bluuebunny/crossref_metadata_2025 huggingface dataset:
A validation of underlying cause of death, as recorded by clinicians on stillbirth and neonatal death certificates
Authors: DULEY LELIA M. M.
Published: August 2005

Summary. Clinical case notes and necropsy reports were used to validate underlying causes of death as recorded and coded on 590 stillbirth and neonatal death certificates. There were 55 cases ascribed to respiratory distress syndrome, in 45 this was validated, three cases were not assigned to respiratory distress syndrome which should have been. In 102 cases death was ascribed to congenital malformation, this was validated in 96, 13 cases should have been assigned to congenital malformation, but were not. Use of available clinical and necropsy information when completing death certificates would have decreased the number of deaths attributed to respiratory distress syndrome by 13%, and increased the number certified as dying from congenital malformation by 10%.
Uptake of amniocentesis in women aged 38 years or more by the time of the expected date of delivery: a two‐year retrospective study
Authors: KNOTT PETER D. , PENKETH RICHARD J. A. , LUCAS MARY K.
Published: August 2005

Summary. The uptake of amniocentesis for the prenatal diagnosis of chromosome abnormalities in older women ( 38 years by the time of the expected date of delivery) is reviewed over a 2–year period. Overall, 41·3% of women were not tested, including a group of 7% in whom no record of discussion of prenatal diagnosis could be found on review of obstetric records. Refusal of the offer of amniocentesis and late booking were significantly greater in Asian women (P < 0·01). One‐third of chromosomally‐abnormal infants were not detected antenatally in the study group.
The predictive value of fetal breathing movements in the outcome of premature labour
Authors: JASCHEVATZKY OSCAR , ELLENBOGEN ADRIAN , ANDERMAN SHMUEL , FRISCH LEON , NOY YITZHAK , GRUNSTEIN STEPHAN
Published: August 2005

Summary. Fetal breathing movements (FBM) were assessed in 28 pregnant women, presenting with uterine contractions before 34 weeks gestation. External tocometry was used to determine uterine contractions objectively. The first group consisted of 17 patients, treated by tocolytics after the ultrasound scanning showed absence of FBM. The second group comprised 11 patients with FBM present, who were observed only. In the first group nine women were delivered within 1 week, whereas in the second group no patient was delivered in that period, all of them being discharged. In patients with premature contractions the presence of FBM seems to indicate that the pregnancy will continue while absence of FBM foreshadows early delivery.
Routine hysteroscopy for patients with a high risk of uterine malignancy
Authors: RAJU KANKIPATI SHANTI , TAYLOR RONALD W.
Published: August 2005

Summary. Seventy patients with abnormal vaginal bleeding were examined with a Storz hysteroscope. The examination took an average of only 5 min. Sixty patients had the examination under general anaesthesia, five under paracervical block and five had no form of anaesthesia. All tolerated the procedure well. There were no complications directly related to the hysteroscopic examination. There was complete correlation between the histology of the endometrium obtained at subsequent curettage and the hysteroscopic findings.
Fetal transcutaneous carbon dioxide monitoring – the effect of different fixation methods
Authors: NICKELSEN CARSTEN , WEBER TOM
Published: August 2005

Summary. Fetal transcutaneous carbon dioxide tension (tc‐Pco2) was monitored simultaneously by two electrodes fixed with glue or suction during 10 deliveries. There were no differences in success rate, tc‐Pco2 readings or stabilization time between the two fixation methods, but the glue fixation method was more time consuming, caused more discomfort to the patient and generally did not permit reapplication of the electrode.
Magnetic resonance imaging—its application to cervical carcinoma
Authors: POWELL M. C. , WORTHINGTON B. S. , SOKAL M. , WASTIE M. , BUCKLEY J. , SYMONDS E. M.
Published: August 2005

Summary. Twenty‐five women with primary carcinoma of the cervix were examined with magnetic resonance imaging (MRI). A number of different pulse sequences with T1 and T2 weighting were employed to determine optimum tissue contrast, and the potential for staging cervical cancer was assessed and compared with the clinical findings. MRI is seen to give a unique view of cervical cancer in particular in stage I and II disease where other imaging techniques have known limitations. In addition, stages III and IV were well seen with demonstration of tumour comparable with that of computerized axial tomography (CT).
Ultrasonography for early detection of ovarian carcinoma
Authors: ANDOLF ELLIKA , SVALENIUS ELIZABETH , ÅSTEDT B.
Published: August 2005

Summary. Ultrasound scan for detection of ovarian enlargements was performed in a target group of out‐patients attending the clinic for various reasons in the 40–70 years range. Overall 805 women were examined, in 99% of whom the ovaries and/or their vessels could be identified. Pathological findings were suspected in 83 patients at the first scan, and were confirmed in 50 after a repeat scan, 39 of whom subsequently underwent surgery. Various ovarian lesions were found in 35 women, including five mucinous and serous cystadenomas, one carcinoma, two borderline tumours, and a cancer of the caecum. None of the borderline or malignant ovarian lesions were found by manual pelvic examination. Ultrasound screening appears to be a useful diagnostic aid, though its usefulness might be further improved if other risk factors such as heredity and period of ovulatory activity are taken into consideration.
Obstetric hysterectomy–an 11‐year experience
Authors: THONET R. G. N.
Published: August 2005

