bluuebunny/crossref_metadata_2025 huggingface dataset:
The consumers’ attitude to obstetric care
Authors: MORGAN BARBARA M. , BULPITT CHRISTOPHER J. , CLIFTON PAMELA , LEWIS PETER J.
Published: August 2005

Questionnaires were sent to 1000 mothers, 1 year after childbirth, to elicit opinions about various aspects of obstetric care in labour and effects on child bonding. Questionnaires were returned by 632 women. Some attitudes were in broad agreement with the views of natural childbirth groups but more were in agreement with the established medical view. The majority of women did not consider that medical care was excessive and 63% found fetal monitoring reassuring. Questions on mother and child bonding showed that only few mothers (19%) thought that this was influenced by events during labour and delivery. Having pain in labour was seen as an essential part of the emotional experience of childbirth by 45% of the respondents. This attitude and others were correlated with certain psychological traits, marital status and race. Before changes are made in obstetric practices in response to‘consumer’ pressure, the opinions of recently delivered mothers ought to be taken into account.
Effect of mode of delivery on outcome of very‐low‐birthweight infants
Authors: YU V. Y. H. , BAJUK B. , CUTTING D. , ORGILL A. A. , ASTBURY J.
Published: August 2005

The hospital survival rate was 47% in 111 inborn infants who weighed 501–1000 g and 90% in 211 who weighed 1001–1500 g. The survival rate after caesarean birth was significantly higher than that after vaginal delivery in the 1001–1500 g group but not in the 501–1000 g group. At 2 years of age, 73% of survivors born at 501–1000 g and 85% of those born at 1001–1500 g had no neurological or developmental disability; no significant difference was found between caesarean and vaginal births. The mode of delivery did not significantly affect survival or late outcome of the 192 singleton infants with cephalic presentation. Although the survival rate was not significantly different between infants with breech and cephalic presentations, the former had a significantly higher disability rate. Within the group of 72 singleton infants with breech presentation, the survival rate after caesarean birth was significantly higher than after vaginal delivery in the 1001–1500 g group but not in the 501–1000 g group. No significant difference in late outcome was found between caesarean and vaginal births in this subgroup.
A randomized trial of external cephalic version with tocolysis in late pregnancy
Authors: BROCKS V. , PHILIPSEN T. , SECHER N. J.
Published: August 2005

The effect of external version under tocolysis with intravenous ritodrine during the 37th week of gestation was studied in a prospective randomized trial comprising 130 consecutive women with a fetus in breech presentation. Version was successful in 41% of the patients, all of whom had a cephalic vaginal delivery. Of the 56 women in the control group in whom version was not attempted; 8 (14%) converted to the vertex presentation spontaneously. Failure of version was significantly correlated with primiparity, location of the placenta on the anterior uterine wall, and maternal weight. The caesarean section rate was significantly lower in the version group (27%) than in the control group (46%) (P<0–05). The overall caesarean section rate for a fetus in breech presentation was 50%. There were no serious complications associated with version and the condition of the infants at birth was better in the version group than in the control group. We advise external version under tocolysis in late pregnancy to reduce the frequency of breech presentation in labour.
Prostaglandins in menstrual fluid in menorrhagia and dysmenorrhoea
Authors: REES MARGARET C. P. , ANDERSON ANNE B. M. , DEMERS LAURENCE M. , TURNBULL A. C.
Published: August 2005

Menstrual fluid was collected in vaginal cups inserted for 2 h during the first 2 days of menstruation and menstrual serum concentrations of prostaglandins PGF2α and PGE2 were measured by radio‐immunoassay. In 16 women from whom menstrual fluid was collected on both days, PGF2α and PGE2 concentrations were significantly higher on day 1 than on day 2. The highest concentrations of PGF 2α and PGE2 were found in dysmenorrhoeic women on day 1. In non‐dysmenorrhoeic women, the amount of PGF2α and PGE2 collected in 2 h correlated directly with total menstrual blood loss. There was no statistically significant difference in the amount of prostaglandins collected in 2 h in pain‐free menorrhagic women and dysmenorrhoeic women with normal loss. There was also no significant 9‐ketoreductase or 9‐hydroxydehydro‐genase activity present in menstrual fluid which could suggest PGE2 to PGF2α interconversion.
HLA tissue typing and chronic vulval dystrophy
Authors: LAVERY H. A. , PINKERTON J. H. M. , MIDDLETON D.
Published: August 2005

Tissue typing was performed on 25 patients who attended the Royal Victoria Hospital with chronic vulval dystrophy (CVD). Age‐matched control groups who had pernicious anaemia only and achlorhydria only were also tissue typed as these conditions had been found more frequently in our patients with CVD. When these three groups were compared with age‐matched control groups of blood donors and patients with gynaecological disorders other than CVD, no specific tissue type was found in patients with CVD nor in those with pernicious anaemia or achlorhydria only.
The management of vaginal intraepithelial neoplasia after hysterectomy
Authors: WOODMAN C. B. J. , JORDAN J. A. , WADE‐EVANS T.
Published: August 2005

Twenty‐three patients with vaginal intraepithelial neoplasia (VaIN) presented between 6 months and 13 years after hysterectomy for cervical intraepithelial neoplasia. All were discovered by cytological follow‐up, were colposcopically assessed and diagnosis confirmed by histological examination before treatment. The CO2 laser was used as the initial treatment in 14, but only six remain free of disease after mean follow‐up of 30 months. The reasons for the disappointing results with this form of therapy are discussed and it is suggested that its use may be inappropriate in the management of VaIN following hysterectomy as atypical epithelium may frequently be inaccessible as a result of being sequestered above the vault suture line or hidden in the recesses of the angles of the vaginal vault.
Quantitative microcolpohysteroscopic assessment of the extent of endocervical involvement by cervical intraepithelial neoplasia
Authors: SOUTTER W. P. , FENTON D. W. , GUDGEON P. , SHARP F.
Published: August 2005

