bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue macrophage response in human papillomavirus infection and cervical intraepithelial neoplasia
Authors: TAY S. K. , JENKINS D. , MADDOX P. , SINGER A. , HOGG N.
Published: August 2005

Summary. Tissue macrophages in the uterine cervix were studied immunocytochemically with monoclonal antibody (MoAb) 3.9 which reacts with the majority of macrophages, and Ell which is specific for the C3b receptor, CR1. Samples from five normal women, six with human papillomavirus (HPV) infection and 10 with cervical intraepithelial neoplasia (CIN) were tested. A small population of MoAb 3.9 positive and only occasional MoAb Ell positive macrophages were found in the normal cervix. In HPV infection and CIN there was a significant infiltration of MoAb 3.9 positive and MoAb Ell positive macrophages in both the epithelium and the stroma. The pattern of infiltration in these groups of women suggests that these macrophages were most likely to be functioning as the first line of defence against the spread of the virus infection, either through a direct anti‐virus mechanism or non‐specific phagocytosis.
Incidence and aetiology of hydatidiform mole: an epidemiological review
Authors: BRACKEN MICHAEL B.
Published: August 2005

Summary. Epidemiological investigation of the incidence and aetiology of hydatidiform mole (HM) is receiving increasing attention. Recent, population‐based studies suggest that earlier reports of a very high incidence of HM in Asia, Africa and South‐Central America may have been exaggerated, due primarily to selection bias in patients studied at university hospitals. Japanese population studies indicate a two‐fold higher rate of HM compared with Caucasian rates but Chinese rates appear to be similar. Population studies presently available suggest a worldwide range of HM somewhere between 0.5 and 2.5/1000 pregnancies. When deliveries form the rate denominator the rates are somewhat higher, depending primarily on the national rate of induced abortions. The independent effects on incidence of geographic locale, ethnicity and socio‐cultural factors have not been adequately disentangled although the genetic studies suggest ethnicity might be the predominant variable. Maternal age is the most consistently demonstrated risk factor; teenagers and, especially, women over age 35 being at increased risk. The independent effects of paternal age and pregnancy history arc not established. Women with a history of one HM seem to have a ten‐fold risk of repeat HM compared with women who have no history of HM. Aetiological studies have not revealed any environmental risk factor for which there is unequivocal agreement about its influence on HM. New case‐control studies of HM aetiology must classify HM according to genetic aetiology. Cohort studies are required to explore more fully the relation of HM to malignant sequelae.
Whole blood viscosity during normal pregnancy
Authors: HUISMAN A. , AARNOUDSE J. G. , HUISJES H. J. , FIDLER V. , ZIJLSTRA W. G. , HEUVELMANS J. H. A. , GOSLINGA H.
Published: August 2005

Summary. In a serial study the changes in whole blood viscosity at different shear rates and its major determinants were determined in 24 healthy women with normal pregnancies. Whole blood viscosity and plasma viscosity were measured with a rotational viscometer. Red cell aggregation was measured by syllectometry. During normal pregnancy we found a decrease in whole blood viscosity at all shear rates until 29 weeks gestation, followed by a smaller increase between 30 and 37 weeks, which was most pronounced at higher shear rates, especially in nulliparae. The changes in whole blood viscosity were to a great extent determined by the changes in haematocrit and plasma viscosity. Haematocrit was more important for whole blood viscosity at lower shear rates, while plasma viscosity had more influence on high shear blood viscosity. The continuous increase in red cell aggregation had no demonstrable influence on low shear blood viscosity as measured in vitro in a rotational viscometer.
Uterine artery blood velocities during contractions in pregnancy and labour related to intrauterine pressure
Authors: JANBU TORUNN , NESHETM BRITT‐TNGJERD
Published: August 2005

Summary. Doppler recordings from branches of the uterine artery were made simultaneously with intrauterine pressure measurements in eight women in labour. Blood velocities fell and pulsatility index (PI) increased during all 22 contractions studied. Velocities were reduced almost linearly by up to 60% when pressure increased from 0 to 50 mmHg. To study the effect of uterine contractions before labour on uterine blood flow, simultaneous Doppler recordings from branches of the uterine artery and external tocodynamometry were made in seven women during the last trimester. Velocities fell during 18 of the 20 contractions studied (median 35%, range 19–71%). Extrapolating from labour contractions, this corresponds to a pressure increase of 30–40 mmHg. Fetal heart rate (FHR) recordings were normal during all contractions.
Prostaglandins, chorioamnionitis and preterm labour
Authors: BERNAL A. LÓPEZ , HANSELL D. J. , SOLER R. CAÑETE , KEELING J. W. , TURNBULL A. C.
Published: August 2005

Summary. The production of prostaglandin E (PGE) and leukotriene B4 (LTB4) by amnion was measured in vitro in 12 women delivered after spontaneous preterm labour and in 15 women delivered after spontaneous labour at term. The placenta and fetal membranes were examined histologically in all cases. PGE output (fmol/mg dry weight/2 h) in the amnions from uncomplicated preterm deliveries was low (median 486, range 232–3203, n= 7) compared with the values obtained after spontaneous labour at term (5529, 1722–14226, n= 15). In amnions from preterm deliveries complicated by acute chorioamnionitis or round cell infiltration there was massive release of PGE (15 262,10 905–27 640, n= 5) which was accompanied by an increase in LTB4 production. Inflammatory infiltration of the fetal membranes results in a huge increase in PG production which could cause preterm labour.
Production of prostacyclin, 6‐keto‐PGFlα and thromboxane B2 by human umbilical vessels increases from the placenta towards the fetus
Authors: BENEDETTO C , BARBERO M , REY L , ZONCA M , MAAOBRIO M , ROCCA G. , SLATER T.F.
Published: August 2005

