bluuebunny/crossref_metadata_2025 huggingface dataset:
Vulvar intraepithelial neoplasia with superficially invasive carcinoma of the vulva
Authors: Herod J. J. O. , Shafi M. I. , Rollason T. P. , Jordan J. A. , Luesley D. M.
Published: August 2005

Objective
To investigate the long‐term outcome of patients presenting with vulvar intraepithelial neoplasia WIN) with superficially invasive carcinoma of the vulva (SICa).

Design
A retrospective study using information obtained from patient case notes.

Sample
Twenty‐six women found at presentation to have VIN in association with superficially invasive carcinoma were identified during a 15–year period.

Results
Pruritus vulvae was the most frequent presenting symptom in 18 patients (69%). Sixteen women (61.5%) had multiple symptoms. Features noted at vulvar examination were variable and none were pathognomonic of either VIN or of superficial invasion. All patients had VIN 3 in association with a superficially invasive carcinoma. Histological changes associated with human papillomavirus were found in 19 (73%) women. Half had a co‐existent or previous abnormality of the lower genital tract. Local excision was the most frequent initial treatment (n= 9 [35%I). Mean follow up time was 65 months (range 12–174). Disease persisted after primary treatment in five women (19%). Both histological recurrence (of either VIN or SICa) or symptomatic recurrence occurred in 10 patients (38YO). All patients who experienced recurrence did so within 36 months of treatment. Overall, 12 patients (46%) relapsed (histological or symptomatic recurrence); the mean time was 18 months. Fourteen patients (54%) were managed satisfactorily by their initial treatment. One patient died of recurrent cervical cancer. Three progressed to frankly invasive disease: two (aged 31 and 39 years) with carcinoma of the vulva and one aged 34 years with carcinoma of the perianal margin. All are alive and well after treatment. One patient had recurrence of superficially invasive carcinoma treated by local excision with no further problems. No episode of metastasis. 1a lymphatic or vascular channels has been seen.

Conclusions
Patients with superficially invasive carcinoma of the vulva may be safely treated by local excisional methods without recourse to lymphadenectomy. Relapse after primary treatment is common, and there appears to be a significant risk of progression to frankly invasive carcinoma.
Randomised evaluation of a prototype suction fetal scalp electrode
Authors: Metin A. , Cheryl V. , Hofmeyr G. Justus , Bunn Anthony E.
Published: August 2005

Objective
To compare the performance and acceptability of a prototype suction fetal scalp electrode with that of a double helix spiral electrode.

Setting
An urban academic hospital in Johannesburg, South Africa.

Design
Randomised, by means of sealed opaque envelopes opened consecutively.

Participants
One hundred women in active labour with an indication for direct fetal heart rate monitoring.

Intervention
Application of a fetal scalp electrode to the presenting part.

Outcome measures
Performance of the electrodes with respect to application success, detachment, quality of the tracings, scalp trauma and women's preferences.

Results
Application of the suction electrode was unsuccessful in 15/50 (30%) compared to 1/50 (2%) with the spiral electrode. Detachment rates were similar. There were more tracings of average quality with the suction electrode (nine versus four). There were three instances of scalp bleeding at delivery with the spiral electrode. The suction electrode was preferred by more women and its application caused somewhat less discomfort.

Conclusions
The lower rate of successful application with the suction electrode needs to be weighed against the advantage of avoiding fetal scalp penetration. In particular, women's concerns about pain or harm to the baby from needle electrodes, the theoretical risk of viral transmission, and the risk of serious scalp infection must be considered. These factors favour the use of a suction electrode when direct fetal heart rate monitoring is required. Needle electrodes should be considered when suction electrode application is unsuccessful. Correction of practical problems experienced with the prototype suction electrodes used in this study may result in improved success rates.
Effects of fish oil supplementation in late pregnancy on blood pressure: a randomised controlled trial
Authors: Salvig Jannie Dalby , Olsen Sjúrdur F. , Secher Niels Jsrgen
Published: August 2005

Objective
To study the effect of fish oil supplementation on blood pressure during the third trimester of pregnancy.

Design
In the 30th week of pregnancy 533 healthy women were randomly assigned in a ratio 2:1:1 to receive fish oil (2–7 g/day n‐3 fatty acids (Pikasol)), or a control regimen of either olive oil or no oil supplementation.

Main Outcome measures
Blood pressure measured with an automatic device (Dinamap 1846 SX, Criticon) at baseline and in weeks 33, 37, 39 and subsequently weekly until delivery.

Results
Mean blood pressure increased during the third trimester, and this was not influenced by group assignment. No significant effects on either systolic or diastolic blood pressure were seen in the fish oil group compared to the control groups. The proportions of women with a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg were not significantly different in the fish oil group compared with the control groups, although the proportion of women with diastolic above 90 mmHg tended to be lower in the fish oil group compared with the olive oil group. The corresponding relative risk was RR = 048 (95 % CI 0.22–1.06; P= 007).

Conclusion
2.7 g/day of marine n‐3 fatty acids provided in the third trimester of normal pregnancy showed no effect on blood pressure.
Central and peripheral haemodynamic changes in post‐term fetuses: correlation with oligohydramnios and abnormal fetal heart rate pattern
Authors: Weiner Zeev , Farmakides George , Schulman Harold , Casale Angela , Itskovitz‐Eldor Joseph
Published: August 2005

Objective
To assess the hypothesis that the occurrence of oligohydramnios and abnormal fetal heart rate (FHR) pattern in post‐term fetuses is associated with impaired fetal cardiac function.

