bluuebunny/crossref_metadata_2025 huggingface dataset:
Diurnal variation of uterine contractility
Authors: LUNDSTRÖM V. , ENEROTH P. , SWAHN M.‐L. , GRANSTRÖM E.
Published: August 2005

summary

The diurnal uterine activity in four normal women in the secretory phase of their menstrual cycles and one woman suffering from dysmenorrhea were studied in relation to concomitant hormone levels in blood (progesterone, hGH, prolactin, cortisol, vasopressin, and 15‐keto‐13, 14‐dihydro‐PGF2α). In the four normal women uterine activity decreased after midnight, unrelated to circulating levels of 15‐keto‐13,14‐dihydro‐PGF2α. But during a dysmenorrheic episode the uterine hyper‐contractility pattern correlated well with levels of the PGF2α‐metabolite, indicating a role of endogenous‐produced PGF2α in this condition. The results demonstrate a diurnal rhythm, possibly related to the wake‐sleep cycle. No simple associations were seen between vasopressin, cortisol, prolactin, hGH, the PGF2α‐metabolite, and uterine activity.
Endocrine effects of danazol in the treatment of endometriosis
Authors: BEVAN J. R. , DOWSETT M. , JEFFCOATE S. L.
Published: August 2005

summary

The effects of danazol therapy on circulating gonadotrophins, oestradiol and sex hormone‐binding globulin (SHBG) binding capacity have been studied in eight patients with endometriosis. There was a significant rise in luteinizing hormone (LH) in the first week of treatment with a fall in oestradiol levels. There was a marked fall in SHBG in the first week which continued up to 4 weeks. It is concluded that danazol is not ‘antigonadotrophic’ as frequently claimed and that its therapeutic actions, side effects and the endocrine changes could be explained by an effect on SHBG production. The rationale of its use in other conditions requires reconsideration.
A comparative study of various dosages of danazol in the treatment of endometriosis
Authors: LOW ROBERT A. L. , ROBERTS ANTHONY D. G. , LEESt D. A. RUSSELL
Published: August 2005

summary

The results of a randomized trial to investigate the efficacy of different dosage regimens of danazol in the treatment of endometriosis indicate that for mild endometriosis 200 mg/day of danazol is adequate therapy with less severe side effects than higher dosages. However, more extensive disease requires a higher dose.
Treatment of condylomata acuminata with the carbon dioxide laser
Authors: GRUNDSELL H. , LARSSON G. , BEKASSY Z.
Published: August 2005

summary

Extensive and/or recurrent condylomata acuminata in 78 women were treated with the CO2 laser. Urethra, clitoris or the anal canal were inved in about one‐fourth of the cases. Most were treated as outpatients with the more extensive lesions staged for multiple treatments. After a follow‐up period of 6–33 months, 91% of women were free from disease and treatment failures occurred in 9%, some of which may have been new infections. No serological investigations were performed.
Maternal diabetes and neonatal respiratory distress. II. Prediction of fetal lung maturity
Authors: JAMES D. K. , CHISWICK M. L. , HARKES A. , WILLIAMS M. , TINDALL V. R.
Published: August 2005

summary

Fifty babies were born at ≤ 37 weeks to mothers with diabetes. Delivery was undertaken in all patients with the reassurance that the L/S ratio was ≥2.0 within the preceding 72 h. Five babies (10%) developed respiratory distress syndrome (RDS). Prediction of fetal lung maturity was improved dramatically by measuring amniotic fluid concentrations of phosphatidylcholine (PC), phosphatidylinositol (PI) and phosphatidyl‐glycerol (PG). Fourteen babies were predicted as having ‘no surfactant’ (PC < 20 mg/1, PI < 2 mg/1 and PG < 2 mg/1), five developed RDS. None of the remaining 36 babies developed the illness: they were predicted as having either ‘early surfactant’ (PC ≥ 20 mg/1, PI ≥ 2 mg/1 but PG < 2 mg/1) or ‘late surfactant’ (PC ≥ 20 mg/1, PI ≥ 2 mg/1 and PG ≥ 2 mg/1). Measurement of PC levels alone was the most accurate method of predicting RDS. There was a significant association between low surfactant phospholipid concentrations and the development of transient tachypnoea of the newborn.
The recovery of gases insufflated at laparoscopy
Authors: CHAMBERLAIN GEOFFREY
Published: August 2005

summary

The recovery of gases used for insufflation at gynaecological laparoscopy was investigated in 163 women who were randomly allocated to receive insufflation with nitrous oxide or carbon dioxide, the two most commonly used gases. No difference was detected and since nitrous oxide has dangerous side effects, the use of carbon dioxide is recommended. Methods of enhancing the recovery of gas were then investigated in a further 207 women, treatment being allocated in a random fashion. No merit was found in the use of these techniques and they have been abandoned.
The role of cervical mucus‐semen interaction in infertility of unknown aetiology
Authors: SCHATS R. , AITKEN R. J. , TEMPLETON A. A. , DJAHANBAKHCH O.
Published: August 2005

summary

An in‐vitro penetration assay, which incorporates measurements of sperm motility and forward velocity, was used to investigate sperm‐cervical mucus interaction in 20 couples with unexplained infertility. Evidence of impaired cervical mucus penetration was found in this group of patients and in seven couples the results correlated with previous assessment by laparoscopic sperm recovery. The impairment of cervical mucus penetration was found to be due to defective sperm function rather than to the quality of the cervical mucus itself. Of the criteria of semen quality measured in this study, sperm motility and the zona‐free hamster egg penetration test showed significant correlations with cervical mucus penetration.
Prognostic value of biochemical tests in the assessment of fetal outcome in threatened abortion
Authors: SALEM H. T. , GHANEIMAH S. A. , SHAABAN M. M. , CHARD T.
Published: August 2005

