bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal cardiac electromechanical intervals during labour and effects of hypoxia and cord compression
Authors: DOIG J. R. , ADAM A. H. , FLEMING J. E. E. , WHITFIELD C. R.
Published: August 2005

Summary. Cardiac electromechanical intervals were measured during labour in 103 unselected human fetuses. Mean values (±SD) for the three intervals measured were 76.01±9.93 ms for the pre‐ejection period, 41.56±8.51 ms for the isovolumetric contraction time and 156.23±16.58 ms for the left ventricular ejection time. These are consistent with previously reported data from our own and other centres. The intervals studied did not alter significantly as labour proceeded or during uterine contractions. There was no consistent correlation between them and fetal scalp blood P o2,P co2 or pH, although the pre‐ejection period was shortened considerably in three very acidaemic or hypoxic fetuses, and it was prolonged in association with tight nuchal cord entanglement and variable decelerations in fetal heart rate. These findings raise the possibility of using recorded cardiac electromechanical intervals to determine the clinical significance of different fetal heart‐rate patterns that suggest the possibility of fetal distress.
Endosalpingiosis in pregnancy
Authors: BRYCE R. L. , BARBATIS C. , CHARNOCK M.
Published: August 2005

Summary. At caesarean section, an unusual cystic lesion was found on the anterior uterine surface and on both ovaries. Biopsy established a diagnosis of endosalpingiosis. The pathogenesis and possible significance of the lesion are discussed, this being the first time this condition has been described in pregnancy.
Baseline in human fetal heart‐rate records
Authors: DAWES G. S. , HOUGHTON C. R. S. , REDMAN C. W. G.
Published: August 2005

Summary. Large variations in the pattern of normal fetal heart‐rate traces near term are described. The presence of flat or bimodal frequency distributions of pulse intervals in these traces complicates the derivation of a baseline by statistical methods. A system is described for deriving an appropriate baseline from which accelerations or decelerations may be measured.
Pattern of the normal human fetal heart rate
Authors: DAWES G. S. , HOUGHTON C. R. S. , REDMAN C. W. G. , VISSER G. H. A.
Published: August 2005

Summary. With an improved method for fitting baselines to human fetal heart‐rate traces, the patterns of episodic variations, accelerations and decelerations were similar in 215 64‐min records from normal pregnancies and in 95 with mild hypertension and normal outcome. The change in signal loss with gestational age, by Doppler ultrasound for recording heart rate, was entirely due to the greater loss in episodes of high heart‐rate variation. The changes in the numbers and sizes of accelerations and decelerations with gestational age were described. There were many records which had only one or no acceleration at 28–33 weeks gestation (16.2%) or 34–41 weeks (7.3%). However, only two (0.7%) had episodes of high heart‐rate variation lasting <10 min from 28 weeks onwards. The presence of these episodes, with clusters of fetal movements, is therefore likely to be a better numerical index of normality.
An assessment of radiotelemetry in the monitoring of labour
Authors: CALVERT JOHN P. , NEWCOMBE ROBERT G. , HIBBARD BRYAN M.
Published: August 2005

Summary. Conventional and telemetric monitoring of labour were compared in a randomized study of 200 patients to assess the effect on the pattern of labour, outcome and attitude of the patients. All the telemetry patients had the option of mobility, but only 45% elected to get out of bed, and then often only for short periods. No clear physical benefits accrued from voluntary mobility. Ambulant patients who had spontaneous deliveries had a longer second stage and more of their babies were slow to establish regular respiration. Quantitative subjective assessments of pain, anxiety and comfort were made. Primigravidae with telemetric monitoring who chose to get out of bed had higher pain scores than primigravidae monitored conventionally, but anxiety scores were highest among primigravidae with telemetry who elected to stay in bed. There was a significant bias towards increased anxiety in the lower social classes. Primigravidae gained more reassurance from monitoring than did multigravidae, but there were no differences resulting from whether or not the recording apparatus was within the patient's view. Multigravidae who had experienced both forms of monitoring preferred telemetry because they felt less restricted and less anxious.
Prolonged pregnancy: is induction of labour indicated?
Authors: GIBB D. M. F. , CARDOZO L. D. , STUDD J. W. W. , COOPER D. J.
Published: August 2005

Summary. A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non‐induction of labour in prolonged pregnancy is reported.‘Certain postmaturity’ was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of <5 at 1 min; induction of labour at 42 weeks gestation did not affect the neonatal outcome compared with that in patients allowed to go into spontaneous labour. Induction of labour in patients designated as‘certain postmature’ and‘uncertain postmature’ reduced the number of vaginal deliveries and increased the caesarean section rate from 9.6 to 26.7 and from 2.2 to 31.2% respectively. The failure to improve the perinatal outcome does not support or justify induction of labour for uncomplicated postmaturity.
Serum deoxycytidylate deaminase as an index of high‐risk pregnancy
Authors: WILLIAMS G. F. , JONES D. D.
Published: August 2005

Summary. Serum deoxycytidylate deaminase (EC 3.5.4.12, dCMP deaminase) activity was routinely estimated over 7 years in 2460 pregnancies. The results confirm that elevated dCMP deaminase activity (>4.8 units) is associated with the development of pre‐eclampsia but not with essential hypertension in pregnancy; a high rising level can precede eclampsia. Elevated enzyme activity was also found in women who developed jaundice in pregnancy and in some with apparently normal pregnancies. An unexpected finding was that these so called‘false positive’ high levels were associated with all the unexplained intrauterine fetal deaths that occurred later in pregnancy. Although elevated dCMP deaminase levels may be associated with a normal outcome, persisting high levels indicate the need for careful monitoring of fetal well being and, in the presence of any other sign of placental insufficiency, delivery should be expedited.
Changes in the renin‐angiotensin‐aldosterone system in normotensive primigravidae in the four days after normal spontaneous delivery
Authors: JADOUL F. A. C. , BROUGHTON PIPKIN F. , LAMMING G. D.
Published: August 2005

