bluuebunny/crossref_metadata_2025 huggingface dataset:
Discriminant analysis of urethral pressure profilometry data for the diagnosis of genuine stress incontinence
Authors: VERSI EBOO
Published: August 2005

Summary. Urethral pressure profilometry (UPP) has been advocated for the diagnosis of genuine stress incontinence (GSI) but no published data exist to define clearly the criteria of measurement that should be used. The aim of this study was to examine the value of UPP in the diagnosis of GSI. Data from 102 urodynamically normal women and 70 women with GSI were compared. Thirty UPP variables from the resting and stress profiles were examined. The urodynamic diagnosis was made on the basis of a pad test, uroflowmetry and videocystourethrography. Each UPP variable was examined singly and thereafter all the measurements were examined by discriminate analysis. The single most discriminatory UPP variable was ‘area under the stress profile’ but the overlap between normal and GSI patients was too great to allow the test to be used diagnostically. Discriminate analysis resulted in correct classification in 78% of cases. On the basis of these results, UPP is not an accurate test for the diagnosis of GSI.
Is amniotic fluid quantitation of value in the diagnosis and conservative management of prelabour membrane rupture at term?
Authors: ROBSON M. S. , TURNER M. J. , STRONGE J. M. , O'HERLIHY C.
Published: August 2005

Summary. This study examined the hypothesis that ultrasound quantitation of amniotic fluid depth is of value in the diagnosis and management of prelabour rupture of the membranes (PROM) at term. The deepest vertical pool was measured in 151 consecutive patients with a history of suspected PROM for at least 10 h before labour. In 100 patients the diagnosis of PROM was confirmed by the collection of amniotic fluid at the vulva. There was no difference in mean depth of amniotic fluid in 100 patients with confirmed PROM, compared with 51 in whom PROM was not confirmed (48.5 mm SD 16.4 vs. 60.1 mm SD 16.5); the frequency of oligohydramnios (fluid depth <30mm) was 5% and 5.8% respectively. There was no relation between ultrasound amniotic fluid quantitation and the onset of labour, the duration of labour nor the frequency of oxytocin augmentation in labour. The results show that ultrasound quantitation of amniotic fluid is of no value in the diagnosis and conservative management of PROM at term.
Rapid pulses of luteinizing hormone during the ovarian cycle
Authors: MURDOCH A. P. , DIGGLE P. J. , WHITE M. C. , KENDALL‐TAYLOR P. , DUNLOP W.
Published: August 2005

Summary. Luteinizing hormone has been shown to be secreted in a complex pattern of low‐amplitude, high‐frequency pulses superimposed on high‐amplitude, low‐frequency pulses. To test the hypothesis that the rapid, small pulses vary during the ovarian cycle, 16 normal women were studied on two occasions each, in the early and late follicular phases of one cycle or the luteal and following early follicular phase. Blood samples were taken every 1 min for 1 h. Statistical methods of time series analysis were applied to the data. There were significant amplitude differences between subjects at all stages of the cycle. We found no evidence to support the hypothesis that the frequency of the small rapid pulses varied during folliculogenesis. The results for the luteal phase, while less uniform, showed no consistent change. It is suggested that the rapid pulses may be related to function of the hypothalamic‐pituitary axis rather than direct ovarian control.
The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy
Authors: CROWTHER C. A. , VERKUYL D. A. A. , NEILSON J. P. , BANNERMAN C. , ASHURST H. M.
Published: August 2005

Objective–To test whether a policy of hospitalization for bed rest, from 28–30 weeks gestation until delivery, lengthens the duration of gestation, improves fetal growth and decreases neonatal morbidity in twin pregnancy.

Design–A randomized controlled trial.

Setting–Harare Maternity Hospital, Zimbabwe.

Subjects–118 women with an uncomplicated twin pregnancy between 28 and 30 weeks gestation.

Intervention–Hospitalization for bed rest. Encouraged to rest in bed as much as possible, although voluntary ambulation was allowed.

Main outcome measures–Gestational age at delivery and number of infants delivered preterm (<37 weeks); birthweight and number of small‐for‐gestational age (SG A) infants; neonatal morbidity was assessed by number of infants requiring admission to the neonatal unit and the length of stay.

Results–There was no effect on duration of gestation or the occurrence of preterm delivery. Mean birthweight was greater in the hospitalized group (t = ‐2‐28, df 234, P = 0.02) and there were fewer SGA infants (OR 0.57, 95% CI 0.33–0.96). No differences were found in neonatal morbidity.

Conclusions–Hospitalization for bed rest does not prolong pregnancy but can improve fetal growth, although this was not reflected in improved neonatal morbidity. Whether twin fetal growth can be enhanced similarly in other populations should be investigated.
Normal early pregnancy: serum hCG levels and vaginal ultrasonography findings
Authors: CACCTATORE BRUNO , TTTTTNEN ATLA , STENMAN ULF‐HÅKAN , YLÖSTALO PEKKA
Published: August 2005

