bluuebunny/crossref_metadata_2025_split huggingface dataset:
A double‐blind, placebo controlled study of postmenopausal oestrogen replacement therapy and carotid artery pulsatility index
Authors: Jackson Simon , Vyas Sanjay 
Published: August 2005

Objective
To determine whether postmenopausal oestrogen replacement therapy affects carotid artery pulsatility index.Design
A prospective double‐blind placebo controlled trial.Setting
University associated teaching hospital.Participants
Twenty‐eight postmenopausal women who were more than 12 months postmenopausal and who had not taken exogenous oestrogen.Interventions
Independent randomisation to receive oral oestradiol (2 mg daily) or placebo for 20 to 24 weeks.Main outcome measures
Internal carotid artery Doppler pulsatility index, measured within one centimetre of the carotid bifurcation.Results
Replicate data were available from 27 women. The mean pulsatility index decreased by ‐0.11 in 15 women receiving oestradiol, compared with a mean rise of 0.05 in the 12 women who received placebo (P = 0.006, 95% CI for treatment difference 0.06–0.31).Conclusions
Oestrogen replacement decreases postmenopausal carotid artery pulsatility index, probably reflecting decreased peripheral vascular resistance. This is a further mechanism whereby hormone replacement therapy may impart cardiovascular protection.
The Ipswich Childbirth Study: 1. A randomised evaluation of two stage postpartum perineal repair leaving the skin unsutured
Authors: Gordon Beverley , Mackrodt Carolyn , Fern Elizabeth , Truesdale Ann , Ayers Sarah , Grant Adrian 
Published: August 2005

Objective
To evaluate a policy of two stage postpartum perineal repair leaving the skin unsutured.Design
A stratified randomised controlled trial using a 2 × 2 factorial design.Setting
The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.Sample
1780 women requiring surgical repair of episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery.Methods
A policy of two‐stage perineal repair leaving skin unsutured was compared with a policy of three stage repair including skin closure with interrupted or subcuticular sutures. Both groups were assessed by a research midwife, blind to the allocation, completing questionnaires at 24 to 48 hours and 10 days postpartum, and by self‐completed questionnaires at three months after birth.Main outcome measures
1. 24 to 48 hours postpartum: perineal pain; healing; 2. 10 days postpartum: perineal pain, healing and removal of sutures; 3. three months postpartum: perineal pain, removal of sutures, resuturing, dyspareunia, and failure to resume pain‐free intercourse.Results
Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. No differences were detected in perineal pain at 24 to 48 hours (62%vs 64%; RR 0.96, 95% CI 0.90–1.03; 2P = 0.3) and 10 days (25%vs 28%; RR 0.90,95% CI 0.77–1.06; 2P = 0.2). Significantly fewer women allocated to two‐stage repair reported tight stitches at ten days (14%vs 18%; RR 0.77, 95% CI 0.62–0.96, 2P = 0.02); similar numbers of repairs were judged to be breaking down (five compared with seven women). At three months postpartum fewer women allocated to the two‐stage repair reported perineal pain and more had resumed pain‐free intercourse. Amongst women who had resumed intercourse there was a significant difference in dyspareunia (15%vs 19%; RR 0.80, 95% CI 0.65–0.99; 2P = 0.04). Significantly fewer women in the two‐stage repair group (7%vs12%; RR 0.61, 95% CI 0.45–0.83; 2P = < 0.01) reported removal of suture material. Four women in the two‐stage repair group had required resuturing, compared with nine allocated to the three‐stage repair.Conclusions
Two‐stage repair of perineal trauma leaving the skin unsutured appears to reduce pain and dyspareunia three months postpartum. There are no apparent disadvantages, in particular no evidence of an increased risk of breakdown of the repair and resuturing.
Value of magnetic resonance imaging with an endovaginal receiver coil in the pre‐operative assessment of Stage I and IIa cervical neoplasia
Authors: DeSouza N. M. , McIndoe G. A. J. , Soutter W. P. , Krausz T. , Chui K. M. , Hughes C. , Mason W. P. 
Published: August 2005