Summary. Plasma renin activity, plasma renin concentration, plasma renin substrate, plasma angiotensin II and plasma aldosterone were measured in 10 true primiparae, normotensive throughout pregnancy, for 4 days after a spontaneous vaginal delivery. The concentration of all the measured variables, except plasma renin substrate, fell steeply over the first 3 days post partum. In four of the 10 patients, all components of the renin‐angiotensin system increased in concentration somewhat thereafter, although not to the levels of the first day post partum. There are multiple potential sources of renin in the fetoplacental unit and it is possible that this‘pregnancy’ renin may be capable of the partial suppression of the maternal renin production during pregnancy. The slight rebound observed in some patients may represent a hunting for re‐establishment of non‐pregnant values.
Haemoconcentration in severe pre‐eclampsia
Authors: SAGEN NORVALD , KOLLER ODDMUND , HARAM KJELL
Published: August 2005

Summary. The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non‐anaemic women suffering from severe pre‐eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre‐eclampsia causes increased maternal blood viscosity which predisposes to placental pathology and initiates a vicious circle.
Effect on low implantation of the placenta on maternal blood pressure and placental function
Authors: NICOLAIDES K. H. , FARATIAN B. , SYMONDS E. M.
Published: August 2005

Summary. Low implantation of the placenta may protect against the development of pregnancy‐induced hypertension (PIH) and is associated with improved values in tests of placental function. PIH occurred in six of 201 (3%) consecutive patients with placenta praevia managed at the City Hospital, Nottingham, from 1 April 1973 to 30 June 1981. None of the six patients developed associated proteinuria. Of the total number of 24549 patients delivered in the same hospital for the years 1974–1978, 3744 (15%) developed PIH. Of the patients with placenta praevia, 52% had serum levels of human placental lactogen above the 95th centile and 25% had 24–h urinary oestriol levels above the 95th centile. The birthweight distribution was not different from that of the total live births at the City Hospital, Nottingham (based on 1975–1976 deliveries).
Human placental lactogen and pregnancy‐specific β1‐glycoprotein in pregnant diabetic women
Authors: PLEDGER D. R. , LUNAN C. B. , BELFIELD A.
Published: August 2005

Summary. Serum placental lactogen (hPL) and pregnancy‐specific β1 glycoprotein (SP1) concentrations were measured in 16 insulin‐dependent pregnant diabetic women and in 16 non‐diabetic control subjects matched for placental weight. hPL concentrations were found to be significantly higher in diabetics with placental weight >90th centile compared with those in (i) non‐diabetic controls with placental weight >90th centile and (ii) diabetics with placental weights <90th centile. SPl concentrations were higher in both diabetic groups compared with those in their respective nondiabetic controls, but no difference existed between the two diabetic groups. In the control subjects infant birthweights were lower in the women with small placentae, but no such difference was observed between the two diabetic groups.
Circadian variation of circulating levels of four placental proteins
Authors: HOUGHTON D. J. , NEWNHAM J. P. , LO K. , RICE A. , CHARD T.
Published: August 2005

Summary. Serial plasma levels of human placental lactogen, human chorionic gonadotrophin, Schwangerschaftsprotein 1, and placental protein 5 (PP5) were examined over a 24‐h period in six subjects. All proteins showed random circadian variation, that of PP5 being considerably greater than the other three. There was no coherent pattern of fluctuation among the different proteins: the variation of each individual protein was completely independent of the others.
Cervical dilatation with 16,16‐dimethyl‐trans‐Δ2 PGEl methyl ester vaginal pessaries before surgical termination of first trimester pregnancies
Authors: WELCH C. , ELDER M. G.
Published: August 2005

Summary. The effect of a vaginal pessary containing 1 mg of 16,16‐dimethyl‐trans‐Δ2 PGE1 methyl ester inserted 3 h before surgical termination of first trimester pregnancies is described. All patients were primigravidae and had had no previous cervical operations. The treated group had a significant degree of cervical dilatation before operation and the force required to insert the largest dilator necessary was considerably reduced.
Treatment of carcinoma of the cervix with bromocriptine
Authors: GUTHRIE D.
Published: August 2005

Summary. Twenty‐eight patients with advanced cancer were treated with 2·5 mg of bromocriptine twice daily. One patient with carcinoma of the ovary achieved tumour stasis. Of 18 patients with carcinoma of the cervix, three achieved tumour stasis and five achieved very long remissions with a median survival of more than 6 years from the start of treatment.
The value of ultrasound for monitoring ovarian responses to gonadotrophin stimulant therapy
Authors: FINK RICHARD S. , BOWES LESLEY P. , MACKINTOSH COLIN E. , SMITH W. I. , GEORGIADES EMMANUEL , GINSBURG JEAN
Published: August 2005

