bluuebunny/crossref_metadata_2025 huggingface dataset:
The outcome of pregnancy after CO2 laser conisation of the cervix
Authors: Hagen Bjørn , Skjeldestad Finn Egil
Published: August 2005

Objective
To investigate the effect of laser conisation of the cervix on the outcome of subsequent pregnancy.

Design
Case‐control study.

Setting
Department of Obstetrics & Gynaecology, University Hospital, Trondheim, Norway.

Subjects
Three hundred and fifty‐one women were treated for cervical intra‐epithelial neoplasia (CIN) by laser conisation of the cervix between 1 January 1983 and 31 December 1985. The 56 women among them who had been delivered of live infants beyond 22 weeks gestation after the conisation and before 1 January 1991 were studied for the outcome of their pregnancies. For each case, two controls of equal parity and age (±3 years) were selected.

Main outcome measures
The length of gestation and birthweight of the infants.

Results
The median (range) length of gestation was 39 weeks (26–43) in cases compared with 40 weeks (34–42) in controls (z=−4.0, P<0.001). The median (range) birthweight was 3330 g (1150–4940) in cases and 3630 g (1610–5080) in controls (z=−3.5, P<0.001). Overall 38% of cases were delivered preterm (≤37 weeks gestation), compared with 6% of controls (P<0.0001; odds ratio 9.0, 95% CI 3.7–21.7). A logistic regression analysis of a set of possible confounding factors revealed no significant risk factors in addition to conisation for the occurrence of preterm delivery. No correlation was found between the height of the cone and the occurrence of preterm delivery in subsequent pregnancy.

Conclusion
Conisation with microsurgical laser technique increases the risk of preterm delivery in subsequent pregnancies. Laser conisation in young women should be restricted to those with high grade CIN or a lesion extending into the endocervical canal.
A comparison of bioelectrical and mechanical activity of the female urethra
Authors: Barnick C. G. W. , Cardozo L. D.
Published: August 2005

Objective
To determine the relationship between mechanical function and innervation of the urethra in order to clarify the effect of denervation and re‐ennervation on urethral function.

Design
Prospective observational study.

Setting
Tertiary referral urodynamics unit.

Subjects
Thirty‐six women, 21 with urinary symptoms and urodynamically proven genuine stress incontinence and 15 without urinary symptoms.

Interventions
All women underwent concentric needle electromyography of the urethral sphincter and urethral pressure profilometry at rest and during cough induced stress.

Results
Significant correlations were found between variables indicating denervation and reinnervation and improved resting urethral function. No correlation was found between these variables and urethral function under stress.

Conclusions
Our findings contradict current opinion that denervation of the urethral sphincter is associated with a reduction in the sphincteric function of the urethra, at rest or during stress, and suggest that denervation cannot therefore be a major aetiological factor in the development of genuine stress incontinence.
The predictive value of uterine artery flow velocity waveforms in miscarriage in older women
Authors: van den Elzen H. J. , Cohen‐Overbeek T. E. , Grobbee D. E. , Wladimiroff J. W.
Published: August 2005

Objective
To determine whether uterine artery blood flow velocity measurements can predict miscarriage in older women.

Design
Prospective study.

Subjects
Three hundred and ninety‐three women aged 35 years and older in the first trimester of pregnancy.

Main outcome measures
Miscarriage, genetic abortion, pulsatility index (PI), maternal age, gestational age at intake.

Results
Twenty women miscarried; 10 pregnancies were terminated because of chromosomal anomalies. Maternal age and gestational age at intake were significantly associated with miscarriage rate (P= 0.01 and P= 0.001, respectively). Uterine artery PI values declined significantly during the first trimester (P= 0.001). However, no association was found between uterine artery PI values and miscarriage rate. PI, maternal age and gestational age at intake were not essentially different between women who miscarried before or after chorionic villus sampling. No association was found between PI, maternal age, and gestational age at intake and genetic abortion rate.

Conclusions
Uterine artery blood flow velocity waveforms, as expressed by the pulsatility index, bear no relation to miscarriage.
The assessment of clinical competence in obstetrics and gynaecology in two medical schools by an objective structured clinical examination
Authors: McFaul P. B. , Taylor D. J. , Howie P. W.
Published: August 2005

Objective
To compare and assess clinical competence among final year students in two British medical schools using a standardised objective structured clinical examination (OSCE) in obstetrics and gynaecology.

Design
A comparative study of an OSCE with stations designed to test student abilities in history‐taking, physical examination, interpretation of data or results, interpersonal skills, practical procedures, as well as factual knowledge.

Subjects
Two groups of final year medical students from two British medical schools.

Methods
An OSCE of 26 stations.

Results
The standardised OSCE was simple to organise and conduct once the content had been decided. Analysis of the results revealed significant differences in mean marks between the two sets of students in six stations, and in eight stations the mean score was less than five for one or other sets of students. The reasons for the differences between the medical schools and the poor performance of the students at some stations were investigated and possible causative factors identified.

Conclusions
We have shown that an OSCE is suitable for testing clinical competence of students within and across medical schools, is able to highlight differences in standards between institutions, and can identify areas where teaching methods and/or course content are deficient.
Doppler ultrasound screening as part of routine antenatal scanning: prediction of pre‐eclampsia and intrauterine growth retardation
Authors: Bower Sarah , Schuchter Katharina , Campbell Stuart
Published: August 2005

Objective
To assess the value of incorporating continuous wave Doppler ultrasound of the uterine arteries into the routine scan as a screening test in an unselected population.

