bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging in the assessment of complex Müllerian anomalies
Authors: Minto Catherine L. , Hollings Nicholas , Hall‐Craggs Margaret , Creighton Sarah
Published: December 2003

Objective
To evaluate the accuracy of magnetic resonance imaging in assessment of adolescent patients with complex Müllerian anomalies and its contribution towards operative management.

Design
A retrospective review of magnetic resonance imaging and operative findings.

Setting
A London teaching hospital that is a tertiary referral centre for complex reproductive tract disorders.

Sample
All adolescents referred for assessment of complex Müllerian anomalies, from 1996 to 1999, and undergoing both magnetic resonance imaging and surgical assessment.

Method
In the nine suitable patients magnetic resonance imaging and surgical findings were compared and the role of magnetic resonance imaging in determining the route and type of surgery was evaluated.

Main
outcome measures Magnetic resonance imaging data on reproductive tract anatomy and surgical findings detailing reproductive tract anatomy.

Results
There was good correlation of magnetic resonance imaging and operative findings in all cases. The best correlation was with uterine structure. In four cases the magnetic resonance imaging findings were essential for the appropriate choice of the surgical approach and type of procedure.

Conclusions
Magnetic resonance imaging is a valuable tool in the management of this particular complex group of patients.
Choosing a strategy to prevent neonatal early‐onset group B streptococcal sepsis: economic evaluation
Authors: Stan Catalin M. , Boulvain Michel , Bovier Patrick A. , Auckenthaler Raymond , Berner Michel , Irion Olivier
Published: December 2003

Objective
To determine the most appropriate strategy to prevent neonatal streptococcal sepsis in a setting with a low incidence of the disease.

Design
Decision analysis and economic evaluation.

Setting
Geneva University Hospitals, Switzerland.

Population
Pregnant women at 35‐37 weeks of gestation and in labour.

Methods
Local data and data from the literature were used in a decision analysis to compare the current policy of antibiotic administration at Geneva University Hospitals with the recommended preventive strategies.

Main outcome measures
Number of episodes of sepsis averted; cost and number needed to treat to prevent one episode of sepsis; and proportion of women receiving antibiotics during labour.

Results
Compared with the current policy, the risk factors strategy would prevent 69 streptococcal sepsis per million deliveries and the screening strategy would prevent 102 cases of sepsis per million deliveries. Cost per averted sepsis case would be £60, 700 and £473, 600, respectively. The number needed to treat to prevent one sepsis would be 1087 with a risk factors strategy and 1029 with a screening strategy. Preventive strategies would increase the proportion of women receiving antibiotics during labour from 6% with the current policy, to 13.5% and 16.5% respectively.

Conclusions
Preventive strategies are more effective than the current policy, but imply increased hospital costs and a notable increase in the proportion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting.
Activin βA‐subunit and activin receptors in human myometrium at term and during labour
Authors: Schneider‐Kolsky Michal , Manuelpillai Ursula , Gargett Caroline , Wallace Euan M.
Published: December 2003

Objective
To measure activin A content and to localise and semi‐quantitate activin receptors in human myometrium at term and during labour.

Design
Myometrium was collected from non‐pregnant women (n= 6), pregnant women at term not in labour (n= 6) and at term in labour (n= 6).

Setting
Monash Medical Centre, Melbourne, Australia.

Main
outcome measures Tissue lysates of myometrium were analysed for activin A content using an enzyme‐linked immunosorbent assay and activin receptor proteins IA, IIA and IIB using Western hybridisation. Activin βA‐subunit and activin receptors were localised in myometrium by immunohistochemistry.

Results
Activin A was detected by ELISA in non‐pregnant, pregnant and labouring myometrium. Levels were significantly higher in labouring myometrium. The three activin receptors IA, IIA and IIB were detected in all myometrial samples by Western hybridisation. Receptor IA was expressed in significantly higher levels in pregnant myometrium. Receptor IIA was very weakly expressed throughout. The expression of receptor IIB was similar in all three groups. Activin βA‐subunit and all three receptors were localised to the endothelial cells of myometrial blood vessels. Neither activin βA‐subunit nor any of the three activin receptors were immunolocalised to myometrial smooth muscle cells in the three groups. This result was confirmed by Western blotting for expression of activin receptors in isolated myometrial smooth muscle and microvascular endothelial cells.

Conclusion
The myometrium is not a target for activin A during late pregnancy or labour. However, activin A may have a role in the regulation of microvascular endothelial cell function in the myometrium.
Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units
Authors: Moster Dag , Lie Rolv Terje , Markestad Trond
Published: December 2003

Objective
To compare neonatal mortality in geographical areas where most deliveries occur in large hospitals with areas where a larger proportion of deliveries occur in small maternity units.

Design
Population‐based study using data from The Norwegian Medical Birth Registry.

Setting
Records on all deliveries in Norway from 1967 to 1996, a total of 1.7 million births, were equipped with data on the size of the maternity units used by delivering women in that particular area.

Main outcome measure
Risk of neonatal death.

