bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal and maternal morbidity in relation to the length of the second stage of labour
Authors: SAUNDERS NIGEL ST. G. , PATERSON CATHERINE M. , WADSWORTH JANE
Published: August 2005

Objective
To investigate the relation between the duration of the second stage of labour and subsequent early neonatal and maternal morbidity.

Design
Retrospective analysis of a regional obstetric database.

Setting
17 maternity units in the North West Thames Health Region.

Subjects
Selected from 36 727 consecutive singleton deliveries in 1988. The analysis was confined to the 25 069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour.

Main outcome measures
The relative risk of early maternal morbidity, postpartum haemorrhage (PPH) and postpartum infection, and neonatal morbidity, as judged by low Apgar scores or admission to the special care baby unit (SCBU), in relation to anthropomorphic characteristics (parity and birthweight), interventions (epidural analgesia, episiotomy and operative delivery), signs of fetal compromise (meconium staining of the amniotic fluid or abnormal cardiotocography (CTG)), maternal morbidity in labour (pyrexia) and the duration of the second stage of labour.

Results
The duration of the second stage of labour had a significant independent association with the risk of both PPH and maternal infection after adjustment for other factors. However, there was a similar or greater risk of PPH in association with operative delivery or a birthweight greater than .4000 g. Both maternal pyrexia in labour and primiparity were associated with a greater risk of post partum maternal infection than was the duration of the second stage, although all these factors were statistically significant. In contrast, the duration of the second stage was not significantly associated with the risk of a low Apgar score or admission to SCBU after adjustment for other factors.

Conclusions
The duration of the second stage of labour has a positive independent association with early maternal morbidity. We could show no such relation between time spent in the second stage of labour and the frequency of low Apgar scores or the rate of admission to SCBU. With current management approaches, in the absence of factors suggesting fetal compromise, second stage labours of up to 3 h duration do not seem to carry undue risk to the fetus.
Abdominal irradiation in childhood; the potential for pregnancy
Authors: CRITCHLEY H. O. D. , WALLACE W. H. B. , SHALET S. M. , MAMTORA H. , HIGGINSON J. , ANDERSON D. C.
Published: August 2005

Objective
To investigate the impact of premature ovarian failure due to whole abdominal radiotherapy (DXT) in childhood on uterine physical characteristics and blood flow and measuring the uterine response to exogenous sex steroid replacement

Design
A comparative observational study

Subjects
10 women with premature ovarian failure due to treatment with whole abdominal irradiation in childhood. A comparison group of 22 women with premature ovarian failure who had not received whole abdominal DXT.

Main outcome measures
Uterine length and uterine blood flow measurement plus serial assessment of endometrial thickness during a cycle of exogenous sex steroid replacement.

Results
Uterine length was significantly less (P<0.01) in women who had been exposed to whole abdominal DXT in childhood (mean 4.1 cm, 2SE 0.8) compared with a mean of 7.3 cm (2SE 0.6) in the comparison group. The three women in the DXT group who were studied serially had no increase in endometrial thickness in response to physiological sex steroid replacement therapy and most of the 10 irradiated women had no detectable uterine blood flow with Doppler ultrasound.

Conclusions
Uterine musculature and blood flow are irreversibly affected by high dose irradiation in childhood. Non‐invasive assessment of this nature may predict potential for pregnancy following ovum donation and embryo transfer.
Calcium homeostasis in pregnancy during long‐term heparin treatment
Authors: DAHLMAN T. , SJÖBERG H. E. , HELLGREN M. , BUCHT E.
Published: August 2005

ObjectiveTo investigate the effect of subcutaneous heparin treatment on calcium homeostasis in pregnancy.

DesignA longitudinal case‐control observational study.

SettingDepartment of Obstetrics and Gynaecology, Karolinska Hospital, Stockholm, Sweden.

Subjects36 pregnant women with previously verified thromboembolic complications and 23 healthy pregnant control women similar in age, parity, weight, and smoking habit.

InterventionsThromboprophylaxis during pregnancy and 6 weeks post partum was given with subcutaneous heparin twice daily to the 36 women with a history of thromboembolic complications, 16 received an average dose of 24 500 IU/day and 20 a mean dose of 17 300 IU/day. Venous blood and urine samples were obtained every 4 weeks.

Main outcome measuresSerum concentrations of total calcium, ionized calcium, calcitonin and urinary calcium.

ResultsWomen on high‐dose heparin treatment showed significantly higher concentrations of total and ionized calcium and of calcitonin in serum and significantly lower concentrations of calcium in urine than did 23 normal pregnant controls. The differences were most pronounced in the third trimester. The results obtained in the low‐dose heparin group were between those in the high‐dose and the control groups. At 8 weeks postpartum there were no significant differences between the heparin‐treated women and the controls. No significant differences were found during pregnancy in haematocrit, liver or renal function, serum levels of albumin, phosphate, magnesium, alkaline phosphatase, parathyroid hormone or urinary cyclic AMP.

ConclusionsHeparin treatment during pregnancy results in changes in calcium homeostasis and a dose‐dependent response is suggested.
Length and variation in the menstrual cycle—a cross‐sectional study from a Danish county
Authors: MÜNSTER KIRSTINE , SCHMIDT LONE , HELM PETER
Published: August 2005

Objective
To investigate the current epidemiology of menstrual patters among women of fertile age.

