bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of prenatal chromosomal analysis using multicolour fluorescent in situ hybridisation
Authors: Thilaganathan Baskaran , Sairam Shanthi , Ballard Terence , Peterson Caroline , Meredith Rodney
Published: August 2005

Objective
To evaluate the clinical effectiveness of multicolour fluorescent in situ hybridisation (FISH) analysis in routine prenatal diagnosis.

Design
Prospective study.

Sample
3203 amniotic fluid samples.

Methods
Unique DNA (chromosomes 13 and 21) and α satellite centromeric‐specific (chromosomes X, Y and 18) probes were used in two mixes to permit the simultaneous analysis of several chromosomes. The performance of multicolour FISH and conventional cytogenetic analysis was compared.

Results
Conventional cytogenetic analysis identified 111 chromosomal abnormalities, of which 94 were potentially detectable by the FISH technique and 97 would be typically associated with neonatal phenotypic abnormalities. Multicolour FISH analysis detected 84% (93/111) of all chromosome abnormalities and 99% (93/94) of abnormalities where there was a specific probe. The sensitivity of multicolour FISH analysis was 95% (92/97) for chromosomal abnormalities likely to result in an abnormal postnatal outcome. Multiple ultrasound abnormalities were detected in all five cases of clinically relevant chromosomal abnormalities missed by multicolour FISH. FISH results were available within 48 hours and the sample failure rate was 0.1% (3/3202).

Conclusion
Multicolour FISH analysis is a sensitive and reliable technique for the rapid prenatal diagnosis of chromosomal abnormalities. Examining only five chromosomes allowed 95% of clinically relevant chromosomal abnormalities to be diagnosed correctly. As routine antenatal screening is targeted at the major autosomal trisomies and sex chromosome aneuploidies, multicolour FISH analysis may potentially replace conventional cytogenetic analysis in routine prenatal diagnosis.
The RUMI manipulator and Koh colpotomiser system for total laparoscopic hysterectomy
Authors: Keriakos Remon , Zaklama Maged
Published: August 2005

The initial experience in 25 patients of using the Koh Colpotomiser System in conjunction with the RUMI Manipulator, a new modified technique for performing total laparoscopic hysterectomy, is presented. Of 25 operations, 23 (92%) were completed successfully. Complications were limited to minor pre‐operative haemorrhage in two patients and post‐operative bleeding in another. The Koh Colpotomiser System successfully maintained a pneumoperitoneum following colpotomy, giving the operator improved visibility and access to the pelvic organs. This resulted in greater efficiency, while eliminating the difficulties of vaginal access.
The relation between tissue kallikrein excretion rate, aldosterone and glomerular filtration rate in human pregnancy
Authors: Platts Julia K. , Meadows Pauline , Jones Robert , Harvey John N.
Published: August 2005

The changes in renal kallikrein synthesis through normal pregnancy and its relation to aldosterone excretion and the glomerular filtration rate was investigated. Overnight urinary kallikrein and aldosterone excretion rates and glomerular filtration rate were measured at 18 weeks, 34 weeks, term and postpartum in normal human pregnancy. Kallikrein excretion was raised at 18 weeks compared with the nonpregnant state (P < 0.001) but was significantly reduced at term. The reduction in renal kallikrein was not due to falling aldosterone concentration, which increased in the third trimester, compared with 18 weeks (P= 0.002) and remained elevated at term compared with the nonpregnant state (P < 0.001). Glomerular filtration rate remained elevated at term despite the reduced kallikrein excretion rate. These data are consistent with the hypothesis that increased aldosterone production is one factor responsible for increased kallikrein synthesis which contributes to elevated glomerular filtration rate in early pregnancy. Other factors clearly inhibit renal kallikrein production at term. In the face of plasma volume expansion associated with increased mineralo‐corticoid production, the effects of reduced kallikrein synthesis at term on glomerular perfusion and reabsorption of sodium by the distal tubule may predispose to blood pressure elevation in late pregnancy.
Good prognosis for psychomotor development in survivors with nonimmune hydrops fetalis
Authors: Haverkamp F. , Noeker M. , Gerresheim G. , Fahnenstich H.
Published: August 2005

We examined the psychomotor development of 33 of 61 surviving children, from a series of 107 consecutive live‐born cases with nonimmune hydrops fetalis. The majority had a normal outcome. Three had a (simultaneous) serious underlying disease (e.g. fetal herpes infection) and had either severe psychomotor retardation or blindness. Two showed clumsiness and were considered to have minor neurological dysfunction. We conclude that survivors, especially those with transient benign intrauterine conditions, such as lymphatic aetiology have no additional risk to their psychomotor development.
Ambulatory urodynamics: do they help clinical management?
Authors: Gorton Emma , Stanton Stuart
Published: August 2005

Objective
To assess the contribution of ambulatory urodynamics to the treatment of women with urinary incontinence.

Design
A retrospective casenote review of all women referred from the urogynaecology clinic for ambulatory urodynamic monitoring from 1 April 1994 to 31 December 1997.

Setting
A teaching hospital tertiary referral centre urodynamic laboratory.