summary

Maternal concentrations of serum progesterone, oestradiol, chorionic gonadotrophin, Schwangerschaftsprotein 1 and placental protein 5 were measured in 67 patients with threatened abortion. The levels of all biochemical variables were significantly reduced in those patients who had an unfavourable outcome. The clinical efficiency of each of these tests was very similar.
Follow‐up study of children whose mothers were treated with warfarin during pregnancy
Authors: CHONG MARGARET K. B. , HARVEY DAVID , DE SWIET MICHAEL
Published: August 2005

Summary. Twenty‐two children whose mothers took the oral coumarin anticoagulant warfarin during pregnancy were seen, to assess their physical and mental development; a comparison was made with matched controls. No significant difference was observed between the study group and controls, nor within the study group according to the period of gestation when their mothers took warfarin.
Effect of short‐term maternal exercise on maternal and fetal cardiovascular dynamics
Authors: PIJPERS L. , WLADIMIROFF J. W. , McGHIE J.
Published: August 2005

Summary. Maternal and fetal cardiovascular dynamics were studied immediately after moderate short‐term maternal exercise in 28 healthy nulliparous subjects at between 34 and 38 weeks gestation who were randomly assigned to an exercise group (n= 14) or a control group (n = 14). At the end of the study, data from 11 exercise and 12 control subjects were available for analysis. A significant rise in maternal heart rate and systolic and diastolic blood pressure during exercise was observed. Mean blood flow velocity in the fetal descending aorta as measured by pulsed Doppler ultrasound and fetal heart rate did not show any significant changes. These data indicate that there are no cardiovascular signs of fetal stress immediately after moderate short‐term maternal exercise.
Posture in labour: patients' choice and its effect on performance
Authors: STEWART P. , CALDER A. A.
Published: August 2005

Summary. In a study to assess the influence of maternal posture on the progress and efficiency of labour, 275 parturients were asked to choose between remaining in bed during labour or being ambulant. Among primigravidae in spontaneous labour those who remained ambulant throughout had the shortest labours; they also had shorter labours than others who were only partially ambulant. Analysis of the data, based on original preference, however, suggests that an easy labour allows ambulation rather than vice versa. Radiotelemetry was used to transmit the fetal heart signal in all ambulant patients and provided satisfactory fetal surveillance in both high‐ and low‐risk labours.
Controlled study of 16,16‐dimethyl‐trans‐δ2 prostaglandin E1 methyl ester vaginal pessaries prior to suction termination of first trimester pregnancies
Authors: FISHER P. R. , TAYLOR J. H.
Published: August 2005

Summary. A pessary containing the prostaglandin analogue, 16,16‐dimethyl‐trans‐δ2prostaglandin El methyl ester (Cervagem) was inserted into the vagina of primigravid women 2 h before suction termination of pregnancy. The cervix was softer, easier to dilate and more widely dilated at the start of the procedure than in a control group of women who received placebo pessaries containing the vehicle alone. Intra‐operative blood loss was diminished. The incidence of pre‐ and post‐operative abdominal cramps was increased in the Cervagem‐treated group. No gastrointestinal side‐effects were noted.
Invasive cervical cancer in young women
Authors: LA VECCHIA CARLO , FRANCESCHI SILVIA , DECARLI ADRIANO , GALLUS GIUSEPPE , PARAZZINI FABIO , MERLO ENZO
Published: August 2005

Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients (P<O.001). The prognostic relevance of the clinical stage decreased after adjustment for lymph–node involvement, but the statistical significance of lymph–node involvement was unaffected when stage was allowed for. In the present series, the estimated 10–year disease–free survival was 80% in patients treated by radical hysterectomy compared with 62% in the group treated by total hysterectomy (stage IB to IV patients only); this difference, however, was not statistically significant when the data were adjusted for clinical stage (P=O.10). None of the 20 patients with recurrent disease could be managed successfully.
Controlled trial of external cephalic version
Authors: KASULE J. , CHIMBIRA T. H. K. , BROWN I. McL.
Published: August 2005

Summary. A prospective randomized, controlled trial involving 640 singleton breech presentations after 30 weeks gestation was conducted to assess the value of external cephalic version. In 310 patients external cephalic version was attempted; the other 330 patients in whom version was not attempted constituted a control group. There were three perinatal deaths directly attributable to external cephalic version. No significant differences were found between the study and control groups respecting the incidence of vaginal breech delivery, caesarean section rate, perinatal mortality and morbidity. Our results suggest that there is no place for external cephalic version before 36 weeks gestation.
Fetal umbilical artery flow velocity waveforms and placental resistance: clinical significance
Authors: TRUDINGER BRIAN J. , GILES WARWICK B. , COOK COLLEEN M. , BOMBARDIERI JOHN , COLLINS LEE
Published: August 2005

