bluuebunny/crossref_metadata_2025 huggingface dataset:
Normal range of fetal transcutaneous carbon dioxide tension during labour
Authors: NICKELSEN CARSTEN , WEBER TOM
Published: August 2005

Summary. Fetal transcutaneous carbon dioxide tension (tc‐Pco), was monitored during 122 deliveries, using an electrode temperature of 44°C in 80 cases and of 41°C in 42 cases. Significant correlations between tc‐Pco2 and umbilical artery blood Pco2 were found using both electrode temperatures, but the regression lines indicated a larger and more inconstant CO2‐contribution from skin metabolism when the low electrode temperature was used. Normal range of tc‐Pco2 was calculated at 41°C and 44°C electrode temperatures. Mean values of fetal tc‐Pco2 were found to increase during normal labour, and especially in fetuses developing acidosis, but only four of six infants born with acidaemia had tc‐Pco2 values exceeding the normal range.
Plasma fructosamine in non‐diabetic pregnancy
Authors: STALEY M. J. , MURRAY‐ARTHUR F.
Published: August 2005

Summary. Plasma fructosamine and its relation to plasma total protein and albumin was examined in 40 non‐diabetic pregnant women. Plasma fructosamine did not correlate with haemoglobin Al or plasma albumin. The mean intra‐individual ranges were plasma fructosamine 0·53 mmol/1 (SD 0·17); haemoglobin A, 1·42% (SD 0·42); plasma fructosamine/g albumin 0·024 mmol (SD 0·005) and plasma fructosamine/g total protein 0·008 mmol (SD 0·003). A high degree of individuality for these variables was also observed.
Complement factors in fetal and maternal blood and amniotic fluid during the second trimester of normal pregnancy
Authors: STABILE I. , GRUDZINSKAS J. G. , N1COLAIDES K. H. , RODECK C. , BACH A. , TEISNER B. , WESTERGAARD J. G.
Published: August 2005

Summary. Complement factors (C3, C4, C5; Factors B, H and I) were measured in maternal and fetal serum and amniotic fluid obtained from 55 women with singleton pregnancy undergoing diagnostic fetoscopy at 15 to 28 weeks gestation. Maternal serum levels were consistently 10 times higher than fetal levels which in turn were 10 times higher than levels in amniotic fluid. Spearman rank correlation analysis at weeks 20 to 22 (n= 20) revealed a statistically significant correlation between maternal and fetal levels of C3 and Factors B and I, and between maternal and amniotic fluid levels of Factors B and I. A significant increase in fetal levels of C3, C4 and Factor H, and in amniotic fluid levels of C3 and Factor B was seen in relation to advancing gestational age. These differences were not seen in maternal scrum during the short interval of pregnancy studied. These data confirm earlier assumptions of fetal synthesis of complement factors, and provide normal reference ranges of complement factors in fetal blood and amniotic fluid.
Sexually transmitted diseases including genital papillomavirus infection in male sexual partners of women treated for cervical intraepithelial neoplasia III by conization
Authors: BISTOLETTI P. , LIDBRINK P.
Published: August 2005

Summary. History and clinical prevalence of sexually transmitted diseases (STD), including genital human papillomavirus (HPV) infection, were studied in 60 sexual partners of 60 women previously treated for cervical intraepithelial neoplasia (CIN) III by conization. Investigations included serological and bacteriological screening, histopathology and colposcopy. A history of STD was reported by 20 men (33%), and 34 (57%) had signs of STD including genital HPV infection, 2 (3%) had a chlamydial infection, one had molluscum contageosum, 7 (12%) had genital warts and 24 (40%) had abnormal acetowhite epithelium, indicating HPV infection. The HPV lesions were principally subclinical and located on the glans penis and the prepuce. Colposcopy and application of acetic acid are essential for detection. The gynaecologist and venereologist must recognize the sexually transmitted nature of CIN, and the causal link between CIN and HPV infection. Assessment and treatment of the male sexual partner of women treated for CIN might be an essential part in disease control with the aim of preventing cervical cancer.
The serum pregnancy‐specific β1‐glycoprotein to betahuman chorionic gonadotrophin ratio as an index of prognosis in patients with choriocarcinoma
Authors: SAKURAGI NORIAKI , OHKUBO HITOSHI , YAMAMOTO RITSU , SHIINA YOSHIHIRO , TANAKA TOSHINOBU , ICHINOE KIHYOE , FUJIMOTO SEIICHIRO
Published: August 2005

Summary. The ratio of serum pregnancy‐specific β1‐glycoprotein (SP1) to the β‐subunit of human chorionic gonadotrophin (β‐hCG) before and after chemotherapy was measured in 12 patients with metastatic choriocarcinoma. The ratios before chemotherapy ranged between 0.03 and 0.75, with a mean value of 0.34 (SD 0.21). The ratio increased to over 1.0 (1.05–53.3) after one or two courses of chemotherapy in seven of the 12 patients. These women achieved complete remission. In the other five patients who died of the disease due to drug resistance of the tumour, the ratio after chemotherapy was low (0.04–0.74) and tended to decline. These data suggest that the serum SPl/β‐hCG ratio can be used to predict the prognosis of patients with choriocarcinoma.
Interim report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomized trial of cervical cerclage
Authors:   MRC/RCOG WORKING PARTY ON CERVICAL CERCLAGE
Published: August 2005

