bluuebunny/crossref_metadata_2025 huggingface dataset:
The ‘simple’ ovarian cyst: aspirate or operate?
Authors: DE CRESPIGNY LACHLAN CH. , ROBINSON HUGH P. , DAVOREN RUTH A. M. , FORTUNE DENYS
Published: August 2005

Summary. One hundred ultrasound‐guided ovarian cyst punctures were performed in 88 patients. To minimize the risk of unexpected malignancy, only persistent or painful cysts <10 cm in diameter were aspirated, cysts with solid areas or multiple locules were excluded. Cytological diagnosis was not possible in 72 of the 100 fluids; of the others 20 contained cells suggestive of follicular or luteal cysts, four samples suggested endometriosis and four benign tumours of epithelial origin. Oestradiol levels were high in 54 cystic fluids, and a combination of oestradiol estimation and cytology facilitated the identification of a follicular origin. Most such patients would normally have undergone surgery, but this was eventually required in only 10 of 60 in whom the cyst fluid was clear or slightly blood‐stained and in 16 of the 28 with heavily blood‐stained fluid. Ultrasound‐guided ovarian cyst puncture would appear to be a valid alternative to surgery for carefully selected benign ovarian cysts especially when the cyst is considered not to contain blood.
Listeriosis revisited: the role of the obstetrician
Authors: BUCHDAHL R. , HIRD M. , GAMSU H. , TAPP A. , GIBB D. , TZANNATOS C.
Published: August 2005

Summary. The clinical course and outcome is described of three pregnancies complicated by listeriosis encountered during a 6‐month period. All three ended in preterm labour characterized by the passage of meconium by the fetus. Two babies died in the early neonatal period and the third survived with neurological handicap. Although the diagnosis of listeriosis was made only after delivery, all the mothers had a pyrexial illness before delivery. A high index of suspicion is needed for the early detection and prompt treatment of this life‐threatening perinatal infection. Effective advice concerning prevention of listeriosis by avoidance of high‐risk foods must be given to women during pregnancy.
Haemostatic changes during continuous oestradiolprogestogen treatment of postmenopausal women
Authors: SPORRONG TOMMY , MATTSSON LARS‐ÅKE , SAMSIOE GÖRAN , STIGENDAL LENNART , HELLGREN MARGARETA
Published: August 2005

Summary. To identify changes in haemostatic balance during continuous oestradiol‐progestogen treatment, 60 postmenopausal women with climacteric complaints, mean age 55.4 years (range 44–68) were randomly allocated to receive one of four hormone replacement regimens for one year. All four formulations were administered daily and continuously, each contained 2 mg of 17 β‐oestradiol in combination with either norethisterone acetate, 1 mg (group A) or 0.5 mg (group B) or megestrol acetate, 5 mg (group C) or 2.5 mg (group D). No significant changes occurred during treatment within or between the groups in platelet count, fibrinogen and 2‐antiplasmin. Activated partial thromboplastin time was shortened (P<0.05) in group D and a decline in factor VII activity and antigen (P<0.001) and in AT1II activity (P<0.05) was noted in group A. Protein C tended to decline in all treatment groups but statistically significant changes were noted only in groups A and C. Two women developed crural thrombosis during the observation period.
The physiological and clinical effects of progesterone inhibition with mifepristone (RU 486) in the second trimester
Authors: HILL N. C. W. , SELINGER M. , FERGUSON J. , BERNAL A. LÓPEZ , MACKENZIE I. Z.
Published: August 2005

Summary. A double‐blind placebo‐controlled trial was performed in 20 primigravidae to assess the physiological and clinical effects of oral mifepristone on myometrial contractility and sensitivity in the second trimester. Ten women received 600 mg of oral mifepristone and 10 women a placebo 24 h before abortion was induced in both groups, with extra‐amniotic PGE2 instillation. Intrauterine pressure recordings demonstrated increased spontaneous uterine activity and increased sensitivity to PGE2 and ergometrine, but no change in oxytocin sensitivity after mifepristone treatment. There were no significant differences in PGE or PGF metabolite concentrations in peripheral maternal plasma over the 24‐h study period after treatment between the mifepristone and placebo groups. The mean induction abortion interval in the mifepristone group was 512 (SD 321) min compared with 1128 (SD 606) min in the placebo group (P≤0.02). The mechanism whereby mifepristone provokes enhanced uterine contractility and sensitivity to prostaglandins, with a reduction in abortion times, does not appear to be through endogenous production of PGE or PGF.
Twin pregnancy complicated by single intrauterine death. Problems and outcome with conservative management
Authors: FUSI L. , GORDON H.
Published: August 2005

Summary. During an 11‐year period we encountered 16 pregnancies in which one twin died in utero and the pregnancy continued. Eight of these twin pregnancies were monochorionic. None of the women developed severe disseminated intravascular coagulation. The fetal outcome indicates that the prognosis for a surviving dichorionic twin is relatively good, with immaturity the main hazard. By contrast the surviving monochorionic twin has a poor prognosis with a high frequency of neurological damage. This damage is not related to intrapartum or neonatal problems and at present cannot be diagnosed before birth. There is no evidence that birth of the surviving twin by caesarean section will improve the prognosis. Early diagnosis of monochorionic twins and subsequent ultrasound follow up should identify fetal growth discrepancy and possible twin to twin transfusion requiring early delivery.
Prostaglandin induced cervical ripening under tocolytic cover in primiparae: results of a double blind placebo controlled trial
Authors: TAYLOR A. V. G. , BOLAND J. C. , MACKENZIE I.Z.
Published: August 2005

