bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic ovarian diathermy: an effective treatment for anti‐oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome
Authors: Armar N. A. , Lachelin Gillian C. L.
Published: August 2005

Objective
To determine the long term efficacy of laparoscopic ovarian diathermy in the management of refractory anovulatory infertility in women with the polycystic ovary syndrome.

Design
Open study of 50 women treated over a period of 3 years and 3 months, with follow up until 18 months after the last woman was treated.

Setting
Teaching Hospital.

Subjects
Fifty consecutive women with refractory anovulatory infertility (mean duration 5.3 (SD 3.5) years). All had been treated unsuccessfully with anti‐oestrogens and more than half with gonadotrophins.

Interventions
Laparoscopic ovarian diathermy.

Main outcome measures
Ovulatory cycles and pregnancies.

Results
Forty‐three women (86%) ovulated following ovarian diathermy; the mean time to ovulation was 23 (SD 6.2) days. Three nonresponders ovulated following anti‐oestrogen treatment to which they were previously resistant. Thirty‐three women have conceived 58 pregnancies; 22 had no treatment other than ovarian diathermy prior to their first post‐operative conception; in seven an anti‐oestrogen was given because of lengthening cycles; two were treated elsewhere with gonadotrophins without prior postdiathermy anti‐oestrogen therapy and conceived; four had the operation repeated and two of these conceived. Twenty‐six women conceived within the first 8 post‐operative months. Forty‐two pregnancies ended in the birth of normal live healthy babies, eight are ongoing and eight miscarried. Of the 22 women who had no pelvic abnormality other than polycystic ovaries, 19 (86%) have had one or more successful pregnancies.

Conclusion
Laparoscopic ovarian diathermy is a very effective treatment for anti‐oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome and should be considered as the next step in those who fail to respond to anti‐oestrogen treatment.
Prediction of fetal acidaemia in pregnancies complicated by maternal diabetes mellitus by biophysical profile scoring and fetal heart rate monitoring
Authors: Salvesen Douglas R. , Freeman Jill , Brudenell J. Michael , Nicolaides Kypros H.
Published: August 2005

Objective
To determine whether computer assisted fetal heart rate analysis or the biophysical profile score can provide noninvasive prediction of fetal acidaemia.

Design
Cross sectional study.

Setting
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital School of Medicine, London.

Subjects
Forty‐one women with pregnancies complicated by diabetes mellitus.

Interventions
Fetal heart rate (FHR) monitoring with computer assisted analysis, biophysical profile score (BPS) and cordocentesis for measurement of umbilical venous blood glucose concentration and blood gases, up to 24 h before delivery at 27 to 39 weeks gestation.

Results
The mean umbilical venous blood pH was significantly lower than the normal mean for gestation, and was below the 5th centile in 18 pregnancies, including all six cases where the mother had nephropathy and hypertension. The mean pO2 was not significantly different from the normal mean for gestation. There were significant associations between fetal acidaemia and both the BPS (r= 0.46, P<0.01) and FHR variation (r= 0.42, P<0.01). However, of the 12 acidaemic fetuses of non‐nephropathic mothers, nine had normal BPS and six had normal FHR variation.

Conclusions
In pregnancies complicated by maternal diabetes mellitus, BPS and FHR variation are of limited value in the prediction of fetal blood pH.
Randomised controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia
Authors: Dwyer Nuala , Hutton John , Stirrat Gordon M.
Published: August 2005

Objective
To evaluate the effectiveness of endometrial resection as a surgical treatment for menorrhagia.

Design
Randomised controlled trial.

Setting
Gynaecology department at a teaching hospital.

Subjects
Two hundred women needing surgical treatment for menorrhagia between January 1990 and May 1991. After withdrawal of four women 97 underwent hysterectomy and 99 underwent endometrial resection.

Main outcome measures
Patient satisfaction 4 months after surgery; post‐operative complications; length of hospital stay; duration of time before return to work, normal daily activities and sexual intercourse; change in premenstrual symptoms.

Results
The difference in patient satisfaction between endometrial resection (84 out of 99) and abdominal hysterectomy (89 out of 95) just reached statistical significance in favour of abdominal hysterectomy at 4 months after surgery (difference = 9%, 95% confidence intervals (CI) 1.1%–17.5%). Post‐operative morbidity, length of hospital stay and time taken to return to work, normal daily activities and sexual intercourse were significantly less in the endometrial resection group. However, the premenstrual symptoms of dysmenorrhoea, bloating and breast tenderness were less frequent after hysterectomy.

Conclusion
In the short term, endometrial resection was almost as satisfactory as abdominal hysterectomy for the surgical treatment of menorrhagia, and was associated with less morbidity. However, even at 4 months after surgery, there was a failure rate of at least 10% in those in whom endometrial resection appeared complete. Longer term comparative studies are necessary before the widespread introduction of endometrial resection as an alternative to abdominal hysterectomy for the surgical treatment of menorrhagia.
The effect of early labour, maternal analgesia and fetal acidosis on fetal plasma oxytocin concentrations
Authors: Thornton S. , Charlton L. , Murray B. J. , Davison J. M. , Baylis P. H.
Published: August 2005

Objective
To determine the effect of early labour, maternal analgesia and fetal hypoxia on circulating fetal oxytocin concentrations.

