bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomised controlled trial of prophylaxis of post‐abortal infection: ceftriaxone versus placebo
Authors: Henriques Carsten Ulrik , Wilken‐Jensen Charlotte , Thorsen Poul , Møller Birger R.
Published: August 2005

Objective
To investigate the incidence of post‐operative infection after first trimester abortion in women treated with a long‐acting cephalosporin (ceftriaxone) compared with low risk patients receiving no treatment and with high risk patients receiving our standard treatment of ampicillin/pivampicillin and metronidazole.

Design
A prospective, randomised controlled trial.

Setting
Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark.

Subjects
Nine hundred and ninety‐six women, admitted on an outpatient basis for legal termination of pregnancy at 12 weeks or less of gestation, were included in the study after giving informed consent. The women were divided into high risk and low risk categories and allocated either to treatment with ceftriaxone or to standard treatment. For high risk patients the standard treatment was initiated by a peroperative injection of ampicillin and metronidazole, followed by oral doses of metronidazole and pivampicillin three times daily for four days. No prophylactic antibiotics were given to the women randomised to standard treatment in the low risk group.

Interventions
All women were kept under observation, and, between six and 14 days post‐operatively, underwent pelvic examination. Clinical endpoints were noted.

Main outcome measures
Post‐operative pelvic inflammatory disease in women applying for legal first trimester abortion.

Results
Seven hundred and eighty‐six women fulfilled the criteria for evaluation. A tendency toward a prophylactic effect of ceftriaxone was observed in most clinical findings. A significant prophylactic effect of ceftriaxone was found in the low risk group.

Conclusions
This study demonstrated a significant reduction in post‐operative pelvic inflammatory disease in low risk patients, who were applying for legal first trimester abortion, treated peroperatively with ceftriaxone. No significant difference was demonstrated between high risk patients treated with ceftriaxone or ampicillin/pivampicillin and metronidazole.
Menorrhagia—a pragmatic approach to the understanding of causes and the need for investigations
Authors: Fraser Ian S.
Published: August 2005

Menorrhagia is a symptom denoting excessively heavy menstrual bleeding. It is a complaint that is difficult to verify objectively in many cases, even with a detailed case history. Issues of perception and tolerance of symptoms are important in whether a patient presents to a doctor, and this varies considerably from one society to another. Research studies indicate that the upper limit of normal blood loss is between 60 and 80 ml/month. Above this level women tend to become progressively iron deficient. Hence, any development which may help the precision of this assessment is valuable, and several of these will be discussed. Causes of menorrhagia can be divided into three groups: (1) pelvic diseases, such as myomata and adenomyosis; (2) systemic disorders, such as coagulopathies and hypothyroidism; and (3) dysfunctional uterine bleeding—a diagnosis of exclusion. Investigations are mainly aimed at improving the precision of the underlying diagnosis, defining the severity of the condition and excluding anaemia. Hence, the most important investigations are a full blood count, a diagnostic hysteroscopy and endometrial sampling. In clinical practice, other specific investigations need only be carried out if there are unusual features in the history or examination, or if previous treatments have failed. In a research situation there have been numerous studies aimed at elucidation of the mechanisms of heavy bleeding and some of these will be reviewed.
Evaluation of surgical options in menorrhagia
Authors: Lalonde A.
Published: August 2005

Total abdominal and vaginal hysterectomy has been the standard treatment for intractable and unmanageable menorrhagia for many years. However, in the last few years, hysteroscopic treatment of menorrhagia through surgical resection and/or ablation of the endometrial cavity has gained success. Over 625000 hysterectomies are performed each year in the USA alone. More than 30 % are done for menorrhagia as a primary diagnosis. Three times more hysterectomies are performed using the abdominal route than the vaginal approach. Morbidity is higher using the abdominal route alone. Complications of abdominal and vaginal hysterectomies will be briefly discussed. Menorrhagia caused by submucous fibroids can be treated hysteroscopically. A review of methods, complications, advantages and long‐term follow up will be presented. Laparoscopically‐assisted vaginal hysterectomy (LAVH) is the latest surgical option offered for menorrhagia. The advent of a hysteroscopic approach to the treatment of menorrhagia and careful analysis of the advantages and disadvantages of LAVH will be discussed.
Interleukin‐6, turnour necrosis factor and soluble turnour necrosis factor receptors in women with pre‐eclampsia
Authors: Vince Gill S. , Starkey Phyllis M. , Austgulen Rigmor , Kwiatkowski Dominic , Redman Christopher W. G.
Published: August 2005

Objectives Generalised maternal endothelial cell dysfunction appears to be an underlying problem in pre‐eclampsia presumed to be caused, directly or indirectly, by one or more circulating factors derived from the placenta. Recently it has been suggested that tumour necrosis factor (TNF) may play an important role in pre‐eclampsia and contribute to endothelial activation. This study was designed to investigate this proposal.

Design Plasma TNF‐α, IL‐6 and both forms of soluble TNF receptors (p55 and p75 TNF‐R) have been measured by ELISA in 31 pre‐eclamptic patients and 31 pregnant controls matched for age, parity and gestational age.

