bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical value of amniotic fluid interleukin‐6 determinations in the management of preterm labour
Authors: Dudley Donald J. , Hunter Cheri , Mitchell Murray D. , Varner Michael W.
Published: August 2005

Objective
To ascertain whether the determination of amniotic fluid interleukin‐6 (IL‐6) concentrations would be a useful clinical test in the management of women with preterm contractions.

Setting
The labour and delivery unit and the Fetal Diagnostic Centre at the University of Utah.

Subjects
Pregnant women at various stages of gestation in the third trimester.

Design
Amniotic fluid samples were collected from women experiencing one of four clinical scenarios: 1. term pregnancy, not in labour with no evidence of intrauterine infection; 2. normal term labour with no evidence of infection; 3. preterm labour with no evidence of infection and undelivered within one week of sampling; and 4. preterm labour and delivered within seven days of sample collection. Amniotic fluid was obtained by amniocentesis or at the time of amniotomy or hysterotomy. IL‐6 in each specimen was determined by a specific rapid ELISA.

Results
Amniotic fluid IL‐6 levels, given as mean (SEM) in the four groups of women listed were: 1. term pregnancy, not in labour: 20.9 (7.2) pg/ml (n= 60); 2. normal term labour with no infection: 554 (90.7) pg/ml (n= 46); 3. preterm labour with no evidence of infection, undelivered: 47.0 (17.2) pg/ml (n= 35); and 4. preterm labour, delivered: 456.7 (101.7) pg/ml (n= 40). There was no significant difference in the means of amniotic fluid IL‐6 for the term labour and preterm labour delivered groups. In general, amniotic fluid IL‐6 levels during term labour increased with advancing cervical dilation. There was no correlation of cervical dilation and amniotic fluid IL‐6 levels in women having preterm delivery. Receiver‐operator curves revealed optimal IL‐6 levels for discrimination of labour at term to be 50 pg/ml and for preterm delivery to be 200 pg/ml.

Conclusions
IL‐6 can readily be detected in the amniotic fluid of most women who are in active labour, regardless of gestational age. Our data suggest that amniotic fluid IL‐6 determinations may be clinically useful in the management of preterm labour.
Endometrial ablation in the treatment of menorrhagia
Authors: Erian J.
Published: August 2005

A prospective 5‐year multicentre study, involving three UK gynaecology centres with a special interest in endoscopic laser surgery, was set up to determine the safety, acceptability, clinical effectiveness and complications of neodymium yttrium‐aluminium‐garnet laser ablation of the endometrium in the treatment of menorrhagia. A total of 2342 women with disabling menorrhagia that was unresponsive to medical therapy were involved. The main outcome measures were: preoperative endometrial preparation, duration of laser ablation, intra‐ and postoperative complications, amenorrhoea rate, oligomenorrhoea rate, and the women's subjective assessment of treatment. No major complications occurred in the 2342 treatments. Nine (0.4%) cases of transient fluid overload, 11 (0.5%) of infection and five (0.2%) of uterine perforation occurred. None of the women required a laparotomy. The mean duration of the laser ablation was 24 min. The post‐surgery amenorrhoea rate was higher in women pretreated with danazol. Of the 1866 women followed up for at least 1 year after treatment, 1043 (56%) developed complete amenorrhoea, 701 (38%) reported continuing but satisfactorily reduced menstruation, and 122 (7 %) patients failed to improve with the first treatment (57 of these 122 women responded to a second laser ablation). Overall, 1744 (93%) had a satisfactory response to laser ablation and only 33 (1.8%) required subsequent hysterectomy. In conclusion, this study showed that hysteroscopic endometrial laser ablation is an acceptable alternative to hysterectomy for the treatment of menorrhagia.
Blood pressure changes during labour and whilst ambulating with combined spinal epidural analgesia
Authors: Shennan Andrew , Cooke Vicky , Lloyd‐Jones Fiona , Morgan Barbara , De Swiet Michael
Published: August 2005

Objective To determine the influence of combined spinal epidural analgesia with fentanyl and low dose bupivacaine on maternal blood pressure and pulse rate in labour. Also, to evaluate the maternal cardiovascular response to mobilising with this form of analgesia in labour. Finally, to define the changes that occur in blood pressure and pulse rate during the second stage of labour and immediately postpartum when using combined spinal epidural analgesia.

Design A prospective observational study.

Subjects and methods Blood pressure and pulse measurements were made at least every 10 minutes, using the Space Labs 90207 ambulatory blood pressure monitor, on 62 women in labour with combined spinal epidural analgesia.

Results A significant fall in systolic blood pressure (> 20%) occurred in eight women (12%), all within 30 minutes of the spinal injection. Fifty‐two women subsequently received an epidural dose (mean interval 90 minutes after spinal) and none of these women had a fall in systolic blood pressure of greater than 20%. No women had symptoms related to hypotension. Thirty‐five women ambulated for more than 10 minutes on 65 occasions. Average blood pressure remained unchanged while ambulating (126/79 versus 126/79), but pulse rate was significantly increased (85 to 90, P≤ 0.001). The mean blood pressure in the second stage of labour (n= 41) did not rise with pushing (134/83 versus 134/83), but the pulse rate increased significantly (94 to 108, P≤ 0.001). Blood pressure remained unchanged immediately postpartum (n= 33) (134/83 versus 134/81) following ergometrine administration.