Summary. Since the umbilical arteries carry fetal blood to the placenta we studied flow velocity waveforms in these vessels with a simple continuous wave Doppler system to assess placental blood flow. The ratio of peak systolic to least diastolic (A/B) flow velocity was measured as an index of placental flow resistance. In 15 normal pregnancies there was a small but significant decrease in this ratio through the last trimester. The A/B ratio was measured on 436 occasions in 168 high‐risk pregnancies. In 32 of 43 fetuses subsequently shown to be small for gestational age there was an increase in placental flow resistance with reduced, absent or even reversed flow in diastole. This finding was also present in the one fetus which died in utero. Serial studies in patients with fetal compromise indicated increasing flow resistance, a reverse of the normal trend. These results were not available to the clinician yet of 24 fetuses born before 32 weeks 13 had a high A/B ratio, and all of them were born electively. Maternal hypertension was associated with an increase in fetal placental flow resistance. The umbilical artery A/B ratio provides a new and non‐invasive measure of fetoplacental blood flow resistance.
Long‐term culture of human trophoblast cells
Authors: MORGAN D. M. L. , TOOTHILL VALERIE J. , LANDON M. J.
Published: August 2005

Summary. A technique is presented for the preparation of cultures of replicating human trophoblast cells from term placentas. The adherent cells obtained were very slow growing (doubling time 12.5 days) as measured b y the rate of increase in cell protein, [14C]‐leucine uptake and cell number. Cells from individual placentas have been maintained in continuous culture for up t o 1 year (10–12 passages) and have been successfully recultured after storage in liquid nitrogen. Cultured cells showed positive immunofluorescent staining for human placental lactogen, human chorionic gonadotrophin, transferrin and type IV collagen. The adenine nucleotide content indicated that energetically the cells were in balance even after prolonged culture.
Amniotic fluid prostaglandins do not reflect human fetal lung maturation
Authors: CVETKOVIC M. , YLIKORKALA O.
Published: August 2005

Summary. Experimental data suggest the involvement of classic prostaglandins (PG), prostacyclin (PGI,) and thromboxane A2 (TxA2) in fetal pulmonary development. To explore this possibility in man, we assayed serial amniotic fluid samples from 33 women for 13, 14‐dihydro‐15‐keto‐PGF2α (M‐PGF2α a metabolite of PGF2α), 6‐keto‐PGF1α (a breakdown product of prostacyclin (PGI2)), and thromboxane B2 (a metabolite of TxA2) as well as for the lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol. No difference in these prostanoids was seen between the samples with the immature (< 2) or mature 2) L/S ratio, or between the samples with undetectable or detectable phosphatidylglycerol. The L/S ratio matured in 16 women and phosphatidylglycerol became detectable in 19 women during serial smpling, but even in these women the changes in the amniotic fluid prostanoids were inconsistent. It is concluded that the amniotic fluid M‐PGF2α, 6‐keto‐PGF1α, and TxB2 do not reflect fetal pulmonary maturity.
Domperidone; secretion in breast milk and effect on puerperal prolactin levels
Authors: HOFMEYR G. J. , VAN IDDEKINGE B. , BLOTT J. A.
Published: August 2005

Summary. The possible effect on the infant of dopamine antagonists used to promote lactation is cause for concern. Domperidone (Motilium) may be safer than other drugs in this group as it does not cross the blood‐brain barrier. The mean serum level of prolactin 2 h after treatment with 20 mg of domperidone in the puerperium was 255 ng/ml compared with 150 ng/ml after a placebo. The mean domperidone level in all breast milk samples during treatment with 10mg, three times daily, was 2·6 ng/ml. This was significantly more than levels after a single 20 mg dose sampled at 2 h (0.24 ng/ml) and at 4 h (1·1 ng/ml), and considerably less than values available for metoclopramide and sulpiride, relative to the therapeutic dosage. The effectiveness of domperidone to augment lactation requires further study.
Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment
Authors: LUESLEY D. M. , McCRUM A. , TERRY P. B. , WADE‐EVANS T. , NICHOLSON H. O. , MYLOTTE M. J. , EMENS J. M. , JORDAN J. A.
Published: August 2005

Summary. A retrospective study of the complications of cone biopsy showed that among 9 15 women examined between the years 1976 and 1982, 121 (13%) had primary or secondary haemorrhage, 153 (17%) cervical stenosis and 39 (4%) subsequent infertility or an abnormal pregnancy. Cervical stenosis was commonest among women who had had long cones removed. Stenosis occurred more often in the group of women who had been assessed by colposcopy before operation but this was due to the fact that prior colposcopy selected a favourable group of patients with lesions of limited extent that were susceptible to treatment by local destructive therapy, so that prior colposcopic assessment resulted in the removal of longer cones.
Spontaneous resolution of cervical warty atypia: the relevance of clinical and nuclear DNA features: a prospective study
Authors: EVANS A. S. , MONAGHAN J. M.
Published: August 2005

Summary. A selected group of 51 patients with histological features of cervical warty atypia was observed for 1 year. Initial features were compared with a cohort of 50 patients with CIN. Twenty‐four patients showed resolution of the warty atypia. in 19 it remained unchanged, and in eight patients CIN or microinvasive disease was present on repeat biopsy. The DNA patterns obtained by tissue imprint of the initial biopsies and subsequent integrated densitometry, using a Vickers M85 scanning densitometer. showed that warty atypias could be objectively distinguished from CIN, but that the method could not predict the group of warty atypias that would resolve. There was no clinical feature or group of features which allowed a means of predicting the outcome of such lesions.
Is group B streptococcal screening during pregnancy justified?
Authors: EASMON C. S. F. , HASTINGS M. J. G. , NEILL JANE , BLOXHAM BARBARA , RIVERS R. P. A.
Published: August 2005

