bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed pushing with lumbar epidural analgesia in labour
Authors: MARESH M. , CHOONG K.‐H. , BEARD R. W.
Published: August 2005

Summary. Seventy‐six primigravidae with epidural analgesia were randomly assigned to one of two groups for management in the second stage. In one group the women delayed pushing and in the other they were managed conventionally. The two groups were well matched for maternal and infant characteristics, including position and level of the presenting part at full dilatation and fetal scalp blood pH. The mean waiting time in the second stage before pushing was increased from 27 min in the conven‐ tional group to 123 min in the delayed group. This delay was not associated with an increase in abnormal fetal heart rate abnormalities or any decrease in umbilical cord pH or Apgar scores. In contrast, the delay was associated with an increase in spontaneous deliveries and a decrease in forceps deliveries (P=0.06). These findings suggest a need for redefining the management of the second stage of labour with epidural analgesia.
Non‐immune hydrops fetalis: changing contribution to perinatal mortality
Authors: ANDERSEN HELEN M. , DREW J. H. , BEISCHER N. A. , HUTCHISON A. A. , FORTUNE D. W.
Published: August 2005

Summary. During the decade to 1979, 203 hydropic infants died in the State of Victoria, Australia. Non‐immune hydrops fetalis (NIHF) became more common than immune hydrops fetalis as a cause of fetal hydrops, and its contribution to the total perinatal mortality increased from 0.1% to 3%. The perinatal mortality rate of infants with NIHF was virtually 100%. The most consistent finding at post‐mortem was pulmonary hypoplasia which was probably due to compression from serous cavity effusions. Survival may be improved by early diagnosis and termination of the pregnancy in selected patients with viable infants before the development of gross serous cavity effusions The most constant clinical sign associated with hydrops fetalis was polyhydramnios which is an indication for ultrasonography and cardiotocography to detect cases of NIHF and to select the optimum time for delivery.
Ten‐year survival in 290 patients with endometrial cancer: prognostic factors and therapeutic approach
Authors: LA VECCHIA CARLO , FRANCESCHI SILVIA , PARAZZINI FABIO , COLOMBO ELENA , COLOMBO FABIO , LIBERATI ALESSANDRO , MANGIONI COSTANTINO
Published: August 2005

Summary. Between 1970 and 1976, 290 patients with endometrial cancer were treated at the 1st Obstetrics and Gynecology Clinic of the University of Milan. The median age was 62 years. Surgery was completed in 262 (90.3%) patients. Abdominal hysterectomy was used in 158 (70.9%) stage I and 40 (71.4%) stage II/III patients; vaginal hysterectomy in 55 (24.7%) stage I and nine (16.1%) stage II/III patients. Resection of the upper vagina was performed in 168 patients. Postoperative external beam radiotherapy was used in stage II/III patients and in 44 (19.7%) stage I high‐risk patients. Ten‐year survival, determined by the life‐table method, was 84.8% in stage I (223 patients), 53.4% in stage II (37 patients), 64.4% in stage III (19 patients), and 9.1% in stage IV (11 patients). Factors associated with poorer prognosis were: late age at diagnosis (P<0.001); deep myometrial invasion (P<0.001); poorly differentiated histological grade (P=0.11); lack of resection of the upper vagina (P= 0.13). The role and importance of surgery is discussed, with special emphasis on the selective use of the vaginal route in aged, obese and medically high‐risk patients.
Acute effects of nicotine on fetal heart rate variability
Authors: LEHTOVIRTA P. , FORSS M. , RAURAMO I. , KARINIEMI V.
Published: August 2005

Summary. The effects of nicotine on fetal heart rate (FHR) variability were studied in seven women in the second trimester and eight women in the third trimester of pregnancy by giving them nicotine‐containing chewinggum. The possible effects of carbon monoxide or some other agents of nicotine‐free smoke on FHR variability were tested in eight women in the second and eight in the third trimester of pregnancy by giving them herbal cigarettes to smoke. The gum caused an acute decrease in the interval index of FHR variability in both trimesters, as we have observed previously in association with tobacco smoking, and an acute decrease in the differential index in the second trimester but not in the third trimester. These effects differ from those associated with tobacco smoking, during which the differential index decreased in the third trimester but remained unchanged in the second trimester. In the second trimester the gum elevated the baseline FHR, as did tobacco smoking. In the third trimester, the gum decreased the baseline FHR in contrast to tobacco smoking, which had no effect on it. Smoking a herbal cigarette had no effect on FHR and no depressant effect on FHR variability, as had nicotine. The only fetal response was a transient increase in the interval index 5—10 min after smoking in the second trimester. We conclude that nicotine seems to be responsible for the depressant effect of tobacco smoke on the fetus, as manifested in lowered interval indices. The different responses of the differential index and baseline FHR to tobacco smoking and chewing nicotine‐containing gum at different stages of gestation remain unexplained.
Smoking habits and maternal serum a‐fetoprotein levels during the second trimester of pregnancy
Authors: THOMSEN STEN G. , SALLY LENNARTISAGER , LANGE AKSEL P. , SAURBREY NINA , SCHIOLIER VIBEKE
Published: August 2005

Summary. In a prospective study the influence of cigarette smoking on maternal serum a‐fetoprotein levels at 16 weeks gestation was examined. Significantly higher levels were found in 120 smokers compared with 138 non‐smokers (median 54.0 and 44.3 μg/1 respectively, P<0.001). No difference in maternal body weight between the two groups could account for the results. The possibility of smoking‐induced increased permeability of the placental barrier is discussed.
Reviewing birthweight standards
Authors: CARR‐HILL ROY A. , PRITCHARD COLIN W.
Published: August 2005

