bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials
Authors: CROWLEY PATRICIA , CHALMERS IAIN , KE1RSE MARC J. N. C.
Published: August 2005

Summary. Continuing differences of opinion among obstetricians and neonatologists about the place of corticosteroid administration before preterm delivery have prompted us to carry out a systematic review of the relevant controlled trials, using methods designed to minimize systematic and random error. Data from 12 controlled trials, involving over 3000 participants, show that corticosteroids reduce the occurrence of respiratory distress syndrome overall and in all the subgroups of trial participants that we examined. This reduction in respiratory morbidity was associated with reductions in the risk of intraventricular haemorrhage, necrotizing enterocolitis and neonatal death. There is no strong evidence suggesting adverse effects of corticosteroids. The risks of fetal and neonatal infection may be raised if they are administered after prolonged rupture of the membranes, but this possibility is not substantiated by the results of the available trials. The available data on long‐term follow‐up suggest that the short‐term beneficial effects of corticosteroids may be reflected in reduced neurological morbidity in the longer term.
Child outcome following mid‐trimester amniocentesis: development, behaviour, and physical status at age 4 years
Authors: FINEGAN J.‐A. K. , QUARRINGTON B. J. , HUGHES H. E. , MERVYN J. M. , HOOD J. E. , ZACHER J. E. , BOYDEN M.
Published: August 2005

Summary. Four‐year‐old children whose mothers had mid‐trimester amniocentesis (n = 88) were compared with children whose mothers chose not to have the procedure (n = 46). Intelligence, visual‐motor‐perccptual skills, language, behaviour, social competence, temperament, physical growth, hearing, and middle‐ear function were measured using standardized procedures. Health histories were obtained by maternal report. The results suggest that the wide range of developmental and behavioural variables studied is not influcnced by removal of amniotic fluid in the mid‐trimester. However, mothers who had amniocentesis were more likely to report a history of ear infections in their child (P = 0.04). In support of this finding were the results of audiological assessment which demonstrated a trend toward a higher rate of bilateral middle‐ear impedance abnormalities in children whose mothers had amniocentesis (P = 0.06). Further study of the upper respiratory system is recommended to explore potential long‐term sequelae of mid‐trimester amniocentesis.
The effect of maternal work on fetal growth and duration of pregnancy: a prospective study
Authors: LAUNER LENORE J. , VILLAR JOSE , KESTLER EDGAR , DE ONIS MERCEDES
Published: August 2005

Summary. The effect on birth outcome of work requiring different degrees of physical exertion was examined among 15 786 pregnant women who were followed through the Guatemalan Social Security Institute's hospital. Work inside and outside the home was ascertained through a questionnaire administered to each woman before delivery. Odds ratios were adjusted for household income, maternal height and age, and birthweight of previous infant. Women with three or more children and no household help were at increased risk for small‐for‐gestational‐age (SGA) births compared with women with family (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.31, 2.47) or hired help (OR 2.0; 95% CI 1‐16 to 3‐33). Compared with office work, manual work increased the risk for an SGA (OR 1.32 95% CI 1.12 to 1.56) and SGA/preterm birth (OR 2.56; 95% CI 1.10 to 5.96). Work in a standing compared with sitting position significantly increased the risk for a preterm birth (OR l.56; 95% CI l.04 to 2.60). There was a significant positive trend in frequency of SGA and SGA/preterm birth with an increase in the physical demands at work, as measured by an activity score. These data suggest that interventions to reduce physical exertion among pregnant women could improve birth outcome.
Transvaginal ultrasound in the diagnosis and treatment of tubo‐ovarian abscess
Authors: TEISALA K. , HEINONEN P. K. , PUNNONEN R.
Published: August 2005

Summary. Transvaginal ultrasound showed tubo‐ovarian abscess in 10 patients admitted for acute pelvic inflammatory disease, and transvaginal ultrasound‐guided aspiration of tubo‐ovarian abscess was performed under antimicrobial treatment. Only light sedation was required and the procedure was well tolerated by the patients. The short‐term recovery of all patients was quick and uncomplicated. This new technique is a useful alternative for the diagnosis and treatment of tuboovarian abscess.
Relaxin in sera during the luteal phase of in‐vitro fertilization cycles
Authors: EDDIE LAWRENCE W. , MARTINEZ FRANCESCA , HEALY DAVID L. , SUTTON BEVERLEY , BELL ROBIN J. , TREGEAR GEOFFREY W.
Published: August 2005

Summary. To identify the time when relaxin can first be detected in peripheral sera after in‐vitro fertilization (IVF) and embryo transfer, blood samples were collected from 20 women up to 14 days after oocyte retrieval. Sixteen women did not become pregnant and in eight of them relaxin (but not beta‐human chorionic gonadotrophin, (β‐hCG) was measurable for the first time at days 6 to 12. Concentrations of other hormones measured were also different in these eight women compared with the remaining eight non‐pregnant women; their serum concentrations of 17α‐OH progesterone, progesterone and oestradiol were higher but concentrations of luteinizing hormone and follicle‐stimulating hormone were lower. Three women became pregnant; relaxin and β‐hCG were first detected on the same day (10 to 12). The remaining woman had increased β‐hCG levels but did not develop a clinical pregnancy. Measurement of serum relaxin during IVF cycles may allow assessment of corpora luteal function before its identification by levels of steroid hormones.
Caesarean section for the birth of the second twin
Authors: SAMRA JAG S. , SPILLANE HELEN , MUKOYOKO JAMES , TANG LAWRENCE , OBHRAI MANJIT S.
Published: August 2005

