bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of 25 mg and 50 mg oestradiol implants in the control of climacteric symptoms following hysterectomy and bilateral salpingo‐oophorectomy
Authors: Panay N. , Versi E. , Savvas M.
Published: August 2005

Objectives
1. To compare the effects of 25 mg and 50 mg oestradiol implants on serum follicle stimulating hormone and oestradiol levels; and 2. to assess the relationship of the dose of oestradiol implant and serum oestradiol on the effectiveness and duration of climacteric symptom control.

Design
Randomised, double‐blind investigation.

Participants
Forty‐four women, who had undergone total abdominal hysterectomy and bilateral salpingo‐oophorectomy.

Methods
The women were randomised to receive either 25 mg (n= 20) or 50 mg (n= 24) oestradiol implants. Follow up consisted of prospective symptom enquiry and hormone assays.

Main outcome measures
Primary: climacteric symptom control: duration and effectiveness; secondary: serum oestradiol and follicle stimulating hormone levels

Results
Serum oestradiol was significantly higher and serum follicle stimulating hormone significantly lower after the fourth month of treatment in women receiving 50 mg implants. No significant difference in symptom control was noted in the two groups. The mean duration of symptom control was similar in the two groups: 5.9 months (SD 2.4) in those receiving 50 mg oestradiol and 5.6 months (SD 2.3) in those receiving 25 mg.

Conclusion
The higher level, 50 mg oestradiol implants does not result in better control of symptoms nor in longer periods of symptom control compared with 25 mg oestradiol implants. In order to maximise compliance, 25 mg oestradiol implants should therefore be the treatment of choice for women with normal bone density seeking relief of climacteric symptoms.
Postmenopausal hormone replacement improves proteinuria and impaired creatinine clearance in type 2 diabetes mellitus and hypertension
Authors: Szekacs Bela , Vajo Zoltan , Varbiro Szabolcs , Kakucs Reka , Vaslaki Lajos , Acs Nandor , Mucsi Istvan , Brinton Eliot A.
Published: August 2005

Objective
To determine whether hormone replacement therapy can reverse established renal microvascular damage in type 2 diabetes and hypertension.

Design
Prospective, single centre clinical trial.

Setting
Outpatient clinics.

Participants
Sixteen diabetic and hypertensive postmenopausal women (age 47–57 years)

Methods
Administration of a cyclic combination of oestradiol and norgestrel orally for 3.5 monthly cycles.

Results
Comparing the baseline values, mean (SD) 24‐hour urine protein excretion was reduced from 0.452 g (0.039) to 0.370 g (0.047) (P < 0.01) and creatinine clearance was increased from 1.68 mL/sec (0.11) to 1.77 mL/sec (0.08) (P < 0.05). Fasting plasma glucose also improved from 6.92 mmol/L (0.47) to 6.51 mmol/L (0.28) (P < 0.05), as did serum total cholesterol from 7.26 mmol/L (0.28) to 6.65 mmol/L (0.14) (P < 0.05). Blood pressure did not change significantly. Univariate linear regression analysis showed no significant correlation between the individual changes in blood pressure, fasting plasma glucose or serum cholesterol and the individual changes in proteinuria or creatinine clearance.

Conclusions
This study shows that hormone replacement therapy may reduce proteinuria, and even improve creatinine clearance, in diabetic and hypertensive postmenopausal women. These effects are additive to nephroprotective therapy, and the mechanisms appear unrelated to conventional risk factors for vascular complications, such as high blood pressure, elevated plasma glucose or serum cholesterol.
Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one‐year follow up
Authors: Mørkved Siv , Bø Kari
Published: August 2005

Objective
To evaluate the long term effect of a postpartum pelvic floor muscle training course in prevention and treatment of urinary incontinence.

Design
A prospective matched controlled trial.

Sample and methods
All women who had participated in a matched controlled study evaluating the effect of an eight‐week pelvic floor muscle training program in prevention and treatment of urinary incontinence in the immediate postpartum period were contacted by telephone one year after delivery. They were invited to participate in a follow up study. The study group consisted of 81 matched pairs (n= 162), with a mean age (range) 28 years (19–40), and mean number (range) of deliveries 1.8 (1–5). Seventy‐six pairs had normal vaginal deliveries and five elective caesarean sections. Registration of continence status was by structured interview and a standardised pad test. Clinical assessment of pelvic floor muscle function and strength were by vaginal palpation and vaginal squeeze pressure.

Main outcome measure
Stress urinary incontinence.

Results
At the one year follow up, significantly more women in the former control group than in the training group reported stress urinary incontinence and/or showed urinary leakage at the pad test (P < 0.01). A significantly greater (P < 0.01) muscle strength increase in the period between 16th week and one year postpartum was demonstrated in the former training group (mean 4.4 cm H2 O, 95% CI 3.2–5.6) than in the control group (mean 1.7 cm H2 O, 95% CI 0.8–2.7).

