bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical, laparoscopic and microbiological findings in acute salpingitis: report on a United Kingdom cohort
Authors: Bevan C. D. , Johal B. J. , Mumtaz G. , Ridgway G. L. , Siddle N. C.
Published: August 2005

Objective
To determine the clinical features and microbial aetiology of acute salpingitis in women attending an inner city teaching hospital.

Design
Prospective, longitudinal cohort study.

Subjects
One hundred and forty‐seven women presenting consecutively with acute abdominal pain and clinical signs of acute salpingitis were evaluated microbiologically and laparoscopically.

Results
One hundred and four women (70.7%) had acute salpingitis diagnosed at laparoscopy. Other pathological conditions were identified in 20 women (13.6%). No visually identifiable pathology was found in 23 (15.6%). Thirty‐five women with acute salpingitis had evidence of pelvic adhesions (33.7%). Bilateral tubal occlusion was present in 6 (5.8%) cases. Chlamydia trachomatis was identified in the genital tract in 40 (38.5%) of the women with acute salpingitis and Neisseria gonorrhoeae in 15 (14.4%). A dual infection was present in eight cases (7.7%). Serological evidence suggested that a further seven women (6.7%) had acute chlamydial infections at the time of diagnosis. C. trachomatis was identified in the genital tract of 5/23 (21.7%) of the women who had no laparoscopic evidence of intra‐abdominal pathology.

Conclusions
The responsible care of women with suspected acute salpingitis depends on establishing an accurate diagnosis, so that appropriate therapy can be instigated. This study provides evidence to challenge the outpatient management of acute salpingitis on clinical grounds alone as potentially inadequate. Early laparoscopy in hospitalised women improves diagnostic precision and accurately determines disease severity, providing prognostic information for future fertility. In this urban population, sexually transmitted micro‐organisms were the commonest pathogens found in the genital tract of women with acute salpingitis. The high prevalence of C. trachomatis in these women suggests that appropriate chemotherapy for acute salpingitis should always include a specific antichlamydial agent.
Fertility in β thalassaemia major: a report of 16 pregnancies, preconceptual evaluation and a review of the literature
Authors: Jensen C. E. , Tuck S. M. , Wonke B.
Published: August 2005

Objectives
To examine the pregnancies, mode of delivery and outcomes, review the literature on fertility and discuss preconceptual guidance for women with β thalassaemia major.

Design
An observational study.

Subjects
Sixteen women with p thalassaemia major.

Setting
Two collaborating London teaching hospitals.

Main outcome measures
Pre‐pregnancy assessment, pregnancy course, mode of delivery, gesta‐tional age at delivery and birthweight.

Results
There were 16 pregnancies in 11 women. Three of these pregnancies were terminated. Of the 13 deliveries, there were two normal deliveries, one forceps delivery and 10 caesarean sections. The main findings in a further five women seeking fertility treatment were of hypogonadotrophic hypogonadism, diabetes and cardiomyopathy.

Conclusions
Pregnancy in women with p thalassaemia major does not appear to have a deleterious effect on the course of the disease. No increased obstetric complications were encountered except for the high caesarean section rate, essentially due to cephalopelvic disproportion. A high incidence of cardiomyopathy and diabetes dictates a careful assessment before embarking on ovulation induction to treat the hypogonadotrophic hypogonadism which is common in these women.
A comparison of colour Doppler sonography and the pelvic arteriogram in assessment of patients with gestational trophoblastic disease
Authors: Chan F. Y. , Chau M. T. , Pun T. C. , Lam C. , Ngan H. Y. S. , Wong R. L. C.
Published: August 2005

Objective
To assess whether colour Doppler sonography can replace pelvic arteriography in the assessment of patients with gestational trophoblastic disease.

Design
An observational study in which patients with gestational trophoblastic disease were assessed with both pelvic arteriography and colour Doppler sonography.

Setting
The oncology unit of the Department of Obstetrics and Gynaecology, University of Hong Kong. The unit is the main tertiary referral centre for treatment of trophoblastic diseases in Hong Kong.

Subjects
Thirty‐two consecutive women referred over an 18 month period.

Main outcome measures
The site of localisation of the tumour and the size of the tumour as assessed by both methods.

Results
Eleven patients had a spontaneous fall of β‐hCGtitres and did not have pelvic arteriograms performed. The remaining 21 patients had both investigations performed. Four patients had no evidence of abnormal pelvic vessels either on colour Doppler sonography or on pelvic arteriography. Their raised P hCG titres were due to metastatic disease elsewhere. In the remaining patients the location of the tumour vessels was found to be concordant between the two methods of imaging. Measurements of the mean diameter of tumour bulk by the two methods also agreed well (r = 0.93, P < 0–0001). Pelvic arteriogram over‐estimated the size of the tumour in two patients by 2 and 3 cm, respectively, but this did not alter the risk categories of the patients.

Conclusion Colour Doppler sonography is a noninvasive technique that can replace pelvic arteriography in the assessment of patients with trophoblastic diseases.
Standards for ultrasound fetal growth velocity
Authors: Owen Philip , Donnet M. Louise , Ogston Simon A. , Christie Alexander D. , Howie Peter W. , Patel Naren B.
Published: August 2005

Objective
An ultrasound study to establish the nature and limits of fetal growth in a low risk population from 22 weeks of gestation until term.