Results
Women living in areas where the most frequently used delivery unit had less than 2000 annual deliveries had 1.2 fold the risk of experiencing neonatal death of their newborn (95% CI 1.1‐1.3). The relative risk of neonatal death in geographical areas where more than 75% of deliveries occurred in units with more than 3000 annual births was 0.8 (95% CI 0.7‐0.9) compared with areas where none delivered in such large units. The relative risk of neonatal death in areas where the most frequently used delivery units had less than 100 annual births was 1.4 (95% CI 1.1‐1.7) compared with areas where units of more than 3000 annual births were the most frequently used. Differences in outcome could not be explained by differences in travelling distance to an urban centre where most referral delivery units are located, differences between rural and urban municipalities, or by differences in biological or socio‐economic risk factors between municipalities.

Conclusions
We observed a small but significantly decreased neonatal mortality in areas where the great majority of births occurred in large hospitals.
Computerised analysis of fetal heart rate recordings in maternal type I diabetes mellitus
Authors: Tincello Douglas , White Sarah , Walkinshaw Stephen
Published: December 2003

Objective
1. To study computerised cardiotocograph parameters from women with type I diabetes; 2. to examine the significance of observed differences from the expected normal values.

Design
Prospective observational study in the third trimester of pregnancy.

Setting
The medical antenatal clinic of a tertiary referral centre.

Population
Twenty‐six women with type I diabetes mellitus with a singleton pregnancy.

Methods
Computerised cardiotocograph recordings were made weekly from 28 to 39 weeks. Derived parameters were compared with the published figures for uncomplicated singleton pregnancies. Details of maternal blood sugar, labour and delivery and neonatal outcome were recorded. Data were compared between groups according to the computerised analysis of the antenatal CTGs.

Results
One‐hundred and thirty‐one recordings were made with a median of five per patient (range 1–12). 11.3% showed absent episodes of high variation compared with the expected value of 0.8%, a difference of 9.5% (95% CI 4.5‐15.3). Differences in short term variation, basal heart rate, frequency of fetal movements and heart rate accelerations were also found which changed with gestation. Overall these changes represented a more immature form of fetal heart rate than that which would be expected. No relationship between the changes and adverse fetal outcome could be identified.

Conclusions
Significant differences exist in cardiotocographs in maternal type I diabetes compared with normal fetuses. The changes may represent a delay in fetal maturation. The analysis mode of the computer will register these as abnormal features, but there is no evidence that they are pathological. We would recommend that computerised analysis is not used to assess pregnancies complicated by maternal type I diabetes mellitus.
Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years
Authors: Nieminen Kari , Heinonen Pentti K.
Published: December 2003

Objective
To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse.

Design
Retrospective observational study with long term follow up.

Setting
Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland.

Sample
and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80‐93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2‐113] months.

Main
outcome measures Intra‐ and post‐operative morbidity, mortality and recurrence of prolapse.

Results
Sixteen of the 25 women (64 %) had no major intra‐ or post‐operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy.

Conclusion
Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.
Cellular proliferation in the female lower urinary tract with reference to oestrogen status
Authors: Blakeman Peter J. , Hilton Paul , Bulmer Judith N.
Published: December 2003

Objective
To assess cell proliferation throughout the tissues of the female lower urinary tract and to compare cell proliferation rates in women of varying oestrogen status.

Design
Prospective observational study.

Setting
A large teaching hospital.

Sample
Fifty‐nine women undergoing surgery for urogynaecological conditions of whom 23 were premenopausal, 20 were postmenopausal and taking no oestrogen supplementation and 16 were postmenopausal and receiving some form of hormone replacement therapy. Biopsies were taken during surgery from the bladder dome, trigone, the proximal and distal urethra, vagina and vesico‐vaginal fascia in the region of the bladder neck.

Methods
Formalin‐fixed paraffin‐embedded biopsies were labelled by an avidin–biotin technique with a monoclonal antibody raised against part of the nuclear matrix known as Ki‐67 antigen.

Main
outcome measures Ki‐67 expression was assessed in the epithelial, subepithelial and muscle or deep fascial regions of all tissues and related to oestrogen status.

Results
Ki‐67 expression was only found in high levels in biopsies containing squamous epithelia. Significantly higher levels of Ki‐67 expression were observed in the tissues of oestrogen replete women in the premenopausal and hormone replacement groups, compared with postmenopausal women receiving no oestrogen supplementation.

Conclusions
Squamous epithelia of the female lower urinary tract exhibit greater levels of cell proliferation in oestrogen replete as compared with oestrogen deficient women. As these same squamous epithelia also consistently express oestrogen receptors, the findings suggest a mechanism by which oestrogen exerts its effect on the lower urinary tract and also provide an explanation for the success of oestrogen in the treatment of some conditions causing lower urinary tract dysfunction in postmenopausal women.
Estimation of an expected caesarean section rate taking into account the case mix of a maternity hospital. Analysis from the AUDIPOG Sentinelle Network (France)
Authors: David Sandra , Mamelle Nicole , Rivière Olivier ,   Obstetricians of AUDIPOG
Published: December 2003

Objective
To provide maternity unit with an expected caesarean section rate, according to its case mix (i.e. women's characteristics associated with caesarean section risk).

Design
Cohort study.