Summary. The aim of this study was to investigate the production of prostacyclin (PGI2) and thromboxane B2 (TXB2) by incubated samples of umbilical arteries and veins taken at different distances (2, 10,20,30 cm) from the placenta to provide additional information relevant to the haemodynamics of umbilical blood flow. The production of PGI2, and 6‐keto‐PGF1α (the stable metabolite of PGI2), was higher in both veins and arteries as the distance from the placenta at which the vessels were sampled was increased. A similar correlation between production by venous rings and distance from the placenta was observed for TXB2, but there was no apparent gradient of TXB2 production by the samples of arterial rings. No statistically significant variations were discernible in the ratio of 6‐keto‐PGF1α:TXB2 (∼50 in the veins and ∼20 in the arteries) in relation to the sampling distance. The significance of these high ratios is discussed in relation to umbilical blood flow and fetal well‐being and development.
Maternal fat stores and fat accretion during pregnancy in relation to infant birthweight
Authors: LANGHOFF‐ROOS JENS , LINDMARK GUNILLA , GEBRE‐MEDHIN MEHARI
Published: August 2005

Summary. Maternal fat stores and fat accretion during pregnancy were estimated from body weight and skinfold thicknesses and by the factorial method in a sample of 56 Swedish women in their second pregnancies who gave birth to singletons at term. Prepregnancy lean body mass, and not fat mass, were strongly correlated with infant birthweight. Total weight gain was significantly correlated with infant birthweight. A wide range of maternal fat accretion during pregnancy was observed, and the amount of fat accumulated was related to the total weight gain. In spite of this, maternal fat accretion during pregnancy was found to have little bearing on the infant birthweight at term.
Fertility and obstetric history in patients with familial Mediterranean fever on long‐term colchicine therapy
Authors: EHRENFELD MICHAEL , LEVY MICHA , ELIAKIM MARCEL , BRZEZINSKI AMNON
Published: August 2005

Summary. The obstetric histories were examined for 36 women with familial Mediterranean fever (FMF) on long‐term colchicine treatment followed for periods ranging between 3 and 12 years. Seven of 28 pregnancies (25%) associated with colchicine therapy ended in miscarriage. Thirteen women (36%) had periods of infertility; these were due to ovulatory dysfunction in six women, to peritoneal adhesions in four and remained unexplained in three women. The rates for miscarriage and infertility are high but are similar to those reported for women with FMF before colchicine therapy was introduced. All 16 infants born to mothers who had taken colchicine during pregnancy were healthy. Currently, we do not advise discontinuation of colchicine before planned pregnancy but recommend amniocentesis for karyotyping and reassurance.
Effects of subcutaneous oestradiol implants on ovarian activity
Authors: MAGOS A. L. , STUDD J. W. W. , COLLINS W. P.
Published: August 2005

Summary. The effects of subcutaneous oestradiol implants on ovarian activity were investigated in 14 ovulating premenopausal women. Treatment with either 100 mg or 150 mg oestradiol was combined with cyclical oral norethisterone from days 20 to 26 of the cycle to ensure regular withdrawal periods and prevent endometrial hyperplasia. Ovarian function was monitored by regular pelvic ultrasonography and urinalysis over a period of nine cycles. During the first three cycles after hormone implantation, follicular development continued in almost half the study group, but only one of the women in each treatment group showed signs of follicular rupture and luteinization. By the sixth cycle, over half the women given the lower dose of oestradiol were developing follicles, including a large functional cyst in one, but none of them ovulated. A further implant given early in the seventh cycle was associated with ovarian suppression in all cases. Both doses of implant elevated the excretion of oestrone‐3‐glucuronide compared to pretreatment. The contraceptive and therapeutic implications of these results are discussed.
Cisplatin, vincristine, methotrexate and bleomycin (POMB) as initial or palliative chemotherapy for carcinoma of the cervix
Authors: RUSTIN G. J. S. , NEWLANDS E. S. , SOUTHCOTT B. M. , SINGER A.
Published: August 2005

Summary. Chemotherapy was given as initial therapy to 12 women with very advanced squamous cell carcinoma of the cervix and to 19 women with recurrent disease. They received a median of four courses of POMB which comprised vincristine 1.0 mg/m2 and methotrexate 300 mg/m2 followed by folinic acid rescue, bleomycin 30 mg as a 48‐h infusion or intramuscular injection and cisplatin 100 mg/m2 as a 12‐h infusion. Two of the 14 assessable patients with recurrent disease (14%) had a complete response with no disease found histologically in one, and seven (50%) had a partial response. Although the actuarial median survival of all 19 patients with recurrent disease was 8 months, five patients have remained free from tumour progression for a median of 17 months from start of chemotherapy. Six of the 10 assessable patients receiving initial chemotherapy (60%) had a complete response (confirmed histologically in two) and two (20%) had a partial response. Nine patients had additional treatment with radiotherapy and or surgery. Although only four of the patients remain disease‐free at 61, 51, 7 and 4 months, all but two were initially FIGO stage IV. Although cisplatin‐induced emesis is controllable and the side‐effects of methotrexate can be avoided, the POMB regimen remains potentially toxic. The small number of patients with very advanced disease who are long‐term survivors prompts us to study further the role of aggressive chemotherapy as the initial treatment of patients with visceral or nodal involvement from carcinoma of the cervix.
Primary adenocarcinoma of the cervix: treatment and results
Authors: RAJU KANKIPATI SHANTI , TAYLOR RONALD W. , BATES THELMA D.
Published: August 2005