Summary. Twin pregnancies delivered after 28 weeks gestation between 1980 and 1988 were reviewed. Of 510 twin pregnancies, 184 (36%) were delivered by caesarean section. There were 22 (4.3%) combined vaginal/abdominal deliveries which comprised 12% of the 184 twin pregnancies delivered by caesarean section. Persistent transverse lie or a high breech presentation was the commonest indication for caesarean section for the second twin.
The use of mifepristone (RU 486) for cervical preparation in first trimester pregnancy termination by vacuum aspiration
Authors:   WORLD HEALTH ORGANIZATION
Published: August 2005

Summary. Animal and clinical evidence suggests that the antiprogestin mifepristone may be of potential use for cervical preparation before surgical termination of pregnancy. A double‐blind, multicentre study was undertaken of 230 primigravid women with 10–12 weeks amenorrhoea who were randomly assigned to groups given 0 (placebo), 25, 50 or 100 mg mifepristone twice at 24 and 12 h before vacuum aspiration. In mifepristone‐treated women the cervix was on average between 0.9 and 1.2 mm more dilated at operation, but the effect was not dose related. High resistance during further mechanical stretching tended to be encountered more often and at a smaller cervical diameter in the placebo group than in the women given mifepristone, but these differences were not statistically significant. In contrast, the ease of dilatation assessed subjectively by the operating surgeons was not only improved by the antiprogestin, but was also dose related. Mifepristone therapy was not associated with any side‐effects and only two of the women from the highest dose group experienced preoperative vaginal bleeding. Per operative blood loss, post‐operative complications, the duration of post‐operative bleeding and the interval to the first period were similar in the four treatment groups.
The contact Nd:YAG laser: a new technique for conservation of the fallopian tube in unruptured ectopic pregnancy
Authors: KECKSTEIN JÖRG , HEPP SIGRID , SCHNEIDER VOLKER , SASSE VOLKER , STEINER RUDOLF
Published: August 2005

Summary. Between August 1986 and April 1988, 22 women with unruptured tubal pregnancy were treated by laparoscopy in the Department of Gynaecology and Obstetrics at the University of Ulm. Linear salpingotomy was performed using the contact Nd:YAG laser technique. The laser beam was delivered by special sapphire probes attached to a standard optical fibre for incision and coagulation. Two different shapes of sapphire probes were used. The specific laser properties and the application of vasopressin enabled treatment without any other incision instruments or coagulation agents. In one patient subsequent laparoscopy became necessary due to persisting trophoblastic tissue. Sixteen women were assessed subsequently by second‐look laparoscopy or hysterosalpingography for tubal patency and possible formation of adhesions. In 14 (88%) women the tubes were patent, and in two women adhesions were seen.
‘Normal but dead’: perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983
Authors: KIRKUP BILL , WELCH GORDON
Published: August 2005

Summary. The case notes relating to 75 of the 91 perinatal deaths of nonmalformed babies of birthweight ≥2.5 kg born in the Northern Region in 1983 were examined. The major groups involved antepartum deaths of unknown cause (40%), and deaths due to intrapartum anoxia or trauma (35%). A case‐control study compared each of the 75 cases with two controls matched for place of birth, obtained by taking the next two babies born in the same maternity unit (excluding perinatal deaths, birthweight <2.5 kg, and malformations). Four factors were found to be significantly associated with risk of perinatal death in this group: primigravidity, parity ≥3, not booked for antenatal care by 20 weeks, and corrected birthweight <3.2 kg (adjusted for gestation). Two further factors were related only to the risk of perinatal death consequent upon intrapartum events: labour post‐term and malpresentation in labour. All four factors relevant to the whole group remained independently associated with risk of perinatal death after multivariate analysis by two techniques. Adjusted odds ratios (95% CI) were estimated as: primigravidity 2.1 (1.1 to 4.1); parity three or more 5.7 (1.9 to 17); not booked for antenatal care by 20 weeks 15.7 (3.0 to 81); and corrected birthweight <3.25 kg 2.5 (1.3 to 4.6). An avoidable factor, as defined, was detected in 50% of deaths. In 30% of deaths there was an avoidable factor (grade 2) such that absence may have been expected to lead to a different outcome had all other factors remained equal. Of the avoidable factors detected, 61% related to intrapartum management, as did 76% of the grade 2 factors. Most of these involved failure to respond to evidence of fetal distress in labour. The defined group constituted 21% of all perinatal deaths, suggesting that this is an important category, particularly as their potential for normal survival should otherwise have been high.
Failure to prevent preterm labour and delivery in twin pregnancy using prophylactic oral salbutamol
Authors: ASHWORTH M. FELICITY , SPOONER S. F. , VERKUYL D. A. A. , WATERMAN R. , ASHURST HAZEL M.
Published: August 2005

Summary. A double blind, controlled study was performed to see whether the use of prophylactic oral salbutamol would reduce the incidence of preterm labour in twin pregnancy. Of the 144 women studied, 74 took salbutamol and 70 placebo. No difference was found in the length of gestation, birthweight or fetal outcome, although fewer babies suffered from respiratory distress syndrome in the salbutamol group. Women did not experience troublesome side‐effects from salbutamol.
Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/1 (IRP)
Authors: CACCIATORE BRUNO , STENMAN ULF‐HÅKAN , YLÖSTALO PEKKA
Published: August 2005

