bluuebunny/crossref_metadata_2025 huggingface dataset:
Rescue of menotrophin cycles prone to develop ovarian hyperstimulation
Authors: RABINOVICI JARON , KUSHNIR ORI , SHALEV JOSEF , GOLDENBERG MORDECHAI , BLANKSTEIN JOSEF
Published: August 2005

Summary. In an attempt to prevent the loss of‘overstimulated cycles’ associated with human menopausal gonadotrophin (hMG)‐induced ovulation, oestradiol levels and ovarian follicular state were monitored in 12 women with‘overstimulated cycles’ after withholding hMG for several days. Human chorionic gonadotrophin (hCG) was administered when oestradiol levels were 1700 pg/ml and the leading follicles between 17 and 22 mm in diameter. During the withholding period follicular growth continued in all patients, while oestradiol levels declined in all but three. These three patients conceived. Ovulation was observed in six additional women. Ovarian hyperstimulation did not occur in any of the 12 patients. We conclude that a rescue of‘overstimulated cycles’ is sometimes possible. Conception seems to depend on a continuing rise of E2 levels and early detection of‘overstimulation’.
Is C‐reactive protein really useful in preterm premature rupture of the membranes?
Authors: FISK NICHOLAS M. , CHILD ANDREW G. , BRADFIELD ALAN H. , FYSH JOHN , JEFFERY HEATHER , GATENBY PAUL A.
Published: August 2005

Summary. In a prospective blind study 380 daily serum samples from 55 women with preterm premature rupture of the membranes were analysed for C‐reactive protein (CRP). Although the last CRP before delivery was higher in patients with histological chorioamnionitis (P= 0.007), considerable overlap between infected and non‐infected pregnancies occurred, precluding the use of CRP as a diagnostic test if published normal levels were used. When upper limits were set at 30, 35, or 40 mg/1, the last CRP before delivery proved 90, 95 and 100% specific and 88, 92 and 100% positively predictive of infection in singleton pregnancies. Such high specificities are needed to prevent inappropriate intervention based on false positive results. We therefore propose upper limits for single estimations of 30, 35, or 40 mg/1 depending on the relative risks of preterm delivery versus infection at various gestational ages. In addition, consecutive values <20 mg/1 appeared highly predictive of infection.
Progesterone inhibition in mid‐trimester termination of pregnancy: physiological and clinical effects
Authors: SELINGER MARK , MACKENZIE IAN Z. , GILLMER MICHAEL D. , PHIPPS SUE L. , FERGUSON JANE
Published: August 2005

Summary. A double‐blind, placebo controlled clinical trial was conducted to assess the clinical and physiological effects of‘epostane’, a progesterone synthesis inhibitor, in mid‐trimester prostaglandin termination of pregnancy. Mean peripheral progesterone levels had fallen by 74% after 72 h in the patients treated wtih epostane. The mean induction abortion interval in the treatment group was 490 (SD 271) min, compared with 1432 (SD 640) min in the control group. Intrauterine pressure recording demonstrated increased sensitivity to prostaglandin E2 after epostane treatment but no change in oxytocin sensitivity. The clinical implications of facilitated induction of abortion are discussed.
A randomized study of fetal abdominal diameter and fetal weight estimation for detection of light‐for‐gestation infants in low‐risk pregnancies
Authors: SECHER N. J. , HANSEN P. KERN , LENSTRUP C. , ERIKSEN P. SINDBERG , MORSING G.
Published: August 2005

Summary. A total of 2771 pregnant women with gestational age esti‐mated by ultrasound measurement of the fetal biparietal diameter (BPD) before the 22nd week of gestation were re‐examined by ultrasound in the 32nd and 37th week of pregnancy at which time the fetal BPD and abdominal diameter (AD) were measured. An additional examination was performed at 34 weeks if the fetal weight in the 32nd week was estimated to be less than 95% of the expected mean weight. Light‐for‐gestational age (LGA) was suspected if the estimated birth‐weight was less than 85% of the expected mean birthweight. This applied to 186 uncomplicated pregnancies in which there was no clinical suspicion of poor intrauterine growth. These pregnancies were randomly allocated to a treatment group (AD and estimated weight reported) or to a control group (AD and estimated weight withheld). Induction of labour was significantly more common in the treatment group (41%) than in the control group (15%). No statistically significant difference was found in the use of instrumental vaginal delivery or caesarean section. There was a Suggestion of marginal benefit in terms of neonatal morbidity but this was not statistically significant.
A new method for fetal weight estimation using real‐time ultrasound
Authors: DUDLEY NICHOLAS J. , COPPING CYNTHIA , LAMB MARTIN P.
Published: August 2005

Summary. A method for estimating fetal weight by calculating an approximate fetal volume from abdominal area, head area and femur length has been developed. Birthweights were calculated within 48 h before delivery for 434 patients, using this method and two other methods already in widespread use. Statistical analysis of the three sets of predictions gave standard deviations of 297 g for the new method, compared with 323 g and 342 g for the other methods. Further analysis of the data showed that estimates closest to the true birthweight were obtained in 41% of cases by using the new method, and in 33% and 26% of cases using the other methods.
Continuous oestrogen‐progestogen treatment and serum lipoproteins in postmenopausal women
Authors: JENSEN JYTTE , RIIS BENTE JUEL , CHRISTIANSEN CLAUS , STRØM VERNER
Published: August 2005