Design
Prospective observational study.

Setting
Delivery suite in a District General Hospital.

Subjects
Fifty women at term who did not require oxytocin administration or more than one form of analgesia. Study groups: vaginal delivery with (1) no analgesia, (2) pethidine, or (3) epidural analgesia. Caesarean section under regional analgesia (4) prior to, and (5) after the onset of labour.

Interventions
Samples of blood were collected from the umbilical artery (UA) and umbilical vein (UV) immediately after fetal delivery prior to placental separation or oxytocic administration.

Main outcome measures
Plasma oxytocin (OT) concentration, umbilical vein pH, cystine aminopeptidase activity.

Results
The geometric mean UA–OT was significantly greater than UV–OT in all groups and was not altered by pethidine; however, epidural administration increased the UA–UV difference. The UA–UV difference at caesarean section was not significantly altered by the onset of labour. There was no correlation between UV pH and UA–UV plasma oxytocin. Cystine aminopeptidase activity was not detectable in UA and UV plasma.

Conclusions
Fetal OT production is increased by epidural but not by pethidine analgesia. It is not influenced by the onset of labour or fetal hypoxia.
Levels of insulin‐like growth factor‐I and insulin‐like growth factor‐binding protein‐1 in pregnancy with preterm delivery
Authors: Wang Hsin‐Shih , Lee Cheng L. , Chard Tim
Published: August 2005

Objective
To investigate the relationship between preterm delivery and maternal serum insulin‐like growth factor‐I (IGF‐I) and insulin‐like growth factor‐binding protein‐1 (IGFBP‐1) levels.

Design
A study over a 12 month period in which all samples were collected according to a pre‐set protocol.

Setting
St. Bartholomew's Hospital, London.

Subjects
Thirty‐eight nonpregnant adult females, 456 pregnant women at various gestational ages, 84 women with average‐for‐gestational‐age babies at term delivery, and 49 pregnant women with preterm delivery (44 with singleton pregnancy and five with twin pregnancy).

Main outcome measures
Serum IGF‐I and IGFBP‐1 levels were determined by radioimmunoassay.

Results
Serum IGF‐I concentrations increased as pregnancy progressed. In the third trimester, serum IGF‐I levels in singleton preterm deliveries were lower than those in normal pregnancies, and IGFBP‐1 concentrations were higher than those in normal pregnancies. This phenomenon was not obvious in the second trimester. Maternal circulating IGFBP‐1 levels were correlated inversely with birthweight in women with singleton preterm delivery.

Conclusions
Neither IGF‐I nor IGFBP‐1 appears to play a significant role in preterm delivery since maternal serum IGF‐I and IGFBP‐1 levels are similar in preterm and term deliveries.
The incidence of vaginal bleeding with tibolone treatment
Authors: Rsymer J. , Fooelman I. , Chapman M. G.
Published: August 2005

Objective
To determine the incidence of breakthrough bleeding and its significance in recently postmenopausal women who take tibolone (Livial‐Organon).

Design
A two year comparative nonrandomised prospective study of women taking tibolone (2–5 mg) and control subjects not on medication.

Setting
Teaching hospital menopause and well women clinic.

Subjects
One hundred women who were recently menopausal (between 6 and 36 months since last menstrual period). Fifty were commenced on tibolone and 50 received no medication.

Main outcome measures Episodes of bleeding throughout the two year study period were recorded. Oestradiol levels were measured at baseline and at six, 12 and 24 months. The age of menopause and time since last menstrual period (LMP) were noted.

Results
Twenty percent (12/59) (95% CI 11.0% to 32.8%) of women in the tibolone group had breakthrough bleeding compared with 9.4% (5/23) (95% CI 3.1% to 20.7%) in the control group. Of the women who bled in the tibolone group, 50% had LMP between six and 12 months prior to entering the study, and 83% were younger than the average age of menopause. Sixty‐seven percent had detectable oestradiol levels on at least one occasion over the two years (five women had detectable oestradiol levels and did not bleed). None had evidence of endometrial stimulation at dilatation and curettage. Eighty percent of women who bled in the control group were between six and 12 months since LMP on entry into the study, and 80% had detectable oestradiol levels during the study. At dilatation and curettage there was no evidence of endometrial stimulation.

Conclusions
A minority of women will bleed on tibolone therapy. Women who are likely to bleed are younger, are recently menopausal, and may have remaining endogenous oestrogen production.
Taking account of vaginal bleeding in screening for Down's syndrome
Authors: Cuckle H. , Van Oudgaarden E. D. , Mason G. , Holding S.
Published: August 2005

Objective
To derive a method for revising the risk of Down's syndrome in maternal serum marker screening when there is vaginal bleeding. The effect on screening performance of routinely allowing for the presence or absence of bleeding in all women is also assessed.

Design
Overview of published studies on the rate of reported vaginal bleeding in pregnancies with Down's syndrome, on the rate according to maternal age and on the association of bleeding with alpha‐fetoprotein (AFP) level. The publications are supplemented with data on unconjugated oestriol (uE3), human chorionic gonadotrophin (hCG) and AFP levels in a consecutive series of screened women.