Conclusion
This one year follow up study demonstrates that a specially designed postpartum pelvic floor muscle training course was effective in the prevention and treatment of stress urinary incontinence. The benefits from pelvic floor muscle training are still present one year after delivery.
Standards for the management of cervical and vulval carcinoma
Authors: D'Arcy Thomas J. , Roy Amy , Thomas Anna , McIndoe Angus , Soutter W. P.
Published: August 2005

Objective
To examine the feasibility of achieving designated target standards for the management of women with cervical and vulval cancer.

Design
Retrospective casenote review.

Setting
The Gynaecological Oncology Centre at Hammersmith Hospital, London.

Population
Sixty‐one women with cervical and vulval cancer presenting to the gynaecological oncology clinic at the Hammersmith Hospital during 1996 and 1997. Various aspects of the management of those women were compared with standards suggested by a multidisciplinary panel of local experts. Targets included the referral and treatment process, the accuracy of staging, and measures of surgical performance.

Results
The target interval of seven days between receipt of the referral and the first visit at the cancer centre was achieved in 93% of women. Surgical treatment was administered to 92% of the women within the target of 20 working days from the first clinic appointment. Tumour close to or involving the margins of the specimen was noted in 13% of cervical and 9% of vulval cancers. The node count fell below the target standards in 13% of pelvic and 10% of groin dissections. Appropriate imaging investigations for staging were not undertaken in 15 of 39 cases (38%) of cervical cancer and in 5 out of 22 (23%) of vulval cancers.

Conclusion
The suggested targets of process and surgical performance are reasonable and achievable. These standards would be appropriate for national use. The area most clearly identified where these targets were not achieved was the requesting of complementary staging investigations. This could be addressed by the use of a simple investigation protocol to be included in each patient's notes and available at specialist clinics and gynaecology wards.
Anal sphincter tears: prospective study of obstetric risk factors
Authors: Samuelsson E. , Ladfors L. , Wennerholm U. B. , Gåreberg B. , Nyberg K. , Hagberg H.
Published: August 2005

Objective
To evaluate intrapartum risk factors for anal sphincter tear.

Design
A prospective observational study.

Setting
Delivery unit at the University Hospital in Göteborg, Sweden.

Participants
2883 consecutive women delivered vaginally during the period between 1995 and 1997. Information was obtained from patient records and from especially designed protocols which were completed during and after childbirth.

Main outcome measures
Anal sphincter (third and fourth degree) tear.

Results
Anal sphincter tear occurred in 95 of 2883 women (3.3%). Univariate analysis demonstrated that the risk of anal sphincter tear was increased by nulliparity, high infant weight, lack of manual perineal protection, deficient visualisation of perineum, severe perineal oedema, long duration of delivery and especially protracted second phase and bear down, use of oxytocin, episiotomy, vacuum extraction and epidural anaesthesia. After analysis with stepwise logistic regression, reported as odds ratio, 95% confidence interval, the following factors remained independently associated with anal sphincter tear: slight perineal oedema (0.40, 0.26–0.64); manual perineal protection (0.49, 0.28–0.86); short duration of bear down (0.47, 0.24–0.91); no visualisation of perineum (2.77, 1.36–5.63); parity (0.59, 0.40–0.89); and high infant weight (2.02, 1.30–3.16). Analysis of variance showed that manual perineal protection had a stronger influence on lowering the frequency, and lack of visualisation of perineum and infant weight had a stronger influence on raising the frequency, of anal sphincter tears in nulliparous compared with parous women.

Conclusions
Perineal oedema, poor ocular surveillance of perineum, deficient perineal protection during delivery, protracted final phase of the second stage, parity and high infant weight all constitute independent risk factors for anal sphincter tear. Such information is essential in order to reduce perineal trauma during childbirth.
Patterns in the incidence of age‐related ovarian cancer in South East England 1967–1996
Authors: Olaitan Adeola , Mocroft Amanda , Jacobs Ian
Published: August 2005

Objective
To study the age‐related trends in the incidence rates of ovarian cancer in South East England between 1967 and 1996.

Design
A retrospective review of systematically collected data on ovarian cancer in South East England.

Methods
Data were obtained from the Thames Cancer Registry on the numbers and rates per 100,000 population of ovarian cancer per five‐year age group (0–85+) in the 30‐year period from 1967 to 1996 from the 26 health authorities in the Thames region. Linear regression was performed to determine the changes in incidence rates of ovarian cancer per age group over time.

Main outcome measures
The change in overall incidence of ovarian cancer in South East England, as well as the change in incidence of ovarian cancer in each five‐year age groups (20–85+) in the 30‐year study period.

Results
There was a strong positive correlation between ovarian cancer rates and year of diagnosis in women aged ≥ 70 years, and this was particularly marked in women > 85 years of age. There was a negative correlation between rates and year of diagnosis in women aged 45–59 years. The analysis did not demonstrate a significant correlation between ovarian cancer rates and year of diagnosis in women < 44 years of age or women aged 60–69 years.