Summary. Serum lipids and lipoproteins were examined in 44 healthy postmenopausal women every 3 months during 1 year of treatment with either continuous oestrogen‐norethisterone acetate or placebo. Total serum cholesterol and LDL‐cholesterol levels were reduced by approximately 15% and 20% (P<0.001), respectively in the hormone group but were unchanged in the placebo group. Serum triglycerides levels remained constant in both groups. HDL‐cholesterol levels were significantly reduced by approximately 10% in the hormone group but significant reductions of 5–10% also occurred in the placebo group so that differences between the two groups were only significant after 3 months of treatment. Vaginal bleedings were experienced during the first 3 months by eight of the 21 women receiving hormones, but in only one woman after 9 months of therapy. The addition of norethisterone acetate to postmenopausal oestrogen therapy in clinically relevant doses had no adverse effects on lipoproteins as previously reported, even though administered continuously. Moreover, the low frequency of bleeding with continuous oestrogen‐progestogen therapy would make this an appropriate alternative in postmenopausal replacement therapy.
Cyproterone acetate, an alternative progestogen in postmenopausal hormone replacement therapy? Effects on serum lipids and lipoproteins
Authors: JENSEN JYTTE , RIIS BENTE JUEL , CHRISTIANSEN CLAUS
Published: August 2005

Summary. Serum lipids and lipoproteins were studied in 76 healthy postmenopausal women treated for 1 year with either oestradiol valerate sequentially combined with the anti‐androgenic progestogen cyproterone acetate (CPA) or placebo. The women were examined every 3 months between days 18 and 21 of the tablet cycle, where the progestogen had been added to the oestrogen for at least 6 days. Combined oestrogen‐CPA therapy resulted in significantly reduced levels of total serum cholesterol and LDL‐cholesterol at all examinations, but serum triglycerides and HDL‐cholesterol levels were similar in the two groups. Total serum cholesterol and LDL‐cholesterol were reduced by approximately 5% (P<0.01) and 8% (P<0.01), respectively, after 1 year of combined oestrogen‐CPA therapy in comparison with both the initial values and the placebo group but serum triglycerides and HDL‐cholesterol levels were unchanged in both groups.
Serum gonadotrophin and sex steroid hormone levels during mid‐follicular and mid‐luteal phases in hyperprolactinaemic women with regular menstrual cycles
Authors: NAKANO R.
Published: August 2005

Summary. Hyperprolactinaemia was found in 15 of 135 infertile patients with regular menstrual cycles, biphasic basal body temperature record and no galactorrhoea. In those 15 women, mean serum prolactin levels during the mid‐follicular and mid‐luteal phases of the menstrual cycle were 29.8 (SEM 1.8) ng/ml and 29–5 (SEM 1.3) ng/ml, respectively. Although serum FSH and LH levels were similar in normal and hyperprolactinaemic women, serum oestradiol level during the mid‐follicular phase was subnormal in hyperprolactinaemic women (P<0.05). In contrast, serum oestradiol and progesterone levels during the mid‐luteal phase and luteal phase length were similar in nor‐moprolactinaemic and hyperprolactinaemic groups. The results suggest that Hyperprolactinaemia is associated with defects of follicle development as measured by oestradiol production during the mid‐follicular phase, but not with corpus luteum function as measured by progesterone production during the mid‐luteal phase, and luteal phase length.
Effect of anal electrostimulation with the‘Incontan’ device in women with urinary incontinence
Authors: ERIKSEN B. C. , BERGMANN S. , MJØLNERØD O. K.
Published: August 2005

Summary. An integrated, automatic electrical stimulator has been developed to treat urinary incontinence. A group of 121 women with either stress‐, motor urge‐ or mixed incontinence was selected for treatment, but 23 discontinued the treatment within 3 months and were excluded from the study. In the study group of 98 women, anal stimulation was applied for an average of 9 months (range 3–36 months). Between 9 and 36 months after the treatment was completed, 91% were either continent or had improved significantly, but in 9% the stimulation had no effect. Significant improvement occurred on clinical and urodynamic testing. There were no serious side‐effects. Intra‐anal electrostimulation therapy provides an alternative to surgery in patients with stress incontinence, and could be the first choice of treatment in women with combined stress and motor urge incontinence.
Genital condylomata acuminata in pregnancy: effectiveness, safety and pregnancy outcome following cryotherapy
Authors: MATSUNAGA JON , BERGMAN ARIEH , BHATIA NARENDER N.
Published: August 2005

Summary. Fifty‐one patients, 16 in the second trimester and 35 in the third, were treated by cryotherapy for genital condylomata acuminata; 19 of them had cervical cryotherapy in the second and third trimesters for cervical involvement. Cryosurgical treatment was performed on an out‐patient basis, with no general anaesthesia or analgesia, and repeated every 2 weeks until resolution of the condylomata. Male partners were treated as necessary. Patients were followed every 2 weeks before and after delivery until 6 weeks postpartum. The newborn infants were examined for the presence of genital or laryngeal condylomata. Most women required two cryosurgical treatment sessions before complete resolution of condylomata; all resolved in pregnancy and no patient had residual disease at 6 weeks postpartum. There was no case of preterm premature rupture of membranes or premature delivery following cryotherapy, and no case of fetal injury. Labour and delivery were unaffected even by cervical cryotherapy.
Serum CA 125 in epithelial ovarian cancer. A longitudinal study
Authors: BRIOSCHI P. A. , IRION O. , BISCHOF P. , BADER M. , FORNI M. , KRAUER F.
Published: August 2005