Summary. In a double blind trial, 60 nulliparae with a modified Bishop score of 5 requiring induction of labour, received either 8 mg of salbutamol or an identical placebo orally, 30 min before vaginal administration of 2 mg prostaglandin E2 gel. Women in the salbutamol group experienced less uterine activity over the subsequent 12 h compared with those given placebo, and fewer (35%) commenced labour compared with the placebo group (62%). However, the change in cervical score was significantly less in the salbutamol group (mean 3.0, SD 3.1) than that in the placebo group (mean 5.8, SD 3.2), and the prostaglandin treatment to delivery time in the salbutamol group (mean 26.1 h, SD 6.49) was significantly longer than that in the placebo group (mean 19.3 h, SD 7.95). The first stage of labour lasted >10h in 11 women in the salbutamol group compared with five in the placebo group. Side effects attributable to salbutamol occurred in 10% > of the treated women but in none of their fetuses and fetal outcome was satisfactory and similar in both groups. Our findings show that salbutamol can suppress prostaglandin‐induced uterine activity during cervical ripening, which could be an advantage in induction of labour where a planned delivery is preferred. However, the poorer outcome of labour in salbutamol‐treated women mitigates against this approach.
Treatment of anovulation due to polycystic ovarian syndrome by laparoscopic ovarian electrocautery
Authors: KOVACS GABOR , BUCKLER HELEN , BANGAH MOHAN , OUTCH KEN , BURGER HENRY , HEALY DAVID , BAKER GORDON , PHILLIPS SHARYN
Published: August 2005

Summary. Our experience of ovarian electrocautery for the treatment of polycystic ovarian syndrome (PCOS) in ten women is described. We found that nine responded favourably, either ovulating spontaneously or becoming more responsive to ovulation induction. There was a significant and persistent fall in serum testosterone levels, and a transient fall with subsequent rise in inhibin. We recommend that laparoscopic ovarian electrocautery is considered as an alternative to ovulation induction with gonadotrophins, in women with PCOS who fail to respond to clomiphene citrate.
Coagulation studies in the syndrome of haemolysis, elevated liver enzymes and low platelets
Authors: DE BOER K. , BÜLLER H. R. , TEN CATE J. W. , TREFFERS P. E.
Published: August 2005

Summary. The presence of disseminated intravascular coagulation (DIC) in the syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP) is debated. We assessed the occurrence of decompensated and compensated DIC (using predefined criteria) in 15 consecutive nulliparous pregnant patients with gestastional hypertension combined with the HELLP syndrome and in 12 consecutive nulliparous controls with pregnancy induced hypertension (PIH) but without the HELLP syndrome. A combination of routine coagulation assays revealed the absence of decompensated DIC in all studied patients. However, using more specific and sensitive coagulation assays, compensated DIC was observed in all HELLP patients and in three patients in the control group. The mean values of antithrombin III, thrombin‐antithrombin III complexes and protein C in the HELLP and the control group were 66 vs 87% (P=0.0004), 21 vs 8 ng/ml (P=0.0008) and 57 vs 90% (P=0.0018) respectively. We conclude that HELLP patients show evidence of compensated DIC which may have pathophysiological significance for the observed organ damage.
Scar rupture in labour after previous lower uterine segment caesarean section: the role of uterine activity measurement
Authors: BECKLEY SARAH , GEE H. , NEWTON J. R.
Published: August 2005

Summary. A series of 12 trials of scar associated with scar rupture is reviewed. Uterine activity patterns were assessable in 10 of them. Clinical features and characteristics of the intrauterine pressure waveform and uterine activity are discussed in relation to the integrity of the scar.
Oestrogen and androgen states in oligo‐amenorrhoeic women with polycystic ovaries
Authors: FOX R. , CORRIGAN E. , THOMAS P. G. , HULL M. G. R.
Published: August 2005

Summary. Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo‐amenorrhoea. Of the 48 women with polycystic ovaries (PCO), 44 (92%) had a withdrawal bleed following progestogen challenge (indicating oestrogenization) compared with just three (18%) of the 17 with non‐PCO (P < 0.001). Median serum concentrations of oestradiol and oestrone were statistically significantly higher in the PCO group but the ranges overlapped widely. Of the four women with PCO but oestrogen deficiency, two were hirsute and had evidence of a severe form of the disorder. The other two were not hirsute and appeared to have hypo‐thalamic dysfunction associated with weight loss overriding the disorder due to pre‐existing PCO. Compared with the non‐PCO group, the PCO subgroup without hirsutism (n = 31) had statistically significantly higher median values of LH, testosterone, androstendione, and dehydro‐epiandrosterone sulphate concentrations, and free androgen index. Concentrations of androgen, but not LH, were significantly higher still in the PCO subgroup with hirsutism (n = 17).
The use of cervicography in a primary screening service
Authors: SZAREWSKI ANNE , CUZICK J. , EDWARDS R. , BUTLER BLANCHE , SINGER ALBERT
Published: August 2005

Summary. The cervicography and concurrent endocervical brush smear results obtained in 1162 women screened at the Marie Stopes Clinic were analysed. Colposcopy and biopsy results were obtained for positive cases. A comparison was made with a group of 1007 women attending the same clinic for routine cytology only. Nearly 10% of women who were screened by cervicography had a technically defective cervicogram, the main single reason being that the view was obscured by blood. Routine cytology was positive in 1%, while cervicography was positive in 13%, where positivity was defined as a result leading to a recommendation for colposcopy. The false positive rate for cervicography was 26%. Even after adjustment, this difference was highly significant (P<0.0001).
Mode of delivery and neonatal death in 17 587 infants presenting by the breech
Authors: KIELY JOHN L.
Published: August 2005

Objective— To study the effects of caesarean section on neonatal mortality in infants presenting by the breech.