Summary. The diagnostic value of vaginal sonography in combination with a discriminatory serum hCG level of 1000 iu/1 (International Reference Preparation) was tested prospectively in 200 pregnant women suspected of having an ectopic pregnancy. An ectopic pregnancy was diagnosed in 68 women (34%), a miscarriage in 56 (28%) and a normal pregnancy in 76 (38%). On admission, an intrauterinc sac was seen in 89% of the intrauterinc pregnancies, but in none of the ectopic pregnancies. Detection of an adnexal mass separate from the ovaries was diagnostic of ectopic pregnancy with a sensitivity of 93%, a specificity of 99%, a positive predictive value of 98% and a negative predictive value of 96%. Tn 19 patients (9%) the initial sonogram was non‐diagnostic and the final diagnosis was obtained after a repeated scan within 6 days. Five of these women had an ectopic pregnancy, 12 a miscarriage and two a normal pregnancy. On admission the hCG level exceeded 1000 iu/1 in 77% of all patients and in 67% of those with ectopic pregnancies. In patients with an initial level exceeding 1000 iu/1, an intrauterine sac was found in all the intrauterine pregnancies but in none of the ectopic pregnancies. The use of this threshold in combination with sonographic detection of an adnexal mass was diagnostic of ectopic pregnancy with a sensitivity of 97%, a specificity of 99%, a positive predictive value of 98% and a negative predictive value of 98%.
Total perinatal wastage. A clarification of priorities
Authors: HOGSTON PATRICK , JAMES DAVID K.
Published: August 2005

Summary. The pregrmncy outcome of 16 971 women carrying 17 352 living fetuses after 16 weeks gestation was studied. As well as recording perinatal deaths, all losses before 28 weeks and up to one year after delivery were recorded to give a total perinatal wastage rate of 21.6 per 1000 fetuses alive at 16 weeks compared with a perinatal mortality rate (stillbirths plus early neonatal deaths) of 7.8 per 1000 births. All deaths were then classified according to pathological sub‐groups. The concept of auditing perinatal care using perinatal mortality was then compared with that using total perinatal wastage.
Increase in plasma prorenin during the menstrual cycle of a bilaterally nephrectomized woman
Authors: BLANKESTIJN P. J. , DERKX F. H. M. , VAN GEELEN J. A. , DE JONG F. H. , SCHALEKAMP M. A. D. H.
Published: August 2005

Summary. To investigate the origin of the prorenin peak that occurs during the normal menstrual cycle, plasma levels of prorenin, renin, oestradiol, progesterone, LH and FSH were measured serially in a nephrectomized woman having regular hacmodialysis. The prorenin peak coincided with the LH surge and preceded the rise of progesterone, whereas renin was below the detection limit during the whole cycle. These findings indicate that the rise in prorenin during the menstrual cycle is not of renal origin but is probably due to increased production by the ovary and supports the increasing evidence for the existence of a local renin‐angiotensin system in the ovary.
Maternal haematocrit in labour is related to fetal cord pH at delivery
Authors: SAUNDERS NIGEL J. St. G. , SPIBY HELEN , PATEL DAKSHA
Published: August 2005

Objective–To determine whether a correlation exists between maternal haematocrit in labour and umbilical cord pH values at delivery.

Design–An observational study.

Setting–The delivery suite.

Subjects–200 pregnant women in labour.

Main outcome measures–Umbilical artery and vein blood pH values.

Results–A statistically significant inverse correlation was observed between maternal haematocrit levels during labour and umbilical vein pH (r=−0.22; P= 0.001) and umbilical artery pH (r=–0.18; P = 0.008) at delivery.

Conclusions–Although an inverse correlation does appear to exist between maternal haematocrit and cord pH values, it is unlikely that this weak association will prove to be of clinical value in the management of labour.
Effects of epidural block with lignocaine and lignocaine‐adrenaline on umbilical artery velocity wave ratios
Authors: MARX GERTIE F. , ELSTEIN I. DAVID , SCHUSS MARVIN , ANYAEGBUNAM AKOLISA , FLEISCHER ADIEL
Published: August 2005

Summary. Umbilical artery blood velocity A/B ratios were recorded in term fetuses once before and twice after the maternal epidural injection of either 8 ml of lignocaine plain (15 women) or lignocaine with adrenaline 1:200000 (40 μg) (16 women). The administration of lignocaine plain led to decreases in the ratio of varying degrees in all fetuses regardless of the height of the initial A/B ratio. The injection of lignocaine with adrenaline produced identical results in fetuses with initially normal A/B ratios. In contrast, all six fetuses with initially high A/B ratios (above 2.90) who received the adrenaline‐containing anaesthetic reacted with a rise in the ratio, and two of these developed transient heart rate decelerations. Thus, if the initial resistance in umbilical blood flow is high, even the small epidural dose of 40 μg of adrenaline produces a further increase which may be associated with clinical implications.
Lactation inhibition by a single injection of a new depot‐bromocriptine
Authors: KREMER J. A. M. , ROLLAND R. , VAN DER HEIJDEN P. F. M. , SCHELLEKENS L. A. , VOSMAR M. B. J. G. , LANCRANJAN I.
Published: August 2005

