bluuebunny/crossref_metadata_2025 huggingface dataset:
The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy for dysfunctional uterine bleeding
Authors: THOMAS E. J. , OKUDA K. J. , THOMAS N. M.
Published: August 2005

Objective— To observe if a combination of a depot GnRH agonist and cyclical hormone replacement therapy decreases menstrual b od loss.

Design— open, observational study comparing the objective assessment of menstrual blood loss before, during and after 3 months treatment.

Subjects— 20 women with a subjective complaint of heavy menstrual loss in whom no cause could be discovered.

Interventions— Each woman received 3 months of depot goserelin (Zoladex) combined with cyclical hormone replacement therapy (Cyclo‐Progynova, 1 mg). Menstrual loss and symptoms were assessed before, throughout and after the study.

Main outcome measures— Changes in objective and subjective assessments of menstrual blood loss and the acceptability of the treatment.

Results— The median pretreatment menstrual loss was 68 ml (range 23–397). Only 8 (40%) of the patients had a loss exceeding 80 ml per period. The median blood loss was 30 ml, 16 ml, and 17 ml in the three treatment cycles (P < 0.001 Wilcoxon rank sum for the third cycle). There was a significant decrease in the median length of menstruation (P < 0.001) and the number of towels or tampons (P < 0.01) used per period in the third treatment cycle. There was a significant decrease (P < 0.005) in the number of women complaining of dysmenorrhoea, premenstrual symptoms, flooding and the passage of clots. Seventeen patients experienced hot flushes. Eighteen of the 20 patients were completely satisfied with the treatment and would have been happy to continue with it for longer than 12 months.

Conclusions— The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy is a successful and acceptable treatment of dysfunctional uterine bleeding.
Sensory urgency: how full is your bladder?
Authors: CREIGHTON SARAH M. , PEARCE J. MALCOLM , ROBSON ISABEL , WANG KATHRYN , STANTON STUART L.
Published: August 2005

Objective— To investigate whether women with sensory urgency have an abnormal perception of bladder fullness.

Design— Prospective observational study.

Setting— Urodynamic Unit, St George's Hospital, London.

Subjects— 15 women with sensory urgency, 15 women with idiopathic detrusor instability and 15 without symptoms of frequency or urgency (control group).

Interventions— All the women attended for cystometry. Each was asked to complete a visual analogue score of how full she perceived her bladder to be on a scale from 1 to 10. This was done before filling cystometry and at three times during bladder filling. At each time actual filled volume was noted.

Main outcome measures— Maximum bladder capacity and individual perception of bladder fullness.

Results— Women with sensory urgency and detrusor instability had similar maximum bladder capacity although values in both groups were significantly lower than in the control group; thus percentage of maximum bladder capacity was used for analysis. Linear regression was performed for each group of patients and a predicted visual analogue score at 25, 50 and 75% of capacity calculated. These were compared between groups by rank analysis of variance. There was no significant difference between sensory urgency and detrusor instability. However, at 25, 50 and 75% of capacity, both groups had a significantly higher score than the control group.

Conclusions— This abnormal perception would explain symptoms of frequency and urgency in these two groups. These results also confirm the similarity between detrusor instability and sensory urgency.
Alpha thalassaemia hydrops fetalis in the UK: the importance of screening pregnant women of Chinese, other South East Asian and Mediterranean extraction for alpha thalassaemia trait
Authors: PETROU M. , BRUGIATELLI M. , OLD J. , HURLEY P. , WARD R. H. T. , WONG KWAI PENG , RODECK C. , MODELL B.
Published: August 2005

Objective
Alpha zero (α° or α‐1) thalassaemia is an important genetic risk for women originating from Hong Kong, Singapore, Vietnam, Thailand, the Philippines or South China. Cypriots are also at risk. Carriers of α° thalassaemia trait can be detected by routine haemoglobinopathy screening. When a couple are both carriers, in each pregnancy there is a 25% risk that the fetus will have α thalassaemia hydrops fetalis; this is fatal for the fetus and carries serious obstetric and psychological risks for the mother. Most informed couples at risk request prenatal diagnosis and selective abortion. This study investigates the effectiveness of screening, counselling and prenatal diagnosis for α thalassaemia hydrops fetalis in the UK.

Design
Retrospective analysis of the notes.

Subjects
18 couples attending University College Hospital London for prenatal diagnosis of α thalassaemia hydrops fetalis since 1982.

Results
The study shows underdiagnosis of both α° thalassaemia trait and α thalassaemia hydrops fetalis leading to avoidable stillbirths and complications in pregnancy.

Conclusion
We recommend early screening for α° thalassaemia trait for all women of Southeast Asian or eastern Mediterranean origin and the offer of prenatal diagnosis when indicated. The diagnosis of α thalassaemia hydrops fetalis should be considered in women of the relevant ethnic origin who have a stillbirth, neonatal death, abnormal ultrasound findings at fetal anomaly scanning (especially a large placenta), or who develop pre‐eclampsia.
A prospective, randomised, cross‐over study comparing the effects of clomiphene citrate and cyclofenil on endometrial morphology in the luteal phase of normal, fertile women
Authors: LI T. C. , WARREN M. A. , MURPHY C. , SARGEANT S. , COOKE I. D.
Published: August 2005

Objective
To examine the effect of two anti‐oestrogens, clomiphene citrate and cyclofenil, on endometrial morphology in the luteal phase.

Design
A prospective, randomised, cross‐over study.

Setting
Jessop Hospital for Women, Sheffield, UK.

