterial vaginosis. Such a test is needed if bacterial vaginosis is to be diagnosed and managed effectively in both general and specialist practice.
Early prediction of pre‐eclampsia by measurement of kallikrein and creatinine on a random urine sample
Authors: Millar J. G. B. , Campbell S. K. , Albano J. D. M. , Higgins B. R. , Clark A. D. 
Published: August 2005

Objective
To assess the measurement of inactive urinary kallikrein (IUK) to creatinine (Cr) ratio (IUK:Cr) on an untimed urine sample, collected between 16 and 20 weeks of pregnancy, as a predictive test for the development of both proteinuric and nonproteinuric pre‐eclampsia.Design
A prospective longitudinal study.Setting
A clinic for antenatal care and a university research department.Participants
Three hundred and seven normotensive women randomly selected (124 nulliparous and 183 parous) attending the antenatal clinic for their booking visit.Main outcome measures
1. Nonproteinuric pre‐eclampsia: a rise in diastolic blood pressure of 25 mmHg or more and a crossing of the threshold of 90 mmHg; 2. Proteinuric pre‐eclampsia: same as 1. plus the development of significant proteinuria (> 1+ on urine dipstick).Results
Thirty‐seven women developed pre‐eclampsia, 12 of whom had proteinuria. Median 1UK:Cr ratio in this group was 78.27, compared with 358.19 in the remainder. Analysis of receiver‐operator characteristics gave an area under the curve of 0803. An IUK:Cr ratio of 170 or less in this study predicted nonproteinuric or proteinuric pre‐eclampsia with a sensitivity of 70% and a specificity of 86%. Ten of the twelve women who had proteinuria had an 1UK:Cr below 170. Median 1UK:Cr for those with proteinuric pre‐eclampsia was 72.91.Conclusions
Measurement of 1 UK: Cr on a urine sample, collected between 16 and 20 weeks of gestation, represents a simple and practical test for the risk of subsequent pre‐eclampsia, with a sensitivity and specificity comparable to those reported by other investigators using the widely recognised, but less practical, angiotensin I1 sensitivity test.
Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus
Authors: Persson B. , Hanson U. 
Published: August 2005

Objective
To determine the relation between maternal levels of blood glucose and glycated haemoglobin (HbAlc) and infant size at birth in pregestational diabetes.Design
Longitudinal study from 6 to 14 weeks gestation. Women were treated intensively with insulin, aiming at normoglycaemia but avoiding hypoglycaemia. Blood glucose was determined six times daily, HbAlc every four weeks. Individual mean fasting and postprandial glucose levels were calculated for three‐week periods of gestation. Birthweight > 2 SD or within ±2 SD for gestational age and gender was classified as large (LGA) or appropriate (AGA), respectively. Birthweight ratio was calculated as the ratio of birthweight to normal mean birthweight after correction for gestational age and gender.Participants
One hundred and thirteen consecutive pregnant women with pregestational diabetes and their newborn infants.Results
Perinatal mortality was nil, the rates of spontaneous preterm delivery (8.9 %) and severe maternal hypoglycaemia (4.4 %) were low. Mothers with LGA infants (26 %) had a significantly higher fasting glucose between weeks 27 and 32 than mothers of AGA infants (P < 0.01). Relative birthweight was significantly and independently associated with pre‐pregnancy bodyweight (r = 0.24, P 005) and fasting glucose at weeks 27 to 29 (r = 0.27, P 0.01) but together could only explain 12.3 % of the variation in birthweight (mult. r = 0.35, P 0.01). HbAlc correlated with glucose levels but was unrelated to birthweight ratio. The fasting glucose level between weeks 30 and 32 was significantly interrelated with the fasting glucose level from each of the six preceding three‐week periods.Conclusion
Near normoglycaemia cannot be obtained in all patients, presumably due to intrinsic differences in glucoregulatory ability between individuals. The incidence of LGA infants was unexpectedly high. The modest abnormality in glycaemic control in mothers with LGA infants could only partly explain fetal oversize, suggesting that other factors must be implicated to explain fetal growth acceleration.
Vulvar intraepithelial neoplasia with superficially invasive carcinoma of the vulva
Authors: Herod J. J. O. , Shafi M. I. , Rollason T. P. , Jordan J. A. , Luesley D. M. 
Published: August 2005

Objective
To investigate the long‐term outcome of patients presenting with vulvar intraepithelial neoplasia WIN) with superficially invasive carcinoma of the vulva (SICa).Design
A retrospective study using information obtained from patient case notes.Sample
Twenty‐six women found at presentation to have VIN in association with superficially invasive carcinoma were identified during a 15–year period.Results
Pruritus vulvae was the most frequent presenting symptom in 18 patients (69%). Sixteen women (61.5%) had multiple symptoms. Features noted at vulvar examination were variable and none were pathognomonic of either VIN or of superficial invasion. All patients had VIN 3 in association with a superficially invasive carcinoma. Histological changes associated with human papillomavirus were found in 19 (73%) women. Half had a co‐existent or previous abnormality of the lower genital tract. Local excision was the most frequent initial treatment (n= 9 [35%I). Mean follow up time was 65 months (range 12–174). Disease persisted after primary treatment in five women (19%). Both histological recurrence (of either VIN or SICa) or symptomatic recurrence occurred in 10 patients (38YO). All patients who experienced recurrence did so within 36 months of treatment. Overall, 12 patients (46%) relapsed (histological or symptomatic recurrence); the mean time was 18 months. Fourteen patients (54%) were managed satisfactorily by their initial treatment. One patient died of recurrent cervical cancer. Three progressed to frankly invasive disease: two (aged 31 and 39 years) with carcinoma of the vulva and one aged 34 years with carcinoma of the perianal margin. All are alive and well after treatment. One patient had recurrence of superficially invasive carcinoma treated by local excision with no further problems. No episode of metastasis. 1a lymphatic or vascular channels has been seen.Conclusions
Patients with superficially invasive carcinoma of the vulva may be safely treated by local excisional methods without recourse to lymphadenectomy. Relapse after primary treatment is common, and there appears to be a significant risk of progression to frankly invasive carcinoma.