Design
Cross‐sectional postal questionnaire study.

Setting
County of Copenhagen, Denmark.

Subjects
3743 women, aged 15–14, selected at random from a Danish county, who were asked to provide information on menstrual pattern during the preceding year, 1981. The response rate was 78%. Information from non‐responders was obtained via telephone interviews.

Results
In women with regular menstrual cycles, the 5th–95th centile range of usual cycle length decreased from 23–35 days in the 15–19 years age group to 23–30 days in the 40–44 years age group. Only 0.5% of regular menstruating women had a usual cycle length of <21 days and 0.9% had a usual cycle length of >35 days. At least one cycle length of <21 days was experienced by 18.6%, whereas 29.5% had at least one cycle of >35 days. Menstrual cycle variation of >14 days was present in 29.3% of all women. Cycle length variation of > 14 days was 2.7 times more frequent in women from lower social groups (controlled by age).

Conclusion
The study confirmed the normally used definitions of polymenorrhoea (cycle length <21 days) and oligomenorrhoea (cycle length between 36 and 90 days), as these very short or long menstrual cycle lengths were very seldom recorded for a longer period. However, the high frequency in a normal population of large menstrual cycle length variation challenges the view that an intra‐individual variation of >5 days should be regarded as a sign of disease in the woman.
Management of prelabour rupture of the membranes in term primigravidae: report of a randomized prospective trial
Authors: GRANT JOHN M. , SERLE ELISABETH , MAHMOOD TAHIR , SARMANDAL PURNIMA , CONWAY DAVID I.
Published: August 2005

Objective
To compare a conservative and an active policy (immediate oxytocin infusion) of management of prelabour rupture of the membranes in term primigravidae.

Design
Randomized trial involving 444 women.

Setting
District maternity hospital.

Main outcome measures
Caesarean section rate in each group; also the rate of forceps deliveries, spontaneous deliveries, length of labour, number of vaginal examinations, type of analgesia, pyrexia in labour or the puerperium and antibiotic use in the mother and the infant in each group. The caesarean section rate for the whole trial where the latent period was > 12 h was compared to that where the latent period was s=12h.

Results
There were fewer caesarean sections in the conservative group (odds ratio (OR) 0.60,95% confidence interval (CI) 0.35 to 1.02; P= 0.06). There was a similar number of forceps deliveries (OR 0.79; 95% CI 0.52 to 1.19; P= 0.26) but more spontaneous deliveries (OR 1.57; 95% CI 1.08 to 2.29; P= 0.02) in the conservative group. More women managed conservatively required inhalational analgesia only for pain relief in labour (OR 2.88; 95% CI 1.46 to 5.68; P= 0.003), a similar number required pethidine (OR 1.29; 95% CI 0.85 to 1.94; P = 0.23), and fewer required epidural analgesia (OR 0.57; 95% CI 0.39 to 0–84; P= 0.005). The number of vaginal exminations was less in the conservative group (difference between means 0.53; 95% CI 0.25 to 0.80; F<0.001). Fewer women managed conservatively experienced four or more vaginal examinations in labour (OR 0.58; 95% CI 0.39 to 0.86; P= 0.007). There were no differences in the lengths of labour, the proportions of women who developed pyrexia in labour or the puerperium or who required antibiotics or in the proportions of infants who required antibiotics.

Conclusions
These results argue in favour of a conservative policy in managing primigravidae at term with prelabour rupture of the membranes.
Biochemical composition of amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy
Authors: CAMPBELL JAMES , WATHEN NEVILLE , MACINTOSH MARY , CASS PETER , CHARD TIM , MAINWARING‐BURTON RICHARD
Published: August 2005

Objective
To determine the biochemical composition of amniotic fluid and extra‐embryonic coelomic fluid between 8 and 12 weeks gestation.

Design
Prospective observational study.

Subjects
40 women with a normal pregnancy between 7 and 12 weeks gestation having termination of pregnancy.

Interventions
Before termination the women had a transvaginal ultrasound guided amniocentesis. Pure samples of amniotic fluid and extraembryonic coelomic fluid were obtained from each woman and standard biochemical variables were measured in each fluid sample immediately after collection.

Results
Levels of sodium, potassium and bicarbonate were significantly higher in amniotic fluid whilst chloride, urea, bilirubin, protein, albumin, glucose, creatinine, calcium and phosphate were present in higher concentrations in extraembryonic coelomic fluid. All differences in concentration were significant (P <0.05; unpaired Mest). No relation was demonstrated between electrolyte concentrations in amniotic fluid or coelomic fluid and stage of gestation.

Conclusions
Amniotic fluid and extraembryonic coelomic fluid have a widely differing biochemical composition. The biological significance of these differences remains unexplained.
CIN 3: the role of lesion size in invasion
Authors: TIDBURY PENELOPE , SINGER ALBERT , JENKINS DAVID
Published: August 2005

Objective
To define the relation between the size of a CIN 3 lesion (measured histologically) and invasive squamous carcinoma.

Design
Measurement of CIN 3 by computerized planimetry of histological sections from 39 cone biopsies containing microinvasive cancer. Comparison with previous measurements of CIN lesions, associated with different grades of dyskaryosis.