Design
Prospective, longitudinal ultrasound study of 274 low risk pregnancies involving organised scanning schedules with all measurements performed by one observer using the same equipment.

Results
Growth velocity charts have been created for a number of ultrasound parameters including estimated fetal weight, by applying appropriate statistical methods to the serial data. The rates of growth of the biparietal diameter, femur length, abdominal area and estimated weight each have characteristic patterns demonstrating maximal growth rates at different gestations.

Conclusions
Appropriately derived and calculated ultrasound fetal growth velocity standards have been established. These data are suitable for the evaluation of ultrasonically estimated fetal growth rates in the prediction of adverse perinatal outcome and the further investigation of the role of the intrauterine environment in the origin of adult disease.
William Hewson and the Lady Without the Coagulable Lymph
Authors: Ingram G. I. C.
Published: August 2005

HEWSON, W. (1739–1774) savant, anatomist and surgeon; partner of William Hunter 1762–1771; Colpley medallist 1769; FRS 1770. His “Inquiry into the Properties of the Blood” was minutely observed and lucidly described, although unfortunately it is sometimes difficult to interpret what he wrote in current terms. This obviously does not apply to the quotation below. Sadly, Hewson fatally wounded himself while dissecting.
Evaluation of post‐operative analgesia following laparoscopic application of Filshie clips
Authors: Fiddes T. M. , Williams H. W. , Herbison G. P.
Published: August 2005

Objective
To evaluate the efficacy of injecting 1% lignocaine into the subserosal aspect of the cornual end of the fallopian tubes to control post‐operative pain after laparoscopic Filshie clip application.

Design
A double blind, randomised controlled trial. Setting The day surgery unit of the Dunedin Public Hospital, Otago, New Zealand.

Participants
Fifty–nine women attending the public hospital requesting sterilisation.

Interventions
The experimental group received an infiltration of 1% lignocaine into the subserosal aspect of the cornual end of the fallopian tubes. The control group received an infiltration of normal saline in the same site.

Main outcome measures
The use of post–operative pethidine and the scores obtained on a modification of the McGill present pain intensity score, a visual analogue scale of present pain, a pain relief score and comparisons of time to first analgesia use.

Results
The use of pethidine in the experimental group was significantly reduced [P= 0. 001] Pain relief scores indicated significant benefit from the intervention. The time to first analgesic use was significantly greater in the experimental group.

Conclusion
Lignocaine infiltration at the cornual end of the fallopian tubes during laparoscopic Filshie clip application is highly effective in producing post–operative pain relief.
Recurrent Stage IB cervical carcinoma: evaluation of the effectiveness of routine follow up surveillance
Authors: Ansink Anca , de Barros Lopes Alberto , Naik Raj , Monaghan John M.
Published: August 2005

Objective
To study the effectiveness of follow up surveillance in detecting recurrent disease following radical hysterectomy for Stage IB cervical carcinoma.

Design
Retrospective analysis of clinical records using a computerised database.

Participants
Six hundred and seventy‐four patients with Stage IB carcinoma of the cervix underwent radical hysterectomy and lymph node dissection.

Interventions
Standard follow up surveillance consisted of clinical history and physical examination six weeks post surgery, and subsequently three monthly for the first year, six monthly for the second year, and yearly thereafter until 10 years post‐treatment.

Results
Of the 674 patients, 112(17%) developed recurrent disease. In only 29/112 (26%) was recurrent disease detected at the time of routine follow up visits. Nearly half of the patients (44%) were referred by their general practitioner between visits to the clinic because of suspicion of recurrent disease.

Conclusion
Routine follow up surveillance is ineffective in detecting recurrent cervical carcinoma. Only one in four recurrences were detected at the time of a clinical visit.
Serum lipids in early pregnancy and risk of pre‐eclampsia
Authors: van den Elzen Helga J. , Wladimiroff Juriy W. , Cohen‐Overbeek Titia E. , de Bruijn Anton J. , Grobbee Diederick E.
Published: August 2005

Objective
To determine whether first and late second trimester serum total and high density lipoprotein cholesterol are associated with blood pressure, uterine artery pulsatility index and pregnancy outcome.

Design
A prospective cohort study. Data were analysed using multiple linear and logistic regression analysis.

Participants
Three hundred and ninety‐three pregnant women requesting chorionic villus sampling because of advanced maternal age (36 years and older).

Main outcome measures
Serum total cholesterol and high density lipoprotein cholesterol were measured by an automated enzymatic method. Uterine artery flow velocity waveforms were recorded using continuous Doppler ultrasound. Pregnancy outcome was assessed by questionnaire.