Summary. Plasma levels of CA 125 were determined in 113 patients with ovarian cancer of epithelial origin. Of these, 69 patients had CA 125 measured before the first laparotomy and 84.6% of them had a CA 125 level >35 U/ml. In 87 of the 113 patients whose tumour was producing CA 125, a good correlation was observed between the CA 125 levels and the clinical follow‐up: 95.7% of the patients in remission had levels < 35 U/ml, whereas all the patients with no change or with a progressive disease had levels >35 U/ml. Furthermore in recurrent disease the levels of CA 125 were also increased (>35 U/ml) in 92.3% of the patients. Thus, CA 125 measurements at regular intervals are of great clinical value in following the evolution of a tumour or the success of a therapy, but unfortunately do not allow detection of an ovarian tumour at an early stage.
Immunity to rubella among women of child‐bearing age
Authors: LEVER A. M. L. , ROSS M. G. R. , BABOONIAN C. , GRIFFITHS P. D.
Published: August 2005

Summary. The results of testing for rubella antibodies in over 6000 sera from women of child‐bearing age are reported and analysed according to pregnant state, age, country of origin and social class. There was no difference between the rubella seroprevalence rates in women who were pregnant and in those who were contemplating pregnancy in the future. Likewise, women (either pregnant or non‐pregnant) who were young enough to have been offered rubella vaccine at school were not more likely to be immune to rubella than were older women. Rubella seropositivity rates were not influenced by social class but significantly higher rates were found in women born in European or Arabian than in African or Asian countries. We conclude that the national scheme for rubella immunization has not reduced the number of women susceptible to rubella entering pregnancy in this Health District and that greater attention should be paid to immunization of women of child‐bearing age from African or Asian countries.
Saliva oestriol, oestradiol, oestrone and progesterone levels in pregnancy: spontaneous labour at term is preceded by a rise in the saliva oestriol:progesterone ratio
Authors: DARNE J. , MCGARRIGLE H. H. G. , LACHELIN GILLIAN C. L.
Published: August 2005

Summary. Saliva steroid levels reflect the unbound unconjugated (free, biologically active) plasma hormone levels. Saliva oestriol (E3), oestradiol (E2), oestrone (E1) and progesterone levels were estimated by radioimmunoassay in saliva samples obtained twice a week from 18 weeks gestation until 38 days before delivery and then daily until the spontaneous onset of labour at term from 20 normal pregnant women. The overall percentage increases in the median concentrations of E3, E2, E1 and progesterone were 718, 370, 80 and 214%, respectively, in the last 20 weeks and 149, 82, 24 and 41%, respectively, in the last 6 weeks of pregnancy. The median E3:progesterone ratio rose slowly from 0.65 at 20 weeks before delivery to 1.0 at 5 weeks before delivery and then rapidly to 1.65 one day before the spontaneous onset of labour. There was an increase in the E3:progesterone ratio from <1 to >1 before labour in every subject.
Oxytocin titration to achieve preset active contraction area values does not improve the outcome of induced labour
Authors: ARULKUMARAN S. , INGEMARSSON I. , RATNAM S. S.
Published: August 2005

Summary. The value of controlling oxytocin titration in induction of labour by a preset uterine activity, assessed as active contraction area, was examined in a randomized study in 60 nulliparae and 54 multiparae. Each parity group was divided into two groups according to the cervical score (5 and >5) and within those four groups the women were randomly allocated to oxytocin titration against a preset frequency of 6–7 uterine contractions every 15 min, or to a preset uterine activity equivalent to the 75th centile for spontaneous labour. The length of labour was slightly, but not significantly, longer in the frequency group. The mode of delivery, Apgar scores at 1 and 5 min and cord artery blood pH values were similar with the two modes of oxytocin titration.The mean maximum dose rate of oxytocin infusion was not significantly different except in the nulliparous group with a poor cervical score. The given mean total dose of oxytocin was similar in the different groups when controlled for parity and cervical score. The results suggest that oxytocin titration to achieve uterine activity values equivalent to the 75th centile of those observed in spontaneous labour does not confer any advantage compared with the traditional practice of titrating the oxytocin infusion to achieve a preset frequency of uterine contractions.
The effects of ethanol methotrexate and diphenylhydantoin on [14C] leucine incorporation by human trophoblast cells cultured in vitro
Authors: LANDON M. J. , TOOTHILL VALERIE J. , MORGAN D. M. L.
Published: August 2005

Summary. The effects of alcohol, diphenylhydantoin and methotrexate on protein synthesis by human trophoblast have been studied in vitro using a cell culture technique. None of the drugs depressed protein synthesis at pharmacological levels and for diphenylhydantoin there was evidence that the cellular accumulation of this drug was negligible.
Abdominal pain after laparoscopy: the value of a gas drain
Authors: ALEXANDER J. I. , HULL M. G. R.
Published: August 2005

Summary. In an attempt to reduce pain after laparoscopy, a drain was left for 6 h in the peritoneal cavity through the umbilical incision to take advantage of visceral peristaltic and voluntary muscle movements to expel residual gas. In a randomized study 25 treated patients were compared with 28 controls. Use of the drain was found to approximately halve the frequency of pain throughout the first 2 postoperative days. The severity of pain was also significantly reduced in the first 6 h and after mobilization at home the next day when pain is usually at its worst.
Effect of anti‐smoking health education on infant size at birth: a randomized controlled trial
Authors: MACARTHUR CHRISTINE , NEWTON J. R. , KNOX E. G.
Published: August 2005