Setting
149 maternity units in France.

Sample
40,512 single births collected by the French Sentinelle Network, in January every year, from 1994 until 1998.

Methods
Univariate analysis was used to identify caesarean section risk factors, and multivariate analysis to adjust for the role of the maternity units’ characteristics, after taking into account the women's characteristics. A two‐level logistic model was used to show that the caesarean section rate varied according to maternity units’ characteristics and to estimate therefore expected caesarean section rates (before and during labour), for each maternity unit, according to its case mix.

Main outcome
caesarean section rates (before and during labour).

Results
Within the Sentinelle Network the caesarean section rate was 15.0% (7.6% were before labour). The joint effect of the size and juridical status on caesarean section risk was studied. The reference hospital was university maternity units with more than 2000 deliveries/year. Community or private maternity units with more than 2000 deliveries/year carried out fewer prophylactic caesarean sections than the reference hospital (ORadj=0.7 and 0.6, respectively). Conversely, private maternity units with fewer than 2000 deliveries/year performed more prophylactic caesarean sections than the reference hospital (ORadj= 1.7). The two‐level logistic model showed that a maternity unit effect still existed after taking into consideration both women's characteristics and those of the maternity unit, and estimated expected caesarean section rates.

Conclusion
Knowledge of the expected caesarean section rate constitutes a personal reference to which the maternity hospital can compare its observed caesarean section rate, and is thus likely to have a significant effect on delivery practices.
Fetal bone metabolism in normal and rhesus isoimmunised pregnancies
Authors: Ogueh Onome , Wright Eileen M. , Jones Julia , Alaghband‐Zadeh Jamshid , Nicolaides Kypros H. , Johnson Mark Richard
Published: December 2003

Objective
To construct gestation‐specific reference intervals for fetal concentrations of biochemical markers of bone metabolism and assess the effect of rhesus isoimmunisation on these.

Methods
Fetal blood samples were obtained by cordocentesis from 175 pregnancies (43 complicated by rhesus isoimmunisation) and assayed for carboxy terminal pro‐peptide of type I pro‐collagen (PICP) and cross‐linked carboxyterminal telopeptide of type I collagen (ICTP) which directly monitor the rate of bone formation and resorption respectively.

Results
Both plasma PICP and ICTP were negatively correlated with gestational age (r =−0.351 and−0.472 for PICP and ICTP, respectively, and P<0.001 for both). In fetuses affected by rhesus isoimmunisation PICP levels were lower (P=0.030) and more variable (P <0.001) than expected, compared with normal unaffected fetuses. However, no such differences were found in the ICTP levels. In the fetuses affected by rhesus isoimmunisation there was a significant correlation between haemoglobin concentration and both PICP (r = 0.504, P= 0.001) and ICTP (r = 0.343, P= 0.030).

Conclusions
Fetal bone turnover declines from early second trimester to term, and may be deranged in fetuses affected by rhesus isoimmunisation.
Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions
Authors: Bouvier‐Colle Marie‐Hélène , Ould El Joud Dahada , Varnoux Noelle , Goffinet François , Alexander Sophie , Bayoumeu Françoise , Beaumont Etienne , Fernandez Hervé , Lansac Jacques , Lévy Gérard , Palot Maryse
Published: December 2003

Objective
To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage.

Design
Retrospective questionnaire survey.

Setting
Three administrative regions of France.

Population
All women who were pregnant or had recently given birth during the year before the survey.

Methods
A European survey (MOMS‐B) defined severe haemorrhages as blood loss ≧1500mL. A specific questionnaire was added in France to analyse the quality of care of these haemorrhages. The survey was carried out in three different administrative regions: Champagne‐Ardenne, the Centre and Lorraine. An expert committee was appointed and began by establishing a framework for qualitative assessment. One hundred and sixty‐five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and ‘mixed’ care were both considered substandard. The 165 cases were coded and then studied with uni‐ and multivariate analysis (logistic regression with SAS and SPSS software).

Results
Of the 165 cases identified, 51 % (85/165) were vaginal, 19% (31/165) operative vaginal, and 30% (49/165) caesarean. The leading cause of haemorrhage was uterine atony. Overall, 62% of the cases received appropriate care, 24% received totally inadequate care and 14% mixed care. After adjustment for sociodemographic factors, antenatal care and organisational aspects, the lack of a 24‐hour on‐site anaesthetist at the hospital and a low volume of deliveries (<500 births per year) were the factors associated with substandard care.

Conclusion
Organisational features are so important that application of good clinical practices for safer motherhood reinforce the need for new organisation of obstetric services. For the first time, the presence of an anaesthetist is shown to have a measurable effect on the quality of care for women giving birth. These results need to be confirmed by others.
The use of intrapartum defibulation in women with female genital mutilation
Authors: Rouzi Abdulrahim A. , Aljhadali Etedal A. , Amarin Zouhair O. , Abduljabbar Hassan S.
Published: December 2003

Objective
To assess the use of intrapartum defibulation for women who have had female genital mutilation.

Design
A retrospective case analysis.

Setting
King Abdulaziz University Hospital, a teaching hospital in Jeddah, Saudi Arabia.