Conclusion The combined spinal epidural analgesia will only result in significant falls in systolic blood pressure within 30 minutes of the spinal injection. No further important changes in blood pressure occur when mobilising or with epidural top‐ups. The combined spinal epidural analgesia may modify the normal compensatory mechanisms of blood pressure control, but does not cause significant maternal hypotension once the spinal injection has been given.
Planned abdominal compared with planned vaginal birth in triplet pregnancies
Authors: Wildschut H. I. J. , Van Roosmalen J. , Van Leeuwen E. , Keirse M. J. N. C.
Published: August 2005

Objective To compare a policy of planned abdominal delivery with a policy of planned vaginal delivery in triplet pregnancies.

Design Retrospective study.

Setting Two Dutch university hospitals, each having a different approach to the planned mode of delivery in triplet gestations.

Subjects Thirty women giving birth to triplets in the hospital in Leiden, who favoured planned abdominal delivery, compared with 39 from the Medical Centre in Amsterdam who favoured vaginal delivery.

Main outcome measures Perinatal mortality and early neonatal complications.

Results Both centres were equally successful in achieving their planned policies: in Leiden 80% of women were delivered by caesarean section but in Amsterdam 87% of women were delivered vaginally. Compared with vaginal delivery, planned abdominal delivery was associated with a significantly hgher perinatal mortality rate (P= 0.02), primarily due to respiratory distress syndrome, and a higher recorded neonatal complication rate (P= 0.03), especially sepsis, respiratory distress syndrome, and necrotising enterocolitis.

Conclusions A policy of planned abdominal delivery in triplets is not superior to a policy of planned vaginal delivery in terms of fetal and early neonatal outcome.
Histological impact of medical therapy – clinical implications
Authors: Fedele L. , Bianchi S. , Marchini M. , Di Nola G.
Published: August 2005

The medium‐ and long‐term effects of gestrinone and danazol on the endometrium were examined in 36 patients with endometriosis. Endometrial biopsies were taken from each patient before treatment and after 3 and 6 months of treatment with 600 mg danazol daily (n= 17) or with 2.5 mg gestrinone twice weekly (n= 19). Endometrial samples were analysed by light, scanning and transmission electron microscopy. At 3 months' treatment the endometria of patients treated with danazol appeared more atrophic than those of the women treated with gestrinone; some cell organelle involution was evident in all patients. After 6 months of treatment a marked atrophy was observed in patients of both treatment groups. A complete involution of cytoplasmic organelles with cytoplasmic collapse and a shift of nucleoplasmic ratio in favour of the nucleus occurred in patients treated with danazol; the cytoplasmic organelle involution was less marked in patients treated with gestrinone. Compared with gestrinone, danazol induces more rapid endometrial atrophy, with greater impairment of the cytoplasm and cell secretory activity.
Elaboration of stem villous vessels in growth restricted pregnancies with abnormal umbilical artery Doppler waveforms
Authors: Macara Lena , Kingdom John C. P. , Kohnen Gaby , Bowman Adrian W. , Greer Ian A. , Kaufmann Peter
Published: August 2005

Objective
To assess the elaboration of placental stem villous vessels from pregnancies complicated by intrauterine growth restriction (IUGR) with absent end–diastolic flow velocity detected prior to delivery in the umbilical artery.

Design
Comparison between IUGR and control groups of the distribution, in 15 pm increments of 600 randomly chosen stem vessel profiles (post‐fixation diameter 10‐160 pm) identified by immunohistochemical localisation of a‐smooth muscle actin in the vessel media.

Setting
Clinical teaching hospital and university anatomy department.

Subjects
Paraffin‐fixed blocks obtained from placentas of eight pregnancies complicated by IUGR and eight gestational age‐matched controls.

Results
The distribution of the stem villous vessels in the IUGR placentas, as assessed by the mean vessel diameter in each case, did not differ from the controls (mean vessel diameter 31.8 μm [SD 2.41 vs 29.6 pm [2.3]; P= 0.13). In five IUGR cases a‐smooth muscle actin positive cells (myofibroblasts) were identified within the stroma of nonmuscularised peripheral (mature intermediate and terminal) villi, but in none of the controls.

Conclusions
Our data do not support the theory that IUGR with absent end‐diastolic flow velocity in the umbilical artery is due to a selective loss of small stem villous vessels. The increased impedance in this condition may be conferred more distally within the nonmuscularised capillaries of the peripheral villi.
Sonographic, stereological and Doppler flow velocimetric assessments of placental maturity
Authors: Burton G. J. , Jauniaux E.
Published: August 2005

Objective
To determine whether sonographic assessments of increasing placental maturity are associated with changes in the theoretical diffusing capacity of the organ and with changes in vascular resistance.

Design
Placental maturity was assessed sonographically in 10 organs: five were classified as completely immature and five as completely mature. Doppler flow velocimetric recordings were obtained shortly before delivery performed by elective caesarean section. Placental biopsies taken immediately after delivery were analysed stereologically.

Results
No differences were observed in either placental weight or volume, but the morphometric diffusing capacity of the villous membrane was 40 % higher in the mature than in the immature placentas. Doppler indices did not alter with increasing placental maturity.

Conclusions
Normal term placentas differ significantly in their diffusion characteristics, even when organ weight and volume remain constant. Umbilical vascular resistance may be heavily influenced by the number of parallel circulatory units offered by the placental lobules.
The mortality and morbidity associated with umbilical cord prolapse
Authors: Murphy D. J. , MacKenzie I. Z.
Published: August 2005

Objective
To examine the management of cord prolapse and its morbidity and mortality.

