bluuebunny/crossref_metadata_2025 huggingface dataset:
Doctors leaving the training grades in obstetrics and gynaecology: a study of the years 1985 to 1988
Authors: Atkins John , Warren Richard , Hilton Paul
Published: August 2005

Objective
To determine the numbers of doctors leaving the specialty after obtaining the Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG), and the factors influencing their decisions to seek alternative career paths.

Design
Retrospective postal questionnaire based survey.

Participants
One hundred and sixty‐eight doctors who had passed the MRCOG examination between 1985 and 1988 but were not known to have achieved Consultant or Senior Registrar status in the British Isles by 1993.

Results
The response rate was 80%. The crude leaving rate was 31%, although 7.5% had never intended to seek consultant appointment in the specialty in the UK. The majority left shortly after obtaining the Part 2 MRCOG examination, 75% within the first two years thereafter. The perception of the lifestyle of a consultant and poor job prospects were commonly seen as the critical factors causing trainees of both sexes to leave the specialty, although hours of work was the single most commonly cited factor among female trainees.

Conclusions
A consistently high rate of loss from the specialty of obstetrics and gynaecology has been demonstrated in surveys covering the period 1978 to 1988. Approximately one‐quarter of this loss reflects trainees who had never intended to pursue consultant appointment in the specialty in the British Isles, half reflects factors which may improve with the implementation of the recommendations contained in the New Deal and the ‘Calman’ report, and one‐quarter reflects loss for inevitable reasons. Loss of trainees for these reasons is therefore a crucial element in manpower calculations.
GnRH analogue in assessing chronic pelvic pain in women with residual ovaries
Authors: Carey Marcus P. , Slack Mark C.
Published: August 2005

Objective
To assess whether suppression of ovarian function by a gonadotrophin releasing hormone (GnRH) analogue could assist in the diagnosis of chronic pelvic pain in women with residual ovaries.

Design
Uncontrolled, observational study.

Setting
District general hospital (seven women) and teaching hospital (one woman).

Participants
Eight women with residual ovaries and chronic pelvic pain.

Interventions
Goserelin 3.6 mg every 28 days was used followed by surgery to remove residual ovaries.

Main outcome measures
The women's response to goserelin and surgery (12 months or more post‐operatively) was assessed clinically.

Results
Goserelin was associated with resolution of pelvic pain in the six women who obtained relief of pain with oophorectomy. The only woman who did not respond to goserelin also failed to gain relief with surgery. One woman who responded to goserelin declined surgery.

Conclusions
Suppression of ovarian function by GnRH analogues may allow differentiation of pelvic pain caused by the residual ovary syndrome from other causes. This would enable selection of cases likely to benefit from surgery, avoiding potentially difficult surgery in women who will gain little or no relief of symptoms with surgery. Only eight cases are reported and a randomised controlled trial would be required to determine the place of GnRH agonists in the treatment of the residual ovary syndrome.
Evaluation of the home pad test in the investigation of female urinary incontinence
Authors: Versi E. , Orrego G. , Hardy E. , Seddon G. , Smith P. , Anand D.
Published: August 2005

Objective
To evaluate the use of the home pad test in the management of patients with urinary dysfunction with reference to feasibility, normal data, reproducibility, compliance and accuracy when compared to video urodynamics.

Design
A prospective study to determine 1. the accuracy of weighing pads by healthcare workers compared to weighing by patients with a spring balance; 2. the effects of evaporation; 3. the pad weight increase in continent women; 4. the compliance over 194 tests in terms of acceptability and feasability; 5. the reproducibility in 112 women for the 24 h and 48 h tests, 6. the comparison with video urodynamic studies in 149 patients.

Setting
A London teaching hospital.

Main outcome measures
Coefficient of variation and mean deviation analysis were employed to determine the accuracy of measurement. Percentage changes in standardised wet pad weights over a period of 8 weeks were used to determine the rate of weight loss due to evaporation. The percentage of patients completing the test satisfactorily was documented. The increase in the weights of all the pads worn during the test period was measured in continent volunteers and incontinent patients. Video urodynamic diagnoses were used as the Gold Standard for comparison.

Results
Twelve perineal pads were weighed by 15 healthcare workers with a resulting coefficient of variation equal to 1.55% (standard error = 0.09%). The mean deviation between patient‐measured pad weights and staff‐measured weights was 49% (SD = 132%). Pads wetted with saline showed no difference in weight after 1 week and less than 5% change in weight after 8 weeks, with the upper 95% confidence limit of less than 10% loss. The mean pad weight increase over 48 h in continent women was 7.13 g (SD = 4.32 g) giving a 95% upper confidence level of less than 15 g. Compliance was reasonably high with 161 (83%) carrying out the test perfectly. Test‐retest analysis of the 24 h and 48 h tests showed a strong relationship with correlation coefficients of 0.90 and 0.94 respectively. The reproducibility was also good, with differences as a percentage of the mean between the first and second test being 6.9% and 1.6% for the 24 h and 48 h tests respectively. There was good concordance when the urodynamic study data was compared with pad weight data in terms of incontinence compared with no incontinence (kappa = 0.65), but a high false positive rate was detected for the pads. When eight of these patients with a false positive pad test had repeat video urodynamic studies, six were found to have detrusor instability on the second study.