Participants
Notes were retrieved of 71 women, 80% of whom had had the investigation because the conventional cystometrogram had been normal.

Results
Technical difficulties occurred in 30 traces, two of which were not interpretable. Detrusor instability was diagnosed in 32 women, including three women who also had stress incontinence (42% of interpretable traces). Of these, 20 women were treated with anticholinergics compared with nine of 37 women where detrusor instability was not diagnosed. None of the women with detrusor instability were offered anti‐incontinence surgery, compared with five of those where the bladder remained stable. Less than half the women who were treated with anticholinergic medication improved, but none were considered suitable for more aggressive treatment.

Conclusions
Although the diagnosis of detrusor instability may be increased by ambulatory urodynamics, this does not always translate into more effective treatment. Ambulatory urodynamic testing does not yet result in clinical improvements in diagnosis and treatment.
A double‐blind randomised trial of leuprorelin acetate prior to hysterectomy for dysfunctional uterine bleeding
Authors: Weeks Andrew D. , Duffy Sean R. G. , Walker James J.
Published: August 2005

Objective
To evaluate the use of pre‐operative leuprorelin acetate for reducing the morbidity from hysterectomy for nonfibroid menorrhagia.

Design
A double‐blind, randomised, placebo‐controlled trial.

Setting
Gynaecology department in a large university teaching hospital.

Sample
Fifty‐one women without uterine fibroids awaiting abdominal or vaginal hysterectomy for dysfunctional uterine bleeding.

Methods
Participants received leuprorelin acetate or placebo for eight weeks prior to hysterectomy.

Main outcome measures
Operative blood loss, operative difficulty, first day morphine use, speed of return to ‘normal health’.

Results
The study and control groups were similar as regards prognostic factors. Two women in the study group withdrew because of side‐effects. Although a 34% reduction in uterine volume was seen in those treated with leuprorelin, there were no significant differences in operative blood loss (183 mL in the study group vs 285 mL in controls, P= 0.27), operation time (39 vs 49 min, P= 0.64) or operative difficulty (visual analogue scale 3.0 vs 4.0, P= 0.09). Furthermore, there was no difference between the groups in post‐operative morbidity or rate of recovery.

Conclusions
Treating women with leuprorelin acetate for 8 weeks prior to surgery for nonfibroid menorrhagia has no significant operative or post‐operative benefits.
A cost effectiveness analysis of goserelin compared with danazol as endometrial thinning agents
Authors: Sculpher Mark , Thompson Elizabeth , Brown Jim , Garry Ray
Published: August 2005

Objective
To analyse the cost, effectiveness and cost effectiveness of two endometrial thinning agents prior to laser ablation for dysfunctional uterine bleeding: danazol and goserelin.

Setting
A district general hospital.

Design
A retrospective cost effectiveness analysis, from the perspective of the health service, based on data from an open, randomised, parallel group comparative study of 160 pre‐menopausal women with dysfunctional uterine bleeding.

Methods
Within the trial, length of operation and duration of hospital stay was recorded for each woman. Resource use due to complications of surgery and adverse drug events was evaluated by one of the authors (R.G.). Additional surgery after completion of the study was collected using a postal questionnaire which was distributed to every woman who had undergone surgery. Resource use was costed using detailed unit costs from a specific NHS trust and from published sources. A cost effectiveness analysis was undertaken relating differential cost to differential rates of amenorrhoea at women's last point of follow up.

Results
Information on amenorrhoea was available from 138 women, of whom 111 had completed the questionnaire to indicate longer term follow up. Women who did not complete the clinical trial were not included in this economic evaluation. On average, women randomised to goserelin spent less time in theatre and on the ward. Based on longer term follow up, rates of retreatment were similar in the two groups. The mean (SD) health service cost of women in the goserelin group was £323.84 (£309.94), compared with £243.45 (£265.23) in the danazol group; median (range) costs were £220.29 (£191–£2127) and £159.76 (£140–£1426) in the two groups, respectively. These costs were significantly higher for goserelin (P= 0.0001). The goserelin group also had a higher rate of amenorrhoea (38.8%vs 28.6%, P= 0.23). Based on mean differences in cost, the incremental cost of goserelin per additional woman with amenorrhoea was £788; based on median differences in cost the ratio was £590.

Conclusions
The shorter duration in theatre and stay in hospital provided a modest offset of the higher acquisition cost of goserelin, but the overall cost of management remained significantly higher than managing women with danazol. The rates of amenorrhoea indicated that goserelin was more effective at 24 weeks and approximately two years after surgery, although statistical significance was only achieved at 24 weeks. The economic impact of women withdrawn from treatment was not considered, but sensitivity analysis indicates that these women may have had a large effect on the overall result of this study. Purchasers will need to decide whether the additional cost of management with goserelin is justified by the increased rates of amenorrhoea and the reduced withdrawals from treatment.
Trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996
Authors: Rajkhowa M. , Glass M. R. , Rutherford A. J. , Balen A. H. , Sharma V. , Cuckle H. S.
Published: August 2005

Objective
To examine the incidence of ectopic pregnancy over the period 1966 to 1996.

Setting
England and Wales.

