bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical contractions: the response of the cervix to oxytocic stimulation in the latent phase of labour
Authors: Oláh Karl S. , Gee Harry , Brown Jeremy S.
Published: August 2005

Objective
To assess the cervical response to myometrial activity in early labour.

Design
Prospective observational study.

Subjects
Women requiring oxytocin stimulation in induced and spontaneous labours.

Setting
A teaching hospital in Birmingham.

Main outcome measures
Simultaneous comparison of the cervical response to myometrial contractions was made on a cycle by cycle basis to deduce the properties of the cervix in early labour.

Results
Sixty‐seven patients have been monitored, of whom 63 had satisfactory cervimetry data. Thirty (47.6%) women exhibited cervical contractions in response to myometrial activity. This response was only observed at dilatations up to 4 cm. The change in behaviour coincides with the transition from latent to active phases of dilatation. The length of the latent phase of labour was significantly longer in those women who exhibited cervical contractions (P<0.001), although the active phase was similar in the two groups (P>0.1). The group without cervical contractions exhibited a greater degree of efface‐ment (P<0.05) and tended to have more dilated cervices (P<0.01) than those who showed cervical contractions.

Conclusions
It is possible for the cervix to contract in early labour. This response may be the result of incomplete preparation of the cervix for the process of dilatation, and is seen during what is recognised as the latent phase in those women in whom the cervix is uneffaced and undilated. These properties of the cervix may explain the poor results obtained from oxytocin stimulation of labour in the latent phase.
Are the WHO (1980) criteria for the 75 g oral glucose tolerance test appropriate for pregnant women?
Authors: Cheng Li‐Chang , Salmon Yvonne M.
Published: August 2005

ObjectiveTo determine the normal response to a 75 g glucose challenge in the context of an oral glucose tolerance test in the third trimester of pregnancy.

DesignProspective observational study.

SettingAntenatal clinic, Kandang Kerbau Hospital, Singapore.

SubjectsSixty‐four normal pregnant women with a low risk for diabetes.

InterventionsGlucose (75 g) challenge following an overnight fast after 28 weeks of gestation.

Main outcome measureVenous plasma glucose levels taken before and 2 h after the glucose challenge.

ResultsUpper limits of normality were found to be fasting glucose 4·9 mmol/l and 2 h glucose 9·2 mmol/l.

ConclusionTheWHO (1980)criteria should not be used in pregnancy.
Effectiveness of antenatal care: a population based study
Authors: Backe Bjørn , Consultant Jakob Nakling
Published: August 2005

Objective
To analyse the effectiveness of antenatal care as a screening for nonsymptomatic disease and obstetrical risk conditions.

Design
Programme evaluation of antenatal care in a geographically based cohort.

Setting
Routine clinical practice in primary and specialist level of health care without intervention.

Subjects
One thousand nine hundred and eight women residing in one Norwegian county giving birth during a 12 month period, 1988 to 1989.

Outcome measures
The detection rates at the time of delivery, for women with five conditions: twin pregnancies, placenta praevia, breech presentation, small for gestational age (SGA) and pre‐eclampsia.

Results
Two hundred and ninety‐two women had one or more of the actual conditions, 124 (42%) had been diagnosed at the time of the delivery. The detection rate for SGA was remarkably low (14%). The detection rates for pre‐eclampsia (75%), breech presentation (69%), placenta praevia (57%) and twin pregnancies (94%) were in the same range as results reported in the literature. The number of false positive antenatal diagnosis was insignificant.

Conclusions
Assessing the effectiveness of antenatal diagnosis of growth retardation is connected with major unsolved methodological problems. Clinical management of such cases may be better than indicated by the results based on the ultimate SGA classification. For important obstetrical conditions this study describes an applicable method for practical evaluation of the effectiveness of antenatal care. Areas where care could be improved are demonstrated.
The effect of introduction of umbilical Doppler recordings to obstetric practice
Authors: Johnstone Frank D. , Prescott Robin , Hoskins Peter , Greer Ian A. , McGlew Tom , Compton Mary
Published: August 2005

Objective
To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results.

Design
Randomised controlled trial.

Setting
A large teaching hospital.

Subjects
Two thousand two hundred and eighty‐nine pregnancies defined as being at risk by referral for Doppler or fetal monitoring.

Interventions
Continuous wave Doppler studies of umbilical artery. Results immediately available to clinicians.

Main outcome measures
Fetal outcome: perinatal mortality, Apgar score and admission to the neonatal unit. Obstetric intervention: admission to hospital, induction of labour and caesarean section. Use of tests of fetal well being: cardiotocography, biophysical profile and ultrasound biometry.

Results
The treatment and control groups were comparable in age, parity, gestation at point of entry and risk features. There were no overall differences in perinatal outcome, obstetric intervention or use of fetal monitoring. Examination of a subset recruited only because of hypertension or suspected intrauterine growth retardation (n = 754) similarly showed no difference attributable to group randomisation. Comparison of only those pregnancies retrospectively defined as low risk and high risk showed more use of cardiotocography in the high risk group with access to Doppler (P= 0.007) but no difference in the low risk group.