Results
First trimester serum total cholesterol was significantly associated with the risk of pre‐eclampsia, with the adjusted relative risk exceeding 5 for women with serum total cholesterol levels above 6.0 mmol/l when compared with women with a cholesterol level below 5.0 mmol/l. First trimester serum total cholesterol also showed a significant relationship with diastolic blood pressure (coefficient of linear regression = 0.02 (mmol/l)/mmHg, 95% CI = 0.01 to 0.03), and the change in both diastolic and systolic blood pressure from the first to the late second trimester was associated with linear changes in serum total cholesterol and high density lipoprotein cholesterol.

Conclusions
These data suggest a relation between serum lipids in early pregnancy and the development of pre‐eclampsia.
Selenium deficiency and miscarriage: a possible link?
Authors: Barrington J. W. , Lindsay P. , James D. , Smith S. , Roberts A.
Published: August 2005

Objective
To investigate a possible relationship between a deficiency in serum selenium concentration and first trimester miscarriage.

Design
An observational study.

Setting
A teaching hospital in South Wales.

Participants and methods
Serum selenium, albumin and total protein concentration were measured in 40 women admitted with first trimester nonrecurrent miscarriage. The results were compared with an equal number of age‐matched nonpregnant healthy volunteers, and also from 40 pregnant women attending the antenatal clinic for booking in the first trimester.

Results
A reduction in serum selenium normally occurs in the first trimester of pregnancies that progress to term. However, a further statistically highly significant decrease in serum selenium was observed in those women who miscarried.

Conclusion
Further studies are required to assess the potential benefits of selenium supplements.
Chlamydia1 antibodies in women who suffer miscarriage
Authors: Osser Stellan , Person Kenneth
Published: August 2005

Objective
To ascertain the relation between previous chlamydial infection and miscarriage.

Design
A prospective study of 349 women who had a miscarriage.

Participants
Women surgically treated for spontaneous pregnancy loss on an outpatient basis at a hospital.

Subjects
Three hundred and forty‐nine women who miscarried, of whom 91 had at least one previous miscarriage and 33 had had two or more miscarriages previously. Age‐matched women who had a normal pregnancy served as controls.

Interventions
Blood samples were drawn from patients and controls for antibody determination.

Main outcome measures
Patients and controls were compared regarding the frequency of Chlamydia trachomatis IgG antibodies (titre 2 1/32). Antibodies to C. pneumoniae were also analysed to study cross reactivity.

Results
The frequency of IgG antibodies among the patients was 137/349 (39.3%) which was not statistically different from that among controls (116/349; 33.2%). Even among those who had miscarried previously the antibody frequencies did not differ significantly between patients and controls. The rate of C. trachomatis antibodies was about the same whether or not antibodies to C. pneumoniae were present in both patients and controls.

Conclusion
No association was found serologically between previous chlamydial infection and miscarriage and no significant cross reactivity between C. pneumoniae and C. trachomatis could be detected.
Obstetric practice and the prevalence of urinary incontinence three months after delivery
Authors: Wilson P. D. , Herbison R. M. , Herbison G. P.
Published: August 2005

Objective
To examine the relation between obstetric factors and the prevalence of urinary incontinence three months after delivery.

Design
2134 postal questionnaires sent between August 1989 and June 1991.

Setting
Teaching hospital in Dunedin, New Zealand.

Subjects
All women three months postpartum who were resident in the Dunedin area.

Main outcome measure
Prevalence of urinary incontinence.

Results
1505 questionnaires were returned (70.5% response rate). At three months postpartum 34.3% of women admitted to some degree of urinary incontinence with 3.3% having daily or more frequent leakage. There was a significant reduction in the prevalence of incontinence for women having a caesarean section, in particular in primiparous women with a history of no previous incontinence (prevalence of incontinence following a vaginal delivery 24.5%, following a caesarean section 5.2% P = 0.002). There was little difference between elective caesarean sections and those carried out in the first and second stages of labour. The odds ratios for women having a caesarean section were 0.4 (95% confidence interval (CI) 0.2–0.7) (all women and all primiparae) and 02 (95% CI 0.0–0.6) (primipara with no previous incontinence) in comparison with those having a normal vaginal delivery. The prevalence of incontinence was also significantly lower in women having had two caesarean sections (23.3%; P = 0.05) but similar in those women having three or more caesarean sections (38.9 YO) in comparison with those women who delivered vaginally (37.7%). Other significant independent odds ratios were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95% CI 0.4–09), parity ≥5 (2.2, 95% CI 1.0–4.9) and pre‐pregnancy body mass index (1.07, 95% CI 1.04–1.10).

Conclusions
Adverse risk factors for urinary incontinence at three months postpartum are vaginal delivery, obesity and multiparity (2 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.
Impaired implantation after in vitro fertilisation treatment associated with hydrosalpinx
Authors: Fleming C. , Hull M. G. R.
Published: August 2005

Objective
To study whether the presence of hydrosalpinx affected success after in vitro fertilisation (IVF) in women with inflammatory tubal damage.

Design
Retrospective, nonrandomised study.

Setting
University private IVF clinic with complete fertility services.

Participants
Two study groups (79 women with hydrosalpinges and 198 women with inflammatory tubal damage but no hydrosalpinx) and a third group (22 sterilised, previously fertile women) for comparison.

Main outcome measures
Clinical pregnancy and livebirth rates per embryo transfer cycle; implantation and live baby rates per individual embryo transferred.

