bluuebunny/crossref_metadata_2025 huggingface dataset:
One stop clinic for assessment of risk for fetal anomalies: a report of the first year of prospective screening for chromosomal anomalies in the first trimester
Authors: Spencer Kevin , Spencer Christine E. , Power Maureen , Moakes Andy , Nicolaides Kypros H.
Published: August 2005

Objective
To evaluate the introduction of a one stop multidisciplinary clinic for screening for fetal chromosomal abnormalities in the first trimester by a combination of maternal serum biochemistry and ultrasonography providing a risk of chromosomal abnormalities within a one hour clinic visit.

Design
One year retrospective review of screening performance.

Population
All women attending for routine antenatal care. The population included 4190 singleton pregnancies in women of all ages screened between 10 weeks and 3 days and 13 weeks and 6 days of gestation between the periods 1 June 1998 and 31 May 1999 in a district general hospital antenatal clinic.

Methods
All women booked into the clinic were offered screening by a combination of maternal serum free β human chorionic gonadotrophin (hCG) and pregnancy associated plasma protein A (PAPP‐A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 18/13 (≥ 1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out.

Main outcome measures
The detection rate for trisomy 21, trisomy 18/13 and all aneuploides, false positive rate, uptake of screening, uptake of chorionic villus sampling in women identified at increased risk and fetal loss after chorionic villus sampling.

Results
Overall 97.6% of the women (4088/4190) accepted first trimester screening. The rate of detection of trisomy 21 was 86% (6/7), for trisomy 18/13 100% (9/9) and for all aneuploides 95% (18/19). Fetal death at presentation was found in 1.6% of pregnancies (69/4088). Of women who accepted screening, 6.1% (257/4088) presented too late for fetal nuchal translucency measurement and 6.5% of the women (271/4088) presented too early. The false positive rate was 6.7% (253/3762). Uptake of invasive testing was 83% (207/253).

Conclusion
First trimester prenatal screening for chromosomal abnormalities using a combination of maternal serum biochemistry and fetal nuchal translucency thickness can achieve detection rates in excess of 90%. These services can be provided in a one stop multidisciplinary clinic.
Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study
Authors: Irving W. L. , James D. K. , Stephenson T. , Laing P. , Jameson C. , Oxford J. S. , Chakraverty P. , Brown D. W. G. , Boon A. C. M , Zambon M. C.
Published: August 2005

Objective
To determine whether maternal influenza virus infection in the second and third trimesters of pregnancy results in transplacental transmission of infection, maternal auto‐antibody production or an increase in complications of pregnancy.

Design
Case‐control cohort study.

Population
Study and control cohorts were derived from 3975 women who were consecutively delivered at two Nottingham teaching hospitals between May 1993 and July 1994. A complete set of three sera was available for 1659 women.

Methods
Paired maternal ante‐ and postnatal sera were screened for a rise in anti‐influenza virus antibody titre by single radial haemolysis and haemagglutination inhibition. Routine obstetric data collected during and after pregnancy were retrieved from the Nottingham obstetric database. Cord samples were tested for the presence of IgM anti‐influenza antibodies, and postnatal infant sera were tested for the persistence of influenza‐virus specific IgG. Paired antenatal and postnatal sera were tested against a standard range of auto‐antigens by immunofluorescence.

Main outcome measures
Classification of women as having definite serological evidence of an influenza virus infection in pregnancy (cases) or as controls.

Results
Intercurrent influenza virus infections were identified in 182/1659 (11.0%) pregnancies. None of 138 cord sera from maternal influenza cases was positive for influenza A virus specific IgM. IgG anti‐influenza antibodies did not persist in any of 12 infant sera taken at age 6–12 months. Six of 172 postnatal maternal sera from cases of influenza were positive for auto‐antibodies. In all cases the corresponding antenatal serum was also positive for the same auto‐antibody. There were no significant differences in pregnancy outcome measures between cases and controls. Overall, there were significantly more complications of pregnancy in the cases versus the controls, but no single type of complication achieved statistical significance.

Influenza infection in the second and third trimesters of pregnancy is a relatively common event. We found no evidence for transplacental transmission of influenza virus or auto‐antibody production in pregnancies complicated by influenza infections. There was an increase in the complications of pregnancy in our influenza cohort.
Estimates of maternal mortality by the sisterhood method in rural northern Tanzania: a household sample and an antenatal clinic sample
Authors: Olsen Bjørg Evjen , Hinderaker Sven Gudmund , Kazaura Method , Lie Rolv Terje , Bergsjø Per , Gasheka Petro , Kvåle Gunnar
Published: August 2005

Objective
To estimate maternal mortality in two samples of a population in northern Tanzania.

Setting
Rural communities and antenatal clinics, Mbulu and Hanang districts, Arusha region, Tanzania.

Population
From a household survey 2043 men and women aged 15–60, and from an antenatal clinic survey 4172 women aged 15–59.

Method
The indirect sisterhood method.

Main outcome measures
The risk of maternal deaths per 100,000 live births (maternal mortality ratio), and the lifetime risk of a maternal death.

