bluuebunny/crossref_metadata_2025 huggingface dataset:
Phospholipase activity in the endometrium of women with normal menstrual blood loss and women with proven ovulatory menorrhagia
Authors: BONNEY R. C. , HIGHAM J. M. , WATSON H. , BEESLEY J. S. , SHAW R. W. , FRANKS S.
Published: August 2005

Summary. The activity of phospholipase A2 types 1 and 2 and phospholi‐pase C was measured in the endometrium of women with ovulatory menorrhagia and in those with normal menstrual blood loss. In both groups of subjects phospholipase A2 type 1 activity was significantly higher in the secretory phase than in the proliferative phase (P < 0.001). The median activity (pmol/mg protein/min) for the proliferative phase was 27–6 in normal subjects and 40–4 in women with ovulatory menorrhagia and for the secretory phase the median activity was 144–5 in normal women and 138–1 in women with ovulatory menorrhagia. There was no difference between the two groups of women at either stage of the cycle. Phospholipase A2 type 2 activity was also higher in the secretory phase than in the proliferative phase (P < 0.05 for normal subjects and P < 0.001 for women with menorrhagia). The median activity (pmol/mg protein/min) for the proliferative phase was 94–4 (normal subjects) and 56–6 (women with menorrhagia) and for the secretory phase 148–3 (normal subjects) and 142–5 (women with menorrhagia). The activity of phospholipase A2 type 2 was significantly lower in the proliferative phase of women with ovulatory menorrhagia compared with normal subjects (P < 0.05). Phospholipase C activity (nmol/mg protein/min) was significantly higher in women with ovulatory menorrhagia (median 8‐2) compared with women with normal blood loss (median 5–5) (P < 0.01).
Delivery in an obstetric birth chair: a randomized controlled trial
Authors: CROWLEY P. , ELBOURNE D. , ASHURST H. , GARCIA J. , MURPHY D. , DUIGNAN N.
Published: August 2005

Objective— To determine whether nulliparae whose second stage of labour is conducted in an obstetric birth chair have a lower incidence of instrumental delivery than those using a conventional delivery bed.

Design— Randomized controlled trial using sealed, opaque envelopes for allocation.

Setting— Delivery ward in a busy teaching hospital.

Patients— 1250 nulliparae with a singleton live fetus with cephalic presentation, without epidural anaesthesia, who had achieved full dilatation.

Intervention— Intention to conduct second and third stages of labour in either the Birth‐EZ chair or the conventional delivery bed, as randomly allocated.

Main outcome measures— Primary measure: vaginal operative delivery; principal secondary measures: duration of second stage, perineal trauma, blood loss, women's views, and neonatal status.

Results— Delivery in the birth chair did not result in a reduction in operative delivery, overall. However, there was a reduction in vaginal operative delivery for fetal heart rate abnormality. There was no beneficial effect on perineal trauma or puerperal perineal pain. Post‐partum haemorrhage was more frequent in the birth chair group.

Conclusions— Delivery in the birth chair does not offer any obvious advantage to women over delivery on a bed.
Maternal angiotensin sensitivity and fetal Doppler umbilical artery flow waveforms
Authors: COOK COLLEEN M. , TRUDINGER BRIAN J.
Published: August 2005

Summary. The angiotensin pressor response was investigated in nor‐motensive pregnancies which had umbilical Doppler flow velocity waveforms suggestive of placental vascular disease. Of the 36 pregnancies studied at between 24 and 38 weeks gestation, 18 had a positive response to the angiotensin pressor test, these women were delivered earlier (35.3 vs 38.5 weeks, P = 0.015), had a lower mean birthweight centile (14 vs 36, P < 0.001) and higher frequency of fetal distress in labour (40% vs 7%, P = 0.06) when compared with the 18 women who had a negative response. The Doppler umbilical systolic‐diastolic (S‐D) ratio decreased with gestation in the negative group, suggesting continuing placental growth and vascular expansion, whereas the S‐D ratio increased in the positive group (P < 0.001), indicative of vascular obliteration. We suggest that the positive angiotensin pressor response is primarily associated with the placental vascular pathology. Angiotensin infusion had no acute effect on maternal uteroplacental or fetal umbilical artery flow velocity waveforms.
Audit of workload in gynaecology: analysis of time trends from linked statistics
Authors: FERGUSON J. A. , GOLDACRE M. J. , HENDERSON J. , GILLMER M. D. G.
Published: August 2005

Objective— To report on trends in workload patterns in gynaecology using linked statistical data.

Design— Retrospective analysis of linked abstracts of hospital inpatient and day‐case records for patients treated in the National Health Service in gynaecology.

Setting— Six health districts in the south of England covered by the Oxford record linkage study.

Subjects— Records for hospital admissions to gynaecology (excluding obstetric admissions) from 1975 to 1985.

Measurement and main results— Inpatient episodes increased by 23.5% and day case episodes increased by 13.1%. More people treated contributed about 90% and increased readmissions contributed about 10% to the increase in workload. The workload was decreased by strike action in 1975 and 1981–2. Average length of stay decreased substantially and consistently over the 11 years. Emergency readmissions increased annually by an average of 2.7%. Admission rates in 11 groups of surgical procedures accounting for 85% of all gynaecological inpatients are reported, and increases occurred in 10 of the 11 groups. For example, average increases in annual admission rates were 1.0% for sterilization, 1.9% for legal abortion and 8.2% for biopsy of the cervix, the rate for dilatation and curettage decreased by 1.4%.