Summary. The standardization of birthweight for gestational age, taking into accounhd sex of infant and maternal height and weight, is clinically useful and essential for some research purposes. In Britain, the most commonly used standards for singletons are those derived from Thomson et al. (1968) from a series of births to women in Aberdeen between 1948 and 1964. The present study starts with the observation that the present population of births in Aberdeen is different. This prompted work to ‘update’ the standards at least for research purposes, and in so doing a number of problems have been encountered which complicate the task of developing universally applicable standards.
Ovarian epithelial tumours of borderline malignancy: pathological features and current status
Authors:   THE OVARIAN TUMOUR PANEL OF THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS
Published: August 2005

Summary. Ovarian epithelial tumours of borderline malignancy are defined and described in detail.
Plasma progesterone in the umbilical vessels at term—an overview
Authors: SHAXTED E. J. , MAYNARD P. V.
Published: August 2005

Summary. This paper reports the results of umbilical cord vein and artery, and maternal peripheral vein plasma progesterone levels in over 300 term human deliveries, individual aspects of which have previously been reported. An attempt was made to assess the fetal status objectively, and the results confirm that cord progesterone levels are correlated with the mode of delivery, the clinical indications for the mode of delivery and the clinical condition of the fetus after delivery. No relation was found to fetal sex, induction of labour or maternal antenatal complications.
Concentrations of hypoxanthine, xanthme, undine and urate in amniotic fluid at caesarean section and the association of raised levels with prenatal risk factors and fetal distress
Authors: HARKNESS R. A. , GEIRSSON R. T. , McFADYEN I. R.
Published: August 2005

Summary. Samples of amniotic fluid were obtained at caesarean section from 33 of 80 consecutive unselected patients in whom the membranes were intact. Concentrations of the ATP metabolites, hypoxanthine and xanthine, as well as uridine and urate were determined using high pressure liquid chromatography. Independent ‘clinical’ factors associated with reduced fetal growth and well‐being were identified and the patients were assigned to one of three groups: those with no recognized risk, those with moderate risk and a small group of four patients with high risk. The mean hypoxanthine concentration was higher in the moderate‐risk group than in the group with no risk. Two of the three patients with proteinuric hypertension in the high‐risk group had normal hypoxanthine concentrations. There were seven patients with fetal distress, and concentrations of hypo xanthine, xanthine, uridine and urate were significantly higher in the three patients who had meconium stained amniotic fluid in addition to abnormal fetal heart rate tracings than in the remaining four who had fetal heart rate abnormalities only. It is suggested that fetal distress at emergency caesarean sections might be quantitated by such analysis.
A controlled trial of naproxen sodium for relief of pain associated with Vabra suction curettage
Authors: SIDDLE N. C. , YOUNG O. , SLEDMERE C. M. , READING A. E. , WHITEHEAD M. I.
Published: August 2005

Summary. In a double‐blind study naproxen sodium (550 mg), or placebo was administered 1 h before Vabra curettage and pain associated with the procedure was assessed immediately after operation and 30, 60 and 120 min later by visual analogue and verbal rating scales, and the McGill pain questionnaire. The pre‐curettage anxiety of the patients was assessed by the Spielberger state anxiety inventory. Of the 58 patients, 51 (87.9%) reported pain during the procedure; there was no relation between the level of pain experienced and the pre‐curettage anxiety score. Compared with the placebo group, the pain experienced by the naproxen group was significantly less as measured by the McGill pain questionnaire immediately after curettage, and by visual analogue scales 30 and 60 min after the procedure. The verbal rating scales showed that naproxen significantly reduced backache 30 min after curettage, and cramp immediately after the procedure and 30 and 60 min later but did not reduce the severity of the pain associated with the procedure.
The investigation of proteinuria in pregnancy using iso‐dalt analysis
Authors: CLARK P. M. S. , EVANS S. E. , WEAVER J. B. , FLORA P. S. , HUGHES S. H. , WHITEHEAD T. P.
Published: August 2005

Summary. Urinary protein excretion has been investigated using the iso‐dalt technique in pregnant patients with hypertension and proteinuria, without hypertension but with proteinuria and without either hypertension or proteinuria. This high resolution electrophoretic technique has shown a great variation in the pattern of protein excreted by these patients, particularly those with hypertension. These showed an increased number of protein species in the urine, some of unknown identity. Two urines from this group appeared to contain no detectable albumin. Currently this technique is inappropriate for the routine analysis of urine proteins. However, further studies may determine the diagnostic value of these changes in urine excretion and allow the development of more specific assays.
A 1‐hour hCG radioimmunoassay detection kit for the management of suspected ectopic pregnancy
Authors: GOH B. H. , MOUNTFORD LESLEY , MACKENZIE I. Z.
Published: August 2005

Summary. The value of a rapid hCG kit was assessed in 60 patients undergoing laparoscopy or laparotomy for suspected ectopic pregnancy, of whom 30 were subsequently proven to be pregnant. A high degree of specificity (93%) and sensitivity (97%) was found, with one false‐negative and three false‐positive results. If the kit had been used as a routine on admission three patients would not have been inadvertently discharged before the diagnosis of tubal pregnancy and 27 could have avoided a laparoscopy to exclude tubal pregnancy.
Doppler blood flow waveforms in the descending thoracic aorta of the human fetus
Authors: GRIFFIN DAVID , BILARDO KATARINA , MASINI LUCIA , DIAZ‐RECASENS JOACQUIM , PEARCE J. MALCOLM , WILLSON KEITH , CAMPBELL STUART
Published: August 2005