Conclusion
Doppler umbilical artery recording has been shown to perform well in prediction power of antenatal fetal compromise. What has been examined in this study is the response of clinicians to the test. The results suggest that obstetricians do not use the test to modify their risk assessment, and, therefore, the need for fetal monitoring in particular pregnancies. There is a real need for accumulation of information from very large data sets, particularly in the prediction power of Doppler for antenatal fetal compromise from apparently chronic utero‐placental cause to guide use of monitoring resources. If simply added to existing fetal monitoring techniques in a hospital where these are widely used, then umbilical artery Doppler recordings may at present simply involve extra resources of staff and expenses, without benefit.
The effect of cordocentesis on umbilical and middle cerebral artery blood flow velocity waveforms
Authors: Hecher K. , Stettner H. , Spernol R. , Harrington K. , Szalay S.
Published: August 2005

Objective
To investigate the effect of cordocentesis on the umbilical and fetal cerebral circulation.

Design
Cross sectional study.

Setting
Department of Obstetrics and Gynaecology, Regional Referral Centre for Fetal Medicine, Klagenfurt Hospital, Austria.

Subjects
Thirty pregnant women undergoing diagnostic cordocentesis at 18 to 38 weeks' gestation.

Interventions
The pulsatility index (PI) in the umbilical artery and fetal middle cerebral artery was measured by pulsed Doppler ultrasound before and immediately after cordocentesis.

Main outcome measures
Change in umbilical artery PI and middle cerebral artery PI.

Results
Cordocentesis was associated with a significant decrease in both umbilical artery PI (median −0.18, range −2.21 to 1.5, P<0.004) and middle cerebral artery PI (mean ‐0.15, SD 0.32, P<0.03) and the decrease in umbilical artery PI was most marked when cordocentesis was performed transplacentally. In four cases, there were absent or reversed frequencies at the end of diastole (EDF) in the umbilical artery before cordocentesis, and in all cases there were positive EDF after the procedure. In contrast, one of the 26 cases with positive EDF developed reversed EDF following the procedure.

Conclusions
Acute alterations in the waveforms from both the umbilical and fetal cerebral circulation can be induced by cordocentesis. The decrease in resistance in the fetoplacental circulation could be attributed to the release of vasodilators, and the increase in resistance observed in some cases could be secondary to arterial vasospasm. Better understanding of the underlying mechanisms might help in making cordocentesis a safer procedure.
Comparative profiles of reliability, cycle control and side effects of two oral contraceptive formulations containing 150 μg desogestrel and either 30 μg or 20 μg ethinyl oestradiol
Authors: ÅKerlund Mats , Rødez Arne , Westergaard Jes
Published: August 2005

Objective
To compare two oral contraceptive pills, both containing 150 μg desogestrel, but with either 20 μg (Mercilon®) or 30 μg (Marvelon®/Desolett®) ethinyl oestradiol (EE), regarding reliability, cycle control and side effect profile.

Design
A double blind, randomised, multicentre study over one year with follow up after three, six and 12 months. The women noted tablet intake and all bleedings on specifically designed diary cards.

Setting
University clinics, central hospitals and private gynaecological practices in Norway, Sweden and Denmark.

Subjects
One thousand women aged 18 to 40 years requesting oral contraceptive pills.

Main outcome measures
Reliability, cycle control, side effects, blood pressure, body weight and haemoglobin.

Results
In a total of 4543 cycles with the 20 μg EE dose pill and 4688 cycles with the 30 μg EE dose pill, the number of pregnancies ascribed to method failure were 0 and 2, respectively. Irregular bleeding (breakthrough bleeding or spotting) was signficantly more frequent with the 150/20 combination in about two‐thirds of the cycles randomly distributed over the one year of the study. Mean blood pressure decreased slightly, particularly in the group on the 150/20 combination (about 1 mmHg), whereas mean body weight increased approximately 0.5 kg in the group with the 150/30 combination after 12 months. Haemoglobin did not change. Side effects other than bleeding problems were rare, but dizziness and mood changes were more frequent in the group on the 150/20 combination. Due to side effects, more women on the 150/20 combination discontinued the study during the one to three and four to six month periods, and women on this pill were also less positive about continuing the study drug at the end of the trial.

Conclusions
Both pills have high contraceptive reliability and are well tolerated, but with the 150/20 combination the cycle control is less effective. However, in view of the potentially increased safety profile of the 150/20 combination, many women can be expected to accept some additional discomfort due to irregular bleeding.
Pregnancy after renal transplantation: 25 years experience in Spain
Authors: Cararach V. , Carmona F. , Monleón F. J. , Andreu J.
Published: August 2005

Objective
To study the outcome of pregnancy in renal transplant patients in Spain.

Design
A retrospective review based on two consecutive national inquiries.

Setting
Departments of Obstetrics and Gynaecology and Renal Transplant Units in Spain.

Subjects
Pregnant women who had renal transplants between 1965 and 1989.

Main outcome measures
From the preliminary inquiry the frequencies of miscarriage, therapeutic abortion, preterm birth, fetal malformation, twins, stillbirths, neonatal deaths and loss of maternal renal function were recorded. The subsequent, more detailed inquiry provided additional information including donor type, previous rejection episodes and interval between rejection and pregnancy, previous creatinine level, previous hypertension and development of hypertension in pregnancy, developments during labour and delivery and the occurrence of intra uterine growth retardation and low birth weight.