Conclusions
There have been significant changes in the pattern of ovarian cancer incidence in South East England during the 30‐year period studied. The observed changes in ovarian cancer incidence in younger women may, in part, be explained by known reproductive factors. The rise in ovarian cancer rates among the older age group is difficult to explain, but has important implications for the future planning and provision of cancer services.
Flatus and faecal incontinence: prevalence and risk factors at 16 weeks of gestation
Authors: Højberg Karen‐Elise , Salvig Jannie Dalby , Winsløw Nitnoi Albertsen , Bek Karl Møller , Laurberg Søren , Secher Niels Jørgen
Published: August 2005

Objective
To evaluate the prevalence of anal incontinence at 16 weeks of gestation and to identify possible maternal and obstetrical risk factors.

Design
Cross sectional study and cohort study.

Setting
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.

Participants
Cross sectional study: 7557 women attending antenatal care. Cohort study: a subgroup of 1726 pregnant women with one previous delivery at our department.

Results
The prevalence of anal incontinence within the preceding year was 8.6%. Incontinence of liquid and solid stools was reported in 2.3% and 0.6%, respectively. Isolated flatus incontinence at least once a week was reported in 4.2%. The risk of flatus incontinence at least once a week was increased with age > 35 years (OR 1.6; 95% CI 1.1–2.4) and with previous lower abdominal or urological surgery (OR 1.5, 95% CI 1.1–2.1) in a logistic regression model controlling for maternal factors. Increasing parity did not increase the risk. The risk of flatus incontinence was increased after anal sphincter tear and birthweight > 4000 g in a logistic regression model controlling for maternal and obstetric variables. Episiotomy was insignificantly associated, while spontaneous perineal tear > 3 cm and a number of other intrapartum factors were not associated.

Conclusion
True faecal incontinence is rare among younger women. However, an age > 35 years and previous lower abdominal or urological surgery increased the risk of flatus incontinence in contrast to increasing parity. This suggests that childbirth plays a minor role compared with age. However, when analysing obstetric variables separately, a birthweight > 4000 g, and anal sphincter tears were significant risk factors for flatus incontinence.
The development and evaluation of a computer‐assisted teaching programme for intrapartum fetal monitoring
Authors: Beckley Sarah , Stenhouse Elizabeth , Greene Keith
Published: August 2005

Objective
The development and evaluation of a computer‐assisted teaching programme of cardiotocog‐raphy and acid‐base balance.

Design
Randomised controlled trial.

Participants
One hundred and seventeen midwifery and obstetric staff at Derriford Hospital, Plymouth.

Methods
The obstetricians and midwives were randomly allocated to use the teaching programme, either early or late. The late group (control) used the teaching programme three months after the early group. To assess the effect of the teaching programme, participants were tested on four occasions over eight months by a multiple choice questionnaire. Two questionnaires on ease of use were also completed.

Main outcome measures
Multiple choice questionnaire scores and opinion questionnaire results.

Results
The mean score in the early group improved from 50.8% (test 1, pre‐teaching programme) to 70.2% (test 2, post‐teaching programme). The mean score in the control group was 50.3% (test 1) and 54.8% (test 2). Knowledge was retained up to seven months.

Conclusions
The teaching programme was effective in improving knowledge of acid‐base balance and cardiotocography and can be used by all staff whilst on duty on the labour ward.
24 hour rhythm to the onset of preterm labour
Authors: Lindow S. W. , Jha R. R. , Thompson J. W.
Published: August 2005

Objective
To describe the time of onset of contractions which result in preterm delivery to investigate if there is a diurnal influence.

Design
The admission register for the neonatal unit was used to identify admissions for prematurity over a three‐year period. Obstetric case records were then reviewed to obtain the recorded time of onset of contractions when delivery was preceded by spontaneous labour.

Setting
A maternity hospital in the United Kingdom.

Main outcome measures
The time of onset of spontaneous contractions which result in preterm labour and delivery.

Results
Four hundred and twenty‐five women in preterm labour were studied. A significant diurnal rhythm in the timing of onset of contractions was noted with 42% of deliveries occurring in labour which commenced between midnight and 0600 hours. Subgroup analysis indicated that there was a significant rhythm in second trimester preterm labours, male and female babies and that this rhythm was present during both the winter and summer months.

Conclusion
The periodicity of preterm labour onset demonstrates a rhythm which is similar to the rhythm in the onset of labour at term. Preterm labour most commonly begins between midnight and 0600 hours.
Contraction kinetics of isolated human myometrium during menstrual cycle and pregnancy
Authors: Tchirikov Mikhail , Peiper Ulrich , Schröder Hobe J.
Published: August 2005

Objective
To investigate the interaction between actin and myosin in the myometrium by studying the contraction kinetics of isolated samples of human myometrium.

Design
Experimental and observational cross‐sectional study.

Setting
Eppendorf University Hospital, Hamburg.

Samples
Myometrium samples were taken from women in the follicular phase (n= 6) or luteal phase (n= 6) of the menstrual cycle and during pregnancy at term (n= 25).

Methods
The frequency, extent and rate of force development were determined in spontaneously active myometrial preparations. From a resting force of 2 mN, sustained tonic contractions were induced by K+‐depolarisation (124 mM), or by protein kinase C activation (19.9 μM indolactam). The steady force was reversibly interrupted by rapid length changes (100 Hz sinus vibrations lasting 1 s, 5% of muscle length). Extent (steady plateau), as well as rate of force increase after cessation of vibrations, were derived from bi‐exponential functions fitted to the time course of force recovery.