Results Levels of IL‐6, TNF‐α and soluble TNF‐R (p55 and p75) were significantly higher in pre‐eclamptic patients, compared with age and gestation matched controls with a wide variation in levels between pre‐eclamptic individuals. There was a correlation between levels of IL‐6 and TNF or TNF‐R and between TNF and TNF‐R levels. However, when the pre‐eclamptic patients were subdivided on the basis of the severity of their disease, the median values of plasma concentrations of IL‐6, TNF‐α and TNF‐R were all higher in the group with lower platelet counts.

Conclusions These new findings are consistent with the concept that the maternal syndrome of pre‐eclampsia is associated with endothelial dysfunction and provide evidence that at least part of this dysfunction could arise from excessive release of TNF‐α into the circulation.
Circadian variation of urinary albumin excretion in pregnancy
Authors: Douma C. E. , van der Post J. A. M. , van Acker B. A. C. , Boer K. , Koopman M. G.
Published: August 2005

Objective The hypothesis was tested that circadian variations in urinary albumin excretion of pregnant women in the third trimester of normal pregnancy are different from nonpregnant individuals.

Design Circadian variability in urinary albumin excretion was studied both in pregnant women and in nonpregnant controls either during normal daily activities or in contrast during continuous bedrest with standardised fluid and food intake to study endogenously generated rhythm.

Setting Outpatient department and metabolic ward of a university hospital.

Main outcome measures Urinary albumin excretion during fixed time periods over the day and the night.

Results Both ambulant pregnant and nonpregnant women have circadian rhythm in urinary albumin excretion but pregnant women have, firstly, a hgher 24 h urinary albumin excretion, secondly, smaller relative day‐night differences than nonpregnant controls and thirdly, in the metabolic ward some pregnant women demonstrate absence of rhythm.

Conclusions The higher albumin excretion during pregnancy in 24 h urine collections can largely be explained by a higher excretion during the night, compared with that of nonpregnant women. The day‐night difference in urinary albumin excretion of ambulant pregnant women is exogenously determined.
A follow up of silastic sling for genuine stress incontinence
Authors: Chin Yue Kim , Stanton Stuart L.
Published: August 2005

Objective To assess the use of silastic sling for genuine stress incontinence.

Design Retrospective descriptive analysis.

Setting Tertiary referral centre for urogynaecology.

Subjects Eighty‐eight women with urodynamically proven genuine stress incontinence, 10 had coexistent detrusor instability. In 74 women, the sling operation was for recurrent incontinence.

Intervention A low Pfannenstiel incision was used and a suburethral tunnel dissected to insert the sling, which was attached under minimal tension with non‐absorbable sutures to each ileopectineal ligament.

Main outcome measures Clinical and urodynamic data were assessed between two and three months post‐surgery; thereafter clinical assessment and pad testing were performed at yearly intervals for five years.

Results The subjective cure at three months was 81% and the objective cure was 69 %. There was a fall in success rate with increasing number of continence operations, and this was statistically significant for women with three or more previous continence operations (P < 0.05). Neither age, parity nor menopausal status made a statistical difference to the cure rate. Twenty‐three women had reached their fifth year follow up and the success rate using life table analysis was 71%. Post‐operatively, 29 women had detrusor instability: 22 women developed detrusor instability de novo and seven had detrusor instability presurgery. Urodynamic findings post‐surgery showed an increase (P < 0.001) in outflow resistance. Four women required removal of sling for voiding difficulties. Ten women developed sling erosions: five vaginal, four bladder erosions and one urethral erosion. After removal of the sling, seven women still remained continent.

Conclusions A silastic sling operation for the treatment of genuine stress incontinence provides a good long term cure, considering that 45% of women had two or more previous failed continence operations. The high prevalence of detrusor instability and voiding difficulties post‐surgery should be noted.
The influence of maternal haemoglobin and ferritin on mid‐pregnancy placental volume
Authors: Howe D. T. , Wheeler T. , Osmond C.
Published: August 2005

Objective To investigate whether low maternal haemoglobin and ferritin levels are associated with increased placental volume by mid‐pregnancy.

Design Prospective study of women attending hospital for shared antenatal care.

Setting A teaching hospital in the south of England.

Subjects Five hundred and sixty‐eight women booking for delivery in the hospital.

Main outcome measures Placental volume measured by ultrasound at 18 weeks gestation.

Results At 14 weeks gestation 9% of women had haemoglobin levels ≤ 11 g/dl and 26% had ferritin levels < 13 μg/1. Placental volume at 18 weeks was inversely related to the maternal haemoglobin and ferritin levels. The influence of haemoglobin and ferritin concentrations was independent of maternal social class, parity, smoking, and weight. Larger placentae were found in taller women, those who had previously been pregnant, and in those who were smoking more than 15 cigarettes daily at the time of their last menstrual period.

Conclusion These data suggest that placental development is influenced from early in pregnancy by the intrauterine environment provided by the mother. In conjunction with other studies they support the proposal that, as a result of these changes, programming of adult blood pressure may be initiated in early pregnancy.
Uptake of meta‐analytical overviews of effective care in English obstetric units
Authors: Paterson‐Brown Sara , Fisk Nicholas M. , Wyatt Jeremy C.
Published: August 2005

Objective To establish the current availability of meta‐analytical overviews of effective care in perinatal medicine, in the form of Effective Care in Pregnancy and Childbirth and the Oxford Database of Perinatal Trials, in English obstetric units and to find out how obstetricians without either one keep up to date.