Design
A cross sectional study by multiple operators using continuous wave Doppler ultrasound to obtain flow velocity waveforms (FVW) from both uterine arteries of all women attending for routine anomaly scan at 18 to 22 weeks over a period of 12 months. An abnormal FVW in either uterine artery was used to predict intrauterine death, antepartum haemorrhage and three different degrees of severity of preeclampsia and growth retardation, singly and in combination.

Setting
King's College Hospital, London.

Subjects
Two thousand, four hundred and thirty women attending for routine anomaly ultrasound scan.

Results
A total of 2430 women were scanned with a 90% follow up rate. The results demonstrate higher sensitivities than previous studies, but with a high proportion of false positive tests. By including an early diastolic notch in the definition of an abnormal FVW the prediction of pre‐eclampsia is markedly improved; the relative risk to a woman with an abnormal waveform of developing moderate or severe pre‐eclampsia is increased 24‐fold. Although the positive predictive value for babies less than the 5th centile for gestation is only 15%, those at risk of neonatal complications may be identified.

Conclusion
This simple test can be performed at a routine visit and a group of women can be identified for further assessment and possible therapeutic intervention.
A loading model for ritodrine administration in preterm labour
Authors: Holleboom C. A. G. , Merkus J. M. W. M. , van Elferen L. W. M. , Keirse M. J. N. C.
Published: August 2005

Objective
To develop a ritodrine infusion scheme for preterm labour that avoids plasma levels above those needed for tocolysis, requires only one rate adjustment, and is easy to apply in practice.

Design
Prospective study of tocolytic effect and plasma ritodrine concentrations during application of the infusion scheme.

Setting
High risk labour ward.

Subjects
Consecutive series of 31 women in labour at less than 36 weeks' gestation.

Intervention
Loading dose ritodrine infusion followed, as soon as tocolysis is reached, by a decrease in the infusion rate calculated on the basis of the interval between start of treatment and tocolysis.

Results
Overall, steady state ritodrine levels were nearly identical to those at the time of tocolysis and correlated well with levels anticipated on the basis of our calculation (n= 30; r= 0.91; P <0.001). Adjustments during steady state were made in 12 women (40%), but in only two of them within 12 h after tocolysis had been reached. Delivery was postponed for more than 48 h in 29 women (93.5%) and beyond 37 weeks' gestation in 19 (61.3%).

Conclusion
The loading model is easy to apply, avoids relative overdoses, requires few adjustments, is well tolerated, uses smaller quantities of ritodrine, and results in lower plasma ritodrine concentrations than the conventional infusion scheme.
Classifying perinatal death: experience from a regional survey
Authors: Settatree Ralph S. , Watkinson Michael
Published: August 2005

Objective
To examine problems encountered in classifying perinatal death using the systems proposed by Hey et al. (1986) and Cole et al. (1986).

Subjects
451 deaths from a regional perinatal mortality survey of which 293 had a post mortem examination.

Methods
Documents from each death were reviewed by four assessors, one from each discipline, selected randomly from a pool of obstetricians, paediatricians, general practitioners and midwives. Each assessor classified the cause of death blind to the others. The degree of agreement between assessors was calculated for the full and shortened obstetric and fetal‐neonatal classifications using the kappa statistic for inter‐rater agreement.

Results
The kappa statistic, which is a measure of the proportion of agreement above chance, gave a value of 0.55 for the full obstetric classification and 0.58 for the full fetal and neonatal classification when all four assessors made an assignment. An assignment was omitted in 6.2%, but the kappa value of zero for these omissions suggested that this was a nonsystematic result due to random protocol violations. The grouped (shortened) classifications generated a higher kappa value of 0.62 for the nine point obstetric system and 0.67 for the six point fetal and neonatal (New Wigglesworth) system. Post mortem had little effect on agreement. The best agreement levels observed were for congenital anomaly.

Conclusion
This survey highlighted the complexity of the 22 and 24 point classifications, the uneven distribution of deaths within their categories, and the variable levels of agreement between professionals classifying deaths, thus questioning the validity of individual maternity units of health districts generating local data in this degree of detail for comparative purposes in regional and national statistics. Grouping the original categories led to greater agreement particularly for the New Wigglesworth classification. The role of post mortems in clarifying the cause of fetal and neonatal death needs further investigation.
Randomised comparison of routine versus highly selective use of Doppler ultrasound in low risk pregnancies
Authors: Mason G. C. , Lilford R. J. , Porter J. , Nelson E. , Tyrell S.
Published: August 2005

Objective
To help answer the question: should Doppler ultrasound of the umbilical circulation be made available to all pregnant women as part of their routine antenatal care?

Design
A randomised trial.

Setting
St James's University Hospital, Leeds.

Subjects
2025 low risk primigravid women.

Main outcome measures
Obstetric intervention rates and short term neonatal morbidity.

Results
The incidence of abnormal Doppler was low (1.7%) with complete absence of end diastolic flow in only 0.3% of cases. No significant differences could be demonstrated between control and study women in any of the outcomes measured.

