bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence, aetiology and clinical significance of pseudo‐sinusoidal fetal heart rate patterns in labour
Authors: MURPHY KARL W. , RUSSELL VIRGINIA , COLLINS AMANDA , JOHNSON PAUL
Published: August 2005

Objective— To investigate the prevalence of sinusoidal and pseudo‐sinusoidal fetal heart rate (FHR) patterns in labour and the relation between the characteristics of the FHR pattern and fetal outcome.

Design— A prospective observational study over a 6 month period in which all women who had continuous FHR monitoring in labour had their intrapartum cardiotocographs (CTGs) scrutinized for the presence of sinusoidal or pseudosinusoidal FHR patterns.

Setting— John Radcliffe Hospital, Oxford.

Subjects— 1520 women who had fetal monitoring during labour for various reasons.

Main outcome measures— Both internal (electrocardiographic) and external (ultrasound) recordings of the FHR were analysed. Abnormal FHR patterns were related to obstetric characteristics and fetal outcome in terms of Apgar scores, umbilical artery pH and admission to the special care unit.

Results— No true sinusoidal FHR patterns were observed, but pseudoinusoidal FHR patterns were found in 230 of the 1520 CTGs examined (15%) Of these, 219 were classified as minor (amplitude 5–15 beatdmin) and 11 as intermediate (amplitude 16–24 beatdmin). Major pseudo‐sinusoidal FHR pat‐terns (amplitude >24 beats/min) were not observed. Minor pseudo‐sinusoidal FHR patterns had a mean duration of 21 (SD 13) min and typically occurred once or twice early in labour. Using logistic regression analysis a significant, independent relation was demonstrated between the presence of minor pseudo‐sinusoidal FHR patterns and the use of pethidine (RR 1.84,95% CI 1.3 to 2.59, P < 0.0001) and epidural analgesia (RR 1.85,95% CI 1.24 to 2.76, P < 0.001). Intermediate pseudo‐sinusoidal FHR patterns were found in association with both in utero fetal sucking and transient episodes of fetal hypoxia such as that caused by periodic umbilical cord compression.

Conclusion— Pseudo‐sinusoidal FHR patterns in labour will usually be associated with a normal fetal outcome but a careful fetal assessment is mandatory.
Self‐reported long‐term outcomes of hysterectomy
Authors: SCHOFIELD M. J. , BENNETT A. , REDMAN S. , WALTERS W. A. W. , SANSON‐FISHER R. W.
Published: August 2005

Objectives— –To investigate women's perceptions of and satisfaction with the long‐term outcomes from a hysterectomy performed between 2 and 10 years ago and to determine whether satisfaction is related to demographic factors, factors associated with the hysterectomy, and the number or type of perceived benefits and problems associated with the hysterectomy.

Design— Retrospective survey by telephone interview and postal questionnaire of 236 women who had a hysterectomy between 2 and 10 years ago.

Setting— Women who had had a hysterectomy were identified from a community survey in the Hunter Region of NSW, Australia.

Subjects— Two hundred and thirty‐six women who self‐reported having had a hysterectomy between 2 and 10 years ago.

Main outcome measures— Perceived benefits resulting from the hysterectomy; perceived physical and psychological problems caused by the hysterectomy; satisfaction with care.

Results— Relief from heavy bleeding was the most frequent benefit (57%) and the most important benefit (32%). Most of the women reported improvements in symptoms experienced before hysterectomy but more than half the women had symptoms which they believed had been worsened or caused by the hysterectomy. Despite this, high levels of satisfaction with the operation were reported.

Conclusion— The results highlight the need to examine more closely decision‐making about treatment for menstrual symptoms such as heavy bleeding.
Relations between the fetal circulation and pituitary‐thyroid function
Authors: THORPE‐BEESTON J. GUY , NICOLAIDES KYPROS H. , SNIJDERS ROSALINDE J. M. , FELTON CARL V. , VYAS SANJAY , CAMPBELL STUART
Published: August 2005

Objective— To study the relation between changes in the fetal thyroid hormone and thyroid stimulating hormone (TSH) concentrations and alterations in the fetal circulation as assessed by Dopplcr ultrasound.