Sample
Two hundred and thirty‐three Sudanese and 92 Somali women who were delivered at the hospital between January 1996 and December 1999.

Methods
The outcome of labour of women with female genital mutilation who needed intrapartum defibulation were compared with the outcome of labour of women without female genital mutilation who did not need intrapartum defibulation.

Results
One hundred and fifty‐eight (48.6%) women had infibulation and needed intrapartum defibulation to deliver vaginally, 116 women (35.7%) did not have infibulation and gave birth vaginally without defibulation, and 51 (15.7%) women were delivered by caesarean section. There were no statistically significant differences, between women who underwent intrapartum defibulation and those who did not, in the duration of labour, rates of episiotomy and vaginal laceration, APGAR scores, blood loss and maternal stay in hospital. The surgical technique of intrapartum defibulation was easy and no intraoperative complications occurred.

Conclusions
Intrapartum defibulation is simple and safe, but sensitivity to the cultural issues involved is essential. In the longer term, continuing efforts should be directed towards abandoning female genital mutilation altogether.
Modelling the potential impact of population‐wide periconceptional folate/multivitamin supplementation on multiple births
Authors: Lumley Judith , Watson Lyndsey , Watson Max , Bower Carol
Published: December 2003

Objective
To develop a model of the impact of population‐wide periconceptional folate supplementation on neural tube defects and twin births.

Design
A hypothetical cohort of 100,000 pregnancies ≥20 weeks, plus terminations of pregnancy after prenatal diagnosis before 20 weeks.

Methods
Application of pooled data on the relative risks for neural tube defects and twins following periconceptional folate from meta‐analysis of the randomised trials.

Main outcome measures
1. Pregnancies with a neural tube defect (i.e. terminations of pregnancy, perinatal deaths, and surviving infants); 2. twin births (i.e. preterm births, perinatal deaths, postneonatal deaths, birth defects, cerebral palsy); 3. numbers needed to treat.

Results
The change in neural tube defects would be 75 fewer terminations (95% CI ‐47, ‐90), 30 fewer perinatal deaths (95% CI 18, ‐35), and 13 fewer surviving infants with a neural tube defect (95% CI –8, ‐16). The change in twinning would be an additional 572 twin confinements (95% CI –100, +1587), among whom there would be 63 very preterm twin confinements (95% CI –11, +174), 54 perinatal and postneonatal deaths (95% CI –9, +149), 48 surviving twins with a birth defect (95% CI –8, +133), and nine with cerebral palsy (95% CI –2, +26). The numbers needed to treat for the prevention of one pregnancy with a neural tube defect is 847, for the birth of one additional set of twins is 175, for the birth of one additional set of very preterm twins is 1587, and for the birth of an additional twin with any of the following outcomes (perinatal death, postneonatal death, survival with a birth defect, or survival with cerebral palsy) is 901.

Conclusions
Monitoring rates of neural tube defects and twinning is essential as supplementation or fortification with folate is implemented.
Gilbert's syndrome is not associated with HELLP syndrome
Authors: Zusterzeel Petra L. M. , te Morsche René , Raijmakers Maarten T. M. , Peters Wilbert H. M. , Steegers Eric A. P.
Published: December 2003

The HELLP syndrome has been associated with postpartum unconjugated hyperbilirubinaemia. Several types of disorders cause unconjugated hyperbilirubinaemia, Gilbert's syndrome being the most common. In Caucasians a genetic defect in the TATA box of the promotor region of the gene encoding for bilirubin UDP‐glucuronyltransferase is tightly associated with Gilbert's syndrome. This defect was assessed by polymerase chain reaction in 237 women with the HELLP syndrome in their obstetric history and 236 controls. Fifteen percent of the cases and 10% of the controls had a homozygous genetic defect (χ2= 2.9; P= 0.23). No evidence was found that Gilbert's syndrome is associated with the HELLP syndrome.
Does deep endometriosis infiltrating the uterosacral ligaments present an asymmetric lateral distribution?
Authors: Chapron Charles , Fauconnier Arnaud , Dubuisson Jean‐Bernard , Vieira Marco , Bonte Hélène , Vacher‐Lavenu Marie‐Cécile
Published: December 2003

Objective
To investigate whether deeply infiltrating endometriosis occurs with equal frequency between left and right uterosacral ligaments.

Design
Retrospective analysis of consecutive cases.

Setting
Department of gynaecological surgery in a tertiary care university hospital in Paris, France.

Population
One hundred and thirty consecutive women with laparoscopic resection of histologically proven deep endometriosis infiltrating the uterosacral ligaments.

Methods
Laterality, intraoperative aspect of the uterosacral ligaments, and associated endometriosis were recorded during laparoscopy. Deep endometriosis infiltrating the uterosacral ligaments was considered as histologically proven in the presence of endometrial glands and stroma.

Main
outcome measure Frequency of left‐ and right‐sided deep endometriosis infiltrating the uterosacral ligaments.

Results
The left uterosacral ligament alone was involved in 69 cases; the right uterosacral ligament alone was involved in 38 cases; both were involved in 23 cases. For patients with unilateral deep endometriosis infiltrating the uterosacral ligaments the observed proportion of endometriosis involving the left uterosacral ligament (69/107, 64.5%) was significantly different from the expected proportion of 50% (χ2=8.98; P < 0.01).