Summary. A linear‐array pulsed Doppler duplex has been used to study third‐trimester Doppler flow velocity waveforms (FVW) in the descending thoracic aorta of 98 normal and 20 severely growth‐retarded fetuses. Waveforms have been normalized (frequency index profile; FIP) to remove the effect of the angle of insonation and so allow comparison at different gestational ages and with complicated pregnancies. There is an increase in end‐diastolic velocities with advancing gestational age indicating a reduction in placental resistance. The growth‐retarded fetuses showed a significant reduction in end‐diastolic velocities and an increase in the pulsatility index (normal PI: mean 1.83, SD 0.22; growth‐retarded PI: mean 2.78, SD 0.60). This reduction of diastolic blood flow may indicate reduced placental vascularity and predict impending fetal hypoxia.
Placental protein 12 (PP12) in menstrual fluid
Authors: RUTANEN E.‐M. , KOISTINEN R. , WAHLSTRÖM T. , STENMAN U.‐H. , SEPPÄLÄ M.
Published: August 2005

Summary. In a previous study we found placental protein 12 (PP12) in the human endometrium. We now show that PP12–like immunoreactive material is released into menstrual fluid where it occurs at concentrations from 43 to 32000 μg/l. The PP12 levels in menstrual fluid are 2– to 2000–fold higher than in serum of the same individuals thus suggesting that the protein either concentrates or is produced in the endometrium. The addition of protease inhibitors has no effect on the PP12 levels. In radioimmunoassay, the dose‐response curves of menstrual fluid PP12 and placental PP12 are parallel. Experiments with fused rocket immunoelectrophoresis show that menstrual and placental PP12 are indistinguishable from each other. In gel filtration, menstrual PP12 has the same molecular weight as that of purified placental PP12. By immunoperoxidase staining, PP12 is localized in the glandular epithelial cells of the menstrual endometrium. The glandular localization and high concentration of PP12 in menstrual fluid, as compared with PP12 levels in serum and endometrium, suggest that PP12 may be secreted by the endometrium.
Serum levels of unbound 17β‐oestradiol during oral and percutaneous postmenopausal replacement therapy
Authors: NILSSON B. , HOLST J. , VON SCHOULTZ B.
Published: August 2005

Summary.The metabolic effects of oestrogen therapy are influenced by the route of administration. Compared with oral treatment, percutaneous administration may have theoretical advantages with respect to liver metabolism, but there are also potential disadvantages related to the specific kinetics of this route. The increase of SHBG binding capacity is much less pronounced, which might result in excess amounts of unbound, biologically‐active steroid during therapy. The serum concentrations of unbound 17β‐oestradiol were calculated in two groups of postmenopausal women during replacement therapy with equivalent amounts of oral and percutaneous oestrogen. A highly significant and quite similar increase of the free fraction as well as in total 17β‐oestradiol was found in both groups of women, in spite of the fact that SHBG binding capacity was unchanged during percutaneous therapy. Albumin binding and the total serum concentration of 17β‐oestradiol were found to be more important for the regulation of unbound steroid concentration than variations in SHBG binding capacity. In conclusion, there was no evidence that percutaneous administrationper sewould carry an increased risk of over‐treatment.
The effect of parity on uterine activity in labour
Authors: ARULKUMARAN S. , GIBB D. M. F. , LUN K. C. , HENG S. H. , RATNAM S. S.
Published: August 2005

Summary. Uterine activity was studied in 40 multiparous Singapore women of Chinese origin who were in normal labour and had a normal delivery. A catheter tip pressure transducer coupled with a uterine activity integrator was used to quantify uterine activity. Normal labour progress was defined as labour progressing within 2 h to the right of a line drawn on the partogram at 1 cm/h in the active phase of labour. A wide range of activity was observed. The median level of uterine activity rose from 815 kPas/15 min at 3 cm dilatation to 1731 kPas/15 min at 9 cm dilatation with an overall median level of 1130 kPas/15 min. The 10th centile value rose from 430 kPas/15 min at 3 cm dilatation to 923 kPas/15 min at 9 cm dilatation. Profiles of dilatation‐specific activity values were constructed. These values were significantly lower than in a comparative group of nulliparous patients. The parous uterus requires to expend significantly less effort to effect normal vaginal delivery than its nulliparous counterpart.
The influence of spontaneous and induced labour on the rise in prostaglandins at amniotomy
Authors: SELLERS S. M. , MITCHELL M. D. , ANDERSON A. B. M. , TURNBULL A. C.
Published: August 2005

Summary. Maternal peripheral plasma levels of 13, 14‐dihydro‐15‐keto‐prostaglandin F (PGFM) were measured immediately before and 5 min after amniotomy. Three groups of women were studied: women in late pregnancy; women in spontaneous labour; and women who had received intravaginal prostaglandin E2 (PGE2) pessary. There was no significant difference in the magnitude of the rise in PGFM after amniotomy in late pregnancy or during spontaneous labour suggesting that labour has no influence on the release of prostaglandin F2α (PGF2α) induced by artificial rupture of the fetal membranes. However, local administration of PGE2 before amniotomy caused a greater rise in PGFM suggesting that PGE2 can influence the release and/or metabolism of PGF2α.
Effects of two ultrasound scanning regimens on the management of pregnancy
Authors: COCHLIN D. L.
Published: August 2005