Conclusions
The home pad test combined with frequency volume chart documentation is an easy test to perform. It is quite robust and reasonably reproducible. This test should be added to complement the routine urodynamic tests and may have a role in detecting occult detrusor instability.
The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives
Authors: Norris L. A. , Bonnar J.
Published: August 2005

Objective
To determine the effect of oestrogen dose and progestogen type on the coagulation and fibrinolytic systems of a group of normal healthy women taking three different oral contraceptive combinations.

Design
Plasma levels of factor VII, X, antithrombin III, protein C, fibrinogen, tissue plasminogen activator activity, plasminogen activator inhibitor I antigen and fibrin (D‐dimer) degradation products were measured at pretreatment, 6, 14, 22 weeks of treatment and at 6 weeks post‐treatment in a group of 67 women taking either 30 μg ethinyloestradiol/150 μg desogestrel (n= 21), 20 μg ethinyloestradiol/150 μg desogestrel (n= 24), 30 μg ethinyloestradiol/75 μg gestodene (n= 22).

Participants
Sixty‐seven healthy normal women, 18 to 34 years, smoking fewer than 15 cigarettes per day. The subjects were within 10% of their normal body weight and had no history of thromboembolic disease.

Setting
Coombe Women's Hospital and St James's Hospital, Dublin, Ireland.

Results
Factor VII and X levels were significantly raised on treatment with both the 30 μg ethinyloestradiol/desogestrel and gestodene combinations. Higher levels of factor VII activity were observed in the 30 μg ethinyloestradiol/desogestrel combination compared with the gestodene combination. Factor VII and X were not significantly affected by the 20 μg ethinyloestradiol combination. Increased plasminogen, fibrinogen and D‐dimer levels and decreased plasminogen activator inhibitor 1 antigen levels were observed during the treatment phases in all three groups. Antithrombin TI1 and protein C activity did not change during treatment with any of the oral contraceptives studied.

Conclusions
Low dose oral contraceptives cause an activation of the coagulation system which is balanced by an activation of the fibrinolytic system. Reducing the dose of ethinyloestradiol from 30 μg to 20 μg reduces the effect on factor VII and X. This effect can be modified by the progestogen. The lesser effect of the 20 μg combination may make this a safer option for some women than pills containing a higher dose of oestrogen.
The usefulness of hCG and unconjugated oestriol in prenatal diagnosis of trisomy 18
Authors: Leporrier N. , Herrou M. , Herlicoviez M. , Leymarie P.
Published: August 2005

Objective
To evaluate the usefulness of the two maternal serum markers, human chorionic gonadotrophin (hCG) and unconjugated oestriol (uE3), in the prenatal diagnosis of trisomy 18.

Design
Retrospective evaluation of uE, and hCG levels at mid‐trimester in cases of trisomy 18 pregnancies identified from a series of women screened for Down's syndrome.

Setting
From a series of 53,893 women screened in the antenatal centre of University Hospital of Caen (France), 22 cases of trisomy 18 were diagnosed either after amniocentesis for maternal age, elevated risk of Down's syndrome, or fetal abnormalities and/or growth retardation on ultrasound assessment, or after birth. In addition, 11 cases of trisomy 18 identified prenatally in two other centres were included.

Results
Individual hCG and uE3 levels for pregnancies with trisomy 18 were significantly lower than in unaffected pregnancies: mean hCG was 0.62 multiples of the median (MOM) and median hCG was 0.5 MOM. uE3 was a much more effective marker than hCG. Mean uE3 was 0.40 MOM and median uE3 was 0.37 MOM. It was observed that screening for trisomy 18 based on selection for amniocentesis with cut‐off values of 035 for hCG and 0.60 for uE3 would lead to a detection rate of 48 % for 0–8 % false positive rate. Using cut‐off values of 0.70 MOM for each one of the two markers would detect 79YO of cases of trisomy 18 with a 3% false positive rate.

Conclusions
Our results confirm that low hCG and uE3 levels observed in the mid‐trimester are predictive of an increased risk for trisomy 18. Since most fetuses with trisomy 18 exhibit morphological abnormalities which should be detected following a careful ultrasonographic examination, biochemical screening could help in the detection of those anatomical defects in selecting for scanning a group of high risk women.
No change in sexual activity during preconceptional multivitamin supplementation
Authors: Czeizel A. E. , Rockenbauer M. , Susamky E.
Published: August 2005

Objective
To study sexual activity related to preconceptional multivitamin supplementation.

Design
The rate of sexual activity (weekly sexual intercourse number) was compared before and during multivitamin supplementation and between women with multivitamin and placebo‐like trace element supplementation.

Setting
The Hungarian randomised double blind controlled trial of periconceptional multivitamin supplementation.

Participants
Six hundred and eighty‐seven women with multivitamin and 655 women with trace element supplementation in the preconceptional period.

Results
There was no difference in the rate of sexual activity between the multivitamin and the trace element groups.

