bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of medical treatments for menorrhagia
Authors: Shaw R. W.
Published: August 2005

Although usually not life‐threatening, dysfunctional uterine bleeding (DUB) can cause discomfort and disruption to life for many women. It has been poorly researched in the past, primarily because of difficulties in trying to accurately measure blood loss and response to treatment. There are several different therapies currently available but, for many, actual evidence of their efficacy is lacking from scientific data. Progestogens are the most frequently prescribed drugs for the treatment of DUB. Data support their use in anovulatory women but a number of comparative trials have shown that an overall reduction in blood loss of only 20% is achieved in ovulatory women. Their use, therefore, must be questioned as the first line of treatment. Combined oral contraceptives were at one time popular but whether the low‐dose, current generation pills are equally effective awaits appropriate trials. Prostaglandin synthetase inhibitors can be useful, with up to a third of women with menorrhagia benefiting from a reduction of between 25 % and 35 % in blood loss. A proportionally greater reduction is seen in women with more excessive bleeding. Antifibrinolytic drugs have been shown to reduce menstrual blood loss in DUB by 50% and would be useful in women in whom oestrogens are contraindicated. Gonadotrophin‐releasing hormone analogues are highly effective because of their ability to induce amenorrhoea, but long‐term use is contraindicated because of their hypo‐oestrogenic effects. One other effective therapy for menorrhagia has been danazol. At a dosage of 200 mg daily, danazol has been shown to be highly effective in several open and randomised comparative trials, with a consistent reduction of blood loss of up to 75 % being achieved with maintenance of a regular menstrual cycle. Reducing the dose to 100 mg daily often results in cycle irregularities, whereas increasing the dose to 400 mg daily induces amenorrhoea. A daily dose of 200 mg of danazol is well tolerated and should be considered as a first‐line option in DUB presenting as menorrhagia requiring medical management.
Vaginal ultrasound studies of bladder neck mobility
Authors: Hol M. , Bolhuis C. Van , Vierhout M. E.
Published: August 2005

Objective To introduce a simple, well‐standardised vaginal ultrasound technique and to compare the position and mobility of the bladder neck in continent and stress incontinent women using this technique.

Design A single‐centre prospective case‐control study.

Setting Ikazia Hospital, Rotterdam, The Netherlands.

Subjects One hundred and sixty women; sixty randomly chosen women referred to our outpatient department who volunteered for the study to develop a standardised technique, fifty stress‐incontinent women and fifty controls who volunteered for the study for comparison using the standardised technique.

Main outcome measures Standardisation with regard to bladder volume, horizontal axis and Valsalva force. The position of the bladder neck at rest, during straining and during squeezing.

Results The probe we use does not alter bladder neck mobility. A standardised bladder volume of 250 ml was used rather than maximum bladder capacity. A Foley catheter introduced into the bladder, with the balloon half‐filled with soapy water and half with air gives an easily recognisable fluid level, which is parallel to the horizontal axis of the patient. A standardised Valsalva force of 30 cm H2O can exclude differences in bladder neck mobility due to spontaneous and uncontrolled abdominal force. Measurements by two independently working investigators showed good conformity. The position of the bladder neck in the stress incontinent women was significantly lower and significantly more posterior at rest, during straining and during squeezing. At the same time in stress incontinent women there was significantly more descent during straining and less elevation during squeezing. However, there was a considerable overlap between the two groups for all parameters.

Conclusions This standardised vaginal ultrasound technique is a feasible, acceptable and reproducible technique for the study of female bladder neck mobility. The position and mobility of the bladder neck is significantly different in stress incontinent women as compared to continent controls. The great overlap between the two groups still limits the clinical relevance.
Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section
Authors: Morrison John J. , Rennie Janet M. , Milton Peter J.
Published: August 2005

Objective To establish whether the timing of delivery between 37 and 42 weeks gestation influences neonatal respiratory outcome and thus provide information which can be used to aid planning of elective delivery at term.

Design All cases of respiratory distress syndrome or transient tachypnoea at term requiring admission to the neonatal intensive care unit were recorded prospectively for nine years.

Setting Rosie Maternity Hospital, Cambridge

Subjects During this time 33,289 deliveries occurred at or after 37 weeks of gestation.

Main outcome measures This information enabled calculation of the relative risk of respiratory morbidity for respiratory distress syndrome or transient tachypnoea in relation to mode of delivery and onset of parturition for each week of gestation at term.

Results The incidence of respiratory distress syndrome at term was 2.2/1000 deliveries (95% CI; 1.7–2.7). The incidence of transient tachypnoea was 5.7/1000 deliveries (95% CI; 4.9–6.5). The incidence of respiratory morbidity was significantly higher for the group delivered by caesarean section before the onset of labour (35.5/1000) compared with caesarean section during labour (12.2/1000) (odds ratio, 2.9; 95% CI 1.9–4.4; P < 0.001), and compared with vaginal delivery (5.3/1000) (odds ratio, 6.; 95% CI 5.‐8.9; P < 0.001). The relative risk of neonatal respiratory morbidity for delivery by caesarean section before the onset of labour during the week 37+0 to 37+6 compared with the week 38+0 to 386 was 1.74 (95% CI 1.1–2.8; P < 0.02) and during the week 38+0 to 37+6 compared with the week 39+0 to 39+6 was 2.4 (95% CI 1.2–4.8; P < 0.02).