Results
The hydrosalpinx group had a significantly lower implantation rate per embryo (8.2%) and chance of a live baby per embryo transferred (5.6%), compared with the nonhydrosalpinx group (14.9% and 11.2%, respectively). The hydrosalpinx group also had a lower clinical pregnancy rate (23%) and live birth rate per transfer cycle (17%) compared with the nonhydrosalpinx group (30% and 26%), but these differences were not significant.

Conclusions
The presence of a hydrosalpinx halves the chance of an embryo implanting, probably due to physical or toxic chemical effects of fluid draining from the hydrosalpinx into the uterine cavity. Women with hydrosalpinges may benefit from distal salpingostomy or salpingectomy as a drainage procedure before in vitro fertilisation treatment, even though such surgery may not increase the chances of natural conception.
Diet in pregnancy and the offspring's blood pressure 40 years later
Authors: Campbell D. M. , Hall M. H. , Barker D. J. P. , Cross J. , Shiell A. W. , Godfrey K. M.
Published: August 2005

Objective
To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life.

Design
A follow up study of men and women born during 1948–1954 whose mothers had taken part in a survey of diet in late pregnancy.

Setting
Aberdeen, Scotland.

Population
Two hundred and fifty‐three men and women born in Aberdeen Maternity Hospital.

Main outcome measure
Systolic and diastolic blood pressure.

Results
The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50 g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (P= 0.02)). At daily animal protein intakes above 50 g, lower Carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (P= 0.004)). These increases in blood pressure were associated with decreased placental size.

Conclusion
Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.
A randomised controlled trial of early versus delayed use of amniotomy and oxytocin infusion in nulliparous labour
Authors: Cammu Hendrik , Van Eeckhout Eddy
Published: August 2005

Objective
To compare routine amniotomy and early intravenous oxytocin (active management of labour) with a more selective use of amniotomy and oxytocin in women in true labour who received comparable continuous supportive midwifery care.

Design
Randomised controlled trial of nulliparous clinic patients in spontaneous labour at term. Setting Labour and delivery ward of a university teaching hospital.

Participants
Three hundred and six parturients: 152 received active management of labour; 154 were more selectively managed.

Interventions
1. Active management: early amniotomy, early use of oxytocin. 2. Selective intervention management: no routine amniotomy and more selective use of oxytocin.

Outcome measures
Use of oxytocin and amniotomy. Labour duration, mode of delivery.

Results
Maternal characteristics were comparable in both groups. Amniotomy was more often performed (91%versus 57%, P < 0.01) and oxytocin more often used (53%versus 27%, P < 001) in the active management group. The first stage of labour, however, was only shortened by half an hour in the active management group (254 min versus 283 min, P= 0.087). Caesarean section rate (3.9%versus 2.6%), spontaneous vaginal delivery rate (78%versus 79%) and neonatal outcome were not significantly different between groups.

Conclusion
Within a set‐up of strict labour diagnosis and supportive midwifery care, routine amniotomy and early use of oxytocin offered no advantage over a more selective use of amniotomy and oxytocin in terms of mode of delivery and labour duration.
Blood folic acid and vitamin B12 in relation to neural tube defects
Authors: Wald N. J. , Hackshaw A. K. , Stone R. , Sourial Nefertiti A.
Published: August 2005

Objective
To determine the relation between blood folic acid and serum vitamin B12 in neural tube defect pregnancies using data from the MRC Vitamin Study and a literature review of all studies.

Design
Stored blood samples collected as part of a randomised trial of vitamin supplementation in the prevention of neural tube defects were retrieved from affected pregnancies (cases) and unaffected pregnancies (controls). Four controls were matched with each case by centre, maternal age and duration of storage of the blood sample. The samples had been collected from women at entry to the trial, immediately before the women became pregnant, and at around 12 weeks of pregnancy. Our results were combined with those already published from other studies to obtain an overall assessment of blood folic acid and vitamin B12 in relation to neural tube defects.

Setting
Blood samples were collected as part of the MRC Vitamin Study. The collaborating centres were in the United Kingdom, Hungary, Israel, Australia, Canada and Russia.

Participants
Twenty‐seven women with neural tube defect pregnancies and 108 matched controls with unaffected pregnancies.

Results
Serum and red cell folic acid and serum vitamin B12 levels were lower in the cases than in controls at each of the three occasions when blood samples were collected, but no comparison was significant (P > 0.05). A systematic review of all studies from the literature showed that on average, during the 1st trimester of pregnancy, serum folic acid was 0.6 ng/ml lower in neural tube defect pregnancies (P < 0.01), red cell folic acid was 77 ng/ml lower (P < 0.001) and serum vitamin B12 was 38 ng/l lower (P < 0.001). A logistic regression showed no association between serum B12 and neural tube defects after allowing for serum folic acid.