Summary. A total of 31 women had obstetric hysterectomy at St Mary's Hospital, Manchester, between 1972 and 1982. Elective caesarean hysterectomy was performed on nine occasions mainly because of preexisting gynaecological problems such as fibroids or menorrhagia. Emergency hysterectomy most frequently followed uterine rupture, postpartum bleeding and major degrees of placenta praevia. The majority of patients required blood transfusion but postoperative problems were few. Late complications included infected discharge and cyclical bleeding after subtotal hysterectomy. There was one neonatal death but no maternal deaths. Although the operation is usually straightforward, and no major technical problems, such as urinary tract injury occurred, the decision to perform it as an emergency must be made before the patien?s condition is extreme; the availability of senior staff is important.
Spontaneous early preterm labour associated with abnormal genital bacterial colonization
Authors: LAMONT R. F. , TAYLOR‐ROBINSON D. , NEWMAN M. , WIGGLESWORTH J. , ELDER M. G.
Published: August 2005

Summary. The association between infection and preterm labour was studied in 72 women in spontaneous preterm labour between 26 and 34 weeks gestation and in 26 control subjects having an elective caesarean section at the same gestational age. The genital microbial flora of each group was studied comprehensively and included mycoplasmas, chlamydiae, ureaplasmas and anaerobes. Subsequent neonatal infection and chorioamnionitis was also studied. Abnormal bacterial colonization, the presence of ureaplasmas, heavy growth of mycoplasmas and chorioamnionitis were all found significantly more often in the study group. This supports the premise that a significant proportion of idiopathic preterm labour is associated with infection and this may permit better prediction and prevention of preterm birth. The continued use of tocolytics should depend upon the identification of the presence or absence of infection. Infection appeared to be the result rather than the cause of ruptured membranes. A recommendation with respect to the classification of abnormal or normal bacterial colonization between 26 and 34 weeks is suggested on the basis of strict criteria.
Immunohistological characterization of endometrial gland epithelium and extravillous fetal trophoblast in third trimester human placental bed tissues
Authors: BULMER JUDITH N. , WELLS M. , BHABRA KALVINDER , JOHNSON P. M.
Published: August 2005

Summary. The distribution, morphology and antigen expression of endometrial glands, uterine vessels and fetal trophoblast have been studied in third trimester placental bed tissues with a panel of monoclonal antibodies in immunohistochemical techniques. Residual endometrial glands were numerous but often were attenuated or compressed and could only be identified clearly with epithelial cell markers. These glands must be clearly distinguished from vessels and trophoblast in immunological studies of cells in the placental bed. The changing pattern of antigen expression of both maternal glands and fetal trophoblast in placental bed tissues may indicate a form of local regulation of gene expression.
Reversibility after female sterilization
Authors: BOECKX W. , GORDTS S. , BUYSSE K. , BROSENS I.
Published: August 2005

Summary. The factors influencing the result of reversal of tubal sterilization were investigated in a series of 78 patients who requsted this operation during a 5‐year period between 1977 and 1982. In the Falopering group isthmo‐isthmic anastomosis resulted in a 92% pregnancy rate. On the other hand, no pregnancy occurred when the final tubal length after anastomosis was less than 4 cm. Ectopic pregnancy occurred in 5% of the patients.
Evaluation of colposcopy in the postmenopausal woman
Authors: TOPLIS PHILIP J. , CASEMORE VALERIE , HALLAM NICHOLAS , CHARNOCK MARK
Published: August 2005

Summary. Cytology, colposcopy and histology findings in 121 postmenopausal and 120 premenopausal women referred to the Oxford colposcopy clinic were compared; 88% of postmenopausal and 69% of premenopausal women were referred by their general practitioners. Cervical smear reports, within the preceding 5 years, were available for 21% of the postmenopausal and 54% of the premenopausal women. Colposcopic assessment was technically unsatisfactory in 53% of the postmenopausal women because the transformation zone was not completely visible, this contributed to a cone biopsy rate of 71% in this group. Only 17% of postmenopausal women with cervical intraepithelial neoplasia (CIN) were managed with local ablative techniques compared with their use in 61% premenopausal patients overall and in over 70% of the women under 35 years. Local ablation was used in 10 of 14 women using hormone replacement therapy. The cytological false negative rate for postmenopausal Papanicolaou class III, IV and V smears was 9% but for persistent class II inflammatory smears it was 43%. Nine of 23 postmenopausal women with persistent inflammatory dyskariosis despite antibiotic or antifungal treatment were found to have colposcopic appearances of CIN and four had microinvasion or invasion. Colposcopy revealed probable microinvasive or invasive disease in 17 postmenopausal women, seven of whom had class II or III cytology.
Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology
Authors: LIU D. T. Y. , HITCHCOCK A.
Published: August 2005

Summary. Seventy‐five women admitted for sterilization were laparoscoped during menstruation. Retrograde spillage of menstrual blood was observed in 76%. The occurrence of dysmenorrhoea was not associated with spillage of menstrual blood, observed endometriosis or tubal pathology. Mild or stage I endometriosis was detected in 43% of all the women but in only 54% of those who had retrograde spill. Retrograde spill was seen in 97% of those with endometriosis. A significant association (P<0.00l) was found between endometriosis and tubal damage not due to endometriosis. The implication of these findings are discussed.
Follicular fluid α1‐antitrypsin—correlation with fertilizing capacity of oocytes
Authors: IMOEDEMHE D. , SHAW R. W.
Published: August 2005