Summary. Between 1972 and 1983,49 patients with adenocarcinoma of the cervix were treated in four ways: (i) radiotherapy alone, (ii) pre‐ or postoperative radiotherapy and a total abdominal hysterectomy and bilateral salpingo‐oophorectomy, (iii) Wertheim's hysterectomy, and (iv) pre‐ or postoperative pelvic radiotherapy and Wertheim's hysterectomy. The 5‐year survival results for patients with FIGO Stage I disease was 90%; with Stage II disease 60%; with Stage III disease 11% and none survived with Stage IV disease. All the patients, except one (Stage 111), with well‐differentiated tumours are alive and disease‐free, irrespective of the type of treatment they received whereas only one patient out of the 13 who had poorly differentiated tumour is alive and disease‐free. Three patients had bowel damage, one after radiotherapy alone and two after Wertheim's hysterectomy and postoperative radiotherapy. No major surgical complications occurred in this series.
Growth retardation in preterm infants
Authors: SECHER N. J. , HANSEN P. KERN , THOMSEN BIRTHE LYKKE , KEIDING N.
Published: August 2005

Summary. This paper combines earlier results on the relation between birthweight and gestational age, and the relation between fetal weight and ultrasound measurements of the fetal biparietal diameter (BPD) and mean abdominal diameter (AD) to investigate whether preterm infants (viewed as a group) are smaller than unborn fetuses of the same gestational age. The birthweight distribution for each sex at 223 and 258 days gestation was derived from the birthweight‐for‐gestational age charts based on 3888 newborn infants. The sex‐specific intrauterine weight distribution was estimated from ultrasound measurement of the fetal BPD and AD performed on randomly selected fetuses of gestational age 223 and 258 days. The birthweights were lower than the intrauterine weights, especially early in pregnancy and for female infants. Thus, the 10th birthweight centile for girls at day 223 corresponds to the 4th centile of the‘true’ intrauterine weight, and the‘true’ intrauterine 10th centile corresponds to the 25th centile birthweight at day 223.
Prophylactic blood transfusion in maternal sickle cell syndromes
Authors: TUCK SUSAN M. , BREWSTER E. M. , STUDD J. W. W. , JAMES CATHERINE E. , PEARSON T. C.
Published: August 2005

Summary. An assessment of the benefits of prophylactic blood transfusion during 51 pregnancies in women with haemoglobin SS, haemoglobin SC and haemoglobin S‐β‐thalassaemia in a retrospective study from 1978 to 1984 has failed to demonstrate any clear conclusions as to their efficacy. Of the transfused patients, 22% developed atypical red cell antibodies and 14% had immediate minor transfusion reactions. Our data show no significant difference in fetal or maternal outcome between those patients who were transfused prophylactically and those who were not. A prospective study to clarify the appropriate place of this important aspect of management in women with sickle cell disease in pregnancy is suggested.
Serum CA 125 levels in epithelial ovarian cancer: relation with findings at second‐look operations and their role in the detection of tumour recurrence
Authors: SCHTLTHUIS M. S. , AALDERS J. G. , BOUMA J. , DE BRUIJN H. W. A. , KOOI H. , WILLEMSE P. H. B. , FLEUREN G. J.
Published: August 2005

Summary. Pre‐operative serum CA 125 levels were elevated (>35U/ ml) in 44 of 46 (96%) patients with epithelial ovarian cancer. Their serum CA 125 levels ranged from 36 to 8670 U/ml and a correlation with tumour stage was found. Also, during progressive disease, 49 of 53 patients showed elevated levels. At the time of second‐look operations, elevated serum CA 125 levels indicated the presence of tumour. However, the presence of small tumour residues (< 2 cm) and of microscopically detectable tumour in biopsies were not associated with raised CA 125 levels, only a few patients (2 of 13 and 2 of 17, respectively) showed levels higher than 35 U/ml before the second‐look operation. Rising levels preceded the clinical discovery of a relapse in 15 of the 22 patients with a median lead time of 3.5 months (1–17 months), and in three patients rising levels were found at the time the tumour recurrence was detected. It is concluded that CA 125, despite its general usefulness, is unable to detect tumour nodules of < 2 cm in size, but it proved to be a sensitive and early indicator of tumour recurrence and progression.
Screening for light‐for‐gestational age infants: a comparison of three simple measurements
Authors: MATHAI MATTHEWS , JAIRAJ PRABHA , MUTHURATHNAM S.
Published: August 2005

Summary. Fundal height, abdominal girth and abdominal length were measured during routine examination in our antenatal clinic. Standard graphs of fundal height, abdominal girth and the ratio of fundal height to abdominal length were drawn using data from 250 consecutive women with uncomplicated pregnancies. These graphs were used to predict low‐birthweight‐for‐gestation (LGA) in 150 high‐risk and 208 low‐risk pregnancies. Fundal height measurements had high sensitivity (78–84%) and specificity (84–88%) and were therefore most reliable in screening for LGA babies.
Acute effects of nitrendipine in pregnancy‐induced hypertension
Authors: ALLEN JIM , MAIGAARD SVEND , FORMAN AXEL , JACOBSEN PREBEN , JESPERSEN LENNART T. , HANSEN KARL PETER BROGAARD , ANDERSSON KARL ERIK
Published: August 2005