Design
Use of official statistics on hospital discharges, maternities, legal abortions and estimated populations of women aged 15–44 years.

Main outcome measures
Incidence rates of ectopic pregnancies.

Results
Between 1966 to 1970 and 1994 to 1996 the recorded incidence increased 4.5‐fold from 3.45 to 15.5 per 1000 maternities, 3.8‐fold from 3.25 to 12.4 per 1000 pregnancies and 3.1‐fold from 30.2 to 94.8 per 100,000 women aged 15–44. The rate of increase was not uniform. Incidence approximately doubled between 1966 and 1985, when the official data collection system changed. By 1989, when data from the new system became available, there had been a further almost doubling of recorded incidence. Subsequently, the upward trend appears to have continued until 1991 to 1992 and has remained stable in the last four years of the study. The trends were similar in each of three 10‐year age groups.

Conclusions
The recorded incidence of ectopic pregnancy has increased markedly over the last three decades. This may be partly due to artefacts of data recording and more sensitive diagnostic tests, but it is likely that the actual incidence has increased, probably due to a sexually transmitted agent.
Genetic influence on birthweight and gestational length determined by studies in offspring of twins
Authors: Clausson Britt , Lichtenstein Paul , Cnattingius Sven
Published: August 2005

Objective
To determine the relative importance of genetic effects on birthweight, gestational length and small for gestational age.

Design
A cohort study, using individual record linkage between the population‐based Swedish Twin and Birth Registers to estimate twin similarities in twins with known zygosity.

Population
Included were 868 monozygotic and 1141 dizygotic female twin pairs, born in Sweden before 1959, who both delivered single births from 1973–1993.

Methods
Quantitative genetic methods, offspring birthweight, gestational length and small for gestational age birth in twin sisters.

Main outcome measures
Twin similarities measured as probandwise concordance rates and intra‐class correlations for birthweight, gestational length and small for gestational age births.

Results
Concordance rates and intra‐class correlations for birthweight, gestational length and small for gestational age were consistently higher in monozygotic compared with dizygotic twins. Model fitting suggested heritability estimates in the range from 25% to 40%.

Conclusions
This study suggests genetic effects not only for birthweight and fetal growth, but also for gestational length. The mediation of these genetic effects may partly be due to similarities in maternal antropometric measures, lifestyle and medical complications during pregnancy. The study does not distinguish between fetal and maternal genetic effects.
A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage
Authors: Giacalone Pierre Ludovic , Vignal Jacques , Daures Jean Pierre , Boulot Pierre , Hedon Bernard , Laffargue François
Published: August 2005

Objective
To determine whether early placental drainage plus cord traction reduces the incidences of manual removal and blood loss, and to determine the risk factors associated with blood loss after delivery.

Design
Prospective randomised study.

Setting
University teaching hospital, Montpellier, France.

Methods
A randomised study compared 239 women who had placental cord drainage plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery were assessed. The duration of the third stage of labour and the time between birth and the beginning of perineal suturing were measured. Statistical analysis used the paired t test for continuous variables, the Kruskal‐Wallis test for nonparametric data and χ2 test for categoric variables. Stepwise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable.

Results
No significant difference was found in the two groups with regard to the incidence of manual removal of retained complete or incomplete placenta or postpartum haemorrhage. The median values of the duration of the third stage of labour, birth‐to‐perineal suture time and drop in haemoglobin were significantly lower in the cord drainage group than in the control group. After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin.

Conclusion
Cord drainage decreases the duration of the third stage of labour and reduces blood loss but not the incidence of manual removal of the placenta.
Anaemia in pregnancy in southern Malawi: prevalence and risk factors
Authors: van den Broek N. R. , Rogerson S. J. , Mhango C. G. , Kambala B. , White S. A. , Molyneux M. E.
Published: August 2005

Objective
To determine prevalence of anaemia in pregnancy in southern Malawi, and to establish if an ‘at risk’ group can be identified for targeted intervention.

Design
Prospective cross‐sectional study.

Setting
A semi‐urban hospital and a rural health clinic in southern Malawi.

Population
Pregnant women attending the antenatal clinic for their booking visit.

Methods
Haemoglobin concentration (g/dL) measured from a capillary blood sample (fingerprick) by battery operated HemoCue machine.

Results
In urban Blantyre 57% of women were anaemic by WHO standards (haemoglobin < 11.0 g/dL) and 3.6% were severely anaemic (haemoglobin < 7.0 g/dL). The prevalence was higher in the rural area; 72% and 4.0%, respectively. Primiparae were at slightly increased risk for overall anaemia and severe anaemia but the effect of targeting this group alone for interventions would mean at least 65% of anaemic women and over half of the women with severe anaemia would be excluded. When the effect of age was examined separate from gravidity, adolescents were not found to be at increased risk of anaemia. Anaemia was more prevalent in the wet season and in women who booked late for antenatal care.