Results
The preliminary inquiry yielded information about 133 pregnancies. The miscarriage rate was 10% and the therapeutic abortion rate was 16%. Of the 99 pregnancies that continued, 46% ended before term and 53% progressed to term. The perinatal mortality rate was 107.8 per 1000 and 4% of the infants had minor congenital malformations. The second inquiry yielded more detailed data about 66 pregnancies. There were no therapeutic abortions and 12% of the pregnancies ended in miscarriage. Among the 58 pregnancies that reached 28 weeks gestation, preterm birth occurred in 28 (48%) and intra uterine growth retardation occurred in 17 (29%). Among 48 women with normal renal function before pregnancy, the perinatal mortality rate was 68 per 1000, the miscarriage rate was 8% and in 10 of these women (21%) renal function was impaired after pregnancy. In constrast, among 18 women with impaired renal function before pregnancy, the perinatal mortality rate was 142 per 1000, the miscarriage rate was 22% and in six of these women (33%) renal function deteriorated after the pregnancy. Impairment of renal function was most common in women with hypertension during pregnancy or with rejection episodes during the year before conception.

Conclusions
Women with a renal transplant can have a successfull pregnancy, but there are definite risks for both mother and fetus. Pregnancy should be discussed with the woman and encouraged only if there is good renal graft function.
Findings on lipid peroxidation and antioxidant function in hypertensive complications of pregnancy
Authors: Uotila J. T. , Tuimala R. J. , Aarnio T. M. , Pyykkö K. A. , Ahotupa M. O.
Published: August 2005

Objective
To assess lipid peroxidation and antioxidant function in hypertensive complications of pregnancy.

Design
Cross sectional study comparing pre‐eclamptic and control patients.

Setting
Tampere University Hospital, Finland.

Subjects
Twenty healthy women with normal, uncomplicated pregnancy; 23 women with severe pre‐eclampsia; 20 women with mild pre‐eclampsia; and 13 women with pregnancy‐induced hypertension.

Main outcome measures
Conjugated dienes; tiobarbituric acid—reactive material or malondialdehyde (MDA); fluorescent chromolipids (FCL); glutathione peroxidase (GSHPx); selenium; uric acid; and vitamin E.

Results
Lipid peroxidation assessed by the appearance of conjugated dienes and malondialdehyde was significantly increased in the hypertensive patients as compared with control patients. Lipid peroxidation products also showed high correlation to the level of blood pressure, but failed to show significant relation to the outcome of the fetus. The activities of erythrocyte and plasma glutathione preoxidase were increased in severe pre‐eclampsia, and high levels of plasma or platelet glutathione peroxidase were found to have some association with fetal growth retardation or asphyxia.

Conclusions
Our findings give support to those few studies considering lipid peroxidation as an important factor in the pathogenesis of pre‐eclampsia. The rise in antioxidants is probably of compensatory nature responding to the increased peroxide load in pre‐eclampsia and may reflect the severity of the disease.
Breech delivery in very preterm and very low birthweight infants in the Netherlands
Authors: Gravenhorst J. Bennebroek , Schreuder A. M. , Veen S. , Brand R. , Verloove‐Vanhorick S. P. , Verweij R. A. , van Zeben‐van der Aa D. M. , Ens‐Dokkum M. H.
Published: August 2005

Objective
To study the relation between various perinatal factors and the sequelae of very preterm birth, applying logistic regression analysis.

Design
In a nationwide collaborative study in the Netherlands, perinatal and follow up data were collected on 899 liveborn singleton nonmalformed infants with gestational age less than 32 weeks or birthweight less than 1500 g born in 1983.

Main outcome measures
Neonatal mortality rate and total handicap rates (minor and major) in surviving children at two years and five years of age.

Results
Comparing breech with vertex presentation, the odds ratio for neonatal mortality (adjusted for duration of pregnancy, birthweight, maternal hypertension and prolonged rupture of membranes) is 1.6 (P<0.05). Comparing abdominal versus vaginal delivery, the odds ratio indicates equal risks. When breech and vertex presentation are analysed separately it appears that breech presenting infants have a significantly lower mortality risk when born by caesarean section compared with vaginal delivery. However, comparing abdominal versus vaginal delivery in breech presentation, the odds ratio for handicap at five years (0.9) is not significantly different from 1.

Conclusion
The data presented suggest a reduced neonatal mortality rate in breech presenting infants born by caesarean section but because of the observational design of the study the statistical analysis described only identifies a possible trend and cannot prove the issue.
Evaluation of six markers of haemostatic system in normal pregnancy and pregnancy complicated by hypertension or pre‐eclampsia
Authors: Cadroy Yves , Grandjean Hélène , Pichon Josiane , Desprats Roland , Berrebi Alain , Fournié Alain , Boneu Bernard
Published: August 2005

Objective
To establish the plasma evolution of prothrombin fragments 1+2 (F1+2), thrombin–antithrombin III complexes (TAT), fibrin fragment D‐Dimers (DD), von Willebrand factor antigen (vWf), Type 1 plasminogen activator inhibitor antigen (PAI) and blood platelet count during normal pregnancy and to compare these values with those obtained in hypertensive or pre‐eclamptic pregnancies.