Summary. Overall 905 pregnant women whose obstetricians were ‘uncertain’ whether to recommend cervical cerclage, chiefly because of a history of early delivery or cervical surgery, were randomly allocated to cerclage or no surgery; 92% were treated as allocated. The overall preterm delivery rate was 30%. The results for those allocated cerclage were marginally statistically significant, more favourable in terms of fewer deliveries before 33 weeks [59 (13%) compared with 82 (18%), P = 0.03] and correspondingly for birthweight under 1500 g [48 (11 %) compared with 73 (16%), P = 0.01] and for miscarriage, stillbirth or neonatal death [37 (8%) compared with 54 (12%), P = 0.06]. There were similar numbers of deliveries between 33 and 36 weeks [65 (14%) compared with 64 (14%)]. These results suggest that the operation had an important beneficial effect in one in 20 to 25 cases in the trial. But because the observed differences are not strongly statistically significant and because no such benefit has been seen in other randomized trials, there remains uncertainty about how much (if any) of this apparent benefit is real. So, the trial still remains open for randomization of more women whose obstetricians are uncertain about the advisability of cerclage.
Endocrine effects of 17 alpha‐hydroxyprogesterone caproate during early pregnancy: a double‐blind clinical trial
Authors: REIJNDERS FRANS J. L. , THOMAS CHRIS M. G. , DOESBURG WIM H. , ROLLAND RUNE , ESKES TOM K. A. B.
Published: August 2005

Summary. The clinical and endocrine effects of progestogen therapy in early pregnancy were investigated using a double‐blind randomized trial in 64 patients who had a viable fetus at 6 weeks gestation and had an increased risk of miscarriage. The patients were randomly allocated to receive either 17 alpha‐hydroxyprogesterone caproate or a placebo between 7 and 12 weeks gestation. Four fetal ultrasonographic variables and 17 maternal endocrine variables were studied in each woman. Only four maternal serum variables (17 alpha‐hydroxyprogesterone, prolactin, thyroxin and thyroxin binding globulin) rose significantly. The serum progesterone levels in the hormone supplemented group were on average 20% higher than in the placebo group but the difference was not statistically significant. However, the relation between the progesterone levels and the fetal outcome was not clear. Therefore it is not advisable to prescribe 17‐OHP‐C during early pregnancy to prevent a miscarriage.
Obstetric deaths in Menoufia Governorate, Egypt
Authors: EL KADY ADEL A. , SALEH SANEYA , GADALLA SAAD , FORTNEY JUDITH , BAYOUMI HUSSEIN
Published: August 2005

Summary. A survey of all registered deaths which occurred during 1981–1983 in women of reproductive age was carried out in Menoufia Governorate, Egypt. Surviving family members were interviewed by trained social workers, and Information was collected on Symptoms of the disease that led to death. The completed questionnaires were reviewed by a panel of local physicians and a cause of death was assigned by the panel. Maternal mortality was a leading cause of death, second only to heart disease. There were 190 maternal deaths per 100 000 livebirths and 45 maternal deaths per 100 000 married women aged between 15 and 49 years. Most of the maternal deaths (63%) were due to direct obstetric causes of which haemorrhage was the main cause. Another 27% of the maternal deaths were due to indirect obstetric causes of which rheumatic heart disease was the main cause.
Serum from pregnant women carrying a fetus with neural tube defect is teratogenic for rat embryos in culture
Authors: ANWAR M. , MACVICAR J. , BECK F.
Published: August 2005

Summary. Sera from 13 pregnant women carrying a fetus with a neural tube defect, and from 13 control women with normal pregnancies at the same stage of gestation were used in the culture of postimplantation rat embryos. Serum from women with normal pregnancies had no adverse effect on rat embryo growth and development. Serum from 10 of the women with affected fetuses had a deleterious effect on the rat embryos as abnormalities of neural tube closure were observed in 28% of the conceptuses compared to only 1·3% of the embryos cultured in control scrum.
The use of ultrasound examinations, intrapartum fetal heart rate monitoring and beta‐mimetic drugs in France
Authors: BLONDEL BEATRICE , RINGA VIRGINTE , BREART GERARD
Published: August 2005

Summary. We conducted a survey of French obstetricians to document their attitudes towards routine ultrasound, intrapartum fetal monitoring and beta‐mimetics in 1987. A questionnaire was sent to 582 obstetricians or gynaecologists who were members of two French medical associations. The response rate was 85%. Of the respondents 92% prescribed two or three routine ultrasound examinations: only one doctor did not use electronic fetal monitoring and 99% of the respondents prescribed beta‐mimetics to prevent preterm delivery. Some obstetricians reported a decrease in their use of ultrasound and more dramatically in the use of beta‐mimetics. Side‐effects were reported to be the major reason for the change in beta‐mimetic use. Obstetricians who read English language journals were more likely to have reduced their use of ultrasound and beta‐mimetics than those who read only French language journals.
Blood velocities in the dorsal pedis and radial arteries during labour
Authors: JANBU TORUNN
Published: August 2005

Summary. To detect evidence of aortic compression by the uterus in the supine position during labour, blood velocity in the dorsal pedis artery was recorded using Doppler ultrasound. Twenty‐seven women in labour, 16 with an epidural block (epidural group) and 11 with painful contractions (non‐epidural group) were studied through several contractions in the lateral and supine position. In the non‐epidural group, blood velocities showed large fluctuations, typical of temperature regulation, between contractions. During contractions, velocities were reduced by 80% in both positions, most likely due to vasoconstriction caused by pain. Radial artery measurements illustrated the same fluctuations between, and reductions during, contractions. In the epidural group, blood velocities were steadily high without fluctuations between contractions, illustrating sympathetic nerve blockade. In 14 of the 16 women, velocities remained high during contractions; in the remaining two women velocities decreased, mainly in systole, during contractions in the supine but not in the lateral position without concomitant fetal heart rate pathology.
Maternal weight, weight gain and birthweight at term in the rural Tanzanian village of IIula
Authors: MÖLLER BO , GEBRE‐MEDHIN MEHARI , LINDMARK GUNILLA
Published: August 2005