Design Standardised telephone questionnaire.

Subjects The consultant obstetrician deemed to be the Royal College of Obstetricians and Gynaecologists' administrative contact in each of the 24 teaching hospitals, and in 74 of 173 (43%) district general hospitals in England.

Main outcome measures Knowledge and use of Effective Care and the Oxford Database in the obstetric unit.

Results Thirty‐seven percent of units did not have access to either Effective Care or the Oxford Database, with significant differences between district general hospitals and teaching hospitals in lack of availability (33/74 (45%) versus 3/24 (12%) respectively, P= 0.02). Effective Care was available in 51% of district general hospitals and 79% of teaching hospitals, compared with the availability of the Oxford Database which was only available in 16% and 62%, respectively. Reasons given for not obtaining either included non‐awareness, expense, and perceived lack of need. The consultants with neither Effective Care nor the Oxford Database claimed to keep up to date by various methods, usually as information from colleagues.

Conclusions These results reflect both inefficient dissemination of medical knowledge in obstetrics and the reluctance of obstetricians to consider adapting their practice as a result of evidence from meta‐analyses of randomised controlled trials. Although Effective Care is more widely available than the Oxford Database, its datedness renders it inferior to the database as a means of facilitating effective care in obstetrics.
Pain and infertility – a rationale for different treatment approaches
Authors: Martin D. C.
Published: August 2005

Endometriosis may result in pain and/or infertility in some patients, while others may remain asymptomatic. The disease appears to progress and regress somewhat unpredictably, making it difficult to determine the appropriate treatment. Progression of the disease can be altered by medical and surgical treatments used according to general guidelines but selected for the individual. Coagulation, medical suppression and observation are frequently the first approaches to infertility or pain resulting from endometriosis. Deep dissection and excision may be indicated with deep disease, persistent pain or persistent tenderness.
Audit of 114 non‐neoplastic vulvar biopsies
Authors: O'keefe Rodeney J. , Scurry James P. , Dennersten Graeme , Sfameni Salvatore , Brenan John
Published: August 2005

Objective
The purpose of this study was to show the benefits and limitations of vulvar biopsy in the setting of a multidisciplinary clinic specialising in non‐neoplastic diseases of the vagina and vulva.

Design
One hundred and fourteen vulvar biopsies were reviewed and classified according to the classification of the International Society for the Study of Vulvar Diseases.

Results
The histological diagnoses were lichen sclerosus 25 YO, nonlichen simplex chronicus 35%, erosive inflammatory dermatoses comprising psoriasis, spongiotic dermatitis, dermatophytosis and psoriasiform dermatitis 13%, erosive vulvitis and lichen planus 9%, nonspecific inflammation 6%, miscellaneous 9% and normal 4%.

Conclusions
Biopsies in cases of lichen sclerosus were useful for confirmation of clinical diagnosis and to exclude early invasive malignancy. In lichen simplex chronicus, biopsies helped exclude an underlying dermatosis requiring specific treatment. Psoriasis, spongiotic dermatitis, dermatophytosis and excoriated lichen simplex chronicus posed a common clinical differential diagnosis of the reddened vulva. The eroded vulva often proved a diagnostic problem clinically and histologically. The clinical syndrome of vestibulitis did not have a specific histological picture, and biopsies showed nonspecific inflammation, mild hyperplasia or were normal. No case of squamous cell hyperplasia was diagnosed and the place of this diagnosis in the ISSVD classification needs review.
Management of female genital mutilation : the Northwick Park Hospital experience
Authors: McCafrey M. , Jankowska A. , Gordon H.
Published: August 2005

Objective
To outline the problems associated with female genital mutilation and to highlight the need for deinfibulation before delivery.

Design
A review of women attending a newly established African Well Woman Clinic. Age at infibulation, gravidity of clinic attenders and adequacy of introitus for management of labour were assessed.

Setting
Northwick Park Hospital, Harrow, Middlesex.

Subjects Fifty women attending a newly established African Well Woman Clinic, of whom 13 were nulliparous, 14 were primigravid and 23 were multigravid.

Results
The average age at which infibulation had occurred was 6–7 years. At the time of clinic attendance the mean age of pregnant and nonpregnant patients was 26 and 23.3 years, respectively. Of the 14 primigravid patients, only 50% had an adequate introitus to allow management of the first and second stages of labour. Five had deinfibulation performed antenatally or at delivery. Ninety‐three percent of the primigravid patients and 74% of the multigravid patients had a vaginal delivery.

Conclusions
We believe that the Northwick Park Hospital management policy for intibulated women closely mirrors the cultural practices in Somalia. The policy also improves obstetric management of infibulated patients. Twenty‐six percent of referrals were of nonpregnant women, and this practice is to be encouraged.
Obstetric antecedents of surgically treated obstetric brachial plexus injuries
Authors: Ubachs J. M. H. , Slooff A.C. J. , Peeters L. L. H.
Published: August 2005

Objective
To determine whether the anatomy of an obstetric brachial plexus lesion (OBPL) is causally related to the preceding obstetric history.

Design
Anatomical classification of the OBPL during reconstructive neurosurgical treatment in consecutive infants who had surgery for OBPL between 1986 and 1994 and relating these findings with the characteristics of the preceding birth.