Design
Cross‐sectional study.

Subjects
Forty‐seven healthy pregnant women with gestational age ranging between 5 and 40 weeks, and fourteen women with gestational age ranging between 25 and 38 weeks presenting with either gestational hypertension (n= 4) or pre‐eclampsia (n= 10). Numbers of nulliparous women in the control, hypertension and pre‐eclampsia groups were 13/47 (28%), 1/4 (25%) and 9/10 (90%), respectively.

Results
All six markers increased with gestational age in normal pregnant women (P<0.01). Using the upper limit of 95% prediction interval obtained from regression curves as normality threshold, TAT showed the best sensitivity (71%vs <30% for F 1+2, DD, vWf, PAI and platelet count).

Conclusion
TAT appears to be an interesting marker for detecting haemostatic system alterations in pregnancies complicated by hypertension or pre‐eclampsia. A large prospective study to determine its clinical usefulness for such complicated pregnancies is currently in progress.
Biparietal diameter and crown‐rump length in fetuses with Down's syndrome: implications for antenatal serum screening for Down's syndrome
Authors: Wald N. J. , Smith D. , Kennard A. , Palomaki G. E. , Salonen R. , Holzgreve W. , Pejtsik B. , Coombes E. J. , Mancini G. , MacRae A. R. , Wyatt P. , Roberson J.
Published: August 2005

Objectives
1. To compare the ultrasound biparietal diameter and crown‐rump length of fetuses with and without Down's syndrome in the first half of pregnancy; 2. To investigate the effect of estimation of gestational age using either measure on the detection rate of serum screening for Down's syndrome.

Design
Matched case‐control study. Cases were singleton Down's syndrome pregnancies with a biparietal diameter or a crown‐rump length recorded. Five controls were matched to each case on: medical centre; the date of the ultrasound scan examination (within two years); gestational age measured as the number of days since the first day of the last menstrual period; and the ultrasound measure used (ie the biparietal diameter (the measure of choice), or the crown‐rump length otherwise). If a woman had a serum screening test for Down's syndrome, the biparietal diameter or crown‐rump length measurement had to be taken prior to the screening test so that the result of the test could not influence whether a scan was performed.

Setting
Ten antenatal screening centres in seven countries in Europe and North America.

Subjects
Two hundred and one women with singleton Down's syndrome pregnancies and 1005 women with unaffected singleton pregnancies.

Results
The median biparietal diameter of fetuses with Down's syndrome was identical to that among the controls (median difference 0.0mm, 95% confidence intervals (CI)–0.5 to 0.5mm). The estimates of gestational age based on biparietal diameter yielded a median gestational age less than that based on the women's last menstrual period: three days less for cases and two days less for controls; small but statistically significant differences probably reflected a minor systematic difference in the conversion of a biparietal diameter to a gestational age estimate. The median crown‐rump length of fetuses with Down's syndrome was also identical to that among controls (median difference 0.0mm, 95% CI–1.5 to 2.0 mm). There was no significant difference between the median gestational age estimate based on crown‐rump length and that based on the women's last menstrual period.

Conclusion
In antenatal screening for Down's syndrome the routine use of an ultrasound biparietal diameter or crown‐rump length measurement to estimate gestational age will not adversely affect the detection rate. To avoid differences in gestational age estimates using the last menstrual period and the biparietal diameter influencing screening performance, separate medians should be derived for each serum marker using the two methods of estimating gestational age. The appropriate set of medians can then be used to calculate the multiple of the median value for each woman screened depending on the method used to estimate her gestational age.
Transient diabetes insipidus and acute fatty liver of pregnancy
Authors: Kennedy Suzanne , Hall Pauline de la M. , Seymour Anthony E. , Hague William M.
Published: August 2005

Objective
To review the association of transient diabetes insipidus and acute fatty liver of pregnancy.

Design
A retrospective study.

Setting
Six women presenting with polyuria and polydipsia in the third trimester or in the immediate postpartum period, referred over a two and a half year period; five out of six were primigravida. All had raised liver transaminases and biopsy‐proven acute fatty liver of pregnancy. Four out of six also had pre‐eclampsia.

Subjects
Tertiary referral centre.

Main outcome measures
There were no maternal deaths and only one fetal death. Desamino‐cys‐1‐D‐arg‐8‐vasopressin administration produced a reduction in urine output in all five women to whom it was administered. In all cases symptoms had resolved by the end of the fourth postpartum week. Three of the women have had subsequent pregnancies uncomplicated by either transient diabetes insipidus or acute fatty liver of pregnancy.

Conclusions
The association of transient diabetes insipidus and acute fatty liver of pregnancy appears more common than previously recognised. Both may be part of the spectrum of pre‐eclampsia.
Specificity of antenatal ultrasound in the Yorkshire Region: a prospective study of 2261 ultrasound detected anomalies
Authors: Brand Ian R. , Kaminopetros Petros , Cave Mairead , Irving Henry C. , Lilford Richard J.
Published: August 2005

Objective
To evaluate the specificity of the ultrasound diagnosis of fetal anomalies. Pregnancies which proceeded to termination and ultrasound‐diagnosed fetal anomalies which were not offered termination were considered.