Summary. Follicular fluid and serum concentrations of α‐antitrypsin (α1‐AT) were determined by radial immunodiffusion in 72 samples obtained from 33 infertile women undergoing in‐vitro fertilization and embryo transfer. A statistically significantly lower concentration of α1‐AT was found in follicular fluids from which mature oocytes were recovered (mean 1.52, SE 0.06 g/l) than in those yielding immature oocytes (mean 2·96, SE 0·22 g/l). There was also a significantly higher rate of fertilization (85%) for oocytes from follicular fluids with α1‐AT concentrations of ≤2·0 g/l than for those obtained when the α1‐AT concentration was >2·0 g/l (only 25%). The mean follicular fluid α1‐AT concentration (1 ·52, SE 0·06 g/l) of follicles yielding mature oocytes was significantly lower than the relevant mean serum concentration (3·17, SE 0·10 g/l). There was, however, no significant difference between follicular and serum concentration of α1‐AT in the group yielding immature oocytes or in the serum concentrations between the different oocyte maturity groups. The measurement of follicular α1‐AT may be a useful adjunct in predicting which oocytes are mature and likely to be fertilized.
Genetics of hypertension in pregnancy: possible single gene control of pre‐eclampsia and eclampsia in the descendants of eclamptic women
Authors: CHESLEY LEON C. , COOPER DESMOND W.
Published: August 2005

Summary. Our report concerns the incidences of pre‐eclampsia and eclampsia in 147 sisters, 248 daughters, 74 granddaughters, and 131 daughters‐in‐law of women who have had eclampsia. The disorder is highly heritable. We have analysed the data in two ways, firstly, as a single gene condition and, secondly, as a multifactorial condition. The observed incidences fit closely with the single gene model with frequency of the putative gene being 0.25. When Falconer's method of estimating heritabilities of discrete characters is used, estimates of 120% (sisters), 88% (daughters), and 105% (granddaughters)—none significantly different from 100%—are obtained. Insofar as possible, our definition of pre‐eclampsia corresponds with EPH in the descriptive classification of the Organisation Gestosis and to ‘severe pre‐eclampsia’ in Nelson's classification. The women were delivered in many different hospitals, however, and many records fail to provide all of the essential information
The content and immunohistochemical localization of placental protein 10 (PP10) in the fallopian tube
Authors: TIITINEN A. , WAHLSTRÖM T. , JULKUNEN M. , SEPPÄLÄ M.
Published: August 2005

Summary. Radioimmunoassay; gel filtration and immunoperoxidase staining were used to study the content and localization of placental protein 10 (PP10) in 15 fallopian tubes removed on medical grounds from patients aged between 35 and 53 years. PP10 was consistently present in all parts of the tube at all ages and in all phases of the menstrual cycle. The PP10 concentration in tissue ranged from 0.08 to 2–95 μg/g of tuba1 cytosol protein. Irnmunoperoxidase staining localized PP10 in monocytic and lymphoid cells that were unevenly scattered in the subepithelial layer of the mucosa. In gel filtration, PP10 from the fallopian tube and purified placental PP10 eluted in the same volume, and graded amounts of PP10‐immunoreactive material from the tube and purified PP10 gave parallel dose‐response curves in radioimmunoassay. We conclude that PP10 is another ‘placental protein’ that has been identified in the fallopian tube.
Haemolytic disease of the newborn—the changing scene
Authors: TOVEY L. A. DERRICK
Published: August 2005

Summary. Between 1950 and 1970 there was a steady decline in the number of infant deaths from rhesus haemolytic disease of the newborn in the Yorkshire Region but no decrease in the number of pregnant women with antibodies. Following the introduction of Rh prophylaxis in 1970, the number of pregnant women sensitized has decreased by 70% and the number of infant deaths by 96%. The number of infants requiring exchange transfusion has also decreased by 70%. During the years 1980 to 1983 there were 163 new cases of maternal sensitization to the D antigen in the Yorkshire Region, 36 were due to failures of administration, 75 were failures of protection and 26 were in primigravidae. Eighteen of the failures of administration occurred after abortion, nine of which were surgical terminations. Antenatal prophylaxis may well have protected 64 (40%) of these 163 women. The number of pregnant women with antibodies other than anti‐D now exceeds those with anti‐D. The effect of these changes in incidence and clinical severity on the management of Rh D negative pregnant women is discussed.
The use of the fasciocutaneous flap in vaginal reconstruction
Authors: MORTON KAREN E. , DAVIES D. , DEWHURST JOHN
Published: August 2005

Summary. Vaginoplasty in two girls with severe vaginal stricturing due to congenital adrenal hyperplasia is described. The strictures were so tight and long that conventional flap techniques were inappropriate, and long fasciocutaneous flaps from redundant labioscrotal tissue were used. This technique has gained wide usage in plastic surgery, but has not been described previously in this site.
Primary and myoma‐associated menorrhagia: role of prostaglandins and effects of ibuprofen
Authors: MÄKÄRÄINEN LEO , YLIKORKALA OLAVI
Published: August 2005