Results
Microinvasive carcinoma of the cervix is associated with extensive CIN 3 on the surface and in endocervical crypts. The mean size of CIN 3 lesions showing microinvasion is seven times greater than that for severe dyskaryosis without invasion, (P<0.0001) and a 100‐fold greater than with mild dyskaryosis (P<0.00001).

Conclusion
Invasive squamous carcinoma of the cervix arises in large CIN 3 lesions and these are associated usually with severe dyskaryosis. We propose a model for the development of high‐grade precancer as a small focus within low grade pre‐cancer which then undergoes expansion in size, accompanied by apparent progression in cytological grade.
The role of partial colpectomy in the management of persistent vaginal neoplasia after primary treatment
Authors: CURTIS PAUL , SHEPHERD JOHN H. , LOWE DAVID G. , JOBLING TOM
Published: August 2005

Objective
To describe and assess the technique of partial colpectomy for the treatment of persistent vaginal neoplasia.

Setting
Gynaecological oncology unit of a London teaching hospital.

Subjects
12 women with persistent vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia (CIN) or for benign disease.

Technique
Partial colpectomy using a vaginal approach assisted by a Schuhardt incision to improve access.

Results
Assessment of patients between 9 and 99 (mean 55) months after partial colpectomy for VAIN showed no recurrence of disease in ten patients (83%).

Conclusion
This technique of partial colpectomy is an effective procedure, associated with minimal morbidity which should be considered as primary treatment for patients suffering from persistent vaginal disease after hysterectomy or other procedures.
A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis
Authors: NEZHAT CAMRAN , NEZHAT FARR
Published: August 2005

Objective
To describe optimal procedures and preliminary results for videolaparo‐scopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea.

Design
Observational study with follow up for at least one year.

Setting
Subspecialty practice: Endometriosis Clinic and Centre for Special Pelvic Surgery.

Subjects
Eighty five women (18–4–5 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded.

Interventions
Excision and vaporization of endometriotic pathology was followed by presacral neurectomy.

Outcome measures
During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively.

Results
There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief.

Conclusions
Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.
Genital tract infections associated with the intrauterine contraceptive device can be reduced by inserting the threads into the uterine cavity
Authors: PAP‐ÅKESON MARGARETHA , SOLHEIM FOLKE , THORBERT GUNNAR , AKERLUND MATS
Published: August 2005

Objective
To study the influence of the position of the threads of an intrauterine contraceptive device (IUCD) on the development of genital tract infection.

Design
A multicentre randomized controlled trial. Subjects Women requesting an IUCD.

Interventions
The women were randomized to be fitted with an IUCD either with the threads contained in the uterine cavity (threads‐up group) (n= 208) or passing through the cervix to the vagina in the usual way (threads‐down group) (n= 237). Multiple centre study with follow‐up at three months, 1 and 2 years. At the final visit ‘missing’ threads were retrieved using a disposable instrument (RetrievetteR).

Main outcome measures
The occurrence of infection in the lower or upper genital tract.

Results
63 women in the threads‐up group and 78 in the threads‐down groups dropped out. Previous gynaecological infection was reported by 21 and 48 women in the threads‐up and threads‐down group, respectively (odds ratio 0.44, 95% CI 0.24 to 0.79), 21 and 53 subjects had signs of infection at gynaecological examination (odds ratio 0.39,95% CI 0.21 to 0.69) and a wet‐smear was pathological in 33 and 79 (odds ratio 0.38, 95% CI 0.23 to 0.61). In the threads‐up group the vaginal pH was also lower at the final check up after 2 years. Spontaneous descent of the threads occurred in 11% of the threads‐up group and in six women in the threads‐down group the threads were in the cervix. In 93 women the threads were easily retrieved by means of the RetrievetteR, four women insisted on the threads remaining in the uterus and in 18 thread removal was performed under local or general anaesthesia.

Conclusions
Infectious complications in women using an IUCD are more frequent if the threads lead from the uterine cavity to the vagina. This problem can be reduced by inserting the threads so that they remain entirely within the uterine cavity, a feasible procedure now that an effective instrument for IUCD thread retrieval is available.
Normal amniotic pressure throughout gestation
Authors: FISK N. M. , RONDEROS‐DUMIT D. , TANNIRANDORN Y. , NICOLINI U. , TALBERT D. , RODECK C. H.
Published: August 2005

Objective
To characterize amniotic pressure (AP) in pregnancies with normal amniotic fluid volume.

Design
Observational study, mainly cross‐sectional.

Setting
Fetal medicine unit within a tertiary referral hospital.

Subjects
Patients undergoing transamniotic invasive procedures in whom amniotic fluid volume was subjectively assessed as normal on ultrasound. Those beyond 16 weeks with a deepest vertical pool on ultrasound <3.0 or >8.0 cm were excluded. Overall 194 pregnancies were studied on 232 occasions between 7 and 38 weeks gestation.

Interventions
Manometry readings referenced to the top of the maternal abdomen were obtained via a fluid‐filled line from the needle hub and either connected to a pressure transducer (n= 190) or held vertically against a ruler (n−42).

Main outcome measures
AP in mm Hg, AP corrected for gestational age (z scores), semi‐quantitative ultrasonic indices of amniotic fluid volume, clinical variables.