Design
Prospective, region‐wide study over three and a half years.

Setting
Cases were identified through 25 ultrasound departments representing the 15 districts in the Yorkshire Region.

Subjects
Pregnant women with an ultrasound‐diagnosed fetal anomaly.

Main outcome measures
Information obtained from the ultrasound report was compared with the outcomes determined by cytogenetics, postmortem or paediatric examination.

Results
Of 2261 pregnancies with an ultrasound‐diagnosed fetal anomaly 369, (16%) were terminated and 357 (97%) were followed by postmortem examination. Ultrasound findings exactly matched those of the postmortem or were accompanied by additional anomalies in 325 cases (91%). In 32 cases ultrasound findings were not confirmed by postmortem, but in 30 of these the decision to offer termination remained justified because the correct diagnosis was judged equally or more serious. Two (0.5%) were terminated for an anomaly which subsequently proved less severe than predicted on ultrasound. Ultrasound significantly over‐or under‐diagnosed a major fetal anomaly in 27 of the 1139 (2.4%) cases in which an anomaly was detected, but the pregnancy was not terminated.

Conclusion
Termination of pregnancy was based on the correct prognosis in over 99.5 % of cases. This does not obviate the need for pathological examination of the fetus which changed or refined the diagnosis in 35 % of cases.
Fetal immunological and haematological changes in intrauterine infection
Authors: Thilaganathan Baskaran , Carroll Steve G. , Plachouras Nicholas , Makrydimas George , Nicolaides Kypros H.
Published: August 2005

Objective
To study fetal immunological and haematological changes to intrauterine infection.

Design
In 37 pregnancies at risk of intrauterine infection, fetal blood obtained by cordocentesis at 20 to 36 weeks gestation was used for differential leucocyte counts, platelet count, enumeration of lymphocyte subpopulations, and neutrophil adhesion receptor expression.

Setting
Harris Birthright Research Centre for Fetal Medicine, London.

Results
All four fetuses with viral infections had platelet counts below the 5th centile and three had natural killer (NK) cell counts greater than the 95th centile of the normal range. Similarly, all five fetuses with bacterial or candidal infection had neutrophil counts greater than the 95th centile of the normal range; lymphocyte subpopulations were normal.

Conclusions
In pregnancies complicated by intrauterine infection, fetuses exhibit NK cell lymphocytosis and thrombocytopenia in response to viraemia, and neutrophilia in response to bacteraemia from at least 21 weeks gestation.
The dose–response of percutaneous oestradiol implants on the skeletons of postmenopausal women
Authors: Studd John W. W. , Nigel Holland E. F. , Leather Andrew T. , Smith Roger N. J.
Published: August 2005

Objective
To determine whether there is a dose‐iresponse effect of percutaneous oestradiol implants on the skeletons of postmenopausal women using a range of doses available in clinical practice.

Design
One year randomised study.

Subjects
Forty‐five postmenopausal women who requested oestrogen replacement therapy were randomised to receive 25 mg, 50 mg, or 75 mg oestradiol implants. The bone mineral density changes were compared with a control group of 15 untreated women.

Main outcome measures
Dual energy X‐ray absorptiometry using Hologic 1000 QDR before treatment and after one year of treatment. Plasma oestradiol and follicle stimulating hormone levels before treatment and after one year.

Results
There were significant correlations between the plasma oestradiol levels and the percentage increase in bone density at the lumbar spine, the total hip, the femoral neck, and the trochanter. The median (range) plasma oestradiol level was 327 pmol/1 (114–853) in the 25 mg group, 358 pmol/1 (220–957) in the 50 mg group and 518 pmol/1 (167–828) in the 75 mg group. Three women who lost a significant amount of bone from the clinically relevant sites in the 25 mg oestradiol group all had plasma oestradiol levels below 300 pmol/1. None of the women in either the 50 mg or 75 mg oestradiol groups lost bone from these sites.

Conclusions
Oestradiol implants resulted in a wide range of circulating oestradiol levels with each of the doses used. There was a significant relation between plasma oestradiol levels and the increases in bone density at both the lumbar spine and the proximal femur. None of the women lost bone density at the clinically important sites of the spine and femoral neck if their plasma oestradiol levels were above 300 pmol/1.
Factors potentiating the smoking‐related risk of fetal growth retardation
Authors: Spinillo Arsenic , Capuzzo Ezio , Nicola Sabrina E. , Colonna Laura , Egbe Thomas O. , Zara Carlo
Published: August 2005

Objective
To estimate the risk of fetal growth retardation resulting from the interaction between maternal smoking during pregnancy and other recognized risk factors.

Design
Case‐control study of prospectively recorded data.

Setting
Department of Obstetrics and Gynaecology, University of Pavia, Italy.

Subject
Three hundred and forty‐seven singleton pregnancies with diagnosis of fetal growth retardation and 694 control pregnancies with appropriately grown fetuses.