Conclusions— The increase in admission rates in gynaecology was almost entirely due to increases in numbers of people treated. The rise would have been even greater if the increase in private patients had been considered. The increase may reflect increased expectations on the part of patients and their doctors, advances in technology and increased bed availability due to declining lengths of stay.
Immunocytochemical localization of neutrophil elastase in term placenta decidua and myometrium in pregnancy‐induced hypertension
Authors: BUTTERWORTH B. H. , GREER I. A. , LISTON W. A. , HADDAD N. G. , JOHNSTON T. A.
Published: August 2005

Objective—The aim of the study was to determine whether there was evidence of elastase containing neutrophils at the materno‐fetal interface in women with pregnancy‐induced hypertension (PIH).

Design—An observational prospective study.

Setting—The Simpson Memorial Maternal Pavilion Edinburgh.

Methods—Placentas were obtained at vaginal or abdominal delivery from 51 consecutive women, 23 had normal pregnancies (13 caesarean sections) and 28 had PIH (18 caesarean sections). An immunocytochemical technique was used to localize elastase containing neutrophils in the placenta, decidua and myometrium.

Main outcome measures—The numbers of positively stained cells, estimated subjectively as minimal, moderate or heavy, in subchorionic plate, perivillous fibrin and decidua.

Results—In both normal and PIH pregnancies neutrophils were absent from the myometrium. However, elastase containing neutrophils were located in areas of fibrin in the subchorionic plate and around the villi although there was no significant difference between the normal and PIH group. Neutrophils were also located in the fibrin of the decidua and in this case the number was significantly greater in the PIH group than in the normal group and correlated with plasma urate.

Conclusion—The release of neutrophil elastase in the decidua could contribute to the vascular damage evident in PIH.
Cancer of the cervix in women under 40 years of age, a regional survey, 1975–1984
Authors: PEEL K. R. , KHOURY G. G. , JOSLIN C. A. F. , O'DONOVAN P. J. , MGAYA H. , KEATES G. , HEAD C. , THOROGOOD D. J.
Published: August 2005

Objective— To review the method and results of treatment of carcinoma of the cervix in women <40 years old.

Design— Retrospective review of all available case records.

Setting— Yorkshire Regional Health Authority.

Subjects— 428 women <40 years old treated for stage IB‐IV carcinoma of the cervix between 1975 and 1984 inclusive.

Main outcome measures— Overall survival, by stage, effect of age, identifiable factors of prognostic significance, survival, grade 3 morbidity and pattern of recurrence in relation to treatment.

Results— The 5‐year actuarial percentage survival by stage was 78–4 (IB), 54–4 (II), 18–4 (III) and 0 (IV). Identifiable factors of prognostic importance were stage, nodal metastases (P<0.001) and tumour grade (P<0.01).

Conclusion— Primary surgical treatment for young women with early disease allows ovarian conservation and the avoidance of radiotherapy in 80% of them. Such treatment results in less local recurrence, particularly evident in patients with moderate or poorly differentiated tumours and a lower incidence of serious morbidity.
Pre‐eclampsia and offspring's blood pressure, cognitive ability and physical development at 17‐years‐of‐age
Authors: SEIDMAN DANIEL S. , LAOR ARIE , GALE RENA , STEVENSON DAVID K. , MASHIACH SHLOMO , DANON YEHUDA L.
Published: August 2005

Objective— To investigate the influence of maternal pre‐eclampsia on the blood pressure, physique and intelligence of the offspring at the age of 17 years.

Design— Data obtained at the age of 17 during assessment for drafting to the Israel Defence Forces and from the records of the mothers' pregnancies from the Jerusalem Perinatal Study.

Subjects— Study subjects were 145 girls and 283 boys whose mothers had had pre‐eclampsia and controls were 12 701 girls and 20 416 boys whose mothers did not have pre‐eclampsia.

Main outcome measures— Systolic and diastolic blood pressure, weight, height and intelligence scores at the age of 17 were related to birthweight and the occurrence of pre‐eclampsia during their mothers' pregnancies.

Results— Systolic blood pressure was >140 mmHg in 6.9 and 11.0% of the study girls and boys, compared with 2.9 and 9.9% of the control girls and boys. The study boys but not the girls had a higher mean body mass index than the controls (P<0.001). There were no differences in the intelligence scores. Using multiple logistic regression to allow for the confounding effects of body mass index, weight and birthweight, the odds ratio for the risk of a systolic pressure >140 mmHg was 2.30 (95% CI 1.80–4.46) for the study girls but was not significantly increased for the study boys.

Conclusion— Maternal pre‐eclampsia does not impair growth and cognitive performance in the children who reach late adolescence but may be associated with hypertension.
Evaluating the quality of the maternity services—a discussion paper
Authors: PATERSON C. M. , CHAPPLE J. C. , FRCOG R. W. BEARD , JOFFE MICHAEL , STEER P. J. , WRIGHT C. S. W.
Published: August 2005

Objective— A review of the use of computer collected audit data in assessing the quality of maternity services.

Setting— All maternity units managed by the North West Thames Regional Health Authority.

Recommendations— A system of audit must supply information that is both credible and of interest to clinicians managers and consumers. The information should be adjusted for differences in populations to allow valid comparisons between units. It needs to be presented in an easily digested form. One way of implementing audit would be to establish a regional group representative of clinicians, patients and managers who would initially interpret the data and make recommendations. A local group of similar composition would be asked to comment on and respond to these with a plan for the following year. Changes would be monitored by analysis of the routinely collected data.