Results
The risk of a maternal death per 100,000 live births was 362 (95% CI 269–456) and 444 (95% CI 371–517) for the household and antenatal clinic surveys, respectively. The lifetime risk of maternal death was 1 in 38 and 1 in 31, respectively, for the two surveys. A significantly lower risk of maternal death was observed for the respondents attending antenatal clinics closer to the hospital than for those attending clinics further away: 325 (95% CI 237–413) compared with 561 (95% CI 446–677) per 100,000 live births. Lifetime risk of maternal death was 1 in 42 and 1 in 25, respectively.

Conclusions
The risk of maternal death per 100,000 live births in this area were comparatively high, but in our survey substantially lower than in previous surveys in Tanzania. Increasing distance from the antenatal clinics to the hospital was associated with higher maternal mortality. There was no significant difference between results based on household and antenatal clinic data, suggesting that accessible health facility data using the sisterhood method may provide a basis for local assessment of maternal mortality in developing countries.
Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy
Authors: Bakour Shagaf H. , Khan Khalid S. , Gupta Janesh K.
Published: August 2005

We examined the relative significance of hysteroscopic and ultrasonographic evidence of endometrial atrophy in relation to insufficient sample on outpatient endometrial biopsy in women with abnormal uterine bleeding. Multivariate logistic regression modelling was used to evaluate the independent effects of age, menopausal status, hysteroscopic findings and sonographic endometrial thickness on outpatient endometrial sampling (sufficient or insufficient) used as the binary dependent variable. Insufficient sample on endometrial biopsy was associated with hysteroscopic finding of endometrial atrophy (OR 4.79, 95% CI 1.05–21.91, P= 0.04) and sonographic endometrial thickness below 5 mm (OR 0.19, 95% CI 0.07–0.53, P= 0.001). There was no association with patient's age and menopausal status. In conclusion, when reassuring women with insufficient sample on outpatient endometrial biopsy, one can be confident about absence of pathology provided the hysteroscopic and sonographic endometrial assessment is consistent with endometrial atrophy.
Pregnancy and delivery: a urodynamic viewpoint
Authors: Chaliha C. , Bland J. M. , Monga A. , Stanton S. L. , Sultan A. H.
Published: August 2005

Objective
The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function.

Design
Prospective longitudinal study. Twin channel subtracted cystometry was performed in the standing and sitting position, with a cough stress test at the end of filling. The investigations were repeated three months postpartum.

Participants
Two hundred and eighty‐six nulliparae with singleton pregnancies who were delivered between April 1996 and November 1997 attended for antenatal assessment after 34 weeks of gestation and 161 who returned postpartum.

Setting
Department of Obstetrics and Gynaecology in a London teaching hospital.

Results
The mean urodynamic values both in pregnancy and postpartum lower than values defined in a non‐pregnant population. The prevalence of genuine stress incontinence and detrusor instability were antenatally 9% and 8%, respectively, and postpartum 5% and 7%, respectively. Obstetric and neonatal factors were not related to urodynamic variables.

Conclusions
Despite the reported high prevalence of urinary incontinence related to pregnancy and childbirth, neither pregnancy nor delivery resulted in any consistent effects on objective bladder function. Postpartum urodynamic measurements were not related to either obstetric or neonatal variables, but were dependent on antenatal values.
Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters
Authors: Meyer S. , Hohlfeld P. , Achtari C. , Russolo A. , De Grandi P.
Published: August 2005

Objective
To compare the effects of forceps delivery and spontaneous delivery on pelvic floor functions in nulliparous women.

Design
A longitudinal prospective study with investigations during the first pregnancy, 10 weeks and 10 months after delivery.

Setting
Antenatal clinic in a teaching hospital.

Population
One hundred and seven patients aged 28.4 years, divided into those with forceps (n= 25) or spontaneous (n= 82) delivery.

Methods
Investigations with a questionnaire, clinical examination, assessment of bladder neck behaviour, urethral sphincter function, intra‐vaginal/intra‐anal pressures during pelvic floor contractions.

Results
The incidence of stress urinary incontinence was similar in both groups at 9 weeks (32%vs 21%, P= 0.3) and 10 months (20%vs 15%, P= 0.6) after delivery, as was the incidence of faecal incontinence (9 weeks: 8%vs 4%, P= 0.9; 10 months: 4%vs 5%, P= 1) and the decreased sexual response at 10 months (12%vs 18%, P= 0.6). Bladder neck behaviour, urethral sphincter function and intra‐vaginal and intra‐anal pressures were also similar in the two groups. However, 10 months after delivery, the incidence of a weak pelvic floor (20%vs 6%, P= 0.05) and the decrease in intra‐anal pressure between the pre‐ and post‐delivery values (−17±28 cm H2O vs 3±31 cm H2O, P= 0.04) were significantly greater in the forceps‐delivered women.