Objective
To assess the value of high resolution endovaginal magnetic resonance images (MRI) of the uterine cervix in planning management of early cervical cancer.Design
Prospective cross‐sectional study.Setting
Specialist gynaecological oncology unit of a postgraduate teaching hospital.Participants
Thirty nine women aged 25–76 years old (mean 42.5 years) with invasive carcinoma Stage I or IIa of the cervix.Methods
A ring coil was positioned endovaginally around the cervix. Imaging was performed on a 1.0 T HPQ Vista or 0.5 T Asset (Picker, Highland Heights, Ohio, USA) using T1 weighted and T2 weighted sequences in transverse and sagittal planes with thin slices (2.5 mm) and small fields of view (12 cm). Tumour volumes were measured and any extension into adjacent organs and parametrium was noted. The patients were followed up after treatment and the outcome related to the MRI findings.Results
There was one false positive and one false negative result among five Stage Ia patients being assessed for residual disease after cone biopsy or LLETZ. The MRI assessment of the size and distribution of the tumour was confirmed histologically in all 31 patients with Stage Ib or IIa disease who were treated surgically. One of these patients in whom no endocervical tumour was visible on MRI underwent radical trachelectomy. Three patients had radiotherapy as primary treatment. Patients with Stage Ib or IIa disease who had tumour volumes > 10 cm3 with early parametrial extension on MRI had a substantially worse prognosis at 24 months (disease‐free survival 58.3% vs 95.5%, P= 0.003).Conclusion
High resolution MRI with an endovaginal coil allows precise measurement of tumour volume and identifies patients with small volume disease who might be considered for more conservative therapy. This technique also reveals early parametrial invasion that cannot be identified reliably by any other method. Early parametrial invasion in women with large tumours appears to have a very much worse prognosis.
Pre‐operative serum level of tumour‐associated trypsin inhibitor and residual turnour size as prognostic indicators in Stage III epithelial ovarian cancer
Authors: Venesmaa Pekka , Stenman Ulf‐Håkan , Forss Matti , Leminen Arto , Lehtovirta Pentti , Vartiainen Juhani , Paavonen Jorma 
Published: August 2005

Objective
To evaluate the use of the pre‐operative tumour‐associated trypsin inhibitor (TATI) level and residual tumour size at primary surgery as a prognostic indicators for patients with Stage III epithelial ovarian cancer.Design
Retrospective cohort study.Setting
Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland.Participants
Ninety‐eight women with Stage III ovarian cancer.Methods
TATI was measured by radioimmunoassay from serum samples obtained within one week before surgery. A cutoff value of 22 μg/L was used. Multivariate analysis included pre‐operative TATI level, age, histologic grade and histologic type. Mantel‐Cox test was used for calculating statistical significance of differences in survival between groups.Main outcome measures
Cumulative five‐year survival, pre‐operative serum TATI level and residual tumour size.Results
Surgery was optimal (residual tumour size ≤ 2 cm) in 55 patients and suboptimal (residual tumour size > 2 cm) in 43. Pre‐operative TATI level ≤ 22 μg/L predicted better prognosis both in patients with optimal and suboptimal surgery compared with patients with pre‐operative TATI level > 22 μ/L. Patients with optimal surgery and a pre‐operative TATI > 22 μg/L had a twofold relative risk of death compared with those with a pre‐operative TATI ≤ 22 μg/L. The cumulative survival was less than three years for patients with suboptimal surgery and pre‐operative TATI > 22 μg/L.Conclusions
Pre‐operative serum TATI in combination with residual tumour size may be useful in stratifying patients with Stage III ovarian cancer into different categories in randomised treatment trials.
Optimising maternal‐fetal outcomes in preterm labour: a decision analysis
Authors: Macones George A. , Bader Thomas J. , Asch David A. 
Published: August 2005

Objective
To compare, using decision analytic techniques, maternal and fetal risk and benefits of three strategies for the management of preterm labour after 32 weeks. These strategies are empiric tocolysis, no tocolysis, or amniocentesis for fetal maturity testing.Data Sources
Published medical literature provided the probabilities, including those for tocolysis efficacy, maternal and neonatal outcomes, and steroid efficacy.Data Synthesis
Separate decision trees were created for hypothetical cohorts of patients presenting with preterm labour at 32,34, and 36 weeks of gestation to compare strategies. The primary outcome was the total number of expected adverse maternal and neonatal events for each strategy at each gestational age.Results
At 32 weeks tocolysis yielded the lowest total number of adverse maternal and neonatal events. At 34 weeks, both tocolysis and no tocolysis yielded similar overall outcomes. At 36 weeks most clinical outcomes were good regardless of strategy.Conclusions
This analysis supports the empiric use of tocolytics at 32 weeks. At 34 weeks, either tocolysis or no tocolysis appear to be reasonable alternatives. At 36 weeks no tocolysis is probably preferred. This analysis also suggests that amniocentesis should not be employed in the management of preterm labour at these gestational ages.
A role for noradrenaline in pre‐eclampsia: towards a unifying hypothesis for the pathophysiology
Authors: Manyonda Isaac T. , Slater Donna M. , Fenske Christine , Hole David , Choy Mei Y. , Wilson Catherine 
Published: August 2005