Summary. Recently, long‐acting injectable forms of bromocriptine have become available for the prevention of lactation. The first developed depot‐form was very effective, but had the disadvantage of a slowly metabolized carrier. We investigated the pharmacokinetics, efficacy, tolerance and safety of 40 and 50 mg of a new rapidly eliminated depotform in 61 postpartum women. Bromocriptine rapidly increased after injection and prolactin was effectively suppressed during the studyperiod of 60 days. Overall efficacy was very good or good in 98% and no rebound lactation occurred. Sixteen women experienced side effects. Tolerance at the injection site was good and safety tests did not show abnormalities. There were no differences between the two dosages. We conclude that this new depot‐bromocriptine is a safe, well tolerated and effective drug in the suppression of prolactin and the prevention of postpartum lactation.
Uterine size and endometrial thickness and the significance of cystic ovaries in women with pelvic pain due to congestion
Authors: ADAMS J. , REGINALD P. W. , FRANKS S. , WADSWORTH J. , BEARD R. W.
Published: August 2005

Summary. In a group of 55 women with chronic pain due to pelvic congestion measurement by ultrasound revealed they had a larger uterus and thicker endometrium as compared with a group of normal women matched for age, parity and the presence of polycystic ovaries found on ultrasound scanning. Many women with pelvic congestion (56%) were found on ultrasound to have cystic changes in their ovaries which ranged from a classic polycystic pattern to the appearance of clusters of 4–6 cysts in bilaterally enlarged ovaries. It is suggested that uterine enlargement and thickening of the endometrium are caused by oestrogen, either from the effects on the target organs of an increased concentration or of hypersensitivity to oestrogen.
The influence of suture material on vaginal vault granulations following abdominal hysterectomy
Authors: MANYONDA ISAAC T. , WELCH C. ROSS , MCWHINNEY NORMAN A. , ROSS LESLIE D.
Published: August 2005

Summary. A questionnaire was circulated to 1147 members (consultant status) and fellows of the Royal College of Obstetricians and Gynaecologists to survey the current management of the vaginal vault following abdominal hysterectomy. Of the 56% who responded, the majority (87%) routinely close the vault. An interrupted mattress suture is used by 60%, a continuous suture by 43% and the Lembert suture by 2%. Chromic catgut is favoured by 60%, a synthetic polymer by 33% and plain catgut by 6%. We then organized a prospective, randomized trial involving 114 women who underwent total abdominal hysterectomy for benign indications. No. 1 polygalactide (Vicryl) was used in 58 women, and No. 1 chromic catgut in 56. Overall, 37 (32%) had vault granulations 6 weeks post‐operatively. Chromic catgut had been used in 25 (68%) and polygalactide in the remaining 12 (32%) (P= 0·01). Only 2 (5%) of these women denied any symptoms, while the rest complained of vaginal discharge, bleeding or both. Neither the patients' age, weight or parity, nor the status of the surgeon influenced the occurrence of granulations. We conclude that the widespread use of chromic catgut revealed by our survey is unacceptable: polygalactide, a synthetic polymer, is associated with fewer vaginal vault granulations than chromic catgut.
Reproductive prognosis after abdominal metroplasty in bicornuate or septate uterus: a life table analysis
Authors: CANDIANI GIOVANNI BATTISTA , FEDELE LUIGI , PARAZZINI FABLO , ZAMBERLETTI DANIELA
Published: August 2005

Summary. Reproductive prognosis after abdominal metroplasty was assessed in 73 women with a septate and 71 with a bicornuate uterus who underwent metroplasty at the First Obstetric and Gynecologic Clinic of the University of Milan between 1972 and 1985. The overall cumulative 5‐year delivery rates were respectively 70% and 73% in women with septate and bicornuate uterus, rising constantly with time. The number of previous miscarriages did not affect the reproductive prognosis: the 5‐year probability of giving birth was 64% and 75% in the women with septate uterus and respectively fewer than two or two or more previous miscarriages, and the corresponding values were 66% and 73% in the bicornuate uterus subgroup. The miscarriage rate (about 20%) was similar with both types of malformation.
Menstrual symptoms in women with pelvic endometriosis
Authors: MAHMOOD T. A. , TEMPLETON A. A. , THOMSON L. , FRASER C.
Published: August 2005

Objective— To investigate menstrual symptoms in relation to pelvic pathology.

Design— A prospective questionnaire‐based study.

Setting— Aberdeen Royal Infirmary, Scotland.

Subjects— 1250 questionnaires were sent out prior to planned admission and 1200 women (96%) brought the completed questionnaires. They comprised 598 women undergoing laparoscopic sterilization, 312 having laparoscopy because of infertility, 156 having laparoscopy because of chronic pelvic pain and 134 women undergoing abdominal hysterectomy for dysfunctional uterine bleeding.

Main outcome measures— The occurrence of dysmenorrhoea, menorrhagia, menstrual regularity, premenstrual spotting, deep dyspareunia and pelvic pain in women with either endometriosis and post infective pelvic adhesions or a normal pelvis.

Results— Menorrhagia, menstrual irregularity and premenstrual spotting occurred with equal frequency in all groups. Deep dyspareunia, pain after intercourse and recurrent pain unrelated to menstruation or coitus was more common in women with endometriosis and those with post infective pelvic adhesions than in those with a normal pelvis. Dysmenorrhoea appears to be more prevalent among women having endometriosis.