Design— Population‐based non‐experimental comparison of infants presenting by the breech born vaginally with those born by caesarean section. Neonatal mortality rates were calculated for 250 g birthweight intervals. Weight‐specific relative risks (RRs) were further adjusted for birthweight in 50 g categories.

Setting— New York City, 1978–1983. Data came from the Department of Health's computerized vital records on livebirths and infant deaths.

Subjects— 17 587 singleton breech livebirths ≥500 g birthweight, with congenital anomaly deaths excluded. 6178 were born vaginally and 11409 were born by caesarean section.

Main outcome measures— Birthweight‐specific and birthweight‐adjusted neonatal mortality.

Results— At birthweights of 501 to 1750 g, the risk of neonatal death for breech infants born vaginally was significantly higher than the risk for those born by caesarean section (weight‐adjusted RR=1.7). For breech infants with birth‐weights over 3000 g, the weight‐adjusted risk was 5.6 times greater for a vaginal birth compared with caesarean section. The addition of 16 additional control variables in multiple logistic regression analyses did not change these RRs.

Conclusion— Population‐based studies indicate that an increase in the caesarean section rate among breech singletons may be associated with increased neonatal survival, but a large multicentre randomized trial of management of breech presentation would answer the question much more definitively.
Perinatal outcome of pregnancies complicated by vaginal bleeding
Authors: SIPILÄ P. , HARTIKAINEN‐SORRI A.‐L. , OJA H. , VON WENDT L.
Published: August 2005

Objective
To examine the effect of first and/or second trimester vaginal bleeding on pregnancy outcome.

Design
A prospective one‐year birth cohort.

Setting
Two northernmost administrative districts of Finland.

Patients
8718 singleton pregnancies, of whom 807 (9.3%) reported bleeding during the first (601) and/or second trimester (206); light bleeding in 595 cases and heavy bleeding in 212. The remaining 7911 women served as a reference group.

Main outcome measures
Low birth weight rate (LEW), preterm birth rate, congenital malformations and perinatal mortality rate.

Results
Bleeding was most frequent in women of more advanced age (≥35 years old), with previous miscarriages, with infertility problems or using an IUCD prior to the pregnancy. Parity, smoking and social status were not associated with bleeding. Caesarean section rate and placental complications during the third trimester and at delivery were more common among the bleeders than in the reference group. The LBW rate was three‐fold among the bleeders and the preterm birth rate twofold. The risk (OR) of a LBW infant among second trimester bleeders was 4.1 (95% CI 2.6–6.4), that of preterm birth 2.9 (95% CI 1.9–4.6), and that of congenital malformations 2.9 (95 % CI 1.7‐4.7). No association existed between bleeding and perinatal mortality.

Conclusions
Bleeding during the second trimester indicates a poor pregnancy outcome and an increased risk of LBW, and preterm birth and/or congenital malformation.
Fetal scalp and umbilical artery blood lactate measured with a new test strip method
Authors: NORDSTRöM L. , PERSSON B. , SHIMOJO N. , WESTGREN M.
Published: August 2005

Objective
To compare the measurement of lactate in fetal scalp and umbilical artery blood by a new dry reagent strip method with a commercially available enzymatic method using plasma (Monotest).

Design
Comparative study.

Subjects
Fetal scalp blood samples were obtained during labour from 24 fetuses and umbilical artery blood samples were obtained at birth in a further 51 deliveries.

Results
The concentration of lactate in scalp and umbilical artery blood measured by the reagent strip method correlated well (r= 0.94, P<0.001 and 0.95, P<0.001 respectively) with the enzymatic plasma method. The paper strip method tended to give lower readings than the enzymatic method when the fetal haematocrit was ≥50%.

Conclusions
The new dry reagent strip method which takes only 1 min to carry out and requires only 20 μl of blood seems to be handy and reliable. This system provides a convenient and rapid test for measuring fetal blood lactate.
Long term predictive value of Doppler studies in high risk fetuses
Authors: WILSON DAVID C. , HARPER ANN , McCLURE GARTH , HALLIDAY HENRY L. , REID MARK
Published: August 2005

Objective
To determine whether the predictive value of Doppler ultrasonography extends beyond the perinatal period.

Design
Descriptive follow‐up study.

Setting
Specially designated paediatric clinic in Royal Maternity Hospital

Subjects
40 children who as high risk fetuses had had assessment of umbilical artery flow velocity waveforms.

Interventions
Parental history, physical examination, anthropometry, Denver developmental screening test.

Outcome measures
Weight, height, head circumference, neurological impairment, Denver developmental screening test

Result
Abnormal waveforms were an accurate predictor of neonatal outcome, with significant differences in birthweight, gestational age, need for nursery admission, and frequency of intrauterine growth retardation between normal and abnormal waveform groups. However, abnormal Doppler studies were not predictive of long‐term adverse sequelae. There were no significant differences in height, head circumference, proportion with neurological impairment, or results of Denver developmental screening test at a median age of five years.

Conclusion
The predictive value of Doppler ultrasonography is less for long‐term growth and neurodevelopment than for perinatal outcome in the high risk fetus.
Medical abortion in women of ≤56 days amenorrhoea; a comparison between gemeprost (a PGE1 analogue) alone and mifepristone and gemeprost
Authors: NORMAN J. E. , THONG K. J. , RODGER M. W. , BAIRD D. T.
Published: August 2005

Objective
To determine the efficacy of a new dose regimen of vaginal gemeprost (l mg every 6 h up to three doses) in induction of abortion in women ≤56 days gestation, and to compare this regimen with mifepristone (200–600 mg) followed 48 h later by a single dose of gemeprost (l mg).