Results
The overall odds ratio for fetal growth retardation associated with maternal smoking was 2.87 (95% confidence interval, 2.17–3.80). In logistic models the factors which independently increased the smoking‐related risk of fetal growth retardation were a male fetus, nulliparity, maternal age 20 years or less, a history of first trimester haemorrhage and low (less than 50 kg) pre‐pregnancy weight. The combined effect of smoking and caffeine consumption on the risk of fetal growth retardation was found to be additive rather than multiplicative.

Conclusions
Several factors can affect the risk of fetal growth retardation associated with maternal smoking. The prenatal identification of these factors could help detect subgroups of women at high risk of fetal growth retardation.
Evaluation of an antenatal HIV testing programme in an inner London health district
Authors: Hawken Jennifer , Chard T. , Jeffries D. J. , Costeloe Kate , Grant K. , Ward F. , Hudson C. N.
Published: August 2005

Objective
To study an antenatal human immunodeficiency virus (HIV) testing programme in an inner London health district.

Design
A standardised research interview was given to women in the first half of pregnancy and the findings were compared with those of the routine clinical interview. The observations were analysed in relation to the results of HIV antibody testing, either attributable by consent or anonymously, in these women.

Setting
The Homerton Hospital, London.

Subject
Three thousand seven hundred and twenty‐nine women, of whom 1696 (45.5%) consented to testing.

Results
Four women who had consented to testing had a positive result. Amongst the 2033 women (54.5 %) who declined the test, four (or five) had a positive result. The number of risk factors ascertained by the research study interview was substantially greater than that elicited by the preceding routine interview. In addition, more information was obtained by a routine computer interview than by its unstructured equivalent. There was no obvious association between the presence of a risk factor and whether or not the women had consented to the test.

Conclusions
Our formal voluntary testing programme detected nearly 44 % of HIV seropositive individuals. Thus, there were four known positives during the study period against a total of nine detected by anonymous testing. Since all the known positive results in the study were associated with recognised risk factors, there is some doubt as to the value of a universal testing programme. However, if testing is to be based upon the existence of a risk factor elicited at the booking history, then the deficiencies in this history revealed by the present study need to be corrected.
Human papillomavirus vulvitis: a new disease or an unfortunate mistake?
Authors: Dennerstein Graeme J. , Scurry James P. , Garland Suzanne M. , Brenan John A. , Fortune Denys W. , Sfameni Salvatore F. , O'Keefe Rodney J. , Tabrizi Sepehr N.
Published: August 2005

Objective
To determine whether human papillomavirus (HPV) was responsible for symptoms in women with vulvar pruritus, pain and superficial dyspareunia who had been referred with a diagnosis of HPV vulvar disease made on clinical and/or colposcopic and/or histological grounds.

Design
In addition to standard clinical and laboratory investigations of the whole population, a sample of 15 test cases from the population of 71 women referred with a clinicopathological diagnosis of HPV vulvar disease, and two positive and 21 negative controls were assayed for HPV DNA. Polymerase chain reaction assays using L1 consensus primers were performed blinded to the clinicopathological diagnosis.

Setting
Dermogynaecology Clinic at Mercy Hospital for Women.

Subjects
Seventy‐one women referred with a diagnosis of HPV vulvar disease.

Results
Thirteen cases which could be tested for HPV DNA were negative. Diagnoses other than HPV were found for the women's presentation in all cases.

Conclusions
In the population studied, our investigations indicated that the clinicopathological diagnosis of HPV infection was incorrect and that HPV was not a cause of vulvar symptoms. We believe that the term HPV vulvitis is unfortunate as it has invited destructive treatments and drawn attention away from more likely causes of this difficult group of vulvar conditions.
Charts of fetal size: 3. Abdominal measurements
Authors: Chitty Lyn S. , Altman Douglas G. , Henderson Annabel , Campbell Sruart
Published: August 2005

Objective
To construct new size charts for fetal abdominal circumference and area.

Design
A prospective, cross sectional study.

Setting
The routine ultrasound department of a London teaching hospital.

Subject
The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days.

Methods
Fetuses were scanned once only for the purpose of the study at gestations between 12 and 42 weeks, when up to 20 dimensions were measured. Separate regression models were fitted to estimate the mean and standard deviation as functions of gestational age. Gentiles were derived by combining these two regression models, assuming that the measurements have a Normal distribution at each gestation.

Results
A total of 610 fetuses had their abdominal circumference measured directly. Abdominal diameters were recorded for 425 fetuses and the circumference was also derived from these, as was the abdominal area. New charts for abdominal circumference (directly measured and derived from diameters) are presented. The directly measured circumferences were consistently (by about 3.5 %) greater than those derived from measurement of the abdominal diameters. The new charts are compared with previously published charts that are in wide use. A chart for abdominal area is also presented.

Conclusions
We have constructed new size charts for the fetal abdominal circumference, both measured directly and derived from abdominal diameters. We have demonstrated the difference between the size charts constructed from these two sets of values and hence the importance of using the appropriately derived chart when assessing the abdominal circumference. The differences between the new charts and previous ones may be largely due to methodological differences.
Age related changes in the female reproductive cycle
Authors: Fitzgerald C. T. , Seif M. W. , Killick S. R. , Bennett D. A.
Published: August 2005

Objective
To investigate the effect of age on the control of the reproductive cycle in regularly menstruating women.