Conclusions— Menstrual symptoms, while raising a high index of suspicion for endometriosis, are not entirely reliable as indicators of disease. Dysmenorrhoea is the most common reported symptom in endometriosis sufferers. Diagnostic laparoscopy should be considered before institution of treatment in women complaining of pelvic pain and menstrual symptoms.
Early postoperative mortality following hysterectomy. A Danish population based study, 1977–1981
Authors: LOFT ANNE , ANDERSEN TAVS FOLMER , BRØNNUM‐HANSEN HENRIK , ROEPSTORFF CHRISTIAN , MADSEN METTE
Published: August 2005

Summary. The main objective of this cohort study was to analyse the early postoperative mortality after ‘simple’ hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977–1981. Patients were only included if no cancer was diagnosed and if no major co‐surgery was performed (29 192 patients). Cancer patients were also excluded in the reference group (16182 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16.1 per 10000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% CI 4.33–9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (RR = 3.22; 1.72–6.04). Patients with more than one diagnosis at discharge (RR = 4.53; 2.12–9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo ‘simple’ hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including quality of life for longer periods of time following operations.
Comparison of the T/QRS ratio of the fetal electrocardiogram and the fetal heart rate during labour and the relation of these variables to condition at delivery
Authors: NEWBOLD SANDRA , WHEELER TIMOTHY , CLEWLOW FRANK
Published: August 2005

Summary. The T/QRS ratio of the fetal electrocardiogram (ECG) was recorded to within 30 min of delivery from 105 women in labour. There were no significant differences in the mean T/QRS ratio in the last hour of record between those with normal and intermediate, or abnormal fetal heart rate (FHR) patterns. In 66 labours the mean T/QRS ratio in the first hour of record was compared with that of the last hour; the only significant change was a small decrease in the mean ratio from 11% to 7% in a group of 11 fetuses with an abnormal FHR pattern throughout the recording time. Eight babies were born with evidence of acidosis (umbilical artery pH<7.16), and another four were born in poor condition (1 min Apgar score <4) without evidence of acidosis; none had a mean last hour T/QRS ratio significantly different from the previously established normal range.
Repeated measurement of maternal weight during pregnancy. Is this a useful practice?
Authors: DAWES M. G. , GRUDZINSKAS J. G.
Published: August 2005

Summary. A retrospective study of 1092 pregnant women showed that the use of a centile chart of maternal weight gain was not effective at detecting women who give birth to small for gestational age (SGA) infants. Multiple regression analysis showed that of the various weight measurements recorded, weekly weight gain and maternal size at booking were the only factors which had a significant association with infant birthweight after taking into account maternal gestation, age, smoking habit and parity. Low maternal booking weight (< 51 kg) was the most effective maternal weight measurement for antenatal detection of SGA infants (positive predictive value 20.0%). Low average weekly maternal weight gain (< 0.20 kg) had a positive predictive value of only 12.9% for detecting these pregnancies. Weight loss or failure to gain weight over a 2‐week interval occurring in the third trimester was observed in 46% of all women studied. Maternal smoking had a positive predictive value of 16.3% in antenatal detection of SGA infants. Maternal weight need be recorded only at booking, with the exception of patients in whom nutrition is of concern. The subsequent routine weighing of patients may produce unnecessary anxiety and should cease.
Conflicting views on the measurement of blood pressure in pregnancy
Authors: PERRY IVAN J. , WILKINSON LOUISE S. , SHINTON ROGER A. , BEEVERS DAVID G.
Published: August 2005

Summary. Current practice with regard to the technique of blood pressure measurement in pregnancy was assessed by means of a self‐completed questionnaire sent to all midwives (116) and obstetricians (11) working in a UK District General Hospital obstetric unit. The response rate was 72% (91 respondents). Over half of the respondents (53%) use the fifth phase diastolic end point (contrary to current recommendations). Of the 75 respondents who had access to a large adult cuff 54 (72%) had used it on ‘less than two occasions’ over the preceding four weeks. Only 10% (9) of respondents reported that they record blood pressure to the nearest 2 mmHg and 23% (22) reported that they round blood pressure readings to the nearest 10 mmHg. There were diverse views on the interpretation of multiple blood pressure recordings. The conclusion is that compliance with current recommendations on blood pressure measurement technique in pregnancy is poor. There is poor agreement among midwives and obstetricians as to how blood pressure should be recorded in pregnancy.
Continuation of normal neurobehavioural development in fetuses with absent umbilical arterial end diastolic velocities
Authors: PILLAI M. , JAMES D.
Published: August 2005

Summary. Detailed serial observations of behaviour were made in four singleton fetuses who were very small for dates and who had persistently absent umbilical artery end diastolic velocities for 2 to 9 weeks duration. All were born preterm for deteriorating maternal disease, and in two there were additional fetal indications for delivery. Behavioural comparison with 45 low risk singleton fetuses, at comparable gestations, revealed no significant differences in the development of behavioural cycles, the proportion of time spent in quiet cycles, or the amount of fetal breathing. None of the fetuses developed an abnormal heart rate pattern. We conclude that prenatal neurobehavioural development may continue apparently unimpaired in the presence of absent umbilical artery end‐diastolic velocity of several weeks duration. Long term data of infant outcome are necessary before the clinical significance of this can be assessed.
Fetal liver dysfunction in Rh alloimmunization
Authors: NICOLINI UMBERTO , NICOLAIDIS PETER , TANNIRANDORN YUEN , FISK NICHOLAS M. , NASRAT HASSAN , RODECK CHARLES H.
Published: August 2005