The effects of anti‐smoking health education during pregnancy on smoking behaviour and the subsequent infant's size at birth were investigated in a controlled trial. It was found that the planned educational intervention was incompletely carried out and was given more effectively to primigravidae in whom subsequent reduction of smoking was more evident. The effects of educative intervention on size at birth were therefore analysed for first and later pregnancies separately. The differences in birthweight and length between the intervention and control groups were concentrated almost entirely among the first born infants who were 68 g heavier and 0–75 cm longer in the intervention group than the first born infants in the control group.
Obstetric analgesia and fetal aortic blood flow during labour
Authors: LINDBLAD ANNIKA , BERNOW JENS , MARŠÁL KAREL
Published: August 2005

Fetal aortic blood flow was studied in 50 women during labour, using a method combining real‐time ultrasonography and a pulsed Doppler technique. Eleven women had no analgesia, 24 women received 75–100 mg pethidine intramuscularly, 12 epidural analgesia with 0·25% bupivacaine and three paracervical block with 0·125% bupivacaine. Fetal aortic blood flow increased during labour from 200 to 245 ml/min/kg in the group without analgesia (P>0·05) and from 211 to 236 ml/min/kg in the group with epidural analgesia (P>0·05) but decreased insignificantly from 216 to 204 ml/min/kg after pethidine. After paracervical block the aortic blood flow fell in two out of three fetuses. Not only is epidural analgesia the most effective means of pain relief during labour, it is also the type of obstetric analgesia that interferes least with the physiological response to labour in terms of its effect on the fetal blood flow.
Fetal and uteroplacental haemodynamics during short‐term atenolol treatment of hypertension in pregnancy
Authors: MONTAN SVEN , LIEDHOLM HANS , LINGMAN GÖRAN , MARŠÁL KAREL , SJÖBERG NILS‐OTTO , SOLUM THORE
Published: August 2005

Fetal circulation was studied by means of combined realtime and pulsed Doppler ultrasound in 14 women with pregnancy‐associated hypertension before and during the first and third days of treatment with the β1‐selective blocker, atenolol; in seven of the women the maternal uterine arcuate blood velocity waveform was also studied. Blood flow characteristics were normal both in the fetus and in the maternal arcuate artery, compared with those in uncomplicated pregnancies of corresponding gestational ages. Volume blood flow remained unchanged in the fetal descending aorta, and in the umbilical vein during atenolol treatment, whereas the pulsatility index increased in the fetal descending aorta and in the arcuate artery. This suggests that the peripheral vascular resistance, both on the maternal and fetal side of the placenta, increased during short‐term antihypertensive treament with atenolol.
Ultrasonically guided percutaneous umbilical blood sampling in the management of intrauterine growth retardation
Authors: PEARCE J. MALCOLM , CHAMBERLAIN GEOFFREY V. P.
Published: August 2005

Ten patients, hospitalized because of severe asymmetrical fetal growth retardation before 32 weeks gestation, underwent ultra‐sonically guided percutaneous umbilical blood sampling because of concern over the fetal heart rate trace. In eight patients the fetus was judged to be acidotic and they were delivered immediately by caesarean section. In two patients the fetus was not considered to be acidotic and the pregnancy was allowed to go on. In those babies that were delivered the pH blood collected from the umbilical vein at the time of delivery was compared to the antenatal sample. There were no significant differences. The technique of antenatal umbilical vein blood sampling is readily learned and by assessment of fetal acid base status a more precise diagnosis can be made leading to appropriately planned management.
Time trends of ectopic pregnancies
Authors: HEMMINKI ELINA , HEINONEN PENTTI K.
Published: August 2005

Whether the increase of ectopic pregnancies could be explained by methodological problems or by changing age structure was examined in data from one hospital (Tampere, Finland) between 1972 and 1984. Numbers of ectopic pregnancies, births, and induced and spontaneous abortions were obtained by 5‐year age‐groups and county of residence from the hospital discharge register. Introduction of a more sensitive pregnancy test in 1979 was coincident with the most rapid increase in the role of ectopic pregnancies. Use of incomplete denominators and varying catchment areas and correction of changing age‐distribution of pregnant women did not markedly influence the time trends. Our analysis suggests that the observed increase in ectopic pregnancies in this area was partly real and partly due to better diagnosis.
Plasma renin activity and cAMP in termination of pregnancy induced by sulprostone
Authors: SAARIKOSKI SEPPO , SAASTAMOINEN JUKKA , PENTTILÄ ILKKA , CASTRÉN OLLI
Published: August 2005

Plasma renin activity (PRA), plasma concentrations of cyclic adenosine‐3′, 5′‐monophosphate (cAMP) and the serum levels of oestradiol, progesterone, chorionic gonadotrophin, potassium, sodium and calcium were estimated in connection with termination of pregnancy induced in 23 women by sulprostone, a derivative of prosta‐glandin E2. A rapid decrease in PRA was observed during and after infusion of 1000 μg or 1500 uμg sulpostrone. PRA returned to the initial values at 24 h after drug administration. The lowest levels of PRA were 36% and 51% of the initial values (P>0·001) in the two drug concentration groups. No significant changes were observed in the control group. The value for plasma cAMP did not correspond completely to the changes in PRA. Serum concentrations of oestradiol, progesterone and chorionic gonadotrophin showed a gradual decrease during drug administration. The changes in serum potassium, sodium and calcium were minimal. The decrease in PRA associated with sulprostone is very surprising. Our finding elucidates in part the still rather poorly known mechanisms and function of renin‐angiotensin system in pregnancy.
Correlates of placental abruption
Authors: KROHN MARIJANE , VOIGT LYNDA , MCKNIGHT BARBARA , DALING JANET R. , STARZYK PATRICIA , BENEDETTI THOMAS J.
Published: August 2005