Summary. The release of 6‐keto‐prostaglandin F1α(6‐keto‐PGF1α), a metabolite of prostacyclin (PGI2) and thromboxane B2 (TxB2), a metabolite of thromboxane A2 (TxA2), was estimated in endometrial biopsies taken from 12 menorrhagic and 12 healthy women during the luteal phase of the cycle. The releases of 6‐keto‐PGF1α and TxB2 were normal, but the ratio TxB2/6‐keto‐PGF1α was inversely related to menstrual blood loss in women with measured menstrual blood loss exceeding 70 ml. In the second part of the study, 24 women with excessive menstrual bleeding (13 with primary menorrhagia, 10 with uterine fibro‐myomas, one with haemostatic factor VIII deficiency) were treated at random with ibuprofen (600mg/day and 1200mg/day) and with a placebo. Ibuprofen 1200 mg/day reduced (P<0.01) median blood loss from 146 ml (range 71–374 ml) to 110 ml (30–288 ml) in primary menorrhagia but had no effect on blood loss in women with uterine fibroids and factor VIII deficiency. Blood loss was normal in six women and was not affected by ibuprofen. Thus, our data suggest that there is a PGI2 dominance in the endometrium of patients with menorrhagia. In addition, primary, but neither fibromyoma nor coagulation defect‐associated menorrhagia, can be treated by ibuprofen.
Menstrual dysfunction in Nigerian athletes
Authors: TORIOLA ABEL L. , MATHUR DHIRENDRA N.
Published: August 2005

Summary. Menstrual function was assessed in 475 Nigerian athletes in different sports and 606 non‐athletes. In general, irregular menstrual cycles and oligomenorrhoea or secondary amenorrhoea (O/A) were more common in the athletes (26% and 21%, respectively) than in the non‐athletes (18% and 8%, respectively). Menstruation was more regular and normal in the non‐athletes (50%) than in the athletes (22%). It was noted that menstrual dysfunction in the athletes was associated with significantly low body fat, body weight, relative weight for height, and the stress of sports activity. In the groups of athletes the ball game players (35%) and distance runners (51%) most commonly experienced O/A, whereas the incidence of dysmenorrhoea and menorrhagia was most prevalent in the swimmers (37%), and sprinters (42%). Menstrual disturbances were relatively more common in athletes who began training before the menarche (43%).
Steroid receptors in human ovarian malignancy. A review of four years tissue collection
Authors: TOPPILA M. , TYLER J. P. P. , FAY R. , BAIRD P. J. , CRANDON J. , EASTMAN C. J. , HUDSON C. N.
Published: August 2005

Summary. The oestrogen and progestogen receptor status in ovarian cancers from 72 patients was correlated with histological type, primary. or secondary origin and peripheral hormone concentrations. Changes occurred in receptor status during malignant transformations of ovarian tissues, with those for oestrogen being found more often, and those for progestogen less often than in non‐diseased ovarian fragments. It is suggested that the similarity in sex steroid receptor content between ovarian and breast cancers warrants prospective study of ovarian sex steroid receptor status as a predictive index of survival and response to hormonal therapy in multi‐centre clinical trials. Additional data on androgen receptors are also presented.
The effects of inflammatory bowel disease on pregnancy: a case‐controlled retrospective analysis
Authors: PORTER R. J. , STIRRAT G. M.
Published: August 2005

Summary. Retrospective analysis of 82 pregnancies in women with either ulcerative colitis or Crohn's disease suggested that, in general, neither disease had a major effect on pregnancy outcome. The birthweights of babies born to women with inflammatory bowel disease were marginally lower than those born to women in a control group matched. for age and parity, but the difference was statistically significant only in women with Crohn's disease. In both disease groups there was a higher frequency of low haemoglobin levels in pregnancy than in the matched control groups. There were no statistically significant effects of ulcerative colitis or Crohn's disease on duration of pregnancy, mode of delivery or raised blood pressure and/or proteinuria. In the absence of a relapse, a diagnosis of inflammatory bowel disease should not influence obstetric management.
The effect of interferon on human papillomaviruses associated with cervical intraepithelial neoplasia
Authors: BYRNE M. A. , MØLLER B. R. , TAYLOR‐ROBINSON D. , HARRIS J. R. W. , WICKENDEN C. , MALCOLM A. D. B. , ANDERSON M. C. , COLEMAN D. V.
Published: August 2005

Summary. A double‐blind, placebo‐controlled, trial of leucocyte interferon showed that, contrary to previous reports, interferon had no significant effect on cervical intraepithelial neoplasia (CIN) when applied topically in a geld. DNA hybridization of cervical scrapes was used to monitor the effect of interferon on the human papillomaviruses (HPV) associated with CIN. There was, however, no significant difference in the expression of HPV 6 or 16 in the cervical epithelium of patients treated with interferon compared with those given a placebo. By using superficial cells scraped from the surface of the cervical epithelium as a source of DNA for viral studies, we were able to investigate the relation between HPV and CIN without interfering withthe natural history of the disease. HPV 16 was detected in lesions which persisted while HPV 6 only was detected in one lesion that regressed. Regression was clearly associated with reduction in the number of copies of viral DNA per cell in this case. Dual infection with HPV types 6 and 16 were recorded in two patients with persistent lesions. In one patient, hybridization studies indicated that infectionwith HPV 16 could have occurred after infection with type 6 was established, and it is postulated that this may have changed the nature of the cervical lesion.
Alpha interferon in human pregnancy
Authors: CHARD T. , CRAIG P. H. , MENABAWEY M. , LEE C.
Published: August 2005