Conclusion
Anatomical differences between left and right hemipelvis and differences in the frequency of ovulation between right and left ovary could explain these results.
Follow up after LLETZ: could schedules be modified according to risk of recurrence?
Authors: Flannelly G. , Bolger B. , Fawzi H. , De Barros Lopes A. , Monaghan J.M.
Published: December 2003

Objectives
To document the pattern of recurrence of disease following large loop excision of the transformation zone (LLETZ) to identify a low risk group of women who might benefit from less intensive cytological surveillance.

Design
Analysis of prospectively collected information with retrospective review of follow up smears.

Population
Three thousand, five hundred and sixty women who underwent LLETZ (median age 31 years; IQR 12 years).

Setting
Colposcopy clinic at Northern Gynaecological Oncology Centre, Gateshead.

Methods
Women treated with LLETZ from 1988 to 1995 were reviewed. Information on the pathology from LLETZ was collected prospectively and information on the subsequent smears was obtained from the family health authorities.

Results
Invasive cancer was detected on the original LLETZ in 134 women who were excluded from the study. Of the remaining 3426 women, histology of LLETZ showed high grade CIN (II and III) in 2371 (69%). At least one follow up smear was undertaken in 3385 women (99%). This constituted 9765 women years of follow up with a mean duration of 35 months. Four hundred and seventeen women (12.2%) had a dyskaryotic follow up smear. Incomplete excision of the lesion and an age of ≥ 50 years at the time of the LLETZ were associated with an increased risk of recurrent CIN. Based on these risk factors the study group was divided into three risk groups: 1. women aged < 50 with no disease at the margins (n=1680); 2. women aged ≥ 50 with disease at the margins (n=93); and 3. women aged < 50 with positive margins, or aged ≥ 50 with negative margins (n=1653). The cumulative survival without recurrent CIN at five years for these groups were 92%, 57% and 86%, respectively.

Conclusion
Women aged ≥ 50 with CIN at the margins of excision constituted a small minority high risk group (3%). Consideration should be given to repeat treatment of these women rather than surveillance. Women aged < 50 with complete excision of low grade CIN comprised 51% of the study group. These women were at low risk of recurrent CIN and might benefit from less intensive cytological surveillance following LLETZ.
A new condition‐specific health‐related quality of life questionnaire for the assessment of women with anal incontinence
Authors: Bugg G.J. , Kiff E.S. , Hosker G.
Published: December 2003

Objective
To design and validate a condition‐specific health‐related quality of life questionnaire for the assessment of women with anal incontinence.

Design
A psychometric study by postal survey.

Setting
South Manchester University Hospital, UK.

Sample
Two hundred and twenty women with known anal incontinence.

Method
The questionnaire was adapted from the King's Health Questionnaire, a condition‐specific health‐related quality of life questionnaire for the assessment of women with urinary incontinence. The questionnaire was then tested for acceptability, reliability and validity by postal survey.

Results
The Manchester Health Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test–retest reliability, criterion and construct validity.

Conclusion
The questionnaire is both a valid and reliable instrument for the assessment of health‐related quality of life among women with anal incontinence. It will be useful in many different clinical settings and be of practical use in the evaluation of women after childbirth. As the good response rates show it could be a successful part of a postal survey.
Risk factors predisposing to fetal loss following a second trimester amniocentesis
Authors: Papantoniou Nikolaos E. , Daskalakis George J. , Tziotis John G. , Kitmirides Stylianos J. , Mesogitis Spyros A. , Antsaklis Aris J.
Published: December 2003

Objective
To examine the influence of possible risk factors on fetal loss rate following amniocentesis.

Design
Retrospective analysis of case records between 1993 and 1998.

Setting
Fetal medicine unit of a large teaching hospital.

Population
One thousand and six women with singleton pregnancies formed the study group. Seven hundred and eight of them had bleeding during the current pregnancy before the procedure, while 298 had a history of three or more first trimester abortions and/or a second trimester miscarriage or termination of pregnancy. Four thousand and twenty‐four women who had amniocentesis and had no risk factors served as controls. Both groups were also classified according to maternal age. Group 1: 1610 women aged 20–34 years; Group 2: 2850 women aged 35–39 years; Group 3; 570 women > 40 years.

Methods
Women of both groups underwent a second trimester amniocentesis between 16 and 21 weeks of gestation. Fetal losses following amniocentesis were examined in three time intervals: 1. in the first two weeks after the procedure; 2. up to the 28th week; 3. from the 28th week to term.

Results
There was a statistically significant difference in the fetal loss rate between women aged 20–34 years (2.54%) and those > 40 years (5.1%). Women with a history of vaginal bleeding during the current pregnancy had a higher fetal loss rate compared with controls (6.5%vs 2.8%), which corresponds to an odds ratio of 2.4 (95% CI 1.69–3.42). A similar difference was found between the group of women with a history of previous abortions/terminations and the controls (8%vs 2.8%): OR 3.03 (95% CI 1.92–4.79).