Conclusions— Medical audit in the maternity services requires new concepts if it is to influence the quality of clinical care and the use of resources available to provide that care. The appropriate balance needs to be found between the perspectives of clinicians, patients and managers. A major challenge is the collection of valid data. This has largely been overcome by the St Mary's maternity information system. The next stage is to devise a system of audit that is epidemiologically sound and is acceptable to those who will be asked to implement the lessons that emerge. Only then will it be possible to determine whether clinical practice and the use of resources can be altered to the benefit of patients.
The Stamey endoscopic bladder neck suspension: a clinical and urodynamic investigation, including actuarial follow‐up over four years
Authors: HILTON P. , MAYNE C. J.
Published: August 2005

Objective— To assess a modified Stamey endoscopic bladder neck suspension as a management for genuine stress incontinence in women unsuitable for colposuspension because of vaginal narrowing or inefficient voiding.

Design— Uncontrolled observational study.

Setting— Regional university gynaecological urology unit.

Subjects— A hundred women, median age 58 years, with genuine stress incontinence confirmed by urodynamic investigation; 65 had had previous surgery for the same problem.

Treatment— A Stamey procedure with monofilament nylon and short buffers of silastic tubing at each anchor site.

Main outcome measures— Urodynamic reassessment 3 months after surgery and clinical follow‐up for up to 4 years, using life table methods. The median follow‐up was 27 months.

Results— At 3 months the objective cure rate was 83%. Subjectively the cure rates at 4 years were 53% in patients under 65 years of age and 76% in those who were older. Overall mean bladder capacity decreased from 506 to 458 ml after surgery (P<0.05) and, in those who were cured, mean peak flow rate fell from 25.5 to 19.6 ml/s (P<0.05). The urethral functional length and the pressure transmission in the proximal three quarters were increased by successful surgery (P<0.01) but the resting urethral profile, voiding pressure and the frequency of detrusor instability were unchanged.

Conclusions— This modification of the Stamey operation has an important role in the management of elderly patients those with previous unsuccessful operations, and those with inefficient voiding pre‐operatively.
Platelet reactivity and serum thromboxane B2 production in whole blood in gestational hypertension and pre‐eclampsia
Authors: LOUDEN K. A. , PIPKIN F. BROUGHTON , HEPTINSTALL S. , FOX S. C. , MITCHELL J. R. A. , SYMONDS E. M.
Published: August 2005

Objective— To determine the nature and extent of changes in platelet reactivity in gestational hypertension and pre‐eclampsia (using whole blood techniques which may be more physiological than those previously employed).

Design— Cross‐sectional observational study.

Subjects— 8 normal primigravidae, 16 women with gestational hypertension and 12 women with pre‐eclampsia, studied at around 36 weeks gestation.

Results— Platelet reactivity (aggregation and release reaction) induced by stimulation with adrenaline was decreased in the pre‐eclamptic group. Serum thromboxane B2 production was unchanged in both hypertensive groups compared with the control group.

Conclusions— In the context of evidence of platelet activation in pre‐eclampsia, our findings are interpreted as reflecting platelet exhaustion.
Erythropoietin levels in amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy
Authors: CAMPBELL JAMES , WATHEN NEVILLE , LEWIS MARK , FINGEROVA HELENA , CHARD TIM
Published: August 2005

Objective
The aim was to measure erythropoietin levels in amniotic fluid and extraembryonic coelomic fluid from 7–12 weeks’ gestation.

Subjects
Twenty healthy women with ultrasonographically normal first trimester pregnancies prior to surgical termination.

Methods
Paired samples of amniotic fluid and extraembryonic coelomic fluid were collected by transvaginal ultrasound guided needling. Erythropoietin was measured in both pregnancy fluids using a radioimmunoassay.

Results
There was a highly significant difference between erythropoietin levels in extraembryonic coelomic fluid (median level 15.45 mU/ml; range 6.8–32.1 mU/ml) and those in amniotic fluid (median 5.0 mU/ml; range <5.0–5.8 mU/ml) (P<0.0001; Mann‐Whitney U‐test). The levels of erythropoietin in maternal serum (median 15.4 mU/ml; range 5.6–29.4 mU/ml) were similar to those in the extraembryonic coelom (P= 0.81; Mann‐Whitney U‐test). No relation was demonstrated between erythropoietin levels in amniotic fluid or coelomic fluid and stage of gestation.

Conclusion
High levels of erythropoietin in coelomic fluid suggests that the hormone is involved in the process of human extraembryonic erythropoiesis. The exact regulatory role remains unknown.
Home visits for pregnancy complications and management of antenatal care: an overview of three randomized controlled trials
Authors: BLONDEL BEATRICE , BREART GERARD
Published: August 2005

Objective
To examine whether a policy of home visits reduces the amount of antenatal care provided by hospital maternity units.

Design
A meta‐analysis of three randomized controlled trials. Setting 9 maternity units in France.

Subjects
1410 women with pregnancy complications.

Intervention
1 or 2 home visits a week by a midwife.

Main outcome measures
Admission rate and length of stay in hospital.

Results
The home‐visiting system did not affect the hospital admission rate (typical odds ratio = 0.9; 95% CI = 0.7–1.2). In each trial, the length of hospital stay did not differ between the intervention and the control groups.