Conclusions
Forceps delivery is not responsible for a higher incidence of pelvic floor complaints or greater changes in bladder neck behaviour or urethral sphincter functions. However, patients with forceps delivery have a significantly greater decrease in intra‐anal pressure and a greater incidence of a weak pelvic floor.
Subtotal abdominal hysterectomy: a surgical advance or a backward step?
Authors: Ewies A. A. A. , Olah K. S. J.
Published: August 2005

Objective
To review the short and medium term outcomes of subtotal abdominal hysterectomy. We also describe the management of cervical stump complications by vaginal trachelectomy or large loop excision of the transformation zone.

Design
Retrospective analysis.

Setting
Warwick General Hospital, Warwickshire, UK.

Sample
One hundred and fifty women underwent subtotal abdominal hysterectomy between 1993 and 1999. Five women had vaginal trachelectomy and another five had large loop excision of the transformation zone for complications relating to the cervical stump.

Results
The prevalence of intra‐operative and early post‐operative complications was 4% and 7.3%, respectively. Twenty women (13.3%) had late complications, of whom 17 (11%) presented with symptoms directly related to the stump (two had also genuine stress incontinence). Three presented with genuine stress incontinence alone. The commonest problem was regular menstruation, which occurred in 12 women (8%). Ten of these women underwent vaginal trachelectomy or large loop excision of the transformation zone. None had intra‐operative or post‐operative complications.

Conclusions
The high prevalences of cervical stump problems should be taken into account before a change in surgical procedure from total to subtotal hysterectomy is recommended. Further prospective studies with prolonged follow up are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Total hysterectomy, preferably by the vaginal route, remains the procedure of choice for most women. Should a problem develop, vaginal trachelectomy or large loop excision of the transformation zone by an experienced surgeon are the best options for these women.
Combined oral oestradiol valerate‐norethisterone treatment over three years in postmenopausal women: correlation between oestrogen levels and bone mineral density sites
Authors: Perry W. , Wiseman R. A.
Published: August 2005

Objective
To compare trabecular and compact bone response and relationship to oestrogen status using continuous oestradiol valerate 2 mg and norethisterone 0.7 mg daily as hormone replacement and to determine the therapeutic range of 17 beta‐oestradiol.

Design
Open label trial.

Setting
Independent endocrine clinic

Sample
One hundred and thirty‐one patients were compared at point of entry and at 36 months.

Methods
Postmenopausal women were assessed using a Lunar dual photon and single photon bone scanner, and bone mineral density of the lumbar spine, right hip and left forearm were annually correlated with 17 beta‐oestradiol and oestrone levels over three years. Total alkaline phosphatase was compared between improvers and decliners of bone mineral density.

Results
Significant improvement in bone mineral density (P < 0.0001) occurred at all sites except the left forearm, where bone loss was prevented. There was no correlation between oestrogen levels and bone mineral density improvements at hip sites. However, in the lumbar spine larger improvements in bone mineral density occurred in women with 17 beta‐oestradiol levels > 185 pmol/L compared with those below, which were statistically significant for those with 17 beta‐oestradiol levels > 248 pmol/L. Bone turnover, as quanitifed by total alkaline phosphatase measurements, was suppressed in most patients, but there were no differences in the mean alkaline phosphatase levels between the best improvers and worst decliners for lumbar spine bone mineral density. Improvers had an age mean of 5.21 years greater than decliners (P= 0.01) and a mean duration difference since the menopause of 5.1 years compared with decliners (P= 0.007).

Conclusion
This combined continuous preparation of hormone replacement therapy improves not only trabecular bone but prevents compact bone loss, and the data suggest that the therapeutic range of 17 beta‐oestradiol is between 200 pmol/L and 350 pmol/L.
Pregnancy testing prior to sterilisation
Authors: Kasliwal Asha , Farquharson Roy G.
Published: August 2005

Objective
To determine the incidence of positive pregnancy test on the day of laparoscopic sterilisation.

Design
Prospective longitudinal observational study.

Setting
Gynaecology unit in a UK teaching hospital.

Sample
Between 1 January 1997 and 31 December 1998, eight hundred and two consecutive women were admitted for laparoscopic sterilisation after assessment in the gynaecology clinic. On the day of planned surgery, all women had a pregnancy test performed on a urine sample taken that morning following overnight fasting, immediately prior to operation.

Main outcome measures
A positive pregnancy test on the day of planned surgery.

Results
Of 802 women tested, 21 (2.6%) were pregnant. A careful medical history taken before surgery revealed evidence of amenorrhoea and menstrual irregularity in 17 of the pregnant women. Of the 21 pregnant women, 11 underwent termination of pregnancy, six continued the pregnancy, four had a miscarriage and one had an ectopic pregnancy.

Conclusion
The routine practice of pregnancy testing on the day of laparoscopic sterilisation introduced in our hospital should continue to be part of a thorough clinical assessment before surgery. This may help to reduce the considerable level of existing litigation in a high risk area of gynaecological practice.
Cardiac troponin I in pre‐eclampsia and gestational hypertension
Authors: Fleming Sean M. , O'Gorman Thomas , Finn Joseph , Grimes Helen , Daly Kieran , Morrison John J.
Published: August 2005

Objective
To investigate serum cardiac troponin I, a sensitive marker of cardiac myocyte damage, in normal pregnancy and pregnancies complicated by hypertension with and without significant proteinuria.