Conclusion
This study did not demonstrate any benefit or harm from Doppler ultrasound as a routine screening test for all low risk women, whereas our previous studies have suggested that it is useful in high risk pregnancies. Any marginal returns on extending access to Doppler ultrasound from high risk to all women must be small. Since this test has excellent performance characteristics (sensitivity and specificity) for the prediction of fetal hypoxia and acidosis our results call into question the cost to benefit ratio of all tests designed to predict these outcomes in low risk women.
Early discharge following vaginal hysterectomy
Authors: Hancock Karl W. , Scott James S.
Published: August 2005

Objective
To assess the feasibility of discharging selected patients home within 72 h of vaginal hysterectomy.

Design
Women for whom vaginal hysterectomy was planned and who were invited to take part. Those who accepted were visited at home by a staff nurse experienced in gynaecology to assess home conditions and family support. If these were suitable, the general practitioner was informed and invited to comment. If the operation was uneventful women were discharged on the third post operative day and visited at home by the nurse until the seventh day.

Setting
Leeds Western Health Authority.

Main outcome measures
The number of minor complications requiring treatment by the general practitioner, the readmission rate and the acceptability to the woman and her family.

Results
For 11 out of 61, home conditions proved unsuitable for early discharge. In six of the remaining 50, abdominal hysterectomy proved preferable to vaginal. Thirty women were discharged home on the third day after vaginal hysterectomy, five on the fourth and seven on the fifth. Two developed urinary tract infections, treated by their general practitioners. Two required readmission to hospital. Twenty‐eight of 30 discharged on the third post operative day and nine of 12 discharged on the fourth or fifth post operative day were enthusiastic about the scheme.

Conclusions
Early discharge following uncomplicated vaginal hysterectomy in selected patients appears to be a safe procedure, appreciated by the majority of women. Its adoption as a routine procedure would enable the surgical throughput in a unit to be maintained on a smaller bed complement.
Maintained bone density at advanced ages after long term treatment with low dose oestradiol implants
Authors: Naessén Tord , Persson Ingemar , Thor Leif , Mallmin Hans , Ljunghall Sverker , Bergström Reinhold
Published: August 2005

Objective
To investigate whether the bone preserving effect of low dose oestrogen replacement therapy (20 mg oestradiol implanted subcutaneously every six months) persists during continuous long term treatment through advanced ages.

Design
Cross sectional clinical study of postmenopausal women treated with oestradiol implants as compared with nonusers matched for age.

Setting
Outpatient research unit at a university hospital.

Subjects
Thirty‐five women with a mean age of 67 years (range 47–83 years) at the time of investigation who, after a prior hysterectomy, had been treated with oestradiol implants for climacteric symptoms for a mean period of 16 years (range 5.5–31 years). The results were compared with those in women matched for age and without any diseases or medications known to affect the bone metabolism.

Main outcome measures
Bone mineral densities (BMD) in the distal forearm, vertebrae and hip analysed by study group, age and duration of treatment.

Results
Implant users had a median serum oestradiol concentration in the luteal range, 313 (range 126–1711) pmol/1, and premenopausal levels of follicle stimulating hormone (FSH). All women except one who were given the standard dose at the standard intervals had serum oestradiol levels below 650 pmol/1. Compared with nonusers, women treated with oestradiol implants had 20 to 25% higher BMD at all measurement sites: distal radius (P<0.0001), lumbar vertebrae (P<0.0002) and femoral neck (P<0.0001). These differences also remained after adjustment for potential confounders (height, age at menarche, parity, smoking habits, physical exercise and education) (P<0.01 at all sites). In a multiple regression analysis the negative effect of advancing age was more than compensated by the positive effect of increasing treatment duration with a higher BMD at all measurement sites in women with a longer as compared with shorter, duration of treatment; the regression coefficients were significant (P<0.05) in the spine and hip measurements.

Conclusions
Continuous long term treatment with low dose oestradiol implants yielding physiological levels of serum oestradiol preserves both compact and cancellous bone and the effect seems to persist into advanced ages without any inevitable age related bone loss.
Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years' experience with a see‐and‐treat policy
Authors: Loobuyck Henk A. , Duncan Ian D.
Published: August 2005

Objective
To assess the efficacy of the Semm Cold Coagulator (100°C) for CIN 1 and 2 applying a ‘see and treat’ policy.

Design
Retrospective review of women with CIN 1 and 2 seen and treated at their first visit when specific criteria were satisfied.

Setting
Colposcopy Clinic, Ninewells Hospital, Dundee.

Subjects
485 women with CIN 1 and 680 women with CIN 2 confirmed by colposcopically directed biopsy and treated between 1 January, 1978 and 31 December, 1990.

Results
Overall, a 96.7% primary success rate with a single treatment (97.1% for CIN 1, 96.5% for CIN 2) and 99% overall success rate after one or more treatments with the cold coagulator. None of the women developed micro‐invasive or invasive cancer and only 1.1% developed CIN 3. In 98.3% treatment was undertaken at their first and only colposcopy clinic attendance. Heavy vaginal bleeding occurred in 1.5% after treatment and 0.6% complained of a heavy vaginal discharge. One woman developed cervical stenosis which required dilatation because of dysmenorrhoea.