Conclusions
The home‐visiting system did not greatly alter the practice of antenatal hospital admission in the maternity units studied. The results question the way the health services were used and suggest that a better integration of hospital and home services is needed to make a more rational use of health care resources.
Gammaglutamyltransferase, aspartate and alanine aminotransferases and their ratio, mean cell volume and urinary dolichol in pregnant alcohol abusers
Authors: HALMESMÄKI ERJA , ROINE RISTO , SALASPURO MIKKO
Published: August 2005

Objective
To study the activities of serum gammaglutamyltransferase (GGT), aspartate and alanine aminotransferases (AST, ALT), and their ratio (AST/ALT), mean erythrocyte cell volume (MCV) and urinary dolichol output in alcohol‐abusing pregnant women, and compare the results to those of abstinent pregnant women.

Design Prospective descriptive study.

Setting Special outpatient clinic for pregnant problem‐drinkers in the department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland.

Subjects 25 pregnant women referred to the special clinic at between 12 and 24 weeks gestation, they consumed at least 150 g of ethanol weekly, and a control group of 20 abstinent pregnant women matched for age, parity and smoking habits.

Interventions The women were encouraged to visit the clinic at 2–4 week intervals. At each visit blood and urine samples were obtained, and the women were interviewed on their alcohol consumption during the previous weeks and encouraged to abstain in the future.

Mean outcome measures Neonatal condition, fetal alcohol effects (FAE) in the newborn. Serum activities of GGT, AST and ALT, the AST/ALT ratio, the MCV, and the urinary concentration of dolichol in alcohol‐abusing women with either healthy or FAE infants, compared with those of abstinent women with healthy infants.

Results
Of the 25 alcohol‐abusing women 13 gave birth to infants with FAE and 12 to healthy infants. All the women in the control group gave birth to healthy infants. GGT, AST and ALT activities were increased in all alcohol‐abusing women, regardless whether the infant had FAE or not. GGT was the best of these markers, GGT activities above the 95th normal centile were found in 33% of the samples from all alcohol‐abusing women. The AST/ALT ratio, MCV and urinary dolichol concentration were poor indicators of abusive drinking.

Conclusions
Maternal alcohol abuse is difficult to assess by laboratory tests. Of the commonly used and easily available tests, GGT proved to be the best in our study.
A randomized placebo‐controlled study of the effect of low dose aspirin on platelet reactivity and serum thromboxane B2 production in non‐pregnant women, in normal pregnancy, and in gestational hypertension
Authors: LOUDEN K. A. , PIPKIN FIONA BROUGHTON , SYMONDS E. M. , TUOHY P. , O'CALLAGHAN C. , HEPTINSTALL S. , FOX SUSAN , MITCHELL J. R. A.
Published: August 2005

Objective
To investigate the effect of 60 mg aspirin daily on platelet reactivity and prostaglandin production in various groups of patients. Similar regimens, which are thought to act through inhibition of platelet thromboxane production, are currently undergoing clinical assessment for the prevention of pre‐eclampsia and intrauterine growth retardation.

Design
A prospective randomized placebo controlled study.

Setting
University Hospital, Nottingham.

Subjects
12 non‐pregnant female volunteers, 18 normal primigravidae before 16 weeks gestation and 16 pregnant women admitted with gestational hypertension (GH) at a mean gestation of 38 weeks.

Interventions
In the non‐pregnant women blood samples were taken before and after a 10‐day course of 60 mg aspirin daily. The primigravidae had blood samples taken at 16 weeks and then they were randomized to receive either 60 mg aspirin daily or a matched placebo. Further blood samples were obtained at 28, 32 and 36 weeks.

Main outcome measures
Changes in platelet reactivity and release reaction, and serum thromboxane production, were estimated in whole blood.

Results
60 mg aspirin daily significantly inhibited cyclo‐oxygenase dependent platelet aggregation, release reaction and serum thromboxane production in non‐pregnant and pregnant women, and in women with GH (P<0.01). When adrenaline was used as the aggregating agent, the cyclo‐oxygenase pathway was recruited in the increased reactivity seen in the third trimester of normal pregnancy, and was sensitive to inhibition by low dose aspirin.

Conclusion
Low dose aspirin would appear to be an appropriate agent for the inhibition of platelet reactivity associated with hypertensive pregnancy.
The characteristics of the second stage of labour in 25 069 singleton deliveries in the North West Thames Health Region, 1988
Authors: PATERSON CATHERINE M. , SAUNDERS NIGEL ST. G. , WADSWORTH JANE
Published: August 2005

Objective
To define the contemporary characteristics of the second stage of labour in one Health Region.

Design
Retrospective analysis of a regional obstetric database.

Setting
Seventeen maternity units in the North West Thames Health Region.

Subjects
Selected from 36 727 consecutive singleton deliveries in 1988. The analysis was confined to the 25 069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour.

Main outcome measures
Second stage duration, obstetric intervention and maternal and fetal morbidity.

Results
The duration of the second stage and the use of operative intervention were strongly negatively associated with parity and positively associated with the use of epidural analgesia. Maternal age, fetal birthweight and maternal height were also independently associated with the duration of the second stage. There were small but significant differences in the characteristics of women using epidural analgesia and those using alternative methods of pain relief. Parous women using epidural analgesia behaved in a similar manner to nulliparae without epidurals. Despite the longer second stages observed in women using epidural analgesia there appeared to be no significant increase in fetal morbidity. Within the region the epidural rate in individual units positively correlated with the overall forceps rate, the rate of caesarean section in the second stage of labour and the duration of the second stage.