Summary. Ultrasonic measurement of ovarian follicles was used in conjunction with conventional measurement of urinary oestrogen output to monitor responses in infertile women receiving gonadotrophin stimulant therapy. In the 21 women who conceived during the first 15 months, in which this combined monitoring was used, ultrasound proved superior to oestrogen measurement alone for assessing follicular maturity and hence deciding when to administer the ovulating dose of chorionic gonadotrophin. The use of ultrasound imaging improves efficiency of treatment with gonatodrophin stimulant therapy, but is not predictive of multiple pregnancy or of hyperstimulation.
Problems in the management of patients with artificial valves during pregnancy
Authors: O'NEILL HILARY , BLAKE SEAN , SUGRUE DECLAN , MACDONALD DERMOT
Published: August 2005

Summary. During the past 15 years, 12 patients with prosthetic valves were treated during 18 pregnancies in the four Dublin maternity hospitals. These patients were on long‐term anticoagulants and their pregnancies were reviewed to assess the problems associated with anticoagulation. One baby had warfarin embryopathy, six pregnancies ended in spontaneous abortions and there were two intrauterine deaths. On the basis of the findings a policy on the most appropriate anticoagulant regimen in such cases was formulated.
Plasma high‐density‐lipoprotein cholesterol levels during long‐term use of an oral contraceptive in Nigerian women
Authors: TAYLOR G. OLADUNNI , AGBEDANA E. O. , OJO O. A.
Published: August 2005

Summary. Total and high‐density lipoprotein (HDL) cholesterol were estimated in 131 blood samples obtained from women who had been taking the oral contraceptive Noriday 1+50Fe (one packet contains 21 tablets of 1 mg of norethindrone +0·05 mg of mestranol, and 7 of 75 mg of ferrous fumarate) for 1–60 months. Thirty five women who had never used oral contraception (OC) formed the control group. There was a significantly higher mean HDL cholesterol level, and HDL cholesterol/total cholesterol ratio but not total cholesterol level in the women who had been using OC for 19–60 months. The values in women who had been using OC for 1–18 months were not significantly different from those in the control group. The increase in the HDL cholesterol level may not depend on the oestrogen content of the oral contraceptive but on the duration of its intake.
Prophylactic single‐dose metronidazole before abdominal hysterectomy
Authors: WALKER E. M. , GORDON A. J. , WARREN R. E. , HARE M. J.
Published: August 2005

Summary. The vagina is a common source of non‐sporing anaerobic bacteria which may be the cause of postoperative infection after hysterectomy. A single vaginal pessary containing 1 g of metronidazole inserted the night before abdominal hysterectomy reduced the mean duration of postoperative pyrexia from 15·4 to 8·3 h (P<0·05).
Role of antenatal radiography in the management of breech deliveries
Authors: RIDLEY W. J. , JACKSON P. , STEWART J. H. , BOYLE P.
Published: August 2005

Summary. A retrospective study was made of 228 mature singleton breech deliveries occurring over a 2 year period to determine the role of antenatal radiography, in particular, of pelvimetry. Many (65%) had abdominal radiography. Where antenatal pelvimetry was performed (38%) the infants were in significantly better condition during the neonatal period; this was most marked with parous women. There was no significant difference in the neonatal condition of 25 infants born vaginally of women with favourable pelvimetry compared with 31 infants born by elective caesarean sections.
Maternal plasma α‐fetoprotein and low birthweight: a prospective study throughout pregnancy
Authors: BROCK D. J. H. , BARRON LILIAS , WATT MURIEL , SCRIMGEOUR J. B. , KEAY A. J.
Published: August 2005

Summary. Maternal plasma α‐fetoprotein (AFP) was measured serially between 15 weeks gestation and term in 520 patients. Thirty‐seven of these women were delivered of normal singleton infants with birthweights <2·5 kg. The median plasma AFP values in this group of women were highest between 15 and 20 weeks gestation and then declined steadily towards term. It is concluded that the use of maternal plasma or serum AFP in the early detection of low birthweight babies is optimal in the period most suitable for screening for fetal neural tube defects.
Tissue and plasma concentrations of pregnancy‐associated plasma protein‐A (PAPP‐A): comparison with other fetoplacental products
Authors: DUBERG S. , BISCHOF P. , SCHINDLER A. M. , BÉGUIN F. , HERRMANN W. , SIZONENKO P. C.
Published: August 2005

Summary. Human placental lactogen (hPL), α‐fetoprotein (AFP), prolactin (PRL) and pregnancy‐associated plasma protein‐A (PAPP‐A) were measured by radioimmunoassay in plasma, in homogenates of trophoblast, decidua, chorion, amnion and in amniotic fluid from 10 patients after non‐complicated term delivery. Plasma samples and homogenates of trophoblast and decidua were also collected from 10 patients undergoing surgical termination of pregnancy between 7 and 12 weeks gestation. In addition, plasma and endometrial samples from 10 patients undergoing hysterectomy for other indications than malignancy were analysed for comparison. The highest tissue concentrations of hPL, AFP and PRL corresponded in each case to the known site of synthesis. For PAPP‐A the highest concentration was found in maternal plasma at term [238·8±75·6 (SEM)μg/ml]. The highest tissue concentration was found at term in the decidua (57·0±2·0 μg/g), more than three times higher than that in the trophoblast (16·9±5·4 μg/g). The concentrations of PAPP‐A in endometrial samples from non‐pregnant women (1·9±0·6 μg/g) was 40 times higher than that in the corresponding plasma samples (0·05±0·02 μg/ml). These observations point to the decidua as a possible source of PAPP‐A.
Intrauterine‐pressure studies in African nulliparae: delay, delivery and disproportion
Authors: COWAN D. B. , VAN MIDDELKOOP A. , PHILPOTT R. H.
Published: August 2005

