bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant lymphoma presenting as an ovarian tumour: a clinicopathological analysis of 34 cases
Authors: FOX H. , LANGLEY F. A. , GOVAN A. D. T. , HILL A. SHIRLEY , BENNETT M. H.
Published: August 2005

Summary. The clinicopathological features of 34 patients with malignant lymphoma or leukaemia where the initial presentation was as an ovarian tumour are described. Nineteen patients died, usually within 1 year of diagnosis, whilst 15 survived, some for long periods. Factors indicating a poor prognosis were rapid onset of abdominal symptoms, the presence of systemic symptoms, bilateral ovarian tumours, advanced stage and a histological pattern other than that of a B‐cell lymphoma. For staging purposes the Ann Arbor method appeared a more sensitive prognostic indicator than did the FIGO staging system. It is suggested that primary malignant lymphomas of the ovary are extremely rare and that for therapeutic purposes all lymphomas of the ovary should be regarded as local manifestations of systemic disease.
The incidence and morphology of hydatidiform mole in Abu Dhabi, United Arab Emirates, 1978–1986
Authors: GRAHAM IAIN H. , FAJARDO AURORA M.
Published: August 2005

Summary. In a combined retrospective and prospective study of the frequency and morphology of hydatidiform mole in Abu Dhabi between 1978 and 1986, the incidence at Al Corniche Hospital was 2·02 per 1000 deliveries. Morphological classification showed that complete moles formed 80% of the total.
Human papillomavirus in paired normal and abnormal cervical biopsies–implications for treatment
Authors: CASSIDY L. J. , CHUDLEIGH A. , KENNEDY J. H. , MACNAB J. C. M.
Published: August 2005

Summary. A total of 143 consecutive patients with abnormal cervical cytology was examined at a large colposcopy clinic in Glasgow. Each patient had paired biopsies from normal and abnormal cervical epithelium examined both histologically and by immunoperoxidase staining for human papillomavirus (HPV) infection. More than 71% of the abnormal biopsies and 39% of the normal paired biopsies had histological evidence of HPV infection. Cytological evidence of HPV infection was seen in 38.5% of cervical smears. Immunocytochemistry revealed HPV antigen in 22% of the abnormal biopsies and in 4.2% of the ‘normal’ biopsies. The presence of HPV infection in colposcopically normal cervical tissue both inside and outside the transformation zone may help to explain why current methods for treatment of cervical HPV infection are often unsuccessful.
Sodium‐renin‐aldosterone relations in normal and hypertensive pregnancy
Authors: BROWN MARK A. , NICHOLSON ELLEN , GALLERY EILEEN D. M.
Published: August 2005

Summary. To examine the short‐term regulation of sodium excretion, plasma volume, and the renin‐aldosterone system in pregnancy, women in their first pregnancy received either a high‐salt (HS) (250 mmol/day) or a low‐salt (LS) (20 mmol/day) diet for 7 days during the second and third trimester and after delivery (total 213 studies). Twenty women, studied while normotensive during mid‐pregnancy, developed pregnancy‐induced hypertension (PIH) in the third trimester. There was slightly greater difficulty adapting to sodium depletion (LS diet) during normal pregnancy compared with postpartum. The final mean values for sodium excretion were 27 (SE 2), 28 (SE 3) and 14 (SE 4) mmol/day in the second and third trimester and postpartum respectively. Sodium excretion with the HS diet was similar at all stages and plasma volumes were maintained as effectively during pregnancy as after delivery following both diets. Plasma renin activity (PRA) and aldosterone concentration rose and fell significantly following the LS and HS diets but the sensitivity of renin response to changes in salt intake was blunted during normal pregnancy. Women who later developed PIH, when studied whilst normotensive, failed to stimulate plasma aldosterone after salt depletion in their second trimester and did not exhibit the ‘sodium‐independent’ component of PRA seen in continuously normotensive subjects at this stage.
The binding of epidermal growth factor to the human uterus and leiomyomata in women rendered hypooestrogenic by continuous administration of an LHRH agonist
Authors: LUMSDEN M. A. , WEST C. P. , BRAMLEY T. , RUMGAY L. , BAIRD D. T.
Published: August 2005

Summary. The binding of epidermal growth factor (EGF) to human myometrium and leiomyomata was assessed in a group of women rendered hypo‐oestrogenic with the LHRH agonist Zoladex (ICI118630). The results were compared with those obtained with tissues from women with normal cycles. Tn normal women, the specific binding of radiolabelled [125I] EGF to both myometrial and fibroid homogenates did not vary during the menstrual cycle, but the specific binding of [125I] EGF to fibroid in women treated with LHRH agonist was significantly less than in the untreated group. Since the hypo‐oestrogenic state induced by the agonist is associated with a decrease in fibroid size, the results suggest that the effect of oestrogen on fibroid tissue may partly be mediated by EGF.
Medical malpractice claims in obstetrics and gynaecology: comparisons between the United States and Britain
Authors: QUAM LOIS , WALL ROBERT DING , FENN PAUL
Published: August 2005