Conclusion
Cold coagulation at 100°C of CIN 1 and 2 proven by colposcopically directed biopsy using a ‘see and treat’ policy subject to specific conditions is a safe, cost effective, practical approach. It is more likely to return the cervix to sustained normality than withholding treatment and simply maintaining cytological surveillance, and it should prevent some of the invasive cancers that have been described in reports of management by cytological surveillance.
Plasma prostaglandin metabolite concentrations in normal and dysfunctional labour
Authors: Johnston Tracey A. , Greer Ian A. , Kelly Rodney W. , Calder Andrew A.
Published: August 2005

Objective
To determine the concentrations of the metabolites of prostaglandin E2 (PGEM) and of prosta‐glandin F2α (PGFM) prior to the onset of labour and during spontaneous labour, and to correlate the changes in concentrations of these metabolites with labour outcome.

Design
Longitudinal study throughout labour.

Setting
Labour ward of a large maternity unit.

Subjects
Seven primigravid and 11 parous women in the late third trimester with no signs of labour, and 17 primigravid and 11 parous women in spontaneous labour.

Interventions
Six of the primigravid women required augmentation with oxytocin because of dysfunctional labour.

Results
Before labour, parous women had significantly higher concentrations of both PGEM (P<0.007) and PGFM (P<0.006) compared with primigravid women. During labour, PGFM concentrations were significantly higher in both primigravid (P<0.0002) and parous (P<0.0001) women compared with the concentrations of these metabolites in women not in labour; the same was true for PGEM in primigravid (P<0.003) but not in parous (P= 0.1) women. There was a small but significant increase (P<0.02) in PGEM as labour progressed in both the normal groups. Amniotomy was associated with a significant increase in PGFM in primigravid and parous women (P<0.002 and P<0.009, respectively). The concentration of PGFM one hour following amniotomy correlated inversely with the amniotomy to delivery interval in both the normal primigravid (r=−0.624; P= 0.04) and the parous (r= 0.745; P= 0.021) groups. Women with dysfunctional labour showed no significant rise in PGEM or PGFM. Their PGFM concentrations were significantly lower than those seen in normal labour (P<0.05). The concentration of PGFM in cord blood was significantly higher (P<0.0001) in the parous women who laboured than in women delivered by elective caesarean section. There was no difference in the corresponding concentrations of PGEM (P= 0.9).

Conclusions
These data show that spontaneous labour is associated with increased concentrations of prostaglandin metabolites in the maternal plasma, and are consistent with PGF2α being an important stimulator of uterine contractility, with a relative deficiency of PGF2α being associated with dysfunctional labour.
The use of free β‐hCG in antenatal screening for Down's syndrome
Authors: Wald Nicholas , Densem James , Stone Rossana , Cheng Raymond
Published: August 2005

Objective
To investigate the value of the measurement of free β human chorionic gonadotrophin (hCG) as a serum marker of Down's syndrome in the second trimester of pregnancy.

Design
A prospective observational study using stored antenatal serum samples.

Setting
Serum samples collected from women receiving routine antenatal care in Oxford.

Subjects
Seventy‐five singleton pregnancies with fetal Down's syndrome and 367 unaffected singleton pregnancies. Each affected pregnancy was matched with five control pregnancies for maternal age, gestational age, and duration of storage of the serum sample. None of the pregnancies were associated with neural tube defects.

Main study measures
Maternal serum free β‐hCG levels. These were compared with total hCG levels in the same pregnancies. The performance of screening using free β‐hCG was compared with that using the principal markers, namely alpha‐fetoprotein (AFP), unconjugated oestriol (uE3), and total hCG together with maternal age.

Results
The median free β‐hCG level in the affected pregnancies was 2.22 multiples of the normal median (MoM), significantly higher than in the unaffected pregnancies (95% confidence interval, 1.84–2.68 MoM). The discriminatory performances of free β‐hCG and total hCG, each considered separately, were similar; with a cut‐off level of 2.5 MoM the detection rate was 43% and 5.7% of unaffected pregnancies had raised free β‐hCG levels (likelihood ratio of 7.5 (43/5.7)), somewhat better discrimination than the 32% and 4.6% respectively using total hCG (likelihood ratio of 7.0 (32/4.6)). With a higher cut‐off level of 3.5 MoM, the rates were 19% and 2.7% respectively (likelihood ratio of 7.0), using free β‐hCG, worse than the 19% and 1.4% using total hCG (likelihood ratio of 13.6). Screening using maternal age, AFP, uE3 and free β‐hCG (instead of total hCG) yielded a detection rate of 62% (instead of 58%) at a screening risk cut‐off level corresponding to a 5% false‐positive rated).

Conclusion
The main advantage in using free β‐hCG instead of total hCG is that there is a small increase in the detection rate (4%) for a given false‐positive rate when used with maternal age, AFP and uE3. The main disadvantage is that there is less practical experience with free β‐hCG measurement and insufficient data to screen in certain categories of pregnancy (e.g., twins). The best practical advice is to use total hCG for the present but consider changing to free β‐hCG either (i) after further data are available that will permit the interpretation of screening results in the same way as is currently available with total hCG, or (ii) if its use with another marker confers a worthwhile increase in the detection rate for a given false–positive rate.
The value of cytology and colposcopy in the follow up of cervical intraepithelial neoplasia after treatment by laser excision
Authors: Mahadevan N. , Horwell D. H.
Published: August 2005

Objective
To determine the value of colposcopic assessment in the follow up of cervical intraepithelial neoplasia (CIN) treated by laser excision.

Design
Retrospective analysis of case records of women with CIN treated by laser excision over the period 1986 to 1990.