Summary. The concentration of interferon‐alpha was measured by a specific two‐site immunoradiometric assay in a variety of fluids and tissues collected during human pregnacy. Maternal blood and blood and tissues from non‐pregnant adults contained little or no interferonalpha. Fetal blood, fetal organs, placenta, membrances, amniotic fluid and decidua all contained significant and roughly equivalent amounts ranging from 1:1 to 10 u/ml (or per g of tissue). These findings demonstrate that the fetus and its immediate surroundings are permeated with interferon. It is suggested that this may play a role in regulation of the maternal‐fetal graft relation.
High concentrations of immunoreactive renin, prorenin and enzymatically‐active renin in human ovarian follicular fluid
Authors: DERKX F. H. M. , SCHALEKAMP M. A. D. H. , ALBERDA A. T. , ZEILMAKER G. H.
Published: August 2005

Summary. Prorenin (enzymatically inactive) and renin (active) were measured by radioimmunoassay, üsing monoclonal antibodies reacting either with both prorenin and renin or with renin alone, in preovulatory follicular fluid (FF) from women in an in‐vitro fertilization programme who were stimulated with human menopausal/human chorionic gonadotrophin. The concentration of prorenin in FF was 40 times higher than in plasma taken a! the time of FF collection; renin in FF was 10 times higher. The plasma concentration of prorenin, but not of renin, in these women was higher than in non‐stimulated women in the late follicular phase of the menstrual cycle. The concentration of renin‐substrate and angiotensin‐converting enzyme in FF was 60% of that in plasma. Contamination of blood, which may occur at the time of FF collection, was less than 5%. Prorenin in FF was irreversibly converted into renin after adding trypsin or by endogenous serine protease, using procedures that also cause conversion of prorenin in plasma. These results support the hypothesis that the increased plasma level of prorenin in women whose ovulation is stimulated for the collection of oocytes has originated from the ovary and is under gonadotrophic control. This may also be true for the increase of plasma prorenin that has been observed in non‐stimulated women during the luteal phase of the cycle and in early pregnancy.
Lymphocyte phenotypes in cervical intraepithelial neoplasia and human papillomavirus infection
Authors: TAY S. K. , JENKINS D. , MADDOX P. , SINGER A.
Published: August 2005

Summary. Lymphocyte phenotypes in cervical mucosa were studied using a panel of monoclonal antibodies. T lymphocytes were predominant both within the epithelium and in the subepithelial stroma. In the normal cervix, both the T4+ (helper/inducer) and T8+ (suppressor/ cytotoxic) subsets were present in a ratio similar to that in the peripheral circulation. In human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) there was depletion of intraepithelial lymphocytes, especially of T4+ subset, with reversal of the ratio of T4+ to T8+ subsets to less than one. In contrast, there was no significant reduction in the number of lymphocytes in the subepithelial stroma. Tac+ (antigen primed and clonal expanding) lymphocytes were absent both within the epithelium and in the subepithelial stroma. These findings support our suggestion that there is a localized immunodeficiency in HPV infection and CIN. The aetiological and therapeutic implications are discussed.
Medroxyprogesterone acetate in non‐metastatic gestational trophoblastic disease
Authors: GOLDBERG GARY L. , CLOETE KOBUS , BLOCH BASIL , WISWEDEL KLAUS , ALTARAS MARCO M.
Published: August 2005

Summary. The effect of medroxyprogesterone acetate (MPA: Depo‐Provera, Upjohn) as a contraceptive agent was assessed in 45 patients with non‐metastatic gestational trophoblastic disease and compared with 13 patients using hormonal and 26 patients using non‐hormonal methods of contraception. In the whole group of 84 patients 18 (21.4%) required chemotherapy. There was no statistically significant difference in the incidence of persistent trophoblastic disease between MPA (9/45) and the oral contraceptive group (2/13) and MPA and the non‐hormonal contraceptive groups (7/26).
A clinical trial using danazol for the treatment of premenstrual tension
Authors: WATTS J. Ff. , BUTT W. R. , EDWARDS R. LOGAN
Published: August 2005

Summary. Forty women with premenstrual tension received either placebo, 100, 200 or 400 mg danazol daily for 3 months in a pilot study arranged as a double‐blind trial. Thirteen patients withdrew by the third month usually because they complained of no improvement. They had significantly higher pretrial symptom scores than those who continued. In patients treated with danazol, symptom scores for breast pain during the second and third months and for irritability, anxiety and lethargy during the third month were significantly (P<0.05) lower than scores in those given placebo. Most symptoms improved on placebo in the first month but by the third month only three remained improved. In contrast eight symptoms were improved on 200 mg danazol by the third month. By the end of the trial more than 75% of patients who were still taking danazol were essentially free of breast pain, lethargy, anxiety and increased appetite, but results for other common symptoms were no better than with placebo.
Experimental estimation of intrauterine fetal irradiation dosage in computed tomography using a Rando Phantom
Authors: GUIDOZZI F. , ANDERSON J. , MOORE R.
Published: August 2005

Summary. A Rando Phantom was used experimentally to estimate the dosage of intrauterine irradiation a fetus would be subjected to if a computed tomographic investigation were to be performed antenatally. Lithium fluoride thermoluminescent dosimetry chips (TLD chips) were placed in the assumed intrauterine fetal position in a Rando Phantom. A scanogram was then used to identify the location of the chips and a computed tomographic scan was performed of the assumed intrauterine fetal position. It was felt that the measurement obtained from the TLD chips would give a more realistic estimate of the total dose that a fetus may be subjected to, both due to the primary and the scattered irradiation of the computed tomographic examination.
Does conception before marriage matter?
Authors: GOLDING JEAN , ROBINSON JANET , HENRIQUES JANE , THOMAS PETER
Published: August 2005