Conclusions
There is a higher risk of fetal loss following amniocentesis in women > 40 years of age compared with those aged 20–34 years. Bleeding in the current pregnancy, a history of three or more first trimester abortions, a second trimester miscarriage or termination of pregnancy seem to be significant predisposing factors for fetal loss after an amniocentesis.
Comparison of cervical vacuum cup cannula with metal cannula for hysterosalpingography
Authors: Cohen Shlomo B. , Wattiez Arnaud , Seidman Daniel S. , Lidor Arie L. , Hendler Israel , Rabinovichi Jaron , Goldenberg Mordechai
Published: December 2003

Objective
The aim of this study was to compare the use of a cervical vacuum cap cannula with the traditional metal cannula.

Design
A prospective, randomised, single‐blinded comparative study.

Sample
Fifty consecutive infertile women undergoing hysterosalpingography for evaluation of infertility

Methods
Hysterosalpingography was performed either with the traditional metal cannula (n=25) or a cervical vacuum cap cannula (n=25).

Main outcome measures
Length of procedure, fluoroscopic time, amount of contrast medium, pain to the patient while applying the cannula and injecting the contrast medium, level of difficulty to the performer, the need to reapply the cannula, complications, and results of the hysterosalpingography.

Results
Using the cervical vacuum cap cannula, compared with the metal cannula, the duration of the procedure was significantly shorter (5.3 vs 9.3 minutes; P<0.001), less fluoroscopic time was needed (0.9 vs 1.8 minutes; P<0.001), a smaller amount of contrast medium was used (4.6 vs 15.7 mL; P<0.001), the procedure caused less pain to the patient (3.2 vs 6.8, respectively; on a scale of 1–10; P<0.001), and was easier for the physician to perform (1.4 vs 3.4; on a scale of 1–10; P<0.001). No significant differences were encountered between the two groups in the need to reapply the cannula, in the rate of complications or in the results of the hysterosalpingography.

Conclusions
The cervical cap cannula appears to be superior to the traditional metal cannula for performing hysterosalpingography.
Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy
Authors: Jolly M. , Taylor M. , Rose G. , Govender L. , Fisk N.M.
Published: December 2003

Current treatments for twin reversed arterial perfusion sequence are associated with significant morbidity and most are not feasible in early gestation. We report the use of an interstitial laser in two pregnancies complicated by this sequence at 14 and 15 weeks, respectively. A 600μm laser fibre was introduced via a 17 gauge needle into the abdomen of the perfused twin close to the vitelline artery and umbilical vein, which were occluded by neodymium:yttrium aluminium garnet (Nd:YAG) laser. Both pregnancies continued uneventfully and each resulted in the birth of a healthy baby at term.
Long term outcome following laparoscopic supracervical hysterectomy
Authors: Okaro Emeka O. , Jones Kevin D. , Sutton Christopher
Published: December 2003

Objectives
To assess the long term outcome of laparoscopic supracervical hysterectomy.

Design
Retrospective study.

Setting
Minimal Access Surgical Unit, Department of Gynaecology, Royal Surrey County Hospital, Surrey.

Methods
Analysis of patient case records.

Population
Seventy consecutive women who had a laparoscopic supracervical hysterectomy.

Outcome
measures Symptoms related to the cervical stump and the need for further surgery.

Results
The mean time of patient follow up was 66 months (range 52–84). The mean time from initial procedure to second treatment was 14 months (range 3–53). Seventeen women (24.3%) reported symptoms related to the cervical stump, and all required further surgery. The cervical stump was removed in 16 (22.8%). One patient had laparoscopic adhesiolysis only and two had a laparotomy and trachelectomy because the bowel was adherent to the cervical stump. Nine had a laparoscopically assisted cervical trachelectomy as the sole procedure. Five had laser treatment to endometriotic deposits, and laparoscopically assisted cervical trachelectomy. Histological analysis showed normal cervical tissue in six (35.3%). Endometriosis was detected in four cervical stumps (23.5 %), residual endometrium in another four (23.5 %) cases, and chronic cervicitis, mild CIN and a mucocoele in a further three patients. Of the 17 women who reported cervical stump symptoms, 14 (82.3%) had been treated for endometriosis in the past, compared with 17/53 (32%) who did not have symptoms (P<0.0002, χ2 test).

Conclusions
Symptoms related to the cervical stump requiring further surgery frequently occur following a laparoscopic supracervical hysterectomy.
Levels of cord blood thyroid stimulating hormone after external cephalic version
Authors: Yik‐Si Chan Louis , Kin Lau Tze , Yu Chiu Pui , Wing‐KinWong Gary , Leung Tse Ngong
Published: December 2003

Objective
To investigate the relationship between breech presentation, external cephalic version and levels of cord blood thyroid stimulating hormone.

Design
Case–control study.

Setting
University teaching hospital.

Population
The study group consisted of 289 consecutive singleton deliveries at term over a four‐year period, all of whom had an attempt at external cephalic version performed near term for breech presentation. The control group included 23,001 singleton term deliveries during the same four‐year period.

Methods
Between group differences were compared with the Mann‐Whitney U test or χ2 test when appropriate.