Summary. The acute effects of a single, 20 mg oral dose of nitrendipine were studied in 10 women at between 32 and 42 weeks gestation with stable pregnancy‐induced hypertension (PIH). Blood pressure (BP), maternal heart rate and fetal heart rate (FHR) were assessed for 8 h after nitrendipine intake together with the plasma levels of nitrendipine, noradrenaline, adrenaline, plasma renin activity (PRA) and vasopressin. The mean initial systolic/diastolic BP was 158 (SEM 3.7)/ 108 (SEM 2.7) mmHg. Within 1 h stable, reduced mean BP‐levels of 141–145/90–95 mmHg were reached and maintained for 4 h after medication. This antihypertensive effect was closely related to the maternal plasma concentration of nitrendipine, which reached a maximum of 9.1 (SEM 2.6) ng/ml 3 h after tablet intake. After 4 h, systolic and diastolic BPs slowly increased in parallel to a successive decrease in plasma concentrations of nitrendipine. Maternal heart rate increased by less than 10%, while FHR remained unchanged. No hypotensive incidents occurred. The initial mean plasma concentrations of noradrenaline, adrenaline, vasopressin and PRA did not change during the treatment. No major maternal and no fetal side‐effects were observed. Three of 10 patients experienced mild, transient facial flushing.
Units for the evaluation of uterine contractility
Authors: PHILLIPS G. F. , CALDER A. A.
Published: August 2005

Summary. An improved system of units is proposed for evaluating the contractile activity of the myometrium. Mean active pressure (in kPa) provides the best overall measure of contractility. This measure is broadly compatible with studies quoting‘uterine activity integral’ in kPa s per 15 min, but may be applied to any period of time. Units are suggested for measuring the amplitude, frequency and duration of contractions. It is shown that these are independent variables, and that mean active pressure is the numerical product of these three components.
Prophylactic long‐term oral tocolysis of multiple pregnancies
Authors: GUMMERUS MARTTI , HALONEN OUTI
Published: August 2005

Summary. After admission to hospital for bed rest, 200 women with multiple pregnancies were randomly allocated to receive either 4 mg of salbutamol orally five times daily, or to receive no drug. After an average of 6 weeks treatment, no difference between the experimental groups could be detected with respect to duration of gestation, birth‐weight or any other of the outcomes of pregnancy observed.
Pain after laparoscopy related to posture and ring versus clip sterilization
Authors: DOBBS F. F. , KUMAR V. , ALEXANDER J. I. , HULL M. G. R.
Published: August 2005

Summary. In an attempt to reduce pain after laparoscopy, presumed to be due to persistence of CO2 in the peritoneal cavity especially under the diaphragm, women were kept 30° head down for 30 min immediately after operation. By random selection 67 treated patients were compared with 64 kept flat, postoperative symptoms being recorded at fixed times for 3 days. Although tilting was found to be of no significant benefit there were two useful findings. In both groups there was a significant fall in the frequency of upper abdominal pain during the first postoperative night from about 53% to about 25%, followed by a rise after returning home on the first postoperative day to about 60% and only a slow fall in the next 2 days. The severity of pain followed the same pattern. Patients should be warned to expect increased pain on ambulation after leaving hospital. Also, there was doubling in lower abdominal pain during the first 6 h associated with the use of Falope rings for sterilization, compared with either Hulka clip sterilization or only diagnostic laparoscopy.
Circulatory changes in the fetal aorta after maternal smoking
Authors: ERIKSEN POUL SINDBERG , MARŠÁL KAREL
Published: August 2005

The acute cardiovascular responses of the human fetus to maternal smoking of one cigarette were studied in 10 healthy pregnant women. Following maternal smoking, a significant increase was found in the nicotine concentration in maternal plasma accompanied by a significant increase in the fetal heart rate. The flow velocity was recorded in the fetal descending aorta by combining real‐time ultrasonography and the 2 MHz pulsed Doppler technique and the waveform of the maximum blood velocity was analysed. The duration of the acceleration part of the pulse cycle (start‐to‐peak time) remained unchanged during the study period. The least diastolic blood velocity increased significantly after smoking. The pulsatility index fell significantly during the first 5 min after smoking, probably as the consequence of fetal tachycardia, but was normal again at 10 min. The rising slope rose significantly within the first 10 to 20 min after the onset of smoking. The results indicate, that, following maternal smoking of one cigarette, fetal central circulation increases but peripheral resistance is unchanged.
Wound pain may be reduced by prior infiltration of the episiotomy site after delivery under epidural analgesia
Authors: KHAN G. Q. , LILFORD R. J.
Published: August 2005

Local infiltration is seldom used during episiotomy repairs in patients who have been delivered under an effective epidural block and increased post‐episiotomy pain has been found in association with epidural analgesia. The hypothesis that this leads to tight wound closure and thereby causes increased perineal pain was examined in a double‐blind randomized trial in patients who had normal deliveries and medio‐lateral episiotomies. Mean pain scores on the day after delivery were significantly reduced from 4·5 to 3·6 and analgesic requirements were also diminished by local infiltration with saline before the episiotomy repair. It is postulated that the oedema of inflammation can be accommodated under less pressure if ‘slack’is created by prior distension of the tissues.
The short‐term effect of radical hysterectomy on urethral and bladder function
Authors: FARQUHARSON D. I. M. , SHINGLETON H. M. , ORR J. W. , HATCH K. D. , HESTER S. , SOONG S‐J.
Published: August 2005