Summary. Two obstetric ultrasound scanning regimens were compared with each other and with two control groups by studying the effects on the management of pregnancy. One group of women was scanned routinely whilst the other was scanned only for specific clinical indications. Management was improved in both the scanned groups compared with that in the control groups, mainly in the mode and timing of delivery and in the admission pattern during pregnancy. Routine scanning resulted in more accurate early detection of placenta praevia and multiple pregnancy but there was no improvement in the management of labour compared with that in the group scanned only for specific reasons.
Sexuality in pregnancy and premature labour
Authors: GEORGAKOPOULOS P. A. , DODOS D. , MECHLERIS D.
Published: August 2005

Summary. The relation of sexual behaviour during pregnancy to the initiation of labour was investigated in 358 patients of whom 58 were delivered after premature labour and 300 were delivered spontaneously at term. In all patients the mean weekly coital frequency and the frequency of orgasm were investigated by means of a retrospective questionnaire. There was no significant difference in coital or orgasmic frequency between the women who had a premature labour and those who had a spontaneous delivery at term. This was also true when those having premature labour were divided into those starting labour with ruptured membranes and those starting with contractions.
An unusual sex ratio of births in an industrial town with mortality problems
Authors: LLOYD O. LL. , LLOYD M. M. , HOLLAND Y. , LYSTER W. R.
Published: August 2005

Summary. In a small industrial town in central Scotland, geographical and temporal relations were established between respiratory cancer and an abnormally high sex ratio of births. Various categories of mortality and the sex ratios of births showed comparable annual trends, and suggest a possible role of air pollution.
Absence of prolactin receptors in normal and malignant uterine cervix
Authors: DOWSETT M. , McGARRICK G. E. , STAFFURTH J. , WORTH R. W. , CHAPMAN M. G. , JEFFCOATE S. L.
Published: August 2005

Summary. Bromocriptine has been found to be an effective agent in the treatment of advanced cancer of the uterine cervix, and it was thus possible that the tumours were prolactin‐dependent. A prolactin receptor assay was established and validated, but no receptors were found in cervical tissue whether normal or with benign or malignant disease. It is unlikely that cervical tumours are prolactin‐dependent.
Treatment of advanced ovarian cancer with combination chemotherapy using cyclophosphamide, adriamycin and cis‐platinum
Authors: MILSTED R. , SANGSTER G. , KAYE S. , CALMAN K. , CORDINER J. , SOUTTER W. , BARR W. , CUNNINGHAM D. , SOUKOP M. , KENNEDY J. , McEWAN H.
Published: August 2005

Summary. Fifty‐four patients with advanced ovarian cancer have been treated with combination chemotherapy using cyclophosphamide, adriamycin and cis‐platinum. The toxicity of the regimen was manageable but few patients were prepared to tolerate more than 6 months of treatment. Those in complete clinical remission at that time were offered second‐look laparotomy and if apparently free of disease, therapy was discontinued. Forty‐seven patients could be assessed of whom 33 had had no previous therapy. Twenty‐two of these were clinically free of disease after completion of chemotherapy of whom 12 had no detectable disease at second‐look laparotomy. Of 14 patients who had failed previous therapy only one remains clinically free of disease. The results in the untreated patients demonstrate the primary importance of bulk reduction at initial laparotomy. The use of the regimen in patients who have failed on previous treatment or in patients with bulk disease seems to be palliative and the toxicity should be assessed in this context.
Pelvic inflammatory disease after hysterosalpingography associated with Chlamydia trachomatis and Mycoplasma hominis
Authors: MØLLER BIRGER R. , ALLEN JIM , TOFT BENTE , HANSEN KARL BROGAARD , TAYLOR‐ROBINSON DAVID
Published: August 2005

Summary. A total of 116 women were referred for hysterosalpingography because of primary or secondary infertility. Chlamydia trachomatis was isolated from the cervix of four (3.4%) of the patients whereas Mycoplasma hominis was isolated from 39 (33.6%) of them. Four patients developed acute pelvic inflammatory disease after hysterosalpingography; two of them were chlamydia culture‐positive and developed a significant chlamydial antibody response during the course of the disease. One of the other two patients, who developed upper genital‐tract infection, was culture positive for M.hominis and developed a significant antibody response to this micro‐organism. The results indicate that C.trachomatis should be sought in patients before hysterosalpingography and, if detected, appropriate antibiotic cover should be instituted before the procedure.
A comparison of saliva, plasma unconjugated and plasma total oestriol levels throughout normal pregnancy
Authors: LACHELIN GILLIAN C. L. , MCGARRIGLE H. H. G.
Published: August 2005

Summary. Saliva unconjugated, plasma unconjugated and plasma total oestriol (E3) levels were measured longitudinally, by radioimmunoassay, in 25 normal women from 13 weeks gestation until delivery. The increase in salivary unconjugated oestriol closely paralleled that of plasma unconjugated oestriol and to a lesser extent that of plasma total oestriol. In each patient the percentage value of salivary E3/plasma unconjugated E3 X 100 was virtually constant throughout pregnancy but this percentage varied from one patient to another (mean 14.4%). The overall correlation coefficient (r) for salivary and plasma unconjugated E3 was 0.90. The variability in salivary levels in samples collected at daily, hourly, 15 min and 5 min intervals (12.7, 13.4, 10.1 and 9.3%) was similar to that previously described for plasma unconjugated E3. There was no distinct pattern in diurnal variation. It seems probable that measurement of salivary E3 could adequately replace that of plasma unconjugated E3 in the assessment of fetoplacental function.
Determination of the stage of gestation by the assay of chorionic gonadotrophin and Schwangerschaftsprotein 1
Authors: AHMED ABDEL GHAFFAR , KLOPPER ARNOLD , DATI FRANCESCO
Published: August 2005