Setting
Routine Down's syndrome screening tests carried out on women having antenatal care at the St James's University Hospital, Leeds.

Subject
Eight hundred and nine screened women.

Results
In five studies the rate of vaginal bleeding in Down's syndrome pregnancies was 1.7 times that in unaffected pregnancies on average. In three studies, the vaginal bleeding rate increased proportionally by 2.2 % on average for each year of maternal age. Three studies and our own data were consistent with a 10% increase in the mean AFP level associated with vaginal bleeding, but it did not appear to materially alter uE3 and hCG levels or the standard deviations and correlation coefficients for any of the three analytes. An individual woman's risk was calculated by multiplying her age‐specific odds of Down's syndrome by two likelihood ratios, one relating to the vaginal bleeding itself and one from the marker levels. Routine allowance for the presence or absence of vaginal bleeding was estimated to increase the detection rate by less than 1%.

Conclusion
Our method is of clinical value in revising the risk when there is concern that vaginal bleeding might be responsible for a negative maternal serum Down's syndrome screening result. A policy of routinely incorporating information on vaginal bleeding in risk estimation for all women would have too small an effect on overall screening performance to recommend it.
The cell adhesion molecule, VCAM‐1, is selectively elevated in serum in pre‐eclampsia: does this indicate the mechanism of leucocyte activation?
Authors: Lyall Fiona , Greer Ian A. , Boswell Fiona , Macara Lena M. , Walker James J. , Kingdom John C. P.
Published: August 2005

ObjectiveTo determine whether circulating levels of cell adhesion molecules, markers of endothelial damage and leucocyte activation, were increased in pre‐eclampsia.

DesignSerum was prepared from peripheral venous blood and stored at –70°C. The cell adhesion molecules, VCAM‐1, E‐Selectin and ICAM‐1, were measured by ELISA.

SettingDepartment of Obstetrics and Gynaecology, Royal Infirmary, Glasgow.

SubjectsSixteen primigravid women with pre‐eclampsia were recruited for the study. The pre‐eclampsia group were compared with 18 healthy primigravid women with uncomplicated pregnancies.

ResultsThe pre‐eclamptic group had significantly higher serum levels of the cell adhesion molecule VCAM‐1 (t= 3.673;P< 0.001). There were no significant differences in the adhesion molecules ICAM‐1 or E‐Selectin.

ConclusionsEndothelial damage and dysfunction are common to all the pathological features of pre‐eclampsia. This study shows that concentrations of cell adhesion molecules, which indicate leucocyte‐endothelial attachment and activation, are elevated in the serum of patients with pre‐eclampsia. Such increases in soluble circulating cell adhesion molecules may reflect increased expression of these molecules on the endothelium and thereby explain the mechanism for leucocyte activation in pre‐eclampsia.
Planned vaginal delivery after two previous caesarean sections
Authors: Chattopadhyay Sisir K. , Sherbeeni Mariam M. , Anokute Charles C.
Published: August 2005

Objective
To determine the outcome of trial of labour after two caesarean sections.

Design
Prospective observational study.

Setting
Maternity and Children's Hospital, Riyadh, Saudi Arabia.

Subjects
Women with two previous caesarean sections considered suitable for a trial of vaginal delivery.

Main outcome measures
The rates of vaginal delivery, scar dehiscence, uterine rupture and associated complications among 115 women with two previous sections who underwent trial of labour were compared with 1006 women with two previous sections who did not have a trial of labour.

Results
Trial of vaginal delivery was requested by 230 out of 1136 women (20%) who had two previous caesarean sections. Of the 115 women accepted for the trial, 103 (89%) were delivered vaginally. Labour started spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin (PGE2) in the remaining 37. Augmentation of labour with oxytocin was required in 32 (28%) of the trial labour group. There were no scar dehiscences among the women delivered vaginally. There was one scar dehiscence and one woman required hysterectomy after failed trial of labour, a frequency comparable to the occurrence of these complications in women who did not have a trial of labour.

Conclusion
A trial of labour in selected patients with two previous caesarean sections appears a reasonable option.
Fetal fibronectin detection for prediction of preterm birth in low risk women
Authors: Hellemans P. , Gerris J. , Verdonk P.
Published: August 2005

Objective To evaluate the clinical value of cervical fetal fibronectin detection by a quantitative enzyme‐linked immunosorbent assay (ELISA) (PTDcheck®, Adeza Biomedical, Sunnyvale, California, USA) as a screening tool for the prediction of preterm contractions and preterm delivery in an unselected population of pregnant women globally considered to be at low risk for preterm delivery (n = 133).

Design A prospective study in which cervical fetal fibronectin samples were collected at two‐week intervals between 26 and 36 weeks of gestation.

Setting A regional training hospital.

Subjects One hundred and thirty‐three singleton pregnancies presenting consecutively at an antenatal clinic.

Main outcome measure Occurrence of preterm contractions and preterm delivery (delivery at < 37 weeks of gestation).