Conclusions
In our study the duration of the second stage in women not using epidural analgesia was similar to previous findings, but in those using epidural analgesia, the duration of the second stage was longer than has been reported previously, possibly reflecting a more conservative approach to operative intervention. Survival analysis indicates that in multiparae not using epidural analgesia the likelihood of spontaneous vaginal delivery after 1 h in the second stage was low, but in those multiparae using epidural analgesia and in all nulliparae there was no clear cut‐off point for expectation of spontaneous delivery in the near future; they continue to give birth at a steady rate over several hours. While maternal and fetal conditions are satisfactory, intervention should be based on the rate of progress rather than the elapsed time since full cervical dilatation.
An objective and subjective assessment of uterine blood loss in postmenopausal women on hormone replacement therapy
Authors: SPORRONG TOMMY , RYBO GÖRAN , MATTSSON LARS ÅKE , VILBERGSON GUDJON , CRONA NILS
Published: August 2005

Objective
To determine the volume of withdrawal blood loss in women taking hormone replacement therapy (HRT).

Design
Prospective randomized double blind cross‐over trial.

Subjects
Twenty‐nine postmenopausal women, with climacteric symptoms.

Interventions
The women were treated with cycles of 2 mg oestradiol valerate for 21 days combined with either 250 μg levonorgestrel or 10 mg medroxyprogesterone acetate, for the last ten days. Each woman was randomly allocated to one of the preparations and switched to the other after four months.

Twenty‐nine postmenopausal women, with climacteric symptoms.

Main outcome measures
Uterine blood loss was estimated by the alkaline haematin method. Bleeding patterns were recorded specifying the number of days with bleeding and subjective rating of the amount of blood lost.

Results and conclusions
The mean uterine blood loss was 35.2 ml and was equivalent to the normal menstrual blood loss. There was no significant difference between therapies but the women themselves considered that they bled more heavily when taking the levonorgestrel combination. The intraindividual variation in blood loss was small, independent of preparation taken, but the variation between individuals was large. Withdrawal bleeding started 2–3 days earlier when the women used the medroxyprogesterone acetate compared to the levonorgestrel formulation.
Study of the birthweight of parents experiencing unexplained recurrent miscarriages
Authors: CHRISTIANSEN O. B. , MATHIESEN O. , LAURITSEN J. G. , GRUNNET N.
Published: August 2005

Objective
To examine birthweight and preterm birth rates in couples with unexplained recurrent miscarriages.

Design
A case control study. Birth data of couples with recurrent miscarriages were obtained from midwife records. Time and sex‐matched births from the same records served as controls.

Setting
A Regional Hospital in Denmark.

Subjects
79 singleborn women with recurrent miscarriages and 60 of their male partners comprised the main study groups. Two control groups comprised 474 female and 360 male singleborn infants who survived day 7 postpartum.

Main outcome measures
Mean birthweight in the two main study groups and in subgroups with histories of 3, 4 and ≥5 miscarriages.

Results
The mean birthweight of the women with recurrent miscarriages was 3265 g (SE 70) and in female controls 3414 g (SE 23) (P<0.025). The 17 women with five or more miscarriages had a mean birthweight of 2991 g (SD 140) (P<0.001 compared with controls). Of the women in the study group 10.8% were born preterm compared with 2.9% of the controls (P= 0.01). The mean birthweight of the male partners in the study group, 3470 g (SE 68), did not differ significantly from that of 3504 g (SE 31) in the male controls (P<0.5).

Conclusions
Women suffering unexplained recurrent miscarriages have on average had a significantly lower than normal birthweight themselves, whereas this was not observed in their male partners. This points towards the existence of a birthweight‐reducing trait associated with recurrent miscarriages, the trait being manifest only in the woman.
Leiomyosarcomas have a poorer prognosis than mixed mesodermal tumours when adjusting for known prognostic factors: the result of a retrospective study of 423 cases of uterine sarcoma
Authors: OLÁH K. S. , DUNN J. A. , GEE H.
Published: August 2005

ObjectiveTo determine the survival data for the various tumour types of uterine sarcoma and determine the influence of various prognostic factors on survival.

DesignRetrospective analysis of all uterine sarcoma cases registered in the 15 year period 1967–1981.

SettingWest Midlands Regional Cancer Registry, serving a catchment area of 2.6 million women.

Subjects423 women registered as having a uterine sarcoma; 367 of these were associated with the two main histological types, leiomyosarcomas (LMS) and mixed mesodermal tumours (MMT).

Main outcome measuresDuration of survival was taken as the primary endpoint.

ResultsThe overall 5‐year survival for uterine sarcomas in this series was 31%, with the major prognostic indicator being tumour stage. Survival for mixed mesodermal tumours is similar to other sarcomas despite a tendency towards less differentiation, wider dissemination and a greater age of the patient at diagnosis. Multivariate analysis shows that for cases with similar stage, age and grade, mixed mesodermal tumours have a better prognosis than leiomyosarcomas.

ConclusionsThese results demonstrate the danger of considering each variable in isolation when the relation between variables can lead to spurious significance or lack of significance because of the imbalances in the numbers between groups of prognostic importance. This study underlines the need for an adequate inspection of the infra‐abdominal contents at the time of hysterectomy for uterine fibroids.
Higher multiple births and the modern management of infertility in Britain
Authors: LEVENE MALCOLM I. , WILD JENNIFER , STEER PHILIP
Published: August 2005

Objective
To assess prospectively the number of triplet and higher multiple births born in 1989 and their methods of conception. To assess obstetric factors and the effect of these pregnancies on neonatal medical Services.