Summary. Serial assays of Schwangerschaftsprotein 1 (SP1), SP1α, SP1β and human chorionic gonadotrophin were performed in 12 subjects from ovulation until the pregnancies had reached 16 weeks. From these data formulae were devised for deducing the stage of gestation from the concentration of the placental protein. These formulae were then tested by assays on 34 women not included in the original study. Assays of hCG do not give reliable indications of the stage of gestation when this has progressed beyond 9–10 weeks but SP1 assays give predictions of gestation corresponding closely to that derived from the last menstrual period up to 16 weeks gestation.
A prospective controlled study of the effect on blood pressure of contraceptive preparations containing different types and dosages of progestogen
Authors: WILSON E. S. B. , CRUICKSHANK J. , MCMASTER M. , WEIR R. J.
Published: August 2005

Summary. A prospective controlled study investigated the effects of oral contraceptives on blood pressure in 485 women who were between 17 and 46 years of age and had blood pressures of <140/90 mmHg at entry. The women were divided into seven groups depending on the chosen method of contraception: intrauterine device or barrier method (control group); ethinyl oestradiol 30 μg plus levonorgestrel 150 μg (Microgynon‐30 or Ovranette); norethisterone 350 μg (Micronor); norgestrel 75 μg (Neogest); norethisterone oenanthate 200 mg intramuscularly every 2 months for the first 6 months, then every 3 months thereafter; ethinyl oestradiol 30 μg plus ethynodiol diacetate 2 mg (Conova‐30); and ethynodiol diacetate 500 μg (Femulen). Blood pressures were measured every 3 months by the family planning clinic nurse under standardized conditions using an Elag‐Köln automatic sphygmomanometer. After one year, blood pressure had risen significantly (P<0.05) in the 137 women taking ethinyl oestradiol plus levonorgestrel (mean systolic and diastolic rises 6.4 and 2.7 mmHg respectively) and in the 91 women taking ethinyl oestradiol plus ethynodiol diacetate (mean systolic and diastolic rises 6.2 and 3.0 mmHg respectively). The 94 women taking the progestogen‐only preparations and the 143 women in the control group showed no increases in blood pressure. These data were confirmed after 2 years of follow‐up.
Concentration of 13,14‐dihydro‐15‐keto‐prostaglandin E2 in the maternal peripheral plasma during labour of spontaneous onset
Authors: HUSSLEIN P. , SINZINGER H.
Published: August 2005

Summary. The concentration of 13, 14‐dihydro‐15‐keto‐PGE2 (PGEM) was measured by radioimmunoassay in pregnant women in the third trimester, in women at term but not in labour and during labour of spontaneous onset. The plasma concentration of PGEM in pregnant women was elevated above that in a non‐pregnant control group. Before the onset of labour no increase of PGEM concentration could be identified. Women in labour had higher PGEM plasma concentrations than before the onset of labour, although there was no progressive increase. Immediately after delivery PGEM levels reached a maximum, which decreased significantly to pre‐labour values within 30 min. Artificial rupture of the membranes had no influence on plasma PGEM levels. It is concluded that labour is associated with an increased synthesis of PGE2 and that PGE2 may be inved in the mechanism of placental separation. The rapid disaearance of high PGEM levels after labour confirms that PGE2 is probably synthesized mainly in the fetal compartment.
Diagnostic ultrasound in the assessment of patients with incompetent cervix
Authors: JACKSON G. , PENDLETON H. J. , NICHOL B. , WITTMANN B. K.
Published: August 2005

Summary. Twenty‐five pregnant women with suspected cervical incompetence were assessed by serial ultrasound. A dilating internal os was documented in one patient, incompetence was ruled out in two, and a ‘;sliing suture’ was demonstrated in another; the remaining patients were subjected to cerclage on the basis of their history alone. Patients in whom the diagnosis of cervical incompetence is indefinite should have a diagnostic ultrasound scan to visualize the cervix for length, opening of the canal and integrity of the internal os. Selective ultrasonography may be beneficial in both the diagnosis and treatment of cervical incompetence.
Pregnancy‐induced hypertension in twin pregnancy
Authors: McMULLAN P. F. , NORMAN R. J. , MARIVATE M.
Published: August 2005

summary

A prospective study of 54 primigravid twin pregnancies in Durban showed that pregnancy‐induced hypertension occurred in 37%. This was more than twice the expected rate for singleton pregnancies in this Black African population. The babies born in the group of patients with pregnancy‐induced hypertension were significantly lighter and had a higher rate of fetal growth retardation than the babies born in a normotensive control group of patients matched for age and parity. Monozygotic twins, identified by HLA typing, occurred significantly more often in the group with pregnancy‐induced hypertension than in the control group. A possible immunological explanation for this finding is presented.
Effect of bromocriptine on menstrual cycle length
Authors: SMITH STEPHEN K. , SOBOWALE OLADELE , LENTON ELIZABETH A. , COOKE IAN D.
Published: August 2005

summary

Forty‐seven women with regular ovulatory menstrual cycles and normal plasma prolactin levels were treated with different doses of bromocriptine, and changes in follicular and luteal phase length determined by daily estimation of plasma gonadotrophin concentration. Follicular phase length was highly significantly reduced from a median duration of 12.7 days in the basal cycle to 11.7 days in the first treatment cycle, and to 10.7 days during the second treatment cycles. The length of the luteal phase was unaltered by treatment with bromocriptine. Reduction of follicular phase length was not influenced by the dose of bromocriptine used, and it is concluded that this effect is a consequence of the reduction of plasma prolactin concentration.
Imaging ovarian tumours by nuclear magnetic resonance
Authors: JOHNSON I. R. , SYMONDS E. M. , WORTHINGTON B. S. , KEAN D. M. , JOHNSON J. , GYNGELL M. , HAWKES R. C.
Published: August 2005