Summary. The liver enzymes, aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP), were measured in the blood of 25 fetuses with severe Rh alloimmunization at the time of their first, second and third intravascular transfusions and in 17 comparison fetuses. In the comparison group, GGT increased with advancing gestation (r = 0.7; P = 0.002), whereas ALP, AST and ALT did not correlate with gestational age. Rh hydropic fetuses (n = 8) had higher blood ALT levels than the comparison fetuses (P = 0.008) and significantly increased transaminases when compared with non hydropic fetuses (n = 17). In hydropic fetuses, AST correlated with the nucleated red cell count before transfusion (r = 0.94; P = <0.0001). Fetal transaminases were no longer increased in hydropic fetuses by the second (AST) or third (ALT) transfusion. In both hydropic and non hydropic fetuses, GGT increased by the second transfusion (median percentage change +85%, range −83% to +596%; P = 0.003). The rise in fetal GGT was transitory and correlated with the increase in fetal haematocrit at the first transfusion (r = 0.58; P = 0.006). This study reports liver dysfunction secondary to extramedullary erythropoiesis in Rh alloimmunization and implicates portal hypertension for the rise in fetal GGT with transfusion.
The miscarriage clinic: an audit of the first year
Authors: TURNER M. J. , FLANNELLY G. M. , WINGFIELD M. , RASMUSSEN M. J. , RYAN R. , CULLEN S. , MAGUIRE R. , STRONGE J. M.
Published: August 2005

Summary. We preview the results of the first year in a Miscarriage Clinic set up in 1989 in an effort to improve the support and counselling of women who have a miscarriage. Of 381 patients referred, 79% attended. The only statistically significant difference between the women who attended and those who did not attend was in the proportion of women who had planned their pregnancies (65% versus 33%, P<0.01). Of the 300 patients who attended, 4% reported no grief reaction; 75% experienced a reaction which had resolved within one month and 21% experienced a reaction which had not resolved. No factor was identified which could predict the duration of the grief reaction. This audit demonstrates that there is a strong demand and need for this service for couples who experience a miscarriage.
Microsurgical salpingostomy is not an obsolete procedure
Authors: WINSTON R. M. L. , MARGARA R. A.
Published: August 2005

Objective— A review of the results of microsurgery for bilateral distal tubal blockage.

Design— A retrospective review.

Setting— Hammersmith Hospital London and local private hospitals.

Subjects— 388 patients with bilateral ampullary occlusion treated between 1971 and 1988 by microsurgery.

Interventions— Full investigation for other causes of infertility followed by abdominal microsurgical salpingostomy. Repeated meticulous follow‐up was essential with check laparoscopy one year after surgery.

Main outcome measure— Successful pregnancy in relation to tubal damage.

Results— In 65 women microsurgery followed tubal reocclusion after failed conventionally performed salpingostomy. 74 women (23%) had one term pregnancy after primary salpingostomy and 12 women (18%) after repeat salpingostomy. Over half the women having a term pregnancy subsequently had a second infant. The tubal damage was classified in four stages according to the degree of mucosal damage and tubal fibrosis, the presence of isthmic disease and the quality of tubal and ovarian adhesions. Approximately one quarter of patients had stage I disease and amongst these 39% had babies after primary salpingostomy and 25% after repeat salpingostomy.

Conclusion— Microsurgical salpingostomy is a specialized procedure. Proper selection of patients, competent microsurgical technique and adequate follow‐up appear crucial to success. In selected patients treatment by salpingostomy gives better results than multiple cycles of in vitro fertilization.
Autoreactivity in women with endometriosis
Authors: TAYLOR PAMELA V. , MALONEY MICHAEL D. , CAMPBELL JAMES M. , SKERROW SYLVIA M. , NIP MARIA M. C. , PARMAR REKHA , TATE GEOFFREY
Published: August 2005

Summary. Serum samples from 71 patients with laparoscopically staged endometriosis and from 109 age‐matched non‐pregnant control women were tested for antibodies to nuclear, phospholipid, smooth muscle and sperm antigens. Immunoglobulin G, M and A and complement components C3 and C4 were measured. Prevalence of the following autoantibodies was statistically significantly greater in women with endometriosis than in the control group: antinuclear antibodies, antibodies to ribonucleoproteins, smooth muscle antibodies, lupus anticoagulant and anticardiolipin antibody. Forty‐one women with endometriosis (58%) had some type of autoantibody compared with 13 controls (12%). More women in the endometriosis group had IgG and IgM levels above the normal range. This was statistically significant for IgG in women with grade 3 and for IgM in those with grade 4 endometriosis, IgG levels were significantly higher in antibody‐positive women with endometriosis than in the control group. Immunoglobulin and complement component levels tended to have a positive correlation with stage of disease.
Vulvar vestibulitis syndrome: a clinico‐pathological study
Authors: FURLONGE C. B. , THIN R. N. , EVANS B. E. , McKEE P. H.
Published: August 2005