Results
Frequency of spontaneous contractions was higher in the follicular phase [mean (SD) 18.3 contractions/hour (1.0)] than in the luteal phase [13.4 contractions/hour (8.1)] or in pregnancy at term [8.8 contractions/hour (7.6)]. During indolactam treatment, steady force in pregnancy at term was significantly increased [8.8 mN (4.0)], compared with the follicular phase [3.7 mN (0.9)]. Force recovery was distinctly slower in pregnancy at term during indolactam treatment [time constant 99.2 s (57.9); P < 0.005] than during K+‐depolarisation [time constant 29.1 s (5.9)], whereas in the follicular phase the rate of force recovery was faster with indolactam [16.8 s (7.1)] than with K+ depolarisation [24.4 s (5.9); P < 0.005].

Conclusions
The responses of human myometrium to contraction stimuli differ according to the reproductive state. Membrane depolarisation causes similar responses in all myometrial strips. In contrast, near term stimulation of protein kinase C generates a large tonic force and slow contraction kinetics, whereas early in the menstrual cycle contraction kinetics are fast.
Plasma from women with pre‐eclampsia induces an in vitro alteration in the endothelium‐dependent behaviour of myometrial resistance arteries
Authors: Hayman Richard , Warren Averil , Brockelsby Jerry , Johnson Ian , Baker Philip
Published: August 2005

Objective
To compare the in vitro effect of plasma from normal pregnant women and women with pre‐eclampsia on the endothelium‐dependent behaviour of myometrial resistance arteries from normal pregnant women.

Design
An in vitro comparative study.

Setting
Nottingham City Hospital.

Sample
Uterine biopsy specimens were obtained from normal pregnant women delivered by elective caesarean section at term. Plasma was collected from nulliparous women with pre‐eclampsia (n= 18), and from multiparous normal pregnant women (n= 18), all samples being matched for maternal age and gestation at venepuncture. Pools of plasma from women with pre‐eclampsia and normal pregnant women were formed from these samples and were used in all the experiments.

Methods
Myometrial resistance vessels obtained from the uterine biopsies were incubated with normal pregnant plasma, plasma from women with pre‐eclampsia, or without plasma. Wire myography was employed to study the effect of plasma on the endothelium‐dependent behaviour of these vessels.

Results
Incubation of vessels from normal pregnant women with plasma from women with pre‐eclampsia resulted in a significant reduction in endothelium‐dependent relaxation, compared with vessels incubated either with plasma from normal pregnant women or without plasma. This alteration in endothelial function occurred after an incubation period of one hour and required a threshold concentration for its effect to become established. Removal of the vascular endothelium abolished these changes in vessel behaviour. There were no plasma‐induced alterations in the endothelium‐independent behaviour of the vascular smooth muscle.

Conclusions
This study supports the hypothesis that plasma from women with pre‐eclampsia is capable of altering endothelium‐dependent myometrial relaxation in vessels from pregnant women.
The ultrasound diagnosis of retained fetal bones in West African patients complaining of infertility
Authors: Graham O. , Cheng L. C. , Parsons J. H.
Published: August 2005

Prolonged retention of intrauterine bone is a recognised cause of secondary infertility. Between 1989 and 1995, eleven West African women had retained intrauterine bone as the cause of their infertility. All the women had had termination of pregnancies in their countries of origin. Transvaginal ultrasound scan detected bright intrauterine echoes suggestive of bone which was confirmed and removed at hysteroscopy. Subsequently eight women conceived spontaneously 12 pregnancies. Doctors treating West African women with infertility should be aware of this condition and include transvaginal ultrasound scan in their investigations.
Physical health problems after childbirth and maternal depression at six to seven months postpartum
Authors: Brown Stephanie , Lumley Judith
Published: August 2005

Objective
To investigate the relationship between maternal physical and emotional health problems six to nine months after childbirth.

Design
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth, with telephone interview follow up of a sub‐sample of participants at seven to nine months postpartum.

Participants
The postal survey was distributed to all women who gave birth in a two‐week period in Victoria, Australia in September 1993, except those who had a stillbirth or known neonatal death. Follow up interviews were conducted with respondents to the postal survey who provided contact details and expressed interest in participating in further research selected to recruit three groups of equivalent size according to scores on the Edinburgh Postnatal Depression Scale: a low scoring group (< 9); a borderline group (9–12); and a group with scores indicating probable depression (> 13).