Summary. Vaginal sonography and determination of scrum hCG levels were carried out in 22 healthy pregnant women every 2 to 4 days after the first positive pregnancy test until a living fetus was observed. Gestational age was calculated from the day of ovulation, assessed by LH surge or hCG administration, plus 14 days. A gestational sac of 1–3 mm was detected at a mean (SEM) of 31.2 (0.2) days of gestation (range 30–33 days). The corresponding mean hCG level was 730 iu/1 (30) and the range 467–935 iu/1 (International Reference Preparation). The yolk sac was detected at a mean of 36.0 (0.2) days, range 34–38 days, at a mean hCG level of 4130 iu/1 (370), range 1120–7280 iu/1. Fetal heart motion was visible at a mean of 41.1 (0.3) days, range 39–43 days and the corresponding mean hCG level was 12050 iu/1 (1240), range 5280 22 950, iu/1. The yolk sac and the fetal heart motion were always seen when the sac exceeded 10 and 18mm in mean diameter, respectively.
The use of rectus abdominis myocutaneous flaps following excision of vulvar cancer
Authors: SHEPHERD JOHN H. , VAN DAM PETER A. , JOBLING THOMAS W. , BREACH NICHOLAS
Published: August 2005

Summary. Rectus abdominis myocutaneous flaps have been used in 16 women following radical excision of extensive vulvar cancer. In two women the procedure was part of the primary surgery, in 11 for recurrence of vulvar cancer and in three for symptomatic palliation. Fifteen (94%) of the grafts took with primary healing. Thirteen of the 16 patients are alive 6–60 months (median 29 months) after surgery and the three who died benefited from symptomatic palliation. Simultaneous vulvar reconstruction allows good cosmetic rehabilitation and is an important part of the armametarium for the management of patients with advanced primary or recurrent vulvar carcinoma. This technique offers excellent surgical clearance of massive offensive and painful vulvar tumours.
Transvaginal ultrasound for diagnosis of uterine malformations
Authors: NASRI M. N. , SETCHELL M. E. , CHARD T.
Published: August 2005

Summary. Uterine malformations were detected in 8 of 300 patients (3%) referred for transvaginal ultrasound scan (TVS) for different indications. Six of them had a partially septate uterus and two had a uterus didelphys. As uterine malformations can be associated with both sterility and reproductive failure, we suggest that the study of uterine morphology and structure could be a part of routine TVS examination.
Effect on plasma lipids and lipoproteins of postmenopausal oestrogen therapy with added dydrogesterone
Authors: SIDDLE N. C. , JESINGER D. K. , WHITEHEAD M. I. , TURNER P. , LEWIS B. , PRESCOTT P.
Published: August 2005

Summary. In a prospective, randomized, cross‐over study, 14 postmenopausal women completed 9 months of treatment with conjugated equine oestrogens, 1.25 mg daily. Seven women added dydrogesterone 20 mg daily for 12 days during months 2, 3 and 4, and then 10 mg daily for an identical time in months 5,6 and 7. The other seven women added the two dydrogesterone doses in reverse sequence. No dydrogesterone was taken during months 8 and 9. Lipids and lipoproteins were measured before treatment and at the end of months 4, 7 and 9. Lipids were also estimated in an untreated (reference) group of eight postmenopausal women on two occasions 6 months apart; these showed significant changes in HDL2‐ and HDL3‐cholesterol. In the treatment group, HDL‐cholesterol and apolipoprotein (apo) Al were significantly higher and LDL‐cholesterol and apo B were significantly lower at months 4, 7 and 9 compared with baseline values. Triglyceride levels were increased significantly over baseline values, but remained within the normal range. No significant differences between the two dydrogesterone doses were observed on any lipid and lipoprotein fraction, nor were there any differences between the oestrogen‐only and oestrogen/dydrogesterone treatment phases. Dydrogesterone appears to cause little, if any, lipid and lipoprotein changes and assessment in a larger population of postmenopausal women is warranted.
Polyhydramnios and associated maternal and fetal complications in singleton pregnancies
Authors: DESMEDT ELS J. , HENRY OLIVIA A. , BEISCHER NORMAN A.
Published: August 2005

Summary. During the 10‐year period 1 January 1979 to 31 December 1988, polyhydramnios occurred in 537 patients with singleton pregnancies delivered at the Mercy Maternity Hospital. Associated maternal and fetal complications and the perinatal outcome of these pregnancies with polyhydramnios were analysed. In 248 of the 537 pregnancies (46%) in this group there were no maternal complications or fetal malformations and the perinatal mortality (PNM) rate was 2.4%. The PNM rate increased significantly to 13.1% when there was associated pre‐eclampsia, 10% with gestational diabetes, and to 7.6% with miscellaneous complications. When polyhydramnios was associated with a fetal or placental malformation the PNM rate was 61.4%. The commonest malformations were central nervous system (31%), musculoskcletal (12%) and gastrointestinal system anomalies (10%). Placental chorioangioma occurred in two patients (0.4%) and both babies died. In women with low oestriol excretion (18% of the 455 tested) the PNM rate increased five times to 22.7%.
The epithelial changes associated with squamous cell carcinoma of the vulva: a review of the clinical, histological and viral findings in 78 women
Authors: LEIBOWTTCH MICHELE , NEILL SALLIE , PELISSE MONIQUE , MOYAL‐BARACCO MICHELINE
Published: August 2005

Summary. Seventy‐eight excised specimens of squamous cell carcinoma of the vulva were reviewed retrospectively for the presence of lichen sclerosus or vulvar intraepithelial neoplasia (VTN) at sites proximal to the tumour or more distant. Lichen sclerosus was evident in 61% and VIN alone in 31%. VIN III (differentiated) was associated with over 50% of the specimens with lichen sclerosus. HPV 16 was found in six of the 11 VIN lesions, investigated but in none of the six with lichen sclerosus.
Luteal phase deficiency: ultrasonic and biochemical insights into pathogenesis
Authors: HAMILTON MARK P. R. , FLEMING RICHARD , COUTTS JOHN R. T. , MACNAUGHTON MALCOLM C. , WHITFIELD C. R.
Published: August 2005