All cases (884) of placental abruption reported on Washington State birth or fetal death certificates in 1980 and 1981 were compared with 789 randomly selected births from the same time period. The incidence of reported cases of placental abruption was 6·5 per 1000 total births. The combined stillbirth and first month death rate of all abruption cases was 21%. Increased risks of placental abruption were associated with pre‐eclampsia, diabetes, and unmarried status. Neither parity nor maternal age was associated with an increased risk. Infants born after abruption were significantly smaller‐for‐gestation than control infants, more likely to be male, and had malformations more frequently than control infants. Apgar scores of liveborn abruption infants were significantly lower than those of controls after adjustment for infant weight, gestational age, and sex.
Luteal phase after ovarian hyperstimulation
Authors: MESSINIS IOANNIS E. , TEMPLETON ALLAN , BAIRD DAVID T.
Published: August 2005

The luteal phase was investigated in 17 women with normal menstrual cycles and tubal infertility who were superovulated with clomiphene (9 cycles), clomiphene plus pulsatile human menopausal gonadotrophin (hMG) (12 cycles) and clomiphene plus pulsatile follicle stimulating hormone (FSH) (11 cycles) during an in‐vitro fertilization programme. Follicles were aspirated 34–36 h after the onset of the endogenous LH surge. Urinary total oestrogen levels during the first 6 days of the luteal phase were significantly higher, the duration of the luteal phase was significantly shorter and the luteal levels of urinary pregnanediol were significantly lower in the two combination treatment cycles than in the clomiphene only cycles. When the three treatment groups were combined the mid‐luteal peak pregnanediol levels and the duration of the luteal phase showed significant negative correlations with plasma or urinary oestrogen levels during the follicular and the luteal phase. It is suggested that the luteal function in cycles superovulated with clomiphene/hMG or clomiphene/FSH is disrupted and this is related to the high amounts of circulating oestrogen.
A trial of topical idoxuridine for vulvar condyloma acuminatum
Authors: HASUMI KATSUHIKO
Published: August 2005

The effect of 0·25% idoxuridine ointment on condyloma acuminatum of the vulva was investigated in a randomized, doubleblind, placebo‐controlled trial in 24 women. Idoxuridine inhibits DNA synthesis in mammalian cells and is a specific inhibitor of DNA viruses. Of the 24 women with vulvar condyloma acuminatum, 14 applied idoxuridine ointment and 10 a placebo ointment to the lesions twice daily for 2 weeks. In 11 out of 14 patients treated with idoxuridine the condylomata regressed completely. The treatment did not cause any side‐effects. None of the women in the placebo group showed regression of the condylomata. Topical idoxuridine therapy is effective and non‐toxic; it appears to be most effective for new condylomata.
The effect of the duration of the second stage of labour on the acid‐base state of the fetus
Authors: KATZ MIRIAM , LUNENFELD EITAN , MEIZNER ISRAEL , BASHAN NAVA , GROSS JACQUELINE
Published: August 2005

A prospective study was made in 153 patients with a second stage of labour lasting 1 to 120 min. Maternal venous, umbilical artery and vein blood were analysed for acid‐base variables and lactate levels. Blood was obtained immediately at delivery. Fetal heart rate monitoring data and blood test results were related to the duration of the second stage of labour and clinical outcome. In primiparae and multiparae there was a steady rise in umbilical artery lactate levels, with duration of second stage of labour, P>0·025 and P= 0·023, respectively. The median umbilical artery pH decreased significantly from 7·31 in patients with a second stage of labour that lasted ≤15 min to a pH of 7·25 in patients with a second stage of labour that lasted more than 30 min. Changes in Po2 and Pco2 were not statistically significant.
Antecedents and outcome of very early neonatal seizures in infants born at or after term
Authors: MINCHOM PHILIP , NISWANDER KENNETH , CHALMERS IAIN , DAUNCEY MARJORIE , NEWCOMBE ROBERT , ELBOURNE DIANA , MUTCH LESLEY , ANDREWS JOAN , WILLIAMS GERAINT
Published: August 2005

Recent experimentally derived evidence has confirmed earlier suggestions that seizures which occur within 48 h of birth in babies born at or later than 37 completed weeks gestation are particularly likely to reflect intrapartum asphyxia. We have compared 54 cases of such seizures with 41 090 controls in a geographically defined population. Nulliparity, hydramnios, postterm pregnancy, oxytocin augmentation of labour, abnormalities of fetal heart rate and/or meconiumstained amniotic fluid, prolonged second stage of labour, emergency caesarean section, assisted vaginal delivery, low Apgar score and resuscitation at delivery and subsequent ventilatory support were all statistically significantly more common among cases than among controls. Five of the 54 babies who developed seizures died within 28 days of birth and 11 of the 49 survivors had an impairment diagnosed by 3 years of age which was usually associated with some degree of cerebral palsy. Comparison of the frequency of antecedent perinatal risk factors in the seizure babies who died, those who survived with disabilities and normal survivors failed to reveal any clear pattern.
The changing incidence of caesarean section in the Health District of Central Manchester
Authors: KIWANUKA A. I. , MOORE W. M. O.
Published: August 2005