Design
Two separate protocols, with 50% of the subjects randomized to one or other protocol.

Setting
The Royal Infirmary of Edinburgh, Scotland, UK

Subjects
301 referred by their general practitioner or local family planning clinic, requesting termination of pregnancy at ≤56 days amenorrhoea.

Interventions
Ongoing pregnancies and incomplete abortions were terminated surgically.

Main outcome measures
Number of complete abortions, analgesic requirements and bleeding pattern following treatment.

Results
Complete abortion occurred in 87% of women treated with gemeprost alone and 98% of women treated with mifepristone and gemeprost (P=0.0004). Analgesic requirements were greater in the group treated with gemeprost alone, compared with the group treated with mifepristone and gemeprost (P=0.0001).

Conclusion
The new dose regimen of gemeprost can be used for early induced abortion, but the use of mifepristone and gemeprost has several advantages over the use of gemeprost alone.
Survival time after AIDS in pregnancy
Authors: JOHNSTONE FRANK D. , WILLOX LORNA , BRETTLE RAY P.
Published: August 2005

Objective
To examine the suggestion, based on theoretical considerations and case reports, that pregnancy decreases survival time after AIDS (acquired immunodeficiency syndrome).

Design
A total population study in Edinburgh.

Setting
A city with a moderately high prevalence of human immunodeficiency virus (HIV) infection in women.

Subjects
AIDS has been diagnosed in 22 women, five of whom had a pregnancy.

Main outcome measures
Clinical characteristics, disease presentation, lymphocyte markers, pregnancy outcome, subsequent progress and survival time.

Results
Pregnancy was not obviously associated with a difference in clinical findings. The mean survival time for the three women with a pregnancy who died was 24 months and for the 11 women without a pregnancy it was 15 months. (P= 0.63 log rank test).

Conclusions
The clinical presentation, severity of the illness and laboratory findings were not obviously different in pregnancy. All three women who had Pneumocystis carinii pneumonia for the first time in pregnancy survived this initial episode. Survival time was not obviously reduced by the conjunction of pregnancy with AIDS.
A case‐control study of intrapartum stillbirths
Authors: ALESSANDRI LOUISA M. , STANLEY FIONA I. , READ ANNE W.
Published: August 2005

Objective
To determine antenatal and intrapartum risk factors for intrapartum stillbirths in a total population.

Design
Matched case‐control study.

Setting
Western Australia 1980–1983.

Subjects
Intrapartum stillbirths of ≥ 1000 g birthweight (cases) and liveborn infants (controls) individually matched for year of birth, plurality, sex and birthweight of infant and race of mother.

Results
Intrapartum stillbirths were more likely than controls to have had placental abruption (OR = 9.55, CI = 2.09–43.69), fetal distress (OR = 4.64, CI = 1.92–11.19), cord prolapse (OR = 10.00, CI = 1.17–85.60) and unhealthy placentas (OR = 2.26, CI = 1.13–4.52), and more likely to have been born by vaginal breech manoeuvre (OR = 3.51, CI = 1.40–8.80) and emergency caesarean section (OR = 2.15, CI = 1.13–4.10); mothers of intrapartum stillbirths were less likely to have had no labour (OR = 0.14, CI = 0.04–0.55) and to have been delivered normally (OR = 0.20, CI = 0.10–0.40). Mothers of cases born by emergency caesarean section had longer labours than mothers of controls born by this method. All intrapartum stillbirths with breech presentation were born by vaginal breech manoeuvre compared with only 53% of the controls; the remainder of the controls were born by caesarean section.

Conclusions
Results indicate that little could have been done early in pregnancy to prevent the intrapartum stillbirths as no antenatal risk factors predicted these deaths. Most of the risk factors identified related to labour and delivery problems. Considering cases born by emergency caesarean section, delivery of the mother earlier in labour may have prevented some of the deaths.
Increase in bone mass after one year of percutaneous oestradiol and testosterone implants in post‐menopausal women who have previously received long‐term oral oestrogens
Authors: SAVVAS M. , STUDD J. W. W. , NORMAN S. , LEATHER A. T. , GARNETT T. J. , FOGELMAN I.
Published: August 2005

Objective
To determine the effect on the bone density of the skeleton after changing from oral oestrogen to subcutaneous oestradiol and testosterone replacement.

Design
Prospective non‐randomized single centre study.

Subjects
Twenty women who were receiving long‐term oral oestrogen replacement. Ten changed to oestradiol and testosterone implants; the remaining ten continued with oral oestrogens.

Main outcome measures
Bone density was measured using dual photon absorptiometry at the lumbar spine and neck of femur at the start of the study and after one year.

Results
The bone density increased significantly by 5.7% at the spine and by 5.2% at the neck of femur in those women who changed to implant therapy but remained unchanged in those women who continued with oral therapy.

Conclusion
Subcutaneous oestradiol and testosterone implants will result in an increase in bone mass even after many years of oral oestrogen replacement therapy.
Maternal and fetal atrial natriuretic peptide levels at delivery from normal and growth retarded pregnancies
Authors: KINGDOM J. C. P. , McQUEEN J. , CONNELL J. M. C. , WHITTLE M. J.
Published: August 2005

Objective
To determine whether circulating fetal levels of the vasodilator atrial natriuretic peptide (ANP) are reduced in pregnancies complicated by intrauterine growth retardation (IUGR).

Design
Prospective observational study.