Summary. Obstetricians and gynaecologists have been particularly affected by the increase in the cost and number of medical malpractice claims in Britain. US obstetricians and gynaecologists have experienced a disproportionately higher rate of claim than other practitioners in that country. This article reviews the US experience of obstetrics and gynaecology malpractice claims and questions the validity of showing comparisons between the US and the UK. However, even if British malpractice claims do not reach the level of American claims, the effects of claims on the National Health Service, recruitment to obstetrics and gynaecology, and clinical practice are significant.
Kielland's forceps or ventouse—a comparison
Authors: HERABUTYA YONGYOTH , O‐PRASERTSAWAT PRATAK , BOONRANGSIMANT PRASONG
Published: August 2005

Summary. A retrospective study over a 3‐year period compared maternal and neonatal outcomes after birth by Kielland's forceps with those by ventouse when there was deep transverse arrest of head. Of the 259 women, 117 were delivered with Kielland's forceps and 142 were delivered with the ventouse. Of the Kielland's forceps deliveries, 15% were performed by a specialist, compared with 41% of the vacuum extractions. There were no differences in maternal morbidity overall, but when groups of operators were compared maternal complications were more frequent in the forceps group with the less experienced operators. There was little early neonatal morbidity (as judged by Apgar score, intubation, admission to the special care baby unit, jaundice and abnormal neurological behaviour) but cephalhaematoma occurred significantly more often in babies born by the ventouse than by Kielland's forceps. There were no perinatal deaths.
Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study
Authors: AHARONI ARIEL , REITER ALEXANDER , GOLAN DAVID , PALTIELY YOAV , SHARF MORDECHAI
Published: August 2005

Summary. In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3–8 weeks. Each patient had hetween 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 4 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.
Repeat maternal serum alpha‐fetoprotein testing in antenatal screening programmes for Down's syndrome
Authors: CUCKLE HOWARD S. , WALD NICHOLAS J. , NANCHAHAL KIRAN , DENSEM JAMES
Published: August 2005

Summary. The risk of having a Down's syndrome term pregnancy was estimated using maternal age and the results of two maternal serum alpha‐fetoprotein (AFP) tests carried out between 14 and 20 weeks gestation. The estimates of risk were derived from published data and the AFP results from nine affected and 145 unaffected pregnancies in which repeat testing had been carried out. Repeat AFP testing is unjustified in antenatal screening programmes for Down's syndrome, but if a second test happens to have been done, the appropriate estimate of risk that would be applicable when counselling individual patients depends on both results. For example a woman aged 35 years and 6 months with a first AFP level of 0–50 multiples of the normal median (MoM) was estimated to have a risk of 1:172. If a second test were done on a fresh sample and the AFP level were 0·80 MoM then the estimated risk would be 1:216 which is higher than the estimated risk of 1:353 obtained if the second test were regarded as the only result. Estimates of risk are given for maternal serum AFP results in first and second tests ranging from 0·40 to 2·50 MoM.
Variation in the T/QRS ratio of fetal electrocardiograms recorded during labour in normal subjects
Authors: NEWBOLD SANDRA , WHEELER TIMOTHY , CLEWLOW FRANK , SOUL FRANCES
Published: August 2005

Summary. The T/QRS ratio of the fetal ECG was obtained during labour from 25 women with normal pregnancies. The poor signal‐to‐noise ratio of the unprocessed signals, chiefly due to baseline wander, led to a wide variation between individual measurements. This problem was overcome by data averaging, the ratio being expressed as a mean over 1‐min epochs. The average T/QRS ratio of each labour record ranged from 4% to 23% with a mean of 10% (for all 25). The average range (between 5th and 95th centile) of the 1‐min T/QRS ratios was 13% and there were no significant changes as labour progressed. The effect of contractions on the T/QRS ratio was measured from eight subjects and found to be inconsistent.
A prospective longitudinal study of social, psychological and obstetric factors in pregnancy: response rates and demographic characteristics of the 8556 respondents
Authors: KEEPING J. D. , NAJMAN J. M. , MORRISON J. , WESTERN J. S. , ANDERSEN M. J. , WILLIAMS G. M.
Published: August 2005

This paper introduces the Mater Misericordiae Mothers' Hospital‐University of Queensland Study of Pregnancy, a prospective study of 8556 pregnant women interviewed at their first clinic visit, and subsequently interviewed some days after the birth of the baby and again 6 months later. Additional data were derived from the medical record of the pregnancy and delivery. The study was designed to assess the impact of social, psychological and obstetric factors on pregnancy outcome. We present here details of the study design, sampling, response rates and demographic characteristics of the sample.
Meconium aspiration syndrome: a 6‐year retrospective study
Authors: COLTART T. M. , COLTART T. M. , BYRNE D. L. , BATES S. A.
Published: August 2005

The incidence and outcome of babies suffering from meconium aspiration syndrome (MAS) has been analysed in a 6‐year review of 38 395 births at Guy's Hospital and Queen Charlotte's Maternity Hospital. One in 533 births (0·2%) was complicated by MAS, the mortality rate for which was 1 in 12. There was also a number of babies identified as possibly suffering from ‘subclinical MAS’ but no deaths occurred in this group. Males were more affected than females.
The aetiology of vaginal bleeding in children. A 20‐year review
Authors: HILL N. C. W. , OPPENHEIMER L. W. , MORTON K. E.
Published: August 2005

Summary. The cause of vaginal bleeding in girls of 10 years and under is reviewed. Of the 52 patients seen, in 28 (54%) bleeding was caused by a local lesion and 11 (21%) of these had malignant genital tumours. Eleven (21%) children presented with some form of precocious puberty, and in 13 (25%) patients no cause could be found.
Changes in fetal monitoring practice in the UK: 1977–1984
Authors: WHEBLE A. M. , GILLMER M. D. G. , SPENCER J. A. D. , SYKES G. S.
Published: August 2005