The caesarean section rate in England and Wales has practically doubled from 5·6% in 1974 to 10·6% in 1982. Because most statistical reports are based on the practice of individual hospitals and do not reflect what is occurring in a particular community, a retrospective study of the incidence of, and reasons for, caesarean section performed in residents of the geographically defined Health District of Central Manchester was carried out for 1974 and 1982. The caesarean section rate in this community increased from 7% in 1974 to 16% in 1982. Caesarean sections performed for (i) failure to progress in labour, (ii) previous caesarean section and (iii) preterm fetal compromise before labour accounted for three quarters of the increase. Breech presentation was not a significant contributor to the increase. The reasons for the increase in caesarean sections performed for failure to progress in the first stage of labour were not clarified in the records, and is the subject of prospective investigation.
Day case laparoscopic sterilization—time for a rethink?
Authors: THOMAS HILARY , HARE M. J.
Published: August 2005

The postoperative experiences of 50 women undergoing laparoscopic sterilization as a day case procedure were sought together with the views of their general practitioners. The women were not visited routinely at home and few contacted their general practitioners. All the women had chosen day care but one‐third of those eventually discharged on the day of the operation wished that their stay had been longer; most of their general practitioners seemed unaware of these feelings. The importance of adequate discussion with the patient about postoperative pain is reviewed. The arrangements for postoperative care following the patient's return to the community is discussed.
Microbiological and histopathological findings in acute pelvic inflammatory disease
Authors: PAAVONEN J. , TEISALA K. , HEINONEN P. K. , AINE R. , LAINE S. , LEHTINEN M. , MIETTINEN A. , PUNNONEN R. , GRÖNROOS P.
Published: August 2005

Upper genital tract infection was investigated in 45 women admitted to hospital for suspected acute pelvic inflammatory disease (PID). Salpingitis was diagnosed by laparoscopy in 30 (67%) women. Histopathological evidence of endometritis was found significantly more often in the 30 women with salpingitis (87%) than in the other 15 women without salpingitis (33%). C. trachomatis or N. gonorrhoeas, or both, were isolated from the upper genital tract in 14 of the 31 women who had both salpingitis and endometritis or endometritis only but in none of the four women who had salpingitis alone and in none of the 10 women who had no evidence of PID. Bacterial vaginosis was associated with histopathological evidence of upper tract infection. Non‐chlamydial nongonococcal organisms were frequently isolated from the upper genital tract. No organisms were isolated from the upper genital tract from 9 of 35 women with laparoscopic or histopathological evidence of PID compared with 7 of 10 women without evidence of PID. C, trachomatis or N. gonorrhoeae in the endometrium was associated with lymphoid follicles comprising transformed lymphocytes, and correlated with the density of plasma cells on biopsy. The microbiological results support the recommendations of broad spectrum antimicrobial therapy for PID.
Vulvo‐vaginal melanoma—should radical surgery be abandoned?
Authors: DAVIDSON T. , KISSIN M. , WESTBURY G.
Published: August 2005

A total of 32 patients presenting with melanoma of the vulva and vagina over a 20‐year period was reviewed. Primary surgical treatment was by local excision in 14 patients, simple vulvectomy in seven patients and radical resection in 11 patients. Overall 5‐year survival was 25% and only one patient was alive at 10 years. Comparison between the groups showed no benefit either in local control, disease‐free interval or patient survival according to extent of primary resection. We suggest that, as in anorectal melanoma, radical resection of the primary lesion is unlikely to alter the extremely grave prognosis and its routine use should be abandoned.
Stroke and minute distance in pregnancy: a longitudinal study using Doppler ultrasound
Authors: McLENNAN F. M. , HAITES N. E. , RAWLES J. M.
Published: August 2005

Using Doppler ultrasound directed at the aortic arch, stroke and minute distance were measured in 45 normal singleton pregnancies and compared with 42 controls. In the non‐pregnant controls, stroke distance was 5% more in the supine than in the left lateral position (P<0·01) and during pregnancy this relativity was maintained until 36 weeks gestation. In the supine and left lateral positions respectively, stroke distance was increased by 8% (both) at 4 weeks (P<0·05 and NS), by 14 and 11% at 8 weeks (P<0·001 and P<0·01) and showed a maximum increase of 21 and 20% at 16 weeks gestation (both P<0·001). At 40 weeks, supine stroke distance was 14% less than the non‐pregnant control value (P<0·001), and 6% less than the value in the left lateral position (P<0·05), which was itself not significantly different from that in the non‐pregnant controls. The maximum increase of heart rate was at 32 weeks, by 24% in the supine and by 19% in the left lateral position (both P<0·001). Minute distance was maximally increased by 37% in the supine at 16 weeks (P<0·001) and by 30% in the left lateral position at 24 weeks (P<0·001). Thereafter, minute distance, measured in both positions, declined until at 40 weeks it was not significantly different from the non‐pregnant control value.
A randomized control study of oxytocin augmentation of labour. 1. Obstetric outcome
Authors: BIDGOOD K. A. , STEER P. J.
Published: August 2005

Sixty women who were progressing slowly in spontaneous labour were assigned at random to three management protocols. Group 1 were observed without the use of oxytocin for 8 h while groups 2 and 3 were managed with a low‐dose and high‐dose oxytocin protocol respectively. The caesarean section rates were not significantly different between the three groups: 45%, 35% and 26% respectively. Cervical dilatation rate increased significantly after oxytocin infusion in both treatment groups compared with controls. The‘delay‐to‐delivery’interval and second stage duration were significantly shorter in the high‐dose group than in the control group. There were no measureable differences in the condition of the newborn infants between the three groups.
A randomized control study of oxytocin augmentatioi of labour. 2. Uterine activity
Authors: BIDGOOD K. A. , STEER P. J.
Published: August 2005