Design
A cross sectional study was performed on post‐term and term fetuses. Fetal tests included a computerised analysis of the FHR, a biophysical profile and Doppler studies of the abdominal aorta, umbilical artery, middle cerebral artery and the fetal heart. Pulsatility index (PI) was calculated from the abdominal aorta, umbilical and middle cerebral artery flow velocity waveforms. Peak velocity, velocity time integral (VTI), E:A ratio, and heart rate (HR) were calculated from the flow velocity waveforms obtained from the aortic and pulmonic outflow, and from the mitral and tricuspid valves.

Setting
Maternal fetal laboratory, Department of Obstetrics.

Sample
One hundred and twenty post‐term and 42 term fetuses.

Results
Only the tricuspid E: A ratio was significantly higher (P < 0.05) in post‐term fetuses with a normal amniotic fluid index compared with term fetuses. Post‐term fetuses with an abnormal amniotic fluid index had a significantly lower aortic peak velocity (P < 0.01), aortic VTIxHR (P < 0.01), and mitral VTIxHR(PP < 0.05) compared with post‐term fetuses with a normal amniotic fluid index or compared with term fetuses. Post‐term fetuses with reduced FHR variation had a significantly lower aortic peak velocity (P < 0.01), pulmonic peak velocity (P < 0.05), aortic VTI xHR(P < 0.01), pulmonic VTI xHR(P < 0.05) and a significantly lower mitral VTI xHR (P < 0.05) when compared with post‐term fetuses with normal FHR variation. Similar results were obtained in comparing fetuses with normal and adverse perinatal outcome.

Conclusion
The occurrence of oligohydramnios and abnormal FHR pattern in post‐term fetuses appears to be associated with impaired fetal cardiac function. This finding should allow further investigations of post‐term fetuses.
Nonclosure of the visceral and parietal peritoneum at caesarean section: a randomised controlled trial
Authors: Irion Olivier , Lwuy Frank , Béguin François
Published: August 2005

Objective
To assess the short term morbidity of nonclosure of the peritoneum at caesarean section.

Design
Women undergoing a lower segment caesarean section were randomly allocated to either closure or nonclosure of the visceral and parietal peritoneum.

Setting
Tertiary Care University Hospital of Geneva.

Main outcome measures
Length of post‐operative hospital stay. Other outcomes include maternal pain as assessed by both a visual analogue scale and the amount of post‐operative analgesics administered, post‐operative ileus, and febrile morbidity. Operative time was recorded.

Results
We allocated 137 women to the nonclosure group and 143 to the closure group. Population characteristics were similar between groups. The mean length of hospital stay was 6.5 (SD 1.9) days for the nonclosure group and 6.8 (SD 2.2) days for the closure group (P= 0.21). No differences were found in the level of post‐operative pain, the number of analgesic doses given, nor in the proportion with febrile morbidity. Post‐operative ileus resolved later in the closure group (P= 0.006). The mean operative time was shorter by 6 min (P= 0.006) in the nonclosure group.

Conclusions
Short term post‐operative morbidity and maternal pain are not increased by a shorter and more simple surgical procedure in which the peritoneum is left unsutured.
The intrapartum CTG prior to neonatal encephalopathy at term: a case‐control study
Authors: Spencer John A. D. , Badawi Nadia , Burton Paul , Keogh John , Pemberton Patrick , Stanley Fiona
Published: August 2005

Objective
To compare cardiotocograph (CTG) records during labour in cases of neonatal encephalopathy and matched controls.

Design
Case—control study.

Setting
Metropolitan area of Perth, Western Australia.

Subjects
Term deliveries complicated by neonatal encephalopathy and controls matched for sex, hospital, time of birth, day of week of birth and maternal health insurance.

Main outcome measures
Low fetal heart rate (FHR) variability, FHR accelerations, late decelerations, total Kreb's score and FIGO classification of CTG records.

Results
The neonatal encephalopathy group had significantly more abnormal CTG records (89%) classified according to FIGO, although 52% of control CTG records were also abnormal. CTG records from cases developed significant differences in terms of absence of FHR accelerations and low FHR variability, but not late decelerations, prior to delivery.

Conclusion
Given the low incidence of neonatal encephalopathy in this study (7 per 1000) the predictive value of an abnormal CTG record is clinically unhelpful. However, the changes in the FHR in such cases suggest a greater disturbance of fetal (rest—activity) behaviour during labour.
Antecedent circumstances surrounding neural tube defect births in 1990–1991
Authors: Williamson P. , Alberman E. , Rodeck C. , Fiddler M. , Church S. , Harris R. ,   On behalf of the Steering Committee of the National Confidential Enquiry into Counselling for Genetic Disorders
Published: August 2005

Objective
To investigate births with neural tube defects at a time when most districts were screening for the condition. The objective was to document the circumstances surrounding each affected birth and assess the care provided against given standards.

Design
Retrospective review of antenatal casenotes by the obstetric team.