Results
AP in singleton pregnancies increased with advancing gestation (P<0.001), and the sigmoid‐shaped regression curve plateaued in the mid‐trimester. AP z scores were not influenced by volume‐related phenomena such as twin gestation, the deepest vertical pool, or amniotic fluid index, nor by maternal age, parity, gravidity, fetal sex, or subsequent spontaneous preterm delivery.

Conclusions
These findings suggest that AP is not principally determined by intrauterine volume. We speculate that AP, which reflects change in uterine tension as a function of radius, may instead be determined by gestation‐specific anatomical and hormonal influences on gravid uterine musculature. A reference range for AP has been constructed for use in amnioinfusion and amnioreduction procedures.
Intergenerational studies of human birthweight from the 1958 birth cohort. 1. Evidence for a multigenerational effect
Authors: EMANUEL IRVIN , FILAKTI HAROULLA , ALBERMAN EVA , EVANS STEPHEN J. W.
Published: August 2005

Objective
To investigate possible multigenerational influences on birthweight.

Design
Data from the longitudinal study of one week's births in 1958 up to the age of 23 years, the British National Child Development Study, were utilized. These pro‐vide socio‐biological information on the parents of the cohort, on the cohort members from birth onwards, and on the pregnancies and the birthweight of any babies born to the cohort members.

Main outcome measure
The main outcome was the birthweight of babies born to the cohort members, for whom complete intergenerational data were available for 1638 firstborn. Multiple regression modelling was used to investigate any associ‐ations between their birthweight and characteristics of their parents and grandparents.

Results
Significant positive associations were found between babies' birthweight and parental birthweight but not gestational age. For the babies born to female cohort members additional findings included associations between their birthweight and the height of the maternal grandmother and the social class of the maternal grandfather, even after adjustment for such strong predictors of birthweight as maternal weight, smoking habit in pregnancy and baby's sex and birth order.

Conclusion
These results thus offer support for a multigenerational influence on birthweight passed through the maternal line.
Previous miscarriage and stillbirth as risk factors for other unfavourable outcomes in the next pregnancy
Authors: PAZ JOAQUIN E. , OTANO LUCAS , GADOW ENRIQUE C. , CASTILLA EDUARDO E.
Published: August 2005

Objective
To look for associations between previous fetal loss and fetal malformation or low birthweight in a subsequent pregnancy.

Design
A cas‐ontrol study with place of birth, time and sex matched controls.

Setting
72 South American maternity hospitals.

Subjects
18 534 malformed, 1150 no‐alformed babies of low birthweight and 16 394 controls. All babies were from mothers with at least one previous pregnancy.

Main outcome measures
Frequency of stillbirths and miscarriages in the previous pregnancy and outcome of the index pregnancy.

Results
Multiple malformation, Down's syndrome, anencephaly, spina bifida, pes equinovarus, congenital dislocation of the hip and low birthweight are associated with previous fetal loss.

Conclusion
A miscarriage or a stillbirth in a previous pregnancy should be taken into account when the risk of malformations or low birthweight in a subsequent pregnancy is assessed.
A prospective study comparing the outcome of oocytes retrieved in the aspirate with those retrieved in the flush during transvaginal ultrasound directed oocyte recovery for in‐vitro fertilization
Authors: EL HUSSEIN ELSIR , BALEN ADAM H. , TAN SEANG‐LIN
Published: August 2005

Objective
To study prospectively the fate of oocytes collected from the follicular aspirate and subsequent flushes during transvaginal ultrasound directed oocyte recovery for in‐vitro fertilization (IVF).

Setting
A tertiary referral assisted conception centre.

Subjects
100 consecutive patients undergoing 100 cycles of IVF. Four patients were withdrawn because their embryos were electively cryopreserved. Therefore 96 cycles were studied.

Main outcome measures
The oocyte recovery rate, viability, fertilization and cleavage rates and outcome of embryos generated from oocytes that were obtained from either the initial aspirate (Al), dead space in the collecting system (A2) or the first two 2 ml flushes (Fl and F2) were compared.

Results
The overall oocyte recovery rate was 87.8%. Of the 1046 oocytes collected, 40.3% were from Al, 41.3% from A2, 13.7% from Fl and 4.7% from F2. There were comparable numbers of viable and fertilized oocytes and cleaved, transferred and frozen embryos in tubes Al and A2 but all these parameters were significantly lower in tubes Fl and F2 (P<0.0001). All these parameters were also significantly higher in Fl compared with F2 (P<0.001), except for the number of embryos frozen, in which there was no difference. The overall pregnancy rate per cycle was 28.1% and the pregnancy rate per embryo transfer was 31.0%. There were no pregnancies in any of the cycles in which embryos originating from F2 were transferred, nor were there pregnancies in cycles in which only embryos from Fl were transferred.

Conclusion
Follicular aspiration together with one 2 ml flush maximises the recovery of oocytes that will result in pregnancies.
The variability of urinary protein and creatinine excretion in patients with gestational proteinuric hypertension
Authors: LINDOW S. W. , DAVEY D. A.
Published: August 2005

Objective
To determine the variability of protein excretion in patients with proteinuric hypertension and the accuracy of either a urinary protein/creatinine ratio or a Multistix examination for the estimation of a 24 h protein excretion.

Design
An indwelling urinary catheter was placed for 24 h and successive 8 h specimens examined.

Setting
A tertiary referral hospital in Cape Town, South Africa.