Objective
To compare plasma catecholamine (noradrenaline and adrenaline) levels in pre‐eclamptic to normotensive pregnancy, and to study the activity of synthetic enzymes for catecholamines in placental and trophoblastic cell cultures. We postulated that catecholamines might be an important signal secreted by the fetoplacental unit in pre‐eclampsia.Methods
We recruited 12 women with pre‐eclampsia and 12 pregnant women with nonproteinuric hypertension undergoing delivery by caesarean section, 23 normotensive women undergoing elective caesarean section at term, and 26 normotensive primigravid women with ongoing pregnancies at gestations equivalent to those women with pre‐eclampsia. We measured venous blood concentrations of catecholamines. Following delivery, we studied tyrosine hydroxylase (the rate limiting enzyme for catecholamine synthesis) activity in placental tissue of these women as well as from four eclamptic women not in the observer study. We used Northern blot analysis to quantify mRNA for tyrosine hydroxylase and dopamine‐β‐hydroxylase (D‐P‐H, a non‐rate‐limiting synthetic enzyme for catecholamine) in placental tissue, as well as in trophoblast cells in primary culture and trophoblast cell lines.Results
Venous blood concentrations of noradrenaline were significantly higher in pre‐eclamptic women compared with normotensive women. Tyrosine hydroxylase activity was greater in placental tissue from pre‐eclamptic and eclamptic compared with normotensive pregnancies, as were mRNA levels for this enzyme. The mRNA levels for the non‐rate‐limiting D‐β‐H in women with pre‐eclampsia were similar to those in normotensive pregnancies. First trimester trophoblast cells in primary culture and trophoblast cell lines transcript mRNA for tyrosine hydroxylase and D‐β‐H.Conclusions
Trophoblasts have the capacity to secrete catecholamines, and we found increased activity of the rate‐limiting synthetic enzyme in placental tissue from pre‐eclamptic pregnancies. We postulate that the higher levels of catecholamines we found in the plasma of women with pre‐eclampsia might be of placental origin. We hypothesise that in pre‐eclampsia ischaemic trophoblast tissue secretes catecholamines as a physiological signal to increase maternal blood flow to the fetoplacental unit, which itself is spared the vasoconstrictor effects of catecholamines (placental vessels are known to be unresponsive to catecholamines). However, since the basic pathology—defective trophoblast invasion—is not corrected, the increased blood flow fails to resolve the ischaemia, and the secretion of catecholamines is therefore sustained or even enhanced. Noradrenaline is known to cause lipolysis. This results in breakdown of triglycerides to free fatty acids, which are oxidized to lipid peroxides. The latter are cytotoxic and cause widespread endothelial cell damage and dysfunction, culminating in the clinical syndrome of pre‐eclampsia.
The effect of fetal neck position on nuchal translucency measurement
Authors: Whitlow B. J. , Chatzipapas I. K. , Economides D. L. 
Published: August 2005

Objective
To determine the influence of the position of the fetal neck on nuchal translucency measurement.Design
A prospective cross‐sectional study.Population
One hundred and ninety‐six.Methods
Nuchal translucency was measured in the mid‐sagittal plane, with the fetal neck in the flexed, neutral and extended positions. Measurements were made to the nearest 0.1 mm. Statistical analysis used the paired t‐test for differences between the extended and neutral positions, [A extended nuchal translucency] and the flexed and neutral positions [A flexed nuchal translucency].Results
The mean extended nuchal translucency was 0.62 mm greater than the mean neutral nuchal translucency value [95% confidence interval 0.53 to 0.70, T= 14.33, P 0.000011. The mean flexed nuchal translucency was 0.40 mm less than the mean neutral nuchal translucency value [95% CI 0.34 to 0.47, T = 11.99; P= < 0.000011. The repeatability coefficient was lower in the case of neutral nuchal translucency measurements [0.48] and was higher in the other groups [extended = 1.04, flexed = 0.701.Conclusion
Fetal neck position can make a significant difference to nuchal translucency measurements. Repeatability of measurements are more accurate with the fetal neck in the neutral position. These findings have important implications for clinicians using nuchal translucency to screen the general obstetric population.
Maternal intensive care and near‐miss mortality in obstetrics
Authors: Baskett T. F. , Sternadel J. 
Published: August 2005