To investigate bladder neck and urethral function after radical hysterectomy, 21 patients were investigated before and 3 months after the operation. Each patient had an excretory urogram, CO2 cysto‐scopy, uroflowmetry, water cystometry and a urethral pressure profile, using a dual sensor microtransducer catheter, at rest and during stress. Postoperatively there was a significant reduction in urethral length and urethral closure pressure; however, pressure transmission ratios were maintained, indicating no loss of bladder neck support with stress. Of the six patients with pre‐operative bladder neck weakness, two (33%) had stress urinary incontinence at the 3 months assessment. No patient with a normal pre‐operative assessment developed this complication. Fifteen (71%) voided by abdominal straining and this manoeuvre emptied the bladder effectively. These data suggest that patients with pre‐operative evidence of an incompetent bladder neck may be predisposed to develop stress urinary incontinence after radical hysterectomy because of a reduction in the urethral closure pressure.
Treatment of hirsutism in polycystic ovary syndrome with bromocriptine
Authors: MURDOCH A. P. , MCCLEAN K. G. , WATSON M. J. , DUNLOP W. , TAYLOR P. KENDALL
Published: August 2005

The value of bromocriptine in the treatment of hirsutism in polycystic ovary syndrome (PCO) was assessed subjectively and photographically in a double‐blind trial in 22 women studied for 1 year. Menstrual frequency was recorded. Circulating concentrations of oestradiol, oestrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG) were determined before treatment and after 6 and 12 months therapy. On the same occasions gonadotrophin concentrations (mean of 24 samples) and their response to 100 μg LHRH were determined. No evidence was found to support a therapeutic role for bromocriptine in the treatment of hirsutism or menstrual regulation in PCO. No biochemical changes were seen specific to bromocriptine therapy.
Estimating a woman's risk of having a pregnancy associated with Down's syndrome using her age and serum alpha‐fetoprotein level
Authors: CUCKLE H. S. , WALD N. J. , THOMPSON S. G.
Published: August 2005

The risk of an individual woman having a pregnancy associated with Down's syndrome was estimated from her age and her serum alpha‐fetoprotein (AFP) level at 14–20 weeks gestation. The estimates were made using published data on the risk of Down's syndrome in relation to maternal age from 4528 affected and over 5 million unaffected pregnancies, and on the risk in relation to serum AFP from 68 affected and 36 645 unaffected pregnancies. Separate estimates were derived for AFP levels using gestational age based (i) on the time since the first day of the last menstrual period and (ii) on an ultrasound biparietal diameter measurement. In each case this was done with and without adjusting AFP levels to take account of maternal weight. The same sources of data were also used to construct six Down's syndrome screening policies, each combining information on maternal age and serum AFP. For example with one policy the detection rate would be 28% and would involve selecting 2·8% of unaffected pregnancies for amniocentesis; using age alone the same detection rate could only be achieved by selecting 4·3% of unaffected pregnancies for amniocentesis—an increase of 50%. In general, screening for Down's syndrome using both maternal age and serum AFP is more efficient than either alone.
The urinary excretion of albumin in normal pregnancy
Authors: WRIGHT A. , STEELE P. , BENNETT J. R. , WATTS G. , POLAK A.
Published: August 2005

The urinary excretion of albumin was measured in a group of normal pregnant women at 14, 28 and 36 weeks gestation and 6 weeks postpartum. Using 2‐h urine collections, the excretion rate was not found to increase during pregnancy or to differ from that in a group of non‐pregnant controls. The urinary albumin to creatinine concentration ratio was greater at all stages of pregnancy than in the non‐pregnant controls and greater at 36 weeks than at 14 weeks gestation. Correcting for the observed changes in serum albumin and creatinine clearance produced evidence consistent with the hypothesis that mean glomerular permeability to albumin rises progressively during pregnancy. Reasons are given why the measurement of urinary albumin excretion may be a useful screening test in some pregnant women, and may also yield useful information on the effect of multiple pregnancies on renal function. One grand multipara was studied and found to have an increased excretion of albumin at each stage of pregnancy.
Induction of labour, birthweight and perinatal mortality by day of the week
Authors: DOWDING V. M. , DUIGNAN N. M. , HENRY G. R. , MACDONALD D. W.
Published: August 2005

There were 66 974 births at the three largest Dublin maternity hospitals in the years 1980–1982. Data on numbers of spontaneous and elective births, birthweight and perinatal mortality were analysed by day of the week. Perinatal mortality rates were highest on Wednesdays and Saturdays. The rate on Sunday was close to average. The largest number of perinatal deaths per day occurred on Wednesdays and the smallest on Sundays. Significant variations in mortality rates and percentage low birthweight were found among the 19% of infants who were born electively, but not among those born after a spontaneous onset of labour. High‐risk pregnancies, including many with intrauterine fetal death, were induced in large numbers from Tuesdays through Saturdays with a peak on Wednesdays. Low risk cases were induced mainly from Monday through Fridays with a peak on Fridays. The pattern of perinatal mortality through the week followed closely that of the risk status of pregnancies delivered electively. The results indicate that the pattern of perinatal mortality by day of the week of birth was determined by a highly organized weekly routine of selective elective delivery.
The disappearance rate of Schwangerschaftsprotein 1 in normal and pathological pregnancies
Authors: HUTTENMOSER J. L. , WEIL‐FRANCK C. , BISCHOF P.
Published: August 2005