Subjects
10 women who were previously fertile and regularly cycling.

Intervention
The administration of clomiphene citrate or cyclofenil in the treatment cycles. A LH timed endometrial biopsy was taken on day LH + 6.

Main outcome measures
Histological dating and morphometric analysis of the endometrial sample.

Results
Only one out of 10 subjects had abnormal endometrium. There was no difference in the results between cycles treated with clomiphene citrate and cyclofenil.

Conclusions
Clomiphene citrate or cyclofenil does not have a major adverse effect on endometrial morphology in the luteal phase of normal fertile subjects. The possible adverse effects of anti‐oestrogens on endometrium may have been previously overestimated.
Serum relaxin as a potential marker for preterm labour
Authors: PETERSEN LONE KJELD , SKAJAA KRISTJAR , ULDBJERG NIELS
Published: August 2005

Objective
To determine whether high serum relaxin concentrations in the 30th week of pregnancy were associated with preterm labour.

Design
Case‐control study.

Setting
Two antenal clinics of the Department of Obstetrics and Gynecology University Hospital of Aarhus.

Subjects
A cohort of 991 women (82% of 1203 eligible) in the 30th week of pregnancy attending one of the two antenatal clinics. The cases comprised 23 (2.4%) women without pre‐eclampsia or small for gestational age babies, who were delivered spontaneously before 37 completed weeks gestation. The control group of 46 women was randomly selected from the rest of the cohort, all of them were delivered at term.

Interventions
Blood samples were collected at 30 weeks gestation and stored for analysis.

Main outcome measures
Serum relaxin concentrations estimated by ELISA technique, length of gestation at delivery.

Results
The mean serum relaxin concentrations in the 30th week of pregnancy was 455 (SD 169) pg/ml and 327 (SD 139) pg/ml in the cases and controls, respectively (P = 0003, t test). In women with preterm delivery a negative correlation was found between relaxin concentration in the 30th week of pregnancy and the gestational age at parturition (r=−0.53, P= 0.02).

Conclusion
High relaxin concentrations may be associated with preterm delivery but the present results need confirmation in large scale studies.
A randomized controlled trial to compare three types of fetal scalp electrode
Authors: NEEDS LINDA , GRANT ADRIAN , SLEEP JENNIFER , AYERS SARAH , HENSON GAYE
Published: August 2005

Objectives
To compare three scalp electrodes in respect of need for reapplication, trace quality and scalp trauma.

Design
Randomized controlled trial.

Setting
Maternity Unit, Royal Berkshire Hospital, Reading.

Participants
780 women in labour at term, with cephalic fetal presentation, deemed to require electronic fetal heart rate monitoring using a scalp electrode.

Interventions
Three types of fetal scalp electrode: Rocket‐Rolon (double‐helix spiral); Hewlett‐Packard (double‐helix spiral); and Surgicraft‐Copeland (clip).

Main outcome measures
Need for more than one electrode; reason for replacement; trace quality; scalp trauma; direct financial costs.

Results
Reapplication was significantly least likely in the Surgicraft‐Copeland group (odds ratio vs Hewlett‐Packard = 0.61, 95% CI 0.41–0.90; odds ratio vs Rocket‐Rolon = 0.43, 95% CI = 0.29.0.62). This reflected a much lower rate of replacement because of detachment. The Hewlett‐Packard was, however, least likely to be replaced because of poor trace quality. Interpretable traces were equally common, but trace quality tended to be superior in the Hewlett‐Packard group. There was no serious scalp trauma. Difficulty removing the electrode was least often reported in the Hewlett‐Packard group, and a mark on the scalp persisted least often in the Rocket‐Rolon group.

Conclusions
The Surgicraft‐Copeland performed the best overall, and particularly in respect of attachment to the scalp. It appears to be the electrode of choice of the three tested.
Spontaneous fetal reduction in multiple gestations assessed by transvaginal ultrasound
Authors: BLUMENFELD ZEEV , DIRNFELD MARTHA , ABRAMOVICI HAIM , AMIT AMNON , BRONSHTEIN MOSHE , BRANDES JOSEPH M.
Published: August 2005

Objective
To assess the occurrence of disappearance of one or more of the fetuses in pregnancies which start as multiple gestation.

Design
Observational study.

Setting
Infertility section, Rambam Hospital, Haifa.

Subjects
88 women with multiple gestations, established after ovulation induction (54 twin, 26 triplet, five quadruplet, and three quintuplet) and diagnosed by trans‐vaginal ultrasound at 5–6 weeks, in all of whom absorption of at least one gestation sac was detected at follow‐up ultrasound scan.

Interventions
Follow‐up by serial transvaginal and later abdominal ultrasound scan throughout pregnancy.

Results
Of the 54 twin gestations, 51 ended in the birth of a singleton and three in miscarriage. Of the 26 pregnancies starting as triplets, 12 ended in singleton births, 12 in twins and two miscarried. The five quadruplet gestations resulted in one singleton birth, one set of twins, two triplets, and one ended in late miscarriage. Of the three quintuplet pregnancies, two resulted in the birth of triplets, one of them after spontaneous, the other after iatrogenic fetal reduction. In the third quintuplet pregnancy, one fetus vanished spontaneously and another was subject to iatrogenic reduction, two fetuses survived and were liveborn. Of the 221 fetuses identified 107 (48%) vanished spontaneously.