Uterine activity was measured in 60 women whose first labour was progressing slowly in the active phase. The mean level of active contraction area (uterine activity integral, UAI) before oxytocin augmentation was 898 (SD 458) kPas/15 min. UAI increased significantly with time, even in women not given oxytocin. UAI increased logarithmically with increasing oxytocin infusion rate. Levels of uterine activity before and after oxytocin infusion are correlated positively such that the higher the initial level of UAI the higher the UAI in response to oxytocin. However, the regression line approaches the line of identity such that even with high doses of oxytocin UAI would not be likely to exceed 2500 kPas/15 min. There is a positive correlation between uterine activity and cervical dilatation rate in unstimulated labour; however, this is less evident following oxytocin infusion. Increases in uterine activity below 1200 kPas/15 min result from both higher frequency and active pressure, whereas above 1200 kPas/15 min any increase is due mainly to a rise in frequency.
Maternal perception of sound‐provoked fetal movements as a measure of fetal well‐being
Authors: WESTGREN M. , ALMSTROM H. , NYMAN M. , ULMSTEN U.
Published: August 2005

Maternal perception of sound‐provoked fetal movements was studied on 613 occasions in 259 risk pregnancies. The response was compared with a non‐stress (N‐S) test performed immediately after the sound stimulation. A positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 534 occasions (87%) and was always accompanied by a normal N‐S test; sensitivity 100%. An inconclusive (3%) or negative response to sound (10%) had a specificity of 89% and a predictive value for a pathological N‐S test of 19%. There was a positive correlation between inconclusive or negative test results and fetal growth retardation (P<0·01), fetal hypoxia (P<0·05) and neonatal mortality (P<0·05). This rapid test may have a place as a simple first‐line screening test.
Prolactin measurement in the investigation of infertility in women with a normal menstrual cycle
Authors: GLAZENER C. M. A. , KELLY N. J. , HULL M. G. R.
Published: August 2005

Basal serum prolactin concentrations were compared with mid‐luteal serum progesterone concentrations and prospectively studied conception rates up to 12 months in women with otherwise unexplained infertility including a normal menstrual cycle. There were altogether 188 women with mean prolactin levels up to 3075 mU/1: 47 with prolactin up to 200 mU/1, 100 with prolactin 201–400 mU/1,18 up to 600 mU/1, 16 up to 800 mU/1, and 7 greater than 800 mU/1. There were no significant differences in the mean progesterone values or chance of conception between any of the groups. The findings indicate that prolactin measurement is generally of no value in normally menstruating women, except possibly in the unusual event of evidence of persistent distinct luteal deficiency (not found in the present study).
Systematic semen culture and its influence on IVF management
Authors: GUILLET‐ROSSO F. , FARI A. , TAYLOR S. , FORMAN R. , BELAISCH‐ALLART J. , TESTART J. , FRYDMAN R.
Published: August 2005

Semen specimens from 519 men were cultured for organisms 2 weeks before oocyte recovery for in‐vitro fertilization (IVF). The cultures from 72 men contained more than 5000 bacteria/ml and the IVF attempt was postponed. The IVF outcome was assessed in 382 couples in relation to the semen culture result. The pregnancy rate per cycle was significantly reduced when the semen culture contained organisms compared with axenic semen (P<0‐05). This was independent of the cleavage rate of oocytes and the number of embryos transferred. Although mycoplasma was frequently cultured, chlamydial infection was very rare and no viruses were isolated in this study.
Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in postmenopausal women
Authors: WILSON P. D. , FARAGHER B. , BUTLER B. , BU'LOCK D. , ROBINSON E. L. , BROWN A. D. G.
Published: August 2005

The use of oestrogens in the treatment of genuine stress incontinence was assessed by a double‐blind prospective trial in 36 postmenopausal women with genuine stress incontinence who received 3 months of cyclical treatment with either piperazine oestrone sulphate or a matching placebo. Patients were assessed subjectively and objectively before and after treatment by 7‐day bladder charts, urethral pressure profiles (UPP), the Urilos nappy test, vaginal cytology and hormone assays (plasma oestrogens and gonadotrophins). There was no statistical difference in the subjective response to treatment between the two groups. After 6 weeks of treatment there was a greater reduction in the number of pad changes/24 h in the oestrogen‐treated patients that approached statistical significance but, because of a marked response in the placebo group, this difference was not significant after 3 months of treatment. There were also no significant differences between the two groups with respect to the UPP or Urilos measurements but the vaginal cytology and hormone profiles were significantly affected by oestrogens. In view of the possible risks of oestrogen therapy its use in genuine stress incontinence is limited.
Combination chemotherapy followed by surgery or radiotherapy in patients with locally advanced cervical cancer
Authors: KIRSTEN F. , ATKINSON K.H. , COPPLESON J. V. M. , ELLIOTT P. M. , GREEN D. , HOUGHTON R. , MURRAY J.C. , RUSSELL P. , SOLOMON H. J. , FRIEDLANDER M. , SWANSON C. E. , TATTERSALL M. H. N.
Published: August 2005