Population
Three hundred and eight births in England and Wales in 1990 to 1991 were reported to the Office of Population Census Survey (OPCS) to involve neural tube defects. Sufficient information was available to identify both the woman and the obstetrician in 213 pregnancies. Details were obtained from a questionnaire completed by the obstetric team for 168 (79%). In 20/168 cases either the reported outcome was not a live birth/stillbirth or the pregnancy did not involve a neural tube defect: eight resulted in a ‘normal’ infant, eight were terminated and in four the abnormality was not a neural tube defect. Thus 148 eligible cases were available for analysis.

Results
Of the 148 births, the anomaly was not detected prenatally or detected later than 25 weeks of gestation in 98 cases (66%), diagnosed in a multiple pregnancy in 24 (16%) and diagnosed prenatally but the woman chose to continue the pregnancy in 26 (18%). Of the 98 births not detected prenatally or detected late during pregnancy, the surrounding circumstances were that screening was declined in six cases (4%), screening was not offered due to late booking in 30 (20%), serum alpha‐fetopro‐tein screening gave a false negative result in eight (5%), ultrasound screening gave a false negative result in 29 (20%), both screening methods gave false negative results in 17 (11%) and other reasons in eight (5%). The estimated sensitivity of ultrasound screening for anencephaly was 100%. For spina bifida the estimated sensitivity for singleton pregnancies is higher for serum alpha‐fetoprotein screening, 84% to 92%, than ultrasound screening, 70% to 84%, for a range of assumptions regarding the degree of under‐reporting to OPCS of live births and terminations.

Conclusions
Late booking precluded the offer of screening tests in a substantial proportion (22%) of cases. The presence of multiple fetuses including one or more with a neural tube defect was a serious additional complication in prenatal screening, diagnosis and counselling. Screening for neural tube defects was widespread in 1990 to 1991, although variations in the services provided were documented. Ultrasound scanning was a major component but was associated with a lower sensitivity than maternal serum alpha‐fetoprotein screening for neural tube defects other than anencephaly.
Serum levels of the tumour‐associated trypsin inhibitor in patients with endometriosis
Authors: Medl Michael , Ogris Emil , Peters‐Engl Christian , Mierau Michael , Buxbaum Pia , Leodolter Sepp
Published: August 2005

Objective
To show that in patients with endometriosis a 6 kD polypeptide, the tumour‐associated trypsin inhibitor (TATI), can occur at elevated concentrations in serum.

Design
In a prospective study TATI serum levels were assessed prior to surgery in 368 consecutive patients suffering from benign gynaecological diseases (e.g. pelvic pain, infertility, elective sterilisation, uterine fibroids and pelvic masses) with (n= 71) and without (n= 297) endometriosis, who underwent laparoscopy or laparotomy for diagnosis and/or treatment.

Results
The TATI serum levels of patients suffering from endometriosis were significantly different from those in the control group and showed a positive correlation with the stage of endometriosis. The sensitivity of TATI was 0.34 with a specificity of 0.85 for all cases of endometriosis, with an increase of sensitivity (0.67) and slight decrease of specificity (0.82), considering only a group of Stage III/IV patients. Excluding patients with benign ovarian cysts, the specificity of TATI was 0.91 and 0.85, respectively. The combination of TATI and CA125 showed an increase of sensitivity to 0.59 for all cases of endometriosis and 0.89 for patients with Stage III/IV endometriosis.

Conclusions
The sensitivity of TATI as a screening method for endometriosis is too low, but considering its high specificity, TATI in combination with CA125 could provide an additional diagnostic tool in diagnosis and follow up of patients with endometriosis.
Gestational trophoblastic disease with liver metastases: the Charing Cross experience
Authors: Crawford Robin A. F. , Newlands E. , Rustin G. J. S. , Holden L. , A'Hern Roger , Bagshawe K. D.
Published: August 2005

Objective
To define management options for women presenting with gestational trophoblastic disease (GTD) which had already metastasised to the liver.

Design
Retrospective analysis of case records between 1958 and 1994.

Setting
A national referral centre for trophoblastic disease.

Results
The database containing 1676 treated patients was reviewed and 46 patients with hepatic metastases were identified (2.7%). The median age was 32 years (range 19–52 years). The antecedent pregnancy to the GTD was normal in 65% (30/46), and the time interval between the antecedent pregnancy and presentation was longer than one year in 50% (22/44). Lung metastases were present in 43 patients (93%) and brain deposits in 15 patients (33%). Forty‐five patients (98%) were high risk by WHO criteria. The five‐year overall survival was 27%. The five‐year survival of the subgroup of patients having both hepatic and cerebral metastases was 10%. There was no significant survival difference between the different chemotherapy regimens used in the study period (pre‐1979 CHAMOCA: methotrexate, actinomycin D, cyclophosphamide, doxorubicin, melphalan, hydroxyurea and vincristine; 1979 onwards EMA/CO‐EP: etoposide, methotrexate, adriamycin‐D/cyclophosphamide, vincristine‐etoposide and cis‐platinum). Multivariate analysis revealed that a prognostic score > 12 was significant (Hazard ratio 5.4,95% CI 0.7–41.9; P= 0.04).