Design— A cross‐sectional study of small for gestational age (SGA) and red‐cell isoimmunized fetuses undergoing cordocentesis and Dopplcr studies for the assessment and determination of fetal karyotype, acid‐base balance and hac‐moglobin concentration.

Setting— Harris Birthright Research Centre for Fetal Medicine, King's College, London.

Subjects— 38 growth retarded and 38 red‐cell isoimmunised fetuses.

Interventions— Cordoccntesis.

Main outcome measures— Serum TSH total and free thyroxine (T4, FT4) and total and free triiodothyronine (T3, FT3) concentrations; middle cerebral artery (MCAVm) and dcsccnding thoracic aorta (AoVm) mean blood velocities; fetal Po2 and haemoglobin concentration (Hb).

Results— Delta values (8) calculated as the number of SDs from the respective normal mean for gestation were used to compare the results with those from a previous study of normal fetuses. Mean AoVm was increased in the isoimmu‐nized fetuses (P < 0.001) but decreascd in the SGA fetuses (P < 0.001). Mean MCAVm was increascd in both groups (P < 0.01; P < 0.001). There were signifi‐cant associations between the gestational age adjusted values for TSH and MCAVm (r = 0.23, P < 0.05) and between T4, FT4 or FT3 and AoVm (r = 0.41, P < 0.01; r = 0.50, P < 0.001; r = 0.36, P < 0.01 respectively). In addition, T4 and FT4 were associated with 8Po2 and 8Hb.

Conclusion— In the hypoxaemic hypoxia of growth retardation and the anaemic hypoxia of rhesus disease there are significant associations between changes in fetal thyroid hormone concentrations and changes in fetal blood flow as assessed by Dopplcr. Irrespective of whether altercd blood flow is the cause or cffect of changes in thyroid hormone concentrations, the observed changes could have beneficial effects for fetal survival, in the presence of a hostile intrauterine environment.
Erythrocyte hydration in normal human pregnancy
Authors: MACPHAIL S. , THOMAS T. H. , WILKINSON R. , DUNLOP W. , DAVISON J. M.
Published: August 2005

Objective— To determine whether the fall in plasma osmolality in normal human pregnancy resulted in cellular overhydration.

Design— The changes in erythrocyte hydration, potassium and total osmoles in response to a decrease in osmolality in vitro and associated with the fall in plasma osmolality in normal pregnancy were determined.

Subjects— Fifty‐one women were studied serially during pregnancy and again 20 weeks after delivery.

Results— Erythrocytes from pregnant women exposed in vitro to a 29.9% osmolality decrement had a 28.5% increase in cell hydration. At 14 weeks gestation although plasma osmolality was lower than after delivery (281.1 vs 291.6 mosmol/kg; P < 0.01) both erythrocyte hydration (1.83 l/kg dry weight cells) and potassium (264 mmol/kg) contents were reduced from the nonpregnant values (1.88 l/kg; P < 0.001). For the remainder of pregnancy plasma osmolality remained at this lower level but cell hydration and potassium both increased to values at 38 weeks gestation that were greater than in the nonpregnant state (1.92 vs 1.88 1/kg; 287 vs 272 mmol/kg).

Conclusions— These findings suggest that a loss of cell osmoles may be a primary event affecting cell hydration in pregnancy and plasma osmolality is then reduced to maintain normal cell hydration. Subsequent changes in cell hydration were led by changes in intracellular osmole content.
Is oral contraceptive use still associated with an increased risk of fatal myocardial infarction? Report of a case‐control study
Authors: THOROGOOD MARGARET , MANN JIM , MURPHY MICHAEL , VESSEY MARTIN
Published: August 2005

Objective— To investigate the association between fatal myocardial infarction and use of modern low‐dose oral contraceptives.