Conclusion
Iatrogenic fetal reduction should be delayed until 12 weeks gestation in quadruplet or higher multiple gestations, but is probably not indicated in twin and triplet gestations.
Fetal breathing movements in oligohydramnios are not increased by amnioinfusion
Authors: FISK NICHOLAS M. , TALBERT DAVID G. , NICOLINI UMBERTO , VAUGHAN JANET , RODECK CHARLES H.
Published: August 2005

Objective
To determine whether fetal breathing movements (FBM) in pregnancies with oligohydramnios change with restoration of amniotic fluid volume.

Design
A prospective experimental study.

Setting
Fetal Medicine Unit, tertiary referral hospital.

Subjects
16 women with singleton pregnancies complicated by severe oligohydramnios.

Interventions: Restoration of amniotic fluid volume by transabdominal amnioinfusion. Controls comprised pregnancies in which infused fluid leaked vaginally, so that oligohydramnios was not corrected.

Main outcome measures
Change in total breathing movements, change in FBM incidence derived from 40 min recordings immediately before and after amnioinfusion.

Results
There was no significant difference in the change in total breathing movements or in the change in incidence of FBM between the 10 pregnancies in which amniotic fluid volume was restored, and the other six in which fluid leaked after infusion and volume was not restored. In both groups, there was no significant change with infusion in number of FBM (mean change −12, 95% CI −218 to +74 in the fluid‐retained group and −64, 95% CI −273 to +145 in the fluid‐leaked group) and incidence of FBM (median change −2–5%, range −27 to +10 in the fluid retained group and −4–5%, range −34 to +15 in the fluid‐leaked group).

Conclusions
This study suggests that restitution of amniotic fluid volume in human pregnancies complicated by severe oligohydramnios does not acutely alter the incidence of FBM. These data support an increasing literature suggesting that impairment of fetal breathing is not the mechanism for oligohydramnios‐related pulmonary hypoplasia.
Lung volume measured by functional residual capacity in infants following first trimester amniocentesis or chorion villus sampling
Authors: THOMPSON PETER J. , GREENOUGH ANNE , NICOLAIDES KYPROS H.
Published: August 2005

Objective
To determine the incidence of respiratory problems and lung volume abnormalities in babies bom after first trimester amniocentesis or chorion villus sampling.

Design
A prospective randomized study.

Setting
Harris Birthright Research Centre for Fetal Medicine, Paediatric Respiratory Laboratory, King's College Hospital.

Subjects
Babies of mothers who had undergone first trimester amniocentesis (n= 74) or chorion villus sampling (CVS) (n= 86) for fetal karyotyping because of advanced maternal age, parental anxiety or family history of chromosomal abnormal ‐ity in the absence of parental chromosome re‐arrangement.

Main outcomes
Respiratory distress in the neonatal period and lung volume as assessed by measurement of functional residual capacity (FRC).

Results
CVS was associated with a significantly higher incidence of neonatal respiratory distress, six infants in the CVS group but none in the amniocentesis group required admission to the special care baby unit because of respiratory distress (P <0–05). Although there was no significant difference in the mean FRC between the two groups (amniocentesis 29–7 ml/kg vs CVS 29–6 ml/kg) the overall incidence of FRC values <2–5th centile of the normal range was 9%.

Conclusion
Both amniocentesis and CVS performed in the first trimester of preg‐nancy may impair antenatal lung growth.
The cytological detection of persistent cervical intraepithelial neoplasia after local ablative treatment: a comparison of sampling devices
Authors: HUGHES R. G. , HADDAD N. G. , SMART G. E. , COLQUHOUN M. , McGOOGAN E. , MACINTYRE C. C. A. , PRESCOTT R. J.
Published: August 2005

Objective
To determine whether the cytological detection of persistent cervical intraepithelial neoplasia (CIN) after local ablative treatment is improved by the use of sampling devices other than the Ayre's spatula.

Design
A randomized controlled study.

Setting
Lothian Area Colposcopy Clinic.

Subjects
856 patients who had received local therapy (CO2 laser or cold coagulation) for CIN II or III between 9 and 30 months earlier.

Intervention
Each patient had three consecutive cervical smears taken, one with the Ayre's spatula, one with either the Aylesbury, the Rocket or the Multispatula device, and finally one with the Cytobrush. The allocation of which spatula and the order of the first two was randomized. Each patient had a colposcopic examination immediately after the smears were taken.

Main outcome measures
A comparison of the detection of histologically proven persistent CIN by the Ayre's spatula with the detection of persistent disease by alternative sampling devices.

Results
Of the 856 patients 130 had histologically proven persistent CIN. Another 98 had suspicious findings on colposcopy but punch biopsies reported as histologically normal. Of the remaining patients with normal colposcopy 130 were randomly selected to form a control group. The cervical smears from these 358 women were reported. Significantly fewer Ayre’ s samples contained endocervical cells than Aylesbury samples (47%vs 59%, difference 12%; 95% CI 3%‐21%; P<0.1), Rocket samples (47%vs 67%; difference 20%, 95% CI; 12%‐32%; P<0.001) or Multispatula samples (47%vs 76%; difference 29%, 95% CI 19–38%; P<0.001). When punch biopsies contained CIN, dyskaryotic cells were seen in 10% of Ayre's samples, 4.3% of Aylesbury samples, 8.3% of Rocket samples, and in no smear taken with the Multispatula. Obtaining a third smear with the Cytobrush did not substantially improve the detection rate of dyskaryosis. Neither the order of use of the spatulas, the form of initial treatment nor the size of the transformation zone had any apparent effect on the cytological detection of persistent CIN.