Conclusion
The prevalence of anaemia in pregnancy in our population is unacceptably high and deserves more attention. Prophylaxis of all women rather than an ‘at risk’ group based on age or gravidity is recommended.
The influence of bowel atresia in gastroschisis on fetal growth, cardiotocograph abnormalities and amniotic fluid staining
Authors: Dixon James C. , Penman David M. , Soothill Peter W.
Published: August 2005

Objectives
To investigate the relationship between intestinal atresia and fetal growth, intrapartum cardiotocograph abnormalities and staining of the amniotic fluid in gastroschisis pregnancies.

Design
Observational study of 115 gastroschisis pregnancies conceived between 1980 and 1996.

Setting
South West Region of England.

Main outcome measures
Birthweight, intrapartum cardiotocograph abnormality, staining of amniotic fluid and Apgar score.

Results
There was no statistically significant difference between the Apgar scores or the frequency of amniotic fluid staining of gastroschisis cases with or without atresia. Patent bowel gastroschisis was associated significantly with more cardiotocograph abnormalities (61%vs 26%, P= 0.026) and reduced growth (P= 0.02), when compared with cases with intestinal atresia.

Conclusions
Bile vomiting may be an important cause of amniotic fluid staining. Bowel atresia protects against the increased incidence of cardiotocograph and growth abnormality found in cases of gastroschisis which may reflect their aetiology.
Parvovirus B19 infection: association with third‐trimester intrauterine fetal death
Authors: Skjöldebrand‐Sparre Lottie , Tolfvenstam Thomas , Papadogiannakis Nikos , Wahren Britta , Broliden Kristina , Nyman Margareta
Published: August 2005

Objective
To identify the presence of parvovirus B19 infection as a possible cause of fetal loss in the third trimester.

Design
Prospective study of women experiencing third‐trimester intrauterine fetal death (IUFD).

Setting
All cases of IUFD at Danderyd Hospital from 1992 to 1998.

Population
Ninety‐three women with IUFD in 33,759 deliveries (0.3%).

Methods
Detection of B19 DNA by polymerase chain reaction (PCR) in placental and fetal tissue. Placental pathology and B19‐specific immunohistochemistry. Maternal serology in consecutive samples.

Results
Among 93 cases of IUFD, seven (7.5%) had detectable B19 DNA in freshly‐frozen placental tissue. The detection of B19 DNA in these tissues was confirmed by detection of B19 DNA in six separately stored paraffin‐embedded placental tissues. No other explanations for the fetal deaths were found. None of the women had experienced any clinical signs of infection prior to fetal demise. None of the seven fetuses were hydropic. Histopathologic examination of the placentas revealed only minor abnormalities. Serology on maternal samples at birth revealed delayed or absent B19 IgG responses in five of seven cases. Two women were B19 IgG seropositive at the time of delivery but had unusual infection patterns; persistent viraemia for at least five months before birth in one case and likely persistence or re‐infection by B19 in the other.

Conclusion
In our study, 7.5% of IUFDs in the third trimester may have been caused by parvovirus B19 infection, without signs of fetal hydrops. This finding indicates that B19 PCR should be included in the routine investigation of IUFD.
Guidelines in gynaecology: evaluation in menorrhagia and in urinary incontinence
Authors: Chadha Yogesh , Mollison Jill , Howie Fiona , Grimshaw Jeremy , Hall Marion , Russell Ian
Published: August 2005

Objective
To evaluate the effectiveness of national guidelines and local protocols in improving hospital care (process and outcome) for women with menorrhagia and for women with urinary incontinence.

Design
2×2 balanced incomplete block controlled before and after study.

Setting
Gynaecology units in four district general hospitals across Scotland.

Intervention
National guidelines were adapted locally to protocols, which were disseminated at specific local educational meetings and implemented by placing a copy of the appropriate protocol in women's hospital casenotes prior to consultation.

Population
Four hundred and ninety‐seven women with menorrhagia and 449 women with urinary incontinence.

Main outcome measures
Process of care within six key areas of clinical practice: initial hospital assessment; appropriate use of hospital investigations; inappropriate use of hospital investigations; appropriate first line treatments; appropriate pre‐surgery assessment; and use of surgical treatments. Outcome of care using condition‐specific outcome measures and four domains of SF‐36 at zero, six and twelve months following intervention.

Results
There were significant improvements with the introduction of guidelines and protocols in two (initial hospital assessment and appropriate pre‐surgery assessment) of the six key areas of clinical practice assessed. In the other areas there were no significant improvements or deteriorations observed. There was no evidence of effect of guidelines and protocols on the condition‐specific outcome measures or on the four domains of the SF‐36.

Conclusions
There were only very modest benefits observed from the introduction of guidelines and protocols on the hospital management of the two conditions. The reasons for this lack of impact of the guidelines is unclear. Experience of this study raises important methodological issues for future research in this area.
Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse
Authors: Colombo Mario , Vitobello Domenico , Proietti Fabio , Milani Rodolfo
Published: August 2005

Objective
To compare the Burch colposuspension and the anterior colporrhaphy in women with both stress urinary incontinence and advanced anterior vaginal wall prolapse (cystocele).

Design
Prospective randomised study.

Setting
Secondary referral centre, Urogynaecology Unit, San Gerardo Hospital, Monza, Italy.