Design— A case‐control study.

Setting— General practices throughout England and Wales.

Subjects— 161 women aged under 40 dying from myocardial infarction during 1986–1988. Living controls (2 per case), matched for age and marital status, were chosen from general practice lists. Information was collected during structured interviews with general practitioners, and from postal questionnaires sent to surviving partners of the cases and to control women.

Main outcome measures— Mortality from myocardial infarction in relation to many risk factors, notably oral contraception, as measured by relative risk.

Results— After allowing for the confounding effects of medical risk factors and for surgical sterilization, the overall relative risk associated with both current and past use of oral contraceptives was estimated to be 1–9 (95% CI 0–7 to 4–9, and 1–0 to 3–5 respectively). The relative risk associated with current use of preparations containing 50 μg of oestrogen, however, was estimated to be 4–2 (0–5 to 39.2). At least some of the relative risk associated with oral contraceptive use is likely to be attributable to the confounding effect of cigarette smoking, but it is impossible to estimate how much from the available data.

Conclusions— If there was an increased risk of fatal myocardial infarction associated with oral contraceptive use in 1986–1988 it is likely to have been less than two‐fold; in this study risks were slightly, but not significantly, elevated with both current and previous use. It may be that any increase in risk is associated solely with the older combined preparations containing 50 μg of oestrogen.
Assessment of urinary symptoms in early pregnancy
Authors: CUTNER A. , CARDOZO L. D. , BENNESS C. J.
Published: August 2005

Objectives— To determine the correlation between lower urinary tract symptoms and urodynamic findings in early pregnancy.

Setting— The termination clinic and gynaecology ward at King's College Hospital.

Design— Observational study.

Subjects— 47 women before termination of pregnancy at between 6 and 15 weeks.

Interventions— Women filled in symptom questionnaires and then had urodynamic investigations, consisting of uroflowmetry and subtracted provoked cystometry.

Main outcome measures— The occurrence of lower urinary tract symptoms and their association with urodynamic findings.

Results— Lower urinary tract symptoms were fairly common but there was poor correlation with the urodynamic findings.

Conclusions— The findings suggest that lower urinary tract symptomatology alone is insufficient to study lower urinary tract dysfunction in pregnancy.
A randomised placebo controlled trial of labetalol in the treatment of mild to moderate pregnancy induced hypertension
Authors: PICKLES C. J. , BROUGHTON PIPKIN F. , SYMONDS E. M.
Published: August 2005

Objective
To determine the need for, and efficacy of, treatment with labetalol in women with mild‐to‐moderate pregnancy induced hypertension (PIH).

Design
Prospective double‐blind randomised placebo controlled study.

Setting
Maternity units of five hospitals in the Trent Region.

Subjects
144 women (86 primigravid) who developed PIH after 20 weeks gestation.

Interventions
Treatment with oral labetalol up to 600 mg daily or placebo with subsequent care of treatment failures in accordance with the attending obstetrician's practice.

Main outcome measures
Number of days spent as an antenatal inpatient; the development of proteinuria; the perceived need for induction of labour or elective caesarean section; and gestation age at delivery.

Results
Labetalol significantly lowered the blood pressure and reduced the incidence of proteinuria. However, neither the number of days spent as an antenatal inpatient, nor the perceived need for induction of delivery or elective caesarean section, nor the gestation age at delivery differed significantly between the two treatment groups. Post‐randomisation consideration of early (≤32 weeks) and late (>32 weeks) onset groups showed the placebo treated early‐onset group (n= 15) to have more patients with severe hypertension (>150/110 mmHg) and a greater requirement for additional antihypertensive therapy prior to labour than the group treated with labetalol (n= 16).