Setting
De Wever Hospital, Heerlen, The Netherlands.

Subjects
All infants who had surgical treatment for OBPL between 1 April 1986 and 1 January 1994 (n= 130).

Results
An Erb's C546 injury was preceded more frequently by a difficult breech birth (19/26 cases or 73 YO). In contrast, the more extensive forms of Erb's palsy classified as a C547 injury or a total palsy with a C5–Tl injury were observed more frequently after complicated cephalic birth (52/59 or 88%, and 43/45 or 96%, respectively). The extent of anatomical damage as expressed by the incidence of an avulsion of one or more spinal nerves was 18/26 (69 %) in Erb C5–C6, 13/59 (22%) in Erb C547 and 21/45 (47%) in total C5–T1 palsy.

Conclusion
The Erb's CS‐C6 palsy, occasionally bilateral and/or complicated by phrenic nerve injury, was the most frequent form of OBPL after a breech birth. The more extensive form of Erb's palsy and the total palsy were observed more frequently after delivery in a cephalic presentation. The pure form of Erb's palsy and the total palsy were characterised by a higher incidence of nerve avulsions than the extensive form of Erb's palsy.
The European Collaborative Study: clinical and immunological characteristics of HIV 1‐infected pregnant women
Authors: Thorne Claire , Newell Marie‐Louise , Dunn David , Peckham Catherine ,   The names of all collaborators and others who assisted may be found on page 874
Published: August 2005

Objective
To describe the changing clinical and immunological characteristics and timing of diagnosis of HIV‐infected pregnant women enrolled in the European Collaborative Study.

Design
A prospective study of the mothers of children enrolled in the European Collaborative Study on children born to HIV‐infected women.

Setting
Twenty‐one European centres in seven countries.

Subjects
One thousand six hundred and ninety HIV‐infected women and their 1754 deliveries.

Results
The proportion of women in whom HIV infection had been diagnosed before pregnancy increased significantly over time, from 7% in 1984–1985 to 65% in 1994 (P < 0.001). The prevalence of breastfeeding, which was related to the timing of diagnosis, significantly declined over the study period. The mean CD4 count was 510 cells/mm3, and there was a significant decline in average CD4 count over the study period. Black women had a significantly lower CD4 count than white women. From survival analysis it is estimated that five years after delivery 14% of women will have died and 24% will have developed CDC stage IV disease.

Conclusions
Timing of diagnosis is of critical importance if mother‐to‐child transmission is to be reduced through avoidance of breastfeeding and zidovudine therapy and effective antenatal screening policies have become increasingly important. The rate of progression of maternal disease highlights the implications of HIV infection for their children, both infected and uninfected.
Lack of evidence for a circadian rhythm of IGFBP‐1 in the mother and fetus during labour
Authors: Harding S. , Kyei Mensah A. , Hills F. , Howell R. J. S. , Chard T.
Published: August 2005

Objective
To determine whether the circadian rhythm of circulating levels of insulin‐like growth factor binding protein‐1 (IGFBP‐1) is evident at the time of delivery.

Design
Prospective observational study in six pregnant women and cross‐sectional study in 65 women at the time of delivery.

Subjects
Six pregnant women sampled over a period of 24 hours, 23 women sampled at the time of elective caesarean section, and 42 women sampled at the time of vaginal delivery.

Results
In the women sampled serially over a 24 hour period there was an obvious circadian rhythm of IGFBP‐1 with a peak between 01.00 and 09.00 hours. In the women sampled at the time of delivery there was no evidence for any relationship between the time of delivery and maternal or fetal levels of IGFBP‐1.

Conclusions
The circadian rhythm of IGFBP‐1 is not observed in women in labour. Therefore, the time of day is not an important confounding variable in studies on IGFBP‐1 levels at the time of normal delivery.
Pre‐operative morphological and colour Doppler features of borderline ovarian tumours
Authors: Zanetta Gerardo , Lissoni Andrea , Cha Stephen , Bertalero Carlo , Scalambrino Salvatore , Bratina Giorgio
Published: August 2005

Objective
To evaluate pre‐operatively the sonographic morphology and colour Doppler findings of borderline ovarian tumours and to compare these findings to those of benign and malignant tumours.

Methods
Pre‐operative transvaginal and colour Doppler ultrasound examinations were performed on 150 women with adnexal tumours. Pulsatility index, resistance index, peak systolic velocity, site, number and confluence of vessels were recorded.

Results
Fifty‐six women had malignant ovarian tumours, 74 had benign and 20 had borderline tumours. No biological, morphological or demographic parameters were specifically predictive of borderline tumours. Intratumoral vessels with a pulsatility index of below 1.0 were observed in 19 of the 20 borderline tumours; a morphological score suggested malignancy in 15 women whereas the CA125 exceeded 30 u/ml in 10 cases. Confluence of blood vessels was observed only in three cases. A model including intracystic complexity (either vegetations or septa), pulsatility index of less than 1.0, absence of confluence of vessels, CA125 of less than 150 u/L, in a woman under 60 years of age allowed borderline tumours to be detected with 85% sensitivity, 92 % specificity and 91 % accuracy.