Results Twenty‐four (18 %) patients were considered positive for the presence of fetal fibronectin. Overall 15 patients (11%) developed preterm contractions and, despite therapeutic intervention, 10 patients (8 %) were delivered preterm. As a predictor for preterm contractions, cervical fetal fibronectin detection had a sensitivity of 47%, a specificity of 86%, a positive predictive value of 29% and a negative predictive value of 93%. As a predictor for preterm delivery, cervical fetal fibronectin detection had a sensitivity of 60%, a specificity of 85Y0, a positive predictive value of 25% and a negative predictive value of 96%.

Conclusions Cervical fetal fibronectin determinations at a two‐week sampling frequency for prediction of preterm birth in a general obstetric population at low risk for preterm birth has limited clinical value as a routinely performed screening procedure.
Measurement of creatine kinase activity and diagnosis of ectopic pregnancy
Authors: Duncan W. C. , Sweeting V. M. , Cawood P. , Illingworth P. J.
Published: August 2005

Objective To investigate whether the measurement of maternal plasma creatine kinase concentration is of clinical value in the diagnosis of tubal ectopic pregnancy.

Design A retrospective observational study covering a three month period.

Setting The gynaecological emergency service of a UK teaching hospital.

Subjects One hundred and twenty women presenting with clinical suspicion of an ectopic pregnancy such that plasma human chorionic gonadotrophin (hCG) concentration was measured.

Main outcome measures Plasma hCG and creatine kinase concentrations were measured. Pregnancies were classified as ectopic pregnancy, complete miscarriage, incomplete miscarriage or ongoing pregnancy. Pregnancies were further classified as uncertain diagnosis if the diagnosis was not clear after initial investigation.

Results Twenty‐one of the patients had an ectopic pregnancy. Diagnosis was classified as uncertain in 48 % of pregnancies studied and in 54% of ectopic pregnancies during the study period. The mean plasma creatine kinase was higher in ectopic pregnancies than other pregnancies in the study group (P < 0.01) and remained higher in the subgroup of patients with uncertain diagnosis (P < 0.05) but there were significant overlaps in creatine kinase concentrations in all four clinical groups. When a cut‐off point of 45 iu/l is used, the measurement of plasma creatine kinase activity has a sensitivity of 0‐57 and a specificity of 0.67 for the diagnosis of ectopic pregnancy.

Conclusions The plasma concentration of creatine kinase is not sufficiently discriminative to be of clinical value in the diagnosis of tubal ectopic pregnancy.
Initial experience with laparoscopic‐assisted Doderlein hysterectomy
Authors: Garry Ray , Hercz Peter
Published: August 2005

Objective To assess the outcome of a modified laparoscopic‐assisted Doderlein hysterectomy.

Define A prospective clinical study.

Setting Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, Cleveland.

Subjects Twenty consecutive women with indications for hysterectomy and unsuitable for vaginal approach.

Intervention Laparoscopic‐assisted Doderlein hysterectomy with modification to make the technique cost effective.

Main outcome measures Operative time, uterine weight, blood loss, hospital stay, intra‐operative complications and post‐operative complications.

Results The median operative time was 93 minutes, the uterine weight was 168 g, blood loss minimal. The median hospital stay was three days. There were no intra‐operative complications and minimal post‐operative complications.

Conclusions The modified laparoscopic‐assisted Doderlein hysterectomy is a safe, rapid procedure which allows the patient to achieve all the benefits of laparoscopic surgery with simple and inexpensive laparoscopic and vaginal techniques.
The management of recurrent genital herpes infection in pregnancy: a postal survey of obstetric practice
Authors: Brocklehurst P. , Carney O. , Ross E. , Mindel A.
Published: August 2005

Objective
To determine clinical practice amongst bstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection.

Methods
All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection.

Results
There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81)routinely examined the genitals for evidence of a recurrence.

When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (χ2= 30.38, P < 0.0001). Five hundred and ninety‐six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture.

The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was onsidered an acceptable indication for operative delivery by 745 obstetricians (62%).

Conclusions
1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.
Transabdominal cervicoisthmic cerclage in the management of recurrent second trimester miscarriage and preterm delivery
Authors: GIBB DONALD M. F. , SALARIA DABEER A.
Published: August 2005

Objective
To evaluate the role of transabdominal cervicoisthmic cerclage (TCC) in the management of recurrent mid‐trimester pregnancy miscarriage and preterm delivery.

Design
An observational study of 50 women with history of recurrent second trimester miscarriage and preterm delivery in whom TCC was performed.

Setting
A tertiary referral centre for high risk obstetrics.

Results
TCC was performed on 51 occasions in 50 women. One had TCC performed in two successive pregnancies. Prior to the procedure, they had experienced 36 first trimester miscarriages and 163 later pregnancy losses. These included 152 midtrimester miscarriages and 11 neonatal deaths after preterm delivery. There had been 4 survivors after preterm delivery. The total number of pregnancies after TCC was 61 with three women losing one pregnancy and subsequently having a successful pregnancy. Of these women 44 now have had a successful outcome. Six have not had a successful outcome. Eight women have had two successful consecutive pregnancies after TCC. The fetal survival was 85.2% post‐procedure.