Conclusion
Our results are consistent with other evidence that folic acid and vitamin B12 levels are lower in women with neural tube defect pregnancies and consistent with evidence from randomised trials which showed that folic acid is protective.
Characterisation of a sperm coating auto‐antigen reacting with antisperm antibodies of infertile males using monoclonal antibodies
Authors: Poulton T. A. , Everard D. , Baxby K. , Parslow J. M.
Published: August 2005

Objective
In a previous study a number of sperm‐specific antigens were identified which reacted with antisperm antibodies from both infertile and vasovasostomised males. To investigate the localisation and distribution of these antigens and their role in male fertility, monoclonal antibodies were raised against them; immunoblotting techniques were used to select only those antibodies which competed with human antisperm antibodies for these human auto‐antigens.

Design
One antibody, NW21, reacted with an 18 kDa auto‐antigen present on epididymal sperm but absent from testicular sperm. Immunohistochemical studies showed that the antigen is produced in small basal cells between the columnar epithelium of the corpus epididymis, passes up into the tubule and then coats sperm passing along the epididymis. Sperm stored in the cauda epididymis and ductus deferens stain strongly for this sperm coating glycoprotein.

Conclusions
The localisation of this antigen supports the suggestion that auto‐immune infertility may represent a response to epididymal rather than testicular sperm. Monoclonal antibodies raised to unique and immunologically accessible sperm coating proteins, produced in the epididymis rather than in the testis, would seem to present an excellent theoretical solution to male contraception.
Insulin‐like growth factor‐binding protein 1 and insulin‐like growth factor‐binding protein 3 in pre‐eclampsia
Authors: Wang Hsin‐Shih , Lee Jing‐Der , Cheng Bor‐Jen , Soong Yung‐Kuei
Published: August 2005

Objective
To investigate circulating levels of insulin‐like growth factor‐binding protein 1 (IGFBP‐1) and IGFBP‐3 in the mother and the fetus in pregnancies complicated by pre‐eclampsia, and the relationship between serum levels of IGFBPs and fetal birthweight.

Design
A prospective study over an 18 month period.

Setting
A tertiary care academic medical centre.

Participants
Sixty‐six pregnant women with pre‐eclampsia (35 cases of mild/moderate pre‐eclampsia and 31 cases of severe pre‐eclampsia) and 78 nonpra‐eclamptic pregnant women of matched gestational weeks and maternal ages.

Main outcome measures
Serum concentrations of IGFBP‐1 and IGFBP‐3 at the time of delivery.

Results
In pre‐eclampsia associated with intrauterine growth retardation (IUGR), maternal and cord serum IGFBP‐1 levels at the time of delivery were elevated. By contrast, circulating IGFBP‐3 levels in both the mother and the fetus were lower in pre‐eclampsia with IUGR than in nonpre‐eclamptic pregnancy. However, there was no difference in serum IGFBP‐1 and IGFBP‐3 levels between pre‐eclampsia without IUGR and nonpre‐eclamptic pregnancy in both the mother and the fetus.

Conclusions
In pre‐eclampsia, elevated concentrations of circulating IGFBP‐1 and decreased serum IGFBP‐3 levels were observed in both the mother and the fetus. However, these changes may simply reflect low birthweight in pre‐eclampsia.
The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses
Authors: Morssink L. P. , de Wolf B. T. H. M. , Kornman L. H. , Beekhuis J. R. , van der Hall T. P. J. , Mantingh A.
Published: August 2005

Objective
To examine whether in women who are delivered of an extremely small for gestational age infant, raised levels of second trimester maternal serum alpha‐fetoprotein (MSAFP) or human chorionic gonadotrophin (MShCG) levels are related to the presence of placental pathology detected at birth.

Design
Retrospective cross‐sectional study.

Setting
Department of Obstetrics and Gynaecology, Antenatal Diagnosis Unit, Groningen University Hospital, The Netherlands.

Participants
Eighty‐four women who were delivered of an extremely SGA infant (< 2.3rd centile) in whom the MSAFP and the MShCG levels were known and placental pathology reports were available (study group), and 8692 women in whom the MSAFP and MShCG levels were known and the pregnancy outcome was normal (control group). Pregnancies with congenital anomalies were excluded. Analyte levels were expressed in multiples of the median (MOM) for gestational age. Statistical analysis between groups was performed by ANOVA, after logarithmic transformation of the MOMS, to normalise their distribution.

Main outcome measures
1. The means of the MSAFP and MShCG concentrations in the study group with and without placental lesions were compared with those in the control population. 2. The means of the MSAFP and MShCG levels in the study group with placental lesions were compared with those in the study group without placental lesions.

Results
1. Comparison of study groups with controls: in the study group without placental lesions, the mean log MSAFP MOM (0.062), as well as the mean log MShCG MOM (–0.033), was not significantly different (P= 0.11 and P= 0.68, respectively) from the mean analyte levels in the control population (0.002 and 0.006, respectively). The mean logs of these analytes in the study group with placental lesions (0.162 and 0.129, respectively) were significantly higher compared with the MSAFP and MShCG levels in the control population (P < 0.001 for both analytes). 2. Comparison of study groups with each other: the mean log of the MSAFP level of 0.162 in the group with placental lesions was significantly different from the mean of 0.062 of the study group without placental lesions (P < 0.025). The higher mean log MShCG MOM of 0.129 in the group with placental lesions was significantly different from the mean log MShCG MOM of −0.033 in the study group without placental lesions (P < 0.025).