Conclusion
Anti‐hypertensive intervention therapy in pregnancy induced hypertension has been examined using a placebo controlled randomised double‐blind trial of labetalol in pregnancy. The maximum blood pressure prior to labour and the incidence of proteinuria was reduced in women on active therapy. However, the length of gestation was not significantly prolonged and indices of clinical outcome were not significantly altered. The appropriateness of pharmacological therapy for late‐onset PIH may be questioned.
Early teenage pregnancies in Hull
Authors: KONJE JUSTIN C. , PALMER ALAN , WATSON ALAN , HAY DOUGLAS M. , IMRIE ALASTAIR , EWINGS PAUL
Published: August 2005

Objectives
To determine the pattern, obstetric outcome and factors that predispose to pregnancies in young teenagers in Hull.

Design
Retrospective study of case records of pregnancies from 1977 to 1988 in girls aged 16 years or less and in a control group of nulliparous women aged 20–24 years.

Setting
Hull health district hospitals.

Subjects
660 pregnant teenagers and 3 576 nulliparas aged 20–24 years.

Main outcome measures
Ages at pregnancy, number of pregnancies per year, gestational age at booking and delivery, antenatal complications, mode of delivery, utilization of contraceptives and some social factors.

Results
Of the 1 660 pregnancies in the young adolescents, 59.6% were terminations. The youngest girl was 11. The average annual incidence of early teenage pregnancies was 10.5 per 1 000 girls aged 10–16 compared to 6.4 per 1 000 in England and Wales. Physical characteristics and pattern of antenatal care were similar in the study and control groups. Anaemia was 2.53 times as common in teenagers (95% CI 2.19–2.9; P<0.0001) while hypertension alone was 1.7 times as frequent (95% CI 1.28‐2.4; P= 0.002). Pre‐eclampsia and proteinuric disorders were similar in the two groups. Apart from prolonged pregnancy, which was significantly less common in the index group, other gestational ages at delivery and birth weights were the same in both groups. The caesarean section rate in the index group was 0.56 times that in the control group (95% CI 0.4–0.75; P<0.0001) but forceps deliveries were 2.37 times as common in the index group (95% CI 1.80–3.12; P <0.0001). The uncorrected perinatal mortality rates were 13.6/1000 and 15.7/1000 in the index and control groups respectively.

Conclusion
Early teenage pregnancies are common in Hull and, contrary to previous reports, are physically well tolerated by the early adolescents who book early and attend antenatal clinics regularly. Ineffective utilization and ignorance of contraceptive methods are contributory factors. We recommend that emphasis should be placed on providing contraceptive services for teenagers and adopting a more purposeful and holistic approach to sex education.
Serum prolactin concentration in normal and small for gestational age fetuses
Authors: THORPE‐BEESTON J. GUY , SNIJDERS ROSALINDE J. M. , FELTON CARL V. , NICOLAIDES KYPROS H.
Published: August 2005

ObjectivesTo study fetal and maternal serum prolactin concentrations in appropriately‐grown (AGA) fetuses and in small for gestational age (SGA) fetuses.

DesignA cross‐sectional study of 27 AGA and 27 SGA fetuses undergoing cordocentesis for prenatal diagnosis or for determination of fetal karyotype and acidbase balance. Serum prolactin concentration was measured by radioimmunoassay.

SettingHarris Birthright Research Centre for Fetal Medicine.

ResultsIn the AGA group, both fetal and maternal serum prolactin concentration increased significantly with gestation (P<0.001andP<0.01, respectively). In the SGA group, the fetal concentration of prolactin was significantly higher (P<0.05), but the maternal serum prolactin concentration was not different from that of the AGA group.

ConclusionsThe finding of prolactin in the fetal circulation suggests that the anterior lobe of the pituitary is functioning from at least 12 weeks gestation. The increased serum prolactin concentration in SGA fetuses may be the consequence of hypoglycemic stress on the pituitary or the relative immaturity of the inhibitory hypothalamic‐pituitary pathways.
Benign ovarian cysts in England and Wales and in the United States
Authors: WESTHOFF CAROLYN , CLARK COLLEEN J. G.
Published: August 2005

Objective
To compare the rates of hospital admission for management of ovarian cysts in England and Wales and the United States between 1972 and 1974 and 1984 and 1986; and to determine whether these rates are related to rates of early diagnosis of ovarian cancer.