Conclusions
The outcome for women presenting with hepatic metastases from GTD is poor with an even worse prognosis if cerebral metastases are also present. Alternative therapeutic measures, such as high dose therapy or new drugs, should be explored in these women.
The hidden mortality of monochorionic twin pregnancies
Authors: Sebire Neil J. , Snijders Rosalinde J. M. , Hughes Karen , Sepulveda Waldo , Nicolaides Kypros H.
Published: August 2005

In an ultrasound screening study at 10 to 14 weeks of gestation for measurement of fetal nuchal translucency thickness there were 102 monochorionic and 365 dichorionic twin pregnancies. In the monochorionic compared with the dichorionic pregnancies there was a higher rate of fetal loss before 24 weeks of gestation (12.2%versus 1.8%), perinatal mortality (2.8%versus 1.6%), prevalence of delivery before 32 weeks (9.2%versus 5.5%), and prevalence of birthweight below the 5th centile in both twins (7.5%versus 1.7%). However, the proportion of pregnancies with a birthweight discordancy of more than 25% was similar in the two groups (11.3%versus 12.1%).
Antenatal corticosteroid therapy and fetal behaviour: a randomised study of the effects of betamethasone and dexamethasone
Authors: Mulder Eduard J. H. , Derks Jan B. , Visser Gerard H. A.
Published: August 2005

Objectives
To compare the effects of maternal betamethasone and dexamethasone administration on fetal behaviour and fetal heart rate variation.

Design
Aprospective randomised study of 60 women at increased risk of preterm delivery.

Outcome measures
Fetal heart rate and its variation, the incidence of fetal body and breathing movements.

Setting
Obstetric unit, University Hospital, Utrecht, The Netherlands.

Results
Following maternal betamethasone administration (day 2), fetal heart rate variation was reduced by 19% and fetal body and breathing movements by 49% and 85%, respectively. After dexamethasone treatment there was a significant increase in short term fetal heart rate variation (24%) on day 1. All values returned to baseline on day 4, indicating that no fetal deterioration had occurred during the course of the study period.

Conclusion
Betamethasone, with probably the greater beneficial effect, has more effects on fetal behaviour and fetal heart rate variation than dexamethasone. When assessing fetal condition, due account needs to be taken of these effects.
Ultrasound screening for congenital uterine anomalies
Authors: Jurkovic Davor , Gruboeck Katharina , Tailor Anil , Nicolaides Kypros H.
Published: August 2005

The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three‐dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscarriage.
The use of hormone replacement therapy in women with acute myocardial infarction: an audit of current practice
Authors: Edozien G. Y. , Edozien L. C. , Klimiuk P. S. , Mander A. M.
Published: August 2005

We undertook criterion‐based audit of the current practice of prescribing hormone replacement therapy for women with acute myocardial infarction; the audit included 181 consecutive women admitted to one hospital with this diagnosis in one calendar year. The set standard was that, barring any contraindication, all postmenopausal women with acute myocardial infarction should be prescribed hormone replacement therapy before discharge from hospital. The evidence base of this standard derives from more than 30 epidemiological and clinical studies and a large body of biological data. Only 4.7% of the women were current users of hormone replacement therapy and the set standard was met in only 3% of eligible nonusers. Professionals caring for women who have had a myocardial infarction need to consider hormone replacement therapy as a secondary prophylaxis of myocardial infarction. Gynaecologists should liaise with colleagues in other specialties and general practice to ensure that information on the nongynaecological benefits of hormone replacement therapy is widely disseminated.
Selection biases invalidate current low birthweight weight‐for‐gestation standards
Authors: Tin W. , Wariyar U. K. , Hey E. N. ,   on behalf of the Northern Neonatal Network
Published: August 2005

Objective
To obtain unbiased estimates of the variation of birthweight with gestation in infants born before 32 weeks of gestation.

Setting
The former Northern Regional Health Authority.

Design
Information on birthweight was collected during a collaborative study of every registered and unregistered birth at 22 to 31 weeks of gestation in the region in 1983 and 1990 to 1991. These birthweights were then related to computer‐generated Tyneside norms for all registered births at 28 to 42 weeks of gestation between 1984 and 1991. Some local information was also collected on fetal weight after termination of pregnancy on social grounds at 16 to 21 weeks of gestation.

Results
Weight centiles constructed after excluding infants with a gross, externally visible, malformation and those dying before the onset of labour suggest that previously published European standards have overestimated birthweight in infants < 28 weeks of gestation, some low centiles being 30% in error. Female and first‐bom infants weighed 4% less than their male and later‐born counterparts at all gestations studied. A single correction factor can therefore be used to correct for sex and parity, eliminating the need for separate centile graphs. Twin pregnancy was associated with a 10% reduction in mean birthweight in pregnancies lasting < 37 weeks, and this difference increased progressively in pregnancies lasting longer than this.

Conclusion
The small number of low birthweight infants in previous datasets and the selective exclusion of all nonregistered births have made previous second trimester weight‐for‐gestation norms unreliable.
Suppression of serum vascular endothelial growth factor immunoreactivity in normal pregnancy and in pre‐eclampsia
Authors: Lyall Fiona , Greer Ian A. , Boswell Fiona , Fleming Richard
Published: August 2005

Objective
To determine whether vascular endothelial growth factor (VEGF) concentrations are altered in pre‐eclampsia.

Design
Serum was prepared from peripheral venous blood and stored at −70°C. Serum VEGF concentrations were measured by ELISA.

Setting
University of Glasgow Department of Obstetrics and Gynaecology, Royal Infirmary, Glasgow.