Conclusions
Raised levels of second trimester MSAFP and MShCG in women who are subsequently delivered of an extremely small for gestational age infant are related to the presence of pathological changes in the placenta, detectable at birth. It is speculated that these placental pathological changes, which frequently accompany small for gestational age pregnancies, have their origin in the second trimester, when the normal physiological changes of the placenta occur.
A comparison of bladder and ovarian function two years following hysterectomy or endometrial ablation
Authors: Bhattacharya Siladitya , Mollison Jill , Pinion Sheena , Parkin David E. , Abramovich David R. , Terry Peter , Kitchener Henry C.
Published: August 2005

Objective
To test the hypothesis that at two years bladder and ovarian function function are no different following either simple hysterectomy or endometrial ablation (transcervical resectiodlaser ablation).

Design
Randomised controlled trial comparing hysterectomy with endometrial ablation. Two years after trial entry bladder and ovarian function were evaluated subjectively by means of questionnaires and objectively by means of cystometry and estimation of serum follicle stimulating hormone respectively.

Setting
Aberdeen Royal Infirmary.

Participants
Two hundred and four women with dysfunctional uterine bleeding who, when recruited to the initial study two years previously, were aged less than 50 years, weighed less than 100 kg, and who would otherwise have undergone hysterectomy.

Results
Of the 204 women originally recruited, 101 re‐attended the clinic and underwent cystometry and follicle stimulating hormone estimation. These, together with a further 59 women, completed postal questionnaires (79% of original cohort). Rates of stress incontinence (44%vs 44%, 95% CI of difference −16% to +15%), urge incontinence (21% vs 19% 95% CI of difference −11% to +14%), and hot flushes (30%vs 44%, 95% CI of difference −25% to +7%) were similar in the hysterectomy and endometrial ablation groups, respectively. Cystometry revealed 14 (31%) cases of bladder dysfunction after hysterectomy and 17 (35%) after hysteroscopic surgery (95% CI of difference −23% to +15%). Serum follicle stimulating hormone levels > 40 mIu/L were found in three (6%) women following hysterectomy and five (10%) of women after endometrial ablation.

Conclusion
This study suggests that in comparison with endometrial ablation, simple hysterectomy for dysfunctional uterine bleeding does not compromise bladder or ovarian function, at least at two years after the operation. Due to lack of power the estimates of any differences are imprecise, and clinically significant effects cannot be ruled out.
Maternal and fetal levels of methionine and homocysteine in early human pregnancy
Authors: Steegers‐Theunissen Régine P. M. , Wathen Neville C. , Eskes Tom K. A. B. , van Raaij‐Selten Bertie , Chard Tim
Published: August 2005

Objective
To investigate methionine metabolism during normal human embryonic development by measuring levels of methionine and total homocysteine in samples of maternal serum, extra‐embryonic coelomic fluid, and amniotic fluid.

Design
Cross‐sectional observational study.

Setting
Collaboration between St Bartholomew's Hospital, London, and the University Hospital of Nijmegen in The Netherlands.

Participants
Twenty‐three women with uncomplicated pregnancies between 8 and 12 weeks of gestation before surgical termination of an ultrasonographically normal fetus.

Methods
Maternal serum samples were collected prior to surgery. Samples of extra‐embryonic fluid and amniotic fluids were obtained by transvaginal ultrasound‐guided coelocentesis and amniocentesis. Methionine was measured using an aminoacid analyser and total homocysteine by high performance liquid chromatography.

Results
Levels of methionine were four times higher in extra‐embryonic coelomic fluid and twice as high in amniotic fluid compared with maternal serum. In contrast, the total homocysteine concentrations were much lower in both extra‐embryonic coelomic fluid and amniotic fluid than in maternal serum. All differences were significant (P 0.01).

Conclusions
The comparatively high concentrations of methionine in extra‐embryonic coelomic fluid and amniotic fluid, and the concomitant low levels of total homocysteine in these fluids, suggest a role for methionine metabolism during early human pregnancy.
Preventing Rhesus D haemolytic disease of the newborn by giving anti‐D immunoglobulin: are the guidelines being adequately followed?
Authors: Howard Helen L. , Martlew Vanessa J. , McFadyen Iain R. , Clarke Cyril A.
Published: August 2005

Objective
To ascertain whether anti‐D immunoglobulin is being administered to Rhesus D negative women in accordance with the 1991 recommendations for its use to cover all events which may result in fetomaternal haemorrhage.

Design
The notes of women delivered in 1994 were examined for compliance with the 1991 recommendations.

Setting
Seven maternity units using a central antenatal screening service.

Participants
Nine hundred and twenty‐two Rhesus D negative women delivered in these seven hospitals.

Main outcome measures
The prescription, dosage and indications for administration of anti‐D immunoglobulin to women during pregnancy and in the puerperium.

Results
Postnatal anti‐D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti‐D immunoglobulin. The 1991 recommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosage of 250 IU was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes poorly understood, with a ‘negative’ result interpreted as a reason not to give anti‐D immunoglobulin.