A postal survey was undertaken between 1985 and 1987 to assess the changes that have taken place in fetal monitoring practice since 1977. Replies were received from 253 (92%) of 276 consultant obstetric units canvassed. Biophysical methods of assessing fetal well‐being in the antepartum period are almost universally employed and are accepted as the best discriminators of the need to deliver the pregnancy. The number of fetal heart rate monitors on labour wards has increased by 88%. Overall, 63% of units monitor more than 60% of their patients in labour, and 87% permit suitably trained midwives to apply fetal scalp electrodes, which must now be regarded as standard practice. There is still a need for a simplified technique for fetal blood sampling. The perinatal mortality rate correlates with a prematurity factor and probably bears a greater relation to the population served than to the degree of monitoring provided.
Direct chromosome analysis in the second and third trimesters by placental biopsy in 30 pregnancies
Authors: SAURA R. , LONGY M. , GRISON O. , HOROVITZ J. , VERGNAUD A.
Published: August 2005

Direct chromosome analysis was performed on placental villi obtained by ultrasound‐guided transabdominal needle aspiration in 30 women at between 23 and 37 weeks gestation. Placental biopsy is simple in the presence of severe oligohydramnios where fetal blood sampling is usually more difficult. Direct karyotyping of placental villi is more rapid than chromosomal analysis from fetal blood and from amniotic fluid. Two chromosomal anomalies were discovered: one trisomy 18 and one 6p+. Villus sampling failed in one woman and two samples obtained at 36 and 37 weeks gestation could not be karyotyped. The procedure did not affect the outcome of the pregnancy.
A randomized study of a domiciliary antenatal care scheme: the effect on hospital admissions
Authors: DAWSON A. J. , MIDDLEMISS C. , GOUGH N. A. J. , JONES M. E. , COLES E. C.
Published: August 2005

A preliminary randomized study has been made of a domiciliary management scheme which incorporates telephonic fetal heart rate monitoring for women with high‐risk pregnancies. In this paper we report effects of the scheme on the pattern of hospital admissions. Sixty women were randomized 2:1 for domiciliary surveillance or for conventional hospital care, with 40 and 17 records finally available for analysis. The groups were well matched for maternal, obstetric and socio‐economic characteristics. In the domiciliary group, 21 (53%) of the women avoided hospital admission altogether, the admission rate was more than halved, and the mean proportion of the time spent in hospital was reduced from 50% to 16% of the observation period. The women who received domiciliary care were generally satisfied with the scheme. Our study confirms expectations that carefully planned domiciliary surveillance can reduce the number and duration of hospital admissions.
The validity of screening for small‐for‐gestational‐age and low‐weight‐for‐length infants by Doppler ultrasound
Authors: SIJMONS E. A. , REUWER P. J. H. M. , VAN BEEK E. , BRUINSE H. W.
Published: August 2005

Summary. A prospective blind study assessed the efficacy of Doppler examination of the umbilical arteries (pulsatility index) as a screening procedure for predicting small‐for‐gestational‐age and low‐weight‐for‐length (low ponderal index) infants. Birthweight below the 2–3rd and 10th centile and ponderal index below the 3rd and 10th ccntiie were chosen as‘cut‐off levels. Of pregnant women from our university hospital population, 400 were examined at 28 and 34 weeks gestation. The sensitivity of the test was low, ranging from 16·9 to 41·7% for the different indices. The predictive value of a negative screening test also was unsatisfactory, ranging from 79·6% to 97·9%. It is concluded that a single umbilical artery Doppler examination at 28 or 34 weeks does not satisfy the need in obstetrics for a simple and accurate technique to screen for small‐for‐gestational‐age and low‐weight‐for‐length infants in an unselected obstetric population.
The pathophysiology of peri‐ and postmenopausal bone loss
Authors: NILAS L. , CHRISTIANSEN C.
Published: August 2005

Summary. Changes in sex hormones and bone turnover were studied longitudinally in 31 women aged 47–54 years who were approaching the menopause. Every 6 weeks for 2–3 years, hormones and biochemical estimates of the bone turnover were determined and the bone mass was measured at two forearm sites by single photon absorptiometry. Spinal bone mass was measured every 6 months. The bone turnover was normal in women aged 47–54 years with regular menstruation, whereas the estimates of bone resorption were high in the women with irregular menstruation. In nine women, who reached the menopause during the study, bone resorption increased significantly, whereas bone formation showed only a small increase. When the results of the nine women were combined with those of 50 women, who had passed a natural menopause within the preceding 3·5 years, the bone resorption indices reached their peak within the first postmenopausal year, whereas bone formation increased until 1·5–2 years after the last menstrual cycle. At the ultradistal forearm site the rate of bone loss was maximal (5% per year) immediately after the menopause and subsequently declined, which suggests that trabecular bone is more sensitive than cortical bone to changes in bone turnover. Spinal bone loss was identical in late peri‐and early postmenopausal women. We conclude that bone resorption starts to increase during the last perimenopausal years, with a beginning acceleration in bone loss, which then becomes sharp after the menopause. The changes are related to the decline in oestrogens, but other mechanisms may also play a role.
Immunohistochemical determination of tumour growth fraction in human ovarian carcinoma
Authors: WONG W. S. FELIX , TATTERSALL MARTIN H. N.
Published: August 2005