Conclusions A significant reduction in neonatal respiratory morbidity would be obtained if elective caesarean section was performed in the week 39+0 to 39+6 of pregnancy.
Maternal serum hCG and fetal nuchal translucency thickness for the prediction of fetal trisomies in the first trimester of pregnancy
Authors: Brizot M. L. , Snijders R. J. M. , Butler J. , Bersinger N. A. , Nicolaides K. H.
Published: August 2005

Objective To compare the potential value of maternal serum total hCG and free β‐hCG in predicting the risk for fetal trisomies during the first trimester of pregnancy and to examine whether data on maternal hCG and fetal nuchal translucency thickness can be combined to derive risks.

Methods Maternal serum total hCG and free β‐hCG were measured in samples from 83 singleton pregnancies with fetal chromosomal abnormalities (trisomy 21 (n= 41), trisomy 18 (n= 19), trisomy 13 (n= 8) sex chromosome aneuploidies (n= 1l), triploidy (n= 4)) and 394 chromosomally normal controls at 10 to 13 weeks gestation. In all cases, the fetal nuchal translucency thickness was measured at the time of fetal karyotyping.

Results In the 249 chromosomally normal controls with fetal nuchal translucency less than 3 mm, total hCG and free β‐hCG decreased significantly with increased fetal crowt‐rump length. In 145 chromosomally normal fetuses with nuchal translucency 3 to 9 mm total hCG and free β‐hCG were not significantly different from the 249 with nuchal translucency less than 3 mm. In fetuses with trisomy 21, total hCG and free β‐hCG were significantly higher, whereas in trisomies 18 and 13 levels were lower than in chromosomally normal controls. When the cutoff levels for total hCG and free β‐hCG were selected to include 4% of chromosomally normal fetuses, the detection rates for trisomy 21 were 24% and 32%, respectively. There was no significant association between hCG and nuchal translucency thickness in either the chromosomally normal (r=–0.01) or abnormal group (r=–0.15).

Conclusion An improved estimate of risk for fetal trisomies at 10 to 13 weeks gestation can be derived by combining data on maternal age, maternal serum total or free β‐hCG and fetal nuchal translucency thickness.
Increase in bone mass of older postmenopausal women with low mineral bone density after one year of percutaneous oestradiol implants
Authors: Holland E. F. Nigel , Leather Andrew T. , Studd John W. W.
Published: August 2005

Objective To evaluate the effect of 75 mg oestradiol implants on the bone mass of older postmenopausal women with osteoporosis.

Design One year prospective‐controlled study.

Subjects Thirty‐two postmenopausal women over 60 years of age and more than five years postmenopausal with low bone density were recruited. Thirty women completed treatment for one year with 75 mg oestradiol implants. The changes in bone density were compared with a control group of 14 women. The side effects with treatment were documented.

Main outcome measures Dual energy X‐ray absorptiometry of the lumbar spine and proximal femur using Hologic 1000 QDR before treatment and at one year. Plasma oestradiol assays were performed before and after one year.

Results The median percentage changes in the treated group after one year was 12.6% at the lumbar spine and 5.22 % at the total hip. The increase in vertebral bone density was greatest in women with low initial bone density (r = 0.35, P < 0.05) and those with highest treatment plasma oestradiol levels (r = 0.47, >P < 0.01). Side effects were common but most were transient and mild in nature.

Conclusion 75 mg oestradiol implants significantly increase the bone mineral density at the spine and hip of older postmenopausal women with established osteoporosis.
Postnatal maternal morbidity: extent, causes, prevention and treatment
Authors: Glazener Cathryn M. A. , Abdalla Mona , Stroud Patricia , Templeton Allan , Russell Ian T. , Naji Simon
Published: August 2005

Objective To describe the prevalence and causes of postnatal maternal morbidity.

Design Questionnaire survey of postnatal patients. Further data extracted from SMRl returns, case records and the Aberdeen Maternity and Neonatal Databank.

Setting Postnatal care in a teaching maternity hospital, midwife delivery hospital, general practitioner maternity units and in the community.

Subjects Twenty percent random sample of deliveries (1249 women) surveyed one week, eight weeks and 12 to 18 months after delivery.

Main outcome measures Incidence of self reported maternal morbidity, treatment received, readmission rates and causes for readmission.

Results Of mothers in the sample 85% (99% CI 82‐88%) reported at least one health problem in hospital, rising to 87% (84‐90%) of those at home; 76% (71‐81%) reported at least one health problem after eight weeks post‐delivery.

Conclusions Maternal morbiditv is extensive and under‐recognised after delivery. Measures to reduce and alleviate it must be sought.
Three dimensional ultrasound: abnormalities of the fetal face in surface and volume rendering mode
Authors: Lee Andreas , Deutinger Joshp , Bernaschek Gerhard
Published: August 2005

Objective To evaluate three dimensional ultrasound in surface and volume rendering mode in fetal malformations of the face.

Setting Day assessment unit in a university hospital.

Subjects Four cases have been examined: two cases represented cleft lip, one case was a male with trisomy 13 (Patau syndrome) with proboscis, and one case represented a male fetus with unilateral anophthalmia.