In six women with a normal vaginal delivery at term, in 12 women who had a suction curettage between 6 and 12 weeks gestation and in eight women with an ectopic pregnancy, the post‐partum or the post‐surgery decline in radioimmunoassayable SP1 was faster during the first 24 h after surgery or delivery than later, so that two half‐lives were calculated. The first‘half‐life’of about 20 h (0–24 h after delivery or surgery) was of the same order of magnitude in all groups studied and corresponded well to previously published values. The mean second‘half‐life’(<24 h after delivery or surgery) was significantly longer in term (72·2 h) and in ectopic pregnancies (64·1 h) than in first trimester pregnancies (45·5 h). These results might indicate that the metabolism of SP1 either changes during pregnancy or that the changing SPlβ/SPlα ratio during pregnancy markedly influences the levels of SP1 as measured by radioimmunoassay.
Two hundred out‐patient laparoscopic clip sterilizations using local anaesthesia
Authors: MACKENZIE I. Z. , TURNER EILEEN , O'SULLIVAN G. M. , GUILLEBAUD J.
Published: August 2005

Female sterilization using clips applied laparoscopically under local anaesthesia was used in 200 women. Apart from two patients in whom there were technical difficulties, the operation was completed without complication and without immediate or delayed morbidity. The technique, which avoids the risks of general anaesthesia, is commended as a safe, simple method of sterilization suitable for, and acceptable to, the majority of women.
Mucin production in cervical intraepithelial neoplasia and in stage 1b carcinoma of cervix with pelvic lymph node metastases
Authors: IRELAND DAVID , COLE SHIRLEY , KELLY PHILIP , MONAGHAN JOHN M.
Published: August 2005

Sections from cervical intraepithelial neoplasia (CIN 3) and stage 1b carcinoma of the cervix were stained with periodic acid‐Schiff (PAS) and alcian blue to identify the presence of intracellular mucin. One out of seven specimens of CIN 3 demonstrated intracellular mucin. In a series of 33 patients with stage 1b carcinoma of the cervix with pelvic lymph node metastases, PAS demonstrated intracellular mucin staining patterns that were similar in both tumour and lymph node in most patients. In the subgroup of 23 patients classified as having squamous carcinoma, 8 (35%) demonstrated intracellular mucin to some degree and only 2 (25%) of those 8 were alive after 3 years compared with 13 of the other 15 (87%) who did not show any mucin staining (P>0·01).
Fertility after chemotherapy for ovarian germ cell tumours
Authors: PEKTASIDES D. , RUSTIN G. J. S. , NEWLANDS E. S. , BEGENT R. H. J. , BAGSHAWE K. D.
Published: August 2005

Gonadal function was assessed in 17 women who successfully completed chemotherapy with the POMB/ACE regimen (cisplatin, vincristine [Oncovin], methotrexate, bleomycin/ actinomycin D, cyclophosphamide, etoposide) for ovarian germ cell tumours, and had a remaining ovary and uterus. A 20‐year‐old girl has not yet recovered menstruation 5 months off chemotherapy. All the remaining women whose mean age at start of chemotherapy was 21 (9–38) are now menstruating with a median time of recovery of 4½ months after completion of chemotherapy. Five women have so far conceived after chemotherapy resulting in three full term normal deliveries of healthy infants, one termination of pregnancy, two miscarriages and one continuing pregnancy. Gonadal function does not appear to be permanently impaired in the majority of patients receiving POMB/ACE chemotherapy for ovarian germ cell tumours.
The effect of position and delay on stroke and minute distance in late pregnancy
Authors: RAWLES J. M. , SCHNEIDER K. T. M. , HUGH R. , HUCH A.
Published: August 2005

Stroke and minute distance were measured in 12 women in late pregnancy using Doppler ultrasound. In each patient two sets of measurements were made every 2 min for 20 min in the supine and left lateral positions, the sequence of positions being reversed on the second occasion. Within each of the four 20 min measurement periods there were no significant changes with time in stroke distance, heart rate, or minute distance, or in their coefficients of variation. From this evidence there is no justification for delaying the measurement of cardiac output until a 'steady state’is reached. The measurements were influenced both by the sequence and the position in which they were taken, the effects being additive. Overall, stroke distance was 5·1% greater in the left lateral than in the supine position, heart rate was 3·7% less and minute distance not significantly different. Independent of posture, stroke distance was 6·5% greater in the second period of measurement than in the first, heart rate was 3% less and minute distance 2·8% more. In late pregnancy the relative magnitude of cardiac output in the left lateral and supine positions has to be interpreted in the light of a stepwise increase of aortic blood flow with change of posture.
Feto‐maternal haemorrhage associated with genetic amniocentesis: results of a randomized trial
Authors: TABOR ANN , BANG JENS , NØRGAARD‐PEDERSEN BENT
Published: August 2005

Maternal serum alpha‐fetoprotein (AFP) levels were determined before and after genetic amniocentesis (n=283) or ultrasound scan (n=268) in a group of women participating in a randomized trial of genetic amniocentesis. Increases in AFP levels were seen significantly more often after amniocentesis than after ultrasound scan (P<0·001) and 48 women in the amniocentesis group had increases in AFP (ΔAFP) that were larger than the maximum ΔAFP (±25 μg/1) seen in the ultrasound group. If a ΔAFP of <25 μg/1 represents a feto‐maternal haemorrhage (FMH) attributable to amniocentesis, the rate of amniocentesis‐induced FMH was 17%. Such FMH was seen significantly more often after transplacental amniocentesis or after amniocentesis performed by less experienced operators. No association was detected between birthweight and FMH attributable to amniocentesis.
'Unexplained infertility’results of secondary investigations in 95 couples
Authors: HAXTON M. J. , FLEMING R. , HAMILTON M. P. R. , YATES R. W. , BLACK W. P. , COUTTS J. R. T.
Published: August 2005