Summary. Twenty four patients with the vulvar vestibulitis sydrome formed the basis of this clinicopathological study. Entry dyspareunia was the constant presenting complaint and vestibular erythema with acute superficial tenderness the invariable clinical finding. In our series there was a marked predominance of Caucasians, patients were most often of social classes I and II and most frequently in the third decade. The results of laboratory investigation revealed that this syndrome has a diverse range of potential aetiologies including vulval infections, dysplasia and in one instance acute vasculitis.
Quantitative production of prostaglandin E2 and its metabolites by human fetal membranes
Authors: KHAN H. , SULLIVAN M. H. F. , HELMIG R. , ROSEBLADE C. K. , ULDBJERG N. , ELDER M. G.
Published: August 2005

Summary. Cultured amnion, choriodecidua and intact fetal membrane produced similar quantities of prostaglandin E2 (PGE2) (1–5 ng/ml). Choriodecidua and intact fetal membrane also produced very high levels of PGE2 metabolites (100–1000 ng/ml). The total production of PGE (PGE2 metabolites) was similar in intact fetal membrane and in choriodecidua, suggesting that the amnion, although a source of PGE2 contributes little to the overall PGE production by fetal membranes.
The role of postnatal x‐ray pelvimetry after caesarean section in the management of subsequent delivery
Authors: KRISHNAMURTHY S. , FAIRLIE F. , CAMERON A. D. , WALKER J. J. , MACKENZIE J. R.
Published: August 2005

Summary. The purpose of this study was to investigate the influence of postnatal x‐ray pelvimetry after caesarean section on the management of the subsequent pregnancy. The case records of 331 women delivered by casearean section in their first pregnancy were reviewed. By standard radiological criteria, the pelvis was considered to be inadequate in 248 (75%) of them and adequate in 83 (25%). Of the women with a radio‐logically inadequate pelvis, 172 underwent an elective caesarean section. Seventy‐six were allowed vaginal delivery: 51 of these women delivered vaginally and 25 required an emergency caesarean section. Of the women with a radiologically adequate pelvis, 61 achieved a vaginal delivery and 22 were delivered by caesarean section. All of the three cases of uterine rupture occurred in women with a radiologically adequate pelvis. This study suggests that x‐ray pelvimetry is not a good predictor of the outcome of a trial of vaginal delivery. We conclude that the practice of routine postnatal pelvimetry should be abandoned.
Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records
Authors: COULTER ANGELA , BRADLOW JEAN , AGASS MARTYN , MARTIN‐BATES CHARLES , TULLOCH ALISTAIR
Published: August 2005

Objective— To determine referral rates and intermediate and long‐term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics.

Design— General practitioners' records of referrals to outpatient clinics and retrospective audit of general practice notes to determine outcomes.

Setting— General practices in the Oxford Regional Health Authority area referring to 19 gynaecology outpatient clinics.

Subjects— 205 patients aged 15–59, referred in 1983/4 and follow up in 1988/9.

Main outcome measures— Immediate outcomes: the initiation by hospital specialists of investigation, treatment or advice. Five year outcomes: general practice consultation rates and symptom prevalence.

Results— Of 18 754 index referrals recorded by 33 practices over a period of 6 months, 2513 (13%) went to gynaecology clinics. Menstrual disorders constituted 21% (n = 539) of the gynaecology referrals; there was more than three‐fold variation between the practices in referral rates. In the 5 years following the index referral, of the 205 audited patients 167 (81%) had been admitted to hospital, 91 (44%) had had a hysterectomy (including 87 (60%) of the 145 patients referred for menorrhagia), 98 (48%) had dilatation and curettage; 25 (12%) received only drug therapy; and 10 (5%) had no active treatment for these symptoms from either the specialist or the general practitioner. Only 29 (14%) had consulted their general practitioners about menstrual problems in the 12 months preceding the audit.

Conclusions— Guidelines are needed to assist referral decision‐making. If audit is to be used to promote good practice these guidelines should consider the patients' anxieties and preferences, as well as the most appropriate use of investigations and treatments.
Reproducibility of ultrasonic measurement of fetal cardiac haemodynamics
Authors: BEEBY A. R. , DUNLOP W. , HEADS A. , HUNTER S.
Published: August 2005

Summary. Two observers made independent estimates of volume flow across all four heart valves in 27 fetuses using a combination of cross‐sectional and Doppler echocardiography. There were considerable discrepancies between observers in volume flow estimation arising from inconsistency both in cross‐sectional and in Doppler measurements. One observer also produced a second estimate by making new measurements from the original recordings. There was considerable within‐observer variability which was mainly due to errors in cross‐sectional measurements. The problems of applying this technique to fetal cardiac haemodynamics are discussed.
Early amniocentesis: alphafetoprotein levels in amniotic fluid, extraembryonic coelomic fluid and maternal serum between 8 and 13 weeks
Authors: WATHEN NEVILLE C. , CASS PETER L. , CAMPBELL D. JAMES , KITAU MURIEL J. , CHARD TIM
Published: August 2005

Objective— The aim was to establish a normal range of alphafetoprotein (AFP) concentrations in amniotic fluid from 8 to 12 weeks gestation, and to determine any difference between AFP levels in amniotic fluid and extraembryonic coelomic fluid.

Design and subjects— 150 women had a transvaginal ultrasound guided amniocentesis before termination of an apparently normal first trimester pregnancy. Separately identified samples of amniotic fluid and extraembryonic coelomic fluid were obtained and assayed by radioimmunoassay for AFP.