The Hamou microcolpohysteroscope was used to measure the extension of cervical intraepithelial neoplasia into the endocervical canal in patients before cone biopsy of the cervix. These measurements showed good correlation with those found on subsequent histological assessment.
A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery
Authors: RUSH R. W. , ISAACS S. , McPHERSON K. , JONES LESLEY , CHALMERS I. , GRANT A.
Published: August 2005

Summary. The effect of cervical suture on pregnancy outcome was studied in 194 women with a high risk (approximately 30%) of having a late abortion or a preterm delivery. The women were randomly allocated either to have a cervical suture inserted (n=96) or to be managed without a suture (n=98). There was no evidence that cervical cerclage either prolonged gestation or improved survival. Patients allocated to receive cerclage spent significantly longer in hospital, even when the period of admission for insertion was excluded. The patients in the cerclage group were more likely to receive tocolytic drugs, and more of them experienced puerperal pyrexia, although these differences between the groups were not statistically significant.
Amniotic fluid and midtrimester amniocentesis: a review
Authors: FINEGAN JO‐ANNE K.
Published: August 2005

Summary. The potential risks of midtrimester amniocentesis resulting from the loss of amniotic fluid are reviewed. Amniotic fluid fulfils important functions in fetal well‐being, but its replacement time after amniocentesis is not known. A review of experimental amniocentesis in animals suggests risks to limbs and structural changes in fetal lungs. In humans, orthopaedic abnormalities and respiratory difficulties appear to be a risk of amniocentesis, and studies addressing these risks are also reviewed. Continued investigation of risks from fluid loss at midtrimester amniocentesis is recommended.
Characterization of the reduced heart rate variation in growth‐retarded fetuses
Authors: HENSON G. , DAWES G. S. , REDMAN C. W. G.
Published: August 2005

Summary. Fetal heart rate (FHR) variation has been studied by computerized numerical analysis in 20 growth‐retarded fetuses and 20 normal fetuses matched for gestational age. FHR variation was significantly reduced in the 14 growth‐retarded fetuses where there was clinical evidence of associated pathology. Rest ‐ activity cycles were assessed by changes in FHR variation and fetal movements. The growth‐retarded fetuses with reduced FHR variation showed the same pattern of rest and activity as normal fetuses but the changes in FHR variation were of lower amplitude. This was observed even in the subgroup of six fetuses with the lowest FHR variation. Thus the unreactive FHR patterns associated with growth retardation do not arise because the fetus spends less time in activity.
The radiology of stillbirths and neonatal deaths
Authors: WINTER R. M. , SANDIN B. M. , MITCHELL R. A. , PRICE A. B.
Published: August 2005

Summary. Whole body radiographs were made in a consecutive series of 488 infants who were either stillborn or died within the first month of life; autopsies were done in 378. The radiographs were considered to have been useful, or diagnostic in 16% overall, in 100% of infants with dwarfism, in 40% where there were external malformations; and in 9% where there were no external malformations.
The oscillating ‘vena cava syndrome’ during quiet standing—an unexpected observation in late pregnancy
Authors: SCHNEIDER K. T. M. , BOLLINGER A. , HUCH A. , HUCH R.
Published: August 2005

Summary. While studying the lung function of pregnant women at term in four different postures, we were surprised to note marked cyclic accelerations in the heart rate in two‐thirds of the women when in a standing position. The mean cycle length was 105 s (range: 1–4 min) and the amplitude had a mean of 27 beats/min (range: 9–51). Blood flow velocity measurements with ultrasound Doppler over the femoral vein showed that there was an intermittent reduction of flow during quiet standing. When the venous return ceased, maternal heart rate increased, cardiac output decreased and blood pressure fell. After the venous blood flow was restored, maternal heart rate, cardiac output and blood pressure returned to normal until the cycle started again. Concomitant with these maternal heart rate changes, different patterns of fetal heart rate were observed. About 70% of the fetuses showed reduction in the long‐term variability, increase in fetal heart rate or periodic accelerations. Although no woman fainted during quiet standing, the maternal circulatory changes were consistent with those seen in the classical vena cava syndrome.
Beta‐human chorionic gonadotrophin levels before and after the development of pre‐eclampsia
Authors: SAID M. E. , CAMPBELL D. M. , AZZAM M. E. , MAcGILLIVRAY I.
Published: August 2005

Summary. Maternal serum levels of beta‐human chorionic gonadotrophin ((β‐hCG) concentrations were significantly higher in 41 primigravid patients with proteinuric pre‐eclampsia compared with those in 41 primigravid normotensive women matched for age and gestation. β‐hCG was also measured in serial serum samples obtained from 13 women who had a high weight‐gain between 20 and 30 weeks of pregnancy. Seven of these pregnancies were subsequently complicated with pre‐eclampsia while the remaining six continued to be normotensive; β‐hCG levels were found to rise before the clinical signs of pre‐eclampsia appeared.
Obstetrics at Galiwin'ku
Authors: WATSON DAVID S.
Published: August 2005