Results
The response rate to the postal survey was 62.5% (n= 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of non‐English speaking background were under‐represented. The participation rate in telephone follow up interviews was: 89.1% (n= 204), comprising 66 women with an Edinburgh Postnatal Depression Scale score of < 9; 72 women scoring 9–12; and 66 scoring ≥ 13. The point prevalence of depression at six to seven months postpartum was 16.9% (225/1331, 95% CI 14.9–18.9%). Physical and related health problems associated with significantly increased odds of (OR 3.42 [2.2–5.3]); urinary incontinence (OR 2.23 [1.5–3.4]); back pain (OR 2.20 [1.6–3.0]); sexual problems (OR 2.16 [1.6–3.0]); more coughs, colds and minor illnesses than usual (OR 2.78 [1.9–4.1]); bowel problems (OR 1.93 [1.3–2.9]) and relationship difficulties (OR 3.88 [2.8–5.4]). At follow up, three physical health factors were associated with statistically significant linear trends with poorer levels of emotional wellbeing. These were: tiredness (χ2 for linear trend = 12.38, P < 0.001); urinary incontinence (χ2 for linear trend = 5.63, P= 0.02); and more minor illnesses than usual (χ2 for linear trend = 7.94, P= 0.005).

Conclusion
The study confirms a link between maternal emotional wellbeing and physical health and recovery in the postnatal period and has important implications for clinical practice. Strategies for encouraging greater disclosure of physical and emotional health problems, assessment of the physical health of recent mothers presenting with depression, and emotional health of recent mothers presenting with other morbidity should be high priorities for all health professionals in contact with mothers in the year following childbirth.
Levonorgestrel‐releasing (20 μg/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives
Authors: French R. S. , Cowan F. M. , Mansour D. , Higgins J. P. T. , Robinson A. , Procter T. , Morris S. , Guillebaud J.
Published: August 2005

Objective
To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel‐releasing (20 μg per day) intrauterine system (LNG‐20) compared with reversible contraceptive methods in women of reproductive age.

Design
A systematic review and meta‐analysis of randomised controlled trials.

Identification
Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field.

Main outcome measures
Unplanned pregnancy and continuation of contraceptive method.

Results
Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta‐analyses; four were comparisons of the LNG‐20 intrauterine system with nonhormonal intrauterine devices. LNG‐20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380 A intrauterine devices) and those ≤ 250 mm3 (Nova‐T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG‐20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices ≤ 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG‐20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG‐20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG‐20 intrauterine system was compared with Norplant‐2, the LNG‐20 users were significantly more likely to experience oligo‐amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting.

Conclusions
The effectiveness of the LNG‐20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG‐20 intrauterine system, usually unnecessarily, since this end‐organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre‐contraceptive counselling and that absent bleeding may be viewed as a positive outcome.
The effects of family planning education provided to different gender groups
Authors: Özgür Servet , Bozkurt Ali Ihsan , Özçirpici Birgül
Published: August 2005

Objective
To determine whether women or men should be preferred as the target group of the family planning education.

Design
Community trial (educational intervention study).

Setting
Three villages having similar characteristics in Gaziantep, Turkey.

Population
Currently married women aged between 15–49 and their husbands in these villages.

Methods
Family planning education was given only to women in the first village, only to men in the second village and to both women and their husbands in the third village.

Main outcome measures
Changes in knowledge, attitudes, the behaviour of married women and their husbands between surveys performed before and after family planning education.

Results
Important changes in knowledge, attitudes, and behaviour were determined in all intervention groups after family planning education. The rate of effective contraceptive usage among women using any one of the contraceptive methods described significantly increased in all groups, especially where family planning education was given to both sexes.

Conclusions
Family planning education given to one of the couples may easily affect the other. Consistent and regular education is more important than selecting target gender groups for family planning education.
Cervicovaginal fibronectin and cervical length at 23 weeks of gestation: relative risk of early preterm delivery
Authors: Heath V. C. F. , Daskalakis G. , Zagaliki A. , Carvalho M. , Nicolaides K. H.
Published: August 2005

Objectives
To establish the prevalence of cervicovaginal fetal fibronectin positivity at 23 weeks of gestation in a routine population of singleton pregnancies and determine the relative risk of spontaneous delivery before 33 weeks in women with a fibronectin positive result.

Design
Prospective clinical study.

Setting
Inner city antenatal clinic.

Population
Singleton pregnancies attending for routine antenatal care.

Methods
Cervicovaginal fetal fibronectin and cervical length were measured at 23 weeks of gestation. The distribution of fibronectin positivity within subgroups according to maternal characteristics was calculated and the relative risk of spontaneous delivery before 33 weeks was estimated.

Main outcome measures
Prevalence of a fibronectin positive result and its relation to cervical length measurement and spontaneous preterm delivery before 33 weeks.

Results
Of 5146 women participating in the study, 182 (3.5%) had a fibronectin positive result and 76 (1.5%) had a cervical length of ≤ 15 mm. Fibronectin positive women were more likely to be Afro‐Caribbean in origin, to have had a previous second trimester miscarriage and to have a short cervix. In the 5068 women who were managed expectantly, the significantly independent relative risk of spontaneous delivery at < 33 weeks was 46.2 (95% CI 18.8–113.6), for cervical length of ≤ 15 mm, 8.1 (95% CI 3.8–17.5) for a fibronectin positive result, and 4.4 (95% CI 2.2–9.1) for cigarette smoking.

