bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study
Authors: Liselele Hubert B. , Boulvain Michel , Tshibangu Kalala C. , Meuris Sylvain
Published: August 2005

Objective
To assess external pelvimetry and maternal height, as predictors of cephalopelvic disproportion.

Design
Prospective cohort study.

Setting
Four hospitals in Zaire.

Population
Six hundred and five nulliparous women.

Methods
Maternal height and external pelvimetry were assessed during the third trimester antenatal visit. Cut off values for considering women at risk for cephalopelvic disproportion were height < 150 cm and external pelvic distances < 10th centile for the population. Logistic regression analysis, combining height and pelvic measurements, was performed to predict women at risk for cephalopelvic disproportion.

Main outcome measure
Cephalopelvic disproportion was considered when there was caesarean section for failure to progress, vacuum or forceps delivery or intrapartum stillbirth.

Results
Cephalopelvic disproportion was present in 42 women. In univariate analysis, height, intertrochanteric diameter and the transverse diagonal of Michaelis sacral rhomboid area were found to be associated with cephalopelvic disproportion. Logistic regression analysis showed that maternal height < 150 cm and/or transverse diagonal < 9.5 cm were the variables most associated with cephalopelvic disproportion. The adjusted odds ratios were 2.2 (95% CI 0.9 to 5.4) and 6.5 (95% CI 3.2 to 13.2), respectively. The positive predictive value and likelihood ratio were 24% and 4.0 (95% CI 2.8 to 5.8), respectively. The addition of transverse diagonal to maternal height increased the sensitivity in predicting cephalopelvic disproportion from 21% to 52%.

Conclusion
In addition to height, transverse diagonal measurement is able to predict one out of two cases of cephalopelvic disproportion in nulliparous women. After validation in a separate cohort, this simple predictive method may be used in peripheral centres for timely referral of pregnant women at risk for cephalopelvic disproportion.
Prevention of vaginal shortening following radical hysterectomy
Authors: Yamamoto Ritsu , Okamoto Kazuhira , Ebina Yasuhiko , Shirato Hiroki , Sakuragi Noriaki , Fujimoto Seiichiro
Published: August 2005

We describe a surgical procedure and post‐operative management for the prevention of vaginal shortening following radical hysterectomy. A total of 452 patients who underwent hysterectomies were examined prospectively depending on the operation method. This study showed that our procedure was effective in the prevention of vaginal shortening following radical hysterectomy. Preservation of the ovaries appeared to be important in preventing vaginal shortening, and post‐operative hormone replacement therapy was not as effective as the preservation of the ovaries. The effect of external irradiation on vaginal shortening was not conspicuous in the case that the ovaries were preserved.
A prospective study on the effects of depot medroxyprogesterone acetate on trabecular and cortical bone after attainment of peak bone mass
Authors: Merki‐Feld Gabriele S. , Neff Maurus , Keller Paul J.
Published: August 2005

Objective
To study the annual change of bone mass in women aged 30–45 years being treated with depot medroxyprogesterone acetate (DMPA) in order to evaluate whether the bone mass depends on the duration of DMPA use or the oestradiol level.

Design
Prospective longitudinal study over an interval of 12 months.

Setting
A family planning centre of a university hospital.

Patients
Thirty‐six current users of DMPA.

Interventions
Injection of 150 mg DMPA every 12 weeks.

Measurements
Bone mass was measured at the distal radius by peripheral quantitative computed tomography (reproducibility 0.3%).

Results
Mean annual changes (SD) in trabecular and cortical bone mass were 0.06 (1.6%) [P= 0.8] and −0.26% (0.6) [P < 0.04]. The decrease in cortical bone mass was not significant because the changes were within the precision error of the method used for the measurements. Duration of DMPA use and oestradiol levels were not associated to the bone parameters.

Conclusion
We did not find a negative impact of DMPA on the bone mass of premenopausal women aged 30–45 years.
Is the prophylactic administration of magnesium sulphate in women with pre‐eclampsia indicated prior to labour?
Authors: Hall D. R. , Odendaal H. J. , Smith M.
Published: August 2005

Objective
To determine whether prophylactic magnesium sulphate is necessary to prevent eclampsia and associated complications among women with pre‐eclampsia prior to labour.

Design
Case series.

Setting
Tertiary referral centre.

Population
Three hundred and eighteen women with pre‐eclampsia (blood pressure > 140/90 mmHg and > 2+ proteinuria) who were not in labour or for planned induction thereof and had not received magnesium sulphate during transfer.

Methods
Clinical evaluation of the pregnant women with careful blood pressure control. Magnesium sulphate was withheld even in the presence of imminent eclampsia. During labour, the option of magnesium sulphate prophylaxis was left to the clinician, but magnesium sulphate was administered in cases of eclampsia.

Main outcome measures
Eclampsia and related complications.

Results
Five women (1.5%) developed eclampsia, although none developed related complications. Women presented at an early gestational age (mean 30 weeks), with high blood pressure, often suffering from headaches. Twenty pregnancies were terminated prior to viability, of which half were terminated for maternal reasons. Ten intrauterine deaths occurred. Most often fetal distress (38.6%) initiated the delivery process, which was mainly by caesarean section (68.5%). With the exception of epigastric discomfort, symptoms and signs of imminent eclampsia decreased after admission. Blood pressure values were significantly lower at delivery although biochemistry results deteriorated from admission to delivery.