Summary. In an area‐based study in a rural Tanzanian village, the relations of maternal weight and weight gain during pregnancy to birthweight were analysed for 331 term deliveries. The distribution of body‐mass index, used as an indicator of maternal nutritional status, was similar to the pattern seen in Sweden, although mean maternal height (156 cm) was 9 cm below that of Swedish women. Mean initial weight measured at week 14 was 53 kg and total pregnancy weight gain was 6kg. Women weighing ≥60kg in early pregnancy gained less weight (0·16 kg/week) than those weighing <50 kg (0·22 kg/week). Birthweight was correlated both with maternal weight in early pregnancy and with weight gain during pregnancy, but only 10% of the variation in birthweight was explained by these maternal factors. Mean maternal weight 24 h postpartum was equal to the weight at 14 weeks of pregnancy, implying, on the average, no net weight gain. Women with a positive net weight gain had heavier babies than women with a negative net weight gain. Maternal anthropometric characteristics are important underlying determinants of intrauterine growth and birthweight, but they explain only a minor part of the variation and are of little value for screening purposes in individual women.
Protein S and protein C levels in Chinese women during pregnancy, delivery and the puerperium
Authors: LAO T. T. , YUEN P. M. P. , YIN I. A.
Published: August 2005

Summary. The plasma levels of protein S and protein C related antigens were determined in a group of normal pregnant Chinese women and a group of normal non‐pregnant controls, using the sandwich technique of enzyme immunoassay with commercial kits. Compared with non‐pregnant controls, plasma protein S levels were significantly lower during pregnancy, labour, parturition and the early puerperium. There was no significant difference in protein S levels between pregnancy, labour and puerperium. On the other hand, maternal plasma protein C levels during pregnancy and before delivery were similar to those in controls, but a significant increase was found during the third stage of labour. This increase did not persist into the early puerperium. The observed increase in protein C level immediately after delivery in our study may represent a physiological response to counter the tendency towards venous thrombosis in the parturient women, and may help to explain the almost negligible occurrence of thromboembolism in Chinese obstetric patients.
Atopy in couples with unexplained infertility
Authors: HARRISON ROBERT F. , UNWIN ANTONY
Published: August 2005

Summary. In an initial exploratory study, proneness to atopy was measured by specific allergen history, allergen skin testing and plasma IgE in couples with unexplained infertility and in a comparison group of couples who had recently had a child. At least one of the assessments was positive in 29 out of 47 infertile couples and in 52 out of 103 controls, but only five of the infertile group and two of the fertile group had all three assessments positive. Raised IgE levels occurred significantly more often in the infertile couples than in the comparison group.
Suppression of gonadotrophin secretion does not reverse premature ovarian failure
Authors: LEDGER W. L. , THOMAS E. J. , BROWNING D. , LENTON E. A. , COOKE I. D.
Published: August 2005

Summary. The effect of prolonged inhibition of gonadotrophin secretion was studied in 12 women with premature ovarian failure. All the patients had plasma concentrations of follicle‐stimulating hormone (FSH) >20 i.u./l, and in six, primordial follicles had been seen on ovarian biopsy. Goserelin (Zoladex, ICI), a depot synthetic analogue of luteinizing hormone‐releasing hormone (LHRH) was administered by three consecutive 4‐weekly injections. Plasma concentrations of luteinizing hormone (LH) fell from 34 (SD ll) i.u./l to 2·4 (SD 1·9)i.u./l, and plasma concentrations of FSH fell from 106 (SD29) i.u./l to 4·5 (SD 2·6) i.u./l 4 weeks after the first injection. Plasma concentrations of gonadotrophins returned to pretreatment values in every patient within 9 weeks of the final injection of goserelin. Regular ultrasonography during the period following the final injection failed to demonstrate the development of ovarian follicles in any patient, and plasma concentrations of oestradiol remained below 100 pmol/l. This study has failed to show that suppression of gonadotrophin secretion reverses premature ovarian failure.
Long‐term follow‐up of patients with uterine fibroids after treatment with the LHRH agonist buserelin
Authors: MATTA WASSIM H. M. , SHAW ROBERT W. , NYE MALCOLM
Published: August 2005

Summary. Ten patients with uterine fibroids palpable abdominally were treated with the luteinizing hormone‐releasing hormone (LHRH) agonist buserelin, administered intransally, 300 μg three times daily, for 6 months, and were then followed for a further 12 months. Oestrogen levels were markedly reduced in all patients during treatment. At the end of treatment the mean volume reductions were 44·4% (SEM 3·5) for total uterine volume and 57·3% (SEM 7·4) for volume of discrete fibroids as assessed ultrasonically. There was also marked improvement in associated symptoms. After buserelin therapy was stopped, the total uterine and discrete fibroid volumes returned to, or slightly exceeded, pretreatment volumes within 6 months in five patients, and by 12 months in two patients. Three other patients who underwent surgery for their fibroids during the first 4 months after treatment showed regrowth of fibroids to pretreatment size, Four comparable asymptomtic untreated patients showed no significant change in the total uterine or fibroid volume during six monthly ultrasonic assessments. Buserelin therapy may facilitate rather than replace surgery in the management of uterine fibroids.
Menstrual regulation by intramuscular injections of 16‐phenoxy‐tetranor PGE2 methyl sulfonylamide (sulprostone). A multicentre study
Authors:   WORLD HEALTH ORGANIZATION
Published: August 2005