Conclusions
TCC is a procedure that may be used in a highly selected group of women with anatomical defects of the cervix and previous failed transvaginal cerclage resulting in recurrent second trimester pregnancy loss and preterm birth. Strict selection criteria were applied as TCC is an invasive procedure. Although TCC is not widely used our study suggests it may be the procedure to consider in women who have had recurrent second trimester pregnancy losses and preterm births associated with cervical damage.
Labour and delivery of ‘normal’ primiparous women: analysis of routinely collected data
Authors: Middle Claire , Macfarlane Allson
Published: August 2005

Objective
To ascertain whether there is variation in obstetric practice within a defined subgroup of primiparous women.

Design
Analysis of routinely collected data.

Subjects
Ten thousand two hundred and ninety‐five primiparous deliveries defined as ‘normal’ in Scotland during 1990 and 44,820 primiparous deliveries defined as ‘normal’ in England between April 1990 and April 1991.

Results
Little variation was found in the distribution of mothers' ages and gestational ages at delivery, and babies' birthweights. In both England and Scotland there was considerable variation between regions in instrumental delivery rates and caesarean section rates. There were many deficiencies in the quality of the data provided by the English Maternity Hospital Episode System.

Conclusions
There is regional variation in instrumental delivery rates and caesarean section rates in England and Scotland. The poor quality of data for England makes interpretation of the cause of variation difficult because the extent to which variation may reflect deficiencies in the data, rather than differences in practice, is unknown. Improvements need to be made in Maternity Hospital Episode system data, increasing both coverage and data quality. Nevertheless, similar variations in instrumental delivery and caesarean section rates may be associated with differences in population characteristics not measured in these data sets of differences in obstetric practice.
Down's syndrome births and pregnancy terminations in 1989 to 1993: preliminary findings
Authors: Alberman Eva , Mutton David , Ide Roy , Nicholson Amanda , Bobrow Martin
Published: August 2005

Objective
To investigate changes in the numbers of Down's syndrome births and terminations of pregnancies from 1989 to 1993.

Design
Data from a national register of cytogenetic diagnoses of karyotypes associated with Down's syndrome were analysed to obtain observed numbers of births and terminations of pregnancies known to be affected. Allowance was made for those cases diagnosed prenatally for whom the eventual outcome of the pregnancies had not yet been ascertained.

Results
There has been an increase over the study years in the number of cytogenetic diagnoses of Down's syndrome from 1063 in 1989 to 1137 in 1993, despite an overall fall in births in England and Wales. This is largely due to the increase in antenatal screening and diagnosis, but in part also due to the rise in numbers of pregnancies at increased maternal ages. The rise in prenatally diagnosed cases, of which 92% end in termination, has been accompanied by a fall in both the estimated numbers of affected live births, from 764 in 1989 to 615 in 1993, and the rate per 1000 total live births in the same years from 1.1 to 0.9.

Conclusions
Better and speedier information on the outcome of prenatally diagnosed cases of congenital anomalies such as Down's syndrome would improve the quality of information available for those auditing genetic services or those planning for the care of survivors.
Elevated levels of insulin‐like growth factor binding protein‐1 in fetal distress
Authors: Crawford R. A. F. , Hills F. A. , Farkas A. , Chard T.
Published: August 2005

Objective
To investigate the association between fetal distress (abnormal cardiotocograph tracing and/or a low fetal pH) and the levels of fetal IGFBP‐1.

Design
Prospective comparative study.

Subjects and methods
Twenty‐two women in labour with evidence of fetal distress defined by FIGO criteria and 19 women in uncomplicated labour. The gestation range was 37 to 42 weeks and birthweight range was 2500 to 4240 g. IGFBP‐1 was determined by radioimmunoassay.

Results
The umbilical levels of IGFBP‐1 were significantly higher in the study group compared with the control group (median 282.5 μg/l versus 128 μg/l, P= 0.0046; Mann‐Whitney U test). There was a significant inverse correlation between fetal IGFBP‐1 and cord pH (r = 0.58, P≤ 0.0001). There was no difference between the maternal serum levels of IGFBP‐1 in the two groups.

Conclusion
Umbilical IGFBP‐1 is elevated in association with fetal distress.
Low incidence of primary infection with toxoplasma among women in Sheffield: a seroconversion study
Authors: Zadik P. M. , Kudesia G. , Siddons A. D.
Published: August 2005

Objective
To determine the incidence of primary toxoplasma infection in women of childbearing age.

Design
A retrospective study of seroconversion on stored pairs of sera taken for routine antenatal testing.

Setting
The antenatal clinics and general practices of Sheffield between July 1989 and October 1992.

Subjects
One thousand six hundred and twenty‐one women on whom pairs of sera, separated by more than 500 days, had been received.

Main outcome measure
Rate of primary infection determined by seroconversion as measured by the presence of antibody in the second serum and its absence in the first.

Results
Of 1621 women, 160 (9.9%) were initially seropositive. One seroconversion was detected in 2966 woman years of observation for susceptibles. The projected rate for primary infections was 0.23 (95% CI 0.0059–1.3) per 1000 pregnancies.