Conclusion
Multivitamins do not increase sexual activity.
Fetal fibronectin in cervicovaginal secretions as a predictor of preterm birth
Authors: Malak T. M. , Sizmur F. , Bell S. C. , Taylor D. J.
Published: August 2005

Objective
To determine whether fetal fibronectin detected in cervicovaginal secretions of patients with symptoms suggestive of preterm labour is a predictor for preterm birth.

Design
A blind prospective observational study.

Setting
A teaching hospital.

Participants
One hundred and forty‐one women presenting to the delivery suite between 24 and 37 weeks of gestation (112 were between 24 and 34 weeks of gestation) with symptoms suggestive of preterm labour, with intact membranes and cervical dilatation of < 2 cm.

Intervention
Specimens of cervicovaginal secretions were collected from the ectocervix and posterior fornix. Fetal fibronectin levels were measured by an ELISA and samples were considered positive if the level of fetal fibronectin present was ≥ 0.05 μg/ml.

Main outcome measures
Gestation at birth and sampling‐birth interval.

Results
The preterm birth (before 3 7 weeks of gestation) rate in the population studied was 19±1%. Fetal fibronectin predicted preterm birth with sensitivity of 63%, specificity of 95±6%, positive predictive value of 77±3%, and negative predictive value of 91±6%. Analysis of the data from women at less than 34 weeks of gestation showed similar results. A negative test accurately excluded (97±9%) the chance of subsequent birth during the three weeks interval following sampling.

Conclusions
The presence of fetal fibronectin in the cervicovaginal secretions of women admitted with symptoms suggestive of preterm labour indicates a significant risk for subsequent preterm birth. The absence of fetal fibronectin in this group is a very strong indication that subsequent preterm birth is unlikely to occur. Fetal fibronectin test, if combined with clinical findings, has a potentially important role in clinical management of women with symptoms suggestive of preterm labour.
Bacterial 16S rDNA polymerase chain reaction in the detection of intra‐amniotic infection
Authors: Jalava Jari , Mäntymaa Marja‐Liisa , Ekblad Ulla , Toivanen Paavo , Skurnik Mikael , Lassila Olli , Alanen Anna
Published: August 2005

Objective
Bacterial polymerase chain reaction (PCR) was used to detect early subclinical intra‐amniotic infection. We used universal primers which amplify a DNA fragment of 16S ribosomal DNA (rDNA) from all known bacteria and sequenced the positive samples to identify the bacterial species.

Design
Transabdominally obtained amniotic fluid samples from 20 pregnant women with prelabour rupture of the fetal membranes (PROM), showing no signs of clinical infection, and 16 control samples were analysed with universal bacterial PCR. In addition, routine bacterial culture and amniotic fluid glucose were studied.

Results
Out of 20 PROM patients, five were positive in the PCR. PCR detected Ureaplasma urealyticum in two cases, Haemophilus influenzae in one case, Streptococcus oralis in one case and Fusobacterium sp. in one case. Only two of these were positive in a routine bacterial culture. Both were multibacterial infections, which caused discrepancies between the PCR and culture results. Two patients developed infectious complications: both were identified with the PCR assay. Amniotic fluid glucose was lower in PCR positive patients compared with PCR negative patients.

Conclusion
Bacterial 16S rDNA PCR, in properly controlled conditions, promises to be a fast and reliable test for early intra‐amniotic infection especially concerning Ureaplasma urealyticum.
Randomised comparison between a loading and incremental dose model for ritodrine administration in preterm labour
Authors: Holleboom C. A. G. , Merkus J. M. W. M. , van Elferen L. W. M. , Keirse M. J. N. C.
Published: August 2005

Objective
To compare a new loading dose regimen for intravenous ritodrine administration in preterm labour with the conventional dose regimen.

Design
Multicentre randomised trial using numbered opaque sealed envelopes.

Setting
Five teaching hospitals in the Netherlands.

Participants
Women (n= 203) in preterm labour at less than 34 weeks of gestation.

Interventions
Women received either a loading dose ritodrine infusion followed, as soon as tocolysis was reached, by a decrease in infusion rate or the conventional schedule of increasing doses until uterine quiescence was achieved.

Results
Frequency of successful tocolysis (71 %) and duration of treatment (55 h) were similar in both groups, but the loading dose schedule was better tolerated with fewer adverse events. Also the number of dose adjustments was smaller than in the incremental dose group (P < 0.001). Overall, the differences between the two regimens were unexpectedly small.

Conclusions
Despite the small differences, the loading model is easier to apply, requires fewer dose adjustments, is better tolerated with less side effects, and reduces the likelihood of clinical error.
Wedge resection to improve insulin resistance in polycystic ovary syndrome: a study among Chinese women
Authors: Wu Xiao‐ke , Su Yan‐hua , Zhang Zu‐xuan
Published: August 2005

Objective
To investigate the relation between androgen excess and insulin resistance in nonobese Chinese women with polycystic ovary syndrome.

Design
A prospective, controlled study.

Setting
School of Clinical Medicine, Nanjing University.

Subjects
There were three groups: Group 1 (n= 15) comprised nonobese women with polycystic ovary syndrome; Group 2 comprised 12 of these 15 women in whom bilateral wedge resection had been performed six months to one year before enrolling in the study. Group 3 was a control group comprised of 15 normally menstruating women of similar age and body mass index.