Design
All consultant paediatricians received a monthly card asking whether they had been involved in the management of triplet and higher multiple pregnancies delivered after 22 weeks gestation. Detailed questionnaire sent to those giving a positive response.

Setting
British Paediatric Surveillance Unit organized mailings to all members of the British Paediatric Association working in the British Isles.

Subjects
156 pregnancies resulting in 482 babies (143 triplets, 12 quadruplets and l quintuplet set). These data were compared to nationally collected OPCS data.

Main outcome measures
Method of conception, obstetric performance, neonatal outcome.

Results
Of the 156 pregnancies, 47 (31%) were conceived naturally, 52 (34%) had ovarian Stimulation (usually with clomiphene or gonadotrophins) 37 (24%) had IVF and 17(11%) GIFT. All quadruplet and quintuplet pregnancies were established after assisted reproduction. Mothers who had had IVF were significantly older than those who had ovulation induction alone. The median gestation at birth was 33 weeks. Overall 181 (40%) of the babies required intensive care for a median duration of 5 days. The perinatal mortality of the triplets alone and quads and quins together was 70 and 104 per 1000 respectively.

Conclusions
Assisted reproduction is the major cause of triplets and higher multiple births and ovarian Stimulation is the single most important technique currently in use. These babies are very likely to be born pre term and make consider‐able demands on neonatal intensive care facilities.
Cone biopsy: has endocervical sampling a role?
Authors: ANDERSON D. J. M. , STRACHAN F. , PARKIN D. E.
Published: August 2005

Objective
To investigate the sensitivity, specificity and predictive value of endocervical sampling in women with abnormal cervical smears.

Design
A randomized study of two methods of endocervical sampling.

Setting
Colposcopy clinic at Aberdeen Royal Infirmary.

Subjects
100 women with abnormal cervical smears selected for cone biopsy according to current colposcopy criteria.

Interventions
53 women were randomized to have endocervical sampling with the Kevorkian curette and 47 to have sampling with the Medscand endocervical brush.

Main outcome measures
Cytology and histology results from endocervical sampling compared with cone biopsy histology.

Results
The overall sensitivity of endocervical sampling was 56%, with a false negative rate of 44% and a negative predictive value of 26%.

Conclusions
Endocervical sampling should not influence management when colposcopy is unsatisfactory.
Lack of relation between fetal blood gases and fetal blood flow velocity waveform indices found in rhesus isoimmunised pregnancies
Authors: LEGARTH JESPER , LINGMAN GORAN , STANGENBERG MAGNUS , RAHMAN FERYAL
Published: August 2005

Objective
To investigate the relation between umbilical vein blood gas components and the vascular resistance in four fetal arteries in Rh‐immunised pregnancies.

Design
A prospective observational study over a 4‐month period.

Setting
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Subjects
Fifteen Rh‐isoimmunised pregnant women.

Interventions
Pulsed Doppler examinations of the embilical artery, fetal internal carotid artery, thoracic aorta and abdominal aorta before transabdominal fetal blood sampling from the umbilical vein on 38 occasions.

Main outcome measures
Doppler flow velocity pulsatility index (PI), systolic/ diastolic ratio (A/B) and resistance index (RI) in the four fetal arteries investigated were related to the umbilical vein blood gases and acid‐base status (PO2, PCO2, O2‐content, CO2‐content, HCO3, base excess and lactate concentration).

Results
There were no correlations between the Doppler indices in any of the vessels studied and the blood gases components in the umbilical vein. The ratios between the corresponding Doppler indices in the different vessels were also independent of the blood gases and acid‐base status and there were no significant differences in the Doppler indices in the same vessel between fetuses with blood gas values over the 75th centile and those with values below the 25th centile.

Conclusion
This study does not support a reduction in peripheral vascular resistance in the fetal cerebrum in relation to fetal hypoxia in Rh‐immunized pregnancies.
A comparison between computerised (mean range) and clinical visual cardiotocographic assessment
Authors: CHENG L. C. , GIBB D. M. F. , AJAYI R. A. , SOOTHILL P. W.
Published: August 2005

Objective
To compare Computer cardiotocographic (CTG) analysis with clinical visual analysis.

Design
A retrospective blind comparison of the two techniques of CTG assessment.

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

Subjects
One hundred CTG traces of women referred to the unit were studied; the traces were taken after 32 weeks' gestation, within 10 days of delivery and where outcome was known.

Interventions
The CTG traces were assessed both by the Computer (System 8000 computerised CTG analyser, Oxford Sonicaid Ltd) and visually, by one of us.

Main outcome
Computer mean range from 0 to 80 in ms clinical visual CTG score from 0 to 80 (arbitrary units). A score <20 is ominous; suspicious when between 20 and 30; and normal when >30.

Results
Therea was close correlation between the Computer mean range and clinical visual assessment (r= 0.78, n = 100, P= 0.001). However, there were 13 occa‐sions where the Computer classified the trace as abnormal when clinical visual assessment was normal, indicating Computer false positives. All these pregnancies had normal outcomes. There were no traces where Computer analysis was normal and clinical visual assessment abnormal.

Conclusions
Computerised CTG analysis gives an objective assessment which agrees closely with experienced visual assessment. It also provides a number which can be used to assess the value of fetal heart rate analysis.
The risk of acute myocardial infarction after oestrogen and oestrogen‐progestogen replacement
Authors: FALKEBORN MARGARETA , PERSSON INGEMAR , ADAMI HANS‐OLOV , BERGSTRÖM REINHOLD , EAKER ELAINE , LITHELL HANS , MOHSEN RAWYA , NAESSEN TORD
Published: August 2005

Objective
To determine the relative risk of developing a first acute myocardial infarction after treatment with oestrogens alone or oestrogen‐progestogen combinations.