Design
Analysis of published and unpublished hospital discharge data based on national samples, the Hospital In‐patient Enquiry (HIPE), a 10% hospital discharge sample for England and Wales, and the National Hospital Discharge Survey (NHDs), a 5% sample for the United States.

Main outcome measures
Age‐specific discharge rates for primary and secondary diagnoses of ovarian cyst or benign ovarian tumour.

Results
There was an age‐adjusted increase in discharge rates of about 8% in both countries; discharge rates in the United States were approximately double those in England and Wales in both time periods. There was no difference in the rates of early diagnosis of ovarian cancer.

Conclusions
Ovarian cysts are a common cause of hospital admission in both countries. The higher rates in the United States are not associated with earlier diagnosis of ovarian cancer.
Epidermal growth factor receptor expression in normal endometrium and endometriosis: an immunohistochemical study
Authors: PRENTICE A. , THOMAS E. J. , WEDDELL A. , McGILL A. , RANDALL B. J. , HORNE C. H. W.
Published: August 2005

Objective
To study epidermal growth factor (EGF) receptor expression in endometrium throughout the menstrual cycle and to compare EGF‐receptor expression in endometrium from patients with endometriosis with receptor expression in synchronously sampled endometriosis and in endometrium from healthy women.

Design
An immunohistochemical study of receptor expression using murine monoclonal antibodies and timed endometrial and endometriotic biopsies.

Subjects
25 healthy women and 27 patients with a diagnosis of endometriosis.

Results
Positive staining for EGF receptors was observed in 24 of 25 samples from normal women and in 26 of 27 endometrial samples from patients with endometriosis. In neither group was there any variation in the intensity of staining throughout the menstrual cycle and both glands and stroma were stained. EGF‐receptor expression was observed in the glands of 15 out of 17 endometriotic lesions and in 12 of these biopsies positive staining was also present within endometriotic stroma.

Conclusion
This study shows no difference in the intensity of staining of EGF receptors in endometrium throughout the menstrual cycle or between the glands of normal endometrium and those of endometriosis.
Is obstetric and neonatal outcome worse in fetuses who fail to reach their own growth potential?
Authors: DANIELIAN P. J. , ALLMAN A. C. J. , STEER P. J.
Published: August 2005

Objectives
To determine the perinatal outcome of fetuses who had birthweights less than that expected from early third trimester ultrasound scanning.

Design
Retrospective estimation of centile fetal weight at early third trimester ultrasound scanning compared with actual centile birthweight corrected for gestational age, parity and sex.

Setting
Teaching Hospital Obstetric Unit, London.

Subjects
197 unselected women with singleton cephalic pregnancies who were delivered at term in our unit between October 1989 and May 1990.

Main outcome measures
CTG abnormality, need for fetal blood sampling in labour, meconium‐staining of the amniotic fluid, mode of delivery, Apgar scores at 1 and 5 min, need for transfer of baby to neonatal unit, and need for neonatal intubation of the neonate at delivery.

Results
An actual birthweight >5% less than the birthweight estimated from ultrasound scanning identified 44 babies (22%) with an increased risk of CTG abnormalities (χ2= 8.38, P <0.0025; Odds ratio (OR) = 2.54; 95% CI1 1.6 to 4.78) and need for operative delivery (x= 5.81, P <0.0125; OR = 1.94; 95% CI 1.15 to 3.27), when compared with the remainder of the sample. Overall 14 (32%) of this group had birth‐weights above the 50th centile. A group of 44 babies selected as being the smallest for gestational age, without reference to growth pattern, had a similar excess morbidity. (All this group had birthweights below the 39th centile.)