Conclusion
Borderline tumours have haemodynamics resembling those of malignant tumours but the distribution of vessels is often similar to that observed in benign tumours; this observation should be considered when proposing multiparameter scoring systems including colour Doppler ultrasound to identify malignancies of the ovary. Colour Doppler findings may be of assistance in the follow up of women after conservative surgery for ovarian malignancies.
Evaluation of flexible senior registrar training in obstetrics and gynaecology
Authors: Fiander Alison
Published: August 2005

Objective
To evaluate part‐time senior registrar training in obstetrics and gynaecology from the perspective of the trainees.

Design
Postal questionnaire.

Subjects
Past and present senior registrar trainees on the PM(79)3 scheme.

Results
Thirty‐two questionnaires were returned (86% response rate) from 20 current trainees (100% response) and 12 (71% response) past trainees. Family commitments were the main reason for training part‐time. Of these, 84% were satisfied with their training and most (81%) thought the quality as good or better than full time training. Personalised timetables were seen to be of particular benefit. Negative attitudes towards part‐time training and discrimination in favour of full time trainees were seen as some of the biggest difficulties associated with part‐time training. Other problems included administrative delays in organising part‐time posts, time restriction, and the length of training.

Conclusions
Part‐time senior registrar training is effective in retaining trainees with domestic commitments within the speciality. It is regarded as being of high quality but with attendant problems, particularly those related to the negative attitudes of others. Recommendations for improvements have been made.
The 1993 British Society for Colposcopy and Cervical Pathology/National Coordinating Network United Kingdom Colposcopy Survey
Authors: Kitchener H. C. , Cruickshank M. E. , Farmery E.
Published: August 2005

Objective
To evaluate colposcopic practice over a 12‐month period in the UK, April 1993 to March 1994, to compare this with 1988, and to test penetration and acceptance of previously introduced national guidelines.

Design
A nationwide survey of colposcopy practice by postal questionnaire, including referral criteria, diagnosis and treatment, follow up, waiting times and information and counselling.

Setting
All gynaecology clinics in the United Kingdom.

Results
Returns were obtained from 215 clinics (78%), that saw an average of 434 new women per year. Seventy percent of clinics follow the current national guideline for cytological referral criteria for colposcopy. Diathermy loop excision is now by far the most popular treatment method for CIN. The majority of clinics employ both colposcopy and cytology for follow up. A total of 103 invasive cancers following treatment for CIN were reported during the 12‐month period of the survey. Most clinics provide new patients with both information and counselling.

Conclusions
Colposcopy practice has undergone considerable changes in the last five years. There has been a good response to the introduction of a national guideline for referral for colposcopy. While local audits are necessary to identify improvements that need to be made to individual clinical services, this national audit has shown some trends over the past five years, has highlighted the problem of invasive cancer following treatment for CIN and has assessed the impact of a national guideline.
A modification of the technique of sacrospinous ligament fixation
Authors: Hughes G. W. , Freeman R. M.
Published: August 2005

Sacrospinous ligament fixation for vaginal vault prolapse is not H new operation, but the greatest difficulty with it is usually retrieval of the sutures. We describe a simple technique to facilitate this part of the procedure.
Blues and depression during early puerperium: home versus hospital deliveries
Authors: Pop V. J. , Wjnen H. A. , van Montfort M. , Essed G. G. , de Geus C. A. , van Son M. M. , Komproe I. H.
Published: August 2005

Objective
To investigate whether women who give birth at home are less prone to mood disturbances during the early puerperium than those who give birth in hospital.

Design
A prospective study of 303 pregnant women who registered for antenatal care.

Setting
The antenatal clinic at St Joseph's Hospital, Veldhoven, The Netherlands, and five antenatal consultation programmes of local midwives working in the surrounding region.

Subjects
Three hundred and eighty‐two consecutive Caucasian women registering for antenatal care were approached. Of these, 303 consented to participate and 293 completed the study.

Main outcome measure
The predictor variable was the way in which the women gave birth: spontaneous vaginal parturition at home or in hospital as follows: spontaneously; vaginal parturition after stimulation with medication; vaginal parturition with forceps/vacuum extraction; or caesarean section. The outcome variables were blues and depression. The occurrence of blues was assessed at 4 weeks postpartum, using Pitt's criteria. The occurrence of depression was assessed at 4 weeks postpartum using the Research Diagnostic Criteria. The possible confounding effects of a set of obstetrical and psycho‐social variables relating to the early puerperium were investigated using logistic regression analysis.

Results
Of the 293 women who completed the study, 52% gave birth at home. Significantly more nullipara gave birth in hospital. Parturition occurred where it had been planned in 77% of women; referral occurred later on in pregnancy in 11% and during labour in 12%. Nullipara had to be referred significantly more often than multipara. In general, there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. Obstetric factors were not related to the occurrence of blues or depression in the early puerperium.

Conclusions
Women who give birth in hospital are no more prone to postpartum mood disturbances, such as blues and depression, than women who give birth at home.
Ovarian cancers related to minimal access surgery
Authors: Crawford Robin A. F. , Gore Martin E. , Shepherd John H.
Published: August 2005

Objective
To review the clinical features of women with ovarian cancer on whom minimal access surgery has been performed and to determine guidelines for the safe use of minimal access surgery for adnexal masses.

Design
Postal survey of members of the British Gynaecological Cancer Society (BGCS) and retrospective case review.