Participants
Twenty‐two healthy nonpregnant volunteer women, 34 normal pregnant women and 34 women with pre‐eclampsia were studied.

Results
Serum concentrations of VEGF were significantly lower in normal pregnant women (median value 12.89 pg/mL) than in nonpregnant women (median value 166 pg/mL; P < 0.0001). In pre‐eclampsia VEGF concentrations were significantly lower (median value 2.34 pg/mL) than normal pregnancies (P < 0.0001). Postpartum concentrations of VEGF in the group complicated by pre‐eclampsia (median value 76.42 pg/mL) were not significantly different from nonpregnant values (P= 0.2).

Conclusions
Our results show that serum concentrations of VEGF are suppressed in pregnancy and further reduced in pre‐eclampsia. Further studies to elucidate the mechanisms which lead to a reduction in VEGF concentrations may provide new clues to the aetiology of this disorder.
The role of endogenous nitric oxide synthesis in contractility of term or preterm human myometrium
Authors: Jones G. D. , Poston L.
Published: August 2005

Objective
To assess in vitro the role of endogenous myometrial nitric oxide synthesis on human myometrial contraction.

Design
Strips of myometrium were mounted in a standard organ bath for assessment of isometric contraction and the response to modulators of nitric oxide synthesis determined.

Setting
A teaching hospital research laboratory.

Sample
Women undergoing elective nonlabour caesarean section under regional anaesthesia: 54 at term and seven preterm.

Results
Neither addition of L‐arginine, the substrate for nitric oxide synthase, nor of an inhibitor of nitric oxide synthase led to any specific change in spontaneous myometrial contraction.

Conclusion
Endogenous nitric oxide production does not play an important role in the control of human term or preterm nonlabouring uterine smooth muscle contractility.
Lipid peroxidation in cord blood: the effects of umbilical nuchal cord
Authors: Wang Chi Chiu , Rogers Michael Scott
Published: August 2005

Objective
To examine the relation between cord entanglement around the fetal neck and umbilical arterial measures of free oxygen radical activity at birth.

Design
Prospective observational stuy of the lipid peroxide levels in umbilical cord arterial blood.

Setting
Delivery suite of Prince of Wales Hospital, Hong Kong.

Population
Women with a singleton pregnancy, at term (37 to 42 weeks of gestation), cephalic presentation, spontaneous or induced labour and an initially normal fetal heart rate tracing.

Methods
A series of 230 singleton deliveries had determination of two lipoperoxides in umbilical arterial cord blood: malondialdehyde and organic hydroperoxide. Umbilical pH, PO2, PCO2 and base excess were also measured in both umbilical cord arterial and venous blood.

Main outcome measures
Umbilical cord blood gases and arterial malondialdehyde and organic hydroperoxide levels.

Results
Forty‐nine cases of nuchal cord were observed: 14 tight and 35 loose. Tight nuchal cord was associated with a low 1‐min Apgar score and increased lipid peroxide levels. Loose nuchal cord was associated with larger amniotic fluid volume and significantly decreased lipid peroxide levels.

Conclusions
This study suggests that tight nuchal cord is associated with increased free oxygen radical activity in the fetus, but that loose nuchal cord carries no adverse effects.
Randomised controlled trial of cardiotocography versus umbilical artery Doppler in the management of small for gestational age fetuses
Authors: Haley J. , Tuffnell D. J. , Johnson N.
Published: August 2005

Objective
To compare the impact on use of resources in the management of small for gestational age babies using Doppler ultrasound versus cardiotocography.

Design
A randomised controlled trial.

Setting
A large district general hospital delivering 5500 to 6000 infants each year, 30% to 35% of which are to women of Pakistani origin.

Population
One hundred and fifty women delivered of small for gestational age infants.

Main outcome measures
Primary outcome measures were length of hospital inpatient stay and induction of labour rates. Secondary outcome measures included caesarean section rates and length of stay on neonatal unit.

Results
The use of Doppler reduced average hospital inpatient stay from 2.5 days to 1.1 days, compared with cardiotocography (P= 0.036). There was no effect on induction of labour rates or caesarean section rates. There was no significant difference in length of stay on the neonatal unit (P= 0.33). There was a reduction in monitoring frequency and fewer hospital antenatal clinic visits.

Conclusion
The use of Doppler ultrasound to manage small for gestational age infants reduces the use of resources, compared with cardiotocography.
Fetal size and growth velocity in the prediction of intrapartum caesarean section for fetal distress
Authors: Owen Philip , Harrold Anthony J. , Farrell Thomas
Published: August 2005

Objective
To evaluate and compare third trimester ultrasound measurements of fetal size and growth velocity in the prediction of intrapartum operative delivery for fetal distress and admission to the special care baby unit in a low risk antenatal population undergoing labour at term.

Design
Retrospective analysis of prospectively collected ultrasound data.

Setting
Ninewells Hospital, Dundee, Scotland.

Population
Three hundred and ninety‐eight women previously enrolled in a longitudinal study of intrauterine volume undergoing labour at a gestational age of > 37 weeks.

Method
Fetal abdominal area (FAA) standard deviation scores (Z scores) were calculated for size at 32 and 36 weeks of gestation together with the growth velocity Z scores between these two gestational ages. Receiver–operator characteristics were calculated for fetal abdominal area Z scores at 32, 36 weeks and velocity Z scores in the prediction of caesarean section for fetal distress and/or admission to the special care baby unit.