Setting
A colposcopy clinic in a district general hospital.

Subjects
Five hundred‐forty consecutive patients with either CIN or microinvasion diagnosed on laser excision specimens.

Results
Of 452 patients followed up for 10 months, 14 were diagnosed as having persistent CIN. Eleven of these were detected at the first follow up visit at four months using both colposcopic and cytological assessment. Elimination of colposcopic assessment in follow up would have reduced the number detected to five patients.

Conclusion
For patients undergoing laser excision for CIN involving the endocervical canal, a normal initial, post‐treatment colposcopy is necessary before surveillance may be reduced to cytology alone.
The effect of the oxytocin antagonists, CAP 476 and F327, on calcium mobilisation in single cultured human myometrial cells
Authors: Thornton S. , Gillespie J. I. , Anson L. C. , Greenwell J. R. , Melin P. , Dunlop W.
Published: August 2005

Objective
To investigate the mechanism of action of the oxytocin (OT) antagonists, CAP 476 and F327.

Design
A prospective descriptional study.

Subjects
Women undergoing caesarean section at term or hysterectomy.

Interventions
Myometrial cells were cultured from uterine biopsies.

Main outcome measures
Intracellular calcium ([Ca2+]i), determined in single cells.

Results
Application of OT caused a transient increase in [Ca2+]i. CAP 476 abolished and F327 reduced the response to OT but neither reduced the [Ca2+]i transient induced by cell depolarisation with 120 mmol K+. CAP 476 did not reduce transients caused by prostaglandin E2. F327 reduced the frequency of repetitive [Ca2+]i transients occurring during continuous application of OT.

Conclusions
The results demonstrate that the antagonists reduce the effect of OT and that their action is relatively specific. Their mechanism of action as clinical tocolytic agents is discussed.
Ampicillin and metronidazole treatment in preterm labour: a multicentre, randomised controlled trial
Authors: Norman K. , Pattinson R. C. , de Souza J. , de Jong P. , Moller G. , Kirsten G.
Published: August 2005

Objective
To ascertain whether adjuvant ampicillin and metronidazole given to women in preterm labour with intact membranes would prolong pregnancy and decrease the perinatal mortality and morbidity.

Design
A multicentre, prospective, randomised controlled trial.

Setting
Three perinatal centres serving an indigent population.

Subjects
Eighty‐one women in active preterm labour with otherwise uncomplicated singleton pregnancies between 26 and 34 weeks gestation or an ultrasound fetal weight estimate of 800 g to 1500g.

Interventions
The study group received ampicillin and metronidazole for five days. The control group received no antibiotics. In all women contractions were suppressed with hexoprenaline and indomethacin for 24 h, and betamethasone was given for fetal lung maturity.

Main outcome measures
Days gained and perinatal mortality and morbidity.

Results
The study (n= 43) and control groups (n= 38) were comparable at entry. In those receiving ampicillin and metronidazole the pregnancy was significantly prolonged (median 15 days versus 2.5 days, P= 0.04) with significantly more women still pregnant after seven days (63%versus 37%, P= 0.03, OR 0.34 95% CI 0.13–0.94). Significantly more infants in the control group developed necrotising enterocolitis than in the study group (5 versus 0, P= 0.02).

Conclusion
Adjuvant ampicillin and metronidazole in the management of women in preterm labour with intact membranes significantly prolonged the pregnancy and decreased neonatal morbidity.
Behavioural state dependency of renal artery and descending aorta velocimetry and micturition in the normal term fetus
Authors: de Koekkoek‐Doll Petra K. , Stijnen Theo , Wladimiroff Juriy W.
Published: August 2005

Objective
To examine the behavioural state dependency of renal artery and descending aorta pulsatility index and hourly fetal urinary production rate (HFUPR) in the normal term fetus.

Design
An observational study.

Subjects
Twenty‐three healthy women with a normal singleton pregnancy between 36 and 40 weeks gestation.

Main outcome measures
Renal artery and descending aorta pulsatility indices were established using pulsed Doppler ultrasound. HFUPR (ml) was estimated using real‐time ultrasound. Fetal behavioural states 1F (quiet sleep) and 2F (active sleep) were determined from combined recordings of fetal heart rate, eye movements and body movements.

Results
An inverse correlation between pulsatility index and fetal heart pattern was established for both the renal artery (r= 0.60; SD = 0.22; P= 0.0001) and the descending aorta (r= 0.73; SD = 0.16; P= 0.0001). The difference in mean pulsatility index between states IF and 2F adjusted for fetal heart pattern was 0.09 (SD 0.23) for the renal artery (P= 0.02) and 0.26 (SD 0.19) for the descending aorta (P= 0.0001). Mean HFUPR was significantly higher (44.8 %, P= 0.01) in state 1F (96 ml) compared with state 2F (54 ml) During the urinary filling phase, a poor correlation existed between renal artery pulsatility index and HFUPR (r= 0.04) and between descending aorta pulsatility index and HFUPR (r= 0.01).

Conclusions
In the normal term fetus renal artery and descending aorta pulsatility indices are reduced during fetal behavioural state 2F, suggesting reduced downstream impedance at the fetal trunk and in particular at renal level. This behavioural state is, however, also associated with reduced micturition. No correlation exists between renal artery and descending aorta pulsatility indices and fetal urinary output.
Platelet activation in normotensive and hypertensive pregnancies complicated by intrauterine growth retardation
Authors: Norris L. A. , Sheppard B. L. , Burke G. , Bonnar J.
Published: August 2005

Objective
To study platelet function in normotensive and hypertensive intrauterine growth retardation (IUGR).