Conclusion A new technique of three dimensional ultrasound visualisation in fetal malformation using surface and volume rendering is presented. The equipment consisted of a commercially available ultrasound machine, a built‐in graphic workstation, and three dimensional software. Post‐processing of data required approximately 10 minutes of calculation. The application of three dimensional ultrasound in complex malformations of the face appears to provide reasonable value for prenatal diagnosis and may become clinically useful in the near future.
Immune dysfunction – a potential target for treatment in endometriosis
Authors: Gleicher N.
Published: August 2005

The treatment approach towards endometriosis has been traditionally either surgical or hormonal in nature. Since endometriosis is, to a large extent, a microscopic disease, a surgical approach cannot be expected to eradicate the disease. Treatment is, therefore, generally attempted by hormonal manipulation, an approach based on the known oestrogen sensitivity of endometriosis.

Hormonal manipulation can only temporarily affect endometriosis, and quite clearly does not address the underlying aetiology and/or pathophysiology of the disease. Since neither is, at present, well understood, one can only speculate as to the treatment approach that would, in fact, affect the pathophysiology of the condition.

Endometriosis has, in recent years, been characterized by a large number of immunological abnormalities in the host. It is, therefore, very tempting to speculate that an immunological defect represents the basic abnormality which later leads to the occurrence of the disease. This assumption is supported by the observation that those immunological defects are already present in the mildest forms of the disease. In fact, if one believes that many cases of unexplained infertility represent undiagnosed microscopic endometriosis, then evidence suggests that this precursor stage of the disease is basically characterized by an identical immunological profile to that of endometriosis.

An immunological aetiology and/or pathophysiology of endometriosis should lead to an immunological treatment approach toward the disease. Specifically, a number of non‐specific immunomodulators, presently utilized in a variety of medical conditions with immunological aetiologies, would seem to represent promising new therapeutic strategies to conquer endometriosis at its roots. A new treatment approach to endometriosis appears urgently needed since, at least with regard to the effects of endometriosis on fertility and pregnancy loss, present approaches have proven ineffective.
Reduction of menstrual blood loss in women suffering from idiopathic menorrhagia with a novel antifibrinolytic drug (Kabi 2161)
Authors: Edlund Mans , Andresson Kerstin , Rybo Goran , Lindoff Claes , ÅStedt Birger , Von Schoultz BO
Published: August 2005

Objective
To compare the effect of Kabi 2161 (a prodrug of tranexamic acid) and placebo on the reduction of menstrual blood loss in women suffering from idiopathic menorrhagia and to evaluate tolerance and effectiveness in a two‐dose regimen.

Design
A randomised, double blind parallel group study using double dummy technique.

Setting
The departments of gynaecology at three medical centres in Sweden.

Subjects
Ninety‐one outpatients visiting the gynaecological clinics from March 1991 to May 1992 were randomised into the study; 68 women fulfilled the study.

Interventions
Two run‐in cycles, followed by administrations of Kabi 2161 (600 mg) tablets (1 four times daily or 2 twice daily) or placebo for the first five days of three menstrual cycles.

Main outcome measures
Objective measurement of the change in menstrual blood loss during the treatment periods compared with menstrual blood loss during the run‐in periods.

Results
A statistically significant reduction of menstrual blood loss was found for each treatment group, compared with the placebo group (P < 0.001). The mean reduction with 95% confidence interval (CI) was 33 % (24–40) in the group treated with 1 four times daily and 41 % (33–49) in the group treated 2 twice daily. The difference between the treated groups in reduction of menstrual blood loss is not significant. No significant differences were found in the frequencies of reported unwanted events during run‐in and during treatment between the different treatment groups. There were also no significant differences between the treatment groups and the placebo group.

Conclusion
Kabi 2161 in a dosage of 2.4 g per day gave a statistically significant reduction in objectively measured menstrual blood loss in a two (41 %) as well as in a four (33 %) dosage regimen compared with placebo. Frequency of unwanted events did not differ from those during run‐in or from those in the placebo group. The optimal daily dosage needs to be further evaluated in a dose titration study.
Communication following a stillbirth or neonatal death: room for improvement
Authors: Crowther Mary E.
Published: August 2005

Objective
To assess the extent of knowledge which mothers had about a previous stillbirth or neonatal death, their satisfaction with the information and advice given them, and their degree of anxiety during a subsequent pregnancy.

Design
Personal interview.

Setting
Antenatal clinic of a British military hospital in Germany.

Subjects
Forty‐eight Caucasian, pregnant women, 28 of whom had had a previous stillbirth (Group A) and 20 a neonatal death (Group B).

Results
Over half (25/48) the women had a poor or confused knowledge of the events surrounding the death, only 29% were satisfied with the information they had received, and nearly 40% became pregnant within six months of the death despite medical advice against conceiving soon after such an event. The mothers of stillborn babies were significantly less likely to know the birthweight than the mothers of babies who died after birth (60%vs 95%), and 40% had not given the baby a name. Over a third of the mothers were admitted to hospital because of anxiety about the current pregnancy.