Sample
Seventy‐one women undergoing surgery for primary genuine stress incontinence and concurrent grade 2 or 3 cystocele (descending at or outside the vaginal introitus).

Methods
Full urodynamic investigation performed pre‐operatively and repeated six months after surgery. Clinical follow up continued for 8 to 17 years.

Main outcome measures
Subjective (patient history) and objective (negative stress test result) cure of stress incontinence. Assessment of cystocele recurrence.

Results
Thirty (86%) of the 35 evaluable women who had the Burch colposuspension and 17 (52%) of the 33 evaluable women who had the anterior colporrhaphy were subjectively cured (OR 5.6, 95% CI 1.6 to 21.6; P= 0.005). Objective cure rates were 74% (26 of 35) and 42% (14 of 33), respectively (OR 3.9, 95% CI 1.3 to 12.5; P= 0.02). A recurrent cystocele of grade 2 or 3 with or without prolapse at other vaginal sites was recorded in 34% (12 of 35) and 3% (1 of 33) of women, respectively (OR 16.7, 95% CI 2.0 to 368.1; P= 0.003).

Conclusions
The Burch colposuspension was better in controlling stress incontinence but it lead to an unacceptable high rate of prolapse recurrence. The anterior colporrhaphy was more effective in restoring vaginal anatomy but it was accompanied by an unacceptable low cure rate of stress incontinence. Neither of the two operations is recommended for women who are suffering from a combination of stress incontinence and advanced cystocele.
An audit of the management of uterine malignancy within the West Midlands
Authors: Redman C. W. E.
Published: August 2005

Objective
To audit the management of uterine malignancy.

Design
Retrospective casenote analysis.

Setting
Cancer units/centres within the West Midlands.

Sample
The last 10 cases managed by each hospital in 1997.

Results
Ninety‐six cases of uterine malignancy from ten hospitals were analysed. Only six hospitals were able to provide a complete data set. Eighty‐eight cases (92%) presented with abnormal, usually postmenopausal, vaginal bleeding. Over 90% of the cases were primary endometrial carcinomas. Of the 15 standards audited, 11 were met by at least one hospital. No hospital met all the standards, although every hospital was able to meet at least one. Standards concerned with initial referral and diagnostic intervals were universally failed. Outpatient diagnosis was made in only 30%. The availability of Rapid Access Clinics neither promoted outpatient diagnosis nor sped up diagnosis. Once the diagnosis had been made, surgery was usually performed within six weeks.

Conclusions
This audit has provided valuable baseline data for future activity. Serious attention must be given to improvement in clinical cancer data collection. Referral pathways for women with suspected uterine cancer, and endometrial cancer in particular, need improvement. It is recommended that the current standards remain unaltered, and after the West Midlands Gynaecological Oncology Group had the opportunity to consider and implement the necessary changes, the audit be repeated.
Is ureteral endometriosis an asymmetric disease?
Authors: Vercellini Paolo , Pisacreta Anna , Pesole Antonella , Vicentini Sarah , Stellato Giovanna , Crosignani Pier Giorgio
Published: August 2005

Six cases of endometriosis obstructing the left ureter were observed among 1054 consecutive patients undergoing surgery in an eight‐year period. In addition, 125 women with ureteral endometriosis (left‐sided, n= 66; right‐sided, n= 40; bilateral, n= 19) were described in 62 articles identified in a systematic review of the English language literature between 1980 and 1998. Considering only the patients with unilateral ureteral endometriosis and combining the published figures with those of our surgical series, the observed proportion of left lesions (72/112, 64%; 95% CI 55% to 73%) was significantly different from the expected proportion of 50% (χ2i, 9.14, P= 0.002). The lateral asymmetry found in the location of ureteral endometriosis is compatible with the menstrual reflux theory and with the anatomical differences of the left and right hemipelvis
High risk human papillomavirus in women with normal cervical cytology prior to the development of abnormal cytology and colposcopy
Authors: Hopman E. H. , Rozendaal L. , Voorhorst F. J. , Walboomers J. M. M. , Kenemans P. , Helmerhorst Th. J. M.
Published: August 2005

Objective
To study the significance of the presence of high risk human papillomavirus (HPV) in women with initially normal cervical cytology for the development of abnormal cytology and an abnormal colposcopic impression.

Design
Prospective, observational study

Participants and methods
Sixty‐eight women with cytomorphologically normal smears and at least one positive HPV test result were evaluated every six months by cytology, colposcopy and HPV testing. The endpoint of the study was abnormal cervical cytology.

Results
The median time of follow up from the first positive HPV test was 34 months. A total of 17 women developed abnormal cytology, of whom 16 (94%) had persistence of a high risk HPV infection. Women with persistent high risk HPV were more likely to develop abnormal cervical cytology than women without high risk HPV (hazard ratio 28.2, 95% CI 3.72–215.2); they also had an increased risk of developing an abnormal colposcopic impression (hazard ratio 4.4, 95% CI 1.69–11.7). Among the 17 women with abnormal cytology, high grade dysplasia was histopathologically demonstrated in eight women.