Subjects
22 women with significant proteinuria in pregnancy were studied.

Main outcome measures
The urine volume, protein excretion and creatinine excretion in eight hourly periods were measured. Multistix examination of each specimen was recorded.

Results
A large coefficient of variation in urine volume (41%), amount of protein excreted (44%) and the amount of creatinine excreted (22%) in the eight hourly specimens were noted. The protein creatinine ratio did not accurately predict the 24 h protein excretion. The Multistix examination was less accurate with increasing amounts of proteinuria. The amount of creatinine excreted correlated with the volume of urine passed (r = 0.43).

Conclusion
The analysis of a 24 h specimen or urine for protein excretion remains the best method of monitoring proteinuria in pregnancy. The amount of creatinine excreted in 24 h cannot be used as an index of completeness of collection of the 24 h specimen.
Pregnancy in sickle cell disease in Bahrain
Authors: EL‐SHAFEI AFFAF M. , DHALIWAL JAGJEEVAN KAUR , SANDHU AMARJEET KAUR
Published: August 2005

Objective
To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls.

Design
A case‐control study.

Setting
Ministry of Health hospitals in Bahrain.

Subjects
147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity

Main outcome measures
The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statisties in the index and control women.

Results
Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anaemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity.

Conclusion
Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.
Jejunal atresia related to the use of methylene blue in genetic amniocentesis in twins
Authors: VAN DER POL JOHAN G. , WOLF HANS , BOER KEES , TREFFERS PIETER E. , LESCHOT NICO J. , HEY HUGO A. , VOS ANTON
Published: August 2005

Objective
To calculate the incidence of jenunal atresia in newborns in The Netherlands. To study the relation between the occurrence of jejunal atresia and genetic amniocentesis to determine a possible iatrogenic cause for the unexpected high incidence of this anomaly in twins.

Design
Retrospective study.

Subjects
Eighty‐nine consecutive twin pregnancies in which amniocentesis had been performed for prenatal diagnosis. In 86 methylene blue solution had been used to mark the amniotic cavity that was punctured first.

Main outcome measure
The occurrence of jejunal atresia in one of the two twin infants.

Results
The incidence of jejunal atresia at birth in The Netherlands is estimated to be 1 in 14 000. This anomaly occurred in 17 out of 89 twin pregnancies (19%). In 15 of the 17 it was possible to determine which of the two children had been exposed to intra‐amniotic methylene blue. In all 15 pregnancies, the infant exposed to the dye was suffering from jejunal atresia.

Conclusion
A causal relation between the use of methylene blue in second trimester amniocentesis and the occurrence of jejunal atresia is strongly suggested. We recommend that no dyes should be injected into the amniotic sac.
Clinical overview of cardiotocography
Authors: Spencer John A. D.
Published: August 2005

Twenty years after its widespread introduction, the role of continuous fetal heart rate and contraction monitoring in labour (cardiotocography, CTG) remains uncertain. Although a normal pattern is very reassuring about fetal condition, the predictive value of an abnormal pattern is low. In most studies the use of CTG has been associated with an increase in intervention in labour, particularly caesarean section, without clear evidence of benefit. Fetal blood sampling is the most useful associated technique for minimizing unnecessary intervention. The relationship between fetal heart rate, fetal blood pH changes and long‐term outcome remains obscure and further work to clarify this relationship is urgently needed.
The fetal ECG: accuracy of measurements
Authors: Dawes G. S.
Published: August 2005

Analysis of fetal heart rate is very dependent upon the accuracy with which fetal events can be timed. This depends upon signal quality and the type of processing used in signal analysis. Signal quality is affected by mode of recording and positioning of sensors. Signal loss can be kept to below 5% in routine clinical practice with appropriate attention to technique. Accuracy of beat‐to‐beat measurement needs to be 1 ms if shortterm variability (epoch length 1/16 min) is to be assessed reliably.
The effects of exercise induced tachycardia on the maternal electrocardiogram
Authors: Asher U. A. , Ben‐Shlomo I. , Said M. , Nabil H.
Published: August 2005

Objective
To determine whether pregnancy has an effect on the maternal electrocardiographic response to stress.

Design
Eight maternal ECG parameters were screened before, during and after exercise induced tachycardia at 29 and 37 weeks gestation and at 6 weeks post partum for each participant.

Setting
General Hospital in Safed, Israel.

Subjects
Fifteen healthy, pregnant women aged 22 to 34 years with singleton pregnancies volunteered from the peripheral antenatal clinics.

Intervention
Exercise stress tests were performed on a Quinton 3000 treadmill stress test system according to a Modified Bruce Protocol, producing a heart rate of 85% of age predicted maximum.

Main outcome measures
The ST‐segment, T‐wave, QRS complex, axis, rhythm, disorders of impulse conduction, the P–Q and Q–T intervals were screened before, during and after the exercise test.

Results
The study results suggest an increase in the ST‐segment changes induced by stress at 37 weeks of pregnancy compared to 29 weeks (ST‐depression in 6 women out of 15 versus 2, P= 0.125, McNemar's Test for Correlated Proportions – Exact Test, two tailed; 95% CI, 0.042–0.492,0.01 < P<0.05) and to the post partum test (ST‐depression in 6 women out of 15 versus 1, P= 0.125; 0.029–0.637, 0.01 P < 0.05). No significant alteration of the other ECG parameters. No significant correlation between blood haemoglobin level, serum levels of sodium, potassium, calcium, glucose and 17β‐oestradiol with the appearance of the ECG change.