Conclusion
Fibronectin positivity at 23 weeks of gestation provides useful prediction of pregnancies at risk of spontaneous preterm delivery before 33 weeks, with a relative risk that is twice as high as cigarette smoking, but is a sixth of that of cervical length.
Women's knowledge of and attitudes to first and second trimester screening for Down's syndrome
Authors: Mulvey S. , Wallace E. M.
Published: August 2005

One hundred women were interviewed at their first hospital antenatal visit to assess their knowledge of, and attitudes to, first versus second trimester screening for Down's syndrome. Overall, the women had limited knowledge of Down's syndrome, and the prenatal screening and diagnostic tests that are available. However, when informed, the majority of women expressed a clear preference for first trimester screening tests for Down's syndrome, regardless of the rate of miscarriage of Down's syndrome pregnancies between 10 and 15 weeks of gestation. These findings have implications for the planning of prenatal Down's syndrome screening programmes.
A comparison of the contractile properties of human myometrium obtained from the upper and lower uterine segments
Authors: Luckas Murray J. M. , Wray Susan
Published: August 2005

This study compared the contractile characteristics of myometrium taken from upper and lower uterine segments. Biopsies were obtained from women undergoing classical caesarean section. Myometrial strips were dissected and mounted in an organ bath, and the contractions were recorded. The cross sectional area of the contractile elements within the strips was measured enabling strips of differing dimensions to be compared. There were no significant differences in the contractile rate and force production produced by myometrium from the upper and lower segments. This study demonstrated that for contractile studies, the use of lower segment is appropriate. The results fail to demonstrate any functional regionality of the human uterus in terms of contractility.
Risk factors and clinical manifestations of pre‐eclampsia
Authors: Ødegård Rønnaug A. , Vatten Lars J. , Nilsen Stein Tore , Salvesen Kjell Å. , Austgulen Rigmor
Published: August 2005

Objective
To study associations between established risk factors for pre‐eclampsia and different clinical manifestations of the disease.

Design
A population‐based, nested case‐control study.

Setting
Information from 12,804 consecutive deliveries that took place over three years at a birth clinic, which alone serves a population of nearly 240,000 in Rogaland county, Norway.

Subjects
Cases of pre‐eclampsia (n= 323) and healthy controls (n= 650) were selected. Pre‐eclampsia was defined as increase in diastolic blood pressure (≥ 25 mmHg to ≥ 90 mmHg) and proteinuria (≥ 1+ by dipstick testing) after 20 weeks of pregnancy.

Main study measures
Parity, previous pre‐eclampsia, blood pressure, maternal weight, and maternal smoking were included as study varstudy variables. Women with pre‐eclampsia were grouped according to clinical manifestations of the disease (i.e. severity [mild, moderate or severe]) and time of onset (early or late gestation). Associations with the study factors were estimated as relative risks (odds ratio, OR).

Results
Both nulliparity and hypertension increased pre‐eclampsia risk, with no clear preference for any clinical subtype. High maternal weight was related to a higher risk of mild and moderate, but not severe, pre‐eclampsia. Previous pre‐eclampsia strongly increased the risk for pre‐eclampsia in the current pregnancy, and the risk of early onset disease was especially high (OR 42.4; 95% CI 11.9–151.6). Overall, smoking was associated with a reduced risk for pre‐eclampsia (OR 0.6; 95% CI 0.4–0.9). However, no effect of smoking was observed in the early onset disease group and among women with repeated pre‐eclampsia.

Conclusion
Nulliparity and hypertension increased the risk for each subgroup of pre‐eclampsia, but high maternal weight, previous pre‐eclampsia and smoking were not consistently associated with each clinical subtype. This observation may suggest that heterogeneous clinical manifestations of pre‐eclampsia may be preceded by different pathological mechanisms.
Can glucose tolerance test predict fetal hyperinsulinism?
Authors: Weiss Peter A. M. , Haeusler Martin , Tamussino Karl , Haas Josef
Published: August 2005

Objective
To establish cut off levels for oral glucose tolerance test in pregnancy using fetal hyperinsulinism as a clinical endpoint.

Design
Capillary blood glucose levels at 0, 1, and 2 hours after the ingestion of either 1 g/kg or 75 g glucose, at 28 (SD 5) weeks of gestation were analysed in 220 women with elevated amniotic fluid insulin levels [≥ 42 pmol/L (≥ 7 μU/mL)] after a mean (SD) of 31 weeks (3) and in 220 nondiabetic controls.

Results
In women with elevated amniotic fluid insulin levels the mean (SD) capillary blood glucose values at 0, 1, and 2 hours were 5.2 mmol/L (1.0) [94 mg/dL (18)], 10.5 mmol/L (1.4) [189 mg/dL (25)] and 8.2 mmol/L (2.0) [147 mg/dL (36)], respectively. The one‐hour value had the highest sensitivity to predict elevated amniotic fluid insulin levels. The 5th centile of the one‐hour blood glucose levels representing a detection rate of 95% was 8.9 mmol/L (160 mg/dL).