Summary. A study is presented of the outcome of the 683 deliveries of the Aboriginal women resident on Elcho Island between 1971 and 1982. Comment is made on birth rates, fertility rates, antenatal attendance, risk factors and the outcome of the preterm labours. Current strategies for improving antenatal care are outlined including the use of real time scanning.
The fetal renin‐angiotensin system in pregnancy‐induced hypertension
Authors: SYMONDS E. M. , LAMMING G.D. , CRAVEN D.J.
Published: August 2005

Summary. Maternal and fetal blood samples were obtained from 10 normotensive primigravidae and 10 primigravidae with pregnancies complicated by hypertension and proteinuria. Measurements were performed of plasma renin activity (PRA), plasma renin concentration (PRC) and plasma renin substrate (PRS). PRA and PRC were significantly higher in cord artery and cord vein blood than in maternal venous blood in normotensive women, and PRS was significantly lower. PRS levels were lower in maternal plasma of hypertensive women and, although PRC and PRA were lower in the cord blood of infants born to hypertensive women, these differences did not achieve statistical significance.
The rate and regularity of breathing movements in the normal and growth‐retarded fetus
Authors: DORNAN J. C. , RITCHIE J. W. K. , RUFF S.
Published: August 2005

Summary. The rate and regularity of fetal breathing movements (FBM) were determined in 14 women with uncomplicated singleton pregnancies, eight of whom were between 30 and 33 weeks gestation and six between 37 and 40 weeks gestation. Similar observations were made in 19 women with pregnancies complicated by severe intrauterine growth retardation, 11 of whom were between 30 and 33 weeks and eight between 37 and 40 weeks. In normal pregnancy recordings of breath‐to‐breath intervals showed that FBM became more regular with advancing gestational age, and the rate [breaths/min, mean (SEM)] slowed from 57.2 (1.3) at 30–33 weeks to 47.9 (0.8) at 37–40 weeks. FBM in the growth‐retarded group were regular at each gestation studied and the rate was even slower than in the normal group at term, being 41.9 (1.2) at 30–33 weeks and 41.1 (1.0) at 37–40 weeks. Hyperoxia and hypercapnia aeared to have no consistent effect on fetal breathing rate. Fasting for >12 h considerably reduced the rate of FBM in the normal fetus but only marginally so in those with growth retardation. It is concluded that the pattern of FBM provides more information about the fetus than the amount of time spent breathing, particularly when growth is retarded.
In‐vivo accuracy of ultrasound measurements of intrauterine ume in pregnancy
Authors: GEIRSSON R. T. , PATEL N. B. , CHRISTIE A. D.
Published: August 2005

Summary. The accuracy of ultrasonic measurements of intra‐amniotic ume using a parallel planimetric area method was assessed in 18 women by comparison against different measures of the same ume space. In nine patients undergoing second‐trimester termination of pregnancy amniotic fluid ume was measured using a dye dilution method and fetal ume was measured by either water displacement or calculated from fetal weight. The estimated intra‐amniotic ume by this method was not significantly different from the ultrasonic measurement. In one patient who had a hysterotomy, fetal and amniotic fluid umes showed a difference of 1.01% between ultrasonically‐measured and actual intra‐amniotic ume. In eight patients studied in the third trimester the mean difference between ultrasonic and estimated intra‐amniotic ume at delivery was 6.2%.
The symptomatology of the climacteric in relation to hormonal and cytological factors
Authors: JAMES CATHERINE E. , BREESON A. J. , KOVACS G. , HILL J. G. , GRANT CLAIRE , ALLEN KATHRYN M. , FRY D. E. , BAYLIS E. MARY
Published: August 2005

Summary. Climacteric symptomatology was investigated in a group of non‐selected women aged between 54 and 56 years of age, Vasomotor complaints and dyspareunia, in particular, were noted and related to plasma hormone levels and vaginal cytology. Only 33% of those women who were within 5 years of the menopause had symptoms of a magnitude that might require hormone replacement therapy. Neither the vasomotor complaints nor dyspareunia correlated with the hormone levels or cytology findings to such an extent as to be helpful in planning treatment. Aarently only a minority of women in their middle 50s demonstrate a symptomatic need for hormone replacement therapy and laboratory investigations are of little use in their identification.
The recovery of preovulatory oocytes using a fixed schedule of ovulation induction and follicle aspiration
Authors: TEMPLETON ALLAN , VAN LOOK PAUL , LUMSDEN MARY ANNE , ANGELL ROSLYN , AITKEN JOHN , DUNCAN ANDREW W. , BAIRD DAVID T.
Published: August 2005

summary

Thirty‐two unteer women, scheduled for laparoscopy, were subjected to a fixed regimen of ovulation induction and ovarian follicle aspiration, following manipulation of the previous menstrual cycle with oral contraceptive pills or norethisterone. This allowed the time of oocyte recovery to be planned several weeks in advance. The recovery rate of mature oocytes (loosely dispersed cumulus) in the patients who had their cycles adjusted with norethisterone was comparable to that in a group of women treated in an embryo‐transfer programme who were being individually monitored, although there was evidence from cleavage rates and concentration of sex steroids in follicular fluid that further follicular maturation could have occurred. It is suggested that a modification of this schedule could provide an acceptable recovery rate of pre‐ovulatory oocytes for research purposes, and possibly by simplifying the monitoring technique could be alicable to a wider range of patients seeking embryo transfer.
An assessment of pre‐operative microbial screening on the prevention of post‐abortion pelvic inflammatory disease
Authors: MILLS ANGELA M.
Published: August 2005