Conclusions
We recommend that surveillance of patients who have received local ablative therapy for CIN should be by both cytology and colposcopy, and that cytological samples should be obtained using the Ayre's spatula.
Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean
Authors: DULEY LELIA
Published: August 2005

Objective
To present estimates of maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean, and to discuss strategies to prevent these deaths

Design
Retrospective review of all available data.

Setting
Database of the World Health Organization's Maternal Health and Safe Motherhood Programme.

Main outcome measures
Estimates of the total maternal mortality and the proportions of deaths associated with hypertensive disorders of pregnancy.

Results
Estimates of mortality associated with hypertensive disorders of pregnancy were similar in Africa, Latin America and the Caribbean, despite considerably higher total mortality in Africa. Variations in both overall mortality and that associated with hypertensive disorders of pregnancy were greatest in Asia. Despite their limitations, these data suggest that between 10–15% of maternal deaths are associated with hypertensive disorders of pregnancy, and that 10% are associated with eclampsia.

Conclusions
Where maternal mortality is relatively high, the excess is likely to be due to a high mortality associated with haemorrhage and infection and reductions are most likely to come from reductions in these deaths. Evidence from both developed and developing countries suggests that deaths associated with hypertensive disorders of pregnancy are the most difficult to prevent. More rigorous assessment of interventions designed to prevent these deaths is urgently required.
Management of severe pre‐eclampsia and eclampsia by UK consultants
Authors: HUTTON J. D. , JAMES D. K. , STIRRAT G. M. , DOUGLAS K. A. , REDMAN C. W. G.
Published: August 2005

Objective
To determine the current management of severe pre‐eclampsia and eclampsia in the United Kingdom.

Design
One‐page postal survey to all (1007) UK consultant obstetricians with questions about use of antihypertensive and anticonvulsant drugs in severe pre‐eclampsia and eclampsia, other management strategies, definition of factors determining severity, protocol development and regional review.

Results
688 replies (69.6% response rate). The antihypertensive drugs used were mainly oral labetalol (35%), oral methyl dopa (23%) and parenteral hydralazine (29%); diuretics were not used. Diazepam was the preferred drug in eclampsia. Very few consultants used magnesium sulphate (2%). Anticonvulsants were also prescribed by 85% of consultants to prevent fits; the drugs then preferred were diazepam (41%), phenytoin (30%) and chlormethiazole (24%). Two‐thirds of consultants felt there was a need for trials to study the effectiveness of antihypertensive and anticonvulsant drugs. In a woman with proteinuric hypertension, 15% of consultants did not regard the development of headache as indicating severe pre‐eclampsia. Consistent management practices were not associated with agreement about protocols. Regional review does not appear to have occurred.

Conclusion
Antihypertensive and anticonvulsant therapies are widely used but trials are considered necessary. Improvements in the management of women with severe pre‐eclampsia or eclampsia might occur if UK obstetricians sought more collective opinion and undertook regional audit of protocols.
Placental bed biopsies in placental abruption
Authors: DOMMISSE J. , TILTMAN A. J.
Published: August 2005

Objective
To investigate structural changes in the uteroplacental blood vessels in association with placental abruption.

Design
Prospective descriptive study.

Subjects
18 women with clinical evidence of severe placental abruption delivered by caesarean section.

Interventions
Placental bed biopsies were obtained at caesarean section and studied histologically.

Results
Six specimens did not include trophoblast in the myometrium and were therefore not representative of the placental bed. Of the 12 representative specimens, seven demonstrated absence of physiological transformation of the utero‐placental arteries (four of these were from hypertensive patients). Four biopsies showed abnormal vascular structures deep in the myometrium. One of these abnormal vessels included a fresh plug and extensive surrounding intramyometrial haemorrhage.

Conclusions
Vascular malformations in association with placental abruption may be the result of trophoblastic invasion and could be the site of vessel rupture. Further descriptive and comparative studies are needed.
25 mg oestradiol implants—the dosage of first choice for subcutaneous oestrogen replacement therapy?
Authors: OWEN E. J. , SIDDLE N. C. , MCGARRIGLE H. T. , PUGH M. A.
Published: August 2005

Objective
To assess the oestrogen concentrations and symptom relief obtained with 25 mg oestradiol implants.

Design
Open, observational study.

Subjects
Twelve symptomatic, post‐menopausal women seen in a designated menopause clinic.

Intervention
A 25 mg oestradiol pellet was inserted subcutaneously, blood samples were obtained before implantation and at regular intervals (2–4 weeks) until symptoms refused as hypoestrogenaemia developed.

Main outcome measures
Change in symptom score following implant treatment. Concentrations of oestrogens and their metabolites before and during low dose subcutaneous oestradiol therapy.

Results
Ten of the 12 women had excellent symptom relief, associated with oestradiol concentrations in the follicular range for between 28 and 35 weeks. The ratio of circulating oestrogen metabolites remained physiological, despite the oestradiol concentrations being substantially higher on treatment.

Conclusions
We suggest that 25 mg pellets should be used as the initial dose for subcutaneous oestrogen treatment, and a combination of return of symptoms and weeks since insertion used to judge the timing of reimplantation.
Endometrial responses in artificial cycles: A prospective study comparing four different oestrogen dosages
Authors: LI T. C. , COOKE I. D. , WARREN M. A. , GOOLAMALLEE M. , GRAHAM R. A. , APLIN J. D.
Published: August 2005

Objective
To examine the endometrial response to four different regimens of oestrogen.