Conclusion
Persistent presence of high risk HPV in normal cervical smears is associated with a significantly increased risk of developing abnormal cytology and to a lesser degree with developing an abnormal colposcopic impression.
A randomised double‐blind placebo‐controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy
Authors: Lau W. C. , Tam W. H. , Lo W. K. , Yuen P. M.
Published: August 2005

Objective
To assess whether transcervical intrauterine instillation of local anaesthetic agent reduces pain during diagnostic outpatient hysteroscopy and endometrial biopsy.

Design
Prospective, randomised, double blind, placebo‐controlled trial.

Setting
Outpatient hysteroscopy clinic in a university teaching hospital.

Population
Ninety women undergoing outpatient diagnostic hysteroscopy with or without endometrial biopsy.

Methods
Transcervical intrauterine instillation of 5 mL of 2% lignocaine into the uterine cavity before performing the procedure.

Main outcome measures
Evaluation of pain at different stages of the procedure using a visual analogue scale and changes in blood pressure and heart rate.

Results
The use of local anaesthetic did not alleviate pain experienced during hysteroscopy and endometrial biopsy. It did not prevent the occurrence of vaso‐vagal reactions; however the incidence of these was low.

Conclusions
Transcervical instillation of local anaesthesia neither reduced pain nor prevented vasovagal reaction during hysteroscopy and endometrial biopsy.
Effect of SR49059, an orally active V1a vasopressin receptor antagonist, in the prevention of dysmenorrhoea
Authors: Brouard R. , Bossmar T. , Fournié‐Lloret D. , Chassard D. , Åkerlund M.
Published: August 2005

Objective
To investigate the clinical effect of SR49059 when given shortly before the onset of menstruation as a preventative treatment of dysmenorrhoea.

Design
A double‐blind, randomised, placebo‐controlled, cross‐over trial in complete block design (three periods, three treatments).

Setting
A clinical research organisation in Paris, France.

Participants
Women aged 18–35 years suffering from primary dysmenorrhoea.

Interventions
In each of three menstrual cycles, women reported to the study centre and were given a daily dose of either placebo, 100 mg or 300 mg SR49059 from a minimum of 4 hours up to a maximum of three days before the onset of bleeding and/or menstrual pain. If this did not control the pain, women were allowed once a day to take a second dose of study treatment providing that at least 4 hours had passed since the first drug intake.

Main outcome measures
Intensity of menstrual pain recorded by means of a visual analogue scale. Rating of symptoms of dysmenorrhoea (mainly back and pelvic pain) in relation to functional capacity (Sultan score). Self‐assessment of menstrual blood loss in a menstrual diary record.

Results
Analysis of intensity of menstrual pain, as recorded by visual analogue scale and Sultan pain score (back and pelvic pain) during the first 24 hours of dysmenorrhoea, showed a dose‐related effect of SR49059. The 300 mg dose of SR49059 was significantly more effective than placebo. Similarly, a dose‐related effect of SR49059 was shown on total Sultan score. SR49059 was well tolerated and no significant effect on the bleeding pattern was noted.

Conclusions
This study showed for the first time a therapeutic effect of an orally active vasopressin V1a receptor antagonist in the prevention of dysmenorrhoea. Further studies are required to examine effect mechanisms and determine effective doses.
Car seatbelts in pregnancy: the practice and knowledge of pregnant women remain causes for concern
Authors: Johnson Helen C. , Pring David W.
Published: August 2005

Objective
To evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy.

Design
A structured questionnaire.

Setting
District hospital antenatal clinic.

Participants
Two hundred pregnant women attending for their routine mid‐pregnancy anomaly scan.

Main outcome measures
The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems.

Results
One hundred fifty‐nine women (80%) completed the questionnaire. Ninety‐eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information (P= 0.03). Thirty‐nine percent had an airbag system fitted and one woman had de‐activated it. Fifty‐eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted.

Conclusions
Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage.
Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants
Authors: Kurkinen‐Räty Merja , Koivisto Maila , Jouppila Pentti
Published: August 2005

Objective
To assess maternal morbidity, and neonatal outcome and especially long term sequelae in infants born preterm due to maternal or fetal indications.

Design
Analysis of retrospective cohort.

Setting
Oulu University Central Hospital, Finland.

Population
One hundred and three women, who were between the 24th and the 33rd week of pregnancy, delivered by caesarean delivery because of maternal or fetal indications. They were matched with 103 women who had spontaneous preterm delivery at corresponding gestational weeks between 1990–1997.

Main outcome measures
Maternal morbidity, reasons for caesarean delivery, neonatal mortality and morbidity rates, and later development of the infants.

Results
Pre‐eclampsia was diagnosed in 57% of the women in the indicated group and only in one woman in the control group. All infants in the indicated group and almost a third in the control group were born by caesarean birth; the main indication was threatening fetal asphyxia. There was a significant difference in neonatal mortality rates between the groups (175 vs 78 per thousand live births in the indicated vs control infants; RR 2.3, 95% CI 1.02, 4.9) and the main cause of death was respiratory insufficiency: 64% in the indicated group and 22% in the controls; RR 2.9, 95% CI 0.8, 10. Respiratory distress syndrome occurred more often (73%vs 53%, RR 1.4, 95% CI 1.1, 1.7) and it was more severe and more complicated in infants in the indicated group, compared with those in the control group. Symptomatic chronic lung disease at one year of age was more common in infants in the indicated group than in the control group (15%vs 3%; RR 4.6, 95% CI 1.4, 15.9).