Conclusion
In women with pre‐eclampsia prior to labour, where blood pressure control was carefully applied but magnesium sulphate not given, the eclampsia rate was low and eclampsia did not appear to worsen the existing prognosis for mother or fetus.
Which women should be tested for Chlamydia trachomatis?
Authors: Macmillan Susan , McKenzie Hamish , Flett Gillian , Templeton Allan
Published: August 2005

Objective
To assess the prevalence of genitourinary Chlamydia trachomatis infection among women in different clinical settings, with a view to making decisions about who should be tested routinely.

Design
Cross sectional study.

Setting
One regional hospital and family planning clinic serving an urban centre.

Population
Two thousand thirty‐five sexually active women attending various outpatient settings.

Main outcome measures
Prevalence of positivity by clinical setting, stratified by age.

Results
Overall, prevalence of lower genital tract chlamydial infection was similar in a variety of clinical settings. Infertile women were the only exception, demonstrating a much lower prevalence. Stratifying the study population by age found a clear trend towards high prevalence in teenagers and virtually no infection in women over the age of 30 years.

Conclusions
The prevalence of chlamydial infection in women is related to age, regardless of clinical presentation. In practice, opportunistic screening should target sexually active women under 30 years of age.
A double‐blind placebo controlled randomised trial of misoprostol and oxytocin in the management of the third stage of labour
Authors: Walley Robert L. , Wilson John B. , Crane Joan M. G. , Matthews Kay , Sawyer Elizabeth , Hutchens Donna
Published: August 2005

Objective
To compare oral misoprostol 400 μg with intramuscular oxytocin 10 IU in the routine management of the third stage.

Design
Double‐blind placebo controlled trial.

Setting
Main referral hospital and its associated polyclinics in Accra, Ghana.

Population
Four hundred and one low risk women, in the second stage of labour with anticipated vaginal delivery, who entered labour spontaneously.

Methods
After delivery of the anterior shoulder of the baby, the women were randomised to receive either: 1. misoprostol 400 μg powder in water orally and 1 mL normal saline intramuscular injection (placebo); or 2. powdered cellulose in water orally (placebo) and 1 mL oxytocin 10 IU intramuscular injection.

Main outcome measures
Change in haemoglobin concentration from before delivery to 12 hours postpartum. Secondary outcomes included need for additional oxytocics, blood loss > 500 mL and > 1000 mL, operative intervention for postpartum haemorrhage, and side effects, including nausea, vomiting, diarrhoea, shivering and elevated temperature.

Results
Demographic characteristics were similar. There was no significant difference in change in haemoglobin concentration between the two groups (0.60 g/dL for misoprostol and 0.55 g/dL for oxytocin; relative difference 9.6%; 95% CI 20.5–39.6%; P= 0.54). There were no significant differences in secondary outcomes with the exception of shivering, which occurred more frequently in the misoprostol group (22.2%vs 5.7%; relative risk 4.73; 95% CI 2.31–9.68; P < 0.0001).

Conclusions
In low risk women oral misoprostol appears to be as effective in minimising blood loss in the third stage of labour as intramuscular oxytocin. Shivering was noted more frequently with misoprostol use, but no other side effects were noted. Misoprostol has great potential for use in the third stage of labour especially in developing countries.
The p53 codon 72 polymorphism in black South African women and the risk of cervical cancer
Authors: Pegoraro Rosemary , Moodley Jack , Naiker Shunbagavelli , Lanning Pamela , Rom Lee
Published: August 2005

The p53 codon 72 genotype was examined in blood samples taken from 121 Zulu‐speaking black South African women with histologically proven squamous carcinoma of the cervix. Freshly biopsied tumour tissue was also available for human papillomavirus subtyping from 100 of these women. A control group consisted of 251 healthy race‐matched women attending a contraceptive service facility. The results show that there were no statistically significant differences in the frequency of the homozygous arginine genotype between patients with cancer of cervix, irrespective of human papillomavirus status, and healthy controls. This finding suggests that the arginine allele does not predispose towards viral tumour genesis in this population, and supports the findings of research done in other ethnic groups.
A comparison of the side effects of prilocaine with felypressin and lignocaine with adrenaline in large loop excision of the transformation zone of the cervix: results of a randomised trial
Authors: Howells R. E. J. , Tucker H. , Millinship J. , Shroff J. Foden , Dhar K. K. , Jones P. W. , Redman C. W. E.
Published: August 2005

Objective
To test the hypothesis that prilocaine with felypressin causes fewer side effects than lignocaine with adrenaline when performing large loop excision of the transformation zone of the cervix.

Design
Randomised trial.

Setting
Colposcopy clinic in a large district general hospital.

Participants
Two hundred consecutive women undergoing large loop excision of the transformation zone of the cervix.

Methods
Two different local anaesthetic combinations (prilocaine with felypressin and lignocaine with adrenaline) were compared in women undergoing large loop excision of the transformation zone. Prospective collection of clinical and treatment data was undertaken with scoring using an ordinal scale of pain experienced by the women during the procedure. Peri‐operative blood loss and any side effects were also recorded.