Design
Prospective cohort study utilizing a prescription‐based and record linkage System for a follow‐up period from 1977 to 1983. Average individual observation time was 5–8 years.

Setting
The entire female population of the Uppsala Health Care Region (14 million inhabitants), one‐sixth of the total Swedish population.

Subjects
23 174 women aged 35 years and older, identified from pharmacy records as having been prescribed non‐contraceptive oestrogens during 1977–1980.

Outcomes
Admissions to hospitals for first acute myocardial infarctions.

Results
Overall, 227 cases of a first acute myocardial infarction were observed as against 281–l expected, RR=0.81 (95% confidence limits 0.71 to 0.92). Women who were younger than 60 years at entry into the study and prescribed oestradiol com‐pounds (1–2 mg) or conjugated oestrogens (0.625–1.25 mg) showed a significant 30% reduction of the relative risk (RR=0.69,0.54 to 0.86). Those prescribed a com‐bined oestradiol‐levonorgestrel brand also demonstrated a significantly lowered relative risk (RR=0.53, 0.30 to 0.87). The risk estimates were near unity during the first year of follow‐up but decreased during subsequent years. Exposure to the weak oestrogen oestriol did not alter the risk.

Conclusion
Hormonal replacement therapy with oestrogens alone, and maybe also when cyclically combined with progestogens, can reduce the risk of acute myocardial infarction.
The efficacy of phenytoin in relation to serum levels in severe pre‐eclampsia and eclampsia
Authors: NAIDU S. , MOODLEY J. , BOTHA J. , McFADYEN L.
Published: August 2005

Objectives
To investigate the efficacy of phenytoin in relation to total and free serum levels in patients with severe pre‐eclampsia and eclampsia.

Design
Prospective descriptive study.

Setting
Labour Ward, King Edward VIII Hospital, Durban, South Africa. Tertiary referral centre serving an underprivileged community.

Subjects
Eleven patients admitted with a hypertensive crisis. Four patients had eclampsia and 7 had impending eclampsia.

Main outcome measures
Free and total phenytoin levels; efficacy of phenytoin as an anticonvulsant and side‐effects of therapy.

Results
Although total phenytoin levels were within the therapeutic range, free phenytoin levels were abnormally high in all patients. Three patients (2 with eclampsia and 1 with imminent eclampsia) each had a seizure after phenytoin treatment had been initiated.

Conclusion
Neither total nor free phenytoin levels were good predictors of seizure control. It is postulated that the poor performance of phenytoin as an anticonvulsant in severe eclampsia may relate to inadequate distribution of the drug to the brain as a result of cerebral oedema and poor cerebral perfusion rather than paradoxical seizure activity associated with high free phenytoin levels.
Differences between obstetricians in caesarean section rates and the management of labour
Authors: GUILLEMETTE JULIE , ERASER WILLIAM D.
Published: August 2005

Objective
To determine if interobstetrician variation in caesarean section rates was associated with different approaches to the management of labour.

Design
A retrospective cohort study.

Setting
A tertiary care teaching hospital in Quebec, Canada.

Subjects
546 nulliparae in spontaneous labour at term were grouped according to the rate of caesarean sections for dystocia of their obstetrician (high: women of two obstetricians with rates of 13.2% and 15.0%; and low: women of three obstetricians with rates of 6.0%, 6.2% and 6.5%).

Main outcome measures
Frequency and timing of oxytocin, epidural, amniotomy, forceps.

Secondary outcome measures
Indicators of neonatal asphyxia and trauma.

Results
No difference between groups was observed in the frequency or timing of use of oxytocin or epidural analgesia. Amniotomy was practised earlier by the obstetricians in the high group. Differences in section rates for dystocia were greatest in the second stage (low—24%, high—7.9%). Obstetricians in the low group intervened earlier with forceps or vacuum extractor. Nine babies (all in the low group), 8 of whom had had an instrumental vaginal delivery, suffered trauma (5 clavicular fractures, 4 facial palsies) (Fisher's exact test, P= 0.0139).

Conclusion
The practice patterns of the two groups are distinguished by differences in management of the second stage. Although lower section rates were associated with an increase in mild neonatal trauma, this appears to have been mediated by the earlier use of forceps in this group.
Prenatal microbiological risk factors associated with preterm birth
Authors: McDONALD H. M. , O'LOUGHLIN J. A. , JOLLEY P. , VIGNESWARAN R. , McDONALD P. J.
Published: August 2005

Objective
To study the vaginal flora of pregnant women at 22–28 weeks gestation to determine whether the presence of specific micro‐organisms is significantly associated with preterm birth and prelabour rupture of the membranes.

Design
A comprehensive descriptive prospective study of the vaginal micro‐flora of women between 22–28 weeks gestation comparing those who gave birth preterm (<37 weeks) with those who gave birth at term. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Tri‐chomonas vaginalis. Multiple logistic regression analysis was used to account for confounding obstetric and demographic variables.

Setting
The Queen Victoria Hospital, Adelaide, South Australia.

Subjects
135 women who gave birth preterm compared to 651 women who gave birth at term.