Conclusions
Dissatisfaction with the quality of information given by hospital staff, rapid conception despite medical advice to the contrary, and anxiety in a subsequent pregnancy were common after a previous stillbirth or neonatal death. A poor or confused knowledge about the baby's death was more likely if the death had been intrauterine and unexplained, or associated with maceration, a lethal abnormality, an emergency delivery resulting in stillbirth, or a preventable cause.
Infertility and the seeking of infertility treatment in a representative population
Authors: Schmidt Lone , Münster Kirstine , Helm Peter
Published: August 2005

Objective
To investigate lifetime prevalence of infertility, the seeking of infertility treatment and outcomes of treatment.

Design
Cross‐sectional postal questionnaire study.

Setting
County of Copenhagen, Denmark.

Subjects
Three thousand, seven hundred and forty‐three women, 15 to 44 years old, selected at random were asked about infertility, their seeking of infertility treatment, diagnoses provided by their doctors and subsequent parenthood. Response rate was 78%, n= 2865. A random sample of non‐responders was interviewed by telephone.

Main outcome measures
Fertility status, seeking of infertility treatment, subsequent deliveries and adoptions.

Results
Of the women who had attempted to have a child, 26.2% had experienced infertility; 4.1% of the women aged 25 to 44 years were currently primarily infertile and 8.6% had involuntarily not delivered a first child; 47.4% of the infertile women had sought infertility treatment. Significant predictors for seeking infertility treatment were school education > 9 years and not having delivered a child. Of the infertile women 54.9% subsequently had a child. Only 30% of these reported that the successful delivery was treatment‐related.

Conclusions
The health care system should see to it that infertile couples from lower social classes are offered information on the possibility of infertility treatment. High quality infertility treatment has to include both the “supply” of taking care of the infertile couple's psychosocial strain and the goal of ensuring successful pregnancies.
A clinico‐pathological classification of perinatal deaths in the Faroe Islands
Authors: Olsen Sjúröur F. , Samuelsen Steintora , Joensen Høgni D.
Published: August 2005

Objective
To highlight the causes of perinatal mortality in the Faroe Islands where perimortality is high according to Nordic standards.

Design
Two systems were employed to classify perinatal deaths on the basis of clinico‐pathological findings, one focusing on obstetrical factors and the other on fetal‐neonatal factors.

Setting
Faroe Islands. Data from Iceland were used for comparison since the two communities have many similarities, including similar birthweight distributions.

Subjects
Birth and death certificates and medical and midwife files were recovered for 98 of the 102 officially recorded perinatal deaths in the Faroes during 1977–1986. Icelandic data for 1976–1985 were available in the literature.

Results
The perinatal mortality rate was 13.7 per 1000 births. Obstetric factors were classified as unexplained, congenital anomaly, antepartum haemorrhage, pre‐eclampsia, mechanical causes, and maternal disorders and accounted for 43%, 18%, 15%, 11%, 6%, and 6% of the 98 cases, respectively. Fetal‐neonatal factors were classified as antepartum asphyxia, congenital anomaly, intrapartum asphyxia, hyaline membrane disease, pulmonary immaturity, and other causes, and these factors accounted for 43%, 18%, 15%, 9%, 5%, and 8%, respectively. The excess perinatal mortality rate of 4.1 cases per 1000 births in the Faroes, relative to Iceland, could mainly be attributed to an excess of 2.9 cases per 1000 births in the group classified as unexplained, as defined according to the obstetrics classification.

Conclusions
No well defined cause was particularly common in the Faroes or could account for the excess perinatal mortality rate in the Faroes relative to Iceland.
Fertility and pregnancy outcome following large loop excision of the cervical transformation zone
Authors: Cruickshank M. E. , Flannelly G. , Campbell D. M. , Kitchener H. C.
Published: August 2005

Objective
To determine if large loop excision of the transformation zone affects subsequent fertility and pregnancy outcome.

Design
A case‐control study.

Setting
A teaching hospital serving a regional population.

Subjects
One thousand women who had undergone large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN) between 1989 and 1991. Two controls were matched for each of the 149 women who had a singleton pregnancy progressing beyond 20 weeks of gestation following treatment, with regard to age, parity, height, husband's or partner's social class and smoking habits to account for common independent risk factors for adverse obstetric outcome and cervical intraepithelial neoplasia.

Main outcome measures
Intention to conceive, number of pregnancies, gestation, low birthweight, mean birthweight, mode of delivery, and duration of labour.

Results
Out of a cohort of 1000 women who underwent LLETZ for the treatment of CIN, 653 women replied to a postal questionnaire. When asked up to 54 months after treatment, 130 women (19.9%) had become pregnant and 47 (7.2%) had tried to become pregnant. A total of 199 pregnancies from 178 women was identified from the cohort of women.

For the 149 women from the case cohort, the mean birthweight was 3380 g compared with 3373 g in the control group (P= 0.88). The incidence of low birthweight in pregnancies progressing to at least 37 weeks of gestation was 3.1% in the treated group, compared with 3.2% in the control group (P= 098). Following LLETZ, 94% of deliveries were preterm (< 37 weeks of gestation), compared with 50% in the control group (P= 0.12). There was no significant difference in mean gestation, mode of delivery, indication for caesarean section or duration of labour between the women who had undergone LLETZ and the controls.