Design
Retrospective study of consecutive babies born after cord prolapse, identified using the Oxford Obstetric Data System, and those with registered handicap, identified by the Oxford Region Register of Early Childhood Impairments.

Setting
District maternity hospital managing more than 6000 deliveries annually.

Subjects
One hundred and thirty–two babies born after the identification of cord prolapse in the John Radcliffe Hospital between January 1984 and December 1992.

Main outcome measures
Survival rates, condition at birth assessed by Apgar scores at 1 and 5 minutes and blood gas values on cord blood samples, and incidence of major handicap at three years of age.

Results
The incidence of cord prolapse was 1 in 426 total births. There were six stillbirths and six neonatal deaths. One baby died as a result of birth asphyxia. The uncorrected perinatal mortality rate was 91 per 1000. Of 120 survivors, only one baby was known to suffer a major neurological handicap. Electronic cardiotocographs aided the diagnosis of cord prolapse in 41 % of cases. Apgar scores were better with a shorter diagnosis to delivery interval, but cord gas results did not correlate well with Apgar scores or the diagnosis to delivery interval.

Conclusions
Cord prolapse occurs with a relatively stable incidence in this population irrespective of changes in obstetric practices. Despite the high incidence of ominous cardiotocographs, low Apgar scores and acidaemia on blood gas analysis, the fetal outcome is not as poor as might be expected and mortality is predominantly attributable to congenital anomalies and prematurity rather than birth asphyxia.
The effect of social deprivation on birthweight, excluding physiological and pathological effects
Authors: Wilcox Mark A. , Smith Sarah J. , Johnson Ian R. , Maynard Paul V. , Chilvers Clair E. D.
Published: August 2005

Objective
To study the effect of social deprivation on birthweight, excluding the effect of known physiological factors and exploring the effect of possible pathological factors.

Design
Retrospective analysis of computerised obstetric database.

Setting
Two teaching hospitals and an associated district general hospital which provided a defined catchment area in the East Midlands.

Subjects
The final analysis included 7493 women with complete datasets and gestations of between 259 and 300 days at delivery, dated by ultrasound scan.

Main outcome measures
Smoking habit, alcohol consumption, weight gain during pregnancy, systolic and diastolic blood pressures at booking, bleeding during pregnancy and Jarman score; also, the effect of these variables on birthweight, adjusted for the effects of physiological factors using the individualised birthweight ratio.

Results
Smohng during pregnancy reduced birthweight but the effect is not linear, becoming less marked as the number of cigarettes smoked increases. Alcohol intake, diastolic and systolic blood pressures at the booking visit and vaginal bleeding during early pregnancy were not significantly related to birthweight. Pregnancy weight gain was significantly positively related to birthweight especially in the normal weight range (60‐99 kg). A multivariate analysis including physiological and pathological factors found increasing Jarman score to be negatively related to birthweight.

Conclusions
In this central British population social deprivation is correlated negatively with birthweight: the most socially deprived mothers have the smallest babies. This association cannot be explained in terms of physiological differences in the population nor in a higher prevalence of known pathological factors.
Pregnancy in sickle cell disease in the UK: results of a multicentre survey of the effect of prophylactic blood transfusion on maternal and fetal outcome
Authors: Howard Richard J. , Tuck Susan M. , Pearson T. C.
Published: August 2005

Objective
To determine the outcome of pregnancies complicated by sickle cell disease in the UK during 1991‐1993 and the effect of prophylactic blood transfusion programmes on maternal and fetal outcome.

Design
A multicentre study.

Subjects
Eighty‐one pregnancies complicated by sickle cell disease and 100 pregnancies from women of black African descent without haemoglobinopathies to act as a comparative group. Pregnancies complicated by sickle cell disease were divided by the type of haemoglobinopathy and also by transfusion regimen.

Main outcome measures
Antenatal and postnatal complications of sickle cell disease, proteinuric hypertension, preterm delivery, emergency delivery by caesarean section, fetal distress, birthweight, perinatal and maternal mortality.

Results
There were two maternal deaths in the 81 pregnancies and the perinatal mortality rate was 60/1000. Antenatal sickling complications occurred in 46.2% of pregnancies and postnatal sickling complications occurred in 7.7% of pregnancies. Pregnancies complicated by sickle cell disease were significantly more likely to be associated with anaemia, preterm delivery, proteinuric hypertension, birthweight below the 10th centile and caesarean section as an emergency procedure than the comparative group. Severe sickling complications occurred more commonly in the third trimester and there was some evidence that a prophylactic transfusion programme reduced the risk of this. Prophylactic transfusion did not improve obstetric outcome when compared with those pregnancies that were untransfused.

Conclusions
Sickle cell disease remains a severe complicating factor to pregnancy and perinatal mortality and maternal mortality rates in the UK have increased since last reported. A policy of exchange transfusing all women with homozygous sickle cell disease (HbSS) from 28 weeks gestation is recommended to reduce the risk of maternal complications in the thrd trimester and puerperium. There remains a role for earlier prophylactic blood transfusion programmes in women with poor obstetric and haematological histories.
Screening for fetal trisomies by maternal age and fetal nuchal translucency thickness at 10 to 14 weeks of gestation
Authors: Pandya Pranav P. , Snijders Roslainde J. M. , Johnson Sarah P. , de Lourdes Brizot Maria , Nicolaids Kypros H.
Published: August 2005

Objective
To evaluate screening for chromosomal defects by a combination of fetal nuchal translucency thickness and maternal age.