Setting
University teaching hospital and research laboratory.

Subjects
25 normal singleton pregnancies delivered at term by spontaneous vertex delivery (n = 16) or by elective caesarean section (n= 9), and a series of 14 singleton pregnancies complicated by IUGR.

Intervention
Measurement of ANP by radio‐immunoassay in maternal venous, umbilical artery, and umbilical vein plasma from a series of normal, and IUGR pregnancies.

Main outcome measures
Comparison of plasma ANP levels between the three groups; relation between fetal ANP, Po2 and pH.

Results
Mode of delivery did not influence either maternal, umbilical artery or umbilical vein plasma ANP levels in normal term singleton pregnancies. Umbilical vein ANP levels were significantly higher in the IUGR group when compared with normal pregnancies at term (mean 66 95%, CI 36–122 vs mean 37, 95% CI 29–47 pg/ml, P= 0.03) and were inversely related to umbilical artery pH (R2 = 65%; P= 0.003).

Conclusions
These data suggest that umbilical vein ANP levels are elevated in pregnancies complicated by IUGR, and rise appropriately in response to the stress of acidosis. In the absence of any receptor or second messenger defect within fetoplacental vascular smooth muscle, these data suggest that ANP is not directly implicated in the vascular pathophysiology of IUGR.
Increased whole blood platelet aggregation in normal pregnancy can be prevented in vitro by aspirin and dazmegrel (UK38485)
Authors: NORRIS LUCY A. , SHEPPARD BRIAN L. , BONNAR JOHN
Published: August 2005

Objective
To determine the effect of normal pregnancy and the early puerperium on whole blood platelet aggregation and to assess the role of thromboxane A2 (TXA2) in platelet aggregation in pregnancy.

Design
A prospective descriptive study.

Setting
TCD Medical School, St James's Hospital, Dublin.

Subjects
Twenty healthy primigravidae who remained normotensive during pregnancy and the puerperium.

Interventions
20 ml blood samples were obtained serially at 12, 20, 28, 32 and 36 weeks gestation, during established labour and at 1 h, 24 h, 48 h and 6 weeks after delivery.

Main outcome measures
Whole blood platelet aggregation in response to aggregating agents ADP, PAF (platelet aggregating factor) collagen, adrenaline and arachidonic acid (AA) at each stage of pregnancy and peuerperium was measured using a particle counting technique. The in vitro effect of aspirin and dazmegrel (thromboxane synthetase inhibitor UK38485) on platelet aggregation in pregnancy was also investigated.

Results
Platelet aggregation in response to collagen, adrenaline, ADP and AA were increased in the last trimester, during labour and at 1 h after delivery but decreased 24–48 h after delivery. Platelet aggregation in response to AA, collagen and adrenalin was reduced by both aspirin and dazmegrel.

Conclusions
The earliest and most marked increases in platelet aggregation during normal pregnancy were found in response to AA and collagen. These platelet changes were prevented when whole blood was pre‐incubated with either aspirin or dazmegrel. This suggests that enhanced production of TXA2 is reponsible for increased platelet reactivity in normal pregnancy.
Abnormal fetal immunological development in Down's syndrome
Authors: Thilaganathan Baskaran , Tsakonas Dennis , Nicolaides Kypros
Published: August 2005

Objective
To investigate the intrauterine development of the immune system in Down's syndrome.

Design
Cross sectional study.

Setting
Harris Birthright Research Centre for Fetal Medicine, London, UK.

Subjects
16 fetuses with Down's syndrome and 104 fetuses with a normal karyotype at 17–24 weeks gestation.

Main outcome measures
Flow cytometry was used to enumerate T (CD3+), B (CD19+) and NK (CD3– & CD16+/CD56+) lymphocyte subpopulations in fetal blood obtained by cordocentesis.

Results
The median numbers of T, B and NK lymphocytes in fetuses with Down's syndrome (1.52 × 109/l, 0.08 × 109/l, and 0.10 × 109/l, respectively) were significantly lower than in the chromosomally normal fetuses (T lymphocytes: 1.98 × 109/l, z= 3.04, P<0.01; B lymphocytes: 0.50 × 109/l, z= 5.84, P<0.0001; and NK lymphocytes: 0.19 × 109/l, z= 3.14, P<0.01).

Conclusion
These data demonstrate that in Down's syndrome, there is abnormal intra‐uterine development of the immune system.
The Royal College of Obstetricians and Gynaecologists micro‐invasive carcinoma of the cervix study: preliminary results
Authors: Morgan P. R. , Anderson M. C. , Buckley C. H. , Murdoch J. B. , Lopes A. , Duncan I. D. , Monaghan J. M.
Published: August 2005

Objectives
To determine how micro‐invasive carcinoma of the cervix is diagnosed and treated in the United Kingdom. To record the frequency of the various pathological features which comprise the histological diagnosis of micro‐invasion, and to assess their relevance to outcome.

Design
Prospective observational study.

Setting
Hospitals throughout the United Kingdom.

Subjects
Two hundred and eighty‐six cases were submitted for entry into the study. Following independent review of the histological material 116 cases were excluded: 41 were not accompanied by histological slides for review, 55 had no evidence of invasive disease, 17 had invasive disease greater than FIGO Stage 1a, and three were adenocarcinomas. The remaining 170 cases were registered for the study but follow up was incomplete in 18. This report concerns the 152 women with complete follow up to 1991.