Design
ADP and collagen induced whole blood platelet aggregation, β‐thromboglobulin release and platelet count were measured in the IUGR groups at a mean gestational age of 36 weeks (28–40), and at 1, 24, 48 h and six weeks post delivery. The normal pregnancy group were studied serially at 12, 20, 28, 32 and 36 weeks of gestation and at 1, 24, 48 h and six weeks post delivery.

Setting
Trinity College Medical School, St. James's Hospital, Dublin.

Subject
Twenty‐nine women with a fetus with diagnosed IUGR were recruited for the study. Of these, 15 were normotensive throughout their pregnancy and the remaining 14 pregnancies were complicated by both hypertension and proteinuria. Twenty healthy primigravida acted as controls.

Results
In the hypertensive IUGR group, levels of collagen and ADP induced aggregation were almost 50% lower before delivery than in normal pregnancy. Platelet count in the hypertensive group was decreased by 30% compared with normal pregnancy. Levels of β‐thromboglobulin were 40 to 50% higher in both the normotensive and hypertensive IUGR groups compared with normal pregnancy. Unlike the hypertensive IUGR group, the normotensive IUGR group showed similar levels of platelet count and ADP and collagen induced aggregation to those found at 36 weeks of normal pregnancy. In the early puerperium of hypertensive pregnancies, the platelet parameters measured returned gradually to normal. The normotensive IUGR group had increased levels of ADP induced aggregation in the first 24 to 48 h post delivery. The platelet count in the normotensive but not the hypertensive group correlated with birthweight.

Conclusions
Normotensive and hypertensive IUGR are accompanied by platelet activation. In normotensive IUGR, this activation appears to be confined to the uteroplacental circulation. In hypertensive IUGR, the results suggest that platelet activation also extends into the peripheral circulation resulting in a reduced platelet responsiveness and a lower platelet count. Release of vasoactive amines from activated platelets in the peripheral circulation may be responsible for the clinical syndrome of hypertension and proteinuria present in pregnancies complicated by pre‐eclampsia and IUGR but absent in normotensive IUGR.
Ductus venosus flow velocity waveforms in relation to fetal behavioural states
Authors: Huisman Tjeerd W. A. , Brezinka Christoph , Stewart Patricia A. , Stijnen Theo , Wladimiroff Juriy W.
Published: August 2005

Objectives
To establish the reproducibility of flow velocity waveforms in the human ductus venosus and to assess the influence of fetal behavioural states on these waveforms in normal term fetuses.

Design
Reproducibility of Doppler waveform recording and analysis was studied in 10 normal pregnancies. The relation between ductus venosus flow velocities and behavioural states was investigated in 19 other term fetuses. Time‐averaged, peak systolic, peak diastolic velocity, peak systolic/diastolic ratio and period time were calculated in both cross sectional studies.

Setting
Outpatient clinic, department of obstetrics (prenatal diagnosis section), Academic Hospital, Rotterdam—Dijkzigt.

Subject
Twenty‐nine women with normal singleton pregnancies at 36 to 39 weeks of gestation, resulting in uncomplicated births of healthy infants.

Results
Within‐patient coefficients of variation, ductus venosus waveform recordings were approximately 8 to 10% except for the peak systolic/diastolic ratio (4.3%). A decrease of approximately 30% was established for peak systolic, peak diastolic velocity and time‐averaged velocity during behavioural state 1F (quiet sleep) as compared with state 2F (active sleep).

Conclusions
Flow velocity waveform recording in the ductus venosus demonstrates acceptable reproducibility. Fetal behavioural state‐dependent changes were observed, suggesting a redistribution of umbilical venous blood through the ductus venosus shunt during the quiet sleep state.
Mifepristone for labour induction after previous caesarean section
Authors: Lelaidier C. , Baton C. , Benifla J. L. , Fernandez H. , Bourget PH. , Frydman R.
Published: August 2005

Objective
To evaluate the efficacy and tolerance of mifepristone in women undergoing induction of labour at term after previous caesarean section.

Design
A prospective double blind placebo controlled trial.

Subjects
Thirty‐two women at term (after 37.5 weeks' amenorrhea) who had had a previous caesarean delivery with a low transverse uterine incision. All women had a clear clinical indication for induction of labour with unfavourable cervical conditions (Bishop's score < 4). They were randomised to receive either 200 mg of mifepristone or placebo on days one and two of a four‐day observation period.

Results
Thirteen women entered spontaneous labour: 11 were treated with mifepristone and two were in the control group (P < 0.01). Thirteen women, still with an unfavourable cervix on day four needed cervical ripening with vaginal tablets of prostaglandins. Of these, four had received mifepristone and nine the placebo. Mean oxytocin requirements were lower in the mifepristone group (P < 0.01) and the mean time interval between day one and start of labour was also significantly shorter in this group. Mode of delivery and neonatal outcome were similar in both groups.