Design
A prospective, randomized cross‐over study.

Setting
Jessop Hospital for Women, Sheffield.

Subjects
Twenty one women with premature ovarian failure divided into three equal groups.

Interventions
Four different regimens of hormone replacement therapy: variable, fixed 1 mg, fixed 2 mg and fixed 4 mg oestrogen dosages. Each woman received the variable dosage regimen in one cycle and crossed over to receive one of the three fixed dose regimens (1 mg, Group 1; 2 mg, Group 2; 4 mg Group 3) in another cycle.

Main outcome measure
Ultrasonographic measurement of endometrial thickness and outpatient endometrial biopsy on day 19 of the artificial cycle; analysis of endometrial specimens by three separate methods: traditional histological criteria, morphometry and immunohistochemistry.

Results
The endometrial response was similar in those treated with the variable and the fixed 2 mg or 4 mg dosage regimens. The response was suboptimal in those treated with the fixed 1 mg dosage regimen.

Conclusions
Normal endometrial development requires adequate priming of the endometrium by oestrogen, which may be administered in a sequential, variable dosage fashion, or simply by a fixed daily dosage regimen. However, the minimum daily dose required is likely to be 2 mg of oestradiol valerate. No adverse effect on the endometrium was observed at a daily dose of 4 mg oestradiol valerate, which produced plasma levels of oestradiol above the reference ranges of the natural cycle.
Fetal urine biochemistry: an index of renal maturation and dysfunction
Authors: NICOLINI UMBERTO , FISK NICHOLAS M. , RODECK CHARLES H. , BEACHAM JEREMY
Published: August 2005

Objective
To construct a reference range for fetal urinary sodium, potassium, urea, creatinine, calcium and phosphate with gestation and to assess to what extent these biochemical indices are modified in fetuses with lower urinary tract obstruction.

Design
Prospective descriptive study.

Setting
Royal Postgraduate Medical School London.

Subjects
24 women between 17 and 35 weeks gestation with an ultrasound diagnosis of fetal lower urinary tract obstruction, with or without renal dysplasia and a control group of 26 women between 16 and 33 weeks gestation with normal amniotic fluid volume and fetal anatomy.

Interventions
Fetal urine samples (1–100 ml) were aspirated from the control fetuses either before termination of pregnancy(n = 9) or at the time of intrauterine transfusion for Rh alloimmunization (n = 17). The fetuses with obstructive uropathy had urine samples aspirated on one occasion (n = 14) or serially (n = 10).

Main outcome measures
Relation between urine biochemistry and renal damage ascertained clinically or at postmortem.

Results
In the control group, urinary sodium and phosphate decreased and creatinine increased significantly with gestational age, consistent with increasing fetal glomerular filtration rate and progressive maturation of tubular function. Urinary sodium and calcium were significantly higher in fetuses with renal dysplasia compared with those with lower urinary tract obstruction but normal renal histology or normal clinical outcome. Serial urinary samples from fetuses with obstructive uropathy showed more pronounced deviation from the normal with increasing gestation in all fetuses with renal dysplasia. The highest sensitivity in the detection of renal dysplasia was shown by urinary calcium (100%) whereas urinary sodium showed the best specificity (80%).

Conclusion
Renal damage is the direct effect of urinary obstruction, rather than an association so that treatment should start as soon as possible. Urine biochemistry may be helpful in the management of these patients.
Maternal serum unconjugated oestriol and human chorionic gonadotrophin levels in pregnancies with insulin‐dependent diabetes: implications for screening for Down's syndrome
Authors: WALD NICHOLAS J. , CUCKLE HOWARD S. , DENSEM JAMES W. , STONE ROSSANAB.
Published: August 2005

Objective
To investigate maternal serum unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) levels in pregnant women with insulin‐dependent diabetes mellitus and to consider the implications of the results for antenatal screening for Down's syndrome.

Design
Descriptive study using stored antenatal serum samples.

Setting
Stored serum samples collected from women receiving routine antenatal care in Oxford.

Subjects
126 singleton pregnancies in 92 women with insulin‐dependent diabetes mellitus and for each pregnancy, two pregnancies without diabetes matched for gestational age and duration of storage of the serum sample. None of the pregnancies was associated with fetal neural tube defect or Down's syndrome.

Main study measures
Maternal serum uE3 and hCG levels at 15–22 weeks gestation. Alpha‐fetoprotein (AFP) levels were also measured for comparison.

Results
The median uE3 level in the diabetic pregnancies was 0.92 multiples of the median (MoM) for pregnancies without diabetes at the same gestational age (P<0.05); and the hCG level was 0.95 MoM (P=0.48). The median AFP level was also reduced to 0.77 MoM (P<0.001).

Conclusion
The reduction in uE3 and AFP levels in insulin‐dependent diabetic pregnancies is sufficiently great to be taken into account in maternal serum screening programmes for Down's syndrome. Dividing the uE3 and AFP levels in such pregnancies by the corresponding median for insulin‐dependent diabetic pregnancies will yield a similar false‐positive rate in pregnancies with and without insulin‐dependent diabetes mellitus.
Is Stage I epithelial ovarian cancer overtreated both surgically and systemically? Results of a five‐year cancer registry review
Authors: FINN CATHERINE B. , LUESLEY D. M. , BUXTON E. J. , BLACKLEDGE G. R. , KELLY K. , DUNN J. A. , WILSON S.
Published: August 2005

ObjectiveTo review the incidence of Stage I epithelial ovarian carcinoma in the West Midlands region and to identify prognostic factors that have a significant effect on survival.