Summary. Data from the 1970 British Births survey were used to compare 1380 births conceived before marriage (women who were delivered less than 6 months after marriage) with 13845 births to women who had been married for at least 6 months before delivery. Infants in the premarital conception group were at increased risk because of maternal youth, primiparity and maternal health behaviour such as smoking. Once these factors had been taken into account there was no residual risk of perinatal death or low birthweight. There was a slight excess of preterm deliveries.
Fear of failure: a place for the trial of instrumental delivery
Authors: LOWE BARRY
Published: August 2005

Summary. The safety of performing potentially difficult midcavity forceps or vacuum extractions, as trials of instrumental delivery was assessed retrospectively. Successful vaginal delivery was achieved in 61% of 122 patients with delay in the second stage who had a trial of instrumental delivery performed in an operating theatre with full preparations to proceed to caesarean section. The outcome was compared with that in 42 patients who were delivered for the same indication, by primary caesarean section, without prior instrumentation. Transient fetal trauma occurred only in the trials of instrumental delivery, and there was no significant difference in immediate neonatal or maternal morbidity. In another group of 61 patients instrumental delivery was attempted without full preparations for possible caesarean section and when unexpected difficulty arose, the forceps or vacuum extractor were abandoned in favour of caesarean section. Within this group of unexpected failures of instrumentation there were significantly more babies with low Apgar scores, delayed onset of respirations or needing intubation. A carefully conducted trial of instrumental delivery is an acceptable alternative to caesarean section for delay in the second stage due to a potentially difficult midcavity arrest.
Retrograde ejaculation: a systematic approach to non‐invasive recovery of spermatozoa from post‐ejaculatory urine for artificial insemination
Authors: BRAUDE PETER R. , ROSS LESLIE D. , BOLTON VIRGINIA N. , OCKENDEN KIM
Published: August 2005

Summary. Retrograde ejaculation is an uncommon but treatable form of male infertility. Successful recovery of live spermatozoa from the post‐ejaculatory urine for artificial insemination is dependent on careful regulation of pH and osmolarity of the urine into which ejaculation takes place, and separation of the motile spermatozoa from the debris and cells which are found in these samples. Three pregnancies established by artificial insemination of spermatozoa recovered by non‐invasive means from the bladders of men suffering from retrograde ejaculation are described. The techniques for preparing the urine for spermatozoal survival, and for removal of cells and debris by sedimentation or buoyant density centrifugation are discussed.
Nasal absorption of progesterone in women
Authors: DALTON MAUREEN E. , BROMHAM DAVID R. , AMBROSE CARL L. , OSBORNE JOHN , DALTON KATHARINA D.
Published: August 2005

Summary. Absorption profiles were obtained from women following the administration of ointment containing 20, 30 and 40 mg of progesterone to the nasal mucosa. There were no significant differences in area‐under‐curves between groups receiving the drug in one nostril but when 40 mg doses were divided between two nostrils there was a significantly greater area‐under‐curve suggesting that the area of mucosa applied with the drug is more important than dosage.
Ultrasound measurement of fetal blood flow in predicting fetal outcome
Authors: LAURIN JAN , MARŠÁL KAREL , PERSSON PER HÅKAN , LINGMAN GÖRAN
Published: August 2005

Summary. The efficacy of fetal blood flow assessment in predicting fetal outcome was evaluated in 159 pregnancies suspected of intrauterine growth retardation (IUGR). Blood flow in the fetal aorta and umbilical vein was measured with imaging and pulsed Doppler ultrasound. Volume blood flow values and variables describing the waveform of the maximum aortic blood velocity were checked for relations to subsequent fetal outcome. A new semi‐quantitative velocity waveform variable, blood flow class (BFC), was designed and tested. The occurrence of IUGR, imminent fetal distress, a low Apgar score at f and 5 min, and a low pH in the umbilical artery and vein were adopted to characterize fetal outcome. Receiver operating characteristic curves were used to demonstrate the sensitivity and false positive rate, and the Cohen's Kappa index was used to compare the predictive capacity of the various blood flow variables. BFC, describing the blood velocity waveform with emphasis on its end‐diastolic part, was found to be the most powerful marker of imminent fetal asphyxia (Kappa = 0.66) and of intrauterine growth retardation (Kappa—0.48).
Is centralized hospital care necessary for all insulin‐dependent pregnant diabetics?
Authors: TRAUB A.I. , HARLEY J. M. G. , COOPER T. K. , MAGUINESS S. D. , HADDEN D. R.
Published: August 2005

Summary. A retrospective population study in Northern Ireland examined the benefits of centralized care in insulin‐dependent diabetic pregnancies. In the 5 years 1979–1983, there were 139 250 deliveries in Northern Ireland and of these 221 pregnancies occurred in 187 insulin‐dependent diabetic patients; 100 were managed entirely in peripheral maternity units, 61 were referred from a peripheral unit to the Royal Maternity Hospital, Belfast and 60 were managed entirely in this central referral hospital. The patients referred from the periphery had the worst past obstetric history with a combined perinatal mortality rate of 200 per 1000. During the study period the perinatal mortality rate was 107 for the referred pregnancies, 33 for those managed entirely in the peripheral units and 18 for those managed at the Royal Maternity Hospital. If those pregnancies terminated for fetal abnormality, and deaths beyond the perinatal period are included, the figures for total fetal loss were 15.5%, 5.5% and 7.1% respectively. Overall the major congenital malformation rate was 7.5%, and for the respective groups 6.5%, 3.0% and 13.0%. For the general population during the same period the perinatal mortality rate was 1.4% and the major congenital malformation rate was 2.5%. Thus it is suggested that only peripheral hospitals which can offer combined antenatal/endocrine care and with a neonatal intensive care unit should undertake the management of the pregnant diabetic.
Combined echocardiographic and Doppler assessment of fetal congenital atrioventricular block
Authors: KLEINMAN C. S. , COPEL J. A. , HOBBINS J. C.
Published: August 2005