Conclusions
Not only the risks of neonatal mortality and morbidity but also long term pulmonary consequences, appear to be greater in infants born preterm by indicated delivery than in preterm infants born spontaneously at corresponding weeks.
Uteroplacental blood flow and placental vascular endothelial growth factor in normotensive and pre‐eclamptic pregnancy
Authors: Simmons Lisa A. , Hennessy Annemarie , Gillin Adrian G. , Jeremy Richmond W.
Published: August 2005

Objective
To determine whether placental vascular endothelial growth factor (VEGF) is increased in pre‐eclampsia.

Design
Prospective cohort study.

Setting
Royal Prince Alfred Hospital, Sydney, Australia.

Sample
Eleven normotensive women and eight women with pre‐eclampsia matched for age and gestation.

Methods
Uterine artery Doppler ultrasound flow velocity profiles were recorded in the third trimester and resistance index calculated as (Vs‐Vd)/Vs (Vs= peak systolic flow velocity, Vd= end diastolic flow velocity). Placental tissue at delivery was examined for VEGF distribution with avidin‐biotin‐peroxidase immunohistochemistry.

Results
Uterine resistance index [median (range)] was significantly increased in pre‐eclamptic women (normotensive: 0.42 (0.36–0.51); pre‐eclampsia: 0.59 (0.40–0.75); P= 0.005). Notching of the uterine artery waveform, consistent with a high resistance circulation, was evident in early diastole in five women with pre‐eclampsia but only one normotensive woman (P= 0.013). Placental VEGF was increased in women with pre‐eclampsia in the decidual trophoblast (normotensive: 34% (4–59) cells stained for VEGF; pre‐eclampsia: 58% (15–95); P= 0.033) and in the villous syncytiotrophoblast (normotensive: VEGF count 1.4 arbitrary units (1.1–2.1); pre‐eclampsia: 1.8 arbitrary units (1.4–2.2); P= 0.041). Analysis indicated that uterine artery resistance index was directly correlated with placental VEGF staining, mean arterial pressure and birthweight.

Conclusions
Abnormal uterine artery Doppler ultrasound flow velocity profiles in pre‐eclampsia indicate increased uteroplacental resistance. The associated increase in placental VEGF may represent a compensatory mechanism attempting to restore blood flow towards normal.
The effect of local anaesthetic spray on the pain associated with local anaesthetic injection, prior to biopsy or loop diathermy to the cervix in the outpatient colposcopy clinic
Authors: Connell R. J. , Creighton S. M. , Cutner A.
Published: August 2005

We evaluated the effectiveness of local anaesthetic spray prior to injection of local anaesthetic before biopsy or large loop excision of the transformation zone of the cervix at colposcopy. This was a prospective, randomised, double‐blind placebo‐controlled study involving 51 women. Pain or discomfort was measured using a four‐point categorical scale and a visual analogue score. Our results show that the use of local anaesthetic spray has no effect on the pain or discomfort experienced by patients having local anaesthetic injections to the cervix, and cannot be recommended.
Serum CA125 at 11–14 weeks of gestation in women with morphologically normal ovaries
Authors: Aslam Naaila , Ong Charas , Woelfer Brigitte , Nicolaides Kypros , Jurkovic Davor
Published: August 2005

In a number of pregnant women ovarian cysts are found incidentally during the routine first trimester scan. These cysts may pose diagnostic difficulties, and the measurement of serum CA125 levels can be used to aid management. In this study we measured maternal serum CA125 levels in 188 women with uncomplicated pregnancies between 11–14 weeks of gestation. All women had morphologically normal ovaries observed on ultrasound examination. The median serum CA125 levels were 23.4 U/mL (range 2.2–166.3 U/mL, 95% reference interval 5.28–70.15) and did not change significantly with gestation. We conclude that CA125 levels are increased at 11–14 weeks of gestation and cut off values which are used to assess the nature of ovarian cysts in nonpregnant women cannot be applied to pregnant women at this gestation.
Neonatal alloimmune thrombocytopenia due to anti‐HPA 1a antibodies; the level of maternal antibodies predicts the severity of thrombocytopenia in the newborn
Authors: Jægtvik S. , Husebekk A. , Aune B. , Øian P. , Dahl L. B. , Skogen B.
Published: August 2005

Eleven thousand one hundred pregnant women were genotyped for human platelet antigen HPA 1, and 198 HPA 1bb women were followed in the pregnancy with quantitative assay for anti‐HPA 1a antibodies. Antibodies were detected in 24 women, and nine children were born with severe thrombocytopenia (< 50×109/L). All mothers with high levels of antibodies were delivered of children with severe thrombocytopenia. None of the newborn infants had clinical signs of intra‐cranial haemorrhage. The level of maternal anti‐HPA 1a antibodies is predictive for fetal thrombocytopenia and may be used in decisions related to time and mode of delivery.
Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically?
Authors: Heath Victoria , Chadwick Victoria , Cooke Inez , Manek Sanjiv , MacKenzie I. Z.
Published: August 2005

Objective
To assess the value of routine histological examination of tissue samples collected at termination of pregnancy in the first trimester and emergency surgical uterine evacuation.