Main outcome measures
Intrapartum caesarean section for fetal distress and admission to the special care baby unit with a diagnosis of perinatal hypoxia.

Results
Pregnancies ending in caesarean section for fetal distress or admission to the special care baby unit (n= 17) had significantly lower fetal abdominal area Z scores at 36 weeks of gestation (mean Z score −0.71 vs−0.18) and lower fetal abdominal area growth velocity (mean Z score −1.31 vs−0.01). Taking a cutoff Z score of −1.2 derived from the receiver–operator characteristic curve, fetal abdominal area velocity has a sensitivity of 65% and specificity 75% for caesarean section for fetal distress and/or admission to the special care baby unit.

Conclusion
Growth velocity of the fetal abdominal area in the third trimester is superior to a single measurement of the fetal abdominal area at either a mean of 32 or 36 weeks of gestation in the prediction of caesarean section for fetal distress and admission to the special care baby unit in low‐risk women labouring at term. These results support the hypothesis that in the third trimester at least, growth rate in utero is more relevant to intrapartum performance and immediate perinatal outcome than estimates of fetal size alone.
External cephalic version at term: a survey of consultant obstetric practice in the United Kingdom and Republic of Ireland
Authors: Coltart Tim , Edmonds D. Keith , Al‐Mufti Raghad
Published: August 2005

Objective
To undertake a survey of external cephalic version (ECV) in the United Kingdom and Republic of Ireland.

Design
In June 1995 every consultant obstetrician and gynaecologist in the United Kingdom and Republic of Ireland was sent a postal questionnaire which asked whether ECV was routinely performed for breech presentation after 37 weeks of gestation, assuming no contraindications. If consultants did not perform ECV, a supplementary question enquired whether they referred patients to a colleague who would perform ECV. The questionnaires were colour coded for country and dispatched from the Postgraduate Education Department of the Royal College of Obstetricians and Gynaecologists (RCOG).

Results
Overall, 78% of questionnaires were returned. The percentage of consultants routinely practising ECV in each country was as follows: Northern Ireland 82%; Scotland 64%; Republic of Ireland 64%; England 43%; and Wales 41%. When these figures were compared with the latest RCOG Annual Statistical Returns for breech delivery and caesarean section for breech delivery, there was an inverse correlation between the percentage of obstetricians performing ECV in any one country and the incidence of breech delivery (P < 0.001). There was a similar inverse correlation for the percentage of obstetricians performing ECV and the caesarean section rate for breech delivery (P < 0.001).

Conclusion
Although postal survey results are not necessarily an accurate reflection of what happens in clinical practice, these data are supported by evidence from the Cochrane Database of Systematic Reviews indicating that ECV after 37 weeks reduces the incidence of both breech delivery and caesarean section for breech delivery.
Female victims of rape and their genital injuries
Authors: Bowyer Lucy , Dalton Maureen E.
Published: August 2005

Objective
A minority (some report < 10%) of women report sexual assault. Of those that negotiate the police process, only a minority will come to a court hearing. It is thought that the courts still rely upon medical evidence, in particular evidence of genital injury to ‘prove’ the rape. This study aimed to ascertain the incidence of genital injury in victims of alleged rape

Design
Retrospective review of case records of women who reported they had had been raped, provided by women doctors on the Northumbrian Police Doctors scheme.

Sample
Case records from Newcastle, North and South Tyneside, Sunderland and Northumbria.

Methods
Analysis of records in the standardised booklet used by police surgeons to examine women reporting rape.

Main outcome measures
Presence of genital injury, presence of other physical injuries.

Results
A minority of women had genital injuries (22/83); the majority had some form of physical injury (68/83), although most of these were minor.

Conclusion
The study shows that only a minority of women examined by specifically trained police doctors show evidence of genital injury. The absence of genital injury does not exclude rape.
Ploidy profile of morphologically normal squamous epithelium adjacent to high grade cervical intraepithelial neoplasia
Authors: McDermott N. , Suliman Y. , Walsh C. Barry , Kay E. W. , Curran B. , Milburn C. , Turner M. , Prendiville W. , Leader M.
Published: August 2005

We have investigated the ploidy profile of morphologically normal mucosa adjacent to high grade CIN (n= 16) and also from normal cervix (n= 18). DNA ploidy was assessed using flow cytometry and image analysis. All cases were diploid by both modalities. Our results show that morphologically normal squamous mucosa has a stable ploidy profile even when it lies adjacent to high grade CIN. This finding supports the view that high grade CIN is a neoplastic expansion of transformed cells rather than the result of a field change effect.
Effects of transdermal oestrogen therapy in postmenopausal women: a comparative study of an oestradiol gel and an oestradiol delivering patch
Authors: Hirvonen E. , Cacciatore B. , Wahlström T. , Rita H. , Wilén‐Rosenqvist G.
Published: August 2005

Objective
To compare the efficacy, safety and tolerability of an oestradiol gel (1.0 mg of oestradiol daily, Divigel®/Sandrena®) with those of an oestradiol delivering patch (delivering 50 μg oestradiol/24 h, Estraderm TTS®) in hormone replacement therapy of postmenopausal women. Dydrogesterone tablets (Terolut®), 10 mg daily for the first 12 days of every month, were used as the progestogen component of the therapy.