Summary. Twenty‐eight per cent of women investigated during pregnancy were carriers of group B streptococci (GBS). The use of broth enrichment was the most significant factor in determining GBS carriage rates. GBS carriage decreased during pregnancy. Transmission of GBS from mother to baby was related to vaginal carriage but rectal carriage in pregnancy was the best predictor of maternal carriage at term. Rectal and vaginal swabs taken at 28 and 36 weeks correctly predicted 92% of intrapartum GBS carriage. Although accurate prediction of intrapartum GBS carriage is possible, mass screening for GBS in pregnancy is unlikely to be cost‐effective in those countries with a low incidence of neonatal GBS sepsis.
Prophylaxis of thromboembolism in pregnancy: an alternative
Authors: LAO T. T. , DE SWIET M. , LETSKY E. , WALTERS B. N. J.
Published: August 2005

Summary. Twenty‐six pregnancies in women who had one or more episodes of thromboembolism in the past were managed by a regimen in which routine antenatal prophylactic anticoagulation was not given, apart from during delivery which was covered with intravenous infusion of dextran 70. After delivery, these patients received either subcutaneous heparin for 6 weeks or subcutaneous heparin for 1 week, followed by 5 weeks of warfarin. One patient (4%) possibly developed an episode of thromboembolism in the antenatal period. There were no episodes of postnatal thromboembolism. There were two spontaneous mid‐trimester abortions and no perinatal losses. There were no significant complications or reactions related to the use of dextran, heparin or warfarin.
Risk factors associated with small‐for‐dates and large‐for‐dates infants
Authors: OUNSTED M. , MOAR V. A. , SCOTT A.
Published: August 2005

Summary.Relative risks were calculated to assess the potency of different factors associated with the two extremes of the birthweight distribution. Maternal height affected the chances of having a small‐for‐dates (SED) or large‐for‐dates (LFD) baby to an equal and opposite extent; but the risks associated with maternal weight were greater for LFD than SFD infants. Smoking increased the SFD risk by 3.5 times, whereas the LFD risk was only reduced by a half. Pre‐eclampsia was associated with a very high SFD risk (14·6); in the LFD group it was insignificantly raised. The LFD relative risk steadily rose with increasing parity, but in the SFD group it fluctuated around unity. Among multiparae the risks of an SFD or LFD infant when previous siblings had been of relatively low or high birthweight for gestational age, respectively, were much increased. Estimates of attributable risk showed that if pathological factors such as smoking, hypertensive disorders and congenital abnormalities could be completely eliminated the number of SFD babies in this population would be reduced by about 60%; conversely the number of LFD babies would be increased by about 30%.
Ultrasound Doppler flow studies of the ovarian and uterine arteries
Authors: TAYLOR K. J. W. , BURNS P. N. , WELLS P. N. T. , CONWAY D. I. , HULL M. G. R.
Published: August 2005

Summary. The feasibility of studying ovarian arterial blood flow has been demonstrated, using an ultrasonic method combining real‐time imaging and pulsed Doppler (the ‘duplex’ method). Results using a percutaneous full‐bladder technique were validated by comparison with use of an ultrasound probe applied directly to the arteries at laparotomy. The ovarian arteries demonstrated qualitatively and quantitatively distinct flow patterns compared with the internal and external iliac arteries. From recorded waveforms a pulsatility index (PI) reflecting vascular impedance was calculated. The PI was found to be lower, indicating increased blood flow, in the artery supplying the ovary carrying the dominant follicle or corpus luteum. Serial studies suggest that this change occurs at an early stage of the menstrual cycle. possibly before the dominant follicle can be recognized by its size or increased hormone production. Uterine arterial flow was also detectable, more accurately abdominally than vaginally, and the changes typical of late pregnancy were already found to be present, though to a lesser degree, in the first trimester.
Hormonal studies in women with premenstrual tension
Authors: WATTS J. FF. , BUTT W. R. , EDWARDS R. LOGAN , HOLDER G.
Published: August 2005

Summary. Serum hormone concentrations were determined at intervals during the last 17 days of the menstrual cycle in 35 patients with premenstrual tension (PMT) and 11 control subjects without symptoms. The maximum mean concentration of oestradiol occurred 17 days before menstruation in the patients and 14 days before in the controls. The maximum concentrations of progesterone were similar in the two groups but the mean concentrations rose carlier in the cycle in the patients with PMT. These results suggested that the patients tended to ovulate earlier in the cycle than the controls and on the basis of the ovulatory surge in gonadotrophins two groups could be identified, group A who showed signs of ovulation 14 days or less before menstruation (17 patients, 9 controls) and group B who ovulated more than 14 days before menstruation (18 patients, 2 controls). There were no significant differences between the groups in prolactin, thyroid stimulating hormone or testosterone levels, but cortisol concentrations were uniformly higher in both groups of patients compared with those in the controls. Follicular growth was assessed with ultrasound in 18 patients and 16 control subjects. Mean follicular diameters were significantly lower in the patients than in the control group at the time of ovulation. Oestradiol determinations done at the same time correlated with the diameters and were also significantly lower in the patient group. The results suggest that ovulation tends to occur prematurely in women with PMT.
Long‐term effects of the menopause and sex hormones on skin thickness
Authors: BRINCAT M. , MONIZ C. J. , STUDD J. W. W. , DARBY A. , MAGOS A. , EMBUREY G. , VERSI E.
Published: August 2005