summary

Five hundred women were examined for lower genital tract infection before vaginal termination of pregnancy. Pre‐operatively, Neisseria gonorrhoeae was isolated from nine women (1–8%); five of eight male partners also had gonorrhoea. All the women with gonorrhoea were treated at least 48 h pre‐operatively with ampicillin and probenicid; three of them had symptoms of pelvic infection pre‐operatively and one had symptoms postoperatively. Of these women, 120 (24%) had a follow‐up examination within 47 days of abortion; 15 (3%) required an evacuation of retained products of conception and only 12 (2%) had mild suspected pelvic infection. Screening for Neisseria gonorrhoeae and treatment pre‐operatively prevented pelvic infection in a further eight patients.
Screening for liver metastases from ovarian cancer with serum carcinoembryonic antigen and radionuclide hepatic scintiphotography
Authors: SONNENDECKER E. W. W. , DE SOUZA J. J. L. , HERMAN A. A. B.
Published: August 2005

summary

The association between pre‐operative serum carcinoembryonic antigen (CEA) and liver scanning employing technetium (99mTc)‐tin colloid was investigated in 30 women subsequently proven to have primary epithelial ovarian carcinoma to determine whether these two investigations improve the detection of hepatic mtastases. The uer limit of normal for CEA (≥ 5 ng/ml) did not represent the optimal levels for use in predicting ovarian carcinoma nor the presence of liver metastases. But with CEA levels> 10 ng/ml sensitivity for liver metastases was 57%. Liver scanning alone demonstrated metastases in five out of seven patients (71%) with parenchymal liver metastases. The combination of CEA and liver scan was positive in six out of these seven patients (86%).
Antenatal detection of placental steroid sulphatase deficiency: use of a dehydroepiandrosterone sulphate loading test
Authors: OAKEY R. E.
Published: August 2005

summary

Dehydroepiandrosterone sulphate (50 mg) was given intravenously to 15 women in the third trimester of pregnancy in which urinary oestrogen excretion was subnormal (<32 μmol/24 h) without recognizable clinical or therapeutic cause. In six patients, this procedure was followed by a marked increase in plasma oestradiol concentrations [mean (SD), nmol/1] before treatment: 44 (13) and 30 min after injection: 279 (31). After delivery, the placentas from all these patients showed steroid sulphatase activity in vitro (>450 units). In the other nine patients, all of whom subsequently showed negligible placental steroid sulphatase activity in vitro (< 10 units), mean plasma oestradiol concentrations increased only from 18 (9) to 26 (11) nmol/1. Changes in plasma oestradiol concentrations in late pregnancy after injection of dehydroepiandrosterone sulphate therefore readily permit identification of those patients in whom a placental enzyme deficiency is the cause of the subnormal oestrogen production. The defect was identified as steroid sulphatase deficiency by an in‐vitro test of placental tissue after delivery.
Antibacterial activity in human amniotic fluid: relationship to zinc and phosphate
Authors: SCANE T. M. N. , HAWKINS D. F.
Published: August 2005

summary

Antibacterial activity, tested with B. subtilis, was present in all 44 human amniotic fluids at between 36 and 42 weeks of pregnancy and was unrelated to gestational age within these limits, or to maternal age or parity. High‐molecular‐weight (β‐lysin) activity, present in all samples, was directly related to concentration of bound zinc, but not to that of free zinc. Low‐molecular‐weight antibacterial activity (<1000 Daltons) was only present in nine specimens, but sub‐threshold concentrations were demonstrable by concentrating the ultrafiltrates in more than half of the remaining specimens. Low‐molecular‐weight activity in the ultrafiltrates was directly related to the concentration of bound zinc in the original amniotic fluid. Neither high‐ nor low‐molecular‐weight antibacterial activities were associated with amniotic fluid phosphate levels.
Maternal plasma inhibition of prostaglandin synthase during human pregnancy, parturition and the puerperium
Authors: BRENNECKE S. P. , HUMPHREYS J. , BRYCE R. L. , TEASDALE W. P. , TURNBULL A. C. , MITCHELL M. D.
Published: August 2005

summary

To study the possibility that circulating endogenous inhibitor(s) of prostaglandin synthesis (EIPS) represent a control mechanism for prostaglandin production during human pregnancy and parturition, we have measured maternal plasma EIPS levels serially during pregnancy, labour and the puerperium, and cross‐sectionally during the course of labour. No significant trends were detected in relation to pregnancy or parturition. These results do not suort a role for maternal plasma EIPS in the control of prostaglandin production during human pregnancy or labour.
Intrauterine haematoma and placental protein 5 in patients with uterine bleeding during pregnancy
Authors: YLÖSTALO PEKKA , ÄMMÄLÄ PIRKKO , SEÄLÄ MARKKU
Published: August 2005

summary

The prognostic value of placental protein 5 (5) serum levels were compared with ultrasound in the clinical assessment of 26 patients with uterine bleeding at 12–33 weeks of pregnancy. An intrauterine haematoma was found by ultrasound in 16 patients (62%), and in those patients the duration of pregnancy was significantly shorter than in the 10 who did not have a haematoma. Placental abruption ensued in five patients with haematoma, and although the highest serum 5 level occurred in such a patient, the levels were similar to those in the other patients in whom no abruption was indentified. A clinically important finding was that, in placental abruption, a haematoma may accumulate between the fetal membranes and the uterine wall instead of in the retroplacental space. We conclude that ultrasound examination is more effective than 5 measurement in the assessment of prognosis of patients who bleed during pregnancy.
Nile stimulation in late pregnancy causing uterine hyperstimulation and profound fetal bradycardia
Authors: VIEGAS O. A. C. , ARULKUMARAN S. , GIBB D. M. F. , RATNAM S. S.
Published: August 2005