Conclusions
The rate is much lower than for earlier estimates of incidence in the UK but agrees with a more recent estimate from Sheffield and suggests a falling incidence.
Nitric oxide synthase activities in placental tissue from normotensive, pre‐eclamptic and growth retarded pregnancies
Authors: Mmorris Nicholas H. , Sooranna Suren R. , Learmont Jonathan G. , Poston Lucilla , Ramsey Bruce , Pearson JeremyD. , Steer Philip J.
Published: August 2005

ObjectiveTo measure nitric oxide synthase activity in tissues from the placenta, placental bed and umbilical cord at delivery in normal and complicated pregnancies.

DesignA prospective blinded study.

SettingThe obstetric departments of three London teaching hospitals.

SubjectsSamples of whole placenta, dissected stem villous arteries, umbilical cord vessels and the placental bed of the uterus were collected at delivery and assayed for nitric oxide synthase activity. Samples of placenta were taken from ten normotensive, six pre‐eclamptic and eight growth retarded pregnancies, and stem villous arteries from a further seven normotensive pregnancies.

ResultsThere was minimal placental bed nitric oxide synthase activity in each group. Placental villous homogenates from pregnancies complicated by pre‐eclampsia and fetal growth retardation had significantly lower activities of nitric oxide synthase than those from normotensive women with appropriately grown babies. There were no significant differences in calcium dependent or calcium independent nitric oxide synthase activities in the umbilical vein and artery in the normal or in the pre‐eclamptic groups. However, there was significantly more calcium dependent than calcium independent nitric oxide synthase in the umbilical veins in all groups.

ConclusionsLocal nitric oxide production in the placental bed of the uterus is unlikely to contribute substantially to the low resting vascular tone in the uteroplacental circulation. However, a relative deficiency of placental nitric oxide in pregnancies complicated by fetal growth retardation and pre‐eclampsia may contribute to the development of the high impedance fetoplacental circulation found in these conditions.
Presentation and management of choriocarcinoma after nonmolar pregnancy
Authors: Tidy John A. , Rustin Gordon J. S. , Newlands Edward S. , Foskett Marianne , Fuller Sandra , Short Delia , Rowden Philippa
Published: August 2005

Objective
To ascertain the mode of presentation and treatment outcome for women with choriocarcinoma after a nonmolar pregnancy.

Design
Retrospective analysis of case records between 1985 and 1994.

Setting
A referral centre for trophoblastic disease.

Subjects
One hundred women with choriocarcinoma: 62 after a live birth, six after a live birth preceded by a molar pregnancy and 32 after a nonmolar abortion.

Results
Choriocarcinoma after nonmolar pregnancies represent 17% of the total gestational trophoblastic tumours requiring treatment. Vaginal bleeding was the commonest symptom in all groups, but symptoms from metastatic disease were important in the group presenting after a live birth. Metastatic disease was present in 31% of cases after live birth and 43% post‐abortion. The median interval between the antecedent pregnancy and choriocarcinoma was five and six months, respectively. High risk multi‐agent chemotherapy was required in 82% and 60% of cases, respectively. The mortality rate was significantly higher after a live birth than a nonmolar abortion (21%vs 6%).

Conclusions
Treatment of choriocarcinoma after a live birth is associated with an unacceptably high mortality rate. Vaginal bleeding is an important early symptom and a pregnancy test should be performed if it persists after usual medical treatment.
Disappearance of fetal choroid plexus cysts during the second trimester in cases of chromosomal abnormality
Authors: Montemagno R. , Soothill P. W. , Scarcelli M. , Rodeck C. H.
Published: August 2005

We report two cases in which isolated choroid plexus cysts (CPC) disappeared in the second trimester of pregnancy and were associated with chromosomal abnormahty (trisomy 21 and trisomy 18). In the trisomy 21 fetus the CPC was small (2.3 mm) and unilateral.
Pregnancy with stillbirth of both twins
Authors: Rydhstroem Hakan
Published: August 2005

Objective
To identify and evaluate clinical characteristics in pregnancy leading to stillbirth of both twins.

Material and methods
All 68 twin deliveries in Sweden from 1973 to 1989 inclusive, where both twins were dead at birth, were identified by extracting information filed at the Medical Birth Registry (MBR), the National Board of Health and Welfare, Stockholm. Information in the MBR was used for analysis. A questionnaire was also distributed to each delivery unit to obtain information on ultrasound scan made before either or both twins died, and type of placentation.

Results
The relative risk for like‐sexed (n= 66) vis‐à‐vis unlike‐sexed fetuses (n= 2) to suffer intrauterine death was 12.6 (95% confidence limits 4.3, 375). The rate of like‐sexed twins was 97.1%versus 72.2% for the general twin population; monochorionic placentation was identified in 50.0% of these pregnancies. In only seven was there a cause of death evident, including five pregnancies with lethal malformation. The median gestational duration was 33 weeks (range 26 to 41). For the smaller twin in the pair there was an obvious trend toward low birthweight and 16.1% were by definition small for gestational age, whereas the larger twins seemed to have a normal birthweight distribution. The proportion of pregnancies with both twins stillborn increased significantly with increasing discordance in weight (linear trend χ2= 4.5; P= 0.03). The interval between ultrasound examination showing two living fetuses and delivery was nine days or less in half the cases.