Summary. Serial ovarian ultrasound and daily assessments of plasma concentrations of pituitary and ovarian hormones were used to investigate ovarian function in 175 women with unexplained infertility. Their endocrine and ultrasound profiles were compared with similarly derived data from 43 normal volunteers. Fifty‐one (29·1%) of the study group showed subnormal luteal phase rises in progesterone concentrations, described as poor progesterone surge (PPS) cycles. Within this group, 23 women (45·1%) demonstrated luteal cyst formation, a pattern not seen in any of the control cycles. High concentrations of follicle stimulating hormone (FSH) and reduced concentrations of oestradiol (E2) were observed in the follicular phases of the PPS cycles suggesting that the phenomenon is a product of abnormal follicular metabolism. An association of PPS with infertility exists, perhaps related to a combination of disturbances in the follicular micro‐environment compromising oocyte quality, a failure of oocyte release, and impaired endometrial receptivity.
Maternal and paternal moderate daily alcohol consumption and unexplained miscarriages
Authors: PARAZZINI FABIO , BOCCIOLONE LUCA , VECCHIA CARLO LA , NEGI EVA , FEDELE LUIGI
Published: August 2005

Summary. The relation between parental moderate alcohol consumption and the risk of miscarriage was analysed using data from a casecontrol study in Milan between January 1987 and June 1988. Cases were 94 women who had two or more ‘unexplained’ miscarriages (after exclusion of genetic, endocrine and Miillerian factors) and without full‐term pregnancies, admitted or referred to the First Obstetric and Gynecologic Clinic of the University of Milan. A total of 176 women admitted for normal delivery on selected days to the same university clinic and without previous miscarriages were chosen as controls. Compared with non‐drinkers the risk of recurrent miscarriage was 0·9 for regular drinkers. The point estimates were 0·9 for women reporting one drink per day and 0·8 for those reporting two or more. Compared with non‐drinkers, the relative risk estimates for drinking by fathers were slightly above unity, being 1·7 for less than three drinks and 1·4 for three or more drinks per day, but the trend in risk was not statistically significant.
The rate of rise of corticotrophin releasing factor and endogenous digoxin‐like immunoreactivity in normal and abnormal pregnancy
Authors: WOLFE C. D. A. , PETRUCKEVITCH A. , QUARTERO R. , CARABELLI P. , POSTON L. , KERKEZ S. , CAMPBELL E. , LOWRY P. J. , LINTON E. A.
Published: August 2005

Summary. Maternal plasma concentrations of corticotrophin releasing factor (CRF) and endogenous digoxin‐like immunoreactivity (EDLI) were estimated in 80 normal and 88 abnormal pregnancies which were sampled sequentially from 24 weeks gestation to delivery. A slope was fitted for each woman's antenatal EDLI and CRF values, both of which rose significantly during gestation, and the mean of the slopes for the normal and abnormal groups for each value compared. There was no evidence of significant mean differences between groups for EDLI but there was evidence of a significant mean difference for CRF (P<0.05). After adjustment for other variables which may affect pregnancy outcome, the slopes for CRF were found not to be significantly related to outcome.
Immunohistological demonstration of intermediate trophoblast in the diagnosis of uterine versus ectopic pregnancy: a retrospective survey and results of a prospective trial
Authors: SØRENSEN FLEMMING B. , MARCUSSEN NIELS , DAUGAARD HANS O. , KRISTIANSEN JOHN D. , MØLLER JAN , INGERSLEV HANS J.
Published: August 2005

Summary. Immunohistological demonstration of human placental lac‐togen (hPL) in non‐villous, mononuclear intermediate trophoblastic cells may be of routine diagnostic value, when chorionic villi are absent in endometrial curettings from patients suspected of miscarriage of an intrauterine pregnancy. The histological presence and distribution of hPL was investigated in endometrial curettings from 90 patients studied retrospectively (47 had ectopic pregnancies, 14 miscarriages, and 29 legal abortions), and a consecutive, prospective series of 50 patients (40 had miscarriages and 10 had ectopic pregnancies) without chorionic villi in their endometrial curettings. Non‐specific background staining was not a problem. The retrospective survey disclosed that hPL was a highly sensitive marker of intrauterine pregnancy (sensitivity = 0.98). In the prospective series, the predictive value of positive staining for hPL for intrauterine pregnancy was 1.00, and the sensitivity of hPL, as an indicator of uterine gestation, was 0.62. In absence of specific hPL‐staining, the risk of ectopic pregnancy was about 50%. The immunohisto‐chemical demonstration of hPL is a useful tool for identifying patients who are suspected of having had a miscarriage, but for whom evidence in the form of chorionic villi in endometrial curettings is lacking.
Patterns of maternal weight gain in pregnancy
Authors: DAWES M. G. , GRUDZINSKAS J. G.
Published: August 2005