summary

Nile stimulation in late pregnancy may cause oxytocin release sufficient to give uterine hypertonus and danger to the fetus. Three patients are described in whom nile stimulation caused a marked but temporary fetal bradycardia.
Placental protein 12 (12) in the human endometrium: tissue concentration in relation to histology and serum levels of 12, progesterone and oestradiol
Authors: RUTANEN E.‐M. , KOISTINEN R. , WAHLSTRÖM T. , SJÖBERG J. , STENMAN U.‐H. , SEÁLÁ M.
Published: August 2005

summary

Placental protein 12 (12) was measured by radio‐immunoassay in serum and endometrial extracts of 25 women at various phases of the menstrual cycle, and in the decidua from six women undergoing legal abortion in early pregnancy. The results were analysed with respect to endometrial histology and serum oestradiol, progesterone and 12 concentrations. 12 was detected in the secretory phase endometrium and decidua, but not in the proliferative phase endometrium. The 12 concentration in tissue increased from early (1.3–9.4 μg/g protein) to late secretory phase (5.3‐155 μg/g), and considerably higher levels were found in decidua (282‐3846 μg/g). There was a correlation (P<0.001) between endometrial 12 and serum progesterone levels in non‐pregnant women, and there also was a slight correlation (P<0.05) between endometrial and serum 12 concentrations. These results show that 12 is not pregnancy specific and suggest that the occurrence of 12 is dependent on progesterone.
Prophylactic bromocriptine treatment during pregnancy in women with macroprolactinomas: report of 13 pregnancies
Authors: DE WIT W. , BENNINK H. J. T. COELINGH
Published: August 2005

Summary. Ten women with a macroprolactinoma had prophylactic bromocriptine treatment during 13 pregnancies in the second and third trimesters. One patient had signs of tumour enlargement during the first trimester, but none of them showed tumour enlargement during prophylactic bromocriptine treatment. Prolactin levels were reduced in both maternal and cord sera, but they were normal in amniotic fluid. All pregnancies progressed to term. Thirteen healthy infants were born without congenital malformations and growth and psychomotor development were normal during the follow‐up period (7 months to 5 years). The safety of bromocriptine treatment during pregnancy is discussed and our current policy of management of patients with prolactinomas is outlined.
Permeability of the human placenta to bicarbonate: in‐vitro perfusion studies
Authors: AARNOUDSE J. G. , ILLSLEY N. P. , PENFOLD P. , BARDSLEY S. E. , RISPENS P. , HYTTEN F. E.
Published: August 2005

Summary. The effect of maternal acidosis on fetal acid‐base balance was studied in a dual circuit perfusion of a single cotyledon in normal, term, human placentas. Both the fetal and maternal (intervillous) circulations were perfused with a Krebs‐Ringer solution adjusted to pH values between 7.35 and 7.45. After a control period, the perfusate in the maternal circulation was replaced by an acidified medium (mean pH 7.06) for 30 min. This was followed by a second control period of 30 min during which the acidified maternal perfusate was replaced with the original medium. During the 30 min of maternal acidosis, fetal vein pH was not significantly altered despite the large decrease in maternal artery pH, but there was an efflux of total CO2 (tCO2) from the placenta into the maternal circulation which was not matched by an influx of tCO2 from the fetal circulation. The tCO2 transferred was in the form of bicarbonate rather than dissolved CO2, but the maximal rate of tCO2 transfer of in the form of bicarbonate was lower than the rate of placental transfer of tCO2 necessary in vivo. It is probable therefore that bicarbonate does not play a major role in placental CO2 transfer but the placental tissue bicarbonate pool may play an important part in buffering the fetus against changes in maternal pH or blood gas status.
Peripheral vasomotor control and menopausal flushing‐ a preliminary report
Authors: BRINCAT M. , DETRAFFORD J. C. , LAFFERTY K. , STUDD J.W. W.
Published: August 2005

Summary. Menopausal flushing can be considered as an intermittent loss of peripheral vasomotor control. Thermal entrainment testing has been used to assess the degree of peripheral vasomotor control in a preliminary study of seven women receiving oestrogen replacement therapy in the form of percutaneous cream. Significant improvement was demonstrated in the degree of control over a 3–month period in those patients who were symptomatically improved. We suggest that oestrogen exerts an influence on peripheral vasomotor control and flushes and sweats occur when this influence is removed.
Serum levels of progesterone and some of its metabolites including deoxycorticosterone after oral and parenteral administration
Authors: OTTOSON U.‐B. , CARLSTROM Umeå K. , DAMBER J.‐E. , VON SCHOULTZ B.
Published: August 2005

Summary. Single 100‐mg doses of progesterone were given orally and as intramuscular injections t o four women during the follicular phase of the menstrual cycle. After oral administration serum levels of progesterone increased rapidly to reach luteal phase values (mean maximum level 55.6 nm) within 1–4 h and were still elevated after 12 h. The serum concentrations of 20α‐hydroxy‐4‐pregnen‐3‐one showed a similar pattern while there were only minor transient changes in 17α‐hydroxypro‐gesterone concentrations. The serum levels of cortisol and 4‐androstene‐3, 17‐dione were unaffected. In comparison, after intramuscular administration values two to three times higher than by the oral route were achieved. A significant increase in serum deoxycorticosterone was recorded in all women. The mean ratio between the change in deoxy‐corticosterone and progesterone was increased after oral administration. Oral treatment with natural progesterone may develop into a n attractive alternative to synthetic progestogens but the conversion of progesterone into a potent mineralocorticoid may be a potential disadvantage.
Morphological changes in tubal mucosa associated with the use of intrauterine contraceptive devices
Authors: WOLLEN ANNE LONE , FLOOD PER R. , SANDVEI ROAR , STEIER JOHAN A.
Published: August 2005