Summary. Uterine activity was measured in 43 African nulliparae who were in the active phase of spontaneous labour and in whom delay in cervical dilatation had occurred. Details of labour were recorded on a partogramme, on which an alert and an action line had been drawn, and which were 2 h apart. Delay was defined as a cervical dilatation rate of <1 cm/h. Uterine activity was measured with a fluid‐filled intrauterine catheter, an external strain gauge and a pressure‐curve integrator. The uterine activity levels which were observed in association with delay are considerably less than those associated with normal labour progress. The uterine activity levels that were associated with pitocin augmentation after the action line and which resulted in vaginal delivery have been analysed. They were similar to the levels observed in normal labour. The uterine activity levels which were associated with ‘failure to progress in labour’ beyond the action line have also been analysed. It is argued that a minimum uterine activity level of 1800 kPas/15min is required to fully test the cephalopelvic relation.
Treatment of cervical intraepithelial neoplasia by colposcopically directed cryosurgery and subsequent pregnancy experience
Authors: MONAGHAN J. M. , KIRKUP W. , DAVIS J. A. , EDINGTON P. T.
Published: August 2005

Summary. Of 420 patients attending a colposcopy clinic 204 were treated with outpatient cryosurgery for cervical intraepithelial neoplasia. It was possible to assess a definite outcome of therapy in 159 patients, and the lesion was successfully eradicated in 87% of them. Treatment failure appeared to be more common in patients of high parity, when the lesion extended into the cervical canal, and in those patients with large lesions. Failure appeared to be unrelated to patient age and to the histological grade of the lesion. In subsequent pregnancies utero‐cervical function was preserved.
Endometrial and plasma concentrations of pregnancy‐associated plasma protein‐A (PAPP‐A)
Authors: BISCHOF P. , DUBERG S. , SCHINDLER A. M. , OBRADOVIC D. , WEIL A. , FAIGAUX R. , HERRMANN W. , SIZONENKO P. C.
Published: August 2005

Summary. Pregnancy‐associated plasma protein‐A (PAPP‐A), oestradiol and progesterone levels have been measured by radioimmunoassay in plasma and in endometrial homogenates of 30 women undergoing hysterectomy. Results were grouped according to the histological stages of the endometrium. In plasma, oestradiol and progesterone concentrations changed from proliferative to secretory stages in the well‐established pattern of the menstrual cycle, but PAPP‐A levels did not change. In endometrium, oestradiol levels were high during the proliferative stage and low in inactive and secretory endometrium. Endometrial PAPP‐A and progesterone concentrations increased from inactive to secretory stages, but only the increase in PAPP‐A was statistically significant. A positive correlation observed between endometrial PAPP‐A concentrations and plasma oestradiol/progesterone ratio suggests a possible hormonal control for the presence of PAPP‐A in the uterus.
Studies on uterine tract infections and the IUCD with special reference to actinomycetes
Authors: DUGUID HELEN L. D. , PARRATT DAVID , TRAYNOR ROBERT , TAYLOR DIANE , DUNCAN IAN D. , ELIAS‐JONES JOHN , DUGUID ROBERT
Published: August 2005

Summary. Since the advent of the plastic IUCD, an increasing number of patients with clinical pelvic actinomycosis have been reported in the literature and in a very much larger number of women, actinomycetes have been identified in cervical smears, either by Papanicolaou stain or specific immunofluorescence. After a 3‐year study, we have concluded that actinomycetes can readily be cultured when the growth of more rapidly growing anaerobes is inhibited by metronidazole and anaerobic culture is continued for up to 14 days. We consider that actinomycetes form part of a polymicrobial anaerobic infestation developing in the presence of a foreign body. The organisms are found almost exclusively in women who have used all‐plastic IUCDs for a long term and, from a continuing study, it is apparent that most disappear rapidly when the plastic device is removed or replaced by a copper device. Significant symptomatic evidence of infection is found in a small proportion of patients who are actinomycete‐positive.
Plus ça change: predictors of birthweight in two national studies
Authors: PETERS T. J. , GOLDING JEAN , BUTLER N. R. , FRYER J. G. , LAWRENCE C. J. , CHAMBERLAIN G. V. P.
Published: August 2005

Summary. The 16 989 singleton births in one week of March, 1958, studied by the British Perinatal Mortality Survey, were subjected to an analysis of covariance, which showed that major factors associated with birthweight of the infant were: maternal height, history of smoking in pregnancy, parity and history of pre‐eclampsia during the pregnancy. The same analysis was repeated on the data collected on 16 792 singletons born 12 years later in one week of April, 1970 and studied by the British Births Survey. In spite of major changes in obstetric practice and in the maternal population, the same factors were shown to be highly significant and the magnitude of the associations had changed little.
Ritodrine in the treatment of preterm labour: a study of 213 patients
Authors: DOWNEY LAURENCE J. , MARTIN ANTHONY J.
Published: August 2005

Summary. In a study of 213 patients with diagnosed, uncomplicated preterm labour up to 33 weeks gestation, intravenous followed by oral ritodrine (Yutopar) was found to be an effective treatment. Success rate was related to Bishop score at commencement of therapy, the mean time to delivery being 36.9 days. It was ≥56 days in 26.5% of patients and ≥2 days in 91%. Relapse rate was low if infusion was followed by an adequate oral dosage. Concurrent signs and symptoms were seen in a third of patients but drug withdrawal was only necessary in seven. There was no significant difference in the incidence of respiratory distress syndrome between the infants of patients treated with ritodrine alone and those of patients treated with ritodrine plus steroids.
Bacteriuria in pregnancy treated with a single dose of cephalexin
Authors: CAMPBELL‐BROWN MARY , McFADYEN I. R.
Published: August 2005