Objective
To determine the level of near‐miss maternal mortality and morbidity due to severe obstetrical complications or maternal disease in a tertiary maternity hospital.Design
Retrospective review.Setting
A free‐standing maternity hospital delivering 5500 infants per year.Methods
The information coded in the perinatal database concerning women who had required transfer for critical care to a general hospital was reviewed for the 14 year period 1980 to 1993. The complications necessitating transfer and the specialised consultants and services required were noted.Results
Over 14 years there were 76,119 women delivered with two maternal deaths (2.6/100,000). Fifty‐five women required transfer for critical care (0.7/1000). The main reasons for transfer were hypertensive disease (25%), haemorrhage (22%) and sepsis (15%). Transfer to an intensive care unit was required by 80%, and the remainder were transferred to specialised medical or surgical units. Twenty different specialist groups were consulted. The 55 patients spent 280 days in critical care and 464 days hospital after‐care (mean 13 days, range 3–92).Conclusion
A review of near‐miss maternal mortality helps delineate the continuing threats to maternal health and the type of support services most commonly required.
In vivo assessment of failed trophoblastic invasion of the spiral arteries in pre‐eclampsia
Authors: Matijevic Ratko , Johnston Tracey 
Published: August 2005

Objective
To assess the ability of colour/pulsed Doppler ultrasound to detect failed physiologic change of the spiral arteries in pregnancies complicated by pre‐eclampsia.Design
Prospective matched‐pairs caw controlled study.Setting
Tertiary referral teaching hospital.Sample
Sixteen women with severe pre‐eclampsia and 16 normotensive controls.Methods
Colour/pulsed Doppler assessment of blood flow in the uterine arteries and spiral arteries in central and peripheral parts of the placental bed.Main outcome measures
Impedance to blood flow in the spiral arteries in pre‐eclamptic group compared with normotensive controls.Results
In women with pre‐eclampsia there is significantly higher impedance to blood flow in spiral arteries compared with normotensive women.Conclusions
Ultrasound colour/pulsed Doppler based investigation of blood flow in the spiral arteries in ongoing pregnancy can detect failed physiological change of these vessels in pre‐eclampsia. This is in concordance with histologic data.
Non‐invasive RNA‐based determination of fetal Rhesus D type: a prospective study based on 96 pregnancies
Authors: Cunningham Joan , Yates Zoë , Hamlington Jeanette , Mason Gerald , Mueller Robert , Miller David 
Published: August 2005

Objectives
To develop a non–invasive method for determining fetal RhD status in order to provide improved care for women most at risk.Design
A prospective study.Methods
Fetal erythroblasts were enriched from the peripheral circulation of 96 RhD negative women with pregnancies at various stages in gestation using discontinuous density gradients. Amplification of RhD–specific mRNAs was carried out by reverse transcription–polymerase chain reaction assay. RNA, rather than DNA, was selected for amplification because it rarely contaminates samples, thus resulting in fewer false positives; moreover, its presence in multiple copies per cell should enhance the sensitivity of the assay, resulting in fewer false negatives. The study was prospective, relying on postnatal serological confirmation of RhD phenotype.Results
The assay was 75% accurate at predicting fetal RhD status, comparing favourably with standard genomic DNA–based assays. However, we found that accuracy dropped from 85% (29134) in the third trimester of pregnancy, to 82% (32/39) in the second and 48% (11/23) in the first trimester. Discordant data were due to false negatives in the majority (78%) of cases.Conclusions
We suggest that reverse transcription may be a useful and perhaps more sensitive alternative to standard genomic polymerase chain reaction in the majority of cases. However, under certain circumstances the absence or reduction of fetal erythroblasts or possibly RhD mRNA in some preparations may compromise the accuracy of the assay.
Fetal karyotyping by chorionic villus sampling after the first trimester
Authors: Carroll Stephen G. M. , Davies Teresa , Kyle Phillipa M. , Abdel‐Fattah Sherif , Soothill Peter W. 
Published: August 2005