Summary. Fetal heart rate monitoring was combined with fetal echocardiography for examination of atrial reactivity during labour in five fetuses with second or third degree heart block. Alterations in vagal tone accompanying uterine contraction influence atrial rate, even when the ventricle is not under atrial‘control’. Fetal echocardiography enabled diagnosis of the underlying basis of the arrhythmia and located the optimal position for recording atrial activity with an external heart rate monitor. External and internal monitoring of atrial activity demonstrated reactivity during labour. Two patients were delivered vaginally after monitoring throughout labour. One mother preferred elective caesarean delivery. Caesarean section was required in another for cephalopelvic disproportion and in the remaining woman for late decelerations. These monitoring techniques provide an assessment of fetal well‐being in the presence of fetal bradycardia due to variable degrees of heart block.
Pelvic examination: a survey of British practice
Authors: AMIAS A. G.
Published: August 2005

Summary. Of 850 consultant gynaecologists in Great Britain who were asked about their preferred method of pelvic examination, 777 (91%) replied including 87 women. Of these, 574 (74%) regularly choose the dorsal position both for bimanual and speculum examination although 227 of this group use the lateral position in some circumstances. The other 203 (26%) preferred the left lateral for routine speculum examination and 100 of them also regularly used that position for bimanual palpation. There were marked regional variations in clinical practice, the lateral position being broadly more favoured in the South than in the North. The age of the gynaecologist was an important factor but practical clinical considerations appeared to be less important than habit and upbringing in determining choice of method.
The prognostic significance of lymphatic vascular space invasion in endometrial adenocarcinoma
Authors: SIVRIDIS E. , BUCKLEY C. H. , FOX H.
Published: August 2005

Summary. In a histopathological review of 171 cases of endometrial adenocarcinoma, 42 neoplasms demonstrated lymphatic and/or vascular invasion. This finding was significantly correlated with depth of myometrial involvement and stage of disease at operation. Tumour cell type, and histological grade were correlated to a much lesser extent, whilst the patient's age bore no relation. Prognosis was significantly poorer in patients whose adenocarcinomas had invaded lymphatic and/or vascular spaces compared to those whose neoplasms had not. These observations emphasize the importance of considering lymphatic/vascular invasion in staging endometrial adenocarcinomas.
Haemodynamic changes during the puerperium: a Doppler and M‐mode echocardiographic study
Authors: ROBSON S. C. , DUNLOP W. , MOORE M. , HUNTER S.
Published: August 2005

Summary. Serial haemodynamic investigations were performed in 15 women at 38 weeks gestation and then 2, 6, 12 and 24 weeks after delivery. Cardiac output was measured by Doppler and cross‐sectional echocardiography at the aortic, pulmonary and mitral valves. Cardiac chamber size and ventricular function were investigated by M‐mode echocardiography. Flow measurements at the three intracardiac sites correlated closely. Cardiac output fell from a mean of 7.421/min at 38 weeks to 4.961/min at 24 weeks after delivery, a fall of 33%. Most of this decrease (28%) had occurred by 2 weeks. This was associated with a 20% reduction in heart rate and an 18% reduction in stroke volume. By 2 weeks after delivery there was a significant decrease in left atrial dimension and left ventricular end‐diastolic dimension. Left ventricular wall thickness and mass declined throughout the period of study as did aortic, pulmonary and mitral valve areas. M‐mode derived indices of myocardial contractility were all significantly reduced by 2 weeks and thereafter showed no further change. No haemodynamic differences were found between lactating and non‐lactating mothers.
Inhibition of uterine contractions of premature labour with an oxytocin analogue. Results from a pilot study
Authors: ÅKERLUND MATS , STRÖMBERG PER , HAUKSSON ARNAR , ANDERSEN LARS FRANCH , LYNDRUP JENS , TROJNAR JERZY , MELIN PER
Published: August 2005

Summary. A competitive inhibitor of the action of oxytocin on the uterus, l‐deamino‐2‐D‐Tyr‐(OEt)‐4‐Thr‐8‐Orn‐oxytocin, was studied for the first time in 13 patients with established, uncomplicated premature labour. Intravenous infusion of 10–100 μg/min of the analogue was given for 1–10 h and the effect was monitored by external cardiotoco‐graphy. In all women an inhibition of uterine activity was observed, and in the majority of patients infused with 25 μg/min and a total dose of about 5 mg or more of the drug total inhibition of uterine contractions was achieved. There were no effects on the maternal and fetal pulse rates, nor were there any other side‐effects. The results of this preliminary study support the concept of an increased concentration of uterine oxytocin receptors being aetiologically important in uncomplicated premature labour. They also suggest that the present oxytocin antagonist could be an interesting therapeutic alternative in the condition, primarily because of the marked selectivity of its effect.
Effect of relaxin on prostaglandin E production by human amnion: changes in relation to the onset of labour
Authors: BERNAL A. LÓPEZ , BRYANT‐GREENWOOD GILLIAN D. , HANSELL DEBORAH J. , HICKS BEVERLEY R. , GREENWOOD F. C. , TURNBULL A.C.
Published: August 2005