Design
A prospective multicentre screening study where fetal nuchal translucency thickness was measured at 10 to 14 weeks of gestation.

Subjects
20,804 women with singleton pregnancies screened at 10 to 14 weeks of gestation from 1 September 1992 to 28 October 1994.

Main outcome measures
Trisomy 21 and other chromosomal defects identified by increased nuchal translucency thickness and by a combination of nuchal translucency thickness and maternal age.

Results
In normal fetuses nuchal translucency thickness increased significantly with crown‐rump length. The nuchal translucency was above the 95th centile in 77% (66 of 86) of fetuses with trisomy 21 and in 78% (61 of 78) of those with other chromosomal defects. On the basis of the distribution of nuchal translucency measurements in normal fetuses and those with trisomy 21, a new method of screening is proposed which involves assessment of individual risk based on the combination of fetal nuchal translucency, crown rump length and maternal age. The minimum risk was 1/100 in 4.9% of the normal pregnancies, in 80% of those with trisomy 21 and in 77% of those with other chromosomal defects.

Conclusion
Screening for fetal trisomy 21 can be carried out effectively during the first trimester of pregnancy.
The effect of topical oestradiol on skin collagen of postmenopausal women
Authors: Varila Eero , Rantala Immo , Oikarinen Aarne , Risteli Juha , Reunala Timo , Oksanen Hanna , Punnonen Reijo
Published: August 2005

Objective
To examine the effect of topical oestradiol on skin collagen and elastin.

Subjects
Twelve postmenopausal women, aged 52 to 76 years.

Interventions
Topical oestradiol treatment on the skin of lower abdomen and the vehicle only on the contralateral site; once a day for three months.

Main outcome measures
The content of skin hydroxyproline; the levels of the carboxyterminal propeptide of human type I procollagen (PICP) and of the aminoterminal propetide of human type III procollagen (PIIINP).The number and the quality of collagen and elastic microfibrils.

Results
The amount of hydroxyproline in the skin significantly (P= 0.012) increased from 11.8 to 16.3 pgμ(38 %) during oestradiol treatment. After treatment, the PICP level in the blister fluid was significantly (P= 0.024) higher on the treated site than on the control site. Also the level of PIIINP increased, but the change was not statistically significant. Electron microscopy showed morphologic improvement of elastic and collagen fibres, while the number of oxytalan and elaunin fibres was unchanged in light microscopy.

Conclusions
Topical oestradiol treatment increases the amount of skin collagen. The increase in the level of PICP and PIIINP in skin blister fluid indicates that oestradiol treatment stimulates collagen synthesis. Furthermore, our results show that topical ostradiol treatment has a greater influence on the amount than on the quality of skin collagen. On the contrary, in elastic tissue the oestradiol treatment will only result in morphologic improvement.
First trimester fetal nuchal translucency: Problems with screening the general population 1.
Authors: Roberts L. J. , Bewley S. , Mackinson A‐M. , Rodeck C. H.
Published: August 2005

Objective
To evaluate the feasibility of measuring first trimester nuchal translucency in an unselected population, to assess the relationship with gestation and maternal age and to measure reproducibility.

Design
A prospective observational study.

Setting
University College Hospital, London.

Subjects
One thousand and four women attending for a routine first trimester dating scan between eight and thirteen weeks of gestation. Measurements of nuchal translucency were attempted in 1368 (80.‐3%) and successful in 1127 (82% of attempts).

Results
Nuchal translucency is most easily measured at 11 weeks of gestation. If a cut‐off of ≥ 3 mm is used, 6% of unselected fetuses between eight and thirteen weeks of gestation are classified as abnormal. Nuchal translucency increases with gestational but not maternal age. Reproducibility is poor: by repeating measurements with a different operator, the same operator using a different still image, or the same operator using the same still image, 18.8%, 173% or 12.4% of nuchal translucency measurements, respectively, change their classification as normal or abnormal.

Conclusions
If nuchal translucency ≥ 3 mm were used as an indication for karyotyping, 6% of the normal pregnant population would be screen positive. However, the percentage will vary greatly depending on the gestational age profile of the screened population. The poor reproducibility of nuchal translucency measurement could diminish its usefulness as a screening test for Down's syndrome.
First trimester fetal nuchal translucency: Problems with screening the general population 2.
Authors: Bewley S. , Roberts L. J. , Mackinson A‐M. , Rodeck C. H.
Published: August 2005

Objective
To investigate first trimester nuchal translucency 3 mm as a screening test for aneuploidy in the normal pregnant population.

Design
A pilot observational study.

Setting
University College Hospital, London.

Subjects
One thousand one hundred and twenty‐seven women had measurements of nuchal translucency at the time of their dating scan (8–13 weeks of gestation).

Results
Seventy fetuses (6%) had a nuchal translucency ≥ 3 mm. Five karyotypically abnormal fetuses were identified by standard routine techniques (three trisomy 21, two trisomy 18), all in high risk mothers (239 years). Only two had nuchal translucency ≥ 3 mm (one trisomy 21, one trisomy 18).

Conclusions
Although nuchal translucency measurement is feasible and promising, there is at present insufficient data to warrant its introduction for screening of the general population, or to replace traditional second trimester screening.
Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia
Authors: Preston J. T. , Cameron I. T. , Adams E. J. , Smith S. K.
Published: August 2005

Objective
To compare the efficacy and safety of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia.

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

Setting
University Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge.