Conclusion
Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immunisation below the current 1%. It is suggested that more careful application of the recommendations should be evaluated before considering either routine antenatal prophylaxis, or the European recommendation of a larger dose (1000–1500 IU), both of which would increase the requirements for this limited resource.
GAX collagen in the treatment of urinary incontinence in elderly women: a two year follow up
Authors: Khullar V. , Cardozo L. D. , Abbott D. , Anders K.
Published: August 2005

Objective
To determine the efficacy of GAX collagen in the treatment of elderly women with genuine stress incontinence.

Design
A single centre prospective study.

Setting
A London teaching hospital.

Participants
Thirty‐four women older than 60 years of age with genuine stress incontinence diagnosed on videocystourethrography.

Interventions
Up to three paraurethral injections of GAX collagen.

Main outcome measures
Subjective and pad test assessments performed pre‐operatively, after one month, one year and two years after the first injection of collagen. Videocystourethrography and urethral pressure profilometry were carried out pre‐operatively, after three months and one year.

Results
There was a reduction in urinary leakage as measured on pad testing. After two years 77% of the surviving 26 women were symptomatically cured. Objectively after two years 48% of the women were cured and 9% were improved over their initial pre‐treatment level of incontinence. The cure rate was the same whether or not the women had undergone previous vaginal surgery. The maximum urethral closure pressure was not increased with treatment indicating that collagen injections do not act by producing obstruction, but this should be interpreted with caution due to the small sample size.

Conclusion
GAX collagen is an effective method of treating urinary incontinence in the elderly and especially women who have undergone previous continence procedures. The technique is easy to perform and particularly suitable in those who are frail, but if failure occurs after two years consideration needs to be given to its cost effectiveness.
Physical abuse and low birthweight: a case‐control study
Authors: Grimstad Hilde , Schei Berit , Backe Bjørn , Jacobsen Geir
Published: August 2005

Objective
To examine whether physical abuse of a woman by her partner was associated with low birthweight.

Design
A case—control study.

Setting
Department of Gynaecology and Obstetrics, University Hospital of Trondheim, Norway.

Participants/sample
Eighty‐six women who were delivered of a low birthweight (< 2500 g) infant (cases) and 92 women who were delivered of an infant with birthweight 2500 g (controls).

Methods
An in‐depth interview, either postpartum at the maternity ward or one year after delivery. Information about abuse was obtained by direct questioning and a modified version of the Conflict Tactics Scales.

Results
A total of 17% of the women had experienced abuse by a partner. While 7% had been abused by their current partner before the index pregnancy only one woman reported abuse during pregnancy. Relatively more mothers of low birthweight infants were abused (20%) compared with controls (15%), but the association was not statistically significant (OR 1.37, 95% CI 0.63–2.99). Abused women reported a higher consumption of alcohol and cigarettes in pregnancy compared with nonabused women.

Conclusion
Abuse was not found to be a risk factor for low birthweight in this study.
Perinatal mortality and route of delivery in term breech presentations
Authors: Lindqvist Anna , Nordén‐Lindeberg Solveig , Hanson Ulf
Published: August 2005

Objective
To compare intrapartum related infant mortality in term (> 34 weeks) breech presentations in relation to vaginal delivery or delivery by caesarean section.

Design
Register based nationwide study.

Setting
Sweden from 1991 to 1992.

Participants
6542 singleton fetuses born in the breech presentation.

Main outcome measures
Intrapartum and early neonatal deaths, stillbirths and congenital malformations, low Apgar score < 7 at 5 min, mode of delivery.

Results
After exclusion of antepartum stillbirths and congenital malformation, the intrapartum and early neonatal mortality rate was 2/2248 (0.09%) in the group delivered vaginally and 2/4029 (0.05%) in the group delivered by caesarean section. The relative risk was 1.81 (95% CI 0.26–12.84). Thus the difference was not statistically significant. This result was further supported after reviewing individual cases.

Conclusions
The intrapartum related mortality in the group delivered vaginally was low and the result could not verify an increased mortality in term breech presentations delivered vaginally compared with those delivered by caesarean section.
Fetal fibronectin, endotoxin, bacterial vaginosis and cervical length as predictors of preterm birth and neonatal morbidity in twin pregnancies
Authors: Wennerholm U.‐B. , Holm B. , Mattsby‐Baltzer I. , Nielsen T. , Platz‐Christensen J. , Sundell G. , Hosseini N. , Hagberg H.
Published: August 2005

Objective To evaluate the predictive values of fetal fibronectin, bacterial vaginosis, endotoxin and cervical length for preterm birth (< 35 and < 37 weeks) and neonatal morbidity in twin pregnancies.

Participants One–hundred and twenty–one women with twin pregnancies recruited into a prospective longitudinal study at three antenatal clinics in the southwest of Sweden.

Methods Cervical or vaginal fluid was sampled and determined for fetal fibronectin ( 0.05 μg/mL was used as cutoff), endotoxin ( 100 pg/mL) and bacterial vaginosis (presence of clue cells) at two week intervals from 24 to 34 weeks of gestation. The cervical length was measured with transvaginal sonography at the same time intervals.