Conclusion
Glucose cut off levels in most established oral glucose tolerance test criteria are too high, to accurately predict amniotic fluid hyperinsulinism. A one‐hour test may be sufficient for detecting amniotic fluid hyperinsulinism. Since different loads (1 g/kg, 75 g or 100 g) and blood fractions (venous plasma or capillary blood) have minimal impact on oral glucose tolerance test results, a single one‐hour cut off of 8.9 mmol/L (160 mg/dL), independent of the sampling method, may be appropriate for the diagnosis of gestational diabetes mellitus severe enough to cause amniotic fluid hyperinsulinism.
Hormonal regulation of neonatal weight: placental leptin and leptin receptors
Authors: Schulz Solveig , Häckel Carsten , Weise Wolfgang
Published: August 2005

Objective
To examine whether umbilical and maternal leptin levels correlate with birthweight, placental weight, and maternal weight; and to detect membrane‐bound leptin receptors in placental tissue as well as soluble leptin receptors in umbilical and maternal blood.

Design
Prospective observational study.

Setting
University teaching hospital.

Methods
Serum levels of leptin and soluble leptin receptors were analysed in 31 randomly selected mother/newborn pairs at delivery. In addition, placental tissue was assayed for leptin receptors using immunocytochemistry and Western blot.

Results
The mean [SD] leptin level in umbilical cord venous blood (7.1 ng/mL [4.0]) was significantly lower (P < 0.001) than in maternal blood (22.5 ng/mL [10.8]). Umbilical cord leptin concentrations correlated significantly with birthweight (P < 0.001), placental weight (P < 0.005) but not with maternal leptin. Maternal leptin concentrations correlated only with maternal weight (P < 0.001). In chorionic villous tissue, trophoblasts stained strongly positive for leptin receptor‐like immunoreactivity. Two membrane‐bound isoforms of the leptin receptor were also detected in placental tissue. In both umbilical and maternal serum, a soluble leptin receptor was found migrating as broad band at Mr 97,000 D.

Conclusion
The present data strongly reinforce the idea that circulating leptin levels may provide a growth‐promoting signal for fetal development during late pregnancy. While membrane‐bound leptin receptors may be involved in autocrine regulation of placental leptin production, the soluble receptor form may serve as a transport vehicle for leptin to fetal tissues.
Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden
Authors: Essén Birgitta , Johnsdotter Sara , Hovelius Birgitta , Gudmundsson Saemundur , Sjöberg N.‐O. , Friedman Jonathan , Östergren P.‐O.
Published: August 2005

Objective
To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome.

Methods
Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth.

Participants
Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden.

Results
The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance.

Conclusions
Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as ‘survival behaviours’ related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance.
Folate affects apoptosis in human trophoblastic cells
Authors: Steegers‐Theunissen R. P. M. , Smith S. C. , Steegers E. A. P. , Guilbert L. J. , Baker P. N.
Published: August 2005

Effects of folate deficiency on the rate of apoptosis in human cytotrophoblastic cells has been investigated. Apoptosis was determined in cytotrophoblastic cells after culture in 1. control medium, 2. folate‐free medium and 3. folate‐free medium plus 10% fetal calf serum. Apoptosis rates in cells cultured in mediums 2 and 3 were significantly higher than those cultured in the control medium (P < 0.02 and P < 0.03, respectively). In conclusion, human cytotrophoblastic cells show a significantly increased rate of apoptosis in vitro after culture in a folate‐free medium. Possible explanations for the association between folate deficiency and pregnancy complications are suggested.
Gynaecological presentation of retroperitoneal tumours
Authors: Spillane Andrew J. , Thomas J. Meirion
Published: August 2005

Objective
To illustrate the problems associated with mistaken pre‐operative diagnosis following gynaecological presentation of patients with retroperitoneal tumours.

Design
A case series of five referrals.

Results
Non‐gynaecological tumours were not suspected in each case and hence there was a failure to undertake further pre‐operative investigation and referral to a specialised soft tissue sarcoma service. This resulted in four of the patients having an unnecessary laparotomy with an inappropriate transperitoneal biopsy undertaken when the retroperitoneal tumour was discovered. The mistaken diagnosis of ovarian malignancy lead to increased morbidity, compromise of potential for a long disease free interval and/or possibly lessened the chance of cure in each case.

Conclusions
Misinterpretation of clinical signs and an over‐reliance on ultrasound diagnosis were the commonest causes of inappropriate management of these patients. Gynaecologists should consider more frequently the other, less common differential diagnoses of a pelvic mass. This is especially true in circumstances with a predominantly solid tumour, where there are clinical signs of vascular or rectal displacement, or where there is ultrasound evidence of ureteric obstruction. The more frequent utilisation of a computerised tomography scan with intravenous and oral contrast with referral before inappropriate transperitoneal biopsy are recommended as complete en bloc surgical excision at the first laparotomy is the treatment of choice in virtually all primary retroperitoneal tumours.
Births in Finland and Estonia from 1992 to 1996: convergent differences?
Authors: Gissler Mika , Karro Helle , Tellmann Alvi , Hemminki Elina
Published: August 2005

Objective
To describe the differences in childbearing, in prenatal and obstetrical practices, and in perinatal health outcome in Finland and Estonia.