Design
Prospective cross sectional study.

Setting
University hospital delivery suite.

Sample
Serum samples obtained from women in normal pregnancy and in pregnancies complicated by hypertension with and without significant proteinuria.

Method
Women with hypertension in pregnancy (at least two readings of systolic blood pressure > 140 mmHg and diastolic blood pressure > 90 mmHg) (n= 26) and normotensive women (n= 43) were included in the study. Serum cardiac troponin I was measured using Beckman Access immunoassay.

Main outcome measure
Serum cardiac troponin I level in the pregnancies complicated by hypertension (with and without significant proteinuria) compared with the levels measured in normotensive women.

Results
The median serum cardiac troponin I level in pregnancies complicated by hypertension was 0.118 ng/mL (n= 26) which was significantly greater than that measured in samples obtained from normotensive women in pregnancy (0.03 ng/mL; n= 43) (P < 0.0001). There were higher median serum cardiac troponin I levels in hypertensive women with significant proteinuria (0.155 ng/mL; n= 6), compared with those without proteinuria (0.089 ng/mL; n= 20; P= 0.03).

Conclusion
Serum cardiac troponin I is elevated in women with hypertensive disorders of pregnancy indicating some degree of cardiac myofibrillary damage in these disorders.
Factors influencing postnatal liver function tests
Authors: David Anna L. , Kotecha Manisha , Girling Joanna C.
Published: August 2005

Objective
To investigate liver function tests (LFTs) changes in the puerperium and the influence of specific obstetric events on these changes.

Design
A longitudinal observational study.

Setting
West Middlesex University Hospital, Twickenham.

Population
Ninety‐four women with uncomplicated pregnancy who delivered at term.

Methods
Aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transferase (GGT), total bilirubin (Bilirubin) and alkaline phosphatase (ALP) were measured in early labour and on day 1, day 2, day 5 and day 10 postnatal.

Main outcome measures
Peak enzyme concentration, time of peak enzyme concentration, the area under the curve for each enzyme and the rate of change of enzyme level from predelivery to peak concentration.

Results
All LFTs were affected by delivery (P < 0.001), increasing by 88% (0.500%) on day 2 or day 5 for AST, 147% (0–1140%) on day 5 for ALT and 63% (0–450%) on day 5 or day 10 for GOT. Multiple linear regression showed that caesarean section and opioid administration was associated with a faster rise in AST (P= 0.001, P= 0.033 respectively). The mean peak GOT concentration was 39% higher in women having caesarean section compared with vaginal delivery (P= 0.015). Univariate analysis showed that perineal trauma, use of Entonox, maternal age at delivery and breastfeeding also influenced LFT concentration significantly.

Conclusion
Liver enzyme levels change significantly in the puerperium and are affected by common obstetric events, particularly caesarean section. This study aids clinical interpretation of postnatal LFTs in women recovering from liver‐related illnesses, by facilitating the differentiation of physiological and pathological processes.
The impact of maternal serum screening on the birth prevalence of Down's syndrome and the use of amniocentesis and chorionic villus sampling in South Australia
Authors: Cheffins Tracy , Chan Annabelle , Haan Eric A. , Ranieri Enzo , Ryall Richard G. , Keane Rosemary J. , Byron‐Scott Rosemary , Scott Heather , Gjerde Elizabeth M. , Nguyen Anh‐Minh , Ford Judith H. , Sykes Stephen
Published: August 2005

Objectives
To describe the impact of maternal serum screening on the birth prevalence of Down's syndrome and on the use of amniocentesis and chorionic villus sampling in South Australia.

Design
A descriptive population‐based study.

Setting
South Australia (population 1.48 million persons; approximately 20,000 births per year).

Participants
Women who had births or terminations of pregnancy with Down's syndrome in 1982–1996, women who had maternal serum screening in 1991–1996, amniocentesis or chorionic villus sampling in 1986–1996.

Methods
Analysis of data from multiple sources on maternal serum screening, amniocentesis and chorionic villus sampling, births and terminations of pregnancy.

Main outcome measures
Total prevalence and birth prevalence of Down's syndrome each year in 1982–1996; proportion of pregnant women using maternal serum screening in 1991–1996, and proportion using amniocentesis and chorionic villus sampling by indication in 1986–1996, by age group.

Results
Use of maternal serum screening for Down's syndrome increased from 17% when introduced in 1991 to 76% of women who gave birth in 1996. Between 1982 and 1986 and 1996, terminations of pregnancy for fetal Down's syndrome increased from 7.1% to 75% and the birth prevalence of Down's syndrome fell by 60% from 1.05 to 0.42 per 1,000 births, against the background of an increase in total prevalence due to increasing maternal age. The use of amniocentesis increased from 5.8% in 1991 to 10.1% in 1996 mainly due to the increase among women younger than 35 years with maternal serum screening as the main reason. The increasing chorionic villus sampling rate among younger women stabilised at 0.4%, while the rate among older women decreased from 11.0% to 7.4%.