Main outcome measures
Side effects associated with the local anaesthetic agents.

Results
Lignocaine with adrenaline resulted in less blood loss (P= 0.006) but was more likely to cause side effects, such as feeling faint (P= 0.017) and shaking (P < 0.001).

Conclusion
Prilocaine with felypressin causes fewer side effects than lignocaine with adrenaline and is therefore the preferred local anaesthetic combination for large loop excision of the transformation zone.
The effect of endometriosis and its radical laparoscopic excision on quality of life indicators
Authors: Garry Ray , Clayton Richard , Hawe Jeremy
Published: August 2005

Objective
To assess the effect of endometriosis and radical laparoscopic excision on the quality of life of women with this condition.

Design
A prospective study.

Setting
The Northern Endometriosis Centre at South Cleveland Hospital, Middlesbrough and St. James's University Hospital, Leeds.

Population
Fifty‐seven consecutive patients undergoing laparoscopic excision of invasive endometriosis.

Methods
Questionnaires, both pre‐operatively and four‐month post‐operatively, for a number of different symptoms associated with endometriosis were completed by patients. Details of fertility, previous treatments and quality of life as measured by SF12 and EuroQOL (EQ‐5D) and sexual activity questionnaire, as well as linear pain scores for several symptoms, were recorded. Details of intra‐operative findings was also collected.

Main outcome measures
Effect of laparoscopic excision on pain scores and quality of life, operative findings, type of surgery, length of surgery and incidence of intra‐ and post‐operative complications.

Results
Patients with endometriosis were severely ill with significant pain and impairment of quality of life and sexual activity. Four months after radical laparoscopic excision for deep endometriosis there was significant improvement in all the parameters measured including their quality of life based on EuroQOL evaluation: EQ‐5D (0.595:0.729, P= 0.002) and EQ thermometer (68.9:77.7, P= 0.008); SF12 physical score (44.8:51.9, P= 0.015); sexual activity (habit P= 0.002, pleasure P= 0.002 and discomfort P≤ 0.001). Only the mental health score of SF12 failed to show any statistical improvement (47 1:48.4, P= 0.84). Symptomatically, there was a significant reduction in dysmenorrhoea (median 8.0:4.0, P≤ 0.001), pelvic pain (median 7.0:2.0, P≤ 0.001), dyspareunia (median 6.0:0.0, P≤ 0.001) and rectal pain scores (median 4.0:0.0, P≤ 0.001). Complications were noted, but were deemed to be acceptable for the extent of the surgery.

Conclusions
This is an early analysis of the first 57 cases studied, but structured evaluation suggests that meaningful improvements in clinical symptoms and quality of life can be obtained with this approach with acceptable levels of operative morbidity. Further follow up of this series is required, but early evidence would suggest that the technique should be further evaluated as part of a randomised trial.
Factors associated with male infertility: a case‐control study of 218 infertile and 240 fertile men
Authors: Chia Sin‐Eng , Lim Soon‐Tiong Alvin , Tay Sun‐Kuie , Lim Swee‐Tee
Published: August 2005

Objective
To determine the likely risk factors, such as smoking and drinking habits, and occupational groups, for infertility in a group of infertile men with no known cause, compared with a group of fertile men; and to examine the effects of the semen parameters, such as volume, density, motility, viability and normal morphology, on fertility.

Design
A case‐control study.

Setting
The department of obstetric and gynaecology of a tertiary general hospital.

Participants
Six hundred and forty consecutive male partners of couples trying to conceive were recruited from an infertility clinic. Of these, the cases comprised 218 men who had no known cause for their infertility. Two hundred and forty men whose wives were pregnant at the time of the study were recruited as controls.

Results
The semen parameters (e.g. density, total sperm counts, motility, viability and normal morphology) of all cases were significantly poorer than that of the controls. The risk of infertility is associated with smoking (crude OR 2.82, 95% CI 1.93–4.13; adjusted OR 2.96; 95% CI 1.98–4.42). Technicians (adjusted OR 2.81; 95% CI 1.51–4.24) and professional, senior officials and managers were also at a greater risk of infertility (adjusted OR 2.36; 95% CI 1.26–4.40), compared with service and clerical workers. The significant factors predicting infertility were smoking, density of sperm, and viability of sperm. Smoking increased the odds of being infertile. Higher sperm counts and larger percentage of viable sperm decrease the odds of infertility. Based on the multiple logistic regression model, the odds ratio for infertility = 94.70 × 2.88smoking× 0.29logdensity× 0.95viability.

Conclusion
Smoking, density of sperm and the viability of sperm are significant predictors for infertility among men.
Maternal morbidity and mortality in two different populations of Senegal: a prospective study (MOMA survey)
Authors: de Bernis Luc , Dumont Alexandre , Bouillin Dominique , Gueye Abdoulaye , Dompnier Jean‐Pierre , Bouvier‐Colle Marie‐Hélène
Published: August 2005

Objective
To compare maternal morbidity and mortality in two urban populations with contrasting availability of health care, and to test the hypothesis that differences in maternal outcome result mainly from the management of delivery in health facilities.

Design
A population‐based study of a cohort of pregnant women which was part of a multicentre study of maternal morbidity in six countries of western Africa (MOMA).