Main outcome measures
Levels of cord blood thyroid stimulating hormone and the incidence of false positive screening results for congenital hypothyroidism.

Results
Babies who were born vaginally after prior successful external cephalic version had significantly higher median levels of cord blood thyroid stimulating hormone (6.4 vs 6.0mIU/L, P=0.034) and the incidence of false positive screening for thyroid stimulating hormone (12.9%vs 7.2%, P=0.016, OR 1.9) compared with babies with spontaneous cephalic presentation. In babies with a breech presentation born by elective caesarean section, previous attempts at external cephalic version had no effect on cord blood thyroid stimulating hormone levels. There was also no difference in the levels of cord blood thyroid stimulating hormone between cephalic and breech‐presenting fetuses born by elective caesarean section. However, breech‐presenting babies born by emergency caesarean section after onset of labour had higher median levels of cord thyroid stimulating hormone than those with cephalic presentation (5.1 vs 4.5 mIU/L, P=0.008).

Conclusion
Levels of cord blood thyroid stimulating hormone are elevated in babies born vaginally after a successful external cephalic version. This finding may represent a biological difference in fetal response to the stress of labour in breech‐presenting fetuses, which is not correctable by a successful external cephalic version.
Induction of labour with a viable infant: a randomised clinical trial comparing intravaginal misoprostol and intravaginal dinoprostone
Authors: Rozenberg Patrick , Chevret Sylvie , Goffinet Franc¸ois , Durand‐Zaleski Isabelle , Ville Y. , Vayssie`re Christophe , Roberto Aline , Lahna Zouhair , Nisand Israel , Fisch Caroline , Chaumet‐Riffaud Philippe , Chastang Claude
Published: December 2003

Objective
To compare the efficacy and safety of vaginal misoprostol (50μg) with vaginal dinoprostone.

Design
Double‐blind randomised trial.

Setting
Obstetrics Department, Poissy Hospital, France.

Participants
370 patients with medical indications for induction of labour.

Outcome measures
Vaginal deliveries within 24 hours, as well as time to vaginal deliveries, caesarean rates, costs, and fetal, neonatal and maternal condition.

Results
Compared with vaginal dinoprostone, vaginal misoprostol resulted in greater efficacy in several areas: vaginal delivery within 24 hours; time to vaginal delivery; and vaginal delivery within 12 hours. There was a non‐significant increase in the caesarean section rate for fetal distress in the misoprostol group, but fewer caesarean sections for failed induction. Fetal tolerance was similar in the two groups, although significantly more neonates had a cord pH <7.20 and (non‐significantly) none had meconium stained amniotic fluid in the misoprostol group. The incidence of poor neonatal outcome was similar in both groups. Subgroup analysis by indication for induction showed that the higher rates of arterial cord pH <7.20 and of meconium‐stained amniotic fluid with misoprostol persisted only in possible fetal compromise. Poor neonatal outcome was less frequent in the misoprostol group in cases of induction for non‐fetal indications.

Conclusions
Vaginal misoprostol resulted in successful and earlier induction of labour more often than dinoprostone, but the safety of misoprostol raises some concern in potentially compromised infants. Misoprostol should be preferred to dinoprostone in cases of induction for non‐fetal indications.
The relationships between leptin and inflammatory cytokines in women with pre‐eclampsia
Authors: Bartha Jose L. , Romero‐Carmona Raquel , Escobar‐Llompart Miguel , Comino‐Delgado Rafael
Published: December 2003

Objective
To compare maternal serum leptin concentration in women with pre‐eclampsia and women with normal pregnancy, and to evaluate the relationships between leptin and several inflammatory cytokines.

Design
Prospective clinical study.

Setting
University Hospital of Puerto Real, Cadiz, Spain.

Sample
Twenty‐seven women with pre‐eclampsia and 25 normotensive pregnant women.

Methods
Maternal serum levels of TNF‐α, TGF‐β1, interleukin 6, and leptin were measured using a commercially available immunoassay.

Main
outcome measures Maternal serum levels of leptin and its relationship to levels of TNF‐α, TGF‐β1 and interleukin 6.

Results
Maternal serum leptin levels were higher in women with pre‐eclampsia, but this difference was of borderline statistical significance (median 15.9ng/mL; interquartile range (5.4–31.9) vs 30.5ng/mL (13.9–64) (P=0.05). The concentration of maternal serum leptin was correlated with pre‐gestational and gestational body mass index (r=0.45, P=0.03; r=0.44, P=0.04), TNF‐α concentration (r=0.57, P=0.002) and interleukin‐6 level (r=0.46, P=0.02) in women with normal pregnancy. In women with pre‐eclampsia, only a significant correlation between maternal serum leptin level and TNF‐α concentration (0.47, P=0.01) was found.

Conclusions
The level of maternal serum leptin is increased and correlates positively with the level of TNF‐α in women with pre‐eclampsia. In women with a normal pregnancy leptin levels not only correlate with TNF‐α, but also with IL‐6 and body mass index.
Body composition and energy metabolism in normotensive and hypertensive pregnancy
Authors: Martin Allison , O'Sullivan Anthony J. , Brown Mark A.
Published: December 2003

Objective
To determine whether the insulin resistance syndrome and altered body composition are features of hypertensive pregnancy.