Main outcome measures
The effect of treatment on clinical symptoms and on endometrium, total body bone mineral density and lipid metabolism as well as the tolerability of the treatments with special emphasis on skin irritation and compliance were evaluated.

Design
An open, randomised, controlled, parallel‐group trial of 12 months duration.

Setting
The Medical Clinic of Kalevankatu, Helsinki, Finland.

Participants
One hundred twenty postmenopausal women were treated with transdermal oestradiol combined with dydrogesterone. In addition, 25 women without HRT served as a reference group for the bone mineral density measurements.

Results
Both treatment regimens were equally effective in alleviating climacteric symptoms, preserving bone mineral density and were equally safe. A trend towards heavier bleeding was detected in patients treated with the oestradiol delivering patch. A statistically nonsignificant decrease of total cholesterol and triglyceride concentrations but no change in high‐density lipoprotein cholesterol concentration was observed in both groups. The acceptability of the treatment was higher in the gel group (96.4%) than in the patch group (90.7%). Only two (3.3%) women using the oestradiol gel complained of skin irritation whereas 28 patients (46.7%, P<0.001) using the oestradiol delivering patch reported this adverse effect.

Conclusions
Both the oestradiol gel and the oestradiol delivering patch are equally effective in hormone replacement therapy but the gel preparation is less irritative to the skin.
Effects on bone mass after eight years of hormonal replacement therapy
Authors: Eiken P. , Nielsen S. Pors , Kolthoff N.
Published: August 2005

Objective
The purpose of this randomised double‐blind placebo‐controlled study over two years followed by a six year open controlled extension phase was to investigate the effects of hormonal replacement therapy (HRT) both continuous combined HRT and sequential HRT) versus no treatment on lumbar spine bone mineral density (L‐BMD) and distal forearm bone mineral content (F‐BMC). Further, bone mineral density of the proximal femur, lateral spine, and distal forearm was studied after eight years.

Design
Prospective study of normal, early postmenopausal women, initially in a double‐blind, placebo controlled study, subsequently an open, controlled investigation.

Setting
Clinical physiology unit of a general second degree referral hospital.

Sample
Seventy‐three normal, early postmenopausal women (HRT n= 47; placebo/untreated n= 26).

Methods
Dual photon absorptiometry, dual X‐ray absorptiometry, single photon absorptiometry.

Main outcome measures
HRT resulted in a significantly (P < 0.001) higher mean L‐BMD after eight years, when it was 12.1% higher than the mean initial value and 14.8% higher than the mean bone mineral density of the untreated group. L‐BMD increased by 14.6% in women receiving continuous combined HRT compared with 11.1% in those on sequential HRT but intergroup differences were not statistically significant. Mean F‐BMC measured with SPA decreased in the HRT group and in the placebo/untreated group by 0.2% and 14.8% (P < 0.001), respectively. However, after eight years mean F‐BMC was 14.5% higher in the HRT group than in the placebo/untreated group. The study showed after eight years for all regions of the distal radius and ulna a significantly higher bone mineral density value compared with the placebo/untreated group (P < 0.001). An especially large effect of HRT was found on the bone mineral density of the vertebral body of the 3rd lumbar vertebra (L3), this one, measured by lateral scanning, being 18.7% higher than that of the placebo/untreated group. For the proximal femur, only the bone mineral density of Ward's triangle was significantly higher in the HRT group than in the placebo/untreated group.

Conclusion
Eight years of treatment with HRT resulted in a significant, substantial gain of bone mineral density in the lumbar spine. The distal radius, ulna and Ward's triangle showed a significantly higher bone mineral density in the HRT group compared with the placebo/untreated group.
The obstetric experience of carriers of haemophilia
Authors: Kadir R. A. , Economides D. L. , Braithwaite J. , Goldman E. , Lee C. A.
Published: August 2005

Objective
To review the obstetric problems, pregnancy outcome and management of carriers of haemophilia.

Design
Retrospective review of haemophilia and maternity unit records.

Setting
Haemophilia Comprehensive Care Centre.

Participants
Thirty‐two carriers of haemophilia (24 haemophilia A, eight haemophilia B) who had their obstetric care at the Royal Free Hospital over a 10‐year period (1985–1995).

Main outcome measures
Uptake and results of prenatal diagnosis, changes in factor levels during pregnancy, effect of knowledge of fetal gender on obstetric management and neonatal outcome, and maternal haemorrhagic complications.

Results
There were 82 pregnancies and 32 resulted in miscarriage or social abortion. The option of prenatal diagnosis was taken up in only 35% (17/48) of pregnancies. There were five affected male fetuses diagnosed prenatally but only three women opted for termination of the pregnancy. Knowledge of fetal gender was unavailable to the attending obstetrician in 46% (21/46) of pregnancies. A fetal scalp electrode was applied in eight, fetal blood sampling was performed in four, and ventouse delivery was conducted in one of these pregnancies. No adverse effects were reported from the first two procedures, but the ventouse delivery was associated with a huge cephalhaematoma requiring blood transfusion. On the other hand, in five cases fetal blood sampling was withheld because fetal gender was unknown. Four of the eight caesarean sections performed might have been avoided if the gender had been known. The incidence of primary and secondary postpartum haemorrhage was high, 22% (including two cases with massive haemorrhage) and 11%, respectively.