Setting
Two different urban areas of Senegal (Saint‐Louis and Kaolack).

Population
3777 pregnant women who were followed up throughout pregnancy, delivery and puerperium.

Main outcome measures
Maternal morbidity and mortality: morbidity was assessed from women's recall at each visit by the investigator and from obstetric complications diagnosed by the birth attendant within health facilities.

Results
Maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centres, usually assisted by traditional birth attendants, than in Saint‐Louis where women giving birth in health facilities went principally to the regional hospital and were usually assisted by midwives (874 and 151 maternal deaths per 100,000 live births, respectively, P < 0.01). Maternal morbidity, however, was higher in Saint‐Louis than in Kaolack area, especially for births in health facilities (9.50 and 4.84 episodes of obstetric complications per 100 live births, respectively, P < 0.01). Univariate and multivariate analyses showed that morbidity was mainly associated with the training of the birth attendant in facility deliveries and that antenatal care had no effect.

Conclusion
Midwives in health facilities appear to detect more obstetric complications than traditional birth attendants. Immediate detection leads to immediate care and to low fatality rates. This could explain differences in maternal outcome between two urban centres with contrasting health care availability. These results suggest that one of the strongest weapons in the fight against maternal mortality is the employment of the most qualified personnel possible for monitoring labour.
Concurrent genital and rectal prolapse: two pathologies—one joint operation
Authors: Dekel Arieh , Rabinerson David , Rafael Zion Ben , Kaplan Boris , Mislovaty Boris , Bayer Yitzhak
Published: August 2005

This study is a prospective assessment of a joint operation to repair concomitant genital and rectal prolapse, including 10 women treated for concomitant genital and rectal prolapse from 1991 to 1995. Joel‐Cohen vaginal hysterectomy was used to correct the genital prolapse, followed by the Altemeier procedure (transperineal rectosigmoidectomy) to correct the rectal prolapse. The post‐operative course was uneventful in all cases and there were no recurrences of prolapse in the three year follow up period. Improvement of sphincteric tone was shown in all cases by transrectal manometry, and bladder and rectal continence was maintained. The combined surgical procedure for concurrent genital and rectal prolapse is easy to perform and safe and efficient in terms of recurrence and continence. It is hoped this report will increase multidisciplinary awareness of an effective solution for a potentially debilitating problem.
Intimate examinations: use of chaperones in communitybased family planning clinics
Authors: Khan Noreen S. , Kirkman Rosemary
Published: August 2005

We examined women's preferences regarding the use of chaperones during intimate examinations by a female doctor or nurse in community‐based family planning clinics. An anonymous questionnaire was completed before consultation and examination by 126 women attending five family planning clinics selected to cover a range of social and ethnic groups. The questionnaire explored women's views regarding intimate examinations by a woman and the presence of a chaperone. A clear majority (107 vs 19) of our community clinic users preferred to be alone with the woman doctor or nurse during an internal examination. There was no significant difference in preference or strength of feeling when analysed by age, ethnicity or previous experience.
B cell leukaemia/lymphoma‐2 protein concentrations during normal pregnancy
Authors: Buemi M. , Allegra A. , Corica F. , D'Anna R. , Ruello A. , Jasonni V. M.
Published: August 2005

We evaluated bcl‐2 protein levels in whole blood, and intraerythrocytic products of lipoperoxidation, in 65 healthy pregnant primiparous women at the end of the first, second and third trimesters of pregnancy. During pregnancy we found a progressive increase in concentrations of bcl‐2 and intraerythrocytic products of lipoperoxidation. Moreover, a positive correlation was found between bcl‐2 concentrations and lipoperoxidation products, and between bcl‐2 protein, E2 and progesterone. The results show that modifications occurring during pregnancy are accompanied by variations of bcl‐2 protein.
Women's health after childbirth: a longitudinal study in France and Italy
Authors: Saurel‐Cubizolles Marie‐Josèphe , Romito Patrizia , Lelong Nathalie , Ancel Pierre‐Yves
Published: August 2005

Objective
To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner.

Design
Longitudinal multicentre survey with a similar design in France and Italy. Women were interviewed three times: at birth and twice after childbirth. At 12 months after childbirth, the survey was postal in both countries.

Population
Women who had been delivered of their first or second baby in three maternity units in France and five units in Italy. Women who had multiple pregnancies, a stillbirth or known neonatal death were excluded.

Results
The response rates were 83% in France and 88% in Italy. Fifteen symptoms were considered. The results were similar in the two countries and showed that the prevalence of most symptoms was higher at 12 months than at five months after childbirth. When their baby was one year old, more than half of the women reported backache, anxiety and extreme tiredness. Around one‐third of women reported headache, lack of sexual desire, sleep disorders and depression. Piles, constipation and painful intercourse were also common. One year postpartum women with financial problems or a difficult relationship reported poor psychological health more frequently.