Forty‐seven patients with locally advanced cervical cancer at high risk of relapse received three cycles of chemotherapy with PVB (cisplatin, vinblastine and bleomycin) before definitive local treatment with either radical surgery or radiotherapy. Thirty‐one of the 47 patients (66%) responded to initial chemotherapy, and 11 of them have relapsed compared with 13 of the 16 non‐responders. Median time to recurrence was 31 weeks for PVB non‐responders but has not yet been reached for PVB responders. After a median follow‐up of 128 weeks, 14 of the 31 responders (45 %) are alive and disease free compared with 3 of the 16 non‐responders (19%). There was a positive correlation between response to chemotherapy and subsequent response to radiotherapy. PVB was in general well tolerated although one death is probably attributable to chemotherapy. A randomized study comparing radiotherapy alone with initial PVB chemotherapy followed by radiotherapy is in progress.
The Newbury Maternity Care Study: a randomized controlled trial to assess a policy of women holding their own obstetric records
Authors: ELBOURNE D. , RICHARDSON M. , CHALMERS I. , WATERHOUSE I. , HOLT E.
Published: August 2005

To assess a policy of women holding and thus having constant access to their own obstetric records, 290 women attending a peripheral consultant clinic in Newbury, West Berkshire, were randomly allocated to hold either their full case notes, or the more usual co‐operation card. Women holding their full records were significantly more likely to feel in control of their antenatal care (rate ratio 1·45; 95% confidence interval 1·08–1·95) and to feel it was easier to talk to doctors and midwives (rate ratio 1·73; 95% confidence interval 1·16‐2·59). No other beneficial effects were detected. Asked about their preferences for any subsequent pregnancies, women holding their own records in the index pregnancy were more likely to say they would prefer to hold the same kind of record again in a subsequent pregnancy than were women holding a co‐operation card (rate ratio 1·56; 95% confidence interval 1·34–1·81). There was no evidence of negative effects. In particular, women holding their case notes did not feel more anxious than co‐operation card holders. The policy of women holding their notes resulted in savings in elerical time, without evidence of an increase in the rate of lost notes.
Defective haemochorial placentation as a cause of miscarriage; a preliminary study
Authors: KHONG T. Y. , LIDDELL H. S. , ROBERTSON W. B.
Published: August 2005

The morphology of the placental bed in idiopathic sporadic and recurrent miscarriages was studied and the findings correlated with the fetal chromosomal pattern where possible. Defective development of haemochorial placentation, which was not necessarily linked with fetal chromosomal abnormality, was seen in association with some miscarriages. These preliminary results, not previously demonstrated, strongly support the concept that miscarriages and pregnancies complicated by pre‐eclampsia and/or small‐for‐gestational‐age infants may be a continuum of disorders with a similar pathology in the placental bed.
Low human fetal heart rate variation in normal pregnancy
Authors: SMITH J. H. , DAWES G. S. , REDMAN C. W. G.
Published: August 2005

The fetal heart rates of 340 normal singleton pregnancies at 30–33 weeks gestation were screened using a microprocessor system on‐line. Eleven fetuses (3·2%) with a heart rate variation less than the 5th centile were identified, of whom 10 were studied longitudinally. At 30–33 weeks the mean minute range of pulse intervals (a measure of fetal heart rate variation) was 314 (SE 1·5) ms compared with 51·0 (SE 3·4) ms in a randomly selected control group. The study group continued to have significantly lower fetal heart rate variation than controls on each of three subsequent occasions until delivery. There were no significant differences between the two groups in fetal outcome, which was good. This demonstrates that a small proportion of normal fetuses have consistently low heart rate variation, and helps to define the lower limit of the normal distribution of fetal heart rate variation. After delivery, there were no significant differences between heart rate or its variation between the two groups. We conclude that the lower prenatal heart rate variation in the study group was a consequence of the uterine environment.
Amniotic fluid and fetal tissues are not heated by obstetric ultrasound scanning
Authors: SOOTHILL P. W. , NICOLAIDES K. H. , RODECK C. H. , CAMPBELL S.
Published: August 2005

Amniotic fluid temperature in first trimester pregnancies and fetal subcutaneous tissue and amniotic fluid temperature in second trimester pregnancies, measured by a thermocouple probe, did not increase during sector, linear‐array or Doppler ultrasound scanning. The mean fetal muscle temperature was higher (36·9°C) than mean amniotic fluid temperature (36·6°C) during the second trimester.
The clinical significance of pre‐operative serum CA 125 in ovarian cancer
Authors: CRUICKSHANK D.J. , FULLERTON W. T. , KLOPPER A.
Published: August 2005

In a prospective study of 52 patients with ovarian malignancy followed up for 3–18 months the clinical significance of pre‐operative serum CA 125 as a tumour marker was assessed. In 41 patients with epithelial ovarian cancer, the level of CA 125 correlated well with tumour load as indicated by FIGO stage. All epithelial histological types, including mucinous. released CA 125 although serous and undifferentiated tumours produced quantitatively more antigen. There was, however, no correlation between CA 125 concentration and histopathological grade, nor did CA 125 level appear to be of any prognostic value in epithelial ovarian cancer. Elevated CA 125 levels were also found in patients with sex cord/stromal tumours, Krukenberg tumours, an ovarian sarcoma and a serous carcinoma of low malignant potential.
Independent expression in serum of three tumour‐associated antigens: CA 125, placental alkaline phosphatase and HMFG2 in ovarian carcinoma
Authors: WARD B. G. , CRUTCKSHANK D. J. , TUCKER D. F. , LOVE S.
Published: August 2005

Circulating levels of CA 125, the HMFG2 antigen and placental alkaline phosphatase were measured in patients with epithelial ovarian cancer. In 37 patients the antigens were assayed before operation and 161 follow‐up samples from 41 patients were assayed at different times during treatment. These three human tumour‐associated antigens were expressed independently of each other. Measurement of all three antigens, compared with measurement of CA 125 alone, resulted in a statistically significant improvement in the detection rate of patients with localized disease from 18% to 69%.