Summary. A retrospective study of 1145 pregnant women showed that trends in mean maternal weight gain from the time of booking until delivery were not linear. Statistically significant lower rates of maternal weight gain were seen before 16 weeks, after 36 weeks and between 28 and 32 weeks gestation (P < 0.05). The mean maternal weight gain was 10.71 kg (SD 4.3) and the mean weekly weight gain was 0.38 kg (SD 0.16). A wide variation of maternal weight gain was seen in women with a normal outcome. The mean weight gain in heavy (>68 kg) and light (<55.4 kg) women was less than that in women whose weight was in the third quartile (60–68 kg, P<0.05). The mean maternal weight gain was less in young (<20 years) women than in older women (>25 years; P <0.05), less in parous than in primigravid women from week 37 onwards (P<0.05), less in smokers than in non‐smokers from 20 weeks onwards (P<0.05), and greater in hypertensive women (BP> 140/90) than in normotensive women (P<0.05) from week 24 onwards. The mean weight gain in women who had small for gestational age (SGA) infants was not significantly different from that in women who had infants that were of appropriate size for gestational age. After taking into account infant and placental weight using multiple regression analysis, the factors that were associated with statistically significant differences in average weekly weight gain were parity, body mass index, smoking habit and raised blood pressure. Only 9.6% of the variation in average weekly weight gain could be predicted using these variables. It is unlikely that the measurement of maternal weight gain would be useful in detecting women who will have SGA infants or will develop hypertension.
A case‐control study of the effects of birth by caesarean section on intrapartum and neonatal mortality among twins weighing 1500–2499 g
Authors: RYDHSTRÖM HÅKAN , INGEMARSSON INGEMAR
Published: August 2005

Summary. . The aim of this nationally‐based, matched case‐control study was to assess the impact of birth by caesarean section on intrapartum, and neonatal mortality among twins weighing 1500–2499 g, born in Sweden between 1973 and 1983. By using data held at the National Medical Birth Registry, Stockholm, 91 such pregnancies (study cases) where one or both twins died were identified. For each case, two controls (in all 182 pregnancies) were allotted at random from the rest of the twin pregnancies, with similar birthweight (±100 g) and year of delivery (±1 year). The number of twins that died was reduced from 73 during the first four years to 22 between 1977 and 1980, and to 6 during the last 3 years of the study period. Almost a quarter (23.1%) had a lethal malformation. The caesarean section rate increased during the study period, but did not differ between cases and controls (χ2= 1.0; P>0.05). The analysis could not confirm a significant difference between cases and controls regarding the number of infants born vaginally in non‐vertex presentation (χ2= 0.1; P>0.05). The results of this study appear to indicate that birth by caesarean section was not a major factor related to the improved fetal outcome.
Lactation inhibition by the dopamine agonist CV 205–502
Authors: VAN DER HEIJDEN P.F.M. , KREMER J.A.M. , BROWNELL J. , ROLLAND R.
Published: August 2005

Summary. In an open pilot study with a parallel group design 30 bottle feeding women were randomly assigned in a two to one ratio to receive either the new dopamine agonist CV 205–502 or bromocriptine for lactation inhibition. Ten women who intended to breast feed served as normal controls. All treated women reached prepregnant prolactin levels within 72 h with once‐daily 0.075 mg of CV 205–502 or twice‐daily 2.5 mg of bromocriptine, at starting doses of 0.05 mg and 2.5 mg respectively. Fifteen of the 20 women treated with CV 205–502 reported breast symptoms, 50% occurring on days 3 and 4 of treatment. Three of the 10 women treated with bromocriptine had breast symptoms between days 2 and 28. Overall efficacy and tolerance in the two groups was very good. Side effects did not differ between the groups, with the exception of pulse rate in the standing position, which was significantly higher in the bromocriptine treated group than in either the CV 205–502 group (P = 0.02) or the breast feeding group (P < 0.01). The coagulation tests (fibrinogen, AT III, PTT and APTT) showed no significant differences between the three groups.
A multi‐centre collaborative study into the treatment of menorrhagia by Nd‐YAG laser ablation of the endometrium
Authors: GARRY RAY , ERIAN JOHN , GROCHMAL STEPHEN A.
Published: August 2005

Objective— To determine the safety and clinical effectiveness of Nd‐YAG laser ablation of the endometrium in the treatment of menorrhagia.

Design— A prospective 3‐year observational multi‐centre study.

Setting— Gynaecological units in the UK and USA with special interest in endoscopic laser surgery.

Subject— 859 women with menorrhagia resistant to medical therapy.

Main outcome measure— Duration of laser ablation, intra‐ and post‐operative complications, amenorrhoea rate, oligomenorrhoea rate, and woman's subjective assessment of treatment.

Results— No major complications occurred in 859 treatments. Four (0–4%) cases of transient fluid overload, 4 (0–4%) of infection, and 3 (0–3%) of uterine perforation occurred. Each of the perforations occurred during insertion of the rigid instruments and none was produced by the laser. There were no major haemorrhages, no blood transfusions were needed, and no woman required a laparotomy. The mean duration of the laser ablation was 24 min, and the average stay in hospital was <24 h. Of the 479 women followed up for at least 6 months after treatment 288 (60%) developed complete amenorrhoea and 152 (32%) reported continuing but satisfactorily reduced menstruation; 39 (8%) failed to improve with the first treatment, but 26 of them responded to a second laser ablation. Overall 466 (97%) had a satisfactory response to laser ablation and only 13 (3%) required subsequent hysterectomy.