Conclusion When socio‐epidemiological factors associated with the development of cervical intraepithelial neoplasia are controlled for, LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy outcome.
European postcoital tests: opinions and practice
Authors: Guid Oei S. , Keirse Marc J. N. C. , Bloemenkamp Kitty W. M. , Helmerhorst Frans M.
Published: August 2005

Objective
To assess differences in opinion and practice with regard to the postcoital test in Europe.

Design
Multilingual questionnaire survey among heads of departments of obstetrics and gynaecology with large fertility clinics in 16 European countries.

Subjects
Of 203 heads of departments, each responsible for 882 infertility cases per year (95% CI 657–1107) 145 (71%) responded.

Information sought
Use of the postcoital test: its timing in relation to cycle and coitus, methodology used for the test, cut‐off level of normality and treatments applied for abnormal test results.

Results
The postcoital test is used in 92% (and routinely in 68%) of departments. There are large differences in timing of the test in relation to menstrual cycle and coitus, in microscopic magnification used, and in cut‐off levels of normality. More than 10 different treatments are applied for abnormal test results.

Conclusion
Guidelines of the World Health Organisation are not followed and divergence in practice and opinion is wide enough to question whether infertile couples are better off with than without the test.
The application of flow cytometric DNA analysis in detecting the presence of malignant cells in ovarian carcinoma peritoneal fluids
Authors: Kehoe S. , Ward K. , Luesley D. , Chan K. K.
Published: August 2005

Objective
To compare flow cytometric detection of malignant cells with standard cytological evaluation in patients with ovarian carcinoma.

Setting
The City Hospital Trust, The Women's Hospital and CRC Trials Unit, Birmingham.

Subjects
Forty‐three patients with histologically proven ovarian carcinoma and positive cytology, and a control population of 20 patients undergoing surgery for benign gynaecological conditions.

Methods Prospective, blinded study examining ascitic fluid or peritoneal washings obtained at primary surgery by flow cytometric DNA analysis and cytological examination.

Results
Flow cytometry detected aneuploid cells in 27/43 (63%) of malignant and 7/20 (35%) of benign fluid specimens. In malignant samples the mean aneuploid count was 38.5% (range 1–98%) with a mean S‐phase fraction of 5.2% (range 0–33.9%). In benign specimens the mean aneuploid count was 30.4% (range 14.5–66.4%). Based on these results, the overall sensitivity of cytometric detection of malignant cells was 714Y0, specificity 65%, with a positive predictive value of 85.1%. False positivity was found mainly in patients with benign ovarian cysts. Further examination revealed four false negative and four false positive results, where the peritoneal fluid and ovarian tissue DNA ploidy status concurred. Assuming such results to be correct increased the sensitivity of the test to 88.5YO and specificity to 85%.

Conclusions
Although flow cytometry can glean information beyond the capabilities of cytological assessment, using the premise that aneuploid cells alone indicate malignancy, it remains secondary to cytology in the detection of malignant cells in peritoneal fluids.
The effects of gemeprost on the second trimester fetus
Authors: Lazda E. J. , Sams V. R.
Published: August 2005

Objective
To determine whether the use of gemeprost is associated with histological changes in the second trimester fetus.

Setting
Histopathology department of a university hospital.

Design
Retrospective comparison of histological features in fetuses aborted following maternal administration of gemeprost, with those in fetuses after spontaneous miscarriage.

Outcome measures
Degree of tissue fragmentation; other histological abnormalities.

Results
Significantly greater fragmentation of the liver was found in fetuses exposed to gemeprost (P= 0–046). Nonsignificant effects were found for brain (P= 0.082) and heart (P= 0.183), and no effect was seen on the kidney, adrenal and lung. No other significant histological differences were found between the two groups.

Conclusions
This study is the first to document an effect of gemeprost on the fetus, but confirmation is required in further studies. Other implications are discussed.
Detection of fetal fibronectin as a predictor of preterm delivery in high risk asymptomatic pregnancies
Authors: Leeson S. C. , Maresh M. J. A. , Martindale E. A. , Mahmood T. , Muotune A. , Hawkes N. , Baldwin K. J.
Published: August 2005

Objective
The study was designed to determine whether fetal fibronectin would predict delivery before 37 weeks in women at high risk of preterm delivery.

Study methods
Forty‐three women considered at risk of preterm delivery were recruited antenatally into a blind longitudinal study. Quantitative assays of fetal fibronectin were obtained from sequential high vaginal swabs taken fortnightly from 24 to 34 weeks of gestation. Fibronectin concentrations of 0.05 μg/ml or more were considered as positive.

Results
Results were calculated by swab and by subject. The sensitivity of an individual fibronectin swab in predicting preterm delivery within 14 days of testing was 71% and the specificity was 93Yo. The overall positive predictive value was 31% and the negative predictive value was 99%. The sensitivity of the fibronectin swab in predicting delivery before 37 weeks was 17% and the specificity was 93 Oh. The positive predictive value was 50% and the negative predictive value was 73%. For a woman who has had a positive swab the sensitivity in predicting preterm delivery within 14 days of testing was 80% and the specificity was 83 %; a woman was counted as positive only if the final swab was positive and preceded delivery by not more than 14 days. The positive predictive value was 36% and the negative predictive value was 97%. For a woman who has had a positive swab the sensitivity in predicting delivery before 37 weeks was 54%. The specificity, the positive predictive value and the negative predictive value were 85%, 64% and 79%, respectively. Women were counted as positive if any swab in the sampling sequence was positive. Fibronectin swabbing when calculated by patient did predict preterm delivery within 14 days of testing (P= 0.01) and before 37 weeks (P= 0.01). Analysis of the accuracy of predicting delivery from 7 to 28 days after sampling revealed that the best prediction for delivery was within the following 14 days.