Summary. Skin collagen content and skin thickness in a group of postmenopausal women who had been treated with sex hormone implants were compared with those in an untreated group of similar women. Both skin collagen content and thickness were found to be significantly greater in the treated than in the untreated group. In the untreated women skin collagen content declined in relation to menopausal age but not to chronological age. No correlation was found with menopausal age, chronological age or duration of therapy in the treated group. These data suggest that skin collagen is influenced by the sex hormone status arid declines after the menopause. contributing to the increase in urinary hydroxyproline excretion that has been reported to occur a t this time.
Training in tubal microsurgery
Authors: BOECKX W. , GRUFT L. , BROSENS I.
Published: August 2005

Summary. The restoration of normal tubo‐ovarian function was investigated in a training programme using oviduct anastomosis in the rabbit as an experimental model. Ovulation rate, pregnancy rate, nidation index, implantation failure index and degree of adhesions were used as parameters. More than 100 anastomoses had to be performed to reach a perfect degree of atraumatic, function‐restoring surgery. It is concluded that the most difficult aspect in female infertility surgery is not the use of the operating microscope but the experience in applying the principles of atraumatic surgery.
Topical 5‐fluorouracil in the treatment of vaginal intraepithelial neoplasia
Authors: KIRWAN PHILIP , NAFTALIN NICHOLAS J.
Published: August 2005

Summary. The effectiveness of 5‐fluorouracil (Efudix) in the treatment of vaginal intraepithelial neoplasia was assessed in 14 patients diagnosed with the condition between January 1980 and December 1982. All patients received a standard dose of 2.5 g 5‐fluorouracil cream once weekly f o r at least 10 consecutive weeks: mean duration of treatment was 12 weeks (range 10–20 weeks). The vaginal lesion was associated with a major dysplastic lesion of the cervix in all patients. The duration of follow‐up ranged from 4 t o 42 months (mean 15 months). Thirteen patients had complete resolution both colposcopically and cytologically. One patient still had colposcopic evidence of intraepithelial neoplasia (aceto‐white epithelium) but a vaginal smear has been negative. This patient has since been lost t o follow‐up. We conclude that in t h e regimen described 5‐fluorouracil is an effective treatment f o r vaginal intra‐epithelial neoplasia.
Maternal plasma prostaglandin E2 metabolite levels during human pregnancy and parturition
Authors: BRENNECKE S. P. , CASTLE B. M. , DEMERS L. M. , TURNBULL A. C.
Published: August 2005

Summary. Because of methodological problems associated with the measurement in biological fluids of both prostaglandin E2 (PGE2) and its unstable principal circulating metabolite 13,14‐dihydro‐15‐keto‐PGE2 (PGEM), there is little reliable information on these prostaglandins in human pregnancy and parturition. The recent discovery of a stable PGEM degradation product 11‐deoxy‐13,14‐dihydro‐15‐keto‐11β, 16‐cyclo‐PGE2 (bicyclo‐PGEM) has provided a means of studying endogenous plasma levels of PGEM which circumvents the problems encountered with direct measurements of PGE2 and PGEM. Using a radioimmunoassay for bicyclo‐PGEM we have therefore determined maternal peripheral plasma PGE2 metabolite levels during human gestation. PGE2 metabolite levels did not alter significantly during the second or third trimesters nor during labour. This contrasts with maternal peripheral plasma levels of the principal circulating metabolite of PGF2α 13,14‐dihydro‐15‐keto‐PGF2α (PGFM) which increases several fold during labour. Compared t o PGE2 therefore. PGF2α may be quantitatively the more significant prostaglandin associated with human parturition.
Cimetidine in labour: absence of adverse effect on the high‐risk fetus
Authors: McAULEY D. M. , HALLIDAY H. L. , JOHNSTON J. R. , MOORE J. , DUNDEE J. W.
Published: August 2005

Summary. In a prospective randomized trial, 36 women received cimetidine and 32 magnesium trisilicate mixture BP as antacid therapy every 2 h in labour. The women belonged to a high‐risk category and the infants born were <36 weeks gestation, or <2000g birthweight or otherwise in jeopardy because of severe maternal pre‐eclampsia or diabetes. Measurements of a wide range of haematological and biochemical variables revealed no differences between the two groups of babies. The frequency of complications found in the infants was similar, although infants born to the women who received magnesium trisilicate required oxygen therapy for a longer period. Cimetidine did not appear to affect the development of gastric acidity, or to increase bacterial colonization of the gastrointestinal tract in the infant.
Hormonal profiles in the follicular phase, luteal phase and first trimester of pregnancies arising from in‐vitro fertilization
Authors: YOVICH JOHN L. , STANGER JAMES D. , YOVICH JEANNE M. , TUVIK ANN I. , TURNER SIMON R.
Published: August 2005