Conclusion— Endometrial laser ablation would appear to be a popular, safe, effective and economical alternative to hysterectomy for the treatment of menorrhagia.
An analysis of factors influencing the outcome of 232 consecutive tubal microsurgery cases
Authors: SINGHAL V. , LI T. C. , COOKE I. D.
Published: August 2005

Summary. A consecutive series of 232 tubal microsurgical operations performed at the Jessop Hospital for Women, Sheffield, between 1983 and 1989, was analysed. The various contributory factors to tuboperitoneal damage were reviewed. Eighty patients (35%) conceived, resulting in 66 (29%) live births and 14 (6%) miscarriages. A further 12 (5%) had ectopic pregnancies. The overall cumulative conception rate (CCR) was 40% at the end of 50 months. Microsurgery has been most successful in the adhesiolysis group (n=78) with a CCR of 46% at the end of 50 months. The terminal salpingostomy group (n=97) had a CCR of 40% at the end of 36 months. There was a significant reduction in the live birth rate for the group with hydrosalpinx >20 mm in diameter compared with the group with <20 mm (P=0.05). The proximal anastomosis group (n=27) had a CCR of 33%. No pregnancy was reported following reconstructive surgery for multiple occlusion sites. Overall, the extent of pelvic adhesions had a significant influence on the outcome (P=0.02). The likelihood of conception was significantly influenced by the duration of infertility (P=0.02) but not affected by the aetiology of tuboperitoneal damage, parity or age of the patient. In our hands, tubomicrosurgery is more cost‐effective than in‐vitro‐fertilization as a primary treatment of infertility due to tubal diseases.
The place of oophorectomy at vaginal hysterectomy
Authors: SHETH SHIRISH S.
Published: August 2005

Summary. A series of 740 vaginal hysterectomies with attempted vaginal oophorectomy is presented and compared with 700 vaginal hysterectomies without oophorectomy. Vaginal oophorectomy was successful in 94% of the patients. Factors influencing the success include obesity, nulliparity, decreased vaginal access and space, lack of uterine descent, increased uterine size and tubo‐ovarian disease. These have been analysed and the recognition and management of technical difficulties are described. There was no morbidity attributable to the vaginal oophorectomy. With experience and appropriate technique suitable women can be offered prophylactic oophorectomy at the time of vaginal hysterectomy.
Symptoms analysis for the diagnosis of genuine stress incontinence
Authors: VERSI EBOO , CARDOZO LINDA , ANAND DINA , COOPER DEREK
Published: August 2005

Objective— To determine the accuracy of an analysis of symptoms alone for the diagnosis of genuine stress incontinence.

Design— A comparison of results of symptoms analysis with urodynamic findings.

Setting— A gynaecological video‐urodynamic unit.

Subjects— 252 consecutive patients referred for urodynamic investigations.

Interventions— A questionnaire of 20 symptoms of lower urinary tract dysfunction, midstream specimen of urine, pad testing, uroflowmetry, and video‐cystourethrography.

Main Outcome Measures— Using the urodynamic diagnosis as the ‘gold standard’, the accuracy of discriminant function analysis of symptoms was determined.

Results— Symptoms analysis achieved a correct classification of 81% with a false positive rate of 16%. Use of an accumulative probability curve defines patients who fall into the equivocal range.

Conclusions— All women presenting with incontinence should undergo pre‐operative urodynamic studies.
Maternal serum unconjugated oestriol and human chorionic gonadotrophin levels in twin pregnancies: implications for screening for Down's syndrome
Authors: WALD NICHOLAS , CUCKLE HOWARD , WU TIESHENG , GEORGE LYNNE
Published: August 2005

Objective— To investigate maternal serum unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) levels in twin pregnancies and to consider the implications of the results for antenatal screening for Down's syndrome.

Design— Measurement of maternal serum uE3 and hCG levels from 15–22 weeks of gestation in twin and singleton pregnancies. Previously available maternal serum alpha‐fetoprotein (AFP) levels were also presented.

Setting— Stored serum samples collected from women receiving routine antenatal care in Oxford were used.

Subjects— 200 women with a twin pregnancy and, for each, three singleton control pregnancies matched for gestational age (same completed week of pregnancy) and duration of storage of the serum sample (same calendar quarter).

Results— The median uE3, hCG and AFP levels in the twin pregnancies were respectively, 1.67 (95% CI1.56–1.79), 1.84 (95% CI1.64–2.07) and 2.13 (95% CI 1.97–2.31) multiples of the median (MoM) for singleton pregnancies at the same gestational age. The variance of values for the three serum markers (expressed in logarithms), and the correlation coefficients between any two, were similar in the twin and singleton pregnancies.

Conclusion— In maternal serum screening programmes for Down's syndrome dividing uE3, hCG and AFP MoM values in twin pregnancies by the corresponding medians for twin pregnancies will, in expectation, yield a similar false‐positive rate in twin pregnancies as in singleton pregnancies.
A review of 80 endometrial resections for menorrhagia
Authors: PYPER R. J. D. , HAERI A. D.
Published: August 2005

Objective— To assess the efficacy of endometrial resection in treating menorrhagia.

Design— A clinical audit of 80 consecutive patients.

Setting— The department of gynaecology, Ealing Hospital, London.

Subjects— Eighty women referred by their general practitioner with the primary complaint of menorrhagia.

Interventions— Endometrial resection by hysteroscopic electro‐diathermy.

Main outcome measures— Subjective assessment of the change in menstrual blood loss by the 75 patients, who were followed up for at least one year.

Results— Of 75 women assessed after 1 year 45 (60%) had a successful outcome and nine (12%) had ‘some improvement’. There were 21 failures; 14 reported ‘no improvement’ initially and seven were late failures after a good result at 6 months. Fifteen underwent a second procedure with 83% success at 6 months. Complications included uterine perforation in three women, excessive glycine absorption in two, and two women had problems with haemorrhage. Four women came to hysterectomy.