Summary. The proportion of proliferating tumour cells in a tumour (‘growth fraction’) was estimated in 30 patients with primary ovarian carcinoma, using monoclonal antibody Ki‐67 which reacts with a nuclear antigen present only in proliferating cells. A positive correlation between the ‘growth fraction’ and both the clinical stage and histological grade of the tumours was observed. A high ‘growth fraction’ was observed in advanced, metastatic and poorly differentiated tumours and a low ‘growth fraction’ with early stage, well‐differentiated tumours. This information which has not been available previously to clinicians may be of practical value for determining the prognosis, and influencing treatment recommendation.
Management of tubal pregnancy with methotrexate
Authors: ZAKUT H. , SADAN O. , KATZ A. , DREVAL D. , BERNSTEIN D.
Published: August 2005

Summary. Ten women with tubal ectopic pregnancy were treated by the injection of methotrexate into the gestational sac under direct laparoscopic vision followed by a course of intramuscular therapy including folinic acid rescue. One course of treatment induced resolution of the extrauterine pregnancy in eight women. Complete resolution (β‐hCG<10 miu/ml) was achieved within 6–47 days (mean 14·5 days). Serum β‐hCG levels started to decline 3–4 days from the beginning of therapy. Length of hospital stay was 5–11 days (mean 6·4 days). Treatment failed in two patients. One woman had a laparoscopic tubal clip sterilization concomitantly with methotrexate treatment. Tubal patency was demonstrated in all the other seven women (100%) tested subsequently. There is a need to establish criteria for patient selection before methotrexate becomes a routine treatment for tubal pregnancy.
Fetal growth achievement and neurodevelopmental disability
Authors: TAYLOR D. J. , HOWIE P. W.
Published: August 2005

Summary. To investigate the role played by chronic intrauterine insult in the genesis of neurodevelopmental disability (NDD), three analyses have been applied to a case‐controlled study which compared a population of children with NDD with a control group of normally developed children. In the first analysis, average birthweight in children with NDD was 3138 g (SD 592) which was significantly less than in normally developed children, 3280 g (SD 491) (P<0·0005). After correction for confounding factors, birthweight‐for‐gestation (Z score) remained lower in children with NDD (‐0·42) than normal children (‐0·21) (P<0·0025). In the second analysis the fetal growth achievement of children, who had NDD after the prenatal complications, severe hypertension, unclassified antepartum haemorrhage and preterm uterine activity, was significantly less (Z score, ‐0·76) than children who were normally developed after the same maternal prenatal complications (Z score, ‐0·37) (P<0·03). In the third analysis, a risk analysis to assess the relative importance of fetal growth achievement and prenatal complications in the genesis of NDD suggested that the latter was the dominant factor. These data are consistent with the hypothesis that prenatal complications, severe enough to retard fetal growth, can compromise fetal brain development and make an important contribution to NDD.
Oocyte donation: a review
Authors: CAMERON IAINT. , ROGERS PETER A. W. , CARO CATRIONA , HARMAN JAYNE , HEALY DAVID L. , LEETON JOHN F.
Published: August 2005

Summary. Oocyte donation provides an option for achieving pregnancy in women lacking functioning gonads, or in whom IVF techniques have failed to harvest adequate oocytes, or those who do not wish to use their own gametes because of hereditary disease. In agonadal women, artificial menstrual cycles are required before proceeding to gamete donation. A fixed cyclical steroid replacement schedule of oestradiol (E2) valerate and progesterone (P4) pessaries was initially used, but the need for synchrony between donor and recipient cycles, and the narrow window for implantation limited the transfer of fresh embryos. Donorrecipient cycle asynchrony can be overcome by using frozen‐thawed embryos, or by extending the follicular phase in the recipient to widen the transfer window. Twenty‐two pregnancies have now been achieved by the Monash/Epworth group, resulting in the birth of 13 healthy Infants. There were no statistically significant differences in pregnancy rates (per transfer) between transfers in natural cycles (14%, four pregnancies) and steroid replacement cycles (24%, 16 pregnancies). Five pregnancies (36%) were established in women treated with 2 mg of E2 daily 13–18 days before embryo transfer with P, starting on the day of or the day tollowing oocyte retrieval. E2 was continued for a median of 85 days (range 49–110) and P4 for a median of 86 days (range 49–133) after the supposed last menstrual period. All but one delivery was by caesarean section. There were no perinatal deaths and no ectopic pregnancies.
Hysteroscopic endometrial ablation with the neodymium‐YAG laser
Authors: DAVIS JONATHAN A.
Published: August 2005

Summary. Over the past 3 years a series of patients referred to the gynaecological department at Stobhill Hospital with menorrhagia have been treated, as an alternative to hysterectomy, by endometrial ablation with the neodymium‐YAG laser. The results in the first 25 patients with a follow‐up of over 6 months are presented. The overall success rate was only 52%, but by increasing the power output of the laser energy used to 80 W the rate of success increased to 83%. Of the 25 patients 13 were selected for laser treatment because hysterectomy was considered unsuitable on account of obesity or medical and surgical conditions; the other 12 wanted to avoid a hysterectomy. The technique and its problems are discussed.
Pregnancy in women with premature ovarian failure using tubal and intrauterine transfer of cryopreserved zygotes
Authors: ABDALLA H. I. , BABER R. J. , KIRKLAND A. , LEONARD T. , STUDD J. W. W.
Published: August 2005