Design
Women were recruited in the third trimester of pregnancy from the antenatal clinic, day assessment unit, and maternity ward of St George Hospital, Sydney.

Population
Women with pre‐eclampsia (n=12), gestational hypertension (n=12), essential hypertension in pregnancy (n=11), and normotensive pregnancy (n=10).

Methods
Energy metabolism was assessed by indirect calorimetry to measure basal metabolic rate and diet‐induced thermogenesis. Body composition was measured as lean body mass, total body water and fat mass by bio‐electrical impedance. Blood was collected for measurement of glucose, insulin and lipid profiles. Insulin resistance was indirectly assessed by the insulin and glucose concentrations and diet‐induced thermogenesis.

Results
Women with essential hypertension and gestational hypertension were heavier than women with normotensive pregnancies both pre‐pregnancy and in the third trimester, whereas women with pre‐eclampsia were similar to those with normotensive pregnancy. Women with essential hypertension were otherwise similar to normotensive pregnancy but women with gestational hypertension had a reduced diet‐induced thermogenesis and almost double insulin levels. Women with pre‐eclampsia had a similar body composition and insulin levels but reduced basal metabolic rate, diet‐induced thermogenesis and glucose levels compared with normotensive pregnancy.

Conclusions
Women who develop gestational hypertension, but not pre‐eclampsia, are more likely to be overweight. Women with essential hypertension are similar to women with normotensive pregnancy throughout pregnancy. Both gestational hypertension and pre‐eclampsia appear to be associated with some degree of insulin resistance, greater than that occurring in normal pregnancy.
The clinical application of a dual head gamma camera with coincidence detection in 20 women with suspected ovarian cancer
Authors: Lieberman G. , MacLean A.B. , Buscombe J.R. , Hilson A.J.W. , Adamson K. , Reid W.M. , Green A. , Begent R.H.
Published: December 2003

Objective
To assess the effectiveness of a dual head coincidence gamma camera in identifying ovarian cancer as a less expensive alternative to the traditional 2‐[18F] fluoro‐2‐deoxy‐D‐glucose (18FDG) system using positron emission tomography.

Design
Prospective study.

Population
Twenty consecutive women suspected of having ovarian carcinoma. Inclusion was based on abnormal serum CA125 (reference range is 0–35 units/L), ultrasound, computerised tomography or clinical findings.

Methods
Women underwent assessment before staging laparotomy. Two nuclear medicine physicians, who were blinded to the pre‐operative assessment, reported on 18FDG‐ dual head coincidence gamma camera imaging.

Main outcome
measures The histology and operative staging were compared with the 18FDG‐ dual head coincidence gamma camera findings.

Results
Twelve women had pelvic malignancies (nine primary and three recurrences), seven women had benign pathology and one patient had a borderline malignancy. We were able to image accurately all malignant pelvic masses with dual head coincidence gamma camera, as well as accurately demonstrate disease spread. Two of the benign pelvic masses localised 18FDG. The positive predictive value for detecting malignancy was 86%.

Conclusions
Dual head coincidence gamma camera offers accurate and affordable imaging in suspected ovarian masses, with improved specificity over CA125, ultrasound and computerised tomography. These results are similar to those obtained on more expensive dedicated PET systems. We report on a series of patients believed to have primary or recurrent carcinoma and recognise the need to include patients more likely to have benign lesions to assess false positive results. However, we believe that dual head coincidence gamma camera is useful in the pre‐operative assessment of women with suspected ovarian cancer.
Overview of the relationship between use of progestogen‐only contraceptives and bone mineral density
Authors: Banks Emily , Berrington Amy , Casabonne Delphine
Published: December 2003

Objectives
To summarise the available epidemiological evidence regarding the relationship between the use of progestogen‐only contraceptives and bone mineral density.

Design and methods
Overview of the published epidemiological literature.

Results
Overall, 17 studies of the use of progestogen‐only contraceptives and bone mineral density were identified, involving 1529 women exposed to progestogen‐only contraceptives and 2086 controls. Sixty‐eight percent of the data relate to the effects of use of depot medroxyprogesterone acetate. Average bone mineral density was reduced in current users of depot medroxyprogesterone acetate compared with non‐users, although density in users was within one standard deviation of the mean in non‐users. There was significant heterogeneity between the results of different studies (P<0.0001). The reduction in bone mineral density appeared to be greater at the lumbar spine, femoral neck and ultradistal forearm than at the midshaft of the ulna. Studies involving women with a longer average duration of use of depot medroxyprogesterone acetate displayed greater reductions in bone mineral density compared with studies of women with shorter durations of use. Based on limited data, no difference in bone mineral density was observed between former and never users of depot medroxyprogesterone acetate. Results regarding the effect of levonorgestrel implants were conflicting. Studies of progestogen‐only oral contraceptives and the progesterone vaginal ring were small and restricted to lactating women.

Conclusions
Women currently using depot medroxyprogesterone acetate have a lower average bone mineral density than non‐users. The magnitude of this effect is uncertain but appears to be greater with longer durations of use.