Results
The age of the 152 women ranged from 22 to 65 years (median 36 years). In 116 women (76%) the diagnosis was made by cone biopsy (cold knife, loop diathermy, or laser) or wedge biopsy, in 9 women (6%) the diagnosis was made by hysterectomy, and in 27 women (18%) punch biopsy suggested an invasive lesion and subsequent excisional treatment (including radical hysterectomy with node dissection in three) demonstrated micro‐invasion. The depth of invasion was up to 3 mm in 142 women (93%) and 3.1 to 5 mm in 10 women (7%). Capillary‐like space involvement was present in 12 women (8%). Treatment methods used were local cervical surgery in 79 women (52%), simple hysterectomy in 63 (41%), and radical hysterectomy in 10 (7%). There was only one known recurrence and death due to cervical carcinoma.

Conclusion
There is no uniformity in the management of micro‐invasive carcinoma of the cervix. The frequency of recurrence, lymph metastases, and death is low. Nonradical surgery appears to give satisfactory results.
Induction of second trimester abortion with mifepristone and gemeprost
Authors: Thong K. J. , Baird David T.
Published: August 2005

Objective
To determine the efficacy of a new regimen of the antiprogestogen mifepristone and gemeprost for midtrimester abortion.

Design
Prospective study.

Setting
Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.

Subjects
One hundred women undergoing midtrimester abortion.

Interventions
Women were pretreated with 200 mg mifepristone 36 h before prostaglandin; 1 mg gemeprost was administered every 6 h for the first 24 h. If abortion had not occurred, 1 mg gemeprost was administered 3 hourly over the next 12 h.

Measurement and main results
Ninety‐six percent and 99% women aborted within 24 h and 48 h, respectively. The median prostaglandin‐abortion interval was significantly shorter in multigravidae compared to primigravida (6.6 vs 8.2 h, P<0.01). The median number of gemeprost pessaries to induce abortion was only two and 47% of women required one pessary. The incidence of vomiting and diarrhoea was 31% and 5%, respectively. Eighty‐four percent of women required intramuscular diamorphine for analgesia. Thirty‐three percent of women required an evacuation of the uterus following abortion.

Conclusions
The shortened induction‐delivery interval following pretreatment with mifepristone makes it possible to conduct midtrimester abortion on a daycare basis.
Low levels of amniotic fluid placental alkaline phosphatase in Down's syndrome
Authors: Ind Thomas E. J. , Iles Ray K. , Wathen Neville C. , Murugan Poovanni , Campbell James , Macintosh Mary , Chard Tim
Published: August 2005

Objective
To investigate amniotic fluid placental alkaline phosphatase (PLAP) levels in normal and trisomy 21 pregnancies.

Design
Cross sectional study.

Setting
A tertiary referral prenatal diagnostic service.

Subjects
Three hundred and eleven women with singleton pregnancies of normal karyotype between 10 and 23 weeks gestation and 31 women with pregnancies associated with trisomy 21 Down's syndrome.

Outcome measures
PLAP levels were measured by immunoradiometric assay in amniotic fluid obtained by amniocentesis.

Results
Amniotic fluid PLAP was detectable from 12 weeks gestation and the median value rose to a peak of 4.57 iu/1 at 18 weeks. Pregnancies associated with Down's syndrome had significantly lower levels with a median multiple of median (MoM) of 0.638, (U = 3374, P= 0.0016, 95%CI = 0.50, 0.89). For the 20 women with trisomy 21 pregnancies detected at 16 to 18 weeks, the median MoM was 0.482, (U = 3694, P= 0.0011, 95%CI = 0.37, 0.85).

Conclusion
These data demonstrates that PLAP levels are reduced in the amniotic fluid of women carrying a fetus with trisomy 21.
Fetal immunodeficiency: a consequence of placental insufficiency
Authors: Thilaganathan Baskaran , Plachouras Nicolaos , Makrydimas George , Nicolaides Kypros H.
Published: August 2005

Objective
To study the effect of placental insufficiency on fetal lymphocyte subpopulations.

Study design
Cross sectional study of 19 growth retarded fetuses undergoing cordocentesis at 24 to 37 weeks gestation. Flow cytometry was used to enumerate fetal blood lymphocyte subpopulations.

Results
The mean T (CD3+), B (CD19+), T‐helper (CD4+), T‐suppressor/cytotoxic (CD8+) cell counts and the CD4 to CD8 ratio in the growth retarded fetuses were significantly lower than the respective normal mean for gestation (CD3+: z = 3.66, P<0.001; CD19+: z = 2.18, P<0.05; CD4+: z = 3.76, P<0.001; CD8+: z = 2.26, P<0.05; and CD4/CD8: z = 2.27, P<0.05). There were significant associations between the decrease in the T lymphocyte subpopulations and the degree of fetal acidaemia.

Conclusions
Growth retarded fetuses demonstrate immune abnormalities that could be attributed to intrauterine starvation.
Fetal cerebral Doppler in the recognition of fetal compromise
Authors: Chandran Ravi , Serra‐Serra Vicente , Sellers Susan M. , Redman Christopher W. G.
Published: August 2005

Objective
To establish reference ranges for the human fetal middle cerebral artery pulsatility index (MCA PI) for the local obstetric population, and to compare computerised antenatal fetal heart rate (FHR) analysis with the MCA PI as indicators of fetal compromise.

Design
Prospective data collection for selected patients.

Setting
High risk pregnancy unit of a teaching hospital.

Subjects
Group 1 consisted of 18 healthy women with uncomplicated singleton pregnancies. Group 2 consisted of 27 women admitted to the high risk pregnancy unit over a 9 month period with intrauterine growth retardation and other related problems; all these women were delivered by prelabour caesarean section.

Intervention
Serial Duplex sonography to determine fetal MCA PI in Groups 1 and 2. Serial FHR analysis using computerised numerical techniques in Group 2 only.