DesignA retrospective review of all Stage I ovarian cancer patients registered from 1.1.80 to 31.12.84.

SettingWest Midlands Regional Cancer Registry.

Population457 patients with Stage I ovarian cancer—373 with epithelial ovarian carcinoma.

Main outcome measuresSurvival at censor date of 30.6.89.

Results28% developed recurrent disease, and the overall 50‐year survival of the group was 70%. Univariate analysis of all possible prognostic factors showed that stage, adjuvant chemotherapy, histological grade and type, surgical rupture of the tumour, intact capsule histologically, clinical finding of ascites and the performance of peritoneal washings were significantly associated with survival. Adequate surgical staging as defined by FIGO was not significantly associated with survival. A multivariate analysis based on the Cox proportional hazard model identified histological grade, adjuvant chemotherapy, patient age and peritoneal washings as having independent prognostic effects. Surprisingly adjuvant chemotherapy and peritoneal washings had negative effects on survival.

ConclusionsAlthough a retrospective review has limitations, it would appear that adequate surgical staging and adjuvant chemotherapy confer no benefit in terms of survival in Stage I disease.
Antenatal cardiotocogram quality and interpretation using computers
Authors: DAWES G. S. , LOBB M. , MOULDEN M. , REDMAN C. W. G. , WHEELER T.
Published: August 2005

Objective
To test the application in practice of computerized fetal heart rate (FHR) analysis in pregnancy.

Design
Randomized distribution of subjects with computerized analysis automatically revealed or concealed.

Setting
A district general hospital and a teaching hospital outside London.

Subjects
2869 pregnant women studied within a year.

Outcome measures
Quality and duration of the cardiotocogram; quantitative measurement of FHR variation; number of stillbirths.

Results
With interactive advice to the operator, records were of improved quality (up to 28% without signal loss) with potentially much reduced recording time. The short‐term FHR variation measured in the last records before intervention is reported for the first time.

Conclusion
The benefits of using the computers include improvement in record quality and saving of time. In addition, where interpretation depended on estimation of FHR variation there was prima facie evidence of observer misinterpretation; visual analysis was unreliable. A larger trial is now required with more rigorous constraints on intervention.
Spontaneous resolution of pre‐eclampsia‐related thrombocytopenia
Authors: CHANDRAN RAVI , SERRA‐SERRA VICENTE , REDMAN CHRISTOPHER W. G.
Published: August 2005

Objective
To observe the spontaneous resolution of pre‐eclampsia‐related thrombocytopenia.

Design
A retrospective study.

Setting
High Risk Pregnancy Unit, John Radcliffe Maternity Hospital, Oxford.

Subjects
Thirty women with pre‐eclampsia complicated by the HELLP/ELLP syndrome who did not receive any specific treatment for their thrombocytopenia.

Intervention
Serial platelet counts throughout labour and the puerperium until the platelet counts returned to levels above 100 × 109/l.

Main outcome measures
Time taken from delivery and platelet nadir for platelet counts to return to levels above 100 × 109/1. The rate of recovery from the platelet nadir was measured by the slope of the serial platelet counts plotted against time.

Results
The mean time until platelet count exceeded 100 × 109/l was 67 h (SD 25) after delivery and 44 h (SD 17) from the platelet nadir. All women had counts above 100 × 109/1 by 111 h after delivery, and by 88 h after the platelet nadir. Although the time to recovery appeared to depend on the degree of thrombocytopenia, the rate of resolution did not.

Conclusion
These data can be used as a guide by clinicians as to the expected time course for postpartum resolution of pre‐eclampsia‐related thrombocytopenia.
Antenatal testing to predict outcome in pregnancies with unexplained antepartum haemorrhage
Authors: AJAYI R. A. , SOOTHILL P. W. , CAMPBELL S. , NICOLAIDES K. H.
Published: August 2005

Objective
To investigate whether Doppler studies of placental perfusion and antenatal tests for fetal hypoxia can identify reduced placental functional reserve in women with unexplained antepartum haemorrhage (APH).

Design
A prospective, longitudinal study.

Setting
Fetal Surveillance Unit, King's College Hospital, London.

Subjects
48 women with bleeding from the genital tract after 26 weeks gestation without a clinical diagnosis of abruption or ultrasound evidence of placenta praevia.

Interventions
Fetal surveillance by Doppler measurements of the umbilical and uterine arteries, biophysical profile scoring and computerized measurement of the mean minute range of FHR variation.

Main outcome measures
A poor outcome was defined by one or more of the following: (i) birthweight >2SD below the normal mean for gestational age and sex, (ii) abnormal FHR pattern in labour resulting in operative delivery, (iii) umbilical vein blood pH at delivery <7.15, (iv) a 5‐min Apgar score <7.

Results
Fifteen of the 48 pregnancies had a poor outcome; seven occurred in the 10 women delivered preterm (<37 weeks) and eight in the 36 women delivered between 37 and 42 weeks. Two women were delivered after 42 weeks and both infants had a good outcome. The results of Doppler studies of uterine and umbilical arteries, fetal biophysical profile or FHR variation were not significantly different between the two outcome groups. The 36 pregnancies delivered between 37 and 42 weeks were matched retrospectively for maternal age, parity and race with 36 pregnancies without APH; there was no significant difference in outcome between the women with unexplained APH and the matched comparison group.