Results— In amniotic fluid, very high levels of AFP were present at 8 weeks, levels falling rapidly up to 10 weeks after which there was a slight rise. Thus over the period 8 to 10 weeks, there was a significant inverse correlation between amniotic fluid AFP and gestational age (r= 0.67; P <0.001). In extraembryonic coelomic fluid, by contrast there was no trend in AFP relative to gestational age.

Conclusions— The rapidly changing levels of AFP from 8 to 10 weeks as well as the small volume of the amniotic cavity makes the use of amniocentesis impracticable before 11 weeks gestation. The lack of any relation between AFP levels in amniotic fluid and extraembryonic coelomic fluid emphasises the importance of identifying the site of amniocentesis in the first trimester.
Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre‐eclampsia and intrauterine growth retardation
Authors: BEWLEY SUSAN , COOPER DEREK , CAMPBELL STUART
Published: August 2005

Objective— To assess the screening properties of a mid‐trimester uteroplacental Doppler scan in a normal unselected population.

Design— A cross‐sectional study measuring an averaged resistance index (AVRI) from four sites (left and right uterine and arcuate arteries) with continuous wave Doppler ultrasound.

Setting— Routine booking ultrasound, King's College Hospital, London.

Subjects— 977 women at 16–24 weeks gestation.

Main outcome measures— Intrauterine death, birthweight, pregnancy‐induced hypertension (PIH), antepartum haemorrhage.

Results— There was a 96.5% follow‐up. Pregnancies with high AVRI values had a higher prevalence of proteinuric hypertension, placental abruption, small‐forgestational‐age babies, and fetal loss. When AVRI was >95th centile, the overall risk of pregnancy complications was 67%, and the risk of a severe complication was 25%. However, the sensitivity of the test for these complications was only 13% and 21% respectively. The risk for an individual woman with a high AVRI of developing a complication was increased by up to 9.8 times.

Conclusion— Although Doppler screening does detect a unifying defect leading to perinatal death, pre‐eclampsia, growth retardation and placental abruption, the predictive values do not yet justify its introduction as a routine test.
Doppler flow velocity waveform analysis in high risk pregnancies: a randomized controlled trial
Authors: NEWNHAM JOHN P. , O'DEA MICHELLE R‐A. , REID KAREN P. , DIEPEVEEN DEAN A.
Published: August 2005

Objective— To test whether the introduction of Doppler waveform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management.

Design— A randomized controlled trial.

Setting— Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia.

Subjects— 505 women with pregnancy abnormalities referred to an ultrasound department for fetal investigation during the third trimester.

Intervention— Continuous wave Doppler studies of umbilical and utero‐placental arterial circulations. Results were revealed to patients and clinicians.

Main outcome measures— Principal end point was the duration of neonatal stay in hospital; other end points included the number and type of fetal heart rate monitoring studies, obstetric interventions, frequency of fetal distress, birthweight, Apgar scores and need for neonatal intensive care.

Results— There was no effect on the duration of neonatal stay in hospital. Small trends in obstetric management were observed with study group patients having fewer contraction stress tests, less likelihood of antepartum fetal distress, and more likelihood of fetal distress after induction of labour leading to emergency cacsarean section. Depressed Apgar scores were more frequent in the study group.

Conclusion— Introduction of Doppler waveform studies did not result in reduced neonatal morbidity but did have a small effect on obstetric management. For each institution the role of Doppler studies in late pregnancy will be influenced by the usage of other tests of fetal welfare already entrenched in clinical practice.
(Patho)physiological implications of chronic dietary sodium restriction during pregnancy; a longitudinal prospective randomized study
Authors: STEEGERS E. A. P. , VAN LAKWIJK H. P. J. M. , JONGSMA H. W. , FAST J. H. , DE BOO T. , ESKES T. K. A. B. , HEIN P. R.
Published: August 2005

Objective— To study the possible pathophysiological implications of long continued dietary sodium restriction in pregnancy.

Design— Longitudinal prospective randomized study of the effects of a low sodium diet compared with unrestricted sodium intake in pregnancy.

Setting— Academic Department of Obstetrics and Gynaecology at Sint Radboud Hospital, Nijmegen, The Netherlands.

Subjects— 42 healthy nulliparous women.

Intervention— A low sodium diet (20 mmol sodium daily) started in the 14th week of pregnancy and stopped after delivery.

Main outcome measures— Maternal weight gain, food intake, blood pressure, cardiac output, systemic vascular resistance, haematocrit and birthweight.

Results— Total maternal weight gain and dietary energy intake during pregnancy and weight at 1 and 6 weeks postpartum were significantly lower in the low sodium group. Blood pressure during pregnancy did not show major differences. Stroke volume and cardiac output during pregnancy were significantly lower in the low sodium group whereas systemic vascular resistance was significantly higher. Haematocrit values in the low sodium group tended to be lower during pregnancy, but were significantly lower at 1 and 6 weeks postpartum than in the unrestricted group. Placental and birthweights were not significantly different between the two groups.

Conclusions— Chronic dietary sodium restriction during pregnancy is characterized by a diminished body fat accumulation and a reduction in circulating volume, due to a decrease in both plasma and red cell volume, in combination with a high systemic vascular resistance without major effects on blood pressure and birthweight.