Conclusion
Serial fetal fibronectin assessment from 24 to 34 weeks of gestation anticipated preterm delivery within 14 days of testing and before 37 weeks for high risk asymptomatic women. Such testing should be performed every two weeks.
Maternal mortality in England and Wales 1970–1985: an analysis by country of birth
Authors: Ibison Judith M. , Swerdlow Anthony J. , Head Jenny A. , Marmot Michael
Published: August 2005

Objective
To determine the risk of maternal mortality in immigrants to England and Wales. Design Analysis of death registrations, 1970–1985, by country of birth. Setting England and Wales.

Population
Women dying in England and Wales during regnancy, childbirth or the puerperium, or dying fiom malignant tumour of the placenta.

Main outcome measures
The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause‐specific death, adjusted for age, in immigrants compared with women born in England and Wales.

Results
Women born in West Africa (relative risk 10.3; 95% CI 8.0–13.2) and the Caribbean (4.6; 3.8–5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3–2.0) and ‘Europe and the USSR’ (1.7; 1.2–2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the ‘Rest of the World’ and Scotland were at significantly elevated risk.

Conclusions
An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non‐immigrants is required, and into whether this affects the risk of maternal mortality.
Peak systolic over protodiastolic ratio as an objective substitute for the uterine artery notch
Authors: Irion Olivier , Massé Jacques , Forest Jean‐Claude , Moutquin Jean‐Marie
Published: August 2005

Objective
To measure the inter‐rater agreement for the identification of a uterine artery notch, as well as the association between an observed notch and the peak systolic over protodiastolic (A/C) ratio.

Design
Cohort study.

Setting
Tertiary care university hospital.

Population and methods
Six hundred and sixty‐five nulliparous women in whom 1022 examinations of uterine artery velocity waveforms were performed by pulsed Doppler at 18 and at 26 weeks of gestation. Agreement between two independent raters was analysed using Cohen's kappa statistics. A/C ratios of flow velocity waveforms with or without a notch were compared. The agreement between A/C values and the presence of a notch was estimated by measuring the surface under the receiver operating characteristic (ROC) curve.

Results
Inter‐rater agreement for the identification of a notch was 074 (95% CI 0.64–0.83) at 18 weeks and 0.72 (95% CI 0.64–0.80) at 26 weeks. NC ratios were higher when a notch was present (P < 0.0001). The area under the ROC curve was 0.86 (95% CI 0.81491) for the placental uterine artery and 0.93 (95% CI 0.90–0.96) for the nonplacental artery. An A/C value 2.5 in any uterine artery had a sensitivity of 88% and a specificity of 86% to detect a notch.

Conclusion
Although there is no definitive definition of the notch, its detection is reproducible within a center. However, published prevalences between centers in unselected populations vary. The measure of the NC ratio can serve as an objective substitute.
Prevalence of fetal left ventricular hyperechogenic foci in a low risk population
Authors: Merati Roberto , Lovotti Massimo , Norchi Stefano , Teatini Alberto , Tenore Amedeo Carlo , Belloni Carlo
Published: August 2005

Objective
To ascertain the prevalence and clinical significance of small hyperechogenic foci detected in the fetal left ventricle in routine ultrasound screening of pregnant women attending our hospital.

Population and methods
From April 1994 to April 1995, 1135 consecutive pregnant women examined at the obstetric ultrasound unit of our hospital were studied prospectively. A postnatal cardiologic examination was performed when signs of cardiopathy were observed at the prenatal ultrasound investigation or the neonatal examination.

Results
Congenital heart disease was detected in 10/1148 infants born (0.9%); eight diagnoses were made prenatally (detection rate 80%). The prevalence of left ventricular hyperechogenic foci was 3.2% (37/1148 fetuses). In 35 cases (94.6%) the foci were no longer observed at the routine third trimester examination. Only in two cases (5.4%) did foci persist at the postnatal examination but without clinical signs of cardiopathy or karyotype anomalies. No association was observed between foci and major structural abnormalities. The foci were single in 32 cases (86.5%). Four foci (10.8%) were located at the interventricular septum, five (13.5%) bilaterally at the papillary apparatus of the mitral valve, and the others at the ventricular wall. No focus was associated with incompetence of the affected valve, whereas five (13.5%) were associated with a fetal disorder.

Conclusions
The prevalence of intracardiac hyperechogenic foci in our general population considered at low risk was more than five times greater than that reported in the literature. Foci were not associated with structural heart defects or chromosomal abnormalities. Persistence during the third trimester and postnatal life was rare and without evident signs of heart disease.
Sigmoid colon vaginoplasty: a modified method
Authors: Franz R. C.
Published: August 2005

Objective
To assess the technical feasibility and functional results of sigmoid colon vaginoplasty using a modified technique.

Design
Retrospective descriptive analysis.

Setting
Referral centre.