Summary. Twenty‐nine women, mean age 36·3 (SD 5·5) years, with premature ovarian failure received donated ova on an ovum donation programme. Three had Turner's syndrome, four a surgical menopause, one a chemotherapy‐induced menopause and 21 had idiopathic premature ovarian failure. All donated oocytes were fertilized with frozenthawed spermatozoa from the recipient's partner, and the resulting zygotes were frozen until transfer had been arranged. Overall, 19 women had intrauterine embryo transfer (ET) and a mean of 2·7 (SD 0·9) embryos were transferred on 20 occasions; 10 women underwent zygote intrafallopian transfer (ZIFT) and a mean of 3·5 (SD 0·5) zygotes were transferred on 10 occasions. Both groups were matched for age. The pregnancy rate per transfer was 20% in the ET group and 40% in the ZIFT group. After excluding the 10 women in the ET group who had fewer than three embryos transferred, the pregnancy rates were similar in the two groups, 30% in the ET group and 40% in the ZIFT group. Cryopreserved embryos may be used for ovum donation to preserve anonymity and still show a high pregnancy rate of at least 30% per transfer.
Ultrasound fetal femur length measurement in the screening for Down's syndrome
Authors: CUCKLE H. , WALD N. , QUINN J. , ROYSTON P. , BUTLER L.
Published: August 2005

The fetal femur length determined by an ultrasound examination at between 13 and 39 weeks gestation in 83 pregnancies associated with Down's syndrome was statistically significantly less than the expected value for pregnancies with the same biparietal diameter examined in the same ultrasound department (P<0.0001). Expected values were based on linear regressions of femur length on biparietal diameter in 1340 control pregnancies from 27 ultrasound departments. The median value for the affected pregnancies was 0.94 times the expected value (95% CI 0.92 to 0.97). Eleven per cent of affected and 14% of control pregnancies had values ≤0.85 times the expected. The reduction in femur length in affected pregnancies was not related to biparietal diameter or to maternal age. Fetal femur length may be useful as an ancillary screening variable in the antenatal screening for Down's syndrome.
Gynaecological impact of sexual and physical abuse by spouse. A study of a random sample of Norwegian women
Authors: SCHEI BERIT , BAKKETEIG LEIV S.
Published: August 2005

A sample of 150 women aged between 20 and 49 was randomly selected from the census of the city of Trondheim, Norway. Of the 131 eligible for the study, 13 refused to participate; the participating 118 women were interviewed by a gynaecologist. Detailed information about their present and previous spouse(s) and about sexual problems and gynaecological symptoms was obtained. Physical abuse by spouse had occurred in 20 (18%) of the 111 women who had ever lived in a relationship, and sexual abuse in 19 (17%). Eleven (10%) had experienced both physical and sexual abuse. A history of physical abuse with or without sexual abuse by spouse was associated with sexual problems in the present or in previous relationships. Reported abuse by spouse was also associated with a higher frequency of gynaecological symptoms at the time of interview.
2308 second trimester terminations using extra‐amniotic or intra‐amniotic prostaglandin E2: an analysis of efficacy and complications
Authors: HILL N. C. W. , MACKENZIE I. Z.
Published: August 2005

A total of 2308 mid‐trimester terminations using PGE2 extra‐amniotically (1608) or intra‐amniotically (700) has been analysed for efficacy and immediate and early morbidity. The mean induction‐to‐abortion intervals were similar for the two routes. Overall, 67% of the patients were in hospital for 1 night. Morbidity rates were similar for the two administration routes and were no higher than those reported for second trimester terminations using dilatation and evacuation. Minor side‐effects of vomiting occurred in 1006 (44%) and diarrhoea in 320 (14%). Forty (1·7%) lost more than 500 ml of blood during termination and 13 (0·6%) were transfused. Major complications were extremely rare and genital tract trauma only occurred in 4 (0·17%) and proven pelvic infection in 2 (0·08%) patients. Thirty‐three (1·4%) were readmitted and required a surgical evacuation of the uterus. Since long‐term complications have been assessed for this method of termination and found to be infrequent, we see no reason to consider a change in methods for second trimester terminations.
Structural cardiac abnormalities in the fetus: reliability of prenatal diagnosis and outcome
Authors: DAVIS G. K. , FARQUHAR C. M. , ALLAN L. D. , CRAWFORD D. C. , CHAPMAN M. G.
Published: August 2005

Summary. The outcomes of 129 pregnancies in which the fetus was found to have a structural cardiac abnormality are reviewed. Over a 30 month period from January 1985 to June 1987, 1924 patients were referred to the British Heart Foundation Research Centre for Perinatal Cardiology at Guy's Hospital for fetal cardiac seanning. A total of 129 structural cardiac abnormalities was diagnosed; 53% of these patients were referred because of an abnormal ‘four‐chamber view’ on ultrasound at the referring hospital; 47 of the pregnancies (69% of the 68 patients referred before 28 weeks) were terminated, and in the remaining 82 pregnancies outcome was poor with only 20 infants (16%) surviving longer than 11 months. The prenatal diagnosis was fully or partly correct in 96% of the 111 cases where it was possible to verify the diagnosis by post‐mortem or postnatal diagnosis. In the 82 pregnancies not terminated, 13 of the 22 cases given a moderate or good prognosis survived more than 11 months (59% survival), but only seven of the 60 (12% survival) given a fatal, poor or uncertain prognosis. The benefits of a multidisciplinary approach are discussed.
How frequently need vaginal smears be taken after hysterectomy for cervical intraepithelial neoplasia?
Authors: GEMMELL J. , HOLMES D. M. , DUNCAN I. D.
Published: August 2005