Abnormalities of in‐vitro sperm‐mucus penetration, ovarian hormone deficiency, specifically poor progesterone surge, and luteal cyst formation were assessed prospectively in 95 couples with fully investigated primary infertility of 3·3 years duration. Abnormal spermmucus penetration was found in 22, half of whom could have been identified on semen assessment alone. Ten other males had recurrent oligospernia but with normal motility and mucus penetration. Twentyone patients had a poor progesterone surge and seven of them demonstrated retained luteal phase cysts. Endocrine and mucus penetration abnormalities did not coincide, demonstrating that they are distinct and unrelated phenomena. A significant number of couples were found for whom the term‘unexplained infertility’was no longer applicable and appropriate management could be considered.
Control of menorrhagia by the cyclo‐oxygenase inhibitors naproxen sodium and mefenamic acid
Authors: HALL P. , MACLACHLAN N. , THORN N. , NUDD M. W. E. , TAYLOR C. G. , GARRIOCH D. B.
Published: August 2005

Thirty‐five patients with menorrhagia were treated in a double‐blind crossover study with naproxen sodium and mefenamic acid after measurement of their blood loss during control menstrual cycles. Treatment with these compounds reduced the excessive bleeding by an average of 46 and 47% respectively. Drugs in the prostaglandin synthetase inhibitor group are considered to have an important place in the treatment of menorrhagia.
Effects of seven low dose combined oral contraceptives on high density lipoprotein subfractions
Authors: VANGE N. VAN DER , KLOOSTERBOER H. J. , HASPELS A. A.
Published: August 2005

The effects on lipid metabolism of seven combined oral contraceptives were investigated, particularly the effects on high density lipoprotein (HDL) subfractions, which were separated by density gradient ultracentrifugation. There were no differences between the preparations in the effects on the LDL fraction, the so‐called atherogenic particle, but there were marked differences in the effects on the anti‐atherogenic HDL fraction, of which the effects on HDL‐2 were most pronounced. After treatment with monophasic cyproterone acetate and biphasic desogestrel, the cholesterol and phospholipid contents of the HDL‐2 fraction were significantly higher than those found after treatment with the other preparations. The lowest values were found after treatment with monophasic levonorgestrel, whereas monophasic desogestrel, triphasic levonorgestrel, monophasic norethisterone and triphasic gestoden induced intermediate values for these variables. The levels of HDL‐2 reflect the intrinsic androgenicity of the various progestogens used in the preparations.
An objective assessment of physiotherapy for female genuine stress incontinence
Authors: WILSON P. D. , SAMARRAI T. AL , DEAKIN M. , KOLBE E. , BROWN A. D. G.
Published: August 2005

Sixty women with genuine stress incontinence were consecutively assigned to one of four physiotherapy groups who were treated for 6 weeks by either (1) pelvic floor exercises (PFE) in hospital; (2) PFE and faradism; (3) PFE and interferential therapy; (4) PFE at home. Assessment before and after treatment was by 7‐day bladder charts, urethral pressure profiles and perineometry. Approximately two‐thirds of the hospital‐treated patients (groups 1, 2 and 3) experienced marked or moderate subjective improvement and at 6 months, 27% were dry or almost dry. There was little difference in outcome between groups 1, 2 and 3 but hospital‐based therapy was more effective than home treatment. Statistical analyses showed that there were significant improvements in the objective indices measured in the 45 hospital‐treated patients. Successful treatment was more likely in younger patients, in those with lesser degrees of genuine stress incontinence and those who had had no previous pelvic floor surgery.
Long‐term surveillance of mortality and cancer incidence in women receiving hormone replacemen therapy
Authors: HUNT KATHRYN , VESSEY MARTIN , MCPHERSON KLIM , COLEMAN MICHEL
Published: August 2005

This paper reports the preliminary results of a cohort study of 4544 British women receiving hormone replacement therapy (HRT). These women were recruited at 21 specialist menopause clinics around Britain. Up to the end of June 1983, the mean duration of HRT use per woman was 67 months of which, on average, 43% was‘opposed’use. In general, however, both the amount of progestogen given and the number of days per cycle for which it was given was less than would have been the case if the women had been receiving modern opposed therapy. The major focus of the study was to monitor mortality and cancer incidence in the cohort. The mortality results were broadly reassuring: overall mortality was significantly lower than expected on the basis of national rates (relative risk 0·58) and mortality ratios were below unity for all specific causes of death examined apart from cancer of the ovary (relative risk 1·43, 95% confidence limits 0·62–2·82) and suicide or suspected suicide (relative risk 2·53, 95% confidence limits 1·26–4·54). The most likely explanation for the latter finding is selection bias—thus at least 7 of the 11 women who died from suicide or suspected suicide had a psychiatric history before receiving HRT. The cancer incidence results were less reassuring, although they should be interpreted with some caution because cancer registry rates were used for comparative purposes. With this proviso, endometrial cancer risk was significantly elevated (relative risk 2·84,95% confidence iimits 1·46–4·96); many of the women concerned had taken therapy which was predominantly or entirely opposed although only one woman had received an opposed regimen which would now be considered adequately protective to the endometrium. Breast cancer incidence was also significantly increased (relative risk 1·59, 95% confidence limits 1·18–2·10); detailed analysis suggested that the use of unopposed ethinyloestradiol in particular might have undesirable effects on the breast.
Screening for Down's syndrome using an iso‐risk curve based on maternal age and serum alpha‐fetoprotein level
Authors: TABOR ANN , LARSEN SEVERIN OLESEN , NIELSEN JAN , NIELSEN JOHANNES , PHILIP JOHN , PILGAARD BENTE , VIDEBECH POUL , NORGAARD‐PEDERSEN BEN
Published: August 2005