Setting
The gynaecological department of a teaching hospital.

Design
Prospective study of women attending the gynaecological department in a 12‐month period.

Participants
All women undergoing a therapeutic first trimester medical or surgical abortion or an emergency surgical evacuation of a failed pregnancy, suspected incomplete spontaneous miscarriage or incomplete induced abortion.

Main outcome
Association of pre‐operative clinical diagnosis and the post‐operative histological result.

Results
Of 1576 women studied, the histological report confirmed that products of conception were obtained in 1465 (93%); in two women (0.13%) molar changes were reported confirming the pre‐operative diagnosis by ultrasound. Products of conception were not confirmed in the tissue specimens in 0.5% medical terminations, 5% surgical terminations, 10% evacuations following a previous evacuation, 12% evacuations for a failed pregnancy, and 19% evacuations for an incomplete miscarriage. In 87 women (6%), decidua was reported; two of these women had undergone an evacuation for an ultrasound diagnosis of spontaneous miscarriage, but in both a tubal ectopic pregnancy was subsequently diagnosed.

Conclusion
There did not appear to be any obvious benefit from routine histological examination of tissue removed at termination of pregnancy or emergency uterine evacuation. The histological result was sometimes not consistent with the pre‐operative diagnosis and may result in unnecessary further investigation and treatment unless due consideration is given to the clinical presentation.
Social and behavioural influences on the uptake of hormone replacement therapy among younger women
Authors: Kuh Diana , Hardy Rebecca , Wadsworth Michael
Published: August 2005

ObjectiveTo describe the social and behavioural influences on the uptake of hormone replacement therapy before the age of 50.

DesignNationally representative birth cohort study with detailed hormone replacement therapy histories and prospective data on health, social and behavioural factors collected throughout life.

SettingEngland, Scotland and Wales.

PopulationGeneral population sample of 1572 women followed to the age of 50 years.

Main outcome measureAge at first hormone replacement therapy use

ResultsBy the age of 50 years, 45% of women had tried hormone replacement therapy and one third were current users. Over two‐fifths of users had tried more than one preparation and over one quarter had episodic use. For the vast majority, prescribing conformed to current guidelines. More educated women took hormone replacement therapy for long term prevention compared with their less educated peers. Hysterectomy increased the chances of taking hormone replacement therapy, particularly where an oophorectomy had also been performed, and was associated with longer and more continuous use. Results of a Cox's proportional hazards model showed that the age at which first hormone replacement therapy is used by women who have not had a hysterectomy was influenced by previous contact with health services for menstrual disorders, previous use of oral contraception and cigarettes, past reporting of health problems and low social class. The relation between smoking and low social class with early use of hormone replacement therapy may be due to their association with early menopause.

ConclusionsThe trend over the last two decades towards greater use of hormone replacement therapy has continued unabated for younger women. So far, hormone replacement therapy users in this generation have had less healthy lifestyles and social advantages than nonusers, in contrast to many older mainly American studies based on earlier generations. This may have long term implications for health and health care as the postwar baby boom generation ages.
The transplacental transfer of the macrolide antibiotics erythromycin, roxithromycin and azithromycin
Authors: Heikkinen Tuija , Laine Kari , Neuvonen Pertti J. , Ekblad Ulla
Published: August 2005

Objective
To investigate the transplacental transfer of the macrolide antibiotics erythromycin, roxithromycin and azithromycin.

Methods
Twenty‐one term placentas were obtained with maternal consent immediately after delivery and a two‐hour nonrecirculating perfusion of a single placental cotyledon was performed. Erythromycin (2 μg/mL), roxithromycin (2 μg/mL) and azithromycin (0.3 μg/mL) were infused to the maternal inflow at a constant rate, with antipyrine as a reference compound, and their appearance in the fetal circulation was followed. Drug concentrations were measured by high performance liquid chromatography for 120 min.

Results
The mean transplacental transfers (TPTss) for erythromycin, roxithromycin and azithromycin were 3.0%, 4.3% and 2.6%, respectively, calculated as the ratio between the steady state concentrations in fetal venous and maternal arterial sides. Similar results were obtained when the TPT was calculated as the absolute amount of drug transferred across the placenta during 2‐hour perfusion (TPTA). No significant differences were found among the three macrolides in TPTSS (P= 0.39) or TPTA (P= 0.35). The TPTSS of erythromycin, roxithromycin and azithromycin were 41%, 35% and 32% of the freely diffusable reference compound antipyrine, respectively. Steady state was reached in 60 minutes in each perfusion indicating sufficient perfusion time.

Conclusion
The limited transplacental transfer of erythromycin, roxithromycin and azithromycin suggests compromised efficacy in the treatment of fetal infections. On the other hand, the placenta seems to produce an effective barrier reducing the fetal exposure when these three macrolides are used to treat maternal infections.