Summary. In a previous study we have shown that three intramuscular injections of 0·5 mg of the prostaglandin analogue, sulprostone (16‐phenoxy‐W‐17,18,19,20‐tetranor PGE2 methyl sulfonylamide), were equally effective as vacuum aspiration for menstrual regulation in women with a delay of up to 21 days in the onset of expected menses. To assess whether lower doses of the prostaglandin could be effective if treatment were restricted to women with a delay of menses of up to 14 days, a multicentre trial investigated the effect of two injections of 0·25 mg sulprostone given with a 4‐h interval. After an interim analysis showed a clinically unacceptable low rate of complete abortion (41%) amongst the 64 pregnant women thus treated, the dose was doubled to two injections of 0·5 mg. In the group of 51 pregnant women treated with the increased dose, the frequency of complete abortion (67%) was significantly higher although still well below the 91% success rate achieved in our previous study. Both the duration and the subjective vaginal blood loss were greater in women with complete abortion than in those with incomplete abortion or continuing pregnancy. It is concluded that the sulprostone dose used in our previous study (3×0·5 mg) represents the minimal, required dose for menstrual regulation.
C‐reactive protein in preterm labour; association with outcome of tocolysis and placental histology
Authors: CAMMU H. , TEMMERMAN M. , FOULON W. , AMY J. J. , GOOSSENS A. , DERDE M. P.
Published: August 2005

Tocolytics were administered in 66 consecutive women in uncomplicated preterm labour with intact fetal membranes (53 singleton and 13 twin pregnancies). C‐reactive protein (CRP), a marker of infection, was determined daily and used retrospectively to investigate the role of subclinical infection in preterm labour and to predict the efficacy of tocolysis and the development of a clinical perinatal infection. CRP was also determined in 66 women in uncomplicated labour at term (53 singleton and 13 twin pregnancies). The placenta was examined for histological evidence of infection in all patients who were delivered bcfore 36 weeks (n=21) and in all women in the control group (n=66). Elevated CRP levels were more often found in patients who were refractory to tocolysis, suggesting an underlying infectious morbidity. Placental infection was found in 62% of the preterm delivery group and in 12% of the control group. There was an association between elevated CRP levels and histological evidence of placental infection. However, confounding factors such as urinary tract infections limit the usefulness of the CRP test. Because CRP cannot predict clinical perinatal infection accurately, its clinical relevance is very limited.
A randomized study of the sitting position for delivery using a newly designed obstetric chair
Authors: STEWART PETER , SPIBY HELEN
Published: August 2005

A new obstetric chair has been designed to overcome some of the problems of those currently available commercially. The chair has been used to assess the effects of the sitting position in the second stage of labour on the outcome of delivery in 304 women randomly allocated to be delivered either in the chair or in the conventional dorsal position. Delivery in the chair conferred no benefits to mother or baby and resulted in greatcr mean blood loss and a higher rate of postpartum haemorrhage.
Plasma secretin concentrations during normal human pregnancy, delivery, and postpartum
Authors: HOLST N. , MALTAU J. M. , JENSSEN T. G. , BURHOL P. G.
Published: August 2005

Plasma concentrations of secretin were measured at 4‐week intervals throughout eight normal pregnancies and again twice postpartum, and in another six women during parturition and the early postpartum period. Comparisons were made with levels in 16 normal non‐pregnant women. Plasma secretin concentrations increased during pregnancy with maximum levels at 36 weeks. The increase was statistically significant from week 28 to 36, compared with non‐pregnant levels. By 5 days after delivery plasma secretin levels were similar to the non‐pregnant levels. No significant changes in plasma secretin were observed during delivery and early postpartum. The altered secretin levels may be of importance for heartburn in pregnancy, calcium metabolism, and the changes in renal haemodynamics.
Radiation exposure of the ovaries during hysterosalpingography. Is radionuclide hysterosalpingography justified?
Authors: VAN DER WEIDEN R. M. F. , VAN ZIJL J.
Published: August 2005

Summary. Before the introduction of radionuclide hysterosalpingography in our clinic we measured the ovarian radiation exposure during hysterosalpingography (HSG) with fluoroscopy. Radiation dosage varied from 0·33 to 3·74 mGy and increased with both the number of spot films taken and the duration of fluoroscopic exposure. Compared with the conventional HSG, radionuclide HSG delivers an approximately 25 times higher dose of ionizing radiation to the ovaries.
Changes in the connective tissue of corpus and cervix uteri during ripening and labour in term pregnancy
Authors: GRANSTRÖM L. , EKMAN G. , ULMSTEN U. , MALMSTRÖM A.
Published: August 2005