Subjects
One hundred and three women complaining of heavy periods with a regular cycle recruited directly from general practitioners within the hospital catchment area and from consultants' gynaecology clinics.

Interventions
There were forty‐six women on placebo with confirmed ovulatory menorrhagia, defined as menstrual blood loss greater than 80 ml/cycle and mid‐luteal serum progesterone concentration greater than 9 nmol/l). Twenty‐one received norethisterone (5 mg twice a day on days 19 to 26) and 25 received tranexamic acid (1 g four times daily on days 1 to 4) for two cycles.

Main outcome measures
Menstrual blood loss was measured using the alkaline haematin method. Haematological assessments were made both at the beginning and at the end of the study, questionnaires were given to assess subjective endpoints, and patients were asked to report any adverse events during all cycles.

Results
Tranexamic acid reduced mean menstrual blood loss by 45%, from 175 ml to 97 ml (95% CI for the difference in menstrual blood loss 52 to 108, P 0.0001), norethisterone increased mean blood loss by 20% from 173 ml to 208 ml (95% CI for the difference in menstrual blood loss −64 to 2, P= 0.26). Fourteen (56%) women who received tranexamic acid achieved a mean menstrual loss of less than 80 ml per cycle during treatment, but only two (9.5%) who received norethisterone achieved this mean menstrual loss. There were no serious adverse events reported for either drug.

Conclusions
Tranexamic acid is a safe and effective form of medical therapy in women with menorrhaga and is highly likely to normalise blood loss in women losing 80 to 200 ml prior to treatment. Norethisterone at this dose is not effective therapy for ovulatory menorrhagia.
A randomised comparison over 8 months of 100 μg and 200 μg twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome
Authors: Smith Roger N. J. , Studd John W. W. , Zamblera Dante , Holland E. F. Nigel
Published: August 2005

Objective
To determine the efficacy of a 100 μg twice weekly dose of Estraderm TTS compared with a 200 μg dose in the treatment of severe PMS, and to determine the overall acceptability of the treatment. To determine the serum oestradiol levels produced by the two doses of Estraderm and to discover whether the lower dose suppresses ovulation.

Design
Main: randomised, prospective, comparative study. Subsidiary: cross‐sectional and prospective.

Setting
Premenstrual syndrome clinic in teaching hospital.

Subjects
Women with severe PMS confirmed by prospective daily symptom recording.

Interventions
Estraderm TTS® at a dose of either 100 or 200 μg twice weekly continuously with either dydrogesterone 10 mg or medroxyprogesterone acetate 5 mg, from day 17 to day 26 of each cycle.

Main outcome measures
Main: change in total, exponentially smoothed, average maximum score (total‐ESAmax) of 10 common premenstrual syndrome symptoms derived from Trigg's trend analysis and patient satisfaction. Subsidiary: plasma oestradiol and day 21 progesterone levels.

Results
Main: no difference in change in total‐ESAmax between Estraderm 100 μg and 200 μg groups. Greater drop‐out rate and greater incidence of side effects attributed to oestrogen in higher dosage group. Satisfaction rate of 45% to 57% at eight months. Subsidiary: 1. Mean (95% CI) oestradiol level of 300 pmol/l (255 to 345) with Estraderm 100 Fg and 573 (494 to 693) with Estraderm 200 pg; 2. Estraderm 100 μg suppresses mid‐luteal progesterone from a mean (95% CI) of 353 (28.4 to 427) to 3.4 (2.4 to 4.5).

Conclusions
Estraderm TTS 100 μg twice weekly is as effective as 200 μg twice weekly in reducing symptom levels in severe premenstrual syndrome but is better tolerated. Estraderm 100 μg suppresses ovulation and results in a mean plasma oestradiol level similar to that observed in a spontaneous cycle.
A randomised controlled trial of simple compared with complex antenatal fetal monitoring after 42 weeks of gestation
Authors: Alfirevic Zarko , Walkinshaw Steve A.
Published: August 2005

Objective
To compare the impact on perinatal outcome of two different protocols for antenatal fetal monitoring after 42 weeks gestation.

Design
A prospective randomised controlled trial.

Setting
Liverpool Maternity Hospital.

Subjects
One hundred and forty‐five women with singleton, uncomplicated pregnancies after 42 weeks of gestation.

Interventions
Random allocation to fetal monitoring by either: 1. a modified biophysical profile comprising of computerised cardiotocography, amniotic fluid index, and assessment of fetal breathing, tone and gross body movements; or 2. standard cardiotocography and maximum pool depth.

Outcome measures
Cord pH at delivery, number of abnormal monitoring tests, intrapartum management, mode of delivery and neonatal outcome.

Results
There were significantly more abnormal antenatal monitoring results in the modified biophysical profile group (47.2%vs 20.5%; odds ratio = 3.5, 99% CI = 1.3–9.1). There were no differences in cord blood gases, neonatal outcome, or in outcomes related to labour and delivery between the two groups, but a trend towards more obstetric interventions in the modified biophysical profile group was noted. Amniotic fluid volume after 42 weeks was more likely to be labelled as abnormal with amniotic fluid index than with maximum pool depth (44.4%vs 15.1%; odds ratio = 4.5, 99% CI = 1.6–12.8).