Main outcome measure
Preterm birth and preterm prelabour rupture of membranes (PROM)

Results
The prevalence of Gardnerella vaginalis between 22–28 weeks was significantly higher in women who gave birth preterm compared to women who gave birth at term (23%vs 15%; multiple logistic regression odds ratio (OR) 1.8, 95% confidence intervals (CI) 1.01–3.2, P<0.05. Ureaplasma urealyticum was also found in a higher proportion of women who gave birth preterm (49% vs 32% OR 1.7, 95% CI 1.1–2.6, P<0.0005). Preterm PROM occurred in 42% of whom 60% were carriers of U. urealyticum between 22–28 weeks, compared with 32% in the term group (OR 3.2, CI 1.7–6.1, f<0.0005). When women who received antibiotics between the mid‐trimester swab and labour were excluded, G. vaginalis was also significantly associated with preterm PROM (OR 2.7, CI 1.1–6.5, P<0.05). The presence of vaginal enteropharyngeal bacteria (E. coli, Klebsiella spp., Haemophilus spp., Staph. aureus) in the midtrimester was not predictive of preterm birth, but when these organisms were found in labour, they appeared to have been acquired later in the pregnancy.

Conclusion
Women carrying G. vaginalis or U. urealyticum during the midtrimester had nearly twice the risk of preterm birth, while women positive for U. urealyticum had more than a threefold risk of preterm PROM.
Can out‐of‐hours work by junior doctors in obstetrics be reduced?
Authors: McKEE MARTIN , PRIEST PATRICIA , GINZLER MARIA , BLACK NICK
Published: August 2005

Objective
Against a background of concerns about the hours of work of junior doctors, this study examines how the night‐time work of junior staff in obstetrics may be reduced by giving greater responsibility to midwives.

Design
In the first phase of the study, the tasks undertaken at night in four hospitals were identified. In the second phase a nominal group technique was used to seek the extent of agreement among professionals about the appropriateness of postponing surgery to the following day in certain circumstances.

Results
There were considerable variations between hospitals in the rate of obstetric intervention and the division of tasks between doctors and midwives. The panel concluded that many tasks currently performed by senior house officers could be undertaken by midwives.

Conclusion
This study suggests that there scope for reducing the workload of junior obstetricians at night through the adoption of an extended role by midwives.
The multidisciplinary management of a family with epithelial ovarian cancer
Authors: CRUICKSHANK D. J. , HAITES N. , ANDERSON S. , MATHESON H. , HALL M. H. , MILNER B. , AH‐SEE A. , GUNN I. , EREMIN O. , GILBERT F. , JOHNSTON A. W.
Published: August 2005

Objective
To describe the management of a family with an inherited predisposition to ovarian and breast cancer. Particular attention is paid to the problems of contraception, screening, prophylactic surgery and hormone replacement therapy.

Setting
The multidisciplinary Grampian Familial Epithelial Overian Cancer Study Group.

Subjects
162 members of a family extending over five generations. In the third generation, five of the 10 women died with epithelial ovarian cancer. Three women in generation IV have developed premenopausal breast cancer. There are now 78 family members in the fifth generation aged between 2 and 22 years.

Interventions
Counselling of female family members is started at the age of 18 years. The combined oral contraceptive pill is advocated to suppress ovulation. Gynaecological follow‐up after the age of 28 includes yearly pelvic examination, transvaginal ultrasonography and serum CA125 estimation. Laparoscopy with peritoneal cytology is indicated if any part of this yearly assessment is abnormal. Prophylactic oophorectomy is advised between the ages of 35 and 40 years after the family is complete. In generation IV, 20 of the 29 women have undergone prophylactic oophorectomy. Oestrogen hormone replacement therapy with a cyclical progestogen is recommended after prophylactic oophorectomy. Breast cancer screening starts at the age of 25 and involves annual clinical breast examination augmented by mammography and breast ultrasound.

Conclusions
Only by the careful questioning and recording of family history, including at least third degree relatives (cousins), will similar groups with familial ovarian/breast cancer be identified. When predisposing genes are characterized it will be possible to identify carriers within the family and concentrate clinical effort on them while offering appropriate reassurance to those with decreased risk.
Renal sodium retention does not occur during the luteal phase of the menstrual cycle in normal women
Authors: BISSON D. L. , DUNSTER G. D. , O'HARE J. P. , HAMPTON D. , PENNEY M. D.
Published: August 2005

Objective
To determine whether weight gain due to renal sodium and water retention occurs in the luteal phase of the normal menstrual cycle.

Design
Prospective observational study.

Setting
Research laboratory installed with modified spa bath.

Subjects
Ten normal healthy women.

Intervention
Each subject underwent two experiments, one in each phase of the menstrual cycle, involving 3 h head‐out water immersion and a pre‐ and post immersion control hour. 25 ml blood samples were obtained every hour before, during and after water immersion.

Main outcome measures
Renal and hormonal responses to water immersion during the luteal and proliferative phases of the cycle.

Results
There was no change in weight, creatinine clearance, basal sodium excretion or plasma atrial natriuretic peptide between the two phases of the cycle. There was a significant rise in basal progesterone, plasma aldosterone and plasma renin activity in the luteal phase of the ovulatory cycles. Renal and hormonal responses to immersion including sodium and calcium excretion, elevation of atrial natriuretic peptide (ANP) and suppression of plasma aldosterone and plasma renin activity were identical in the two phases of the menstrual cycle.

Conclusion
We found no evidence to support the hypothesis that renal sodium and water retention occurs in the luteal phase of the normal menstrual cycle.