Conclusions— Endometrial resection is an effective treatment for menorrhagia. Improvements in operative technique and equipment gave better results and fewer complications in the second half of the series.
A multicentre study of coagulation and haemostatic variables during oral contraception: variations with four formulations
Authors:   Task Force on Oral Contraceptives
Published: August 2005

Objective— To explore the extent to which progestogen type and oestrogen and progestogen dose may modify the effects of combined oral contraceptives (OC) on coagulation and haemostasis.

Design— Randomized double‐blind clinical trial.

Setting— Gynaecological clinics in Salvador (Brazil), Santiago (Chile), Singapore, and Dublin (Ireland).

Subjects— 622 women aged 18–35 years who had opted for oral contraception. A contrast group of 155 women who were not to receive OC was also studied. Both groups included approximately equal numbers from each of the four centres.

Interventions— Treatment of approximately equal numbers of women at each centre with one of the following OC preparations for at least 12 months: Noreth isterone acetate (NEA) 1 mg + ethinyl oestradiol (EE) 50μg; levonorgestrel (LNG) 250 + EE 50 μg + EE 30 μg; LNG 150 μg + EE 30 μg.

Main outcome measures— Changes over 12 months in 12 coagulation and haemostatic variables.

Results— At 12‐month follow‐up, the women on each OC preparation showed acceleration of prothrombin time and increase in factor X and fibrinogen. With the OC containing NEA there was also a persistent rise in factor VIIC, and reduction of antithrombin 111 and arantiplasrnin. The formulation which contained low doses of both LNG and EE showed the least adverse coagulation changes. Large increases in fibrinolysis were found in all OC groups.

Conclusions— The adverse effects of combined OC on clotting are affected by the type and dose of progestogen as well as the dose of oestrogen.
The surgical management of vaginal vault prolapse
Authors: CREIGHTON SARAH M. , STANTON STUART L.
Published: August 2005

Objective— A review of the results of surgery for vaginal vault prolapse following hysterectomy.

Design— A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital.

Setting— St George's Hospital, London.

Subjects— 28 women.

Interventions— The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year.

Main outcome measures— Pre‐ and post‐operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function.

Results— The mean follow‐up time was 17.1 months for the colposacropexy an 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus.

Conclusion— The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.
Second trimester amniotic fluid oestriol, dehydroepiandrosterone sulphate, and human chorionic gonadotrophin levels in Down's syndrome
Authors: CUCKLE H. S. , WALD N. J. , DENSEM J. W. , CANICK J. , ABELL K. B.
Published: August 2005

Objective— To investigatc the rcason for low matcrnal scrum unconjugated oestriol (uE3) and raised human chorionic gonadotrophin (hCG) levels in Down's syndrome pregnancies.

Design— Mcasurement of uE3, total oestriol (tE3), dehydroepiandrosterone sulphate (DHEAS), a precursor of oestriol, and hCG in 15–20 week amniotic fluid samples from pregnancies with and without Down's syndrome.

Setting— The retrieval and use of stored amniotic fluid samples collected from women who had had an amniocentesis for antenatal diagnosis.

Subjects— 45 women with a Down's syndrome pregnancy and 224 unaffected controls of the same gestational age.

Results— The median level of amniotic fluid in affected pregnancies was low for uE3, tE3 and DHEAS but high for hCG: 0.50,0.46,0.35 and 1–58 multiples of the normal median, respectively.

Conclusion— These results suggest that the abnormal maternal serum levels of uE3 and hCG in affected pregnancies are due mainly to abnormal feto‐placental synthesis, rather than feto‐maternal transfer.
Pulsatile umbilical venous flow and its clinical significance
Authors: NAKAI YUICHIRO , MIYAZAKI YOSHIHIKO , MATSUOKA YASUNAGA , MATSUMOTO MASAHIKO , OGITA MOTOHARUIMANAKA SACHIO
Published: August 2005

Objective
To determine the prevalence and significance of pulsatile waveforms from the umbilical vein.

Setting
A tertiary referral clinic for high risk pregnancies.

Subjects
209 fetuses from 24–41 weeks gestation.

Main outcome measures
The presence of pulsatile waveforms in the umbilical vein and the pregnancy outcome.

Results
9/209 fetuses demonstrated pulsatile waveforms and seven had severe growth retardation or congenital anomalies of the heart. Pulsatile flow and abnormalities of the inferior vena cava waveforms were observed in these seven but not in the two infants who were born at term. Double pulsations are described for the first time.

Conclusion
Examination of the umbilical venous waveform for pulsatile flow is a useful test as it indicates the presence of asphyxial cardiomyopathy or congenital heart lesions.
Perineal video‐ultrasonography in the assessment of vaginal prolapse: early observations
Authors: CREIGHTON SARAH M. , PEARCE J. MALCOLM , STANTON STUART L.
Published: August 2005

Objective
To investigate the efficacy of perineal ultrasonography in the assessment of vaginal prolapse.

Design
A prospective descriptive study.

Setting
Urodynamic Unit, St. George's Hospital, London.

Subjects
Six women, three of them were awaiting colposuspension and three had had a colposuspension.

Interventions
Perineal ultrasound scans were performed on women with and without incontinence and prolapse, both before and after continence surgery. Movement of the bladder, urethra, uterus, vaginal vault and enterocele were observed during coughing and the valsalva manoeuvre.

Main outcome measures
To assess reproducibility, six patients had six different measurements taken of bladder neck and prolapse position and movement relative to the symphysis. The measurements were plotted upon an X‐Y co‐ordinate axis. Each measurement was repeated three times and one way analysis of variance performed upon the readings.