Conclusion
Physical and emotional problems are common after birth, and they tend to increase over time. Backache, headache and piles can seriously interfere with day‐to‐day life. Sexual problems also may be a source of unhappiness for the woman and her partner. Extreme tiredness, anxiety and depression may make a woman feel guilty for not corresponding to the image of a healthy, happy and well‐coping mother. There is a link between financial problems or a difficult relationship with her partner and her own wellbeing. Health professionals should be aware of the high prevalence of health problems among new mothers, and of the social context of women who are more likely to suffer from them. They should counsel the women in their care, in order to help them to find the best solution, be it medical or social in nature.
Descriptive terms for women attending antenatal clinics: mother knows best?
Authors: Byrne Dominic L. , Asmussen Tilo , Freeman Janet M.
Published: August 2005

Objective
To determine the noun for ‘women who attend antenatal clinics’ that is most accepted by the women themselves.

Design
Cross sectional study.

Setting
Consultant‐led antenatal clinics in Cornwall.

Population
All women attending consultant‐led antenatal clinics over a two‐month period.

Methods
The women were surveyed by written questionnaire.

Main outcome measures
The first, second and third choices of descriptions offered to women attending antenatal clinics. Secondary outcome measures include the relation of maternal age, gestation, civil status, occupation and obstetric history to the individual's choice of description.

Results
Questionnaires were received from 446 women, constituting 13% of the antenatal population of Cornwall. Their median age was 28 years and median gestation 22 weeks; 255 (57%) had one or more children and 289 (65%) were married. The most popular choice of description was ‘patient’ (39% of first choices made), whereas the most accepted description was ‘pregnant woman’ (26% of totalled second and third choices). While women who selected ‘patient’ as first choice were slightly younger (mean 27.5 years) than the remaining women (mean 28.4 years), the choice of ‘pregnant woman’ was not related to any of the other recorded characteristics of the respondents. Commercial terms that consistently were selected least included ‘client’, ‘consumer’ and ‘customer’.

Conclusion
Some professional bodies and government organisations have criticised the use of the term ‘patient’ to describe antenatal women. In this, the largest study to investigate what the women themselves would choose, ‘patient’ is the most favoured term.
Expectant management of early onset, severe pre‐eclampsia: perinatal outcome
Authors: Hall D. R. , Odendaal H. J. , Kirsten G. F. , Smith J. , Grové D.
Published: August 2005

Objective
To evaluate the perinatal outcome of expectant management of early onset, severe pre‐eclampsia.

Design
Prospective case series extending over a five‐year period.

Setting
Tertiary referral centre.

Population
All women (n= 340) presenting with early onset, severe pre‐eclampsia, where both mother and the fetus were otherwise stable.

Methods
Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six‐hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward.

Main outcome measures
Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications.

Results
A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (≥ 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care.

Conclusion
Expectant management of early onset, severe pre‐eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern.
Does histological incomplete excision of cervical intraepithelial neoplasia following large loop excision of transformation zone increase recurrence rates? A six year cytological follow up
Authors: Dobbs S. P. , Asmussen T. , Nunns D. , Hollingworth J. , Brown L. J. R. , Ireland D.
Published: August 2005

Objective
To determine the risk of recurrent cervical intraepithelial neoplasia (CIN) in women with complete or incomplete excision of cervical intraepithelial neoplasia treated by large loop excision of transformation zone (LLETZ).

Design
A retrospective study

Setting
One consultant‐led colposcopy clinic at Leicester Royal Infirmary

Population
Three hundred and ninety‐four women referred consecutively to the colposcopy clinic between 1991 and 1992.

Main outcome measures
The histological recurrence rate of CIN, length of cytological follow up following treatment related to degree of completeness of excision at initial treatment.

Results
Three hundred and twenty‐two women had complete cytological or histological follow up. The mean length of follow up was 73 months with a mean number of six smears. Women with incomplete excision of CIN had a significantly higher risk of recurrent CIN (relative risk 8.23) occurring in a significantly shorter time compared with women with complete excision.

Conclusions
This study demonstrates that large loop excision of transformation zone is successful in over 95% of cases. Cytological surveillance is satisfactory for follow up of women who have complete excision of CIN. Women with incomplete excision of CIN at initial LLETZ remain at significant risk of developing further CIN and long term colposcopic and cytological follow up is necessary.
Emotional, physical and sexual violence against women before or during pregnancy
Authors: Irion Olivier , Boulvain Michel , Straccia Anne‐Thérèse , Bonnet Jocelyne
Published: August 2005

The objective of this study was to determine the prevalence of emotional, sexual or physical violence reported by women delivered at the University Hospital Geneva, a tertiary care university teaching hospital, where about 3000 women are delivered each year. This study showed that prevalence of violence against women is high, and is severely underestimated by health case providers.
Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition
Authors: Fox Sarah D. , Stanton Stuart L.
Published: August 2005

Objective
To assess the sacrocolpopexy with mesh interposition in women with pelvic organ prolapse.

Design
A prospective study.

Setting
Tertiary referral urogynaecology and pelvic floor reconstruction unit.

Population
Twenty‐nine consecutive women with symptomatic vault prolapse and rectocele.

Main outcome measures
Subjective and objective success rates and complications.