Conclusion
The major risk factor for fetal deaths seems to be a like‐sexed pregnancy with a monochorionic placenta. About half of pregnancies with available information had no more than nine days between an ultrasound examination, confirming two living fetuses, and birth. The great majority of these twins did not show evidence of growth retardation, but birthweight discordance may be a risk factor for fetal death.
A population based survey of women's experience of the menopause
Authors: Porter Maureen , Penney Gillian C. , Russell Daphne , Russell Elizabeth , Templeton Allan
Published: August 2005

Objective
To describe the prevalence of, and degree of distress caused by, 15 symptoms commonly attributed to the menopause among a random sample of women aged 45 to 54, selected from the total population of a geographically defined area.

Design
Postal questionnaire survey.

Setting
Grampiane Health Board area.

Participants
Eight thousand women, aged 45 to 54, randomly selected from the Grampian Community Health Index.

Main outcome measures
Self‐reported symptoms, including depression, and use of hormone replacement therapy (HRT) among women of differing menopausal status.

Results
The response rate was 78%; 57% of respondents had experienced one or more of the 15 symptoms listed, but only 22% had found such symptoms a problem. Women's experience of classic vasomotor and atrophic symptoms varied according to menopausal status but experience of general somatic and psychological symptoms did not. Users of HRT and women whose menopause was iatrogenic found more symptoms a problem.

Conclusions
Symptoms attributed to the menopause are common among women in the age group studied but often are not perceived as a problem. Among nonusers of HRT, only vasomotor and atrophic symptoms vary with menopausal status. Other somatic and psychological symptoms experienced by middle‐aged women cannot be regarded as part of the same ‘menopausal syndrome’.
A new method for measuring menstrual blood loss and its use in screening women before endometrial ablation
Authors: Gannon Michael J. , Day Philip , Hammadieh Nahed , Johnson Nicholas
Published: August 2005

Objective
1. To develop and validate a method for measuring menstrual blood loss in a routine setting, and 2. To assess the value of measuring menstrual blood loss before endometrial ablation.

Design
A prospective, observational study.

Setting
Four Yorkshire hospitals: The General Infirmary at Leeds, St James's University Hospital, Leeds, St Luke's Hospital, Bradford and The Friarage Hospital, Northallerton.

Participants
Three hundred and seventy‐two women who had been offered endometrial ablation for menorrhagia.

Measurement
Sanitary material was washed with a nonioriic detergent in a known volume of water. The haemoglobin in a sample of solution was measured by mixing with sodium carbonate for spectrophotometric analysis.

Interventions
The menstrual blood loss result was revealed to each woman. Electrosurgical endometrial ablation was performed for those who decided to have surgery.

Main outcome measures
Proportion of women with normal menstrual blood loss ( 80 mL) who avoided surgery. Comparison of endometrial ablation outcome in women with and without genuine menorrhagia.

Results
Thirty‐six women (10%) with normal menstrual blood loss who declined surgery continued to avoid surgery after a mean of 27 months. Two hundred and ninety‐two women were followed up for one year after endometrial ablation. Those with genuine menorrhagia (n= 122) were less likely to be dissatisfied (9%vs 18%) (OR 23, 95% CI 1.1–4.7) or to require hysterectomy (4%vs 7%) (OR 1.8, 95% CI 06–52) than women with normal menstrual blood loss (n= 170).

Conclusions
The objective diagnosis of menorrhagia can be undertaken in a routine setting and may provide some women, who have a normal menstrual blood loss, sufficient reassurance to refrain from surgery. Women with genuine menorrhagia have a better outcome after endometrial ablation than those with normal menstrual blood loss.
Comparison of Gram‐stained smears prepared from blind vaginal swabs with those obtained at speculum examination for the assessment of vaginal flora
Authors: Morgan D. John , Aboud Catherine J. , McCaffrey I. Mary B. , Bhide Supriya A. , Taylor‐Robinson David , Lamont Ronald F.
Published: August 2005

Objective
To determine whether Gram‐stained smears obtained from blind vaginal swabs could be used reliably for the assessment of the vaginal flora.

Design
A prospective, blind comparative study.

Setting
The antenatal clinic of a district general hospital.

Participants
Eighty‐eight women examined and screened for the presence of bacterial vaginosis during their first antenatal clinic visit. Two smears were obtained for each woman, the first prepared from a vaginal swab taken blindly and the second at speculum examination. The smears were Gram‐stained and classified according to the Nugent score: Grade 1 (normal), Grade 2 (intermediate), Grade 3 (bacterial vaginosis).

Results
Eight of the 88 pregnant women were identified as having bacterial vaginosis on the basis of the smear taken at speculum examination, and these were correctly identified as having bacterial vaginosis by smears prepared from the blindly taken swab. This gives the blind vaginal swab technique for detecting bacterial vaginosis a sensitivity and specificity of 100% when compared with swabbing at speculum examination. The flora of two women were graded as intermediate, and of 75 as normal by both techniques. Only in three cases was there a disparity between the two techniques, a difference that was not statistically significant (kappa = 0.8546,95% CI 0.6945 to 1.0).