Summary. Of 87 women in whom bacteriuria was diagnosed on dip slides at between 9 and 22 weeks gestation only 51 (59%) had true bacteriuria in urine obtained by suprapubic aspiration. A single oral dose of cephalexin (3 g) was given to 37 of these patients, 10 were Indian and none of them had recurrence of infection after treatment, whereas 11 of the 27 (41%) ‘indigenous’ women again had bacteriuria within 2 weeks of treatment. None of the other 26 patients had recurrent bacteriuria in the pregnancy studied. Success of treatment was not related to renal concentrating ability nor, apart from ethnic group, were there other significant differences between successes and failures. Although single‐dose treatment seems to be less effective in pregnancy than in the non‐pregnant patients, it is an acceptable method of treatment provided that all treated patients are followed closely to detect those who do not respond and require further therapy.
Cervical wart virus infection, intraepithelial neoplasia and carcinoma; an immunohistological study using a panel of monoclonal antibodies
Authors: MORRIS HUGH B. , GATTER KEVIN C. , PULFORD KAREN , HAYNES PETER , CHARNOCK MARK , TAYLOR‐PAPADIMITRIOU J. , LANE E. B. , MASON DAVID Y.
Published: August 2005

Summary. The pattern of epithelial antigen expression has been examined in normal and disordered cervical squamous epithelium using immunohistological methods and a range of monoclonal antibodies. It was demonstrated that wart virus infection (WVI) is associated with disordered staining for a keratin‐associated component and for HLA‐DR antigen. Furthermore, wart‐infected epithelium shows strong labelling for carcinoem‐bryonic antigen (CEA) and for human milk fat globule antigens 1 and 2 (HMFG1 and 2). In addition these antigens (CEA, HMFG1 and 2) are also expressed in mixed WVI and cervical intraepithelial neoplasia (CIN), CIN III and in carcinoma. While these findings do not allow immunohistological discrimination between non‐neoplastic and neoplastic cervical epithelia, they do provide support for the view that cellular proliferation of the type induced by papilloma virus may represent an initiator stage in the process of neoplastic transformation.
Colposcopy in the diagnosis of papillomavirus infection of the uterine cervix
Authors: WALKER P. G. , SINGER A. , DYSON J. L. , SHAH K. V. , WILTERS J. , COLEMAN D. V.
Published: August 2005

Summary. Morphological criteria are described for the diagnosis of papillomavirus lesions at colposcopy. Using these criteria, evidence of cervical papillomavirus infection was found in 58 (29.0%) of 200 women referred for colposcopy because of an abnormal cytology report. Directed biopsies were obtained from 152 of these patients and histological changes suggestive of papillomavirus infection were found in 47 (30.9%); additional biopsy material from 139 was studied using an immunohisto‐chemical technique and human papillomavirus antigen was demonstrated in 28 (20.1%). Comparison between the colposcopic results and those obtained by histology suggests that whereas it is not possible to make a distinction at colposcopy between lesions due to papillomavirus and those of cervical intraepithelial neoplasia, it is possible to identify those epithelial abnormalties that are most likely to be associated with a papillomavirus infection.
A retrospective review of cervical cytology in women developing invasive squamous cell carcinoma
Authors: WALKER E. M. , HARE M. J. , COOPER PAULINE
Published: August 2005

Summary. The records of 93 women who presented with invasive squamous cell carcinoma were searched for evidence of cervical cytology during the years preceding this diagnosis; a search was also made through the files of local laboratories and contact was made with general practitioners and relevant hospital departments. Only 26 (28%) of these 93 women had had a cervical smear at any time before the diagnosis of invasive cancer, and only 11 (12%) had had regular cytological surveillance. Fifteen (60%) had had a smear taken and reported as negative within the previous 5 years, six (6%) within the previous year. Eleven of these 15 slides were obtained for review: three were regarded as positive and three more were re‐classed as too scanty for conclusive assessment. In nine of the 67 women who had never had a smear, a gynaecological or obstetric examination was known to have been performed or indicated within the previous 5 years, thereby representing a missed opportunity for screening. In three patients cytological abnormalities had been reported within the previous 3 years but no action had been taken.
The risks of antenatal subcutaneous heparin prophylaxis: a controlled trial
Authors: HOWELL RICHARD , FIDLER JACK , LETSKY ELIZABETH , DE SWIET MICHAEL
Published: August 2005

Summary. The risks of long‐term antenatal subcutaneous heparin therapy were assessed in a small controlled trial of prophylaxis of thromboembolism. Forty patients with a documented history of previous thromboembolism were randomly allocated either to receive heparin (10 000 i.u. subcutaneously twice daily) throughout pregnancy and labour or to receive no treatment (control group). All patients were treated with heparin (8000 i.u. twice daily) for 6 weeks after delivery from the first postnatal day. There appeared to be no increased risk of antenatal or postnatal bleeding associated with subcutaneous heparin, but one patient in the control group developed a deep vein thrombosis and one in the treatment group developed severe debilitating osteopenia. The withholding of epidural analgesia may have contributed to both maternal and fetal morbidity in the treatment group. There was one abortion in each group but no other fetal or neonatal losses although more babies from the treated group entered the special care baby unit. Although the numbers are too small for statistical analysis, the findings indicate that the use of long‐term low‐dose subcutaneous heparin is not without complications and there is need for a larger, multicentre trial to allow precise quantification of fetal and maternal risks against the risk of recurrent thromboembolism.
Prolonged heparin therapy in pregnancy causes bone demineralization
Authors: DE SWIET M. , WARD P. DORRINGTON , FIDLER J. , HORSMAN A. , KATZ D. , LETSKY E. , PEACOCK M. , WISE P. H.
Published: August 2005