Results
BGCS consultants used ultrasound scanning (70%) and serum CA‐125 estimations (53%) prior to adnexal mass surgery. The membership felt that adnexal masses with solid elements, diameter greater than 8 cm, multi‐ocular or bilateral cysts or increased blood flow on Doppler scanning should not be operated on by minimal access surgery. A positive family history was also considered to be a contraindication. A total of 29 cases of ovarian cancer were identified on whom MAS had been performed. The incidence of cases was 4.1% of referrals to a tertiary referral centre (the Royal Marsden Hospital). The median age of patients was 37 years (range 20 to 68 years) and 13 had Stage I cancers. The mean delay between diagnosis and staging was 6.5 weeks.

Conclusion
Guidelines on the use of minimal access surgery in the management of adnexal masses need to be agreed. Women who have an ovarian cancer diagnosed whilst having minimal access surgery should have an accepted staging procedure. We do not recommend the routine use of minimal access surgery for the treatment of ovarian cancer outside a trial.
Cyclic guanosine 3′3′ monophosphate concentrations in pre‐eclampsia: effects of hydralazine
Authors: López‐Jaramillo Patricio , Narváez Marcelo , Calle Andrés , Rivera José , Jácome Patricio , Ruano César , Nava Eduardo
Published: August 2005

Objective
To elucidate the role of the L‐arginine: nitric oxide pathway in pregnancy and pre‐eclampsia.

Participants
Pregnant women (nulliparous, age < 25 years). Normotensive pregnancy (n= 22) was defined when blood pressure remained at levels of < 120/80 mmHg and there was no proteinuria. Women with pre‐eclampsia (n= 22) had blood pressure measurements of > 140/90 mmHg and proteinuria of > 300 mg/l. Nonpregnant normotensive women (n= 22) were studied as controls.

Study Design
Blood samples were taken for measurements of ionised calcium, atrial natriuretic factor, cyclic guanosine 3′5′monophophate (GMP), arginine and asymmetric dimethylarginine. Urine samples were collected for determination of cyclic GMP excretion. Cyclic GMP concentrations were also determined in 12 women with severe pre‐eclampsia before and after treatment with hydralazine.

Results
L‐arginine, asymmetric dimethylarginine and atrial natriuretic factor were not different in any group. Cyclic GMP concentrations in plasma [0.94 (SD 0.23) nM] as well as in urine [50.1 (SD15.7)μM] were increased significantly (P < 0.05) in normal pregnancy compared to nonpregnant controls [plasma mean 0.46 (SD 0.12) nM and urine mean 18.4 (SD 10.3) μM], but not in the pre‐eclampsia group [plasma mean 0.48 (SD 0.10) nM and urine mean 24.1 (SD 14.5) μM]. Concentrations of cyclic GMP in plasma and urine increased significantly (P < 0.05) in women treated with hydralazine.

Conclusions
The differences in cyclic GMP concentrations may reflect differences in nitric oxide production. Hydralazine increases cyclic GMP concentrations in severely pre‐eclamptic women. This action could explain the antihypertensive effect of hydralazine.
ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women
Authors:   ECPPA (Estudo Colaborativo para PrevenGdo da PrP‐eclampsia com Aspirina) Collaborative Group
Published: August 2005

Objective
To determine the effectiveness of low dose aspirin in women at high risk of adverse outcomes associated with pre‐eclampsia.

Design
A collaborative randomised trial comparing the effects of low dose aspirin (60 mg) with placebo on pre‐eclampsia and other materno‐fetal complications associated with hypertension.

Setting
Twelve teaching maternity hospitals and 182 obstetricians' offices in Brazil.

Subjects
One thousand and nine women considered to be at high risk for the development of pre‐eclampsia, or its complications, entered the study between 12 and 32 weeks of gestation. They were randomly allocated to receive aspirin (498 women) or placebo (511 women) until delivery, and follow up was obtained for 96%.

Results
There were no significant differences between the treatment groups in the incidence of proteinuric pre‐eclampsia (6.7% aspirin‐allocated compared with 6–0% placebo‐allocated women), of preterm delivery (22.3% compared with 26.1%), of intrauterine growth retardation (8.5% compared with 10.1%), or of stillbirth and neonatal death (7.3% compared with 6.0%), nor were there significant differences in the incidence of proteinuric pre‐eclampsia in any subgroup of women studied, including those who had systolic blood pressures of 120 mmHg or above at entry (8.5% compared with 7.3%) or those who were chronically hypertensive (10.0% compared with 7.1%). Aspirin was not associated with a significant excess of maternal or fetal bleeding.

Conclusion
The results of this study do not support the routine prophylactic administration of low dose aspirin in pregnancy to any category of high risk women (even those who have chronic hypertension or who are considered to be especially liable to early onset pre‐eclampsia).
Lower genital tract swabs in the prediction of intrauterine infection in preterm prelabour rupture of the membranes
Authors: Carroll S. G. , Papaioannou S. , Ntumazah I. L. , Philpott‐Howard J. , Nicolaides K. H.
Published: August 2005

Objective
To examine the genital tract flora in women with preterm prelabour rupture of the membranes and to determine the relationship of these microorganisms to those found in fetal blood and amniotic fluid.

Design
Prospective study of 97 patients with preterm prelabour rupture of the membranes.