Methods
An oral glucose (100 g) tolerance test was performed in all women in each group. The areas under the response curve of serum glucose, insulin, C‐peptide (C‐P), insulin/glucose (I/G) and C‐P/insulin (C/I) were calculated by trapezoid rule.

Results
When fasting the three groups had similar levels of glucose, insulin, C‐P, I/G and C/I. During the oral glucose tolerance test women of Group 1 had a significantly higher mean serum area of the curve of glucose, insulin, C‐P and I/G levels and lower C/I values, compared with the other two groups. Women of Group 2 and those in the control group showed similar levels of these indices during the oral glucose tolerance test.

Conclusions
Androgen excess in women with polycystic ovary syndrome may be responsible for a defect in peripheral insulin sensitivity and hepatic extraction which could be reversed by removing excessive androgens with wedge resection.
Messenger RNA encoding thiol protein disulphide isomerase in amnion, chorion and placenta in human term and preterm labour
Authors: Morrison John J. , Charnock‐Jones D. Stephen , Smith Stephen K.
Published: August 2005

Objective
To investigate levels of messenger RNA (mRNA) encoding thiol protein disulphide isomerase, in human amnion, chorion and placenta during pregnancy and in relation to term and preterm labour.

Design
Amnion, chorion and placenta from 33 women delivered between 24 and 41 weeks of gestation were used in the study.

Setting
Reproductive Molecular Research Group, Department of Obstetrics and Gynaecology, University of Cambridge Clinical School, Rosie Maternity Hospital, Cambridge.

Results
Women who were delivered spontaneously before 30 weeks of gestation had higher levels of mRNA encoding thiol protein disulphide isomerase in placenta and chorion than those who were delivered spontaneously after this time (placenta P < 0.01, chorion P < 0.01) and compared with those who were delivered by elective caesarean section before 30 weeks of gestation (placenta P < 0.001, chorion P < 0.05). In the group in whom spontaneous labour occurred, at all gestations studied, there were increased levels of mRNA encoding thiol protein disulphide isomerase in the placenta (P < 0.001) and chorion (P < 0.001) compared with the amnion.

Conclusion
Changes in the steady state level of mRNA encoding thiol protein disulphide isomerase may play a role in the onset of preterm labour before 30 weeks of gestation.
Urogenital ageing and its effect on sexual health in older British women
Authors: Barlow David H. , Cardozo Linda D. , Francis Roger M. , Griffin Mary , Hart David M. , Stephens Elaine , Sturdee David W.
Published: August 2005

Objective
To provide information on the extent of problems of urogenital ageing in older British women.

Design
A MORI survey of a representative population sample of older British women.

Setting
Home interviews.

Participants
Two thousand and forty‐five women aged 55–85+.

Results
Urogenital symptoms had affected 48.8% of the women at some time, but no more than 11% were currently affected by individual symptoms; however, these were often of long duration. The majority (73%) were not sexually active, with lack of a partner being a factor for many. There was also a decreasing prevalence of sexual activity with increasing age. Those sexually active in the 65–74 year old age group (n= 148) tended to have a similar sexual frequency (at least once per month) compared with the younger women studied. Approximately 12% of those who reported dyspareunia and/or vaginal dryness claimed a severe problem; 33% did not seek professional advice and 36% resorted to an over the counter remedy. Use of hormone replacement therapy was generally of relatively short duration. There was a declining gradient of ever‐use with age.

Conclusions
The extent of significant urogenital symptoms is relatively low, but some women are seriously affected and use self‐help as well as professional assistance. The extent of sexual activity in older women and factors affecting this have been defined, and the effect of urogenital symptoms on sexual activity demonstrated.
Investigation of 100 consecutive negative cone biopsies
Authors: Golbang Pouran , Scurry James , de Jong Sarah , McKenzie Dominique , Planner Robert , Pyman Jan , Davoren Ruth
Published: August 2005

Objective
To investigate the reasons for cone biopsies reported as not containing intraepithelial or invasive malignancy and thereby find ways to decrease their incidence.

Design
One hundred cone biopsies reported as negative were identified out of a total of 436 consecutive cone biopsies. The patients' cytology, colposcopy and histology reports and cytology and histology slides were reviewed. Further opinions in cases of doubt were obtained in cytology and histology. In cone biopsies still considered negative after reviews, deeper levels were cut, exhausting all paraffin blocks. Follow up cytology, colposcopy and histology were reviewed.

Setting
Gynaecological oncology unit in a university teaching hospital.

Results
After re‐evaluation the final diagnoses of cone biopsies initially reported as negative were positive (n= 21), unsatisfactory (n= 27) and true negative (n= 51), with one case excluded because of insufficient material for review. The positive cases were diagnosed on review (n= 11) or extra levels (n= 10). The unsatisfactory cases were all due to denudation. The 51 true negative cases were divided into those which never had had histologic confirmation by punch biopsy or endocervical curettage (n= 47) and those with a previously confirmed histological abnormality (n= 4).