Design
In this prospective study all women were seen regularly during both the follicular and luteal phases. Ultrasound scanning was used to confirm ovulation and measurements were taken to assess follicular development and endometrial thickness. Serum gonadotrophin levels on day 4 of the cycle, the maximum periovulatory oestradiol and progesterone on the seventh day after ovulation were measured and compared in different age groups.

Subjects & Setting
Fifty‐six healthy, regularly menstruating women were recruited from volunteers amongst staff of the University Hospital of South Manchester.

Results
Ovulation occurred later in the cycle for older women, with mean follicular phase length increasing from 13.9 days (in group 21–25 years) to 15–9 days (in group 37–45 years (P < 0.05). The mean of the maximum follicular diameter prior to rupture was significantly smaller in the older women: 16.7 mm in the 37 to 45 years old group compared with 19.6 mm, 21.6 mm and 21.3 mm in the 21 to 25, 26 to 31 and 32 to 36 years old age groups, respectively (P < 0.001). The maximum thickness of the endometrium in the luteal phase was greatest for older women: 15.9 mm in the age group 37 to 45 years compared with 12.1 mm in the age group 21 to 25 years (P < 0.001). Serum gonadotrophin concentrations during menses were higher with increased age; mean follicle stimulating hormone was 4.8 iu/l in the age group 21 to 25 years, and 8.5 iu/l in the age group 37 to 45 years (P < 0.001). Mean luteinising hormone was 4.5 iu/l in age group 21 to 25 years and 7.21 iu/l in age group 37 to 45 years (P < 0.001). Mean ovarian steroid concentrations were no different.

Conclusions
These data illustrate significant age related differences in the pituitary‐ovarian axis and endometrial thickness. This has implications for the management of older women in assisted reproduction and fertility control programmes.
Digital imaging colposcopy, image analysis and quantification of the colposcopic image
Authors: Shafi M. I. , Dunn J. A. , Chenoy R. , Buxton E. J. , Williams C. , Luesley D. M.
Published: August 2005

Objective
To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone.

Design
Prospective programme study of all patients undergoing colposcopy for cytological abnormalities.

Setting
Dudley Road Hospital, Birmingham.

Subject
Fifty consecutive patients having cytological and colposcopic abnormality treated with large loop excision of transformation zone formed the study group.

Main outcome measures
Pretreatment and colposcopic features correlated with histological diagnosis of excised transformation zone.

Results
Index cytology and current smoking status are the most important variables for prediction of histological diagnosis. Other important variables are focality of lesion, surface pattern, intercapillary distance and degree of acetowhiteness.

Conclusion
Digital imaging colposcopy allows image capture, processing and objective analysis. This methodology holds advantages for basic and clinical research, teaching, diagnostics and clinical audit. The system can act as a quality control tool for colposcopy units. This system should prove invaluable for further quantitative studies, for natural history studies and for those patients with deferred treatment of their cytological and colposcopic abnormalities. The statistical models described may be incorporated into the system and can aid the colposcopist in management of the woman with abnormal cervical cytology and colposcopic abnormality.
Retraction: Doppler ultrasound of the uteroplacental circulation in the prediction of pregnancy outcome in women with raised maternal serum alpha‐fetoprotein
Authors: Robson M. , Hamid R. , McParland P. , Pearce J. M.
Published: August 2005

Objective
To determine whether Doppler waveforms from the uteroplacental circulation could improve the prediction of pregnancy outcome in women with raised maternal serum alpha‐fetoprotein and a structurally normal fetus. The study further attempts to determine whether the presence of an early diastolic notch would constitute a better screening test than waveform patterns.

Design
An observational study.

Setting
A tertiary referral obstetric service.

Subjects
All women referred to St George's Hospital with a raised maternal serum alpha‐fetoprotein had waveform measurements from the uteroplacental circulation after exclusion of fetal abnormalities. Pregnancy outcome was determined by questionnaire sent to the referring clinicians.

Main outcome measures
Adverse perinatal outcome in the form of preterm labour, low birthweight and perinatal mortality.

Results
Data from 332 cases were available for analysis. Women with a normal pattern of uteroplacental waveforms had a perinatal mortality of 9.6/1000. Women with a uniform high resistance pattern had a perinatal mortality of 846/1000, and those with a mixed resistance pattern had a perinatal mortality of 268/1000. Overall there were 27 cases of placental abruption which accounted for eight of the 50 perinatal deaths. The remainder were due to prematurity or low birthweight or both. The presence of the early diastolic notch did not improve on the waveform patterns in the prediction of perinatal death.

Conclusion
Women with raised maternal serum alpha‐fetoprotein and normal Doppler waveform patterns from the uteroplacental circulation can be reassured, but mixed or uniform high resistance patterns should encourage increased surveillance and a search for intervention therapies.
Haemostatic, fibrinolytic and endothelial variables in normal pregnancies and pre‐eclampsia
Authors: Halligan Aidan , Bonnar John , Sheppard Brian , Darling Michael , Walshe Joseph
Published: August 2005

Objective
To determine the behaviour of the coagulation variables antithrombin III (ATIII), protein C, thrombin/antithrombin III (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t‐PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre‐eclamptic pregnancies.