Summary. A retrospective longitudinal review identified 341 women who had had a hysterectomy in association with CIN 3, in Tayside Region, during the ycars 1967–1977; 219 (64%) had completed l0 years of cytology follow‐up and of 140 women eligible for 15‐year smears 79 (56%) completed the 15‐year follow‐up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial neoplasia (VAIN) was diagnosed. Only one patient completing 15‐year follow‐up had an abnormal smear and VAIN later diagnosed. No patient over this 15‐year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957–1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CIN 3 at hysterectomy. With such data we would propose screening 6‐monthly during the first postoperative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme.
Magnesium sulphate versus diazepam in the management of eclampsia: a randomized controlled trial
Authors: CROWTHER CAROLINE
Published: August 2005

Summary. This randomized controlled trial compared the use of magnesium sulphate with diazepam as anticonvulsant in 51 eclamptic women. The use of magnesium sulphate was associated with less serious morbidity (in terms of recurrence of convulsions, cardiopulmonary problems, disseminated intravascular coagulopathy, and acute renal failure) but the difference was not statistically significant (relative risk 0.6; 95% CI0.3 to 1.2). The one maternal death occurred in the magnesium sulphate group. Convulsions recurred in five (21%) women in the magnesium sulphate group and seven (26%) women in the diazepam group. Urine output poor enough to prompt diuretic stimulation was less frequent in the magnesium sulphate group than in the diazepam group (RR 0.3; 95% CI 0.1 to 0‐9). Significantly fewer infants born in the magnesium sulphate group had low Apgar scores (<7 at 1 min) compared with those in the diazepam group (RR 0.6; 95% CI 0.4 to 0.9). There were two early neonatal deaths in the magnesium sulphate group, and three stillbirths in the diazepam group. This study suggests that magnesium sulphate has advantages over diazepam for the mother and the infant in the treatment of eclampsia, but the trial is small and should be replicated on a larger scale.
Malignant melanoma of the vulva: a clinicopathological study of 50 women
Authors: BRADGATE M. G. , ROLLASON T. P. , McCONKEY C. C. , POWELL J.
Published: August 2005

Summary.A clinicopathological review of 50 primary malignant melanomas of the vulva in the West Midlands region of England is presented. The overall 5‐year‐survival rate was 35%, when adjusted for age. Significant predictors of survival were clinical stage, patient age, tumour ulceration, cell type and mitotic rate. Tumour thickness was of prognostic importance but as a prognostic variable it did not operate independently of stage and as most lesions were deeply invasive at presentation vulval tumours must be separated for prognostic purposes into bands at greater overall thicknesses than those used for skin melanomas generally. There was no significant relation between survival and type of surgery performed as a primary therapeutic procedure.
Change in ovarian arterial compliance during the human menstrual cycle assessed by Doppler ultrasound
Authors: HATA K. , HATA T. , SENOH D. , MAKIHARA K. , AOKI S. , TAKAMIYA O. , KITAO M.
Published: August 2005

Summary. Ovarian arterial velocimetry, using real‐time two‐dimensional and pulsed Doppler ultrasound, was performed on 36 occasions in nine healthy women with regular menstrual cycles. The change in ovarian arterial compliance was based on the calculation of pulsatility index (PI). In the active ovary carrying a dominant follicle or corpus luteum, the PI in the early follicular phase (mean 6.97, SD 2.01) was significantly higher than that in the late follicular phase (mean 2.36, SD 0.31) (P<0.001), and the PI in the early luteal phase (mean 0.68, SD 0.09) was significantly lower than that in the late follicular phase (P<0.001). The PI in the late luteal phase (mean 0.93, SD 0.16) was significantly higher than that in the early luteal phase (P<0.01). In the inactive ovary, no cyclical changes were seen in the values of PI. There was a significant difference between the values of PI in the active ovary and the inactive ovary in the late follicular, the early and the late luteal phases [2‐36 (SD 0‐31)] vs [6‐29 (SD 1‐02)], [0‐68 (SD 0.09)] vs [6.18 (SD 1.33)], [0.93 (SD 0.16) vs [6‐57 (SD 1.72)] (P<0.001), respectively. Use of non‐invasive Doppler ultrasound to study physiology of ovarian haemodynamics during the menstrual cycle is of great clinical relevance and paves the way for further investigations on sterility.
Is routine colposcopic assessment necessary following laser ablation of cervical intraepithelial neoplasia?
Authors: LOPES ALBERTO , MOR‐YOSEF SHLOMO , PEARSON SHEILA , IRELAND DAVID , MONAGHAN JOHN M.
Published: August 2005