Conclusions
The results suggest that after 42 weeks fetal monitoring with the modified biophysical profile does not improve pregnancy outcome as measured by umbilical cord pH, but is more likely to yield an abnormal result. The higher incidence of abnormal monitoring results in the modified biophysical profile group was likely to be caused by different methods of amniotic fluid assessment in the modified biophysical profile group (amniotic fluid index) and simple monitoring group (maximum pool depth). The use of amniotic fluid index as a test of fetal wellbeing in prolonged pregnancy may lead to more obstetric interventions with, as yet, unclear impact on the perinatal outcome.
Burch colposuspension: a 10–20 year follow up
Authors: Alcalay Menachem , Stanton Stuart L. , Monga Ash
Published: August 2005

Objective
To review the outcome of women who underwent Burch colposuspension 10 to 20 years ago and to assess factors which affect long term success.

Design
Longitudinal retrospective study.

Setting
Urogynaecology Unit, St George's Hospital, London.

Subjects
One hundred and nine women with genuine stress incontinence.

Main outcome measures
Survival analysis of subjective and objective cure of stress incontinence.

Results
Cure of incontinence following Burch colposuspension is time‐dependent, with a decline for 10 to 12 years when a plateau of 69% is reached. Factors adversely affecting cure are previous bladder neck surgery (logrank test P= 0.02), pre‐operative weight greater than 80 kg, intra‐operative blood loss more than 1000 ml and the development of post‐operative detrusor instability. Post‐operative complications included de novo detrusor instability (14.7%), long term complaints of voiding difficulty with objective recovery at the final follow up (22%) and recurrent urinary tract infection (4.6%).

Conclusions
Long term follow up after colposuspension is necessary to assess sequelae. We suggest that new continence procedures should be followed up for 5 to 10 years.
Lack of analgesic effect of systemically administered morphine or pethidine on labour pain
Authors: Olofsson Ch. , Ekblom A. , Ekman‐Ordeberg G. , Hjelm A. , Irestedt L.
Published: August 2005

Objective
To evaluate the true analgesic effect of morphine and pethidine on labour pain.

Design
The analgesic and sedative effects of intravenous morphine or pethidine and their effect on anxiety were compared in a prospective, double‐blind, randomised dose‐response study.

Setting
A Stockholm teaching hospital obstetric unit.

Participants
Ten healthy nulliparous parturients in active labour were included in each group.

Results
Even after repeated doses (up to 0.15 mgkg body weight morphine and up to 15 mag body weight pethidine) the findings were uniform, with very high pain scores maintained in each group as assessed with visual analogue scale. The parturients were all significantly sedated and several fell asleep but were awakened by pain during contractions.

Conclusion
It is concluded that labour pain is not sensitive to systemically administered morphine or pethidine. These drugs only cause heavy sedation. It therefore seems unethical and medically incorrect to meet parturients' requests for pain relief by giving them sedation. Considering the well documented negative effects on newborn infants we also believe systemic pethidine should be avoided in labour.
Changes in maternal heart dimensions and plasma atrial natriuretic peptide levels in the early puerperium of normal and pre‐eclamptic pregnancies
Authors: Pouta Anneli M. , Räsänen Juha P. , Airaksinen K. E. J. , Vuolteenaho Olli J. , Laatikainen Timo J.
Published: August 2005

Objective
To measure plasma atrial natriuretic peptide (ANP) in relation to maternal haemodynamics and body fluid balance in the early puerperium following uncomplicated pregnancy and pre‐eclampsia.

Design
A longitudinal study from late pregnancy and into the early postpartum period (days 1 to 3 and days 4 to 6) compared with nonpregnant controls.

Subjects
Eleven women with uncomplicated pregnancies, 12 women with pre‐eclampsia and 12 healthy, nonpregnant women.

Main outcome measures
Maternal heart dimensions determined by M‐mode echocardiography, concentrations of ANP, and daily urine output and sodium excretion.

Results
After delivery increases in left atrial dimensions, represented as mean (SEM), from 33.2 (1–6) to 37.7 (1.7) mm and ANP levels from 7.9 (1.1) to 19.0 (2.7) pmol/L were observed at 1–3 days postpartum in normal pregnant women, but we were not able to demonstrate a significant increase in diuresis and natriuresis. In the third trimester left atrial dimensions (38.4 (1.2) mm) and ANP levels (15.4 (2.2) pmol/L) were greater in pre‐eclampsia. ANP levels rose further in pre‐eclamptic women in the early puerperium (27.4 (7.4) pmol/L) with an increase in diuresis and natriuresis, while left atrial dimensions did not change significantly (39.4 (1.7) mm). A pericardial effusion was found in 11 pre‐eclamptic but in only three healthy pregnant women.

Conclusions
A concommitant increase in left atrial dimensions and ANP in the early puerperium following uncomplicated pregnancies is consistent with the mechanism of atrial stretch as a stimulus for ANP release, although the biological significance of this finding remained unclear. A significantly higher release of ANP in the early puerperium after pregnancies complicated by pre‐eclampsia may be a mechanism which promotes the renal elimination of excessive body fluids and sodium.
Magnesium sulphate in the treatment of eclampsia and pre‐eclampsia: an overview of the evidence from randomised trials
Authors: Chien Patrick F. W. , Khan Khalid S. , Arnott Neil
Published: August 2005

Objective
To evaluate the effectiveness of magnesium sulphate in the treatment of eclampsia and pre‐eclampsia by a systematic quantitative overview of controlled clinical trials.

Design
Online searching of the MEDLINE database between 1966 and 1995, and scanning of the bibliography of known primary studies and review articles on the use of magnesium sulphate in eclampsia and pre‐eclampsia. Study selection, study quality assessment and data extraction were performed independently by two reviewers under masked conditions. Where possible outcome data from trials were pooled and summarised using the Mantel‐Haenszel method.