Conclusions
Induction of labour is facilitated in term women with prior caesarean section by the use of mifepristone. This induction agent appears safe and useful with no adverse events on the fetus or mother.
The effect of maternal oxygen administration on human fetal cerebral oxygenation measured during labour by near infrared spectroscopy
Authors: Aldrich C. J. , Wyatt J. S. , Spencer J. A. D. , Reynolds E. O. R. , Delpy D. T.
Published: August 2005

Objective
To test the hypothesis that intrapartum maternal oxygen administration increases fetal cerebral oxygenation during normal labour.

Design
A prospective study comparing changes in fetal cerebral concentrations of oxyhaemo‐ globin, deoxyhaemoglobin and cerebral blood volume measured by near infrared spectroscopy, before, during and after maternal oxygen administration using a 60% Ventimask.

Setting
Teaching hospital obstetric unit.

Subjects
Ten term fetuses during uncomplicated labour.

Results
Maternal oxygen administration for 15 min resulted in a significant increase in the mean concentration of fetal cerebral oxyhaemoglobin (0.78 μmol (SD 0.42) 100 g‐1 brain tissue, P < 0.001) and a significant decrease in the mean concentration of deoxyhaemoglobin (0.80 μmol (SD 0.51) l00 g‐1, P < 0.00l). These changes were associated with a significant increase in the calculated mean cerebral oxygen saturation from 43.9 % (SD 6.3) to 57.3 % (SD 5.6) (P < 0.001). The maximum rise in cerebral oxyhaemoglobin concentration occurred at a mean of 10.7 min (SD 3.9) following commencement of oxygen administration. On returning to air breathing these changes reversed. There were no changes in cerebral blood volume.

Conclusion
Maternal oxygen administration during normal labour leads to a significant rise in fetal cerebral oxygenation.
Cancer associated human papillomaviruses: perinata transmission and persistence
Authors: Pakarian Farzin , Kaye Jeremy , Cason John , Kell Barbara , Jewers Richard , Derias Nawal W. , Raju Kankipati S. , Best Jennifer M.
Published: August 2005

Objective
To demonstrate the perinatal transmission and persistence of the cancer associated human papillomavirus types 16, 18, 31 and 33.

Design
Cervical swabs were taken from pregnant women between 20 and 38 weeks of gestation. Buccal and genital swabs were taken from infants at 24 h and at six weeks after delivery and examined for HPV‐16, ‐18,–31 and –33 DNA by the polymerase chain reaction.

Setting
Maternity Unit at St Thomas' Hospital, London.

Subjects
Thirty‐one pregnant women, 16 with a previous history of cervical intraepithelial neoplasia or genital warts, or both, and their 32 infants (one set of twins).

Results
Twenty of the 31 (65 %) women were positive for HPV‐DNA prior to delivery. Twelve of 32 (38%) and eight of 31 (26%) infants were HPV‐DNA positive at 24 h and six weeks respectively. Swabs taken at 24 h demonstrated HPV type 16 in five mother‐infant pairs and HPV type 18 in two mother‐infant pairs. Dual infections with HPV types 16 and 18 were demonstrated in swabs from three mother‐infant pairs. At six weeks, HPV‐16 was demonstrated in swabs from six infants and HPV‐18 in swabs from two infants.

Conclusions
Perinatal transmission of human papillomavirus types 16 and 18 occurred in 55% cases. Persistent human papillomavirus infection was demonstrated at six weeks of age. Whether acquisition of human papillomavirus during the perinatal period predisposes to an increased risk of cervical intraepithelial neoplasia among female infants in later life remains to be established. Information on the persistence of perinatally acquired human papillomavirus is required before rational vaccination programmes can be considered.
The use of ultrasonography and Doppler in the prediction of fetal haemolytic anaemia: a multivariate analysis
Authors: Oepkes D. , Brand R. , Vandenbussche F. P. , Meerman R. H. , Kanhai H. H. H.
Published: August 2005

Objective
To assess the value of ultrasonography and Doppler to predict the severity of fetal haemolytic anaemia.

Design
Ultrasonographic measurements of the fetal liver, spleen, umbilical vein and placenta, and Doppler measurements of umbilical venous and fetal aorta flow velocities were performed before the first intrauterine blood transfusion. Multivariate regression models for the prediction of the fetal haemoglobin level were derived from the measurements.

Setting
National referral centre for management of alloimmunised pregnancies.

Subjects
Forty fetuses in 39 severe red cell alloimmunised pregnancies.

Results
A logistic regression model, incorporating the two Doppler parameters only, predicted the presence or absence of severe anaemia in nonhydropic fetuses with an accuracy of 90 %. Positive predictive value was 89% and negative predictive value was 100%.

Conclusion
In severe red cell alloimmunised pregnancies, Doppler blood flow velocity studies can be used to predict the severity of fetal anaemia. This may lead to a reduction of invasive diagnostic tests, to more accurate timing of intrauterine transfusions, and thus to a higher survival rate.
Pharmacology of the human ovarian vein: responses putative neurotransmitters and endothelin‐1
Authors: Stones R. W. , Beard R. W. , Burnstock G.
Published: August 2005

Objective
An investigation of excitatory vascular responses in the human ovarian vein, a blood vessel normally exposed to high concentrations of ovarian steroid hormones and capable of adaptation to circulatory changes associated with reproductive life.