Conclusions
The increase in the exercise induced ST‐segment abnormalities at 37 weeks of pregnancy may be another physiological effect of late pregnancy which has not been demonstrated previously.
Angiotensin sensitivity predicts aspirin benefit in placental insufficiency
Authors: Cook Colleen‐M , Trudinger Brian J.
Published: August 2005

Objective
To determine whether the beneficial effects of aspirin in the treatment of Doppler umbilical placental insufficiency correlate with the maternal pressor response to angiotensin infusion.

Design
An open trial.

Setting
A tertiary referral obstetric service.

Patients
Women identified at between 25 and 36 weeks of pregnancy with an elevated umbilical artery Doppler systolic/diastolic (S/D) ratio and a positive pressor response to angiotensin infusion.

Intervention
Low dose aspirin (100mg/day) treatment of mothers.

Main outcome measure
Fetal and placental size at delivery in relation to subsequent maternal angiotensin responsiveness.

Results
Women who converted from a positive angiotensin pressor response to angiotensin refractoriness after aspirin administration had larger infants and placentas compared with those whose response remained positive.

Conclusion
Angiotensin sensitivity predicts women with umbilical Doppler detected placental insufficiency responding to aspirin therapy. Loss of the normal refractory response in pregnancy may be a consequence of vascular pathology in the placenta.
A nonpenetrating fetal scalp electrode
Authors: Justus Hofmeyr G. , Cheryl Nikodem V. , Metin Gülmezoǧlu A. , Bunn Anthony E.
Published: August 2005

Objective
To develop a nonpenetrating scalp electrode for intrapartum fetal monitoring.

Design
Preliminary observational evaluation of the device.

Setting
An urban academic hospital in Johannesburg, South Africa.

Subjects
Fifteen women in labour.

Intervention
Application of the electrode for intrapartum monitoring.

Outcome measures
Quality of tracings, duration of application, disconnection of the electrode, marking of the scalp.

Results
Application was successful in 13of 15 women, and high quality tracings obtained in 12.

Conclusions
The design of scalp electrode tested is effective and produces high quality tracings in most cases.
Antithyroid antibodies underlying thyroid abnormalities and miscarriage or pregnancy induced hypertension
Authors: Lejeune B. , Grun J. P. , de Nayer Ph. , Servais G. , Glinoer D.
Published: August 2005

Objective
To assess whether asymptomatic abnormalities, including thyroid auto‐antibodies, were associated with an abnormal miscarriage rate or a poor obstetric outcome.

Design
Prospective study of thyroid auto‐antibodies and thyroid function in an unselected obstetric population.

Setting
Saint‐Pierrie Hospital, Brussels, Belgium.

Subjects
Seven hundred and thirty consecutive pregnant women attending the antenatal clinic.

Main outcome measures
Miscarriage and pregnancy induced hypertension.

Results
Elevated antithyroperoxidase (TPO‐Ab) and antithyroglobuline (TG‐Ab) antibody titres are associated with an increased miscarriage rate. Also, asymptomatic thyroid abnormalities, mainly abnormal echostructure but not antithyroid antibodies, are associated with pregnancy induced hypertension.

Conclusion
The presence of thyroid auto‐antibodies during pregnancy constitutes a marker of increased risk of miscarriage and poor obstetric prognosis.
An audit of the obstetric outcome of 148 consecutive pregnancies from assisted conception: implications for neonatal services
Authors: McFaul P. B. , Patel N. , Mills J.
Published: August 2005

Objective
To assess the outcome of pregnancy following assisted conception.

Design
Cohort descriptive study.

Setting
Unit of Reproductive Medicine, Ninewells Hospital and Medical School.

Subjects
One hundred and forty‐eight consecutive assisted conceptions.

Main outcome measures
Patient characteristics and outcome of pregnancy.

Results
Seventy‐nine percent of mothers were aged between 26 and 35 years (mean 31.4). The main causes of infertility were tubal (48%), unexplained (35%), anovulatory (8%) and male factor (8%). Primary infertility accounted for 61% of cases and 82% of pregnancies occurred within 3 treatment cycles. Thirty‐five (24%) pregnancies miscarried before 14 weeks and 7 (5%) between 15 and 24 weeks gestation. One hundred and three pregnancies resulted in 136 liveborn infants. There was one neonatal death. Thirty‐five babies were admitted to SCBU. Antenatally, 13% of patients were admitted to hospital with hypertension and 8% with APH; 50% of multiple and 13% of singleton pregnancies were delivered prematurely, 68% following preterm labour. There were 28 sets of twins (four miscarried at less than 24 weeks) and four sets of triplets. Multiple pregnancy was not associated with cause of infertility, treatment, age or ovarian hyperstimulation syndrome. Seventy‐eight per cent of singletons and 50% of multipara were delivered vaginally.