Participants
One thousand seven hundred and forty‐three women with eclampsia and 2390 with pre‐eclampsia included in nine randomised trials that evaluated the effects of magnesium sulphate.

Main outcome measures
Seizure activity and maternal death.

Results
In eclampsia, recurrence of seizures was less common with magnesium sulphate therapy compared with phenytoin (odds ratio [OR] 0.27, 95% CI 0.17.0.45, P= 0.00) and diazepam (OR 0–41, 95% CI 0.30–0.57, P= 0.00). As indicated by the point estimate, there was a trend towards a reduction in maternal mortality with magnesium sulphate in eclampsia (OR 0.51,95% CI 0.24–1.07, P= 0.10versus phenytoin; OR 0.78, 95% CI 0.41–1.45, P= 0.52versus diazepam). When used for seizure prophylaxis in pre‐eclampsia, magnesium sulphate was found to be more effective than phenytoin (OR 0.15, 95% CI 0.03–0.72, P= 0.01).

Conclusion
Magnesium sulphate is a superior drug in preventing the recurrence of seizures in eclampsia and in seizure prophylaxis in pre‐eclampsia.
Fetal telemedicine: six month pilot of real‐time ultrasound and video consultation between the Isle of Wight and London
Authors: Fisk Nicholas M. , Sepulveda Waldo , Drysdale Karen , Ridley David , Garner Paul , Bower Sarah , Kyle Phillips , Dhillon Harjeet , Carvalho Julene S. , Wootton Richard
Published: August 2005

Design
Prospective audit of first six months.

Setting
Referral from a district general hospital on the Isle of Wight to a comprehensive tertiary referral service, the Centre for Fetal Care at Queen Charlotte's Hospital 120 km away in London.

Participants
Women whose pregnancy was suspected, or at risk, of fetal abnormality.

Interventions
Remote consultation by transmitting ultrasound and video in real‐time over ISDN 30 telephone lines. Contemporaneous questionnaire to referring practitioner and patient.

Main outcome measures
Frequency, indication, technical success and duration of consultation. Qualitative and semi‐quantitative image quality. Effect of teleconsultation on need for physical referral.

Results
Twenty‐nine women underwent 39 teleconsultations, and image quality was sufficient for diagnosis in all but one. Fetal abnormalities were present in 76%. Referral in person was required for only four women, significantly fewer than the 13 the referring hospital indicated would have been physically referred in the absence of this service (P < 0.001). Most mothers were counselled by the specialist ‘face‐to‐face’ over the link, and 80% felt teleconsultation reduced their anxiety.

Conclusions
A fetal telemedicine service is technically and clinically feasible. This demonstration suggests that such a service reduces the need for physical referral while increasing the rate of consultation, allowing better selection of patients who might benefit from referral. Further evaluation in a variety of clinical settings is now indicated, along with cost‐benefit analysis.
Voluntary universal antenatal HIV testing
Authors: Mercey Danielle , Helps Barbara A. , Copas Andrew , Petruckevitch Ann , Johnson Anne M. , Spencer John
Published: August 2005

Objectives
To assess the uptake of universal voluntary named HIV testing of hospital booked antenatal women and to identify behavioural and demographic factors associated with testing. To identify the number of previously undiagnosed women detected by the new policy and to compare prevalence among those testing with that measured by unlinked anonymous monitoring.

Design
Self‐completion questionnaire and data abstraction from structured booking forms and virology laboratory records.

Setting
Central London teaching hospital antenatal clinic.

Participants
One thousand three hundred and seventy‐four women booking with a hospital based midwife during the 49 weeks from 27 July 1993 to 1 July 1994.

Results
Before the introduction of the new testing policy fewer than 10 women per year had an HIV test, and during the study this rose to 41% (548/1340). In univariate analysis, Caucasian and Mediterranean ethnic origin, fewer previous live births, and more than one lifetime sexual partner were associated with higher uptake of HIV testing. In a multivariate model only the number of previous live births and ethnic origin remained significantly associated with testing. Six women out of 828 (1%) who completed the question about nonprescribed drug use stated that they had injected drugs, and four of these women accepted a test. Two women, both with recognised major risk factors for HIV infection, were diagnosed HIV antibody positive (a prevalence in the tested women of 0.36%). A further three women were already known to be HIV antibody positive. During the 12 months from July 1993 seven women (0.24%) were found to be positive by unlinked anonymous testing.

Conclusions
The introduction of a universal approach to antenatal HIV testing appears feasible: it increased the uptake of the test and detected previously unrecognised infections. Many women chose not to be tested, however, and cases remained undiagnosed. Further studies are required to examine different models of offering HIV testing, reasons for declining the test, and the cost–benefit of antenatal HIV screening.
VEGF mRNA levels in placentae from pregnancies complicated by pre‐eclampsia
Authors: Cooper Jason C. , Sharkey Andrew M. , Charnock‐Jones D. Stephen , Palmer Christopher R. , Smith Stephen K.
Published: August 2005

Objective
To measure the mRNA levels of vascular endothelial growth factor and its receptor in the placenta following delivery after uncomplicated pregnancy and after pregnancies complicated by pre‐eclampsia.

Setting
Rosie Maternity Hospital, Cambridge.

Material
Placental biopsies were obtained following delivery by caesarean section in 23 cases of pregnancy presenting at a range of gestational ages with pre‐eclampsia. These were compared with biopsies from 20 appropriately matched women with uncomplicated pregnancies.