Summary. We examined the endosalpinx of 28 healthy non–pregnant women, 12 of whom had an intrauterine contraceptive device (IUCD) and 16 of whom had neither an IUCD nor used oral contraceptives. Measurements made on light– and scanning electron micrographs showed that the percentage area covered by ciliated cells was approximately 40% in non– IUCD users and only 20% in IUCD users.
Effect of ibuprofen, naproxen sodium and paracetamol on intrauterine pressure and menstrual pain in dysmenorrhoea
Authors: MILSOM IAN , ANDERSCH BJÖRN
Published: August 2005

Summary. The effects of ibuprofen (400 mg), naproxen sodium (250 mg) and paracetamol (500 mg) on intrauterine pressure and menstrual pain was assessed in 12 women with dysmenorrhoea in a double–blind parallel study. Intrauterine pressure was recorded with a microtransducer catheter for 4 h and resting pressure, active pressure, frequency of pressure cycles and the area under the curve were analysed in 30–min periods. Ibuprofen, in a single oral dose of 400 mg, significantly reduced resting pressure, active pressure, the frequency of pressure cycles and the area under the curve and this was associated with a significant reduction in pain intensity. Neither paracetamol nor naproxen sodium effected significant changes in intrauterine pressure or pain score.
Colposcopy in microinvasive carcinoma of the cervix—an enigma of diagnosis
Authors: CHOO Y. C. , CHAN O. L. Y. , HSU C. , MA H. K.
Published: August 2005

Summary. Colposcopy and the complementary roles of cervical cytology and biopsy in the diagnosis of microinvasive carcinoma of the cervix were assessed in 26 patients. The cervical cytology indicated cervical intraepithelial neoplasia in 16 (62%) and invasive carcinoma in 10 (38%) patients. A correct colposcopic diagnosis of microinvasive carcinoma was made in only seven (30%) patients while 12 (46%) were diagnosed as having preinvasive carcinoma and four (15%) as having invasive carcinoma. Atypical vessels, characteristic of invasion, were found in less than a third of patients. Microinvasion, therefore, may not be evident on colposcopy alone. Multiple large biopsies under colposcopic guidance are useful with cone biopsy as a back‐up.
Uteroplacental blood flow velocity‐time waveforms in normal and complicated pregnancy
Authors: TRUDINGER BRIAN J. , GILES WARWICK B. , COOK COLLEEN M.
Published: August 2005

Summary. A simple continuous wave Doppler ultrasound system for recording arterial flow velocity waveforms in branches of the uterine artery in the placental bed is described. Twelve normal pregnancies were studied serially from 20 weeks to delivery. The diastolic flow velocity expressed as a percentage of the systolic provides an index of downstream vascular bed resistance and perfusion. This always exceeded 50% in normal pregnancy and there was a small increase with gestational age indicative of a decreasing flow resistance. Of the 91 complicated pregnancies, studied because of potential uteroplacental insufficiency and fetal risk, 25 resulted in the birth of an infant small‐for‐gestational‐age. In 15 the uterine artery flow velocity waveform revealed a pattern of low diastolic flow velocity. It is postulated that these represent a subgroup of growth‐retarded fetuses in whom there is reduced uterine artery perfusion. Reduced uterine artery diastolic flow velocity in these patients was associated with reduced umbilical artery diastolic flow velocity on the fetal side of the placenta. In contrast the 10 small‐for‐gestation infants associated with normal uterine artery waveforms suggest a primary fetal cause. Twelve patients with severe hypertensive disease of pregnancy were studied. Nine were associated with reduced uterine artery diastolic flow velocity (reduced uterine artery perfusion) consistent with vasospasm in the branches of the uterine artery in the placental bed.
Pre‐eclampsia in second pregnancy
Authors: CAMPBELL DORIS M. , MacGILLIVRAY IAN , CARR‐HILL ROY
Published: August 2005

Summary. A total population of pregnant women from Aberdeen City District 1967–1978 has been studied. There were 29 851 pregnancies and 6637 women had a first recorded pregnancy between 1967 and 1978 and had two or more pregnancy events. As expected the incidence of pre‐eclampsia in a second pregnancy was less than that in a first pregnancy, but it was dependent on the outcome of the first pregnancy. If the first pregnancy was complicated by proteinuric pre‐eclampsia than the incidence of the condition in the second pregnancy was similar t o that in a first pregnancy, but women who were normotensive in the first pregnancy had a reduced incidence of the condition in the second pregnancy. The incidence of proteinuric pre‐eclampsia after early abortion <13 weeks), either spontaneous or induced was similar to the population incidence in a first pregnancy, but after a late spontaneous abortion the risk of proteinuric pre‐eclampsia was significantly reduced. Change of civil status of the offspring from first to second pregnancy did not affect the incidence of pre‐eclampsia in a second pregnancy. There was an effect of birthweight in that women who had proteinuric pre‐eclampsia in conjunction with a low‐birthweight baby (<2500g) in their first pregnancy had double the incidence of proteinuric pre‐eclampsia in their second pregnancy. Only a pregnancy of 37 weeks or more is likely to offer protection or ‘immunity’ to pre‐eclampsia in a second pregnancy and even then the effect is moderated by the development of pre‐eclampsia in the first pregnancy.
The impact of screening on the incidence of cervical cancer in England and Wales
Authors: PARKIN D. M. , NGUYEN‐DINH X. , DAY N. E.
Published: August 2005