Setting
Maternal‐fetal medicine centre.

Methods
High vaginal and endocervical swabs were taken for routine culture of aerobic and anaerobic bacteria and Ureaplasma urealyticum and Mycoplasma hominis. Cordocentesis and amniocentesis were performed and fetal blood and amniotic fluid were cultured for aerobic and anaerobic bacteria. Amniotic fluid was also cultured for Mycoplasma spp. The sensitivities and specificities of genital tract colonisation in the prediction of fetal blood and amniotic fluid infection were calculated.

Results
Positive genital tract cultures for aerobic and anaerobic organisms predicted 40% of positive fetal blood and 53% of positive amniotic fluid cultures with false positive rates of 24% and 25%, respectively. The sensitivity and false positive rates for genital tract colonisation with Mycoplasma spp in the prediction of amniotic fluid infection with these organisms were 85% and 35%, respectively.

Conclusions
In preterm prelabour rupture of the membranes lower genital tract cultures provide poor prediction of intrauterine infection.
Estimation of fetal lung volume using enhanced 3‐dimensional ultrasound: a new method and first result
Authors: D'Arcy Thomas J. , Hughes Stephen W. , Chiu Wilson S. C. , Clark Terry , Milner Anthony D. , Saunders John , Maxwell Darryl
Published: August 2005

Objective To measure fetal lung volume using a computer based, enhanced, 3‐dimensional ultrasound imaging system.

Design An observational study.

Setting The Fetal Medicine Unit at Guys Hospital, London.

Participants
Twenty healthy women with a singleton pregnancy between 24 and 36 weeks of gestation were scanned on one occasion during pregnancy using an ultrasound based 3‐dimensional imaging system. All delivered at term with weights above the 10th centile for gestation.

Results Total lung volume increased exponentially with gestational age. Right lung volume measured consistently greater than left lung volume.

Conclusions The use of this new enhanced 3‐dimensional imaging system allows for estimations of fetal lung volume. Preliminary data confirm that fetal lung volume, measured by a computerised 3‐dimensional ultrasound imaging system increased exponentially with gestational age. The use of this system has obvious application in the further study of lung growth in utero and possible clinical application in disease states where fetal lung growth may be impaired.
Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial haemorrhage in Shizuoka prefecture
Authors: Nishiguchi Tomizo , Saga Kozue , Sumimoto Kazuhiro , Okada Kazuchika , Terao Toshihiko
Published: August 2005

Objective
To compare three methods of vitamin K prophylaxis for neonatal vitamin K deficient intracranial haemorrhage.

Design
We designed three strategies for vitamin K prophylaxis: 1. therapeutic administration of vitamin K in a mass screening system using the hepaplastin test; 2. routine oral administration of vitamin K to newborn infants; and 3. administration of vitamin K to lactating mothers during the late neonatal period in addition to the routine method. We evaluated the efficacy of these methods by determining hepaplastin test values at the first month of age.

Population
66,076 full term healthy newborn infants without any complications.

Results
Of 55,513 infants in the mass screening system, 3068 infants received vitamin K therapeutically. At the first month of age, in the group where vitamin K was administered therapeutically, 56 infants (1.83%) exhibited low hepaplastin test values (< 40%) despite vitamin K administration. But extremely low values (< 20%), indicating a very high risk of neonatal intracranial haemorrhage, were observed in 34 (0.06%) of 52,445 infants who did not receive vitamin K. In the routine administration system, oral administration of vitamin K twice within the first week of life showed a lower incidence (0.19%) of low level cases than a single administration (1.56%). An additional administration of vitamin K to lactating mothers throughout the late neonatal period showed an effective result.

Conclusions
These findings suggest that vitamin K prophylaxis might reduce the risk of developing neonatal intracranial haemorrhage, but a complete prevention of this disease could not be achieved by oral administration of vitamin K. The transmission of vitamin K through breast milk would be a suitable method of vitamin K prophylaxis.
Emergency contraception: a survey of women's knowledge and attitudes
Authors: Smith Blair H. , Gurney Elaine M. , Aboulela Leila , Templeton Allan
Published: August 2005

Objective
To assess women's knowledge and attitudes in relation to emergency contraception and to identify ways in which these might be improved.

Design
Postal survey: questionnaire seeking level of knowledge of emergency contraception, and attitudes to use, publicity and availability.

Population
A stratified random sample of 2000 Grampian women aged 18 to 47. Women were identified through the Community Health Index.

Results
Most women (94%) were aware of emergency contraception and identified an appropriate source. Fewer (39%) knew the correct timing for its use. These figures were generally higher among younger, single women. The popular media represented the commonest source of information, and GPs and Family Planning Clinics were cited rarely. Increased advertising was considered desirable by 71% (mainly older women); only 36% (mainly younger, single women) considered over‐the‐counter availability desirable. Reasons for these responses and factors influencing them were explored.

Conclusions
Knowledge of emergency contraception is greatest among those most likely to use it, but deficient mainly in relation to the correct timing for its use and to intrauterine methods. Publicity should concentrate on the timing of its use. The popular media are an important publicity vehicle, but health professionals appear to be under‐used. Many women hold opinions on advertising and over‐the‐counter availability of emergency contraception which will have to be considered if deregulation proceeds.
Using a logistic model to identify women with first‐trimester spontaneous abortion suitable for expectant management
Authors: Nielsen Sven , Hahlin Mats , Odén Anders
Published: August 2005

Objective
To design a method to identify women with first trimester spontaneous abortion suitable for expectant management.