Main outcome measures
Serial MCA PI values from 24 to 39 completed weeks of gestation in Group 1. Comparison of serial MCA PI values with FHR analysis in relation to fetal outcome in Group 2.

Results
In Group 1 the MCA PI diminished significantly as gestation advanced from 1.73 (SD 0.25) at 24 weeks to 1.38 (SD 0.26) at 39 weeks (P<0.01). In Group 2 eleven babies were hypoxaemic at delivery: all had low MCA PI values while only nine had an abnormal FHR prior to delivery.

Conclusion
In normal pregnancy, there is a fall in the fetal MCA PI with advancing gestation which probably reflects a decreasing vascular resistance to fetal cerebral blood flow. Hypoxaemia at delivery appeared to be better recognised by the fetal MCA flow velocity waveform than the FHR analysis. This increased sensitivity, however, was achieved at the expense of a reduced specificity. Larger studies are needed to confirm the findings of this preliminary investigation.
Chirality in the umbilical cord
Authors: Fletcher Stewart
Published: August 2005

Object
To determine the chiral varieties of the vascular helix of the umbilical cord and find their normal proportions.

Design
Differences between the sexes were tested by a χ2 test and the hypothesis that left‐handed types occur in 50% of cases was tested using the binomial distribution.

Setting
United Arab Emirates.

Subject
Gulf Arab singletons from consecutive normal births, 100 male and 100 female.

Results
Left‐handed helices predominate at 76.5%; right‐handed contribute 15.5%; mixed forms, where both chiralities co‐exist, were found in 6.5%; indeterminable chirality due to poor helix formation, or varices, reached 1.5%. A significant sex difference could not be established. Chiral generation, on genetic and mechanical‐rotational hypotheses, is discussed.

Conclusion
The chirality of the cord is easily determined and is the sole distinguishing feature of the cord. Chirality should be entered in the birth record and in pathological descriptions for whatever value it may have in relation to fetal, or postnatal, characteristics and morbidity.
Morbidity following pelvic inflammatory disease
Authors: Buchan H. , Vessey M. , Goldacre M. , Fairweather J.
Published: August 2005

Objective
To examine patterns of morbidity following hospitalisation for pelvic inflammatory disease (PID).

Design
Cohort study using Oxford Record Linkage Study data.

Setting
Oxfordshire and West Berkshire.

Subjects
One thousand three hundred fifty‐five women discharged from hospital for the first time with a diagnosis of pelvic inflammatory disease during the interval 1970–1985, together with 10 507 control women discharged with various other diagnoses.

Main outcome measures
Hospital admission for abdominal pain, gynaecological pain, endometriosis, hysterectomy, and ectopic pregnancy. Data were not available in this analysis on pregnancies other than ectopic pregnancy.

Results
In comparison with the controls, women with a diagnosis of PID were ten times more likely to be admitted for abdominal pain, four times more likely to be admitted for gynaecological pain, six times more likely to be admitted for endometriosis, eight times more likely to be admitted for hysterectomy and ten times more likely to be admitted for ectopic pregnancy.

Conclusions
Serious sequelae of PID are common, even in a study unable to examine the effects of the disease on fertility. The data on hysterectomy are particularly interesting; the operation in women with pelvic inflammatory disease is most often a consequence of the inflammatory process itself.
The effect of neuromuscular blockade on human fetal heart rate and its variation
Authors: Spencer John A. D. , Ryan Greg , Ronderos‐Dumit Daniel , Nicolini Umberto , Rodeck Charles H.
Published: August 2005

Objective
To determine the effect of neuromuscular blockade on fetal heart rate and its variation.

Design
Case control study.

Setting
Tertiary referral fetal medicine unit in a London teaching hospital.

Subject
Forty women with rhesus iso‐immunisation requiring an intravascular fetal blood transfusion between 28 and 34 weeks gestation.

Intervention
Intravascular injection of pancuronium to the fetus prior to fetal blood transfusion in 20 cases.

Main outcome measures
Comparison between the group receiving pancuronium and the control group with regard to differences in perceived fetal activity and computer derived numerical indices of fetal heart rate and fetal heart rate variation after fetal blood transfusion.

Results
After transfusion in the control group, there were fewer perceived fetal movements, a small reduction in fetal heart rate but no differences in number of fetal heart rate accelerations or measures of fetal heart rate variation. In the study group, pancuronium produced no change in fetal heart rate despite a virtual abolition of perceived fetal movements and fetal heart rate accelerations. Measures of fetal heart rate variation were reduced by 60%. Comparison of the pre‐ to post‐transfusion changes between the two groups showed significant differences for all fetal heart rate indices.

Conclusion
Fetal activity accounts for more than half the measured variation of the human fetal heart rate.
Serum ferritin and cobalamin in growth retarded fetuses
Authors: Abbas Anthony , Snijders Rosalinde J. M. , Nicolaides Kypros H.
Published: August 2005

Objective
To examine fetal and maternal serum cobalamin and ferritin concentrations in pregnancies complicated by fetal growth retardation.

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

Design
Cross sectional study.

Subject
Fetal blood samples obtained by cordocentesis from 20 growth retarded fetuses at 26 to 36 weeks of gestation. Maternal venous blood was also collected and serum ferritin and cobalamin concentrations were measured by radio‐immunoassay in the fetal and maternal samples.