Main outcome measure
mRNA levels of vascular endothelial growth factor (VEGF) and its receptor the fins‐like tyrosine kinase (flt), were quantified in total RNA isolated from placental biopsies using the RNAse protection assay. The amount of RNA was compared with that of the housekeeping gene glyceraldehyde 3–phosphate dehydrogenase (GAPDH), used as a standard. Results were expressed as arbitrary optical density units of VEGF/GAPDH and flt/GAPDH.

Results
In both control and pre‐eclamptic women regression analysis showed that the level of mRNA encoding VEGF declined significantly with gestational age (P < 0.0001). However, levels of VEGF mRNA were significantly lower in the pre‐eclamptic women compared with the control women (P < 0.023).

Conclusions
This study provides evidence of an abnormality of growth factor expression in the placenta during pregnancies complicated by pre‐eclampsia. Such placentae exhibit deficient growth and differentiation of terminal villi and reduced fetal capillary branching and reduced levels of VEGF could well account for these morphometric changes. This finding provides a molecular explanation for this abnormal placental development and points to VEGF as a factor in the aetiology of pre‐eclampsia and its complications.
Late selective termination of fetal abnormalities in twin pregnancies: a multicentre report
Authors: Lipitz Shlomo , Shalev Eliezer , Meizner Israel , Yagel Simcha , Weinraub Zvi , Jaffa Ariel , Shalev Joseph , Achiron Reuwen , Schiff Eyal
Published: August 2005

Objective
To evaluate the outcome of late selective fetal termination based on combined data from eight tertiary perinatal centres.

Design
Israeli law requires institutional committee approval for pregnancy termination. Moreover, after 24 weeks only a district superior committee can approve the termination. A total of 36 bichorionic twin pregnancies who underwent selective fetal termination after 24 complete gestational weeks were identified in eight Israeli centres.

Results
In 23 women (63.9%) the indication for selective termination was structural anomaly, and in 13 (36.1%) the indication was chromosomal abnormality. The mean gestational age at the time of diagnosis was 24.1 ± 1.9 weeks. The termination procedure was performed at a mean gestational age of 25.5 ± 2.0 weeks (median 25, range 24–33 weeks). There was one case of immediate procedure‐related complication (i.e. amnionitis) and the unaffected infant died, which was the only perinatal death in this series. No evidence of coagulopathy was reported. Only five women (13.8%) delivered before 34 completed weeks. The mean gestational age at delivery was 36.9±2.9 weeks (28–41 weeks), and the mean procedure‐to‐delivery interval was 11.8±3.2 weeks (median 13, range 3–17 weeks).

Conclusions
Late (> 24 weeks) selective termination in twin pregnancies is associated with favourable perinatal outcome of the healthy twin. In countries where the law permits late pregnancy termination, the parents should be informed of that possibility.
A comparative study of the cosmetic appeal of abdominal incisions used for hysterectomy
Authors: Currie I. , Onwude J. L. , Jarvis G. J.
Published: August 2005

Objective
To assess the cosmetic appeal of abdominal incisions used for hysterectomy.

Design
A comparative study.

Setting
St James's University Hospital, Leeds

Participants
One hundred women, including 50 consecutive women attending a gynaecology clinic for the first time and 50 hospital staff.

Results
Sixty‐eight percent of women preferred a Pfannenstiel incision as the incision of first choice, while 31% chose the laparoscopic assisted vaginal hysterectomy incisions (LAVH). When women who had undergone previous abdominal surgery were compared with women with no previous surgery, there was a significant difference in their choice (80% Pfannenstiel, 18% LAVH compared with 54% Pfannenstiel, 45% LAVH).

Conclusions
In gynaecological surgery there is already a cosmetically‐favoured incision. One cannot assume that if a gynaecologist uses a minimally invasive surgical technique at hysterectomy that this will be cosmetically acceptable to the woman. Gynaecologists should not use cosmetic appeal in counselling women for LAVH and should concentrate on the other proven benefits of minimally invasive surgery.
Serum levels of endometrial proteins during transcervical resection of the endometrium
Authors: Hahn Robert G. , Olsson Joel , Englund Katarina , Seppala Markku
Published: August 2005

Objective
To study the potential for dissemination of endometrial tissue substances during transcervical resection of the endometrium (TCRE).

Design
Prospective study.

Setting
One university and two county hospitals.

Participants
Forty‐eight women with dysfunctional bleeding.

Interventions
The serum levels of two endometrial proteins, insulin‐like growth factor binding protein‐1 (IGFBP‐1) and placental protein 14 (PP14), were measured before and every 10 min during the operations. Blood loss was also measured by a photometer together with absorption of the irrigating fluid containing glycine 1.5% and ethanol 1% by expired‐breath tests, and serum sodium and volumetric fluid balances.

Main outcome measures
Linear correlations between changes in IGFBP‐1 and PP14 during TCRE and operating parameters such as operating time, blood loss and fluid absorption.

Results
The baseline levels of IGFBP‐1 were normal but PP14 could only be detected in one third of the patients, which was due, in part, to pre‐operative treatment with danazol. The highest levels of IGFBP‐1 and PP14 during surgery correlated positively with the baseline concentrations. Fluid absorption (median 405 ml, range 0–2177) was the only surgical factor associated with increasing serum levels of endometrial proteins.

Conclusion
Absorption of the solution used to irrigate the uterus is associated with dissemination of endometrial products in the bloodstream during TCRE.