Conclusions
The introduction of maternal serum screening in South Australia has resulted in increased use of any prenatal testing for Down's syndrome from about 7% (mainly older women having amniocentesis or chorionic villus sampling) to 84% of women (about 8% having direct amniocentesis or chorionic villus sampling and 76% having maternal serum screening first). This has resulted in a significant fall in the birth prevalence of Down's syndrome, maternal serum screening was the first indication of Down's syndrome for about half the terminations of pregnancy for Down's syndrome in 1993–1996, including three quarters of those in younger women.
The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery
Authors: MacLennan Alastair H. , Taylor Anne W. , Wilson David H. , Wilson Don
Published: August 2005

Objectives
To define the prevalence of pelvic floor disorders in a non‐institutionalised community and to determine the relationship to gender, age, parity and mode of delivery.

Design
A representative population survey using the 1998 South Australian Health Omnibus Survey.

Sample
Random selection of 4400 households; 3010 interviews were conducted in the respondents'homes by trained female interviewers. This cross sectional survey included men and women aged 15–97 years.

Results
The prevalence of all types of self‐reported urinary incontinence in men was 4.4% and in women was 35.3% (P < 0.001). Urinary incontinence was more commonly reported in nulliparous women than men and increased after pregnancy according to parity and age. The highest prevalence (51.9%) was reported in women aged 70–74 years. The prevalence of flatus and faecal incontinence was 6.8% and 2.3% in men and 10.9% and 3.5% in women, respectively. Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery. Multivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5–4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4–4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8–6.6). The difference between caesarean and instrumental delivery was significant (P < 0.03) but was not for caesarean and spontaneous delivery. Other associations with pelvic floor morbidity were age, body mass index, coughing, osteoporosis, arthritis and reduced quality of life scores. Symptoms of haemorrhoids also increased with age and parity and were reported in 19.9% of men and 30.2% of women.

Conclusion
Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.
Endocrinological and endometrial factors in recurrent miscarriage
Authors: Li T. C. , Spuijbroek Marleen D. E. H. , Tuckerman Elizabeth , Anstie Barbara , Loxley Martin , Laird Susan
Published: August 2005

Objective
To investigate the endocrinological and endometrial factors in women with unexplained recurrent miscarriage

Design
Prospective, case study

Setting
Recurrent miscarriage clinic, Jessop Hospital for Women, Sheffield

Participants
One hundred and forty‐four women with unexplained recurrent (≥ 3) miscarriages

Methods
A blood sample was obtained in early follicular phase (day 3–5) to measure follicle stimulating hormone, luteinising hormone, prolactin, androgens and thyroid function; daily blood/urine samples were obtained from mid‐follicular phase to measure luteinising hormone until the luteinising hormone surge was identified; endometrial biopsy and a further blood sample for progesterone measurement were obtained in the mid‐luteal phase. A transvaginal ultrasonography was performed to evaluate ovarian morphology.

Results
Hypersecretion of luteinising hormone or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women, respectively. The free androgen index was elevated in 14.6% of subjects. In the mid‐luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid‐luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test.

Conclusions
Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.
Hepatitis C virus load during pregnancy and puerperium
Authors: Lin Ho‐Hsiung , Kao Jia‐Horng
Published: August 2005

Objective
To assess whether pregnancy and delivery influence serum levels of hepatitis C virus (HCV) in carrier mothers.

Design
A prospective study.

Setting
University department of obstetrics and gynaecology.

Participants
Ten pregnant HCV carriers (group A) and 8 nonpregnant HCV carriers (group B).

Methods
Serum samples were collected for group A at first and third trimesters, delivery, postpartum 1,3,6,9 and 12 months, and at every three months for 1 year for group B.

Main outcome measures
Each serum sample was tested for serum alanine aminotransferase (ALT), anti‐HCV titre and HCV‐cDNA concentration by a competitive polymerase chain reaction (PCR) with a sensitivity of 250 copies/mL serum.

Results
In group A, the HCV levels remained unremarkably changed during pregnancy and delivery. However, all women had decreased HCV levels 1 and 3 months after delivery. Two women had undetectable serum HCV level postpartum and thereafter. Serum ALT values in 3 women were sporadically elevated, but did not correlate with decreased serum HCV levels. Anti‐HCV titres remained unchanged during the study period. In two women from group B, the serum HCV levels were undetectable during follow up. Other 6 women showed fluctuations in the serum HCV levels but all were above 250 copies/mL. Serum ALT values were normal and anti‐HCV titres remained stationary in all 8 nonpregnant carriers.

Conclusion
Serum HCV levels are decreased 1 and 3 months after delivery. This fact might suggest that puerperium is an optimal time for antiviral therapy in HCV carrier mothers.
Altered peripheral vascular response of women with and without pelvic pain due to congestion
Authors: Foong L. C. , Gamble J. , Sutherland I. A. , Beard R. W.
Published: August 2005

Objective
To test the hypothesis that women with pelvic venous congestion have a reduction of reactivity of their peripheral circulation.

Design
Comparison was made between 20 women with chronic pelvic pain due to congestion and a control group of 15 pain‐free women matched for age, parity and body weight. A comparison of these results was made with those from six postmenopausal women taking hormone replacement therapy.