Results
Perineal ultrasonography clearly demonstrated movement of the whole pelvic floor. Minor degrees of both anterior and posterior vaginal wall prolapse could be seen and quantified. An increase in posterior vaginal wall mobility was noted in women after colposuspension. All measurements taken were found to be reproducible.

Conclusions
Perineal ultrasonography is easy to perform and is reproducible. It may improve understanding of why some women develop posterior vaginal wall prolapse after colposuspension and, conversely, why some women develop incontinence following anterior repair for prolapse.
Plasma concentrations of motilin and somatostatin are increased in late pregnancy and postpartum
Authors: HOLST NICOLAI , JENSSEN TROND G. , BURHOL PER G.
Published: August 2005

Objective
To examine plasma levels of motilin and somatostatin throughout pregnancy.

Design
Prospective observational study.

Setting
University Hospital, Norway.

Subjects
Eight healthy pregnant women (aged 24–38 years) six of them primi‐gravidae and eight healthy non‐pregnant women of similar age with ovulatory menstrual cycles.

Interventions
In the pregnant women blood samples were obtained at 4‐week intervals from 8 weeks gestation throughout pregnancy and again at 5 days and 28 days postpartum. In the non‐pregnant controls blood samples were obtained on cycle days 4, 7, 10, 13, 14, 15, 18, 21 and 24.

Main outcome measures
Plasma levels of motilin and somatostatin. Results Plasma concentrations of both motilin and somatostatin rose continuously during pregnancy, and motilin levels increased still further to a peak of 165.1 (SE 35.8) pmol/1 at 5 days postpartum. Plasma motilin levels were significantly higher during the third trimester and at 5 days postpartum compared with non‐pregnant controls (P<0.0001). The highest plasma somatostatin levels were found at 40 weeks gestation and at 5 days postpartum (mean 32.1 SE 1.1 pmol/1). Somatostatin levels were significantly higher during the second and third trimester and the postpartum period compared with levels in the follicular phase of the non‐pregnant controls (P<0.0001).

Conclusions
Circulating levels of motilin cannot play a major role in the relaxation of the gut in pregnancy, but somatostatin may play a part in regulating motility.
Falling incidence of hypoxic‐ischaemic encephalopathy in term infants
Authors: HULL JEREMY , DODD KEITH L.
Published: August 2005

Objective
To examine trends in the incidence of hypoxic‐ischaemic encephalopathy over a 13‐year period.

Design
A retrospective analysis of medical records of all infants admitted in the years 1976–1980 and 1984–1988.

Setting
A large non‐teaching district health authority in central England.

Subjects
Infants admitted to a district general hospital neonatal unit with clinical features of hypoxic‐ischaemic encephalopathy.

Main outcome measures
Incidence of three grades of hypoxic‐ischaemic encephalopathy, handicap and mortality.

Results
During the first 5‐year period the overall incidence of hypoxic‐ischaemic encephalopathy was 7.7 per 1000 live births with 2.6 per 1000 live births being severely affected (grades II and III). In the second 5‐year period the overall incidence was 4.6 per 1000 live births with 1.8 per 1000 live births being severely affected. The difference in the overall rate is statistically significant. Of the infants with severe encephalopathy 61 % had Apgar scores below 4 at 1 min and 60% were born by instrumental or operative delivery.

Conclusions
The fall in incidence of hypoxic‐ischaemic encephalopathy has occurred during a period of falling perinatal mortality rate. It was instructive to find that infants born vaginally and without obstetric intervention formed a larger fraction of the severely affected infants in the later period.
Sweeping of the membranes is an effective method of induction of labour in prolonged pregnancy: a report of a randomized trial
Authors: EL‐TORKEY MOHAMED , GRANT JOHN M.
Published: August 2005

Objective
To determine whether sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy.

Design
Randomized controlled trial.

Setting
A district maternity hospital.

Subjects
65 women attending an antenatal clinic; 33 randomized to sweeping of the membranes and 32 to a control group.

Main outcome measure
Proportion of women achieving spontaneous labour.

Results
Spontaneous labour occurred more often in the sweeping of the membranes group than in the control group (25/33 (76%) vs 12/32 (38%); odds ratio (OR) 4.65; 95% confidence interval (CI) 1.75 to 12.31; P= 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labour ward (16/33 (49%) vs 5/32 (16%); OR 4.39; 95% CI 1.56 to 12.32; P= 0.005). There were fewer maternal infections in the sweeping group (0/33 vs 4/32 (12%); OR 0.12; 95% CI 0.02 to 0.88; P= 0.04). There were no differences in the type of analgesia used in labour, the mode of delivery or neonatal outcome.

Conclusions
Sweeping of the membrances is an effective method of induction of labour in women with prolonged pregnancy.
The modified Pereyra procedure: a clinical and urodynamic review
Authors: KARRAM MICKEY M. , ANGEL OSCAR , KOONINGS PAUL , TABOR BANNIE , BERGMAN ARIEH , BHATIA NARENDER
Published: August 2005

Objective
To review the clinical and urodynamic outcome of treatment by the modified Pereyra procedure in 93 women with genuine stress incontinence.

Design
Retrospective review.

Setting
Harbor/UCLA Medical Center and Los Angeles County Women's Hospital, Los Angeles, California, USA.

Main outcome measures
Clinical and urodynamic assessment one year after modified Pereyra procedure.