Conclusions
The number of negative cone biopsies can be reduced by: 1. taking Pap smears after correction of atrophy and inflammation; 2. more scrupulous colposcopy aimed at reducing the number of unsatisfactory colposcopies or misinterpreted colposcopic findings; this thorough examination should include the vagina and vulva; 3. confirmation of smear and colposcopic findings by biopsy prior to cold‐knife conisation and performing a large loop excision of the transformation zone (LLETZ) for cases where there is a discrepancy between the smear abnormality and colposcopy/biopsy findings; 4. good quality cone biopsies using a technique that does not handle the mucosa and is performed after the mucosa has had time to regenerate following the colposcopic investigations; and 5. exhausting all blocks with multiple levels before reporting a cone biopsy as negative.
Use of magnesium sulphate in Scottish obstetric units
Authors: Smith Gordon C. S. , McEwan Helen P.
Published: August 2005

The greater efficacy of magnesium sulphate compared with diazepam or phenytoin in the treatment of eclampsia is now generally accepted. We used a postal questionnaire to establish the frequency and nature of use of magnesium sulphate in obstetric units in Scotland. Ninety percent of units responded and of these 90% were either using the drug or intended to do so. There was considerable heterogeneity in the indications for its use and some important omissions in the monitoring of patients receiving the drug. The introduction of magnesium sulphate for a rare indication to units with no previous experience of its use may be associated with significant risks to obstetric patients.
Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities
Authors: Ingemarsson Ingemar , Herbst Andreas , Thorngren‐Jerneck Kristina
Published: August 2005

Objective
To study the outcome after acidaemia at term birth, and the relation to gender and duration of pathological fetal heart rate changes.

Design
Population based study of 154 infants with umbilical artery pH < 7.05 at term birth. Neonatal outcome and the result of developmental screening at age four years were compared with a control group with pH > 7.10. Fetal heart rate traces in infants with acidaemia were reviewed, and the relation between duration of fetal heart rate changes and outcome was analysed.

Results
Of the 154 newborns with acidaemia at birth, 10 had encephalopathy, of which two died and two developed cerebral palsy. Nine of these 10 infants were boys, and eight had pH < 7.00. Male newborns (n= 39) more often had pronounced acidaemia (pH < 7.00) than females (n= 22). Although few infants had severe impairment, infants born with acidaemia significantly more often had speech problems at follow up than controls (19/102 versus 8/98; P= 0.03). In infants with acidaemia, duration of abnormal fetal heart rate changes was significantly associated with neonatal encephalopathy and speech problems at age four years.

Conclusions
Acidaemia at term birth was associated with neonatal encephalopathy and with speech problems at four years of age. Boys had more often pronounced acidaemia and a complicated course. A protracted abnormal fetal heart rate trace was associated with poor outcome.
Lipid peroxidation in cord blood: a randomised sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios
Authors: Wang Chi Chiu , Rogers Michael Scott
Published: August 2005

Objective
To determine the efficacy of prophylactic intrapartum amnioinfusion in reducing cord arterial lipid peroxide levels in cases of intrapartum oligohydramnios.

Design
Sequential randomised pairs trial.

Setting
Delivery suite of a teaching hospital, the Chinese University of Hong Kong.

Population
Women with singleton, term pregnancy, cephalic presentation, clear amniotic fluid and an amniotic fluid index 5 cm, with a normal intrapartum fetal heart rate tracing within 30 minutes of amniotomy.

Methods
Selected patients were randomised either for prophylactic saline amnioinfusion or as control cases. Cord arterial lipid peroxide concentrations and acid base balance were determined at delivery.

Main outcome measures
Operative intervention for fetal distress, cord arterial malondialdehyde and organic hydroperoxide levels, pH and base excess.

Results
Amnioinfusion was associated with significant reductions in the incidence of operative delivery for fetal distress and in lipid peroxide levels, an increase hi base excess, but no significant alteration in pH.

Conclusions
Oligohydramnios in labour is associated with high levels of lipid peroxidation, reflecting cellular damage by release of free radicals following hypoxia reperfusion. Prophylactic intrapartum saline amnioinfusion is an effective technique for the reduction of lipid peroxidation and of the incidence of operative intervention for fetal distress but has no significant effect on overall operative delivery rates.
Improved methods of assessing proteinuria in hypertensive pregnancy
Authors: Saudan Patrick J. , Brown Mark A. , Farrell Tanya , Shaw Loretta
Published: August 2005

Objective
To determine whether use of an automated urinalysis device will improve the accuracy of detecting proteinuria, and whether spot urine protein to creatinine ratio will provide accurate quantitation of proteinuria in hypertensive pregnant women.

Design
Prospective studies assessing the accuracy of both detection and quantitation of proteinuria.

Setting
Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia.

Population
Hypertensive pregnant women admitted to hospital or day assessment unit for management of their hypertensive disorders.

Methods
1. Routine dipstick urinalysis and 2. urinalysis by an automated device (Clinitek 100 Ames) on a midstream urine sample were compared with measurement of protein concentration on that sample (n= 103). In a third study, the protein:creatinine ratio on a midstream (spot) urine sample was compared with protein excretion over the subsequent 24 hours (n= 100).

Main outcome measures
Relations between urine protein concentrations and 1. dipstick urinalysis and 2. automated urinalysis; 3. Positive and negative predictive values of spot protein: creatinine ratio for true proteinuria ( 300 mg/day).