Summary. The hormonal profiles for oestradiol‐17β, progesterone, prolactin and β‐human chorionic gonadotrophin (β‐hCG) are documented for the first 24 pregnancies arising from in‐vitro fertilization during a collaborative project between the University of Western Australia and PIVET Laboratory. All patients had ovarian follicle stimulation with clomiphene citrate, sometimes combined with human menopausal gonadotrophin and all had oocyte recovery undertaken 36 h after injection o f 5000 i.u. hCG. The follicular phase profile indicated that patients were admitted for the hCG injection when oestradiol‐17β levels were around 1500 pmol/l per follicle with a dimension of 1·6 cm on ultrasound. Luteal phase data indicated that oestradiol‐17β and progesterone levels were two to three times higher than that expected during spontaneous conception cycles and those pregnancies which subsequently aborted had significantly lower levels in the late luteal phase. During pregnancy elevated oestradiol‐17β and progesterone levels were maintained through the early weeks during organogenesis while the β‐hCG profile was similar to that reported for spontaneous pregnancies arising without ovarian stimulation. Six women aborted and the other 18 pregnancies have generated 22 infants.
The extent and antecedents of uncertain gestation
Authors: HALL MARION H. , CARR‐HILL ROY A. , FRASER CYNTHIA , CAMPBELL DORIS , SAMPHIER MICHAEL L.
Published: August 2005

Summary. The extent and genesis of uncertainty of gestation has been studied in a total obstetric population, using in all cases a best clinical estimate of gestation made according to a specific protocol. In 73·2% of patients, the estimate was assessed as certain, in 19·7% as approximate, and in 7·1% as uncertain. Uncertainty assessed in this way has several antecedents, and coding of only one of these (presence or absence of a precise date for the last menstrual period) is insufficient in data to be used for research in which gestation length is to be used as a variable.
Chronic polyhydramnios is a syndrome with a lactogen receptor defect in the chorion laeve
Authors: HEALY DAVID L. , HERINGTON ADRIAN C. , O'HERLIHY COLM
Published: August 2005

Summary. Human chorion laeve contains a lactogenic hormone [prolactin (PRL), growth hormone (GH) and placental lactogen (hPL)] receptor. Here, we studied binding of the potent lactogen, human GH. to this receptor in 18 normal pregnant women, in 12 patients whose pregnancies were complicated by chronic polyhydramnios and in 13 with chronic oligohydramnios. Polyhydramnios was classified clinically as idiopathic in seven patients. and secondary and associated with various disorders in the remaining five patients. Lactogenic hormone binding was lower in association with polyhydramnios (mean 1·60. SEM 0·15%)) than with normal amniotic fluid volume (mean 3·05, SEM 0·40%; P<0·05): Scatchard analysis indicated that a reduced number of lactogen receptors within the chorion laeve was the reason. The lactogenic hormone receptor defect in the chorion laeve was present in pregnancies complicated by either idiopathic or secondary polyhydramnios. In contrast to chronic polyhydramnios, tissue from patients with chronic oligohydramnios bound lactogenic ligands in a normal fashion. Insulin binding sites were also identified in the chorion laeve, and, in contrast to the lactogens, binding parameters were equivalent in the three patient groups. PRL resistance developing subsequent to this chorion laeve receptor defect might produce the excessive amniotic fluid volume characteristic of polyhydramnios. We propose that a chorionic PRL receptor deficiency underlies the various clinical forms of chronic polyhydramnios.
Platelet values during normal pregnancy
Authors: SILL P. R. , LIND T. , WALKER W.
Published: August 2005

Blood samples were obtained from 26 healthy women at regular intervals throughout pregnancy and analysed using a Coulter Counter Model S Plus III. The mean values for the various haematological indices at each stage o f gestation were first calculated; the platelet count showed a small decrease throughout pregnancy as did haemoglobin concentration while there was an apparent increase in mean platelet volume, platelet distribution width and white cell count. However, analysis of the trends within patients did not always reflect these mean changes; there was considerable variation in platelet count within individuals and the apparent fall in the group as a whole was accounted for by a considerable fall in a few individuals. The assumption that the trends in platelet values determined from groups of patients will indicate how individual pregnant women behave is misleading.
Fetal umbilical artery flow velocity‐time waveforms in twin pregnancies
Authors: GILES WARWICK B. , TRUDINGER BRIAN J. , COOK COLLEEN M.
Published: August 2005

Summary. The umbilical artery flow velocity‐time waveforms were studied in 76 twin pregnancies. The ratio of peak systolic (A) to least diastolic (El) velocity was calculated for each fetus as an index of umbilical placental flow resistance. Seventy‐one sets of twins were studied within 14 days before delivery. In 65 cases both twins were alive at the time of study. In 32 pregnancies both fetuses were of birthweight appropriate for gestational age (AGA) and had A/B ratios within the normal singleton range. In 33 pregnancies one or both of the liveborn infants were small for gestational age (SGA) and in 78% of these at least one fetus had an elevated A/B ratio. Discordancy in birthweight and A/B ratio was associated with growth retardation. Clinically manifest twin‐to‐twin transfusions occurred in five of the ten pregnancies resulting in an SGA infant (eight with discordant weight) associated with a normal and concordant A/B ratio. Two twin‐to‐twin transfusions were associated with perinatal death. The placentas were examined in 61 patients. In 43 dichorionic pairs the A/B ratio was elevated in 12 of the 18 where there was at least one SGA infant. There was a greater incidence of growth retardation in the monochorionic pairs (12 of 18). Only seven of these were identified by an elevated A/B ratio. In 10 of these 18 pairs vascular anastomoses were demonstrated on placental inspection and in a further two there was evidence of twin‐to‐twin transfusion by haemoglobin discrepancy. Twin pregnancy may result in the birth of a small‐for‐dates infant because of intrauterine growth retardation or twin‐to‐twin transfusion. An abnormally elevated A/B ratio identifies growth retardation. In twin‐to‐twin transfusion the A/B ratio of the two fetuses is similar (crossed circulation) yet difference in size may be seen on ultrasound measurement.
Single‐dose amoxycillin in the treatment of bacteriuria in pregnancy and the puerperium‐a controlled clinical trial
Authors: MASTERTON R. G. , EVANS D. C. , STRIKE P. W.
Published: August 2005