Conclusion
Morbidity related to unexplained APH is associated with preterm delivery rather than with damage to utero‐placental function.
External ocular trauma in instrumental and normal deliveries
Authors: HOLDEN ROGER , MORSMAN DAVID G. , DAVIDEK GERVASE M. B. , O'CONNOR GERARD M. , COLES E. C. , DAWSON ANDREW J.
Published: August 2005

Objective
To compare the occurrence of external ocular trauma in instrumental and normal deliveries.

Design
Prospective controlled study.

Setting
University Hospital of Wales, Cardiff.

Subjects
133 babies born consecutively with the use of forceps and 133 control babies born without instrumentation to women matched for parity.

Interventions
External ocular examination.

Main outcome measures
The presence within 24 h of birth of corneal oedema, corneal abrasion, conjunctival chemosis, subconjunctival haemorrhage and lid oedema.

Results
Lid oedema and multiple minor external ocular trauma occurred in 52 and 22 babies, respectively, in the instrumental delivery group and in 13 and 8 babies, respectively in the control group (P<0.001). Corneal abrasion occurred in two babies and corneal oedema in one baby after forceps delivery but in none of the control group. No more serious injuries occurred. All injuries resolved without long term sequelae.

Conclusion
The frequency of sight threatening corneal trauma in instrumental deliveries is low. Specialist ophthalmic screening of these babies is not justified.
Screening for congenital heart disease prenatally. Results of a 2½‐year study in the South East Thames Region
Authors: SHARLAND GURLEEN K. , ALLAN LINDSEY D.
Published: August 2005

Objective
To assess the efficacy of four chamber view examination, during routine obstetric scanning, in the prenatal detection of fetuses with congenital heart disease.

Design
Prospective observational study.

Setting
Ten obstetric ultrasound units in the South East Thames Region.

Subjects
All pregnant women attending for routine obstetric ultrasound examination.

Intervention
Ultrasonographers performing routine ultrasound examinations were taught to obtain, and correctly interpret, the four chamber view of the fetal heart. When this view could not be achieved adequately, an attempt was made to identify a reason for failure and, if possible, to arrange a repeat scan. All suspected abnormalities were referred to a specialized unit.

Main outcome measures
Numbers of true abnormalities detected or overlooked, and the number in whom abnormality was suspected incorrectly.

Results
Over a 2.5‐year period, 69% of the known number of cardiac lesions associated with an abnormality of the four chamber view were detected prenatally during the routine obstetric scan, 10% were identified as a result of referal for other high‐risk factors and 21% were overlooked. The overall positive predictive value in the 10 obstetric units was 36%.

Conclusions
Prenatal screening for some forms of major congenital heart disease is possible by including examination of the four chamber view of the fetal heart in routine obstetric scans. However, there are important limiting factors that will influence the success of abnormality detection and must be taken into account if screening is to be effective nationwide.
Oral contraceptive use and breast cancer risk: a meta‐analysis of variations with age at diagnosis, parity and total duration of oral contraceptive use
Authors: RUSHTON LESLEY , JONES DAVID R.
Published: August 2005

Objective
To review published reports of risk of breast cancer with oral contraceptive use.

Design
Meta‐analysis of study results, using regression techniques to explore the inter‐study heterogeneity.

Setting
Twenty‐seven epidemiological studies of breast cancer risk and oral contraceptive use published 1980–1989.

Main outcome measures
Relative risk of breast cancer with oral contraceptive use; variations by age at diagnosis, parity, and total duration of use, and with study design characteristics.

Results
The overall relative risk estimate was 1.16 (95% CI1 .07–1.25) for the <45 years group, 1.21 (95% CI 0.99–1.47) for the nulliparous subgroup, and 1.27(95%CI 1 12‐1‐44) for durations of use of more than 8 years. Source of subjects, their marital status, the type of study, data collection methods, matching for geographical area, the number of adjustment factors used in the study analysis, the country of study and the calendar period in which the study ended were all important explanatory factors for inter‐study variation, but a substantial proportion of inter‐study variation remained unexplained.

Conclusions
These meta‐analyses suggest that risk of breast cancer may be raised by around 20% in younger, nulliparous and long use duration subgroups of oral contraceptive users. Risk estimates appear to be influenced by several study design factors, which should be considered carefully in designing and reviewing future studies.
Present‐day performance qualities of cardiotocographs
Authors: Carter Michael C.
Published: August 2005

Legislation and standards applying to medical electrical equipment are reviewed. Although there are no official standards for cardiotocographs, de facto standards can be defined. The paper introduces the present‐day performance qualities of cardiotocographs and the factors which affect the quality of the data. The measures used to evaluate the ability of cardiotocogaphs to indicate correctly the fetal heart rate and maternal uterine activity are discussed. Present‐day cardiotocographs generally perform well but the physiological variables need to be defined in order to produce equipment in keeping with clinical needs.
Communicating the significance of the fetal heart rate record to the user
Authors: Redman C. W. G.
Published: August 2005

Fetal heart rate (FHR) records should be presented as measurements derived from numerical analysis. Such analysis requires computerized systems. The Oxford system is the longest established and most tested of the systems available. It could provide the basis for a standardized approach to the numerical analysis of antepartum FHR records. Intrapartum FHR monitoring is of uncertain clinical value. It is premature to recommend standards for numerical analysis to upgrade the present methods of data presentation during labour. Once the patterns of abnormality are better defined numerically such standards will be mandatory because intrapartum FHR records cannot be interpreted reliably by eye.
Multifetal pregnancy reduction: a consecutive series of 61 cases
Authors: Boulot P. , Hedon B. , Pelliccia G. , Lefort G. , Deschampsi F. , Arnal F. , Humeau C. , Laffargue F. , Viala J. L.
Published: August 2005

Objective
The effect of selective fetocide on the course of 61 multiple pregnancies.