Summary. The relation of heparin therapy to osteoporosis was assessed in a retrospective analysis of 20 women treated during and after pregnancy with subcutaneous heparin for thromboembolism prophylaxis. The phalangeal cortical area ratio was significantly less after long term therapy (>25 weeks) compared with that after short term therapy (<7 weeks). The same trend was found in the metacarpal area ratio, although this did not reach statistical significance. The changes were most marked in a woman who had received heparin also in a previous pregnancy. No correlations were found between duration of therapy and back pain, conventional radiology of lumbar spine or the Singh index of femoral trabecular pattern which were within the normal range in all patients. The findings indicate a dose‐related demineralization process associated with prophylactic heparin therapy in pregnancy. The correct methods of and criteria for thromboembolism prophylaxis in pregnancy need critical re‐examination.
Reliability of cytological follow‐up after conization of the cervix; a comparison of three surgical techniques
Authors: TRIMBOS J. B. , HEINTZ A. P. M. , VAN HALL E. V.
Published: August 2005

Summary. A retrospective analysis was made 154 consecutive conizations between 1974 and 1982. Three surgical methods were compared: (A) Sturmdorf sutures; (B) interrupted vertical sutures; and (C) an ‘open’ method using only cauterization and no additional stitches. The mean blood loss during conization was not reduced by ligation of descending branches of the uterine arteries. Post‐conization haemorrhage occurred in only 3% and did not differ between the three groups. Cervical smears with only ectocervical squamous epithelium or too little material to allow diagnosis were considered inadequate. Unreliable follow‐up was defined as inadequacy of more than 25% of a patient's smears. Thirty per cent of all follow‐up smears were inadequate (group A 33%; B 41%; C 16%). In 46% of the patients, cytological follow‐up was unreliable (group A 48%; B 61%; C 18%) and additional measures such as dilatation of the cervix, endocervical curettage, or hysterectomy were required. The differences between group C and the other two groups were statistically significant (P<0.01; χ2 test).
Maternal plasma concentrations of β‐lipotrophin, β‐endorphin and γ‐lipotrophin throughout pregnancy
Authors: BROWNING A. J. F. , BUTT W. R. , LYNCH S. S. , SHAKESPEAR R. A.
Published: August 2005

Summary. Plasma β‐LPH, β‐EP and γ‐LPH concentrations were measured by radioimmunoassay in 10 pregnant women from 12 weeks gestation until term and in nine women in the early follicular phase of the cycle. There was a progressive and significant rise in the concentration of all three peptides throughout pregnancy and by 32 weeks the concentrations of β‐LPH and β‐EP were greater than the corresponding concentrations in the follicular phase: γ‐LPH was greater than in the follicular phase by the end of pregnancy in those women who were delivered after 40 weeks. The ratio of β‐LPH to γ‐LPH did not change significantly throughout pregnancy, but there was a progressive fall in the β‐LPH/β‐EP ratio. The possible presence of a ‘big LPH’ to explain this finding is discussed.
Is pregnancy immunosuppressive? Humoral immunity against viruses
Authors: BABOONIAN CHRISTINA , GRIFFITHS PAUL
Published: August 2005

Summary. Serum samples were obtained during the first trimester, second trimester, third trimester, at delivery and 6 weeks postpartum from each of 50 pregnant women. All 250 sera were tested for their content of antibodies specific for herpes simplex, measles, rubella and influenza A viruses. The geometric mean titres of antiviral antibody were shown to decline by 18–48% between the times of booking and delivery, and to return to initial values by the end of the puerperium. By means of two‐way analysis of variance, the major confounding variable of differences between individuals was identified and controlled for, so that the progression of pregnancy was shown significantly to decrease titres of antiviral antibody. After allowance was made for haemodilution, antibody levels against two viruses (herpes simplex, measles) still declined significantly while those for rubella and influenza viruses actually increased significantly, so that no consistent effect of pregnancy was demonstrable. We conclude that the declining titres of antiviral antibodies seen in pregnant women are predominantly a manifestation of haemodilution and discuss the reasons for believing that humoral immunity re nains intact during pregnancy.
Labour and delivery after a prolonged interval between the present and the last pregnancy
Authors: OPANEYE A. A.
Published: August 2005

Summary. A group of 60 multiparae whose last pregnancy was ≥7 years previously were studied with respect to various characteristics of their present labour and delivery and compared with a control group of 60 multiparae, matched for age and parity, who had intervals of <7 years between the present and last delivery. The results showed that a prolonged interval between pregnancies does not influence subsequent labour and delivery.
Are vaginal fluid concentrations of prolactin, α‐fetoprotein and human placental lactogen useful for diagnosing ruptured membranes?
Authors: HUBER J. F. , BISCHOF P. , EXTERMANN P. , BEGUIN F. , HERRMANN W. L.
Published: August 2005