Summary. Age‐specific incidence curves for clinical cancer of the cervix in England and Wales show progressive changes over the period 1963–1978; in particular, a large reduction in incidence is seen in the age group 35–54. Since screening on any scale began in the early 1960s, we have investigated how much of this reduction in incidence in the middle age range can be attributed to detection of pre‐invasive disease. Data on registrations of in‐situ cancer have been used to estimate the patterns that might have been observed in the absence of screening. The results indicate clear cohort effects on incidence, with rising rates in the generations born 1906–1921 and since 1931, with a fall in the decade between. In addition to this, screening has probably led to a substantial reduction in the number of cases of clinical cancer in women aged 35–54, but has had little effect over the age of 60 where virtually no screening has been performed. Below age 35 the observed increase in incidence may be considerably less than it would have been in the absence of screening.
Dramatic increase of placental protein 5 levels following injection of small doses of heparin
Authors: MENABAWEY M. , SILMAN R. , RICE A. , CHARD T.
Published: August 2005

Summary. In the course of an investigation on the effects of thyroid releasing hormone in pregnant women we noted a dramatic increase in the levels of placental protein 5 (PP5) in maternal blood. This increase ranged from 10 times to over 40 times the basal levels. Further study showed that the rise was associated with the use of heparin to maintain the patency of the cannula through which the samples were collected. Furthermore, the phenomenon appeared to be systemic rather than local, and may well be due to a direct effect of heparin on PP5 secretion by the placenta.
Immunoreactive oestrogens and progesterone in amniotic fluid in twin pregnancies
Authors: NORMAN R. J. , JOUBERT S. M.
Published: August 2005

Summary. Amniotic fluid concentrations of immunoreactive oestrogens and progesterone were measured at the time of caesarean section in 32 twin pregnancies; 25 women had an elective section and seven were in labour at the time of operation. No significant differences between concentrations in the amniotic fluid of the first and second twin were found in respect of conjugated and unconjugated oestrone, oestradiol, oestriol, oestetrol and unconjugated progesterone either before or during labour. It is unlikely that changes in oestrogens or progesterone in the amniotic fluid are responsible for the selective changes seen in prostaglandins and fetal adrenal steroid during labour in the first twin.
Continuous acid‐base assessment of the human fetus during labour by tissue pH and transcutaneous carbon dioxide monitoring
Authors: NICKELSEN CARSTEN , THOMSEN STEN G. , WEBER TOM
Published: August 2005

Summary. Simultaneous monitoring of fetal tissue pH (t‐pH) and transcutaneous carbon dioxide (Tc‐Pco2) was performed in 30 labours. Both t‐pH and Te‐Pco‐2 at delivery were positively correlated with pH (r= 0·69) and Pco2(r= 0·68) of the umbilical artery blood. A tissue/transcutaneous standard base excess (t‐SBE) was derived from the t‐pH and the Tc‐Pco2 and calculated for 13 fetuses a t delivery; there was a correlation with standard base excess of umbilical artery blood. An analysis of t‐pH and Tc‐Pco2 changes during the last hour of labour revealed that only infants who were born with decreased pH of the umbilical artery blood had decreasing t‐SBE, while all others had a constant t‐SBE.
Correlation of the interpretation of fetal heart rate records with cord plasma erythropoietin levels
Authors: WTDNESS JOHN A. , TERAMO KARI A. , CLEMONS GISELA K. , COUSTAN DONALD K. , CAVALIERI RALPH L. , OH WILLIAM , WELCH GREGORY P. , SCHWARTZ ROBERT
Published: August 2005

Summary. On the basis that fetal levels of plasma erythropoietin (Ep) may reflect fetal oxygenation the primary purpose of the present study was to assess the relation between Ep measured in cord plasma at delivery and the intrapartum fetal heart rate (FHR) record. A scoring system for interpreting FHR recordings blindly was prospectively utilized in 41 selected human pregnancies during the 4 h immediately preceding birth. The correlation of the overall mean FHR score for each individual patient with cord plasma Ep was significant such that the highest Ep levels were observed in those infants with the most abnormal FHR scores. Furthermore, when the birthweights of the infants were adjusted for gestational age, sex, and birth order, birthweight centile was negatively correlated with cord plasma Ep. When both FHR score and birthweight were simultaneously correlated with cord plasma Ep using multiple regression, the combined effect of these two factors improved the association of either alone with both contributing approximately equally.
α‐Fetoprotein elevation and proteinuric pre‐eclampsia
Authors: WALTERS B. N. J. , LAO TERENCE , SMITH VALERIE , DE SWIET MICHAEL
Published: August 2005

Summary. In a retrospective study of pregnancy complicated by unexplained elevation of maternal serum α‐fetoprotein (AFP), 60 patients were compared with 120 control subjects. Proteinuric pre‐eclampsia occurred in 13% of the study patients compared with 1% of the control subjects. Primiparity, previous mid‐trimester abortion and recurrent abortions were also significantly more common in the study group. It is proposed that an abnormality of the placenta predisposes to complications and that this abnormality is expressed early in pregnancy when the AFP level is first measured. This group of women is at high risk of adverse pregnancy outcome and requires careful monitoring.
Iatrogenic neonatal and maternal hyponatraemia following oxytocin and aqueous glucose infusion during labour
Authors: SINGHI SUNIT , CHOOKANG E. , HALL J. ST E. , KALGHATGI SUHAS
Published: August 2005