Design
Registry study using the data from the Finnish and Estonian medical birth registries for years 1992 to 1996 (in total 324,021 and 74,297 newborns, respectively).

Results
In 1992 the birth rates were 51 per 1000 women aged 15 to 49 in Finland and 48 per 1000 in Estonia. The birth rate declined in the study period in both countries, but the decline was more rapid in Estonia (−26%) than in Finland (−6%). In the same period the rates of induced abortion declined in both countries (−34% and −6%, respectively), but the rate in 1996 was still much higher in Estonia (46/1000) than in Finland (8/1000). Compared with Finnish mothers, Estonian mothers were younger, had fewer multiple births, less prenatal care and fewer interventions during pregnancy and delivery. The intervention rates increased in both countries during the study period, but this increase was more rapid in Estonia. The infant outcomes were poorer in Estonia, but the differences between Estonia and Finland decreased during the 1990's.

Conclusions
The differences in prenatal and maternal care and in induced abortion rates have decreased between Estonia and Finland. Changes in maternal backgrounds, improved referral system for complicated pregnancies, improvements in prenatal care and in availability of appropriate equipment and technology may have caused improved maternal and infant health in Estonia, but this should be further investigated.
Introduction of the Misgav Ladach caesarean section at an African tertiary centre: a randomised controlled trial
Authors: Björklund Kenneth , Kimaro Melkizedeki , Urassa Ernest , Lindmark Gunilla
Published: August 2005

ObjectiveTo determine whether the Misgav Ladach caesarean section technique can offer benefits compared with conventional caesarean section technique in the prevailing conditions of a busy African tertiary centre.

DesignA randomised controlled trial.

SettingA tertiary African obstetric unit with 18,000 deliveries annually.

ParticipantsThree hundred and thirty‐nine women undergoing caesarean section.

MethodsEight residents and registrars were instructed in the Misgav Ladach technique for caesarean section during one week, after which the study commenced. The course participants instructed their colleagues; in total, 16 doctors participated. Women requiring caesarean section were randomised to Misgav Ladach or to the conventional lower midline incision procedure, excluding those with a previous scar.

ResultsDuring 11 weeks 339 randomised procedures (328 of which were emergency procedures) were carried out. Mean operating time was 25.3 minutes for Misgav Ladach and 32.6 minutes for the lower midline incision procedure (95% CI −8.3; −6.3). Mean blood loss was 354 mL and 447 mL (−133; −53), and the number of sutures 3.1 and 6.1 (−3.1; −2.9), respectively. No significant difference was found in Apgar scores. Mobilisation was earlier with the Misgav Ladach procedure. No difference was found in overall post‐operative infection rates i.e. wound infection or febrile illness, but the combination of wound infection and fever was more common in the Misgav Ladach group.

ConclusionThe Misgav Ladach caesarean section confers benefits such as reduced blood loss, conservation of time and suture material, and rapid mobilisation, but more studies are needed to explore modifications aimed at reducing post‐operative infections in settings with limited resources.
The outcome of 72 pregnancies in 55 women with cystic fibrosis in the United Kingdom 1977–1996
Authors: Edenborough F. P. , Mackenzie W. E. , Stableforth D. E.
Published: August 2005

Objective
To identify pregnancies in women with cystic fibrosis and describe obstetric, infant and maternal medical outcomes in relation to the severity of maternal disease.

Design
Retrospective study, based on casenotes.

Setting
Eleven cystic fibrosis centres in the United Kingdom.

Population
Pregnant women with cystic fibrosis.

Methods
Single observer medical and obstetric casenote review categorising maternal cystic fibrosis (e.g. genotype, pancreatic, hepatic and diabetic status) and pre‐pregnant severity (e.g. weight and lung function) and noting fetal outcome and maternal morbidity.

Main outcome measures
Completed pregnancies and pregnancy losses, fetal outcome and complications, maternal morbidity, such as changes in weight, lung function, pulmonary infections during and after pregnancy. Relation of outcomes to severity of maternal cystic fibrosis.

Results
From 72 pregnancies identified, the outcomes were known for 69; there were 48 live births (70%) of which 22 were premature (46%); 14 therapeutic abortions (20%); and 7 miscarriages (10%). There were no stillbirths, neonatal or early maternal deaths. Three major fetal anomalies were seen, but no infant had cystic fibrosis. At the conclusion of our study three pregnancies were still continuing. Prematurity with increased fetal complications and maternal morbidity with infection, declining lung function and poor weight gain were associated with poor pre‐partum lung function.

Conclusion
Pregnancy occurs in women with cystic fibrosis of all degrees of severity. Outcomes for the infant are generally good but are variable for the mother. Predicting outcome on the basis of maternal severity is difficult but lung function appears to be the most significant determining factor. Pregnancy may be normal in women with normal lung function (forced expiratory volume > 80%). However, it may adversely affect mild and moderate lung disease due to cystic fibrosis and should be avoided in pulmonary hypertension, cor pulmonale and when forced expiratory volume < 50% predicted. Ideally, all pregnancies should be planned with prior counselling and monitored by dedicated cystic fibrosis teams, including obstetricians who are experienced in managing high risk pregnancies.