Summary. Vaginal fluid levels of prolactin (Prl), α‐fetoprotein (AFP) and human placental lactogen (hPL) were assayed to investigate their usefulness in the diagnosis of ruptured membranes. Fifty‐two patients at term were divided into those with intact membranes, and those with ruptured membranes. In patients with intact membranes the concentration of all three substances was low with few exceptions. The mean vaginal concentrations of the three proteins were significantly higher in patients with ruptured membranes, but low values were also found in this group. It is concluded, that because of the overlap between the values, Prl, AFP and hPL measurements in vaginal fluid do not represent a useful advance in the assessment of rupture of the membranes.
Acute effects of smoking on fetal heart‐rate variability
Authors: LEHTOVIRTA P. , FORSS M. , KARINIEMI V. , RAURAMO I.
Published: August 2005

Summary. Smoking a standard filter cigarette caused an acute decrease both in the interval index and the differential index of fetal heart‐rate variability in eight healthy pregnant women at term. The maximum effect occurred 5–10 min after smoking and the indices returned to the presmoking level in 20 min. We suggest that smoking has a dual effect on the fetus: one being narcotic, leading to a lowered interval index, and the other hypoxic, leading to a lowered differential index.
Acute effect of maternal smoking on the human fetal blood flow
Authors: JOUPPILA PENTTI , KIRKINEN PERTTI , EIK‐NES STURLA
Published: August 2005

Summary. The immediate effect of maternal smoking of one cigarette on blood flow in the descending thoracic aorta and umbilical vein was studied in 19 fetuses at between 29 and 39 weeks gestation. Blood flow was measured with a combined real‐time ultrasound and Doppler ultrasound technique immediately before smoking and immediately after cessation of smoke inhalation. The measured flow changes immediately after maternal smoking were insignificant and suggest that the haemodynamic and chemical effects of smoking in the mother do not produce immediate alterations in the blood flow in the fetal thoracic aorta or in the umbilical vein.
Plasma urate, urea and creatinine levels during pregnancy and after the puerperium in normal primigravid Nigerians
Authors: EGWUATU V.E.
Published: August 2005

Summary. Plasma concentrations of urea, uric acid and creatinine were measured in 55 normal primigravid Nigerians during pregnancy and 6 weeks after delivery. Plasma urate concentrations were lowest in early pregnancy and increased with advancing gestation, achieving the highest values in the postnatal period. These findings are similar to those reported for European women. Plasma urea rose during the second trimester, fell in the third to almost first trimester levels and rose again in the postnatal period. Plasma creatinine generally followed the same pattern as urea. It is suggested that these changes are a reflection of fluid distribution rather than a change in urea and creatinine production. An improved nutritional status may explain the urea values which are higher than previously reported in African women.
Fetal sex and pre‐eclampsia in primigravidae
Authors: CAMPBELL DORIS M. , MacGILLIVRAY IAN , CARR‐HILL R. , SAMPHIER M.
Published: August 2005

Summary. The overall sex ratio in 13 432 primigravidae who were delivered between 1967 and 1979 was 104.8. The ratio was 99.4 in the 8639 women who were normotensive and 117.3 in the 3933 who were hypertensive without proteinuria; both values were significantly different from the overall ratio. In women with proteinuric pre‐eclampsia the ratio was 107, not significantly different from the overall ratio.
Application of a real‐time microcomputer monitoring system: surveillance of induced labour by uterine activity quantitation
Authors: TROMANS P. M. , BEAZLEY J. M.
Published: August 2005

Summary. The uterine activity of women during induced labour was analysed with a real‐time Commodore PET 2001 series microcomputer. The active contraction area was measured in torr‐min (1 torr = 0.133 kPa) per 10 min epochs [uterine activity unit (UAU)/10 min]. Surgical induction was followed immediately by administration of a geometric oxytocin infusion and all patients received epidural analgesia. Twenty‐eight primigravidae for whom inductographic and partographic progress were normal had a mean ‘stable phase’ uterine activity of 118±2 SD 43 UAU/10 min (≡942±2 SD 343 kPas/10 min) whereas 15 multiparae had a mean ‘stable phase’ of 83±2 SD 34 UAU/10 min (≡662±2 SD 271kPas/10min). This difference was significant (P<0.01). The construction of uterine activity charts is described and their clinical application discussed.
Amniotic fluid phospholipids and glucocorticoids in multiple pregnancy
Authors: NORMAN R. J. , JOUBERT S. M. , MARIVATE M.
Published: August 2005

Summary. The phospholipid composition of amniotic fluid has been examined in 30 twin pregnancies with a mean gestation of 37.7 weeks. Before the onset of labour there was no difference in ratios of lecithin (L), phosphatidylinositol (PI), phosphatidylethanolamine (PE) and phosphatidylglycerol (PG) to sphingomyelin (S) between the first and second twin. With the start of contractions (6 patients) there was a significant increase in the L/S and PE/S ratios in the first twin (L/S ratio twin I 10.8±5.2, twin II 7.0±3.8; PE/S ratio twin I 0.7±0.2, twin II 0.4±0.1). Growth retardation of one fetus did not alter the phospholipid profile in the amniotic fluid. Amniotic fluid concentrations of glucocorticoids, measured before and during labour in both twins by specific immunoassay, were the same in both sacs before labour. During labour concentrations of unconjugated and conjugated glucocorticoids were significantly increased in the first sac (twin I unconjugated 113.2±16.6, conjugated 505.1±115.9; twin II unconjugated 69.5±41.4, conjugated 284.3±124 nmol/1). Amniotic fluid from growth retarded fetuses did not show higher glucocorticoid levels. In subsequent studies the glucocorticoids were separated by chromatography and only cortisol reacted significantly with the antibody used under the conditions of the assay.
Biofeedback as an aid to childbirth
Authors: ST JAMES‐ROBERTS IAN , HUTCHINSON CHARLES , HARAN FRANCES , CHAMBERLAIN GEOFFREY
Published: August 2005