Conclusion
Carriers of haemophilia A and B require special obstetric care with close liaison with the haemophilia centre, and management guidelines should be available and observed. Knowledge of fetal gender is very valuable for management in labour and should be determined antenatally even if the mother declines prenatal diagnosis.
The disappearance of fetal and donor red blood cells in alloimmunised pregnancies: a reappraisal
Authors: Egberts J. , van Kamp I. L. , Kanhai H. H. H. , Meerman R. H. , Giordano P. C. , Gravenhorst J. Bennebroek
Published: August 2005

Objective
To determine the proportional reduction per day in the number of fetal and donor red blood cells from the fetal circulation after intrauterine intravascular transfusions.

Design
A retrospective study of 302 transfusions in 101 fetuses.

Setting
The Department of Obstetrics and Gynaecology of the University Medical Centre Leiden, The Netherlands.

Methods
We measured the haematocrit in fetal samples both before and after repeated intravascular intrauterine transfusion in fetuses with alloimmune disease. The percentage of fetal erythrocytes was determined in Kleihauer‐Betke stained smears. The decline of fetal, donor and mixed red blood cells was calculated by dividing the proportional decrease of the haematocrit values by the number of days between transfusions, also after correction for changes in fetoplacental volumes. Results (given as mean [SD]) are derived from the proportional changes of haematocrit per day.

Results
The interval between the first and second transfusion (15.5 days [SD 5.2]) was shorter than between subsequent transfusions (means ranging from 21.4 to 21.9 days; P 0.0001). The decline per day of mixed, and of donor red blood cells, calculated without corrections for volume changes did not differ from those corrected for volume changes resulting from the transfusion and from fetal growth (correction factor 1.1 [SD 0.4]). Since the coefficient of variance is smaller for the uncorrected decline values, this type of calculation is preferable for clinical purposes. The disappearance of fetal erythrocytes after the first transfusion (6.1 %/day [SD 2.9]) was faster than that of mixed fetal and donor red blood cells (3.2%/day [SD 1.2]; P < 0.0001) and of donor cells alone (1‐4%/day [SD 1.6]; P < 0.0001). The decline of the mixed red blood cell population became the same as that of the donor cells (2.2%/day [SD 0.8]) after the second transfusion. This decline of donor cells was higher than after the first transfusion (1.4%/day [SD 1.6]; P < 0.05). After the first transfusion the fetal erythrocytes disappeared faster after transplacental puncture of the umbilical cord (6.6%/day [SD 2.8]) than after transamniotic punctures (5.4%/day [SD 2.7]; P= 0.05). The mixed red blood cell also decreased faster (3.5%/day [SD 1.3] versus 2.8%/day [SD 0.9]; P < 0.01).

Conclusion
The fast disappearance of fetal erythrocytes, especially after transplacental punctures, shows that the interval between the first and second transfusion needs to be shorter than that for intervals between subsequent transfusions. The number of donor erythrocytes declines by approximately 2% per day.
Circadian rhythm of frequency‐domain measures of heart rate variability in pregnancy
Authors: Ekholm Eeva M. K. , Hartiala Jaakko , Huikuri Heikki V.
Published: August 2005

Objective
To examine frequency domain measures of heart rate variability and their circadian rhythms in pregnancy.

Design
A longitudinal study.

Setting
University hospital in Turku, Finland.

Participants
Sixteen healthy women between 11 and 27 weeks of pregnancy; 12 women before pregnancy; and four women postpartum.

Main outcome measures
Heart rate variability as measured in frequency domain from 24‐hour ambulatory electrocardiography.

Results
Pregnancy was associated with a lower standard deviation of R‐R intervals (P < 0.01), with reduced very low (P < 0.05), low (P < 0.01), and high frequency (P < 0.05) power spectral components of heart rate variability. The high frequency power was lower at night in pregnancy, but similar in the daytime in pregnant and nonpregnant women.

Conclusions
Pregnancy is associated with an overall reduction in heart rate variability, most markedly reflected in the low frequency component. This suggests altered baroreflex or sympathetic modulation of heart rate, and decreased vagal activation at night.
A medium term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance
Authors: Kelleher C. J. , Cardozo L. D. , Khullar V. , Salvatore S.
Published: August 2005

Objective
The aims of this study were to determine the medium term subjective outcome of treatment for women with a urodynamic diagnosis of detrusor instability and low bladder compliance.

Setting
A tertiary referral Urogynaecology clinic.

Participants and methods
One thousand one hundred and five women referred for the investigation of their urinary symptoms were entered into a prospective, long term, quality of life study. Of these, 348 had a videourodynamic diagnosis of detrusor instability or low bladder compliance and form the basis of this paper. Women were contacted by post at least six months following their urodynamic assessment and asked to complete a questionnaire detailing their treatment, its efficacy and side effects, and any residual urinary symptoms.

Results
Two hundred and fifty‐six women (73.6%) responded to follow up; only 5.5% were cured of their urinary symptoms. The majority (90.2%) had received anticholinergic medication, although only 18.2% continued with this treatment in excess of six months. Many women had residual urinary symptoms following their investigation and treatment.

Conclusion
The medium term efficacy of the treatment of detrusor instability and low compliance is disappointing, and a large part of this failure may be attributable to poor treatment efficacy, side effects of medication, or inadequate follow up following the diagnosis and instigation of therapy.