Patients
A method for creating an artificial vagina was applied in 13 women for the following indications: true hermaphrodite (n= l), gender dysphoria (n= 2), Müllerian dysgenesis (n= 10).

Interventions
A method for sigmoid vaginoplasty was devised whereby transection of the inferior mesenteric artery proximal to the first sigmoid branch provides immediate mobility for the sigmoid colonic segment to reach the introitus (with adequate nourishment from the middle and inferior rectal vascular systems).

Main outcome measures
Assessment of sexual function after a follow up period of 1 to 19 years.

Results
Twelve women reported a satisfactory result. Three of these were lost to follow up after one year, and the others report for regular assessment. Mild stenosis at the muco‐cutaneous anastomosis, which may occur after failed perineal procedures, appears to be amenable to daily dilatations until the women become sexually active. In one woman the prosthesis had to be removed on account of severe pelvic floor fibrosis as a result of previous abdomino‐perineal surgery at the age of seven. Another woman presented with a postcoital vesico‐vaginal fistula after a previous McIndoe procedure; the tear at the base of the bladder was repaired and buttressed with a sigmoid vagina which is now functioning satisfactorily after 19 years.

Conclusion
The creation of a sigmoid vagina which is vascularised by the middle and inferior rectal arterial systems appears to be an acceptable procedure for vaginal agenesis, acquired vaginal loss or sexual reassignment.
The costs of treating miscarriage: a comparison of medical and surgical management
Authors: Hughes Jenny , Ryan Mandy , Hinshaw Kim , Henshaw Richard , Rispin Rachel , Templeton Allan
Published: August 2005

Objective
To estimate and compare the costs of surgical and medical treatment of miscarriage to the National Health Service.

Design
A patient‐centred, partially randomised trial.

Setting
A teaching hospital in Scotland.

Participants
Four hundred and thirty‐seven women with a proven first trimester miscarriage.

Main outcome measures
The cost per patient of surgical and medical management of miscarriage plus the extra cost per patient of introducing medical management of miscarriage under three different scenarios are calculated.

Results
The average cost of surgical treatment was £397 compared with £347 for medical treatment. Sensitivity analysis showed that the extra cost of introducing the medical management of miscarriage ranged from a cost saving of £71 per patient to an additional cost of £37 per patient.

Conclusions
Our analysis showed that it may be possible to generate cost savings by introducing medical methods in the management of early miscarriage. However, the savings assume that costs associated with theatre use can be fully realised.
Children whose mothers had second trimester amniocentesis: follow up at school age
Authors: Finegan Jo‐Anne K. , Sitarenios Gabriel , Bolan Pamela L. , Sarabura Angeline D.
Published: August 2005

Objective
To explore potential long term consequences of second trimester amniocentesis.

Design
Children exposed to second trimester amniocentesis have been followed prospectively from birth to school age and compared with children whose mothers declined the test.

Setting
The Hospital for Sick Children, Toronto.

Sample
Eighty‐six children exposed to amniocentesis and 44 children whose mothers declined the test.

Interventions
Second trimester amniocentesis for the late maternal age indication.

Main outcome measures
Standardised tests of intelligence, academic achievement, speech articulation, visual‐perceptual‐motor ability and fine motor coordination were administered. Parents reported on child behaviour using standardised measures of behaviour problems, social competence, hyperactivity and temperament. Physical growth was also measured, and parents reported on child health.

Results
Group differences were not observed.

Conclusions
Second trimester amniocentesis does not appear to compromise child development, behaviour, growth or health.
A randomised prospective trial comparing laparoscopic and abdominal hysterectomy
Authors: Olsson Jan‐Henrik , Ellström Marie , Hahlin Mats
Published: August 2005

Objective
To compare short term clinical results in a prospective randomised trial of laparoscopic hysterectomy compared with abdominal hysterectomy.

Methods
One hundred and forty‐three women scheduled for total abdominal hysterectomy, with or without salpingo‐oophorectomy and with a maximum uterine width of less than 11 cm, were prospectively randomised to undergo the procedure by laparoscopic hysterectomy (n= 71) or abdominal hysterectomy (n= 72). During laparoscopic hysterectomy, the uterine arteries as well as the upper portion of the cardinal ligaments were transected laparoscopically. The perioperative and post‐operative courses of the groups were compared.

Results
The number of women with a complication did not differ significantly between laparoscopic hysterectomy (27%) and abdominal hysterectomy (33 %) groups. The post‐operative fall in erythrocyte volume fraction was significantly greater following abdominal hysterectomy (5.6% compared with 4.1 % median value, P 0.001). Post‐operative pain, assessed by the patients two days after surgery on a visual analogue scale, was significantly higher following abdominal hysterectomy (4.2 compared with 3.6 units median value, P < 0.05). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value, P < 0.001), the women undergoing this procedure had a shorter post‐operative time in hospital (two compared with four days median value, P < 0.001) and a shorter convalescence (16 compared with 35 days median value, P < 0.001).

Conclusions
Laparoscopic hysterectomy is a safe procedure for selected patients scheduled for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post‐operative pain, shorter time in hospital and shorter convalescence time.
Evaluation of a rapid diagnostic test for bacterial vaginosis
Authors: O'Dowd T. C. , West R. R. , Winterburn P. J. , Hewlins M. J.
Published: August 2005

Objective
To evaluate a new rapid diagnostic test for bacterial vaginosis.