Conclusions
Our data confirm the high incidence of pregnancy loss and preterm delivery associated with assisted conception once allowing for the high rate of multiple pregnancies. The effect of assisted conception programme on health services is discussed.
What is vestibular papillomatosis? A study of its prevalence, aetiology and natural history
Authors: Welch Jan M. , Nayagam Maria , Parry Graham , Das Robert , Campbell Meg , Whatley Julie , Bradbeer Caroline
Published: August 2005

Objectives
To clarify the prevalence, aetiology, symptoms and natural history of vestibular papillomatosis.

Design
Study in two parts: 1. prevalence assessed by colposcopic examination of the vulva of unselected patients by one doctor (J.M.W.); 2. patients selected by clinical appearance as having vestibular papillomatosis (by J.M.W. and other doctors) assessed in a research clinic.

Setting
Outpatient genitourinary medicine clinic in South London.

Subjects
Part 1 study: 295 female clinic attenders; part 2 study: 18 women with clinical vestibular papillomatosis.

Main outcome measures
Part 1 study: number of unselected patients found to have vestibular papillomatosis. Part 2 study: associated symptoms, histology, DNA hybridisation and polymerase chain reaction on vulval biopsies. Clinical regression of lesions. Cervical cytology and colposcopy.

Results
Part 1 study: Vestibular papillomatosis was identified by colposcopic examination of the vulva in 3/295 (1%) of women. Part 2 study: 9/18 (50%) women with vestibular papillomatosis were asymptomatic; the other nine had intermittent mild symptoms. Thirteen (72%) had a history of genital warts. Vulval biopsies had features suggestive of wart virus infection on histology in 17/18 (94%) and HPV16 was found by DNA hybridisation studies or polymerase chain reaction in 7/18 (39%). On follow up (mean duration 9 months) the vulval lesions had regressed in 9/12 patients. Ten patients had cervical wart virus infection or intraepithelial neoplasia (CIN), or both, and five needed laser treatment for this.

Conclusions
In this study vestibular papillomatosis was associated with human papillomavirus (HPV) infection. This study suggests that vestibular papillomatosis need not be treated, but patients with it may be at increased risk for CIN.
Nifedipine versus ritodrine for suppression of preterm labour
Authors: Kupferminc M. , Lessing J. B. , Yaron Y. , Peyser M. R.
Published: August 2005

Objective
To compare the efficacy of tocolysis with specific regimens of nifedipine and ritodrine. Maternal side effects and neonatal outcome also were evaluated.

Design
A prospective, randomised trial.

Subjects
Seventy‐one women, including 11 with twin pregnancies, who had uterine contractions and observed cervical changes.

Main outcome measures
Prolongation of pregnancy for 48 h, seven days and until 36 weeks of pregnancy were evaluated for each treatment. Maternal side effects and haemodynamic changes were compared, as well as neonatal outcomes.

Results
Delivery was delayed for 48 h, seven days, and until the 36th week of gestation in 83%, 67%, and 50%, respectively, of women in the nifedipine group, compared with 77%, 63% and 43%, respectively, of women in the ritodrine group (no significant difference). Maternal side effects were significantly less common in the nifedipine group (27%) than in the ritodrine group (77%) (P <0.001). The neonatal outcome was similar in the two groups. The fall in mean arterial and diastolic blood pressure, and the rise in maternal heart rate were significantly greater in the women who received ritodrine compared with those treated with nifedipine.

Conclusions
Nifedipine is as effective as ritodrine in suppressing preterm labour. Its use is associated with less frequent side effects.
Differential diagnosis of ovarian cancer with tumour markers CA 125, CA 15‐3 and TAG 72.3
Authors: Jacobs Ian J. , Rivera Hector , Oram David H. , Bast Robert C.
Published: August 2005

Objective
To determine the accuracy of tumour associated antigens CA 125, CA 15–3 and TAG 72.3 in the differential diagnosis of benign and malignant pelvic masses and to compare the results with a previously defined risk of malignancy index (RMI).

Design
Retrospective analysis of samples collected during a prospective observational study.

Setting
Department of Obstetrics and Gynaecology, the Royal London Hospital and Duke University Medical Center.

Subjects
One hundred and forty‐three consecutive patients undergoing surgery for an adnexal mass.

Method
Tumour marker levels were determined by radio‐immunoassay in stored serum samples obtained from 143 study subjects.

Results
The highest diagnostic accuracy of the tumour marker panel was achieved by defining a positive result as elevation of any two of CA 125 (>30 u/ml), CA 15–3 (>30 u/ml) and TAG 72.3 (> 10 u/ml), (sensitivity 66.7%, specificity 93.1%). Similar diagnostic accuracy could be achieved by CA 125 alone using an upper limit of 50 u/ml (sensitivity 66.7%, specificity 94.1%). Inclusion of CA 15–3 or TAG 72.3 in stepwise logistic regression analysis did not improve the discriminative performance of the RMI.

Conclusion
The risk of malignancy index incorporating CA 125, menopausal status and ultrasound is superior to the panel of three tumour markers for pre‐operative differential diagnosis of the pelvic mass.
Pressor, heart rate and plasma catecholamine responses to noradrenaline in pregnant and nonpregnant women
Authors: Ramsay M. M. , Pipkin F. Broughton , Rubin P. C.
Published: August 2005

Objective
To study cardiovascular responses to noradrenaline during early pregnancy.

Design
Administration of incremental intravenous infusions of noradrenaline under basal conditions.

Setting
University Hospital, Nottingham.