Design
An observational study.

Setting
A tertiary centre.

Subjects
61 women whose pregnancies included 37 triplets, 18 quadruplets, 5 quintuplets and 1 heptuplet; 97% followed IVF or the induction of ovulation. The aim of the procedure in most cases was to obtain twins.

Interventions
Selective reduction was performed before 13 weeks gestation under general anaesthesia, using either a transcervical (n= 26) or transabdominal approach (n= 35). Fifty‐four twins, 4 singletons and 3 triplets were obtained after the procedure.

Main outcome measure
Preterm labour rate.

Results
The rate of unplanned fetal loss was 13% and was related to the number of suppressed embryos (P<0.05). The preterm labour rate was 56.6%, the mean gestation at delivery was 35.6 weeks. Seven deliveries were before 32 weeks and led to all neonatal deaths. A comparison with published data suggested that fetal reduction reduced the rate of preterm labour in high multiple pregnancies; in 24 twin pregnancies obtained after reduction of triplets there was probably a gain of 2 weeks gestation. Severe growth retardation occurred in 13%. The perinatal mortality rate was 10.8%.

Conclusions
Selective termination reduces but does not prevent early preterm labour. The procedure is of value in pregnancies with more than 3 fetuses and should be considered carefully for triplet pregnancies.
Simulated home delivery in hospital: a randomised controlled trial
Authors: MacVicar John , Dobbie Gordon , Owen‐Johnstone Lucy , Jagger Carol , Hopkins Margaret , Kennedy June
Published: August 2005

Objectives
To compare the outcome of two methods of maternity care during the antenatal period and at delivery. One was to be midwife‐led for both antenatal care and delivery, the latter taking place in rooms similar to those in one's own home to simulate home confinement. The other would be consultant‐led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence, monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out.

Design
Randomised controlled trial.

Setting
Leicester Royal Infirmary Maternity Hospital.

Subjects
Of 3510 women who were randomised, 2304 were assigned to the midwife‐led scheme and 1206 were assigned to the consultant‐led scheme.

Main outcome measures
Complications in the antenatal, intrapartum and postpartum periods were compared as was maternal morbidity and fetal mortality and morbidity. Satisfaction of the women with care over different periods of the pregnancy and birth were assessed.

Results
There were few significant differences in antepartum, intrapartum and postpartum events between the two groups. There was no difference in the percentage of mothers and babies discharged home alive and well. Generally higher levels of satisfaction with care antenatally and during labour and delivery were shown in those women allocated to midwife care.
Changes in platelet intracellular free calcium in normal pregnancy
Authors: Kilby Mark D. , Pipkin F. Broughton , Symonds E. Malcolm
Published: August 2005

Objective
To determine if platelet intracellular free calcium concentration (p.(Ca2+)i) changes with gestation in normotensive, uncomplicated pregnancy.

Design
A prospective, longitudinal study of primigravid pregnant women compared to a large control group consisting of nulliparous nonpregnant volunteers.

Setting
The antenatal clinic at University Hospital, Queen's Medical Centre, Nottingham.

Subjects
Two groups of women were studied. Thirty‐one nulliparous, nonpregnant women not using oral contraception were investigated in the early follicular phase of their menstrual cycles. Also, 24 primigravid women with normotensive, uncomplicated pregnancies were investigated on eight separate occasions during their pregnancies.

Results
A significant increase in mean p.(Ca2+)i was demonstrated by 28 weeks gestation in the pregnant women as compared to the nonpregnant control group and the same individuals when investigated at 12 weeks postpartum (P<0.05; ANOVA). This change was maximal at 36 weeks gestation (P<0.001; ANOVA); concentrations had returned to those not significantly different from nonpregnant women by six weeks postpartum.

Conclusions
Basal platelet (Ca2+)i increases significantly by the third trimester of normal, primigravid pregnancy as compared to prepregnancy values and postnatal values. These data mirror the previously described observations of platelet behaviour noting increased activity at this gestation of pregnancy. It may be that the increased basal p.(Ca2+)i indicates that smaller transient signals have to be generated to induce platelet activity, such as shape change, aggregation and exocytosis.
Trends in multiple deliveries and infertility treatments in France
Authors: Tuppin Philippe , Blondel Beatrice , Kaminski Monique
Published: August 2005

Objective
To point out the association between infertility treatments and the increasing number of multiple deliveries

Design
Comparison over time of the incidence of multiple deliveries, the proportion of deliveries resulting from assisted conception (AC), and ovulation inductor sales.

Data
Use of existing statistics: vital statistics, surveys of AC centres and ovulation inductor sales.

Results
Between 1972 and 1989 the incidence of twin deliveries rose from 8.8/1000 to 11.2/1000, and the incidence of triplet deliveries from 0.9/10 000 to 4.4/10 000. This upward trend was particularly remarkable among women aged 30 to 39. Since 1978, the triplet delivery rates and the sales of Human Menopausal Gonadotrophin have been rising similarly. Between 1985 and 1989, 26 per cent of the triplet deliveries followed assisted conception and nearly 50 per cent were estimated to be due to ovulation inductor agents.

Conclusions
The results suggest a strong influence of infertility treatments and especially ovulation inductor agents in the dramatic increase of triplet deliveries.