Results
Automated urinalysis improved the percentage of true positive urinalyses from 48% with visual urinalysis to 74% (P= 0.02). True negatives were 98% to 100% for both methods. Spot urine protein:creatinine ratio correlated well with subsequent 24‐hour urine proteinuria (r= 0.93, P < 0.001). A protein:creatinine ratio > 30 mg protein/mmol creatinine was the optimum discriminant value for true proteinuria, with sensitivity 93%, specificity 92%, positive predictive value 95% and negative predictive value 90%.

Conclusions
Use of an automated urinalysis device improved accurate detection of proteinuria, particularly reducing false positive tests. A random urine protein:creatinine ratio provides an accurate and rapid quantitation of proteinuria in hypertensive pregnant women. This should improve clinical care, especially when managing hypertensive pregnant women as outpatients.
Single photon emission and cerebral computerized tomographic scan and transcranial Doppler sonographic findings in eclampsia
Authors: Naidu K. , Moodley J. , Corr P. , Hoffmann M.
Published: August 2005

Objective
To define more clearly the neuropathophysiology of eclampsia utilising single‐photon emission computed tomography (SPECT), cerebral computerised tomography (CT) and transcranial Doppler (TCD) ultrasonography.

Design
A prospective study.

Setting
The obstetric unit in King Edward VIII Hospital, a large tertiary referral centre hi Kwa‐Zulu Natal, South Africa.

Participants
Sixty‐five women with eclampsia.

Interventions
Imaging and ultrasonographic investigations were performed within 48 hours postpartum. Unenhanced cerebral CT scans were performed in all the women and SPECT scans were performed on 63 women using Technetium‐99m‐hexamethylpropyleneamineoxime (99mTc‐HMPAO) as a tracer of regional cerebral blood flow. Middle cerebral artery blood flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach.

Main outcome measures
Abnormalities in SPECT scan, CT scan and TCD ultrasound findings.

Results
SPECT scanning revealed perfusion deficits in the watershed areas in all women, 75% of whom had concomitant deficits in the parieto‐occipital areas of the brain. Hypodensities (cerebral oedema) were reported in 38 CT scans (58.5%), with parieto‐occipital involvement in 97.4% of cases. Increased flow velocity measurements in the middle and posterior cerebral arteries were recorded in 36 (85.7%) women in whom TCD ultrasound was performed.

Conclusion
The pathophysiological mechanism of eclamptic seizures is primary cerebral vasospasm with resultant ischaemia and cerebral oedema involving mainly the watershed areas and parieto‐occipital lobes of the brain. SPECT scanning has been shown to be superior to CT scanning and TCD ultrasonography in detecting neuropathophysiologic alterations in eclampsia. However, each of the three investigative tools provide its own unique information and all three are necessary research techniques to improve our understanding of the neuropathophysiological mechanism of eclamptic seizures.
The potential of serum levels of soluble tumour necrosis factor receptor I as a biochemical marker in cervical cancer
Authors: Sheu Bor‐Ching , Lin Ho‐Hsiung , Chang Daw‐Yuan , Ho Hong‐Nerng , Huang Su‐Cheng
Published: August 2005

Objectives
To investigate the significance of serum levels of soluble tumour necrosis factor receptor I (sTNF‐RI) as a potential biochemical marker in women with cervical cancer.

Design
A prospective, case‐controlled study.

Participants
Seventy‐one women with cervical cancer and 33 women with myoma were enrolled in this study.

Methods
Pre‐operative serum levels of sTNF‐RI were measured with a standard enzyme‐linked immunosorbent assay utilising murine monoclonal antibody against sTNF‐RI.

Main outcome measures
All data in both groups were evaluated and correlated with the pre‐operative serum levels of sTNF‐RI. Data analysis was carried out using ANOVA with multiple comparison and linear regression.

Results
The mean serum level of sTNF‐RI in the cervical cancer group was significantly lower than that in the myoma group (P < 0.001). The sTNF‐RI levels decreased sequentially with disease progression from Stage Ia to IIb in women with cervical cancer. The mean serum level of sTNF‐RI was also significantly lower in women with positive lymph node (P < 0.05) or recurrent cancer (P < 0.001). A negative correlation was observed between serum levels of sTNF‐RI and tumour size (r=−0.622, P < 0.0001).

Conclusions
Decreased pre‐operative serum levels of sTNF‐RI are observed in women with cervical cancer. The results do not support that the use of sTNF‐RI as a biochemical marker for cervical cancer.
Observer variability among colposcopists from the West Midlands region
Authors: Etherington I. J. , Luesley D. M. , Shafi M. I. , Dunn J. , Hiller L. , Jordan J. A.
Published: August 2005

Objective To assess variation in diagnoses and management decisions among colposcopists when presented with cervical images; to see the impact of the referral cytology report on diagnostic accuracy.

Design A two‐part video questionnaire study.

Participants Colposcopists from West Midlands Region

Methods Twenty cervical images displaying a range of transformation zones from normal through varying abnormalities up to cervical intraepithelial neoplasia (CIN) grade 3 were shown on video tape together with basic patient information. Two sets of videos were made, the second being identical to the first other than including the referral cytology. Participants recorded their diagnoses and management decisions on prepared questionnaires. The two sets of videos were viewed several weeks apart.