Results
The mean age was 57 years. The mean number of past prolapse operations was 2.6 which included two past sacrospinous ligament fixations and 17 past posterior repairs. The mean follow up was 14 months. There was an increase in constipation from 41% to 50%, a decrease in faecal soiling from 21% to 10%, and an increase in incomplete defecation from 24% to 36%. Dyspareunia decreased from 38% to 17%, and there was some improvement in the stress and urge incontinence. There was a significant reduction of vault prolapse and rectocele (P < 0.001). All women with Stage II and Stage III vault prolapse were corrected, with an increase in Stage I prolapse from 20% to 27%. All women with Stage II and Stage III rectocele were corrected with a decrease in Stage I prolapse from 36% to 7%. The only significant interoperative complication was a cystotomy. One mesh became infected post‐operatively which required removal.

Conclusions
Sacrocolpopexy and mesh interposition is a safe and reliable operation for the correction of vault prolapse and rectocele. A long term follow up is necessary to detect any late complications.
Three methods for hysterectomy: a randomised, prospective study of short term outcome
Authors: Consultant Christian Ottosen , Lingman Göran , Ottosen Lena
Published: August 2005

Objective
To detect differences in clinical short term outcome between total abdominal hysterectomy, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy.

Design
Randomised controlled trial.

Setting
Department of Obstetrics and Gynaecology, Hospital of Helsingborg, Sweden.

Sample
One hundred‐twenty women scheduled for hysterectomy for various indications.

Methods
Randomisation into three treatment arms: total abdominal hysterectomy (n= 40); vaginal hysterectomy (n= 40) and laparoscopic assisted vaginal hysterectomy (n= 40). During traditional abdominal and vaginal surgery, laparoscopic assistance was kept to a minimum. Substantial number of cases needed volume‐reducing manoeuvres due to uterine size.

Main outcome measures
Duration of surgery, anaesthesia, time in hospital and recovery time.

Results
Mean duration (range) of surgery was significantly longer for laparoscopic assisted vaginal hysterectomy compared with vaginal hysterectomy and total abdominal hysterectomy, 102 min (50–175), 81 min (35–135) and 68 min (28–125), respectively. Mean stay in hospital and mean time to recovery was significantly longer for total abdominal hysterectomy compared with vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. The difference between vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy was not significant. It was possible to remove uteri under 600 g with all three methods. Four laparoscopic assisted vaginal hysterectomies and one vaginal hysterectomy were converted to open surgery. Reoperation and blood transfusion were required after two vaginal hysterectomies and one laparoscopic assisted vaginal hysterectomy. One woman needed blood transfusion after total abdominal hysterectomy.

Conclusions
Traditional vaginal hysterectomy proved to be feasible and the faster operative technique compared with vaginal hysterectomy with laparoscopic assistance. The abdominal technique was somewhat faster, but time spent in theatre was not significantly shorter. Abdominal hysterectomy required on average a longer hospital stay of one day and one additional week of convalescence compared with traditional vaginal hysterectomy. Vaginal hysterectomy should be a primary method for uterine removal.
Anti‐E in pregnancy
Authors: Moran P. , Robson S. C. , Reid M. M.
Published: August 2005

Since the introduction of anti‐Rhesus (Rh) D prophylaxis for RhD‐negative women, other Rh and non‐Rh red cell alloantibodies have become relatively more important and are now responsible for the greater proportion of haemolytic disease of the newborn. Anti‐C and anti‐E are the most commonly implicated non‐D Rh antibodies in the pathogenesis of haemolytic disease of the newborn1. In 1977 Pepperell et al.2 reported the outcome of 44 women with anti‐E. This is the only published series that investigates the implications of anti‐E during pregnancy. The present report presents a retrospective study of the outcome of 122 pregnancies in which anti‐E was the sole alloantibody detected.
RhD genotyping by quantitative fluorescent polymerase chain reaction: a new approach
Authors: Pertl Barbara , Pieber Doris , Panzitt Thomas , Haeusler Martin C. H. , Winter R. , Tului L. , Brambati B. , Adinolfi M.
Published: August 2005

Objective
To develop a new method of RhD/d genotype determination using a quantitative fluorescent PCR (QF‐PCR) assay.

Methods
Polymerase chain reaction amplification (PCR) of fragments of exon 7 of both the RHD and RHCE genes was performed from 32 amniotic fluid and 26 chorionic villus samples known to be heterozygous for the RHD gene, 74 peripheral blood samples of RhD‐positive blood donors (homozy‐gous or heterozygous) estimated by serologic typing and 24 RhD‐negative fetal samples. The number of copies of the RHD gene in RhD‐positive samples was determined by comparing the fluorescent intensities of the amplification products specific for the RHD and the RHCE genes.

Results
A ratio of fluorescent intensities of 1:1 clearly indicated D/D homozygous individuals whereas a ratio of 1:2 was demonstrated in samples from D/d heterozygous individuals. The mean fluorescent intensity ratio of the peak areas of homozygous samples was 1.12 (SD 0.128), the mean ratio of the peak areas of heterozygous samples was 0.51 (SD 0.060). Complete agreement was obtained between RhD/d typing by QF‐PCR and RhD genotypes assessed by family studies and serological methods.

Conclusions
The fluorescent PCR‐based DNA test allows easy, rapid and accurate determination of the zygosity for the RHD gene. This new technique provides useful information for the clinical management of pregnancies of sensitised RhD‐negative mothers.
Does a discrepancy between gestational age determined by biparietal diameter and last menstrual period sometimes signify early intrauterine growth retardation?
Authors: Larsen T. , Nguyen T. H. , Greisen G. , Engholm G. , Møller H.
Published: August 2005

Objective
To assess the association between gestational age estimated from the last menstrual period (GALMP) or from the biparietal diameter (GABPD), and the subsequent birthweight for gestational age.