Design
Longitudinal and cross‐sectional observational study.

Setting
Antenatal clinic and maternity hospital.

Subjects
Thirty‐six primigravid normotensive Caucasian patients, four of whom subsequently developed pre‐eclampsia, and 12 patients with established pre‐eclampsia.

Main outcome measures
Plasma levels of PAI‐1, PAI‐2 and t‐PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques.

Results
PAI‐1 and PAI‐2 antigen levels rose progressively throughout normal pregnancy. Among the established pre‐eclamptic group compared with matched normal pregnancies, the PAI‐2 antigen level was significantly lower (48.5±22.8 versus 183.5±37.4; P < 0.001), the PAI‐1 antigen level was significantly higher (122.34±4 versus 79.2±19.7; P < 0.001), ATIII activity was significantly lower (87.8±27.1 versus 110.9±19.3; P < 0.001) and TATIII complex levels were significantly higher (16.9±6.4 versus 10.2±5.9; P < 0.001). Among the four initially normotensive patients who subsequently developed pre‐eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation.

Conclusion
Significantly elevated levels of PAI‐1 and fibronectin occurring early in pregnancies that subsequently develop pre‐eclampsia suggest that these variables may have predictive values. PAI‐2 would seem to be a marker of placental function in pre‐eclampsia while increased t‐PA and TATIII complex levels reflect the severity of the condition.
A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre‐eclamptic pregnancies
Authors: Meekins J. W. , Pijnenborg R. , Hanssens M. , MCFadyen I. R. , van Asshe A.
Published: August 2005

Objective
To investigate trophoblast invasion and vascular changes in placental bed spiral arteries in normal and severe pre‐eclamptic pregnancies.

Design
A histological and immunohistochemical study of placental bed biopsies containing spiral arteries.

Setting
The University Hospital, Leuven, Belgium.

Subjects
Twenty‐one placental bed biopsies from 21 normal pregnancies and 24 placental bed biopsies from 24 severe pre‐eclamptic pregnancies, taken at caesarean section.

Observations
Histological and immunohistochemical appearance of spiral arteries (stained with haematoxylin and eosin), periodic acid schiff, and a monoclonal antibody to low molecular weight cytokeratin.

Results
One hundred and twenty‐seven spiral arteries were studied. In the 21 biopsies from clinically normal pregnancies at term, 100% of the decidual spiral arteries and 76% of the myometrial arteries showed trophoblast invasion. In the 24 biopsies from women with severe pre‐eclampsia, trophoblast invasion was seen in 44 % and 18 % of the decidual and myometrial segments, respectively. Endovascular trophoblast invasion was complete, partial or isolated. A variety of morphological features was present not only in different spiral arteries from the same biopsy but also in different segments of the same artery. The vascular change most commonly associated with normal pregnancies was physiological change and subintimal thickening of both segments of the spiral arteries. In pre‐eclampsia medial disorganisation and hyperplasia in the myometrial arteries and acute atherosis in decidual arteries were common.

Conclusion
Endovascular trophoblast did not show an all or none invasive phenomenon in normal and pre‐eclamptic pregnancies. More decidual than myometrial arteries were invaded in both groups of patients, and there was a gradient in the percentage of decidual and myometrial arteries invaded from normal pregnancy to pre‐eclampsia. Morphological features in one spiral artery may not necessarily be representative of all of those in a placental bed.
Umbilical cord blood gas analysis at delivery: a time for quality data
Authors: Westgate Jennifer , Garibaldi Jonathan M. , Greene Keith R.
Published: August 2005

Objectives
To address the practical problems of routine umbilical cord blood sampling, to determine the ranges for pH, pCO2 and base deficit and to examine the relationships of these parameters between cord vessels.

Design
An observational study of umbilical cord artery and vein blood gas results.

Setting
A large district general hospital in the UK.

Subject
One thousand nine hundred and forty‐two cord results from 2013 consecutive pregnancies of 34 weeks or more gestation, monitored by fetal scalp electrode during labour.

Results
Only 1448 (74.6%) of the 1942 supposedly paired samples had validated pH and pCO2data both from an artery and the vein; 54 (2.8%) had only one blood sample available, 90 (4.6%) had an error in the pH or pCO2 of one vessel and in 350 (18%) pairs the differences between vessels indicated that they were not sampled from artery and vein as intended. Only 60% of the cases with an arterial pH less than 7.05 had evidence of a metabolic acidosis (base deficit in the extracellular fluid 10 mmol/1 or more). Of all the cases, 2.5% had a venous‐arterial pH difference greater than 0.22 units.

Conclusions
Both artery and vein cord samples must be taken and the results screened to ensure separate vessels have been sampled. Interpretation of the results requires the examination of pCO2 and base deficit of the extracellular fluid from each vessel as well as the pH. Confusion about the value of cord gas measurements may be due to the use of erroneous data and inadequate definitions of acidosis which do not differentiate between respiratory and metabolic components.