Summary. Self‐controlled relaxation in childbirth is claimed to relieve pain and speed labour. A comparative study of two methods of relaxation training based on biofeedback techniques has shown that electromyographic (muscular) relaxation can readily be taught at antenatal classes, while skin‐conductance (autonomic) relaxation cannot. The techniques were of some use in early labour but did not postpone the onset of severe pain nor help women to cope with painful uterine contractions. There were no differences in the outcome of labour between women using biofeedback and the women in the control groups.
Pregnancy in patients after severe abdominal burns
Authors: DAW E. , MOHANDAS I.
Published: August 2005

Summary. Eleven viable pregnancies in six patients who had previously suffered severe abdominal burns are reported. The major problem in pregnancy is of abdominal skin which is too scarred to stretch and, in the puerperium, of damaged nipples.
Comparison between antifibrinolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices
Authors: YLIKORKALA OLAVI , VIINIKKA LASSE
Published: August 2005

Summary. The effects of a fibrinolysis inhibitor (tranexamic acid, TA) and prostaglandin synthesis inhibitor (diclofenac sodium, DS) were compared in the reduction of excessive menstrual blood loss in 19 women with an intrauterine contraceptive device (IUCD). These women (mean blood loss before treatment to 135.1±18.9 SE ml, range 70–294 ml) were treated in random order with TA (1.5 g three times daily for 5 days starting on the first day of menstruation for two periods), and with DS (50 mg three times on the first day followed by 25 mg three times daily for 4 days, for two periods), or with placebo (one period) in a double‐blind trial. The placebo treatment did not change menstrual blood loss (128.3±15.6 ml). The TA treatment decreased blood loss to 59.4±7.7 ml (P<0.001) and the DS treatment to 102.1±13.6 ml (P<0.01). Neither treatment abolished pelvic discomfort during menstruation or shortened its duration. Various side‐effects were noted by 12 women during 19 TA treatments and by five women during six DS treatments. Thus, while TA is generally far more effective, DS gave pronounced decreases in menstrual bleeding in some women and had less frequent side‐effects.
The effect of changes in blood gas tension upon the renin‐angiotensin system of the newborn infant
Authors: TETLOW HAZEL J. , PIPKIN FIONA BROUGHTON
Published: August 2005

Summary. Renin and renin‐substrate concentrations were measured in the paired umbilical artery and vein blood of 20 babies born by elective caesarean section, and 36 babies born vaginally. Blood pH, carbon dioxide tension and oxygen tension were measured in all samples. Babies born vaginally were significantly more acidaemic than those delivered by caesarean section. The cord artery blood also had a significantly greater carbon dioxide tension at vaginal delivery. A decrease in pH of either cord artery or vein blood, irrespective of mode of delivery, was associated with an increase in renin concentration. Renin‐substrate concentration tended to be lower in the cord vein blood of acidaemic babies born vaginally, such that the ratio renin: renin‐substrate concentration was negatively correlated with pH. At caesarean section the renin concentration of cord vein blood was positively correlated with carbon dioxide tension and increased dramatically at oxygen tensions <3kPa. This was not observed in babies born vaginally, but the cord artery substrate concentration in these infants was positively correlated with carbon dioxide tension. Thus changes in the renin‐angiotensin system at birth may partly be affected by blood gas tension.
Studies on the half‐life of Schwangerschaftsprotein 1 (SP1)
Authors: AHMED A. G. , KLOPPER A.
Published: August 2005

Summary. Schwangerschaftsprotein 1 (SP1) was measured in 10 women at intervals after delivery of the placenta. SP1α decreased more sharply than SP1β and showed evidence of a two‐compartmental distribution in the mother. Trace amounts of both proteins could still be detected 5 weeks after delivery. It is concluded that the findings support the view that the two proteins are separate biological entities and that there is a possibility that SP1β is generated from SP1α in the maternal compartment.
The gauze hammock sling operation in the treatment of stress incontinence
Authors: KERSEY J.
Published: August 2005

Summary. Moir's gauze hammock sling operation for stress incontinence is described with minor modifications, and a series of 105 consecutive patients with independent follow up from 6 months to 9 years is pre sented. Patients were selected for operation on clinical grounds, urodynamic investigations only becoming available at the end of the series. In 48 patients the operation was a primary procedure. The outcome was determined by clinical review in 93 patients and by case note review in a further 10 with only two patients being lost to follow up. Of the 103 patients assessed, 62 were continent, 26 improved and there were 15 failures. There were two vesico‐vaginal fistulas. The results compare favourably with other suprapubic operations for stress incontinence.
Blood levels of proteinase inhibitors in pre‐eclampsia
Authors: GOW L. , CAMPBELL D. M. , OGSTON D.
Published: August 2005

Summary. The blood levels of α2‐macroglobulin, α1‐antitrypsin, CT inactivator, antithrombin III and α2‐antiplasmin were measured in 18 primigravidae with moderate or severe pre‐eclampsia and in 18 gestation‐matched primigravidae with uncomplicated pregnancy. The mean levels of the proteinase inhibitors did not differ between the pre‐eclampsia and uncomplicated pregnancy groups.