Results Completed questionnaires to both videos were received from 30 colposcopists. Diagnostic accuracy improved with knowledge of the cervical cytology result in cases of CIN 2/3 (x2= 19.45, P < 0.0001) but not where the histology was CIN 1 or less (x2= 2.64, P= 0.10). Overall inter‐observer agreement improved slightly from K = 0.169 to K = 0.212 when the cytology was revealed. While only 2.6% of cases of CIN 2/3 would have been under‐managed after the second questionnaire, 37.5% cases where the abnormality did not amount to CIN would have been over‐treated.

Conclusion There is considerable inter‐observer variability and variation in diagnostic accuracy in scoring cervical images particularly at the lower end of the spectrum of abnormality which has the potential to lead to over‐treatment. We rely considerably on the cervical cytology result in forming a diagnosis. We recommend that a see‐and‐treat approach be abandoned when the referral smear shows minor abnormalities. The study has implications for both training and audit in colposcopy
Blood splashes to the masks and goggles during caesarean section
Authors: Sharma J. B. , Ekoh S. , McMillan L. , Hussain S. , Annan H.
Published: August 2005

A prospective study was performed of 100 caesarean sections (31 elective, 69 emergency) to determine the incidence of blood splashes to the masks and goggles of surgeons, assistants and scrub nurses. The rate of blood splashes was 40% on surgeons’ masks, 49.29% on surgeons’ goggles, 31% on assistants’ masks, 21.12% on assistants’ goggles, 23.1% on scrub nurses’ masks and 15.71% on scrub nurses’ goggles. The use of masks and protective goggles is strongly recommended to avoid body fluid contamination and acquiring disease in obstetrics.
Video colpography: a new technique for secondary cervical screening
Authors: Etherington I. J. , Dunn J. , Shafi M. I. , Smith T. , Luesley D. M.
Published: August 2005

Objective
To assess the diagnostic accuracy of a new technique of cervical imaging and to consider its potential as a secondary cervical screening method.

Design
A prospective cross‐sectional study with each case acting as its own control, comparing video colpography with colposcopy.

Setting
University of Birmingham colposcopy clinics, City Hospital and Birmingham Women's Hospital.

Participants
Fifty women referred for colposcopy.

Interventions
The women had a video colpogram recording made prior to colposcopy.

Main outcome measures
The proportion of technically suitable colpograms obtained and the level of agreement between colposcopist and video screener.

Results
The images were satisfactory or good in 94% cases, and there was a very high level of agreement between colposcopist and video screener (K = 0.79). If the technique had been used in a primary health care setting as a secondary screening method for women with low grade cervical smear abnormalities, 61% would have avoided referral for colposcopy.

Conclusions
Video colpography is an accurate, portable and quick method of cervical imaging. It combines the simplicity of a video camera with the versatility of computerised digital imaging and has great potential in the fields of teaching, audit and screening of low grade smear abnormalities.
Serum screening for Down's syndrome: how much do health professionals know?
Authors: Sadler Michael
Published: August 2005

Objective
To assess knowledge about serum screening for Down's syndrome in health professionals involved in antenatal care.

Design
Postal questionnaire survey of knowledge of performance and interpretation of serum screening. Setting Portsmouth and South East Hampshire health district.

Population
All health professionals likely to be involved in antenatal care.

Methods
Questionnaires were sent to all general practitioners (n= 288), hospital midwives (n= 129), community midwives (n= 71), and obstetricians (n= 29) working in the district.

Main outcome measures
Total number of correct responses given to eight factual questions and percentage of correct responses to each individual question.

Results
Responses were received from 434 health professionals (84%). Fifty‐nine percent of health professionals correctly answered only a half or less of the factual questions on serum screening. Questions relating to the sensitivity, specificity, and positive predictive value were particularly poorly answered. Obstetricians scored most highly. General practitioners scored significantly less than the other groups.

Conclusions
Women need accurate information to give informed consent to serum screening. Most health professionals likely to be involved in antenatal care in this district do not fully understand the test and are thus unlikely to provide such information. Changes in the provision of maternity services following Changing Childbirth may increase the input of midwives and general practitioners. Training of professionals about serum screening should be reviewed.
The deep venous system in the puerperium: an ultrasound study
Authors: Macklon Nicholas S. , Greer Ian A.
Published: August 2005

Objective
To study the vessel wall diameter and blood flow velocity within the proximal deep venous system of the leg in the puerperium and to compare these measures with respect to the left versus right leg, 4th versus 42nd postnatal day, and vaginal versus caesarean delivery.

Design
A combined longitudinal and cross‐sectional observational study.

Setting
The ultrasound department of a teaching maternity hospital.

Results
A reduction in vessel diameter and an increase in flow velocity was observed between the 4th and 42nd postnatal day. Vessel diameter was greater and flow velocity was reduced in the left compared to the right leg. In those delivered by caesarean section, a trend towards reduced flow velocity in the proximal deep leg veins was observed when compared with those delivered vaginally.