Methods
Study and control groups were investigated during the mid‐follicular phase of the menstrual cycle (days 5–9) and the mid‐luteal phase (days 19–23). The study group was also investigated during the fifth month of treatment with suppression of ovarian activity with leuprorelin or medroxyproges‐terone acetate or six months after hysterectomy and bilateral salpingo‐oophorectomy. Head‐up tilt sufficient to increase intra‐vascular pressure in the toe by a standard 40 mmHg was used as a means of raising venous pressure in the lower limb. Skin capillary red blood cell velocity (flux) was measured using a laser Doppler flow probe placed over the pulp of the big toe. Heart rate and blood pressure were also recorded. The change in skin blood flow following head‐up tilt was expressed as a percentage of baseline flow in the supine position.

Main outcome measures
Percentage change in skin red blood cell flux, heart rate and blood pressure in response to 40° head‐up tilt.

Results
In the control group the median response to head‐up tilt in the follicular phase was one of a reduction in flux, whereas in the luteal phase it was more variable ranging from an increase to a decrease in flux. The responses in the pelvic congestion group in both the follicular and luteal phases were similar to those of the control group in the luteal phase. A small but significant increase in heart rate in response to tilt in the pelvic pain group, compared with the control group, was interpreted as being due to a fall in venous return. Treatment of the pelvic congestion group by medical suppression of ovarian activity or total hysterectomy with bilateral salpingo‐oophorectomy resulted in a significant change in response to head‐up tilt from the variable type of luteal response to one of a more constant reduction in flux, similar to that of the control group in the follicular phase. A reduction in flux was also found consistently in postmenopausal women.

Conclusion
The study confirms the hypothesis that women with pelvic pain due to congestion show a change in peripheral vascular reactivity which returns to normal after suppression of ovarian activity. It seems likely that some alteration of normal ovarian function is responsible for the observed changes in peripheral blood flow in response to a rise in venous pressure in women with pelvic congestion.
Women's sexual health after childbirth
Authors: Barrett Geraldine , Pendry Elizabeth , Peacock Janet , Victor Christina , Thakar Rance , Manyonda Isaac
Published: August 2005

Objective
To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.

Design
Cross‐sectional study using obstetric records, and postal survey six months after delivery.

Setting
Department of Obstetrics and Gynaecology, St George's Hospital, London.

Population
All primiparous women (n= 796) delivered of a live birth in a six month period.

Methods
Quantitative analysis of obstetric and survey data.

Main outcome measures
Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.

Results
Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre‐pregnancy levels of 38%. Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P= 0.01) and previous experience of dyspareunia (P= 0.03). At six months the association with type of delivery was not significant (P= 0.4); only experience of dyspareunia before pregnancy (P < 0.0001) and current breastfeeding were significant (P= 0.0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.

Conclusions
Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.
Antenatal home blood pressure monitoring: a pilot randomised controlled trial
Authors: Ross‐McGill H. , Hewison J. , Hirst J. , Dowswell T. , Holt A. , Brunskill P. , Thornton J. G.
Published: August 2005

Objective
To measure recruitment to, compliance with, and the acceptability of a trial designed to test whether a reduced schedule of antenatal visits combined with training in self‐measurement of blood pressure at home may improve hypertension screening and save money. To test the specific hypothesis that even after taking into account extra unscheduled visits, the reduced schedule with ambulatory monitoring reduces total visits.

Design
A pilot randomised controlled trial.

Setting
Four urban and four rural general practices in Yorkshire and Lancashire.

Population
One hundred and five low risk women in the third trimester of pregnancy. Eighty women participated.

Intervention
Women were invited to participate at 24–28 weeks. Those who accepted were allocated either to a standard nine subsequent visit schedule (30, 32, 34, 36, 37, 38, 39, 40, 41 weeks) or to a reduced schedule (34, 38, 41 weeks). Those in the latter group measured their blood pressure weekly using a portable sphygmomanometer at home.

Main outcome measures
Recruitment, total number of clinic visits, frequency of blood pressure measurement, schedule preference, and anxiety.

Results
Although there were more unscheduled visits in the home monitoring group, this did not outweigh the reduction in scheduled visits, (total visits reduced from 7.4 to 4.5, P < 0.001), and blood pressure was measured during more weeks (9 vs 7 weeks, P < 0.001) in the experimental group. Most women expressed a preference for the reduced schedule both when the idea was first suggested, and after they had experienced it, and there were no significant differences in anxiety.