The composition of the connective tissue of human cervix and corpus uteri was studied in tissue specimens from seven nonpregnant women and 14 pregnant women, delivered at term by section, to examine spontaneous cervical ripening and labour‐induced changes in both the uterine and the cervical connective tissue. The main finding in both the cervix and the corpus was a large (40–60%) decrease of the collagen concentration. The collagen extractability, obtained by pepsin digestion, was increased twofold, suggesting a change of the organization of the collagen fibrils. This reorganization process could also be demonstrated by a large increase of the collagenolytic activity demonstrated with an artificial DNP‐peptide substrate. The concentrations of sulphated glycosaminoglycans was lower in pregnant women than in non‐pregnant women. The results show that both the cervix and the corpus uteri contain substantial amounts of connective tissue components (collagen, sulphated glycosaminoglycans and hyaluronic acid) and that during ripening, reconstruction of the connective tissue components occurs in both sites. This indicates that the cervical state reflects that of the myometrium.
Do raised serum luteinizing hormone levels during stimulation for in‐vitro fertilization predict outcome?
Authors: THOMAS A. , OKAMOTO S. , O'SHEA F. , MACLACHLAN V. , BESANKO M. , HEALY D.
Published: August 2005

Previous reports associating raised LH concentrations with reduced fertilization and pregnancy rates in women undergoing in‐vitro fertilization (IVF) have assumed a Gaussian distribution of LH values with IVF treatment. We have determined the serum LH range during ovarian stimulation for IVF with a single regimen of clomiphene citrate/ hMG from 102 consecutive IVF conception cycles. The results show a non‐Gaussian distribution of LH values. Application of this LH range to a consecutive series of 596 women undergoing IVF treated with this single regimen showed no difference in pregnancy rates, fertilization rates, median number of oocytes fertilized or retrieved when analysed with respect to serum LH concentrations above the 75th or 95th centile for ≥3 days of an IVF treatment cycle. We conclude that follicular‐phase LH concentrations do not predict IVF fertilization rates or clinical outcome and are not clinically useful in individual patient management.
Prevention of ovarian cancer: a survey of the practice of prophylactic oophorectomy by fellows and members of the Royal College of Obstetricians and Gynaecologists
Authors: JACOBS IAN , ORAM DAVID
Published: August 2005

Summary. A questionnaire designed to investigate attitudes to prophylactic oophorectomy was sent to 2817 fellows and members of the Royal College of Obstetricians and Gynaecologists. A total of 1142 replies was received from those who performed regular sessions of gynaecological surgery. The number of respondents who said they would usually remove apparently normal ovaries at the time of abdominal hysterectomy from premenopausal women in age groups 35–39, 40–44, 45–49 and over 49 years was 4 (0–4%), 27 (2%), 234 (20%) and 585 (51%) respectively, and from postmenopausal women 974 (85%). The majority of respondents said that (i) they would prescribe hormone replacement therapy in oophorectomized premenopausal women (82%); (ii) they did not consider unilateral oophorectomy to have a role in prevention of ovarian cancer (84%); and (iii) they routinely discussed the question of prophylactic oophorectomy with their patients before operation (65%). Only 128 (11%) of the respondents believed that ≥10% of ovarian cancers in the UK could be prevented by prophylactic oophorectomy at the time of operation for benign disease, and 505 (44%) would perform prophylactic oophorectomy as a primary surgical procedure in women who had a strong family history of ovarian cancer.
Phaeochromocytoma in pregnancy. Five cases and a review of the literature
Authors: HARPER M. ANN , MURNAGHAN G. A. , KENNEDY L. , HADDEN D. R. , ATKINSON A. B.
Published: August 2005

Summary. We report five patients with phaeochromocytoma associated with pregnancy and review the 42 other cases reported in the literature from 1980 to 1987. The overall maternal mortality was 17% and the fetal loss 26%; antenatal diagnosis of phaeochromocytoma reduced the maternal mortality to zero and the fetal loss to 15%, but was made in only 53% of the patients. Although phaeochromocytoma is rare, a high index of clinical suspicion must be maintained and all those at risk investigated if earlier diagnosis and improved outcome are to be achieved. Once the diagnosis is confirmed, alpha‐blockade is essential and beta‐blockade may be required. CT scan or magnetic resonance imaging may be used to localize the tumour during the antenatal period. In the first and second trimesters, tumour resection has a good fetal outcome; in later pregnancy, delivery by elective caesarean section followed by tumour resection is recommended.
Haemodynamic changes associated with caesarean section under epidural anaesthesia
Authors: ROBSON S. C. , DUNLOP W. , HUNTER S. , BOYS R. , BRYSON M.
Published: August 2005

Summary. Serial haemodynamic investigations were performed in 15 women delivered by elective caesarean section under epidural anaesthesia at 38–40 weeks gestation. Cardiac output was measured by Doppler and cross‐sectional echocardiography at the aortic valve. No haemodynamic changes were demonstrable after attainment of surgical anaesthesia (T5 or above). Stroke volume increased 13% after delivery of the placenta and remained elevated until the end of the operation at which time cardiac output was 11% above pre‐operative values. Stroke volume and cardiac output fell during the first postoperative day. Heart rate remained elevated at pre‐operative values for 48 h after delivery. There was a fall in heart rate and cardiac output between the second and the sixth days after delivery. By 2 weeks after delivery cardiac output was 28% lower than pre‐operative values. Compared with pre‐operative values, diastolic blood pressure was lower on the first and second postnatal days.
Obstetric acute renal failure 1956–1987
Authors: TURNEY J. H. , ELLIS C. M. , PARSONS F. M.
Published: August 2005