summary

The alication of nuclear magnetic resonance imaging to the diagnosis of ovarian tumours has been studied in a group of seven patients with ovarian masses and several healthy unteers who provided examples of normal pelvic anatomy. In three patients, benign unilocular ovarian cysts were demonstrated and in three patients, recurrent ovarian tumours were identified and the extent of the tumours defined. One patient with bilaterial ovarian endometriomas was imaged. Endometrial cysts, like masses in other systems which contain blood or lipid‐rich material, show high‐density images whereas malignant tumours show tissue densities closer to those of normal tissues. The potential value of this technique in the assessment of pelvic disease is discussed.
The presence of RNA complementary to HSV‐2 (herpes simplex virus) DNA in cervical intraepithelial neoplasia after laser therapy
Authors: EGLIN R. P. , KITCHENER H. C. , MacLEAN A. B. , DENHOLM R. B. , CORDINER J. W. , SHARP F.
Published: August 2005

summary

In‐situ hybridization of radiolabelled DNA probes to tissue sections detected RNA complementary to HSV‐2 (herpes simplex virus) DNA in 65% (22 of 34) biopsies from cervical intraepithelial neoplasia (CIN) and in none of internally paired benign epithelia from individuals before treatment by laser vaporization cone. Laser therapy did not produce an increase in clinical or subclinical HSV infections of the cervix. Of 18 patients with RNA complementary to HSV‐2 DNA in CIN biopsies before treatment, in whom treatment was successful, virus transcripts were detected at follow‐up in only two of them.
Blood rheology in pre‐eclampsia and intrauterine growth retardation: effects of blood pressure reduction with labetalol
Authors: LANG G. D. , LOWE G. D. O. , WALKER J. J. , FORBES C. D. , PRENTICE C. R. M. , CALDER A. A.
Published: August 2005

summary

Blood viscosity (Contraves L S 30) and its determinants were measured in 23 patients with mild/moderate pre‐eclampsia, 10 patients with intrauterine growth retardation and 22 control subjects, matched for age and gestation. Both abnormal groups had a significantly increased blood viscosity at high shear rate (94 s‐1) associated with increased haematocrit. Fibrinogen levels were also increased, but there were no significant differences between groups in plasma viscosity, low shear viscosity (0.94s‐1) or red cell deformability, measured by a low‐shear washed cell system of filtration through 5‐μm pore diameter Nuclepore filters. In the pre‐eclamptic group, measurements were repeated after 1–2 weeks in nine patients treated with labetalol (a combined alpha and beta adrenergic blocker) and in 10 patients treated with bed rest. Labetalol reduced blood pressure but no change in rheology was seen in either group. Control of blood pressure by labetalol does not adversely affect rheology, in contrast to diuretics which are known to cause haemoconcentration and increased blood viscosity.
Pregnancy‐associated plasma protein A (PA‐A) in non‐pregnant subjects
Authors: BERSINGER N. , KLOER A.
Published: August 2005

summary

A newly developed enzyme immunoassay technique was alied to the measurement of pregnancy‐associated plasma protein A (PA‐A) in the serum of women in the proliferative and luteal phases of the cycle, in hysterectomized and postmenopausal women and in the serum and seminal plasma of males. PA‐A was detected in some individuals in all the categories of women and in seminal plasma but not in male serum. It is surmised that there must be a source of PA‐A other than the placenta and that PA‐A may be a maternal protein whose biosynthesis is stimulated by pregnancy rather than a product peculiar to the trophoblast.
Steroid receptors and response of ovarian cancer to cytostatic drugs in vitro
Authors: GRÖNROOS M. , KANGAS L. , MÄENPÄÄ J. , VANHARANTA R. , PAUL R.
Published: August 2005

summary

Samples of 21 ovarian cancers were assayed for oestrogen receptor (ER) and progesterone receptor (PR) content, and the response in vitro to treatment with a combination of doxorubicin, diacetyldian‐hydrogalactitol and cisplatin was determined. The number of living cells after drug exposure was estimated by a new ATP‐bioluminescence method and the tumours were considered responsive if cell survival was 50% of the value in a corresponding control culture. Of the 16 tumours that responded to drug exposure, nine were ER‐positive, seven ER‐negative and eight were PR‐positive, eight PR‐negative. The mean percentages of surviving cells ranged from 22.2% in PR‐negative tumours to 30.9% in PR‐positive tumours. There were no differences in the response rates or in the degree of response to the cytostatics in terms of either receptor status or tumour histology. The results were also compared with those obtained in the same tumour samples exposed to hormones, tamoxifen and medroxyprogesterone acetate. The average response of all tumours was better to cytostatics than to hormones (P<0.05); this was particularly marked in the ER‐negative tumours. Cytostatics may be preferable to hormones as the primary drug treatment for ovarian cancers but steroid‐receptor determinations aear not to help in formulating the optimum drug treatment.
Analysis of fetal heart rate on‐line at 32 weeks gestation
Authors: LAWSON G. W. , DAWES G. S. , REDMAN C.
Published: August 2005