Summary. Ninety obstetric patients with significant bacteriuria were treated randomly with either a single dose of 3 g amoxycillin or with a conventional course of ampicillin over 7 days. Treatment groups were comparable in terms of age, gravidity and socioeconomic status, and the outcome of pregnancy in the two groups did not differ significantly. Cure rates, assessed at 1 week and 6 weeks after treatment, were not significantly different: 88% for single‐dose treatment and 84% for conventional treatment. It is concluded that a single dose of 3 g amoxycillin is a safe, effective and acceptable treatment for bacteriuria in pregnancy and the puerperium.
Why are stillbirth and neonatal mortality rates continuing to fall?
Authors: ALBERMAN EVA
Published: August 2005

Summary. The Office of Population Censuses and Surveys are producing new annual tabulations including one on population birthweight distribution, and birthweight/cause‐specific perinatal, neonatal and infant mortality rates. With these d a t a it will be easier to distinguish between falls in mortality rates due to primary prevention of the causes, and those due to secondary prevention as a result of improved medical technology. Examples are given of the use of such data.
Some characteristics of antenatal care in 13 European countries
Authors: BLONDEL BÉARICE , PUSCH DETLEV , SCHMIDT EBERHARD
Published: August 2005

Summary. This study compares the organization of antenatal care in 13 European countries having a fetal and infant mortality rate below 20 per 1000. The countries differ in the number of prenatal visits, the role performed by midwives and the use of home care. It shows that there is no single model of antenatal care among countries having similar fetal and infant mortality.
Unexplained infertility: a review
Authors: PEPPERELL ROGER J. , McBAIN JOHN C.
Published: August 2005

Summary. When investigations fail to reveal a cause for infertility, treatment must then be based on possible, but unproven, causes, and since there is a high spontaneous pregnancy rate in unexplained infertility the effect of any treatment is difficult to assess. Such treatment has included correction of anatomical variants such as uterine retroversion and the use of hormonal manipulation during the follicular and luteal phases of the menstrual cycle. Ovum entrapment, occult spontaneous abortion and faults in sperm fertilizing capacity have all been implicated, and it is likely that immunological factors play a substantial role in unexplained infertility. Evidence does not support the use of bromocriptine in the absence of hyperprolactinaemia. Successful treatment by intrauterine insemination is unlikely if there are circulating anti‐sperm antibodies in the partner. Improving cervical mucus by treatment with oestrogens and clearing infections with antibiotics may have a modest place but it is very difficult to show that these treatments have more than a placebo effect. Endometriosis is often missed and the possibility of it having developed after initial investigation warrants repeat laparoscopy after 2 years. Three approaches are currently acceptable in the management of the couple with unexplained infertility: await spontaneous pregnancy, the empirical use of clomiphene and in‐vitro fertilization.
Immunoreactive prostacyclin and thromboxane metabolites in normal pregnancy and the puerperium
Authors: GREER I. A. , WALKER J. J. , McLAREN M. , BONDUELLE M. , CAMERON A. D. , CALDER A. A. , FORBES C. D.
Published: August 2005

Summary. Prostacyclin and thromboxane have been implicated in the pathophysiology of several disorders of pregnancy, but there is little information on concentrations of these prostaglandins in normal pregnancy. The aim of our study was to determine the range of values throughout normal pregnancy and the puerperium and to compare this with concentrations in normal non‐pregnant women. Measurement was by radioimmunoassay of prostacyclin and thromboxane metabolites. We observed a significant difference in prostacyclin metabolites in the first trimester. (mean 19·9, SEM 0·96 pg/ml) compared with the normal non‐pregnant group (mean 15·9. SEM 0·68 pghl). There were no significant differences between values in the normal non‐pregnant group and those in the second and third trimester or postnatally. The increase in prostacyclin in the first trimester may be associated with placentation and physiological vasodilation, and insencitivity to angiotensin It seen in early pregnancy. We noted a significant redaction in thromboxane metabolites in the second (mean 133, SEM 14·9 pg/ml) and third (mean 123, SEM 30·7 pg/ml) trimesters and the puerperium (mean 119, SEM 6·3 pg/ml) compared with the values in the normal non‐pregnant group (mean 142, SEM 4·9 pg/ml). This may be due to increased platelet stability or decreased thromboxane synthesis.
ST waveform changes of the fetal electrocardiogram during labour—a clinical study
Authors: LILJA H. , GREENE K. R. , KARLSSON K. , ROSÉN K. G.
Published: August 2005

Summary. Waveform changes in the fetal electrocardiogram (ECG) are under reassessment as a means of fetal surveillance. The purpose of the study was t o identify ST waveform changes from the fetal scalp lead during labour and to compare any change with conventional signs of fetal distress. Two scalp electrodes provided a sufficiently stable signal from which ST waveform changes could be identified and measured as the T/QRS ratio. No infant was clinically hypoxic. Only 26%’of the 46 patients studied had a continuously normal CTG whereas 67% had no ST waveform abnormalities. A relation was found between the two variables as the mean T/QRS ratio increased from 0·20 (SD 0·11) during epochs of normal CTG to 0.27 (SD 0·17) with CTG changes. A linear correlation (r=0·58: P<0·01) was found between the T/QRS ratio before birth and the cord plasma lactate values.
Paediatric follow‐up of pregnancies complicated by subnormal oestriol excretion.
Authors: WADE RHYL W. , SEARBY JOCELYN , PEPPERELL ROGER J. , KITCHEN WILLIAM H.
Published: August 2005