Results
In the growth retarded group, the mean fetal serum concentration of cobalamin was higher than the normal mean for gestation (t= 3.27, P < 0.01), and this increase was significantly associated with fetal acidaemia (r=−0.686, P < 0.001) and erythroblastosis (r= 0.731, P < 0.001). In contrast, the fetal to maternal ferritin ratio was significantly reduced; there was a nonsignificant decrease in fetal serum and an increase in maternal serum ferritin concentration. There was an association between fetal serum ferritin concentration and erythrocyte count (r=–0.612, P < 0.01).

Conclusions
In placental insufficiency, as in postnatal starvation and Kwashiorkor syndrome, uptake and storage of cobalamin by the fetal liver may be impaired. The decrease in fetal to maternal ratio of ferritin could be the consequence of impaired placental perfusion.
Lack of association between maternal phosphoglucomutase‐1 phenotype and fetal macrosomia in diabetic pregnancy
Authors: Johnstone Frank D. , West John D. , Steel Judith , Whitehouse David B. , Drago Guido A. , Greer Ian A. , Prescott Robin J.
Published: August 2005

Objective
To assess the reports that maternal phosphoglucomutase‐1 (PGM 1) phenotype is highly related to macrosomia in diabetic pregnancy. This could be either a direct metabolic phenomenon, or the PGM1 locus could be a marker for a tightly linked gene involved in the maternal control of fetal growth.

Design
A comparative biochemical genetic study.

Setting
A large diabetic pregnancy clinic.

Subject
One hundred and fifty‐two women who had diabetes during pregnancy, 136 being insulin dependent before pregnancy. Two hundred and thirty‐six women without pre‐existing medical or pregnancy complications who functioned as a control group.

Measures
PGM1 phenotype was assessed by conventional electrophoresis and subgroups were examined using iso‐electric focusing.

Outcome
Standardised birthweight was corrected for sex, maternal parity and gestation confirmed in every case by early pregnancy ultrasound. Maternal diabetes control was assessed by glycosylated haemoglobin.

Results
No differences were found in the observed phenotype frequencies for diabetics and control pregnant women. No association between PGM1 phenotype and macrosomia in diabetic pregnancy was found. PGM1 did not make a significant contribution to birthweight, standardised birthweight, length or ponderal index of the baby as assessed by multiple regression.

Conclusions
Our study of a larger number of insulin dependent diabetics in Scotland makes the claim that macrosomia in diabetic pregnancy is associated with PGM1 phenotype unlikely to be of general significance.
Rapid detection of chromosome aneuploidies in fetal blood and chorionic villi by fluorescence in situ hybridisation
Authors: Pandya P. P. , Kuhn P. , Brizot M. , Cardy D. L. , Nicolaides K. H.
Published: August 2005

Objective
Evaluation of fluorescence in situ hybridisation in the detection of numerical aberrations involving chromosomes X, Y, 13, 18 and 21.

Setting
Harris Birthright Research Centre for Fetal Medicine.

Subjects and methods
Chorionic villi (n= 45) or fetal blood (n= 34) were obtained from 79 pregnancies undergoing fetal karyotyping at 10 to 39 weeks of gestation because of ultrasonographic markers of fetal chromosomal abnormality. Karyotyping was performed by both traditional cytogenetics and fluorescence in situ hybridisation, using commercially available kits which utilise a heterochromatic Y probe and the alpha satellite repeat probes for chromosomes X, 18, and 13/21. The frequency distributions of the number of signals obtained by fluorescence in situ hybridisation in the chromosomally normal and abnormal fetuses were compared.

Results
Traditional cytogenetic analysis demonstrated that the fetal karyotype was normal in 47 cases and abnormal in 32 (including 24 with trisomies 21, 18 or 13, three with triploidy, one with Turners syndrome and four with translocations, deletions or mosaicism). With fluorescence in situ hybridisation it was possible to obtain accurate diagnosis of trisomy 18, Turners or triploidy within six hours of sampling; signal distributions with these chromosomal abnormalities were very different from those of normals. However, for trisomies 21 and 13 there was an overlap in values with those from normals.

Conclusions
In detection of fetal numerical chromosomal abnormalities the use of the combined 13/21 probe cannot provide sufficiently accurate results to justify abandonment of traditional cytogenetics in favour of fluorescence in situ hybridisation.
Retracted: Randomised controlled trial of the use of human chorionic gonadotrophin in recurrent miscarriage associated with polycystic ovaries
Authors: Malcolm Pearce J. , Hamid Rosol I.
Published: August 2005

Objective
To determine whether the use of human chorionic gonadotrophin (hCG) would reduce the recurrent miscarriage rate in women with polycystic ovarian disease.

Design
Double‐blind, prospective, randomised controlled trial.

Setting
A pregnancy loss clinic in a London teaching hospital.

Subjects
One hundred and ninety‐one women with a history of three consecutive spontaneous first trimester miscarriages and polycystic ovary syndrome.

Intervention
10000 i.u. of hCG or a placebo were given when the leading follicle was ≥ 21 ram, then 5000 i.u. of hCG or a placebo were given twice weekly until miscarriage or the tenth week of pregnancy.

Main outcome measure
Miscarriage rate.

Results
Women with polycystic ovaries who received hCG treatment had a lower miscarriage rate (14%) compared with women who received placebo (43%). In women with follicular phase luteinising hormone ≥ 10 iu/1, those who received hCG therapy had a miscarriage rate of 10% compared with a rate of 44% in women who received the placebo. When clomiphene was used for ovulation induction, women treated with hCG had a miscarriage rate of 14% compared with a rate 47 % in women who received the placebo. There was no significant benefit from hCG therapy in natural cycles.

Conclusion
The use of hCG in women with recurrent miscarriage and polycystic ovary syndrome improves the pregnancy outcome.