Design
Pharmacological responses of surgical specimens of human ovarian vein to electrical field stimulation of sympathetic nerves, noradrenaline, α,β‐methylene adenosine 5′‐triphosphate (α,β‐MeATP), endothelin‐1 (ET‐1), and 5‐hydroxytryptamine (5‐HT) were studied. Comparisons were made between in vitro pharmacological responses and the diagnostic category, age, smoking status, reproductive history and hormonal status of patients.

Setting
Research laboratory.

Results
Maximal contractile responses in longitudinal preparations, expressed as a percentage of the response to potassium chloride 125mmol 1−1, were 28% (SE 7.2) to electrical field stimulation and 107% (SE 15.1) to noradrenaline. In ring preparations, maximal responses to various agents were: noradrenaline 93% (SE 10.2); 5‐HT 79% (SE 8.0); α,β‐MeATP 48% (SE 8.4); and ET‐1 87% (SE 10.1). pD2(–log EC50) values for noradrenaline were 5.82 (SE 0.21) in longitudinal preparations and 5.65 (SE 0.10) in ring preparations; for ET‐1 in ring preparations these values were 7.88 (SE 0.74). Responses to sympathetic nerve stimulation were attenuated by the adrenoceptor antagonist phentolamine; any residual responses were blocked by desensitisation of P2‐purinoceptors with α,β‐MeATP or the addition of suramin, indicating that noradrenaline and adenosine 5′‐triphosphate may be co‐transmitters in these nerves. pD2 values for 5‐HT were 5.97 (SE 0.12) in specimens from unsterilised patients (n= 19) compared with 5.20 (SE 0.24) in specimens from those who had previously undergone sterilisation (n= 6) (P < 0.05). No other relation between clinical characteristics and pharmacological responses were detected and, in particular, there were no apparent changes associated with ageing or hormonal status.

Conclusions
Three main conclusions may be drawn from this study: (1) adenosine 5′‐triphosphate is a co‐transmitter in sympathetic nerves in the human ovarian vein; (2) tubal sterilisation affects vascular responsiveness to 5‐HT; and (3) ovarian steroid hormones are likely to influence sympathetic vascular control via effects on catecholamine and adenosine 5′‐triphosphate synthesis, storage, release, degradation or re‐uptake, rather than via effects on vascular smooth muscle receptors.
Fetal lymphocyte subpopulations in red blood cell iso‐immunised pregnancies
Authors: Thilaganathan Baskaran , Makrydimas George , Plachouras Nicolaos , Nicolaides Kypros H.
Published: August 2005

Objective
To study the association between fetal anaemia and alterations in lymphocyte subpopulations.

Design
Cross‐sectional study.

Setting
The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London.

Subjects
Forty‐three red blood cell iso‐immunised pregnancies undergoing cordocentesis at 19 to 38 weeks gestation.

Main outcome measures
Fetal blood haemoglobin concentration, erythroblast count and lymphocyte subpopulations.

Results
The mean T (CD3+), B (CD19+), T‐helper (CD4+), T‐suppressor/cytotoxic (CD8+) and natural killer (NK: CD16 +/CD56 +) cell counts in the anaemic fetuses were significantly lower than the appropriate normal mean for gestation (CD3 + : t=–3.25, P < 0.01; CD19 + : t=–2‐14, P < 0.05; CD4+: t–4.03, P < 0.001; CD8+ : t=–3.39, P < 0.01 and CD16 +/CD56+ : t=–3.49, P < 0.01). Furthermore, there was a significant association between the decrease in T lymphocyte number and the degree of fetal anaemia (r= 0.342, P < 0.05).

Conclusions
Fetuses from red blood cell iso‐immunised pregnancies exhibit nonselective lymphopenia that is proportional to the degree of anaemia.
Magnitude and pattern of skeletal response to long term continuous and cyclic sequential oestrogen/progestin treatment
Authors: Nielsen S. Pors , Bärenholdt O. , Hermansen F. , Munk‐Jensen N.
Published: August 2005

Objective
To investigate the magnitude and pattern of the changes in bone mass during five years of continuous and cyclic sequential oestrogen/progestin treatment.

Design
Prospective study of normal, early postmenopausal women, initially a double‐blind, placebo controlled trial, subsequently an open, controlled investigation.

Setting
Clinical physiology unit of a general hospital.

Subjects
Sixty‐eight normal, early postmenopausal women.

Results
1. Continuous treatment resulted in significantly higher lumbar spine bone density than did sequential treatment (P < 0.001). Lumbar spine bone density was 19% and 15%, respectively, above that of untreated women after three years and onwards, and 10% and 6%, respectively, above the initial value; 2. Both regimens induced a more pronounced rise in lumbar spine bone density than in forearm bone mineral content (P < 0.001); 3. The spontaneous decline (without treatment) in lumbar spine bone density and forearm bone mineral content averaged 1.86% and 1.90% per year, respectively. 4. There was a significant bone loss from the lumbar spine during the last year of active treatment (P < 0.001). This would suggest that lumbar spine bone density rises to a certain level and subsequently declines. However, neither data pooled before computation nor data processed individually for each patient over five years allowed for any definite conclusions regarding the pattern of the long term skeletal response to combined oestrogen/progestin treatment.

Conclusion
Five years treatment with oestradiol/norethisterone resulted in a substantial gain in bone mass. The highest values were found in the axial skeleton with daily administration of 2 mg oestradiol and 1 mg norethisterone. It is likely that bone mass after an absolute rise begins to decline after about four years of treatment.