Objective
To evaluate chorionic villus sampling (CVS) as a technique for karyotyping after the first trimester by examining the incidence of result failure, confined placental mosaicism, and false positive or negative results at different gestational ages.Methods
During a nine year period between 1989 and 1997, all results of CVS between 8 and 37 weeks of gestation provided by the Regional Cytogenetics Centre were analysed retrospectively by examining indications for CVS, weights of tissue received, gestational age at sampling and karyotype results.Results
There were 2424 chorionic villus samples analysed by the direct method and or cell culture. In 1548 cases CVS was performed before 14 weeks (Group 1), in 685 between 15 and 20 weeks (Group 2), in 160 between 21 and 28 weeks (Group 3) and in 31 cases after 29 weeks (Group 4). Although there was a trend for an increasing rate of failed direct preparation results from Groups 1 to 4 which were 3.8%, 4.7%, 5.6% and 6.6%, respectively; these results were not significantly different. There were 19 cases of confined placental mosaicism and the incidence was significantly greater in Group 3 compared with Group 1 (P < 0.05), and in Groups 3 and 4 combined compared with Group 1. There were six false positive and one false negative result following direct analysis with no significant differences between gestational ages.Conclusions
CVS is a useful test after the first trimester, especially when a fast result is clinically required. However, after 20 weeks, when cordocentesis is available, the higher rate of cytogenetic discordancy between the placenta and the fetus means that cordocentesis may be preferable.
Isolated fetal echogenic intracardiac foci or golf balls: is karyotyping for Down's syndrome indicated?
Authors: Thilaganathan Baskaran , Olawaiye Alexander , Sairam Shanthi , Harrington Kevin 
Published: August 2005

Objective
To determine the prevalence of isolated echogenic intracardiac foci and the subsequent risk for Down's syndrome at 18–23 weeks in an unselected obstetric population.Design
Prospective study.Setting
A district general hospital serving a routine obstetric population.Participants
16,917 pregnant women who underwent a routine ultrasound screening at 18–23 weeks of gestation between November 1994 and August 1998.Methods
All women were offered screening for Down's syndrome by nuchal translucency or maternal serum biochemistry. The prevalence of isolated echogenic intracardiac foci was determined and the relative risk for Down's syndrome was calculated for different ultrasound findings.Results
The combined sensitivity of age, nuchal translucency and maternal serum biochemistry for Down's syndrome was 84% (27/32). The relative risk for Down's syndrome was 0.17 (95% CI 0.07–0.41) for the women with normal scan findings at 18–23 weeks. The prevalence of isolated echogenic intracardiac foci at 18–23 weeks was 0.9% (144/16,917). None of these pregnancies were affected by Down's syndrome.Conclusion
The significance of the association between isolated echogenic intracardiac foci and Down's syndrome is a matter of ongoing debate. The data of this study suggest that in an unselected obstetric population with prior, effective, routine Down's syndrome screening, the association between isolated echogenic intracardiac foci and Down's syndrome is no longer significant.
Serum activin A and inhibin A elevated in pre–eclampsia: no relation to insulin sensitivity
Authors: Laivuori Hannele , Kaaja Risto , Turpeinen Ursula , Stenman Ulf‐Håkan , Ylikorkala Olavi 
Published: August 2005

Objective
To assess the possible role of serum levels of activin A, inhibin A and pro‐αC inhibin (pro‐Design αC) in insulin sensitivity in pre‐eclampsia.Design
A prospective study.Setting
Helsinki University Central Hospital.Participants
Twenty‐two nulliparous women with proteinuric pre‐eclampsia and 16 healthy nulliparous controls in the third trimester of pregnancy.Methods
Serum samples were collected before and after intravenous injection of glucose (0.3 g/kg) and insulin (0.03 IU/kg) (the minimal model for testing insulin sensitivity), and were assayed for activin A, inhibin A and pro–αC.Main outcome measures
Comparison of the levels of activin A, inhibin A and pro‐αC between pre‐eclamptic and healthy pregnant women, and the association of these proteins with insulin sensitivity.Results
In pre‐eclampsia elevated levels of activin A (139%, P = 0.0001), inhibin A (39%, P= 0.003), and pro‐αC (92%, P= 0.0008) were observed. The amount of proteinuria (0.3–10.5 g/day) correlated positively with serum concentrations of activin A (P= 0.01) and inhibin A (P= 0.02). These glycol‐proteins were not associated with insulin sensitivity either in women with pre‐eclampsia or controls. A 2.9‐fold rise in blood glucose and a 52.5‐fold rise in insulin during testing using the minimal model were not accompanied by any significant changes in activin A, inhibin A, and pro‐αC.Conclusion
Activin A, inhibin A, and pro–αC are elevated in pre‐eclampsia but do not appear to relate to the insulin sensitivity in pre‐eclamptic or normal pregnancies.