Conclusion
Replacement of antenatal screening visits with home blood pressure monitoring is acceptable to women. The reduction in clinic visits is not compensated by an increase in visits for other reasons and overall blood pressure measurement is omitted less often. Whether it reduces adverse outcomes or has any rare side effects will require a larger trial, but this pilot study indicates that it is likely to be safe, and that such a large trial would be feasible.
Folic acid supplements are more effective than increased dietary folate intake in elevating serum folate levels
Authors: Elkin Amanda C. , Higham Jenny
Published: August 2005

In 1992, recommendations were disseminated aimed at reducing the incidence of neural tube defects. Women were advised to increase consumption of folic acid supplements and dietary folates during the periconceptional period and a major integrated national campaign was launched to help achieve this. In this study we found that only one‐quarter of the women with an uncomplicated obstetric history and 51% with a complicated obstetric history took supplements for the recommended time period. Dietary modification was extremely unusual. Serum analysis demonstrated that intake of folic acid supplements provides a greater elevation in serum folate levels than dietary food intake, suggesting dietary manipulation is an ineffective strategy and that efforts would be better focused on increasing supplement intake at a clinically important time. More effective education strategies are required, and since approximately one‐third of pregnancies are unplanned, fortification of foods with folic acid is warranted.
The effect of submucous fibroids on the dose‐dependent modulation of uterine bleeding by trimegestone in postmenopausal women treated with hormone replacement therapy
Authors: Wahab May , Thompson John , Al‐Azzawi Farook
Published: August 2005

Objective
To assess the value of identifying endometrial structural abnormalities at baseline hysteroscopy in predicting the pattern of bleeding in postmenopausal women treated with hormone replacement therapy.

Design
A randomised, double‐blind, dose‐ranging study.

Setting
A teaching hospital in the UK.

Population
One hundred and seventy‐six healthy postmenopausal women.

Methods
Women were randomised to receive one of four doses of oral trimegestone (0.05, 0.1, 0.25 and 0.5 mg per day), from day 15–28, and a daily dose of 2 mg oral micronised oestradiol for six treatment cycles. Women completed diaries in which the bleeding episodes were recorded. Hysteroscopy under local anaesthesia and endometrial biopsy were performed at baseline and on day 24 of the last treatment cycle.

Results
Women with submucous fibroids had more prolonged (P= 0.026) and heavier (P= 0.002) progestogen‐associated bleeding (odds ratio 4.54). The incidence of intermenstrual bleeding, but not its duration or severity, was higher in women with submucous fibroids (P= 0.017). There was a clear dose‐dependent effect of trimegestone, with a consistently later onset of progestogen‐associated bleeding occurring with increasing doses of trimegestone (P < 0.001), and such episodes became progressively lighter and of shorter duration over time (P < 0.001).

Conclusion
Hysteroscopic evaluation of the endometrial cavity in women treated with hormone replacement therapy, predicts the occurrence of heavy and unscheduled bleeding.
Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation‐wide study of 17,360 users
Authors: Backman Tiina , Huhtala Sakke , Blom Taru , Luoto Riitta , Rauramo Ilkka , Koskenvuo Markku
Published: August 2005

Objective
To establish the continuation rates of the levonorgestrel intrauterine system (LNG IUS) and symptoms associated with its premature removal.

Sample and Setting
All women in Finland who had a LNG IUS inserted between April 1990 and December 1993 and whose doctor had filled in and returned a form at the insertion visit. This study population consists of 46% of all the LNG IUSs sold in Finland between 1990 and 1993.

Design
A questionnaire on reproductive and contraceptive history, gynaecological problems and symptoms experienced during the use of the LNG IUS was sent to 23,885 LNG IUS users. A total of 17,914 questionnaires were returned (response rate 75%). The results cover experience from 58,600 woman years. A log‐rank‐test was used to test differences in continuation rates. Multivariate analyse were performed using Cox's proportional hazard model.

Results
The LNG IUS was prematurely removed from 5175 women. The one, two, three, four and five year continuation rates were 93%, 87%, 81%, 75% and 65%, respectively. The symptoms during the use of the LNG IUS most strongly associated with its premature removal were excessive bleeding and spotting, and infections and pain. The risk of premature removal was markedly lower among women who had occasional or total absence of menstruation. Premature removal was less likely in the oldest age group.

Conclusions
The continuation rate of the LNG IUS compares favourably with other long‐acting contraceptive systems. Totally or occasionally absent menstruation was strongly associated with prolonged continuation.
Piperazine oestrone sulphate and interrupted norethisterone: effects on the postmenopausal endometrium
Authors: Byrjalsen Inger , Alexandersen Peter , Christiansen Glaus
Published: August 2005

Objective
To assess the effects on the postmenopausal endometrium of two doses of oral piperazine oestrone sulphate and interrupted norethisterone in comparison with a continuously combined regimen and placebo.

Design
A prospective randomised trial.

Participants
Two hundred healthy postmenopausal women.

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

Main outcome measures
Effect of treatment on endometrial histology, endometrial thickness, occurrence of uterine bleeding, endometrial oestrogen and progesterone receptor content, endometrial isocitrate dehydrogenase activity, and serum placental protein 14.

Results
The incidence of bleeding declined with time. In the second treatment year, the women receiving lowEP reported on average 7.3 days of bleeding, highEP 16.7 days, and E2+NETA 11.2 days. Histological assessment of endometrial biopsies revealed an atrophic or slightly secretory endometrium. Serum placental protein 14 increased slightly, but was statistically highly significant, during treatment, but no cyclical variation was observed. Endometrial isocitrate dehydrogenase was low in all three hormone groups and the same low level of endometrial oestrogen receptor and progesterone receptor was found comparable to the level in the placebo group.