Summary. A total of 142 women with severe acute renal failure (ARF) resulting from obstetric causes was treated by dialysis at a single centre from 1956 to 1987. One‐year survival was 78·6%, which compares favourably with other causes of ARF. Abortion, haemorrhage and preeclampsia comprised 95% of cases, with survival being best (82·9%) with abortion. Survival was adversely affected by increasing age. Acute cortical necrosis (12·7% of patients) carried 100% mortality after 6 years. Follow‐up of survivors showed normal renal function up to 31 years following ARF; 25‐year patient survival was 71·6%. Improvements in obstetric care and the disappearance of illegal abortions have resulted in a dramatic decline in the incidence of obstetric ARF.
Abdominal pain of unknown aetiology in pregnancy
Authors: BAKER P. N. , MADELEY R. J. , SYMONDS E. M.
Published: August 2005

Summary. The outcome of 140 pregnancies complicated by unexplained abdominal pain was compared with that in a comparison group of 280 women who gave birth at the same time. The two groups were comparable for maternal age and parity but the study group contained a significantly higher proportion of smokers, unmarried women, and women whose partners were unemployed (P<0·001). All the pregnancies resulted in livebirths. There were no statistically significant differences in birthweight, gestational age at delivery or mode of delivery between the two groups.
Perinatal mortality in rural Tanzania
Authors: VAN ROOSMALEN J.
Published: August 2005

Summary. Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent pro longed labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico‐pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).
Cerebral Doppler ultrasound of the human fetus
Authors: VAN DEN WIJNGAARD J. A. G. W. , GROENENBERG I. A. L. , WLADIMIROFF J. W. , HOP W. C. J.
Published: August 2005

Summary. Maximal flow velocity waveforms were recorded in the internal carotid artery (ICA), middle cerebral artery (MCA), posterior cerebral artery (PCA) and anterior cerebral artery (ACA) in 55 normal pregnancies and 14 complicated by intrauterine growth retardation between 25 and 41 weeks gestation. In normal pregnancy, acceptable flow velocity waveforms were obtained in the IC A in 89%, in the MCA in 91%, in the PCA in 58% and in the ACA in 64%. A decrease in pulsatility was observed in all four intracranial arteries during the latter weeks of gestation. In growth‐retarded pregnancies, pulsatility in all vessels was significantly reduced compared with normal pregnancy, suggesting participation of all major intracranial arteries in a brain‐sparing effect in the presence of chronic fetal hypoxia.
The action of squatting in the early postnatal period marginally increases pelvic dimensions
Authors: LILFORD R. J. , GLANVILLE J. N. , GUPTA J. K. , SHRESTHA R. , JOHNSON N.
Published: August 2005

Summary. X‐ray pelvimetry was performed on 43 women in the squatting and erect positions within 1 week of delivery. The act of squatting increased the transverse and antero‐posterior pelvic dimensions by 1 %. The theoretical mechanisms by which posture may affect dimensions are discussed.
Cytological status and lesion size: a further dimension in cervical intraepithelial neoplasia
Authors: JARMULOWICZ M. R. , JENKINS D. , BARTON S. E. , GOODALL A. L. , HOLLINGWORTH A. , SINGER A.
Published: August 2005

Summary. Quantitative histological study of 84 laser cone biopsies showed a highly significant correlation between the grade of a cervical smear and the size of the lesion for all grades of cervical intraepithelial neoplasia (CIN) (CIN 1 P= 0·004; CIN II P= 0·0001; C1N 111 P= 0·003; total CIN P< 0·0001); 10 of 34 (29%) of women with CIN III and mild dyskaryosis or less had significantly smaller lesions than 23 of 36 (63%) of women with CIN III and moderate or severe dyskaryosis. Repeat cytology identified as severe dyskaryosis all those with large CIN III lesions. Lesion size has been neglected in studies of the natural history of CIN and in the assessment of cytological screening, but offers an explanation for the apparent discrepancies between cytological, colposcopic and histological assessment of progression of CIN.
The accuracy of repeat cytology in women with mildly dyskaryotic smears
Authors: GILES J. A. , DEERY A. , CROW J. , WALKER P.
Published: August 2005

Summary. A special colposcopy clinic was established at the Royal Free Hospital to investigate women whose referral smears showed mild dyskaryosis. Of 200 women in the study, 66 (33%) had histologically proven CIN II or CIN III, 59 (29%) had CIN I or human papillomavirus changes, and 54 (27%) were considered normal. These findings demonstrate the importance of adequate diagnosis of this group of women. Of 143 women who had had a single mildly dyskaryotic smear, 45 (31%) had either CIN II or III. Age was not useful for predicting which women were at high risk of significant disease. Careful repeat cervical cytology correlated closely with the histological grade of the lesion. Repeat cytology was associated with an overall 24% false‐negative rate, but most missed lesions were of low grade. Repeat cytology correctly identified 82% of all CIN lesions, and 93% of the most significant lesions (CIN II and III). Women who have a mildly dyskaryotic smear followed by a negative smear should not be considered normal, but careful repeat cytology can be considered a reasonably safe practice.
Cystic lesions in elderly women, diagnosed by ultrasound
Authors: ANDOLF ELLIKA , JÖRGENSEN CONNIE
Published: August 2005