Design
Population‐based follow up study.

Setting
Of 21,936 pregnancies contained in the ultrasound database, 16,387 singleton pregnancies with a reliable last menstrual period date and an ultrasound examination between 12 and 22 weeks of gestation were included.

Main outcome measures
Correlation between: 1. birthweight deviation (birthweight‐expected weight for gestation); 2. birthweight; and 3. pregnancy length and (GALMP‐GABPD). Relative risk of birthweight < 2500 g and low birthweight for gestation (> 22% below normal weight) related to five levels of discrepancy between (GALMP‐GABPD).

Results
(GALMP‐GABPD) was not associated with deviation of birthweight related to GABPD However the risk of low birthweight (< 2500 g) and low birthweight for gestational age was significantly increased when (GALMP‐GABPD) was > 7 days.

Conclusion
A biparietal diameter smaller than expected from the last menstrual period date is mainly a problem of an error related to estimated time of ovulation. At the same time the relative risk of a low birthweight infant is slightly increased.
The surgical management of cervical carcinoma within the South West of England: progress through an audit loop
Authors: Murdoch J. B. , Weeks J. F. , Howe K. , Smith J. , Kirkpatrick A. , McCrum A.
Published: August 2005

Objective
To define and use a minimum clinical dataset for prospective data collection in order to audit the surgical management of cervical cancer in the South West of England. To compare this data set with a retrospective audit allowing assessment of the quality of care offered to patients.

Design
Prospective collection of a defined dataset on paper forms which were put into a computerised database for analysis. Registrations validated against histopathology databases and hospital coding.

Setting
All 13 hospitals in the South West of England which participated in the retrospective audit.

Participants
One hundred and sixty‐five women with cervical cancer diagnosed in 1997.

Main outcome measures
Distribution of cases by hospital and surgeon; workload of individual surgeons; adequacy and accuracy of FIGO staging; adequacy of histological information; and adequacy of surgery.

Results
There is a trend to centralisation of cancer care and radical surgery in the region. Prospective collection of data has dramatically improved FIGO staging with 92% of all cases staged. For cases greater than Stage la, 98% were staged suggesting that a target of 100% staging is feasible. The histological dimensions of tumours were not measured in a high proportion of cases (20% of tumour diameters and 28% of tumour thicknesses). Apparent inadequacies in surgical management are explored. In 10/165 cases (6%) inappropriate conservative surgery may have been unavoidable, suggesting that a quality standard of 95% for appropriate radical surgical management of cervical cancer can be achieved. An anatomically complete removal of pelvic node‐bearing tissue, yielding greater than 10 nodes in more than 95% cases, should be achievable with each surgeon/pathologist achieving a mean of more than 20 nodes.

Conclusion
Regional audit of cervical cancer management is feasible. It can be used to improve the quality of information on management and guide improved service provision.
Piperazine oestrone sulphate and interrupted norethisterone in postmenopausal women: effects on bone mass, lipoprotein metabolism, climacteric symptoms, and adverse effects
Authors: Alexandersen Peter , Byrjalsen Inger , Christiansen Claus
Published: August 2005

Objective
To compare the effects of two doses of piperazine oestrone sulphate combined with interrupted norethisterone, with that of oestradiol continuously combined with norethisterone acetate, and with placebo, in postmenopausal women.

Design
A prospective randomised trial.

Participants
Two hundred postmenopausal women.

Setting
Monocentre study with expertise in osteoporosis.

Methods
The participants were randomly assigned to two years of treatment with alternating three‐day cycles of 1.5 mg of piperazine oestrone sulphate plus 0.7 mg of norethisterone (highEP), or alternating three‐day cycles of 0.75 mg of piperaine oestrone sulphate plus 0.35 mg of norethisterone (lowEP), or 2 mg of 17β‐oestradiol continuously combined with 1 mg of norethisterone acetate (E2+NETA), or placebo.

Main outcome measures
Change in bone mineral density, lipoprotein metabolism, climacteric symptoms, and adverse effects.

Results
One hundred and twenty‐one women completed the study. Spinal bone mineral density was increased about 9% over two years by E2+NETA, about 6% by highEP, 4% by lowEP, but remained unchanged in the placebo group. The same pattern was seen in the hip and forearm. All hormone regimens decreased markers of bone turnover and alleviated climacteric symptoms. Serum lipoproteins decreased by about 10% in all hormone groups.

Conclusions
All hormone regimens studied prevented bone loss completely and lowered serum lipids.
Reactive thrombocytosis after caesarean section and vaginal delivery: implications for maternal thromboembolism and its prevention
Authors: Atalla Rami K. , Thompson John R. , Oppenheimer Christina A. , Bell Stephen C. , Taylor David J.
Published: August 2005

ObjectiveTo assess the duration and severity of reactive thrombocytosis after caesarean section and vaginal delivery.

DesignA prospective cohort study.

SettingA large teaching hospital.