Main outcome measures Occurrence of preterm birth (< 35 and < 37 weeks of gestation) and neonatal morbidity.

Results All positive fetal fibronectin samples obtained at screening between 24 and 34 weeks predicted birth < 35 weeks (RR 18.0; 95% CI2.2–145.9). A positive fetal fibronectin at 28 weeks of gestation predicted delivery < 35 weeks (RR 6.3; 95% CI 2.6–15.1) with a sensitivity, specificity, positive and negative predictive value of 50.0, 92.0, 62.5 and 87.3%, respectively. An independent association between fetal fibronectin at 28 weeks and preterm birth (< 35 weeks) was verified with logistic regression (P= 0.03). A positive fetal fibronectin at 28 weeks of gestation predicted neonatal morbidity (RR 5.1; 95% CI 2.4–11.0) and a longer period of care at the neonatal intensive care unit. The predictive power of cervical sonography was generally low but cervical length (cutoff 33 mm) measured at 28 weeks of gestation was significantly associated with birth < 37 weeks (RR 2.2; 95% CI 1.1–4.2). The presence of endotoxin correlated to bacterial vaginosis, but these tests were not significantly related to preterm birth or neonatal morbidity.

Conclusions Fetal fibronectin predicted preterm birth and neonatal morbidity in twin pregnancies. The predictive value of cervical length determinations was low. Endotoxin and bacterial vaginosis had no predictive power for preterm delivery in this study.
Blood pressure and fetal heart rate changes with patient‐controlled combined spinal epidural analgesia while ambulating in labour
Authors: Al‐Mufti Raghad , Morey Richard , Shennan Andrew , Morgan Barbara
Published: August 2005

Objective
To determine the effect of patient‐controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour.

Design
A prospective study.

Setting
Queen Charlotte's and Chelsea hospital, London.

Participants
Fifty‐five primigravid women in labour at 37 weeks of gestation; 40 women had supervised standing top‐ups given by an anaesthetist. A further 15 women had PCEA top‐ups given in each of standing, sitting and lying positions.

Main outcome measures
Maternal pulse rate, blood pressure and fetal heart rate changes following epidural top‐ups.

Results
In the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top‐ups had no fall in blood pressure in the standing and sitting positions, though the average blood pressure fell significantly when a top‐up was given in the lying position. Maternal heart rate increased significantly at 12 min post top‐up when the women were in the standing position (P= 0.0018). In the 15 women who had PCEA top‐ups, the CTG showed improvement in decelerations when women were in the standing position but deterioration when in the lying position (P < 0.01).

Conclusion
Patient‐controlled epidural analgesia top‐ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top‐ups in the lying position.
Randomised trial comparing the upright and supine positions for the second stage of labour
Authors: de Jong P. R. , Johanson R. B. , Baxen P. , Adrians V. D. , van der Westhuisen S. , Jones P. W.
Published: August 2005

Objective
To assess the maternal and neonatal effects of upright compared with recumbent positions during delivery, in terms of defined outcome variables.

Design
A randomised controlled trial.

Setting
St Monica's Nursing Home, a midwife based maternity unit in Cape Town, South Africa.

Participants
Five hundred and seventeen women of low obstetrical risk assigned to deliver at the nursing home.

Results
The trial showed that women who adopted the upright posture for delivery experienced less pain, perineal trauma and fewer episiotomies than those who delivered in the supine position.

Conclusion
The data suggest that in women of low obstetrical risk, choice of posture during delivery may be encouraged.
Randomised trial of immediate versus deferred treatment strategies for the management of minor cervical cytological abnormalities
Authors: Shafi M. I. , Luesley D. M. , Jordan J. A. , Dunn J. A. , Rollason T. P. , Yates M.
Published: August 2005

Objective
To compare immediate and deferred treatment in women with cervical smears showing borderline nuclear abnormalities or mild dyskaryosis.

Design
Prospective randomised trial.

Setting
Colposcopy clinics at Birmingham and Midland Hospital for Women and the City Hospital NHS Trust, Dudley Road, Birmingham.

Participants
Four hundred and thirty‐five women with minor cytological abnormality younger than 35 years of age, of whom 353 were randomised to immediate treatment or deferred treatment.

Main outcome measures
Comparison of histologies in the subsequent two years in the immediate and deferred treatment groups.

Results
Thirty‐six women (21%) defaulted from follow up. The percentage of high grade abnormalities (CIN II and III) in the deferred treatment arm at two years is similar to that in the immediate treated arm at first colposcopy (25%vs24%). Cytology failed to pick up two cases of CIN III and there was one case of early invasive carcinoma at the six month follow up. If treatment is deferred, the proportion with CIN I is almost halved (25%vs13%); the proportion with koilocytic atypia is slightly reduced (51%vs42%) and the proportion with no abnormality is substantially increased (0.6% vs 20%).

Conclusion
Immediate referral and a select‐and‐treat management strategy of all women with any degree of dyskaryosis is recommended based on the case of invasive cervical cancer, high default rate and the failure of cytology to pick up two cases of CIN III.