Summary. A retrospective review of an entire clinical series of 152 women over 50 years of age, in whom cystic lesions without solid parts had been diagnosed by ultrasound, found there were no malignancies in 58 completely anechoic lesions <5 cm in diameter. Of 10 small lesions (<5 cm in diameter) with some echogenicity or septa, one was a borderline tumour. In contrast, in patients with lesions >5 cm in diameter there were three malignancies in the group of 33 totally anechoic cysts, five in the group of 32 cysts with some echogenicity, and as many as eight malignancies in the 18 lesions where several septa were present. Two borderline and one malignant tumour had been missed at previous clinical examination. We conclude that small anechoic lesions are seldom, if ever, malignant in elderly women. Sonography is helpful in patients with a negative clinical examination when pelvic pain or signs of malignancy are present.
Clinical findings and results of operative treatment in ilioinguinal nerve entrapment syndrome
Authors: HAHN LENNART
Published: August 2005

Summary. Women complaining of lower abdominal and pelvic pain were tested for the presence of an ilioinguinal nerve entrapment. Forty‐six women were considered to fulfill the requirements for this syndrome, five of them bilaterally. In the 51 nerves tested common findings were hyperaesthesia (88%), dysaesthesia (53%) and pain pressure at the nerve exit (75%); hypoaesthesia was rare (6%). A prerequisite for an operation was a positive result of a block with local anaesthesia. Good to excellent results of an operative approach, usually transection of the nerve, were noted after 39 procedures (76%). Some improvement was reported after six procedures whereas the operation had no effect in six others. A probable cause of the neuralgia could be found in only six women. Ilioinguinal nerve entrapment should be considered early in the differential diagnosis of lower abdominal and pelvic pain.
Characteristics of persistent ovarian masses in asymptomatic women
Authors: BHAN V. , AMSO N. , WHITEHEAD M. I. , CAMPBELL S. , COLLINS W. P. , ROYSTON P.
Published: August 2005

Persistent ovarian masses have been found in a substantial proportion of 5479 self‐selected asymptomatic women who were screened for early ovarian neoplasia. Each woman was scheduled to undergo three ultrasound screens (consisting of 1–12 scans) to detect regressing and non‐regressing masses. A total of 14,594 screens (15,977 scans) was performed. The average interval between successive screens was 595 days (range 214–1134 days). Overall, 650screens (4.4%; 10.1% of women) produced a positive result which became negative with successive scans (four times more frequently in pre‐than naturally postmenopausal women), and 338 screens (2.3%; 5.9% of women) had a final positive result (at least one ovary that was grossly abnormal or contained a persistent mass). Biopsies were taken from 336 ovaries (89% of total, 271 women). Overall, 134 tumour‐like conditions and 119 benign tumours were identified. The detection rate of tumour‐like conditions was 1.5 times higher in premenopausal than naturally postmenopausal women, whereas the proportion of tumours to normal ovaries was similar in both groups. Overall, 51% of tumour‐like conditions and 70% of all tumours were detected at screen 1. Four women had metastatic ovarian cancer (three at screen 1, one at screen 2; two were bilateral). Five women (0.1%) had a primary malignant tumour (two at screen 1, three at screen 2; four were stage la and one was stage Ib). All women are being monitored to obtain additional information about the significance of the findings.
Survey of attitudes to testing for human immunodeficiency virus infection in antenatal clinics in West Glamorgan
Authors: THOMAS J. , BOWEN‐SIMPKINS P. , STEWART G. , PATTERSON T.
Published: August 2005

A total of 1023 women attending hospital antenatal clinics in West Glamorgan was surveyed by means of a self‐administered questionnaire, to determine their attitudes to HIV testing in pregnancy. The response rate was 98%. Of the responders, 94% had no objection to their antenatal blood specimen being tested for HIV infection. Of the non‐objectors, 55% wished their permission to be asked first, and 92% wished to be informed of the result, i.e. they wished for named testing. With regard to knowledge of other tests for infectious diseases performed on antenatal blood specimens, only 1·5% had totally correct knowledge, and only one in three knew that their blood was tested for syphilis. The implications of anonymous and named HIV testing are discussed, together with estimates of prevalence of HIV infection in women attending antental clinics, the rate of vertical transmission, and the prognosis for an infected baby.
Using Lamicel to expose high cervical lesions during colposcopic examinations
Authors: JOHNSON N. , CROMPTON A. C. , WYATT J. , BUCHAN P. C. , JARVIS G. J.
Published: August 2005

Summary. Women with abnormal cervical cytology and an unsatisfactory colposcopic examination were offered Lamicel in an attempt to expose the entire transformation zone. The sponge, which softens, dilates and effaces the cervix, was passed intracervically in 41 patients in whom the entire squamocolumnar junction could not be seen. After 3–4 h the sponge was removed and colposcopy repeated. In 29 of the 41 patients the lesion and the squamocolumnar junction were now fully visible. Twenty‐five of these patients were spared a cone biopsy.
Phenytoin sodium and magnesium sulphate in the management of eclampsia
Authors: DOMMISSE J.
Published: August 2005

Summary. Twenty‐two patients with eclampsia were randomly allocated to receive either intravenous phenytoin sodium or intravenous magnesium sulphate. The groups were comparable. No side‐effects occurred and therapeutic levels were obtained in both groups. While none of the 11 patients managed with magnesium sulphate had further convulsions, four of the 11 treated with phenytoin sodium did and were subsequently effectively treated with magnesium sulphate. These results suggest that phenytoin sodium is not as effective an anticonvulsant in eclampsia as is magnesium sulphate.
Doppler umbilical and uterine flow waveforms in severe pregnancy hypertension
Authors: TRUDINGER B. J. , COOK C. M.
Published: August 2005