Antenatal fetal heart rate (FHR) patterns were screened in 634 women with singleton pregnancies at 32 weeks gestation using a microprocessor on‐line. The duration of the record was adjusted according to its character, varying from 10 min with high FHR variation (39% of records) to 45 min with low variation (4.7%). The average duration was 16.7 min. Of the 30 fetuses with the lowest FHR variation (<5th centile), 19 (63%) had a normal outcome. Of the 11 with an abnormal outcome five were born 38 weeks; six were born by caesarean section at 32–34 weeks, resulting in an increased incidence in the group. Analysis of the numbers of accelerations, of decelerations, of episodes of high FHR variation or of fetal movements did not improve long‐term prediction. It was concluded first, that antenatal FHR monitoring for up to 45 min at 32 weeks gestation had no long‐term predictive value; and second, that 3% of our obstetric population have unreactive FHR traces at this age, with a normal outcome. This does not imply that consecutive antenatal records on the same high‐risk patient at short intervals are not valuable clinically.
The transfer of cephradine across the placenta
Authors: LANGE I. R. , RODECK C. , COSGROVE R.
Published: August 2005

The transfer of maternally administered cephradine (1 g given intravenously) to the fetal circulation and amniotic fluid was investigated in 2 pregnant patients undergoing fetoscopy. Cephradine was detected in fetal serum between 23 and 72 minutes after injection and was present in therapeutic concentrations. Fetal serum levels appeared to peak at approximately 40–50 min. Amniotic fluid levels were rising during the sampling period of 97 min. Cephradine is transferred across the placenta and appears to be a suitable antibiotic for use in selected obstetric patients when penetration of the fetal compartment is desirable.
Antimicrobial activity of amniotic fluid in South Indian women
Authors: MATHAI MATTHEWS , JAIRAJ PRABHA , THANGAVELU C. P. , MATHAI ELIZABETH , BALASUBRAMANIAM N.
Published: August 2005

Samples of amniotic fluid obtained from 48 South Indian women in the third trimester of pregnancy were studied for antimicrobial activity. The growth of Staphylococcus albus, Candida albicans and Clostridium perfringens was inhibited by nearly all samples studied while the growth of Staphylococcus aureus, Escherichia coli and Bacteroides fragilis was inhibited by 50%, 42% and 18% of samples respectively. The growth of Streptococcus faecalis was not inhibited. Using radial immunodiffusion, IgG was measurable in all 10 samples studied (mean 23 mg/dl), whereas IgA was measurable in only three of these samples (mean 1.32 mg/dl). However, while specific IgA against C. albicans was detected by indirect immunofluorescence in 93% of samples, specific IgG against C. albicans was detected in only 26% of samples (P<0.001). Amniotic fluid obtained from parous women had greater inhibitory activity against E. coli (P<0.05) than did the amniotic fluid obtained from nulliparae.
The congenital cervicovaginal transformation zone in sexually active young women
Authors: McDONNELL J. M. , EMENS J. M. , JORDAN J. A.
Published: August 2005

A total of 110 sexually active teenage girls was screened cytologically and colposcopically; 71 of them had areas of aceto‐white epithelium within the cervicovaginal transformation zone. Of these 54 had long‐term follow‐up and over a mean period of 36 months the aceto‐white epithelium was observed to disappear in 26. In the remaining 28 girls aceto‐white areas persisted largely unchanged over the period of follow‐up. The characteristics of these persistent aceto‐white areas are documented and suggestions with regard to their origins and significance are made.
Benign cervicovaginal deformities in young women not exposed to diethylstilboestrol
Authors: McDONNELL J. M. , JORDAN J. A.
Published: August 2005

During a 2‐year period six women have been identified with benign cervicovaginal deformities of the type normally associated with diethylstilboestrol (DES) exposure in utero. In none of them could such a hormonal history be identified. It is suggested, in view of these findings, that benign cervicovaginal deformities are not unique to women exposed to DES in utero and some possible reasons why they have never previously been reported are presented.
The efficacy of graduated compression stockings in the prevention of deep vein thrombosis after major gynaecological surgery
Authors: TURNER GILLIAN M. , COLE SUSAN E. , BROOKS JONATHAN H.
Published: August 2005

The efficacy of graduated compression stockings in the prevention of deep vein thrombosis (DVT) after major gynaecological surgery was investigated in a controlled randomized prospective trial in 196 patients who were >35 years of age. The stockings were worn by 104 of the 196 patients throughout their stay in hospital, the other 92 patients did not wear the stockings (control group). All the patients were scanned for DVT postoperatively with the 125I‐labelled fibrinogen test. None of the 104 patients who wore the stockings developed a thromboembolism, but four of the 92 control patients who did not wear the stockings had DVT. This difference between the two groups was statistically significant.
The pelvis as a passageway. I. Evolution and adaptations
Authors: STEWART D. B.
Published: August 2005

Man has an unusual pelvis, a large fetal head, and a complicated mechanism of labour. The evolution of the pelvic girdle, like that of the hind limb, is a story with some chapters still missing. In mammals the pelvis has been modified in various interesting ways to effect compromises between its locomotor function and the requirements of parturition. Among the primates, the increasing size of the fetal brain may have necessitated a change in the attitude of the head from extension to flexion as it goes through the pelvis. The distinctive shape of the hominid pelvis is probably an adaptation to bipedal gait. The birth canal has changed from a shallow bony ring to a deep curved tube, through which the mature fetal head can only pass by rotating as it descends.
Quantitative uterine histology during the menstrual cycle in relation to measured menstrual blood loss
Authors: REES MARGARET C. P. , DUNNILL M. S. , ANDERSON ANNE B. M. , TURNBULL A. C.
Published: August 2005