Summary. The colposcopic and cytological findings at follow‐up of 1000 women treated by laser ablation for cervical intraepithelial neoplasia or human papillomavirus infection at the Regional Department of Gynaecological Oncology, Gateshead, were reviewed. Colposcopy detected six of 27 patients with residual disease compared with cytology which was abnormal in 26 of the 27 and detected 21 as abnormal on the first visit after laser treatment. In our unit invasive disease after laser treatment was never detected solely on initial colposcopic review.
The placental transfer of mifepristone (RU 486) during the second trimester and its influence upon maternal and fetal steroid concentrations
Authors: HILL N. C. W. , SELINGER M. , FERGUSON JANE , MacKENZIE I. Z.
Published: August 2005

Summary. A double‐blind, placebo‐controlled study has assessed the maternal and fetal endocrine effects of the maternal administration of the anti‐progestin mifepristone in mid‐pregnancy. There were six women in each group. Four hours after oral administration of 600 mg mifepristone, the drug was detected in both maternal and fetal circulations and in the amniotic fluid. No significant changes in progesterone, cortisol, oestradiol, or aldosterone concentrations were detected in the maternal circulation after treatment with mifepristone or placebo. In women treated with mifepristone, the mean fetal aldosterone level was 1699 (SD 217) pmol/1 which was significantly higher than the mean level of 999 (SD 84) pmol/1 in the control group but no significant changes occurred in the fetal progesterone, oestradiol or cortisol concentrations. The significance of these results is discussed in relation to the possible therapeutic uses of mifepristone for inducing labour.
A morphological and immunological study of human placental bed biopsies in miscarriage
Authors: MICHEL M. Z. , KHONG T. Y. , CLARK D. A. , BEARD R. W.
Published: August 2005

Summary. Placental bed biopsies were examined in thrce groups of pregnant women for maternal vascular response to placentation as well as for the presence of cells associated with local immunosuppression activity. In the group of women undergoing legal abortion, the histological appearance of trophoblastic invasion was normal in all but one, and the proportion of immunosuppressor cells was also normal. In the missed miscarriage group the histological appearances were abnormal except in one patient. In women with a history of recurrent miscarriage who had miscarried after immunization, placentation was normal in some and defective in others. Immunosuppressor cells appeared to be diminished in number, although there was no correlation between the cytotoxic status of their sera and their pregnancy outcome.
Regional differences in vascular responses in the human uterus
Authors: SVANE DANNY , LUNDIN STEFAN , ANDERSSON KARL‐ERIK , FORMAN AXEL
Published: August 2005

Summary. Tissue specimens from the fundus, isthmus and distal cervix were obtained from 14 women at hysterectomy at various phases of the menstrual cycle. Ring preparations of small intramyomctrial and intracervical arteries were dissected and mounted in organ baths; isometric tension was recorded and responses to contractile agents were studied. The amplitude of responses to K+ (124mmol/l) of the vessel preparations ranked fundus isthmus > cervix. While similar pD2 values for noradrenaline (NA) were found, the Emax values ranked cervix isthmus fundus (cervix > fundus). The pD2 values for arginine‐vasopressin (AVP) showed minor differences, while the Emax values for this peptide ranked fundus isthmus cervix (fundus > cervix). Arteries from the fundus and isthmus displayed weak, inconsistent contractile responses to prostaglandin F2α, but more pronounced contractions were induced by this prostanoid in arterial preparations from the distal cervix. The results suggest regional differences in vascular mechanical responses to endogenous vasoactive agents in the human uterus.
A longitudinal study of platelet behaviour and thromboxane production in whole blood in normal pregnancy and the puerperium
Authors: LOUDEN K. A. , PIPKIN F. BROUGHTON , HEPTINSTALL S. , FOX S. C. , MITCHELL J. R. A. , SYMONDS E. M.
Published: August 2005

Summary. A longitudinal study of platelet behaviour (platelet aggregation and release reaction) in whole blood and of serum thromboxane B2 production was performed before, during and after normal pregnancy. The response of platelets to arachidonic acid and to adrenaline was significantly increased in the third trimester. Six weeks after delivery, values were still modestly increased but return to non‐pregnant values was complete by 12 weeks. Serum thromboxane B2 production was unchanged throughout pregnancy and the puerperium.
Outcome of a second pregnancy after a previous elective caesarean section
Authors: COLTART T. M. , DAVIES J. A. , KATESMARK M.
Published: August 2005

Summary. At Queen Charlotte's Maternity Hospital from 1980 to 1987, 195 women had a trial of scar in their second ongoing pregnancy, having been delivered previously by elective caesarean section. Overall 154 (79%) achieved a vaginal delivery. Patients who went into spontaneous labour had a significantly better chance of being delivered vaginally than those who were induced. A past history of early pregnancy loss had no influence on the outcome, nor was outcome compromised in the group of patients whose elective caesarean section had taken place before 32 weeks gestation.
Thrombin‐antithrombin III complex levels in normal pregnancy with hypertensive disorders and after delivery
Authors: REINTHALLER A. , MURSCH‐EDLMAYR G. , TATRA G.
Published: August 2005