Summary. A cohort of 1238 consecutive women seen early in pregnancy for accurate assessment of gestation had urinary excretion of oestriol measured at 30,35 and 40 weeks; 92 had a low urinary oestriol excretion confirmed in hospital on at least one occasion. The women in the low‐oestriol group were matched for racial origin and maternal age with 90 women in the study population who had persistently normal urinary oestriol excretion values (control group) and their infants were compared. Three infants born in the low‐oestriol group and two in the control group subsequently died; 85 of the 89 (95·5%) survivors in the low‐oestriol group and 84 of 88 (95·5%) control children were assessed by a paediatrician and a psychologist at the age of 6 years. Anthropometric measurements of children in the low‐oestriol group at 6 years of age did not differ significantly from controls and their performance on most psychological tests was not significantly different. The subgroup of 25 children born to women with persistently low oestriol excretion during pregnancy showed a significant reduction in weight and head circumference at 6 years compared with the values in the control group and in the other children in the low‐oestriol group. The children born to women with low oestriol excretion during pregnancy showed no increased evidence of developmental, neurological or physical defects at 6 years of age.
A pilot study of the frequency and significance of placental villitis
Authors: MORTIMER G. , MacDONALD D. J. , SMEETH A.
Published: August 2005

Summary. The prevalence of inflammatory villous lesions was determined in a prospective study of 120 consecutive placentas. Cord blood IgM level was measured as an indicator of fetal intrauterine infection, and the birthweights of the infants were noted. Ten cases of villitis were found. Two infants had elevated cord blood IgM and one of them also had amniotic infection. As only one case of villitis had corroborative evidence of transplacental intrauterine infection, 90% of the lesions require an alternative explanation. The severity of the lesions correlated with the presence of low birthweight. The quality of the inflammatory infiltrate was also considered. Only one case included plasma cells; the remainder showed lymphohistiocytic infiltration. The case with plasmacytic infiltration was the one with elevated cord blood IgM. It is concluded that placental villitis is usually not an infective condition and its aetiology remains unknown.
Fetoscopy in the assessment of unexplained fetal hydrops
Authors: NICOLAIDES K. H. , RODECK C. H. , LANGE I. , WATSON J. , GOSDEN C. M. , MILLER D. , MIBASHAN R. S. , MONIZ C. , MORGAN‐CAPNER P. , CAMPBELL S.
Published: August 2005

Summary. Pure fetal blood samples, obtained fetoscopically from 30 patients with unexplained fetal hydrops at 16 to 32 weeks gestation were investigated for cytogenetic, haematological, biochemical and virological properties. In two patients with oligohydramnios, the fetoscope was introduced transabdominally into the fetal peritoneal cavity and sampling was undertaken from the intra‐abdominal portion of the umbilical vein; in all the other patients an umbilical cord vessel was sampled. Ten (33%) of the fetuses had chromosomal abnormalities, one an erythroblastic process, possibly erythroleukaemia, one α‐thalassaemia and one cytomegalovirus infection. Blood‐film abnormalities were seen in 23 (88%) of 26 fetuses that had this examination. Biochemical analysis of fetal plasma was undertaken in 18 fetuses and hypoproteinaemia was found in all cases. One fetus was subsequently found to have a paroxysmal tachyarrhythmia that responded to digitilization. Three (10%) of the fetuses survived.
Total uterine activity in induced labour—an index of cervical and pelvic tissue resistance
Authors: ARULKUMARAN S. , GIBB D. M. F. , RATNAM S. S. , LUN K. C. , HENG S. H.
Published: August 2005

Summary. Uterine activity was studied during labour induced using an automatic infusion system (AIS) or a peristaltic infusion pump (IVAC) to administer oxytocin. In the 110 patients who achieved vaginal delivery the total uterine activity required to effect full dilatation of the uterine cervix was found to vary according to parity and cervical score but not according to mode of oxytocin infusion. Irrespective of whether the uterine activity level per 15 min was maintained at between 700 and 1500 kPas or at between 1500 and 2000 kPas, the total uterine activity was similar the lower levels being compensated for by a longer duration. Fetal outcome, in terms of 1‐and 5‐min Apgar scores and umbilical vein blood pH, was unaffected by the level of uterine activity. The cervical and pelvic tissue resistance varies according to parity and cervical score and the uterus has to achieve a certain total uterine activity in induced labour which is best achieved by maintaining optimal uterine activity levels of 1500–2000 kPas/15 min to effect vaginal delivery of the baby in good condition in optimal time.
Sex steroid hormone concentrations in preterm labour and the outcome of treatment with ritodrine
Authors: HANSSENS M. C. A. J. A. , SELBY C. , SYMONDS E. M.
Published: August 2005

Summary. Peripheral plasma concentrations of unconjugated oestradiol‐17β, progesterone and total oestriol were measured in patients presenting with uncomplicated preterm labour. Control samples were obtained from normal healthy women matched for maternal age, parity and duration of pregnancy. Oestrogen concentrations were often higher and progesterone concentrations often lower in patients presenting in preterm labour, and in particular, in those presenting in advanced labour and those failing to respond to treatment with ritodrine, but the differences were not statistically significant.