Endometrium and myometrium were collected at hysterectomy from 42 women with measured menstrual blood loss (range 4–840 ml). The specimens, obtained throughout the menstrual cycle, showed no evidence of organic disease on histological examination. The volume fraction occupied by arteries at the myometrial ‐ endometrial junction, and by glandular tissue throughout the endometrium was estimated with a point counting technique. The index of volume‐to‐surface ratio of endometrial glandular tissue was examined by a combination of point counting and linear intercept methods. No correlation was found between menstrual blood loss and endometrial and myometrial arterial density, endometrial glandular density and volume‐to‐surface ratio. Consequently, meno‐rrhagia, occurring in the absence of obvious pathology, does not appear to result from an excessive number of arteries of from abnormal glandular distribution.
A functional study of platelets in menstrual fluid
Authors: REES MARGARET C. P. , DEMERS LAURENCE M. , ANDERSON ANNE B. M. , TURNBULL A. C.
Published: August 2005

Platelets were isolated from menstrual and peripheral venous blood samples taken from nine women during the first 2 days of menstruation. The washed platelets were tested for their ability to aggregate in response to arachidonic acid, ADP, and collagen, and to metabolize arachidonic acid. Menstrual platelets differed from venous platelets in (1) failing to aggregate when challenged with aggregatory stimuli and (2) producing no appreciable cyclo‐oxygenase products from arachidonic acid as reflected in thromboxane B2 release. However, incubation of peripheral venous platelets with menstrual serum obtained from the same patients induced aggregation. The responses of menstrual and peripheral venous platelets were the same irrespective of the patients’ total menstrual blood loss. Uterine venous platelets collected during menstruation from two patients at hysterectomy aggregated normally and produced thromboxane B2.
Normal variation in the length of the follicular phase of the menstrual cycle: effect of chronological age
Authors: LENTON ELIZABETH A. , LANDGREN BRITT‐MARIE , SEXTON LYNNE , HARPER ROSEMARY
Published: August 2005

Normal probability plots were used to analyse the distribution of follicular phase length in a population of 293 apparently ovulatory menstrual cycles from women aged between 18 and 39 years. The length of the follicular phase was defined as the interval (in days) from the onset of menstruation up to, but not including, the day of the LH peak. Follicular phase length appeared to be log‐normally distributed and graphical inspection of the probability plot suggested that the geometric mean (and 95% confidence limits) of follicular phase length in this study group was 12–9 (10–3 to 16–3) days. There was a significant decrease (P<0.001) in follicular phase length with chronological age, from 14–2 days in women aged 18–24 years to 10.4 days in women aged 40–44 years.
Two patients with complete hydatidiform mole with 46, XY karyotype
Authors: FISHER ROSEMARY A. , SHEPPARD DAVID M. , LAWLER SYLVIA D.
Published: August 2005

In a study to correlate the genetic origin of hydatidiform moles with the subsequent fate of the patients, 62 complete moles were examined for cytogenetic and/or biochemical polymorphisms. Comparisons of polymorphisms in molar tissue with those seen in white blood cells from the parents have shown that the majority of complete hydatidiform moles are androgenetic in origin and homozygous for all polymorphisms examined. Where karyotyped, these moles were found to be 46, XX. Three exceptions were found in which the molar tissue was heterozygous for enzyme polymorphisms. Cytogenetic analysis of two of these cases confirmed heterozygosity and also revealed a 46, XY karyotype which was androgenetic in origin, most likely arising by dispermy. The two patients with 46, XY complete moles have been followed up for a minimum of 9 months and neither has required treatment for persistent trophoblastic disease.
Product of fetal crown‐rump length and trunk area: ultrasound measurement in high‐risk pregnancies
Authors: NEILSON J.P. , MUNJANJA S. P. , MOONEY R. , WHITFIELD C. R.
Published: August 2005

Summary. Calculation of the product of crown‐rump length and trunk area (CRLxTA), as measured by ultrasound between 34 and 36 weeks and combined with accurate assessment of gestational age in early pregnancy, was previously shown to be highly effective in detecting the small‐for‐dates fetus in a largely unselected series of patients. To assess the value of this two‐stage schedule in high‐risk pregnancies, 202 patients with singleton pregnancies at risk of fetal growth retardation were studied. Of the 53 babies that were small‐for‐dates at birth, 49 (92%) were identified in advance by CRLxTA measurement. In contrast to previous findings, measurement of trunk area (TA) alone was similarly effective, identifying in advance 48 (91%) of these small‐for‐dates babies.
Maternal zinc status: a determination of central nervous system malformation
Authors: BUAMAH P. K. , RUSSELL M. , BATES G. , WARD A. MILFORD , SKILLEN A. W.
Published: August 2005

Summary. Maternal serum zinc concentrations were estimated during 244 normal pregnancies and 15 abnormal pregnancies. The serum zinc concentrations were lower in the anencephalic pregnancies than in the normal control subjects. The serum zinc levels in women whose pregnancies terminated in a spontaneous abortion were normal. There was no variation of serum zinc level with gestational age between 15 to 18 weeks in normal pregnancies.
Vaginal prostaglandins and labour induction for patients previously delivered by caesarean section
Authors: MACKENZIE I. Z. , BRADLEY SUSAN , EMBREY M. P.
Published: August 2005

Summary. Labour was induced at term with vaginal instillation of prostaglandin E2 in 143 patients who had been delivered by caesarean section in a previous pregnancy. The method was simple, safe and effective with 76% achieving a vaginal delivery, and even when the cervix was very unfavourable at the time of prostaglandin treatment, 68% achieved vaginal delivery. The procedure reduces the need for repeat caesarean section with its potential morbidity, without evidence of undue risk of lower segment scar rupture.