Design
A stepwise logistic regression analysis based on retrospective analysis of clinical and biochemical variables.

Setting
Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Participants
One hundred and three women with inevitable or incomplete spontaneous abortion at < 13 weeks of gestation were chosen for expectant management. Eighty‐one women with complete spontaneous abortion (i.e. complete expulsion and/or resolution of pregnancy products within three days of expectant management) were compared with those (n= 22) who underwent surgical evacuation of the uterus, most commonly owing to retained products of conception after three days.

Results
Employing a stepwise logistic regression procedure, five diagnostic variables possessing prognostic power were identified: serum progesterone, daily serum hCG change, serum CA125, serum alpha fetoprotein and intrauterine diameter. The logistic regression analysis was also applied to three diagnostic variables chosen for routine clinical use: serum progesterone, serum hCG and intrauterine diameter. The probability of complete spontaneous abortion within three days of expectant management in each woman could be calculated.

Conclusion
We have used a logistic model to calculate the probability of complete spontaneous abortion within three days in women with first trimester miscarriages. Such information may be of clinical use in caring for women, as well as for development of management guidelines for those with miscarriages.
Fetal pathology in intrauterine death due to parvovirus B19 infection
Authors: Wright C. , Hinchliffe S. A. , Taylor C.
Published: August 2005

Objective
To study the pathological features of fetuses dying because of parvovirus B19 infection, with particular reference to the presence of hydrops; to assess the usefulness of immunochemistry as a screening method for the detection of parvovirus infection at post‐mortem examination.

Design
Review of clinical, sonographic, serological and pathological data; immunohistochemical staining of post‐mortem tissue.

Sample
Cases of intrauterine fetal death occurring during the 18‐month period January 1993 to June 1994 inclusive, referred for post‐mortem examination to the Pathology Department, Royal Victoria Infirmary, Newcastle upon Tyne.

Results
Eleven cases of fetal death due to parvovirus infection were identified. Seven fetuses were less than 18‐week size. Three fetuses showed conspicuous hydropic change. One of the 11 cases was detected for the first time by retrospective immunochemical screening. Of cases originating from the Newcastle district, parvovirus infection was responsible for about 10YO of all non‐malformed fetal deaths occurring between 10 and 24 weeks of gestation referred for pathological examination.

Conclusions
During the period of study, parvovirus infection was a relatively common cause of mid‐trimester fetal death. Many fetuses dying because of this infection are not noticeably hydropic, and the possibility of parvovirus infection should be considered in any case of intrauterine fetal death. Immunochemistry can be used to confirm the histopathological diagnosis, and may be of particular help where there is advanced autolysis; immunohistochemical screening may detect occasional cases not initially identified by examination of routinely stained tissue sections.
Randomised trial comparing hysterectomy and transcervical endometrial resection: effect on health related quality of life and costs two years after surgery
Authors: Sculpher Mark J. , Dwyer Nuala , Byford Sarah , Stirrat Gordon M.
Published: August 2005

Objective
To compare the impact of endometrial resection and abdominal hysterectomy on a range of health outcomes and health service costs, based on longer term follow up of patients randomised to a clinical trial.

Design
A parallel group randomised control trial.

Setting
The gynaecology department of a teaching hospital.

Participants
196 women requiring surgical treatment for menorrhagia were randomised and received surgery (88 underwent resection and 97 hysterectomy). Longer term follow up was undertaken using a postal questionnaire sent to all 196 women.

Main outcome measures
Longer term assessment was on the basis of menstrual symptoms, health related quality of life using the Short Form 36 (SF36) and the EuroQo1 visual analogue scale, patient satisfaction and health service resource cost.

Results
Of 196 women who were sent a questionnaire, 155 (79%) responded at an average interval of 2.8 years after initial surgery. All aspects of health outcomes were as good or better in patients randomised to hysterectomy. Among patients randomised to resection, 57% had experienced no improvement in premenstrual symptoms following surgery and 23% had taken time off work due to menstrual problems; among hysterectomy patients, these rates were 23% and YO, respectively. Women randomised to hysterectomy had better mean scores on seven of the eight dimensions of the SF36 health related quality of life instrument, with the greatest difference being on the pain dimension (P= 0.01). Women randomised to hysterectomy were generally more satisfied with treatment (P= 0.002). By two years after initial surgery, women randomised to resection had a 12% probability of having had a repeat resection and a 16% chance of having had a hysterectomy. As a percentage of the mean total cost associated with women randomised to hysterectomy, the mean total cost of resection was 53% based on four months follow up; this proportion had increased to 71 YO, based on an average overall follow up of 2.2 years.

Conclusions
These results show that, at an average follow up of 28 years among responders to a questionnaire, women randomised to hysterectomy experienced more of an improvement in menstrual symptoms and higher rates of satisfaction with treatment. There is also some evidence of superior health related quality of life amongst hysterectomy patients. However, the health service cost of endometrial resection remains lower than that of hysterectomy. An assessment of the relative cost effectiveness of the two procedures awaits further research.