Summary. The effect of relaxin on prostaglandin E (PGE) production by human amnion in vitro was investigated. When amniotic discs were incubated in the presence of increasing concentrations of relaxin, two distinct effects were observed. Discs prepared from women delivered by caesarean section before the onset of labour showed a significant decrease in PGE output at relaxin concentrations of 0.5–2 μg/ml; the effect was abolished at higher relaxin concentrations. Discs obtained from women delivered after labour of spontaneous onset responded to the addition of relaxin (4–8 μg/ml) with a significant increase in PGE output, although this increase was only evident in patients in whom labour had started with intact membranes. These results suggest that relaxin, which is present in decidua and chorion laeve at term, may have a paracrine effect on the amnion, inhibiting PGE production during continuing pregnancy but favouring its production during spontaneous labour.
In‐utero intravascular transfusion of the fetus for the management of severe Rhesus isoimmunization—a reappraisal
Authors: MACKENZIE I. Z. , FERGUSON J. , CASTLE B. M. , BOWELL P. J. , ENTWISTLE C. C.
Published: August 2005

Summary. Ten fetuses, severely affected by Rhesus (D) haemolytic disease, received one to three intravascular blood transfusions at between 18 and 30 weeks gestation, with the use of fetoscopically guided needles into one of the umbilical cord vessels. Although the technique was successfully accomplished in all cases, the fetal response to the procedure was varied. Only two fetuses survived beyond the neonatal period, and one child subsequently died principally because of the problems resulting from premature delivery. The reason for the low rate of survival has been explored and the continued use of the method described is now questioned.
Doppler ultrasound assessment of fetal and uteroplacental circulations in severe second trimester oligohydramnios
Authors: HACKETT G. A. , CAMPBELL S. , NICOLAIDES K. H.
Published: August 2005

Summary. Doppler blood flow studies in 41 pregnancies with oligohydramnios in the second trimester found abnormal patterns in all 14 pregnancies with intrauterine growth retardation but in only one of nine pregnancies with premature rupture of the membranes, and one of 10 with fetal renal defects. Mixed patterns were found in a heterogeneous group of fetuses with other malformations or intrauterine infection. Unlike previous reports a diagnosis was achieved in all pregnancies, suggesting that Doppler studies should be an integral part of the antenatal investigation in such pregnancies.
Reproductive performance following conservative microsurgical management of tubal pregnancy
Authors: OELSNER G. , MORAD J. , CARP H. , MASHIACH S. , SERR D.M.
Published: August 2005

Summary. Between 1981 and 1986, 58 women underwent conservative surgery for ectopic pregnancy; 30 had both tubes present, and 28 had the operation on their single tube. Twenty‐five of the 30 women with both tubes present desired pregnancy; 17 (68%) conceived again, 14 (56%) had at least one intrauterine pregnancy and 3 (12%) had a repeat extrauterine pregnancy. Twenty‐six of the women with a solitary tube desired pregnancy, 12 (46%) of them had at least one intrauterine pregnancy, and 10 (38.5%) had a repeat extrauterine pregnancy. It was concluded that the incidence of intrauterine pregnancy after conservative surgery in patients with both tubes present is not lower than after radical surgery, and that the incidence of extrauterine pregnancy is not higher. The intrauterine pregnancy rate in patients with a solitary tube is high and still higher than the best results available with in‐vitro fertilization and embryo transfer. Therefore conservative surgery is indicated in these patients despite the high incidence of repeat extra‐uterine pregnancy. Since most of the patients who conceived did so during the first year following the operation, we recommend that patients try to conceive immediately.
Thyroid function in trophoblastic disease
Authors: LEMON M. , BEVAN B. R. , PENNINGTON G. W. , LI T. C.
Published: August 2005

Summary. Human chorionic gonadotrophin (hCG) levels and thyroid function were monitored in 44 patients receiving chemotherapy for treatment of trophoblastic disease. We observed a strong correlation between hCG and thyroid stimulating hormone (TSH) concentrations measured by radioimmunoassay, and this appears to be due to cross‐reactivity between hCG and the anti‐TSH antibody used. The concentration of thyroid hormones was little affected by the raised levels of TSH or hCG, except when the concentration of the latter rose to high levels, usually above 100 000 i.u./l. The possible mechanisms of thyroid homeostasis in trophoblastic disease are considered.
Treatment of cervical intraepithelial neoplasia (CIN) by radical electrocoagulation diathermy; 5 years’ experience
Authors: GILES JOHN A. , WALKER PATRICK G. , CHALK PHILIP A. F.
Published: August 2005

Summary. During the first 5 years of a colposcopy clinic established in a London teaching hospital 653 new patients were seen, usually referred because they had had an abnormal cervical smear report suggesting cervical intraepithelial neoplasia (CIN). Of 490 women treated within the district for CIN, 361 (73.7%) underwent radical electrocoagulation diathermy, 91 (18.6%) were treated by cone biopsy, 34 (6.9%) underwent hysterectomy and the other four patients were treated by cryocau‐tery. Of the 245 women treated by radical electrocoagulation diathermy who have been followed for at least 12 months, persistent or recurrent disease has been found in only 15, a first time treatment success rate of 93.9%.