Summary. Maternal and umbilical cord serum sodium and osmolality were studied prospectively in 140 deliveries to investigate whether transplacental hyponatraemia, seen following oxytocin infusion during labour, was due to the antidiuretic effect of oxytocin or was secondary to the infusion of aqueous glucose used as a vehicle for oxytocin, or both. Forty‐five women received oxytocin in aqueous glucose for induction or augmentation of labour (oxytocin group), 43 received aqueous glucose infusion alone (glucose group) and 52 did not receive any intravenous infusions (control group). Mean cord sodium levels were significantly lower in the oxytocin (131·4, SD 3·6 mmol/l) and glucose groups (132·5, SD 3·2 mmol/l) than in the control group (135·0, SD 3·0 mmol/l). Hyponatraemia (Na <130 mmol) was seen in 47% and 30% of the infants in the oxytocin and glucose groups respectively, in contrast to only 5.8% of the infants in the control group. Significant negative linear correlations were seen between serum sodium and the dose of oxytocin (P<0·01) and log of the volume of glucose solution infused (P<0·001). The hyponatraemic newborn infants had a significantly higher incidence of transient neonatal tachypnea (7/37, 19%) than the normonatraemic infants (2%). Our results strongly suggest that infusion of oxytocin and glucose both cause maternal and transplacental hyponatraemia, even in recommended doses. This should be taken in account while planning a safe dose of oxytocin and glucose for infusion during labour.
Correlation between cytoplasmic steroid receptors and tumour differentiation and invasion in endometrial carcinoma
Authors: QUINN M. A. , PEARCE P. , FORTUNE D. W. , KOH S. H. , HSIEH C. , CAUCHI M.
Published: August 2005

Summary. The incidence and levels of cytoplasmic steroid receptors were studied in 155 endometrial carcinomas: oestrogen receptors (ER) were measured in all samples, progesterone receptors (PR) in 148 and androgen receptors (AR) in 118. Well‐differentiated adenocarcinomas were significantly more likely to contain ER, PR and AR than were poorly‐differentiated tumours, and mean values of ER and PR content were significantly higher in well‐differentiated adenocarcinomas than in less‐differentiated tumours. Receptor profiles in adenosquamous carcinomas and clear‐cell carcinomas were similar to those in adenocarcinomas. Deeply invasive tumours were significantly less likely to be ER, PR or AR positive and, even when positive, such tumours had significantly lower mean levels of ER and PR. Poorly‐differentiated tumours were significantly more likely to be ER‐negative PR‐positive than well‐differentiated adenocarcinomas and adenosquamous carcinomas.
A prospective trial of computed tomography in the staging of ovarian malignancy
Authors: SHIELS R. A. , PEEL K. R. , MACDONALD H. N. , THOROGOOD J. , ROBINSON P. J.
Published: August 2005

Summary. Thirty patients, thought clinically to have ovarian tumours, were studied prospectively by pre‐operative computed tomographic (CT) scans of the abdomen and pelvis. In six patients (20%) small metastases in mesentery, omentum and on subdiaphragmatic peritoneum were not detected by the scans. CT did not improve the accuracy of staging or assist the surgeons by drawing their attention to disease which they might otherwise have missed. Although CT gives an elegant demonstration of anatomy, it is not an alternative to extended laparotomy in patients with ovarian tumours.
Quality of controlled clinical trials. The case of imaging ultrasound in obstetrics: a review
Authors: THACKER STEPHEN B.
Published: August 2005

Summary. Randomized controlled trials are increasingly used t o assess clinical practices in obstetrics and gynaecology. The strength of these studies is that they usually address the issue of selection bias satisfactorily. Yet, as with any form of scientific investigation, the randomized controlled trial has inherent limitations and is subject to flaws in its conduct. Using basic methodological criteria, this report assesses the quality of the four published controlled trials in which a policy of routine imaging ultrasonography in pregnancy was compared with a more restrictive policy. In addition, a pooled analysis using data from all four trials was conducted to illustrate how increasing the sample size may reveal differences between the two policies which remain undetected in trials using small samples. The researchers in these studies reached different conclusions as to the effectiveness of routine ultrasound screening. Taken together, these four trials provide valuable information about routine ultrasound screening but fail to demonstrate adequately the usefulness of imaging ultrasound as a screening procedure for all pregnant women. The assessment criteria presented here could be used by investigators, editors, referees and other readers as a guideline for assessing the quality of therapeutic studies upon which clinical practice should be based.
A comparison of the effects of four intravenous solutions for the treatment of ketonuria during labour
Authors: MORTON K. E. , JACKSON M. C. , GILLMER M. D. G.
Published: August 2005

Summary. Forty women in whom ketonuria was detected during the first stage of labour were allocated randomly to intravenous treatment with one litre of either normal saline. Hartmann's solution, 5% dextrose or 10% dextrose. The solutions were administered over 1 h and blood was taken immediately beforehand and thereafter at 30‐min intervals for 90 min to assess their effect on intermediary metabolism, plasma osmolality and acid‐base status. Although both the 5 and 10% dextrose infusions caused a rapid decline in whole blood d‐3‐hydroxybutyrate concentrations, they also produced pathological degrees of maternal hyperglycaemia and hyperinsulinaemia and a marked elevation in the mean blood lactate and pyruvate concentrations. Administration of 10% dextrose was also associated with a significant increase in serum osmolality. Hartmann's solution produced significantly higher mean whole blood lactate and pyruvate concentrations than did normal saline. There was a significant increase in the venous base deficit in the group infused with 10% dextrose, indicating that the buffering capacity of the blood had been exceeded. It is concluded that rapid infusions of dextrose or Hartmann's solution should not be administered during labour. Normal saline should be used for rehydration and if dextrose therapy is deemed necessary the dose administered should not exceed physiological requirements.