MethodsWomen admitted for delivery at the Leicester Royal Infirmary were recruited into the study. The platelet count was measured before delivery and postnatally on days 3, 8, 12, 16, 20 and 24. Women who had antepartum haemorrhage, postpartum haemorrhage and those delivered by instrumental delivery were excluded from the study. Sixty‐five were recruited, and 45 completed the study, 20 of whom were delivered by a normal vaginal delivery and 25 by caesarean section. A random effects model was used to compare platelet counts within and between the two groups to assess the severity and the timing of reactive thrombocytosis.

ResultsThere were no statistically significant differences in booking and pre‐delivery platelet counts between the two groups (mean values 248.4 × 109/L and 245 × 109/L in the normal vaginal group and 269.4 × 109/L and 251.6 × 109/L in the caesarean section group, respectively). Postnatally, a rise in the platelet count was noted in the normal vaginal delivery group, reaching statistically significant peak values, compared with booking and pre‐delivery at days 8 and 12 of the postnatal period (mean value 365.8 × 109/L;P< 0.001and 369.4 × 109/L;P< 0.001respectively). In the caesarean section group, the platelet count was raised to a statistically significant high value, compared with booking and pre‐delivery at day 8 of the postnatal period. The platelet count peaked at days 12 and 16 of the postnatal period (mean value 522.5 × 109/L;P< 0.0001and 526.5 × 109/L;P< 0.0001, respectively) and remained significantly higher than booking and predelivery values for 24 days after the caesarean section. There was a greater rise in the platelet count in the caesarean section group compared with the vaginal delivery group. The platelet counts in the caesarean section group were significantly higher than these in the normal vaginal delivery group from day 12 to day 24 of the postnatal period.

ConclusionA significant rise in platelet count occurred eight to twelve days after normal vaginal delivery and caesarean section. The increase in platelet count continued to rise for 16 days after caesarean section, and it stayed significantly higher for more than 24 days after the delivery.
Fetal distress increases interleukin‐6 and interleukin‐8 and decreases tumour necrosis factor‐α cord blood levels in noninfected full‐term neonates
Authors: Jokic Mickael , Guillois Bernard , Cauquelin Brigitte , Giroux Jean Dominique , Bessis Jean Louis , Morello Rémy , Levy Gérard , Ballet Jean Jacques
Published: August 2005

Objective
To assess the influence of fetal distress on interleukin‐1β, interleukin‐6, interleukin‐8 and on tumour necrosis factor‐α blood levels in noninfected full‐term neonates.

Study design
In a multicentre prospective study, cord blood samples were obtained at time of delivery from 234 noninfected full‐term neonates for the purposes of measuring serum levels of interleukin‐1β, interleukin‐6, interleukin‐8 and tumour necrosis factor‐α using immunoassays. Women were classified into four groups according to the mode of delivery (vaginal delivery or caesarean section) and the presence or absence of fetal distress. The role of labour was also investigated.

Results
No significant relationship was found between cytokine cord blood levels and the mode of delivery. Fetal distress was associated with an increase in interleukin‐6 (P= 0.01) and interleukin‐8 (P < 0.001) levels, and a decrease in tumour necrosis factor‐α (P < 0.001). Labour was also associated with a significant increase in interleukin‐6 and interleukin‐8 cord blood levels (P= 0.01 and P < 0.001, respectively).

Conclusion
Fetal distress and labour were each associated with elevated interleukin‐6 and interleukin‐8 cord blood levels in noninfected full term neonates while only fetal distress was associated with decreased tumour necrosis factor‐α levels.
Organisation and cost‐effectiveness of antenatal haemoglobinopathy screening and follow up in a community‐based programme
Authors: Cronin Eugenia K. , Normand Charles , Henthorn Joan S. , Graham Vesna , Davies Sally C.
Published: August 2005

Objective
To consider the organisation cost and effectiveness, of universal, community‐based antenatal screening for the haemoglobinopathies, and to estimate the cost‐effectiveness of programmes at different levels of prevalence and mix of haemoglobinopathy traits.

Design
Retrospective review of laboratory and Sickle Cell and Thalassaemia Centre worksheets with costing of capital equipment, consumables, salaries and overheads, and estimation of costs in a range of circumstances.

Setting
A haematology department, including a Sickle Cell and Thalassaemia Centre, providing antenatal and neonatal screening programmes in Inner London.

Participants
Two thousand one hundred and one women booking at the antenatal clinic whose samples were referred for screening during 1994.

Main outcome measures and Results
In addition to assessing the cost‐effectiveness of antenatal haemoglobinopathy screening in a number of settings, the following specific financial information was assembled for the service in Brent: 1. cost of identifying abnormal haemoglobin in mother (£209); 2. cost of identifying at‐risk fetus before confirmation by prenatal diagnosis (£2455); 3. cost of providing genetic information and counselling to mother with abnormal haemoglobin (£109); 4. programme savings from cases averted (£61,000).

Conclusions
Antenatal screening with follow up counselling can be self‐financing at most prevalences of haemoglobinopathy traits, with greater savings where a high proportion of the traits are β thalas saemia. There is a net financial cost (£1350) only at prevalences below 2.5% of traits if these are mainly for sickle cell disease. Since there are other benefits is it likely that antenatal screening will be considered cost‐effective even at quite low levels of trait prevalence.