Conclusions
Vaginal smears prepared from correctly taken blind vaginal swabs can be used to assess the vaginal flora and screen for bacterial vaginosis. This method could be used in epidemiological studies of bacterial vaginosis in the general population and for screening antenatal populations for abnormal vaginal flora.
A randomised comparison of oral and vaginal misoprostol for cervical priming before suction termination of pregnancy
Authors: Lawrie Alasdair , Penney Gillian , Templeton Nan
Published: August 2005

Objective
To assess the effectiveness and acceptability of oral misoprostol, self‐administered 12 h before surgery, as a cervical priming agent prior to day case suction termination of pregnancy.

Design
Randomised trial comparing oral misoprostol with the local standard regimen of vaginal misoprostol.

Subjects
Sixty consecutive women scheduled for day case suction termination in one gynaecology unit.

Interventions
Cervical priming with misoprostol 400 mg orally, 12 h prior to surgery or 800 mg vaginally, two to four hours prior to surgery.

Main outcome measures
Basal cervical dilatation, cumulative force required to dilate the cervix to 9 mm, operative blood loss and side effects (nausea, vomiting, diarrhoea, abdominal pain and vaginal bleeding).

Results
There were no significant differences between the oral and vaginal treatment groups in relation to basal dilatation, cumulative force to achieve 9 mm dilatation or gastrointestinal side effects. However, those in the oral group experienced more severe pain and heavier pre‐operative bleeding. Two patients in the oral group experienced incomplete abortion at home after taking misoprostol and a further patient required early admission because of heavy bleeding.

Conclusions
Because of the unpredictability of action of oral misoprostol, with incomplete abortion or heavy bleeding occurring prior to admission in three patients, we cannot recommend the dosage schedule evaluated here for routine clinical use.
Sexual risk behaviour in women carriers of Mycoplasma hominis
Authors: Elshibly Salaheldin , Kallings Ingegerd , Hellberg Dan , Mårdh Per‐Anders
Published: August 2005

Objective
To study the sexual behaviour of women harbouring Mycoplasma hominis in the vagina. Setting Two family planning clinics and a youth clinic for contraceptive advice.

Methods
The vaginal flora of 996 women were investigated microbiologically, including culturing for M. hominis from the posterior vaginal fornix. Cultures and tests were also made to diagnose genital Chlamydia trachomatis infections, gonorrhoea, genital herpes, cervical human papillomavirus infection, trichomoniasis, genital warts and human immunodeficiency virus. The sexual behaviour of these women was investigated by structured in‐depth personal interviews.

Results
Of the 996 women, 123 (12.3%) harboured M. hominis in the vagina. The remainder (87.7%), who had a negative M. hominis culture, served as a reference group. Those with M. hominis were significantly more likely to have had more than 10 partners during their lifetime, had a greater frequency of more than one sexual partner during the preceding month and the last six months, and reported more frequent experience of ‘casual sex’, including casual ‘travel sex’. More of them also had experience of group sex and were more likely to have been sexually abused than the women in the reference group. Fewer women with M. hominis had a current steady partner and were less often cohabitors, but more had had sexual intercourse during the previous week than those in the reference group. There was an association between the occurrence of M. hominis and bacterial vaginosis and genital chlamydia1 infection. Adjustment in multifactorial regression analyses therefore changed the results only marginally.

Conclusions
Women with M. hominis have almost the same sexual risk behaviour as women with classic sexually transmitted diseases.
Impact of the introduction of new medical methods on therapeutic abortions at the Royal Infirmary of Edinburgh
Authors: Cameron Sharon T. , Glasier Anna F. , Logan Janet , Benton Lauri , Baird David T.
Published: August 2005

Objective
To assess the impact of the introduction of new medical methods on the provision of therapeutic abortions at the Royal Infirmary Edinburgh.

Design
A review of the total number of abortions performed by medical and surgical means between 1989 and 1995 (inclusive); a prospective survey of the terminations of pregnancy (5 9 weeks of gestation) performed over the six‐month period of January to June 1994; and a questionnaire of the reasons why women chose a particular method.

Setting
Large teaching hospital in Scotland.

Subjects
One thousand and seven women seeking early pregnancy termination between January and June 1994.

Main outcome measures
Proportion of pregnancies terminated by medical means; comparison of complete abortion rate, incidence of complications and morbidity following both medical and surgical methods (5 9 weeks of gestation); reasons for preference of the method of abortion.

Results
Since 1991 there has been a progressive increase in the number of medical abortions performed at the Royal Infirmary of Edinburgh, and by 1994 the majority of women (57%) seeking abortion at ≤ 9 weeks chose a medical method. Women who chose medical abortion had more years at full‐time education and were less likely to smoke (P < 0–04). Both medical and surgical methods were highly effective (> 96% complete abortion) with a low incidence of complications and morbidity. However, women who had chosen the medical method were less likely to receive antibiotics for suspected endometritis than their surgical counterparts (χ2, P= 0.0001).

Conclusions
If this trend towards medical methods in Edinburgh is repeated elsewhere, it will inevitably have an impact on gynaecological services by releasing staff and operating time for other purposes.