Design
Comparison of a new biochemical diamine test with low technology tests and microbiological culture.

Setting
General practice, family planning clinic.

Participants
Patients attending a general practice with vaginal symptoms, women consulting for family planning and cervical smears, and women invited for health checks.

Main outcome measures
Comparison of the new diamine test with microbiological culture for Gardnerella vaginalis, with clue cells, and with the amine test.

Results
Two hundred and twenty‐nine vaginal swabs were assayed quantitatively by the new diamine test. When compared with microbiological culture of Gardnerella vaginalis, the sensitivities and specificities were 86% and 81%, respectively. When compared with clue cell findings, the sensitivities and specificities were 97% and 83%, respectively. In the third comparison with the amine test the sensitivity was 94% and the specificity 84%. Since microbiological diagnosis of organisms related to bacterial vaginosis is difficult, the new test and existing sideroom tests may be more sensitive to the condition and the true frequency of false positives may be less than the specificity in this study suggests.

Conclusions
The new diamine test is accurate, sensitive and specific, and provides the basis for the rapid diagnosis of bacterial vaginosis. Such a test is needed if bacterial vaginosis is to be diagnosed and managed effectively in both general and specialist practice.
Early prediction of pre‐eclampsia by measurement of kallikrein and creatinine on a random urine sample
Authors: Millar J. G. B. , Campbell S. K. , Albano J. D. M. , Higgins B. R. , Clark A. D.
Published: August 2005

Objective
To assess the measurement of inactive urinary kallikrein (IUK) to creatinine (Cr) ratio (IUK:Cr) on an untimed urine sample, collected between 16 and 20 weeks of pregnancy, as a predictive test for the development of both proteinuric and nonproteinuric pre‐eclampsia.

Design
A prospective longitudinal study.

Setting
A clinic for antenatal care and a university research department.

Participants
Three hundred and seven normotensive women randomly selected (124 nulliparous and 183 parous) attending the antenatal clinic for their booking visit.

Main outcome measures
1. Nonproteinuric pre‐eclampsia: a rise in diastolic blood pressure of 25 mmHg or more and a crossing of the threshold of 90 mmHg; 2. Proteinuric pre‐eclampsia: same as 1. plus the development of significant proteinuria (> 1+ on urine dipstick).

Results
Thirty‐seven women developed pre‐eclampsia, 12 of whom had proteinuria. Median 1UK:Cr ratio in this group was 78.27, compared with 358.19 in the remainder. Analysis of receiver‐operator characteristics gave an area under the curve of 0803. An IUK:Cr ratio of 170 or less in this study predicted nonproteinuric or proteinuric pre‐eclampsia with a sensitivity of 70% and a specificity of 86%. Ten of the twelve women who had proteinuria had an 1UK:Cr below 170. Median 1UK:Cr for those with proteinuric pre‐eclampsia was 72.91.

Conclusions
Measurement of 1 UK: Cr on a urine sample, collected between 16 and 20 weeks of gestation, represents a simple and practical test for the risk of subsequent pre‐eclampsia, with a sensitivity and specificity comparable to those reported by other investigators using the widely recognised, but less practical, angiotensin I1 sensitivity test.
Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus
Authors: Persson B. , Hanson U.
Published: August 2005

Objective
To determine the relation between maternal levels of blood glucose and glycated haemoglobin (HbAlc) and infant size at birth in pregestational diabetes.

Design
Longitudinal study from 6 to 14 weeks gestation. Women were treated intensively with insulin, aiming at normoglycaemia but avoiding hypoglycaemia. Blood glucose was determined six times daily, HbAlc every four weeks. Individual mean fasting and postprandial glucose levels were calculated for three‐week periods of gestation. Birthweight > 2 SD or within ±2 SD for gestational age and gender was classified as large (LGA) or appropriate (AGA), respectively. Birthweight ratio was calculated as the ratio of birthweight to normal mean birthweight after correction for gestational age and gender.

Participants
One hundred and thirteen consecutive pregnant women with pregestational diabetes and their newborn infants.

Results
Perinatal mortality was nil, the rates of spontaneous preterm delivery (8.9 %) and severe maternal hypoglycaemia (4.4 %) were low. Mothers with LGA infants (26 %) had a significantly higher fasting glucose between weeks 27 and 32 than mothers of AGA infants (P < 0.01). Relative birthweight was significantly and independently associated with pre‐pregnancy bodyweight (r = 0.24, P 005) and fasting glucose at weeks 27 to 29 (r = 0.27, P 0.01) but together could only explain 12.3 % of the variation in birthweight (mult. r = 0.35, P 0.01). HbAlc correlated with glucose levels but was unrelated to birthweight ratio. The fasting glucose level between weeks 30 and 32 was significantly interrelated with the fasting glucose level from each of the six preceding three‐week periods.

Conclusion
Near normoglycaemia cannot be obtained in all patients, presumably due to intrinsic differences in glucoregulatory ability between individuals. The incidence of LGA infants was unexpectedly high. The modest abnormality in glycaemic control in mothers with LGA infants could only partly explain fetal oversize, suggesting that other factors must be implicated to explain fetal growth acceleration.