On the basis of the significantly different distributions of maternal serum alpha‐fetoprotein (AFP) levels in 86 pregnancies associated with fetal Down's syndrome and in 2018 unaffected pregnancies, an iso‐risk curve for Down's syndrome was constructed. An iso‐risk curve shows, for women of all ages, which combinations of maternal age and level of maternal serum AFP result in the same risk of carrying a fetus with Down's syndrome. A 1:400 risk of Down's syndrome, corresponding to the risk of a 35‐year‐old woman, was chosen as the lowest risk indicating referral for amniocentesis. If all women, irrespective of their age, are offered amniocentesis, when their risk of carrying a Down's syndrome fetus is 1;400 or higher, 53% of the affected fetuses can be detected as compared with 28% of the affected fetuses diagnosed at present in women above 35 years of age.
Mortality and morbidity in infants born between 20 and 28 weeks gestation
Authors: WALKER E. M. , PATEL N. B.
Published: August 2005

Of 149 infants with ultrasound evidence of gestadonal age, born in Ninewells Hospital at between 20 and 28 weeks gestation over a 5‐year period, 50 were alive at birth. Of these infants, 21 died within 1 week, a further three died within 1 month and a further two within 18 months. Of the 24 survivors, 8 (33%) have significant handicap. The obstetric factors leading to delivery and the mode of delivery are discussed.
Cigarette consumption and serum cotinine in relation to birthweight
Authors: HADDOW JAMES E. , KNIGHT GEORGE J. , PALOMAKI GLENN E. , KLOZA EDWARD M. , WALD NICHOLAS J.
Published: August 2005

The concentration of serum cotinine (the major metabolite of nicotine) was measured in sera from 4211 women at between 15 and 21 weeks gestation to determine whether a serum cotinine level was a better predictor of low birthweight than the self‐reported number of cigarettes smoked per day. Both cotinine levels and smoking history were significantly associated with reduced birthweight, but cotinine correlated significantly better. Smokers of ≤25 cigarettes per day, representing the 2·7% of women with the greatest cigarette consumption, had infants 289 g lighter than the 68% of women who were non‐smokers. Women with serum cotinine levels in the top 2·7% (≤284 ng/ml) had infants 441 g lighter than the 68% of women with the lowest cotinine levels (≤24 ng/ml). Our results strengthen the evidence linking smoking with low birthweight and also demonstrate that cotinine can be satisfactorily used to assess and monitor cigarette smoking in pregnancy.
Endocrine changes following pituitary desensitization with LHRH agonist and administration of purified FSH to induce follicular maturation
Authors: SHAW R. W. , NDUKWE G. , IMOEDEMHE D. A. G. , BERNARD A. , BURFORD G. , BENTICK B.
Published: August 2005

Pituitary desensitization was induced in 13 normally menstruating women by administration of an LHRH agonist, Buserelin, intranasally, 100 μg at intervals of 4 h, for a period of 14 days starting on day 22 of the menstrual cycle. Whilst continuing with Buserelin, multiple follicular development was induced by administration of purified FSH (Metrodin) for between 8 and 15 days at a dose of 150 i.u. daily. In one patient no follicular growth was induced after 14 days treatment. In the remaining subjects between 3 and 11 follicles with mean diameter <16 mm were stimulated and between 2 and 10 mature oocytes were recovered laparoscopically for IVF, 34 h after hCG administration. Eight patients underwent embryo transfer and four conceived.
Accuracy of mothers' recall of birthweight and gestational age
Authors: SEIDMAN D. S. , SLATER P. E. , EVER‐HADANI P. , GALE R.
Published: August 2005

Summary. Information on the birthweight and gestational age of previous siblings is usually dependent upon maternal recall. This information is of importance in assessing the current risk of perinatal morbidity and mortality. The validity of maternal recall of birthweight and gestational age of 880 children born to 97 multiparas was examined by comparison with hospital records. About 75% of all reported birthweights were accurate to within 100 g and a similar proportion of reported gestational ages was correct to within 1 week. Recall was most accurate for most recent births as well as for earliest births and was not related to maternal age or education. There was a tendency for the smallness of low birthweight infants to be exaggerated by mothers. We conclude that within defined limitations, maternal recall of birthweight and gestational age of previous children is sufficiently accurate for clinical and even for epidemiological use.
The blood flow velocity waveform in the fetal internal carotid and umbilical artery; its relation to fetal behavioural states in normal pregnancy at 37–38 weeks
Authors: VAN EYCK J. , WLADIMIROFF J. W. , VAN DEN WIJNGAARD J. A. G. W. , NOORDAM M. J. , PRECHTL H. F. R.
Published: August 2005

Summary. The relation between the blood flow velocity waveform in the fetal internal carotid artery (n= 12) and umbilical artery (n= 15) and fetal behavioural states at 37–38 weeks of gestation was studied. In the fetal internal carotid artery, under standardized fetal heart rate conditions, the pulsatility index (PI), as a measure of peripheral vascular resistance, was significantly lower during behavioural state 2F (active sleep) compared with state 1F (quiet sleep) according to the classification by Nijhuis et al. (1982), suggesting increased fetal cerebral blood flow during state 2F. In the umbilical artery, no significant difference in PI between the two behavioural states could be established. This suggests a fetal origin of the state dependency observed in fetal blood flow velocity waveforms.