Summary. The plasma concentration of the thrombin‐antithrombin III‐complex (TAT) was investigated during uncomplicated pregnancy in 15 women in the first, 22 in the second and 46 in the third trimester, and in 19 women with hypertensive disorders between 25 and 40 weeks gestation. Eight women at term after a normal pregnancy were studied before the onset of labour and within 60 min and 24 h after delivery. A comparison group of 16 healthy, non‐pregnant women was investigated. The mean TAT concentration in normal pregnancies increased significantly in the second and third trimester compared with values in the first trimester and in non‐pregnant women. In the group with hypertensive disorders during pregnancy TAT levels were significantly higher than in uncomplicated pregnancies. Within 60 min after delivery a distinct increase of TAT concentrations occurred compared to levels before the onset of labour but the levels had returned to normal by 24 h after delivery. Our findings suggest that an activation of the coagulation system occurs in normal pregnancy. A further activation takes place immediately after delivery. The significantly increased TAT levels in pregnancies with hypertensive disorders suggest a state of chronic disseminated intravascular coagulation leading to an enhanced consumption of and a decreased plasma concentration of antithrombin III.
The treatment of detrusor instability in postmenopausal women with oxybutynin chloride: a double blind placebo controlled study
Authors: TAPP A. J. S. , CARDOZO L. D. , VERSI E. , COOPER D.
Published: August 2005

Summary. Idiopathic detrusor instability is a common cause of incontinence in the elderly for which anticholinergic agents arc regularly prescribed. Oxybutynin chloride combines anticholinergic action with direct muscle relaxant properties. We performed a double blind placebo controlled fixed dose cross over study of oxybutynin chloride in postmenopausal women suffering from detrusor instability. We found oxybutynin chloride significantly more effective than placebo at reducing the symptoms of urgency and urge incontinence and more effective at reducing the height of the highest unstable detrusor contraction. This was at the expense of an increased residual urine and considerable side effects.
Antepartum to postpartum changes in transcapillary fluid balance
Authors: BUNGUM LEIF , TOLLAN ANNE , ØIAN PÅL
Published: August 2005

Summary. During the puerperium significant changes occur in the body volume homeostasis. In the present study the transcapillary fluid balance was examined antepartum in nine healthy women. The interstitial colloid osmotic pressure was measured by the ‘wick’ method, and interstitial hydrostatic pressure by the ‘wick‐in‐needle’ method in subcutaneous tissue on the thorax and at the ankle. From antepartum (gesational week 37‐40) to postpartum (5th day), the following changes were observed: A significant increase in the colloid osmotic pressure both in plasma (mean 1 .8 mmHg, P=0.027) and in the interstitial fluid at the ankle (mean 2.9 mmHg, P=0.008). Neither colloid osmotic pressure gradient (plasma‐interstitium), interstitial hydrostatic pressure, nor haemoglobin and haematocrit changed. The observed rise in the interstitial colloid osmotic pressure must be caused by mobilization of fluid from the interstitium, probably due to a reduced capillary hydrostatic pressure. The increase in plasma colloid osmotic pressure is most likely caused by an increased albumin synthesis and/or transport of interstitial proteins back to the vascular compartment.
The crown‐rump length in early human pregnancy: a reappraisal
Authors: SCHATS R. , VAN OS H. C. , JANSEN C. A. M. , WLADIMIROFF J. W.
Published: August 2005

Summary. The crown‐rump length (CRL) was measured by means of transvaginal sonography in 41 pregnancies resulting from in‐vitro fertilization (IVF). The embryonic CRL could be determined as early as 25 days after follicle aspiration. A reference chart was constructed relating the CRL to the number of days following follicle aspiration. Comparison with the CRL chart by Robinson & Fleming (1975) currently in use revealed that transvaginal sonography allows earlier and more accurate measurement of embryonic CRL.
Management of the pregnant woman with spinal cord injuries
Authors: HUGHES S. J. , SHORT D. J. , McD. USHERWOOD M. , TEBBUTT H.
Published: August 2005

Summary. This paper forms part of an ongoing prospective study of pregnancy and labour in women with spinal cord injuries and combines a prospective and retrospective analysis of 17 pregnancies in 15 women with spinal injuries. The management and outcome in those 17 pregnancies is reviewed.
Is large loop excision of the transformation zone (LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial neoplasia?
Authors: HOWE D. T. , VINCENTI A. C.
Published: August 2005

Summary. In 100 women with suspected cervical intraepithelial neoplasia (CIN) attending the colposcopy clinic the histological diagnoses made from excision biopsies taken by large loop excision of the transformation zone (LLETZ) were compared with those from colposcopically directed punch biopsies taken concurrently. One unsuspected micro‐invasive tumour was found and the diagnosis made by LLETZ was significantly worse than that made by punch biopsy in 24 cases (24%: 95% CI15.6 to 32.4%). LLETZ improves the accuracy of diagnosis of CIN.
The free‐flap vaginoplasty; a new surgical procedure for the treatment of vaginal agenesis
Authors: JOHNSON NICHOLAS , LILFORD RICHARD JAMES , BATCHELOR ANDREW
Published: August 2005

Summary. The ideal operation for a young woman born without a vagina would be a one stage procedure, creating a functionally normal vagina without cosmetically unattractive scars, without the need for subsequent dilatation, stents or obturators. This goal was achieved with a free flap vaginoplasty using a full thickness skin graft taken from the scapula region. The blood supply of the graft was maintained by microvascular anastomosis of the graft pedicles to vessels in the groin. The operation has been performed in three young women who were born with uterine hypoplasia and vaginal agenesis. We experienced no unexpected complications, the procedure was well tolerated and left our patients with a good length, fully functional vagina. However, the operation is a major undertaking and needs to be performed by those with expertise in plastic surgery as well as in gynaecology.