Conclusions
Histological and biochemical assessment of the endometrium showed that interrupted hormone replacement therapy induced the same pattern in endometrial parameters as continuous combined hormone replacement therapy.
The effect of a group programme on women with the Mayer‐Rokitansky‐Küster‐Hauser Syndrome
Authors: Weijenborg Philomeen T. M. , ter Kuile Moniek M.
Published: August 2005

Objective
To evaluate the effect of a group programme on psychological distress in women with the Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome.

Setting
Gynaecologic outpatient clinic.

Sample
Seventeen women with MRKH syndrome participated in this study.

Method
A semi‐structured programme of seven sessions was offered dealing with themes of the MRKH syndrome. Psychological distress was measured at the first visit 3–6 month before the group programme was started (pre‐test‐0), at the first (pre‐test) and then at the last group session (post‐test).

Main outcome measure
The Symptom Check List‐90 was used to assess feelings of psychological distress.

Results
The post‐test subscale scores for anxiety, depression, interpersonal sensitivity and the total score for psychological distress were significantly lower than the pre‐test‐0 and pre‐test scores (P < 0.05). No significant differences were found between the pre‐test‐0 and pre‐test subscale scores and total score.

Conclusion
A semi‐structured group programme seems valuable in helping women with the MRKH syndrome to deal with their psychological stress.
Randomised clinical trials of fish oil supplementation in high risk pregnancies
Authors: Olsen Sjúrour F. , Secher Niels J. , Tabor Ann , Weber Tom , Walker James J. , Gluud Christian
Published: August 2005

Objective
To test the postulated preventive effects of dietary n‐3 fatty acids on pre‐term delivery, intrauterine growth retardation, and pregnancy induced hypertension.

Design
In six multicentre trials, women with high risk pregnancies were randomly assigned to receive fish oil (Pikasol) or olive oil in identically‐looking capsules from around 20 weeks (prophylactic trials) or 33 weeks (therapeutic trials) until delivery.

Setting
Nineteen hospitals in Europe.

Samples
Four prophylactic trials enrolled 232, 280, and 386 women who had experienced previous pre‐term delivery, intrauterine growth retardation, or pregnancy induced hypertension respectively, and 579 with twin pregnancies. Two therapeutic trials enrolled 79 women with threatening pre‐eclampsia and 63 with suspected intrauterine growth retardation.

Interventions
The fish oil provided 2.7 g and 6.1 g n‐3 fatty acids/day in the prophylactic and therapeutic trials, respectively.

Main outcome measures
Preterm delivery, intrauterine growth retardation, pregnancy induced hypertension.

Results
Fish oil reduced recurrence risk of pre‐term delivery from 33% to 21% (odds ratio 0.54 (95% CI 0.30 to 0.98)) but did not affect recurrence risks for the other outcomes (OR 1.26; 0.74 to 2.12 and 0.98; 0.63 to 1.53, respectively). In twin pregnancies, the risks for all three outcomes were similar in the two intervention arms (95% CI for the three odds ratios were 0.73 to 1.40, 0.90 to 1.52, and 0.83 to 2.32, respectively). The therapeutic trials detected no significant effects on pre‐defined outcomes. In the combined trials, fish oil delayed spontaneous delivery (proportional hazards ratio 1.22; 1.07 to 1.39, P= 0.002).

Conclusions
Fish oil supplementation reduced the recurrence risk of pre‐term delivery, but had no effect on pre‐term delivery in twin pregnancies. Fish oil had no effect on intrauterine growth retardation and pregnancy induced hypertension, affecting neither recurrence risk nor risk in twin pregnancies.
Outcome of labour after successful external cephalic version at term complicated by isolated transient fetal bradycardia
Authors: Lau Tze Kin , Lo Keith Wing Kit , Leung Tak Yeung , Fok Wing Yee , Rogers Michael S.
Published: August 2005

Objectives
To investigate factors associated with the occurrence of transient fetal bradycardia after external cephalic version, and labour outcome after isolated transient fetal bradycardia.

Design
Cohort study.

Setting
Teaching hospital with a policy of offering external cephalic version for breech presentation at or beyond 36 weeks of gestation.

Population
Four hundred and twenty‐nine external cephalic versions performed over a 5‐year period.

Methods
Between group differences were compared with the unpaired t test or the χ2 test. Logistic regression analysis was performed to exclude confounding effects.

Main outcome measures
Incidence of caesarean section for fetal distress.

Results
Transient fetal bradycardia occurred in 8.4% of external cephalic versions, and was associated with a successful version (OR 16.45, P < 0.001), a difficult procedure (OR 3.70, P= 0.001), and nulliparity (OR 2.83, P= 0.007). The incidence of intrapartum caesarean section for fetal distress was 16.7% in pregnancies with transient fetal bradycardia, compared with 7.9% in those without (OR 2.34, 95% CI 0.81, 6.71).

Conclusions
Transient fetal bradycardia after external cephalic version may be associated with a higher risk of intrapartum caesarean section for fetal distress.