Results
Overall 82% of patients were subjectively cured while only 63% were objectively cured. Women with failed surgery had significantly lower pre‐operative maximum urethral closure pressures. The procedure had a low operative and postoperative morbidity with no significant disturbance of voiding function noted at one year follow‐up.

Conclusions
Our results with the modified Pereyra procedure for stress incontinence showed a significantly lower success rate than has been reported from many previous studies.
Randomized trial of amniotomy in labour versus the intention to leave membranes intact until the second stage
Authors: BARRETT JON F. R. , SAVAGE JOHN , PHILLIPS KEVIN , LILFORD RICHARD J.
Published: August 2005

Objective
To compare by randomized prospective clinical trial the outcome of labours which are managed with the intention to leave the membranes intact, compared with the practice of elective artificial rupture of the membranes (ARM) in early established labour.

Design
Prospective randomized controlled trial of low risk women admitted in spontaneous labour, with intact membranes.

Setting
The labour ward of St. James's University Hospital, Leeds, UK.

Subjects
362 women in spontaneous labour with intact membranes and no evidence of fetal distress, between 37 and 42 weeks gestation. During the course of the trial it was found that some randomization cards could not be accounted for and a system of daily checks was instituted. The results were analysed for all recorded women (n= 362) and after institution of the more rigorous system (n= 120).

Main outcomes measured
The duration of each phase of labour, epidural rate, prevalence of an abnormal cardiotocograph (CTG) (assessed blind), method of delivery and neonatal outcome.

Results
178 of the 183 women (97%) in the ARM group had their membranes ruptured in early labour, and 83 (46%) of the 179 women allocated to non‐intervention had ARM performed at some stage. A significant decrease in the duration of labour (mean 8.3, SD 4.1 h vs mean 9.7, SD 4.8h, n = 156; P= 0.05) was found amongst primigravidae allocated to ARM when compared with non intervention. The duration of the second stage of labour was unaffected. In the ARM group the epidural rate was higher and labour was more often complicated by CTG abnormalities. There were no differences in the method of delivery, fetal condition at birth (cord blood lactate, Apgar score) or postpartum pyrexia between the ARM and non‐intervention groups. The same trends were observed when analysis was confined to women entered into the trial after the system of rigour was instituted.

Conclusion
Routine ARM results in labour that is slightly shorter than if the membranes are allowed to rupture spontaneously but more epidurals are used suggesting that labour is more painful. There are fewer fetal heart rate abnormalities if the membranes are left intact but amniotomy has no effect on fetal condition at birth.
Fetal acidaemia, the cardiotocograph and the T/QRS ratio of the fetal ECG in labour
Authors: MACLACHLAN NEIL A. , SPENCER JOHN A.D. , HARDING KATE , ARULKUMARAN SABARATNAM
Published: August 2005

Objective
To relate the T/QRS ratio of the fetal electrocardiogram (ECG) to the cardiotocogram (CTG) and fetal pH during labour.

Design
Prospective data collection from selected monitored labours. Setting A postgraduate teaching hospital delivery suite.

Subjects
113 women in labour at term.

Main outcome measures
Correlation of fetal T/QRS ratio values with pH values at the time of fetal blood sampling and at birth (umbilical artery blood). Comparison of the predictive values of raised T/QRS ratio and a pathological CTG for fetal acidaemia.

Results
Complete data sufficient for analysis was available for 51 fetal scalp blood samples and 93 umbilical artery pH samples. The median (range) of T/QRS ratio values before birth of 88 babies not requiring admission to the neonatal unit was 0.13 (0.00–0.32) with a 97.5th centile value of 0.28. T/QRS ratios did not correlate with fetal scalp pH values. Fetal scalp acidaemia (pH<7.20) was detected with rates of 50 and 13% respectively by a pathological CTG and by a T/QRS ratio above 0.28, the positive predictive values being 40% and 50%, respectively. There was a significant correlation between increasing T/QRS ratio and falling pH. Detection rates (sensitivities) for umbilical artery acidaemia (pH<7.12) were 76% and 29% whereas positive predictive values were 38% and 71% respectively for a pathological CTG and a T/QRS ratio above 0.28.

Conclusion
A raised T/QRS ratio (<0.28) had a considerably lower detection rate for fetal acidaemia during labour than a pathological CTG.
Pre‐eclampsia and trisomy 13
Authors: TUOHY JEREMY F. , JAMES DAVID K.
Published: August 2005

Objective
To assess the reported association between field trisomy 13 and maternal pre‐eclampsia.

Design
A retrospective case‐control study.

Subjects
Twenty‐five women who gave birth to trisomy 13 infants in southwest England between 1971 and 1989; 38 women who gave birth to trisomy 18 infants in the same region over the same time and 50 women with normal karyotype infants matched for age, parity, and date of delivery with the trisomy 13 group.

Main outcome measures
The medical records of all the women in the three groups were analysed for evidence of pre‐eclampsia. Four different thresholds of pre‐eclampsia were used. The incidence of pre‐eclampsia was compared between the three study groups and analysed separately for primigravid and multigravid women.

Results
The incidence of pre‐eclampsia in pregnancies complicated by trisomy 13 was significantly higher than the incidence in the trisomy 18 and the normal karyotype control groups. This association was more pronounced in primigravid pregnancies.

Conclusions
This, the largest survey of trisomy 13 and pre‐eclampsia to date, suggests an association between the two conditions. It also supports the argument for a fetal factor in the pathogenesis of pre‐eclampsia. We speculate on how genes encoded on chromosome 13 may be responsible.