Summary. Doppler studies of the umbilical and uteroplacental bed arterial flow velocity waveforms were performed in a series of women suffering from severe proteinuric pregnancy hypertension. Ninety‐five women were studied and the mean interval between the last study and delivery was 1–4 days. An abnormally elevated umbilical artery systolic:diastolic (AB) ratio was present in 61 (64%) of the women. All 10 perinatal deaths were associated with pregnancies with an abnormal umbilical artery AB ratio. An elevated umbilical artery AB ratio was significantly associated with small‐for‐gestation and neonatal morbidity. Infants associated with extremely high umbilical artery AB ratios (≥ 99th centile) spent twice as long in the neonatal nursery as those with a lower value. There was no relation between the duration of hypertension and the umbilical study result. The uteroplacental bed artery flow velocity waveform did not correlate with fetal or neonatal mortality or morbidity. Patients with abnormal uteroplacental AB ratios also had abnormal umbilical artery AB ratios. We conclude that an abnormal fetal umbilical artery Doppler flow velocity waveform correlates with adverse fetal outcome in severe proteinuric pregnancy hypertension and suggest that the associated placental lesion may precede the maternal hypertension.
Social support and pregnancy outcome
Authors: OAKLEY ANN , RAJAN LYNDA , GRANT ADRIAN
Published: August 2005

Summary. A total of 509 women with a history of a low‐birthweight (LBW, <2500 g) baby were recruited from the antenatal booking clinics of four hospitals and randomized to receive either a social support intervention in pregnancy in addition to standard antenatal care (the intervention group) or standard antenatal care only (the control group). At recruitment to the study, mean gestational age was 6 weeks, mean maternal age was 28.0 years, 86% of the women had one previous LBW baby, 11% had two and 2% had had three or more. The study population was socially disadvantaged: 77% of the women were working class, 18% had unemployed partners and 41% were smoking at booking. Social support was given by four research midwives in the form of 24‐h contact telephone numbers and a programme of home visits, during which the midwives provided a listening service for the women to discuss any topic of concern to them, gave practical information and advice when asked, carried out referrals to other health professionals and welfare agencies as appropriate, and collected social and medical information. Pregnancy outcomes were assessed using obstetric case‐note data (obtained for 507 women) and a postal questionnaire sent to all mothers 6 weeks after delivery (94% replied). Babies of intervention group mothers had a mean birthweight 38 g higher than that of control group babies; there were fewer very low‐birthweight babies in the intervention group. The number of hospital antenatal clinic visits was the same in the two groups (mean 5‐1) but more women in the control group (52%) than in the intervention group (41%) were admitted to hospital in pregnancy. Spontaneous onset of labour and spontaneous vaginal delivery were more common in the intervention group, who also used less epidural anaesthesia. The numbers of babies resuscitated at birth and babies admitted to the neonatal unit were similar in the two groups but the babies in the intervention group required less invasive methods for resuscitation and less intensive and special neonatal care. Intervention group mothers and babies were significantly healthier in the early weeks than those in the control group as judged by reported physical and psychosocial health and use of health services. Women's attitudes to the social support intervention were very positive, 80% of those who filled in the postnatal questionnaire singling out that the fact that the midwife ‘listened’ was important.
Endemic placenta accreta in a population of remote villagers in Papua New Guinea
Authors: BARSS P. , MISCH K. A.
Published: August 2005

Summary. Using a combination of prospective registration of definite cases (n = 47) and retrospective identification of probable cases (n = 22) over a 6.5‐year period, we have estimated that the rate of placenta accreta in the Milne Bay Province of Papua New Guinea is at least 1.6 per 1000 births, and probably in excess of 2.3 per 1000. This is substantially higher than other reported estimates of the frequency of this condition, which causes significant maternal morbidity. The study population of 130 000 consisted mainly of subsistence cultivators who live in remote hamlets, and included about 27 600 women between the ages of 15 and 49 years. A number of factors seem likely to be important in the aetiology of the condition in Milne Bay Province, including infection associated with previous childbirth and abortion. Over three‐quarters of the cases would have been prevented if all women of para ≥4 or wi th a history of retained placenta had used effective contraception. Better obstetric care, including early treatment of postpartum sepsis and incomplete abortion, may also help to reduce the frequency of placenta accreta in this population.
Socio‐economic and ethnic factors in stillbirth and neonatal mortality in the NE Thames Regional Health Authority (NETRHA) 1983
Authors: PARSONS LUISE , DULEY LELIA , ALBERMAN EVA
Published: August 2005

Summary. All stillbirths and neonatal deaths occurring in the North East Thames region were studied in 1983. This report describes the socio‐economic and ethnic differences in that cohort. The stillbirth and neonatal mortality rates of babies born to fathers of social class V (16–8 per 1000 total births) was almost double that of social class I fathers (8–6 per 1000 total births). The most marked social class gradient was seen in the macerated stillbirth groups. Of particular concern was the extremely high stillbirth and neonatal mortality rate for women born in the Indian subcontinent. This was most evident in Pakistani women who had a stillbirth plus neonatal mortality rate of 17.3 per 1000 total births, almost twice that of the women born in the UK (9.0 per 1000 total births). Again, as with social class, macerated stillbirths appeared to contribute disproportionately to the excess mortality. Mortality rates were aggre gated into four birthweight specific groups. Asian women had higher mortality rates in the higher birthweight groups, whereas in the lower birthweight group their babies did slightly better. This study indicated that the special needs for working class and ethnic minority mothers within NE Thames were not being met, and the Regional Health Authority was strongly recommended to review services to these groups.