Subjects
Nineteen women admitted for termination of pregnancy in first or second trimester and 18 nonpregnant women as control subjects.

Interventions
Recordings of blood pressure and heart rate responses during the infusion of noradrenaline. Blood samples taken before, during and after the infusion.

Main outcome measures
Evoked responses of systolic and diastolic blood pressure and heart rate at steady state during the noradrenaline infusion. Plasma catecholamine concentrations measured by high performance liquid chromatography.

Results
There were no significant differences between the evoked pressor responses to noradrenaline in pregnancy compared to the nonpregnant state, but there was a lesser bradycardia in response to a standardised change in blood pressure. Neither basal plasma catecholamine concentrations nor those achieved during infusion of noradrenaline differed between pregnant and nonpregnant women. Thirty minutes after discontinuance of the infusion there was a persistent elevation of heart rate in all women, although plasma catecholamine concentrations had returned to basal levels. In pregnant women, systolic and diastolic blood pressures were also elevated at this time, compared to preinfusion levels.

Conclusion
Cardiovascular regulatory mechanisms are altered in pregnancy with a diminution in the bradycardic response to a pressor challenge evoked by noradrenaline and a delayed recovery from that challenge.
An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia
Authors: Sculpher Mark J. , Bryan Stirling , Dwyer Nuala , Hutton John , Stirrat Gordon M.
Published: August 2005

Objective
To evaluate the relative health service cost of endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia and the value women attach to their health state before and after surgery.

Design
A prospective economic evaluation running alongside a randomised controlled trial.

Setting
The gynaecology department of a teaching hospital.

Subjects
200 women requiring surgical treatment of menorrhagia between January 1990 and May 1991; after withdrawals, 97 women underwent hysterectomy and 99 underwent endometrial resection.

Main outcome measures
The total health service cost of managing women in the two arms of the trial until 4 months after their operation. The change in women's valuation of their health state a fortnight after and a minimum of 4 months after surgery relative to that 1 month prior to their operation.

Results
Total health service costs are significantly higher amongst abdominal hysterectomy patients (mean £1059.73) than amongst endometrial resection patients with a mean difference of £499.68 (95% CI £432–£567). This significant difference exists under alternative assumptions about the difference in lengths of stay in hospital between the two treatment groups and the hotel cost per in‐patient day. On a scale of 0 to 100, relative to a month before surgery, there is a statistically significant difference in favour of endometrial resection between the two groups in the increase in value women attach to their health state at a fortnight after surgery (mean difference 11.2; 95% CI 0.6–21.7), but not at a minimum of 4 months after surgery (mean difference 7; 95% CI –17.4 to 3.4).

Conclusions
On the basis of health service resource cost up to 4 months after surgery, endometrial resection has a cost advantage over abdominal hysterectomy. However, given the fact that a subgroup of women requires retreatment due to resection failure and that this study considers a relatively short period of follow up, the long term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.
Clinical birthweight standards for a total population in the 1980s
Authors: Campbell Doris , Hall Marion , Lemon John , Carr‐Hill Roy , Pritchard Colin , Samphier Michael
Published: August 2005

Objective
To derive clinical standards for singleton birthweight in a population based on area of residence.

Design
Analysis of variables recorded in Aberdeen Maternity and Neonatal Databank, calculating for each birth a standardised birthweight score, taking account of determining factors.

Subjects
All singleton live births of 32 to 42 weeks gestation to Aberdeen City District residents from 1979 to 1983.

Results
Basic standards of birthweight are presented correcting for gestational age, sex of the baby and parity of the mother. Birthweight is not normally distributed and empirical data are presented rather than smoothed curves. Adjustment for maternal height is straightforward but adjustment for maternal weight must take account of the gestation at which the woman was weighed. A method of calculating the appropriate correction for height and weight is described in detail.

Conclusion
Birthweight is not normally distributed at each week of gestation. Standardisation for parity, gestation and sex of the baby is essential, but adjustment for maternal size is complex.
Endometrial changes in postmenopausal women treated with tamoxifen for breast cancer
Authors: Cohen Ilan , Rosen Doron J. D. , Shapira Jeremiah , Cordoba Mario , Gilboa Shlomo , Altaras Marco M. , Yigael Dror , Beyth Yoram
Published: August 2005

Objective
To evaluate whether risk factors, other than tamoxifen, can be identified for the development of endometrial pathologies in postmenopausal breast cancer patients treated with tamoxifen.

Design
A cross‐sectional study.

Setting
Department of Obstetrics and Gynaecology and Oncology Clinic, Sapir Medical Center, Kfar Saba, Israel.

Subjects
77 asymptomatic postmenopausal women, treated with tamoxifen for breast cancer. Of these, 55 had no endometrial tissue and 22 had endometrial tissue obtained by biopsy.

Main outcome measures
Demographic characteristics, health habits, risk factors, vaginal ultrasonographic evaluations of endometrial thickness and texture, and histologic evaluations of endometrial biopsies.

Results
Overall, there was a high rate (29%) of endometrial pathological change among the 77 asymptomatic postmenopausal women. There were no significant statistical differences in the features tested between the two groups.

Conclusion
It is impossible to predict which postmenopausal women will develop pathological endometrial changes after treatment with tamoxifen and thus a routine periodic endometrial sampling‐follow up is suggested for all postmenopausal women being treated with this agent.