Conclusions
These data suggest possible physiological mechanisms behind previous clinical observations relating to the period of greatest risk of deep vein thrombosis in the puerperium, the relative preponderance of left sided deep vein thrombosis and the risk of deep vein thrombosis associated with caesarean section.
Human placental syncytiotrophoblast microvillous membranes impair maternal vascular endothelial function
Authors: Cockell Anna P. , Learmont Jonathan G. , Smárason Alexander K. , Redman Christopher W. G. , Sargent Ian L. , Poston Lucilla
Published: August 2005

Objective
To investigate the hypothesis that, should there be an increase in deported syncytiotrophoblast microvillous membrane fragments in pre‐eclampsia, it may cause maternal vascular endothelial dysfunction.

Design
Syncytiotrophoblast microvillous membrane (STEM) vesicles, prepared from normal term placentae, were perfused through small subcutaneous arteries isolated from fat biopsies obtained at caesarean section. Endothelial function of these arteries was studied by determining acetylcholine‐induced relaxation after preconstriction with noradrenaline. As controls, physiological buffer or red blood cell membranes in physiological buffer were used and endothelial function similarly estimated. Transmission electron microscopy was performed on arteries after perfusion.

Sample
STBM vesicles, isolated from the placentae of three healthy women undergoing elective caesarean section for reasons unrelated to pre‐eclampsia, were suspended in physiological buffer. Subcutaneous fat arteries were obtained from a separate group of 13 normotensive pregnant women, also undergoing elective caesarean section at term.

Results
Perfusion with red blood cell membranes or physiological buffer had no significant effect on the concentration dependent relaxation in arteries preconstricted with noradrenaline. However, after 2 h perfusion with STBM vesicles, arteries showed a significant reduction in relaxation to acetylcholine, indicative of altered endothelial function. Transmission electron microscopy of arteries perfused with STBM vesicles confirmed endothelial disruption.

Conclusions
STBM vesicle perfusion specifically altered the relaxation response of preconstricted maternal subcutaneous fat arteries to acetylcholine, suggesting an alteration in endothelial dependent relaxation. Deported microvilli may therefore be capable of producing endothelial cell damage and endothelial dysfunction observed in the maternal syndrome of pre‐eclampsia.
The electroencephalogram during normal third trimester pregnancy and six months postpartum
Authors: Keunen R. W. M. , Vliegen J. H. R. , van der Pol D. A. E. , Gerretsen G. , Stam C. J.
Published: August 2005

In 1942 Gibbs and Reid described a slowing of the electroencephalogram (EEG) at the end of a normal pregnancy. To the best of our knowledge this is the only report that addresses the modification of the EEG in normal pregnancy. We performed a spectral multichannel EEG analysis and revealed no differences during third trimester pregnancy and six months postpartum. Therefore EEG changes seen during pregnancy, which were previously regarded as ‘subtle changes of pregnancy’, may turn out to be clinically relevant changes which indicate either pre‐existing EEG dysfunction or EEG abnormalities in the context of a pregnancy‐related disorder.
Prevalence and characteristics associated with use of hormone replacement therapy in Britain
Authors: Moorhead Timothy , Hannaford Philip , Warskyj Maria
Published: August 2005

Objective
To describe trends in the prevalence of hormone replacement therapy (HRT) use among women living in Britain between 1981 and 1990, and to determine whether women who receive HRT are different from those who do not.

Design
Population‐based, prospective, observational study.

Setting
Fourteen hundred general practices throughout the United Kingdom contributing data to the Oral Contraception Study of the Royal College of General Practitioners (RCGP).

Population
Prevalence of use: women still under general practitioner observation in the Oral Contraception Study at the end of December 1981 (n= 19,949), 1984 (n= 18,037), 1987 (n= 16,063), 1990 (n= 13,379). Characteristics of users: 3806 HRT users and 3806 never‐users matched for age, hysterectomy status and duration of observation in the Oral Contraception Study.

Main outcome measure
Ever‐use of hormone replacement therapy.

Results
Between 1981 and 1990 there was a threefold increase in HRT use among women both among those who had and those who had not had a hysterectomy. Increasing trends were apparent in all age groups. By December 1990, 19% of all women (36% of those who had had a hysterectomy and 16% of those who had not had a hysterectomy) had ever used HRT; 9% were classified as current users. Forty‐one percent of women using HRT who had had a hysterectomy received combined (oestrogen and progestogen) preparations; 31% of those who had not had a hysterectomy received at least one prescription for unopposed oestrogen. Among those who had had a hysterectomy, HRT was more likely to be prescribed in women with a history of smoking, nonpsychotic psychiatric illness, hot flushes, other menopausal symptoms, oophorectomy, migraine or headache. Women with breast cancer were less likely to receive HRT. In women who had not had a hysterectomy, smoking, nonpsychotic psychiatric illness, hot flushes, other menopausal symptoms, migraine, headache and previous use of oral contraceptives increased the chances of HRT being used; a history of breast cancer, ischaemic heart disease or diabetes mellitus reduced the chances. Weaker associations of reduced risk were also found for hypertension and lower social class. The influence of hot flushes and other menopausal symptoms appeared to be stronger in women who used HRT before the age of 50, than in older women.

Conclusions
HRT use increased dramatically within the cohort during the nine year period. HRT users are different from nonusers in a number of ways which could have opposing effects on a woman's risk of cardiovascular disease.