Conclusions
This study supports the hypothesis that in‐utero fetal growth pattern is as important for perinatal outcome as being small for gestational age per se.
Fetal middle cerebral artery blood flow during normal active labour and in labour with variable decelerations
Authors: YAGEL S. , ANTEBY E. , LAVY Y. , CHETRIT A. BEN , PALTI Z. , HOCHNER‐CELNIKIER D. , RON M.
Published: August 2005

Objective
To assess the distribution of fetal blood flow impedance of the umbilical and middle cerebral artery in active uncomplicated labour and in labour complicated by variable decelerations.

Interventions
Blood flow impedance of the umbilical and fetal middle cerebral arteries was assessed by means of pulsed Doppier ultrasonography and measured by the resistance index (RI) and the systolic/diastolic ratio.

Subjects
35 women at 38–40 weeks gestation admitted to, or monitored in the intra‐partum unit. One group of 25 women had a normal active labour, the second group of 10 women were in active labour with moderate variable decelerations. A control group of 25 women—healthy pregnant women at term but not in active labour. All three groups were comparable for maternal age and parity.

Setting
Hospital department of Obstetrics and gynaecology, Israel.

Design
A prospective descriptive study.

Results
There was a 40% reduction in middle cerebral artery blood flow impedance in the two groups of women in active labour compared with the control group. Umbilical blood flow did not differ significantly between the three groups. Fetal middle cerebral blood flow impedance in labour was not significantly different in uncomplicated labours and those complicated by fetal heart rate decelerations.

Conclusions
During active labour, mechanisms that may be unrelated to low fetal blood oxygen content reduce fetal brain blood vessel impedance.
Is transcutaneous electrical nerve stimulation of any value during cervical laser treatment?
Authors: CROMPTON ARCHIBALD C. , JOHNSON NICHOLAS , DUDEK URSULA , BATRA NEELAN , TUCKER ALISON
Published: August 2005

Objective
To assess the value of transcutaneous electrical nerve stimulation (TENS) during cervical laser therapy.

Design
Randomized three arm controlled clinical trial comparing (i) TENS, (ii) local anaesthetic and (iii) TENS plus local anaesthetic (direct infiltration of 2% lignocaine and 0.03 iu/ml octopressin).

Setting
Colposcopy Unit adapted to run randomized trials.

Subjects
100 women with CIN and no previous experience of cervical surgery.

Main outcome measure
Visual linear analogue pain scores.

Results
The median pain score associated with TENS was greater than the score associated with local anaesthesia (23% compared with 17%; P= 0.1). Combining TENS with local anaesthesia did not further reduce pain scores.

Conclusion
Although there was considerable consumer satisfaction with TENS it provided no additional pain relieving effect in addition to direct infiltration of lignocaine and it is inferior to lignocaine alone. We are unable to advocate the use of TENS for laser treatment of the cervix.
The effect of magnesium sulphate on blood flow velocity in the maternal retina in mild pre‐eclampsia: a preliminary colour flow Doppler study
Authors: BELFORT M. A.
Published: August 2005

Objectives
To investigate the use of colour flow Doppler ultrasound to identify retinal blood vessels in women with mild pre‐eclampsia and to assess the effects of an infusion of magnesium sulphate on the baseline retinal blood flow‐velocity.

Design
Prospective descriptive study.

Setting
Ben Taub Hospital, Baylor College of Medicine, Houston, Texas, USA.

Subjects
Eight women with mild pre‐eclampsia

Interventions
Baseline colour flow Doppler ultrasound assessment of the central retinal artery (CRA) and posterior ciliary artery (PCA) blood flow‐velocity before intravenous infusion of 6 g of magnesium sulphate in 100 ml of 5% dextrose water over 20 min, followed by repeat Doppler measurement.

Main Outcome Measures
Blood pressure, heart rate, pulsatility index (PI), resistance index (RI), angle‐corrected flow‐velocity (cm/s).

Results
The CRA and PCA were easily and reliably identified. The infusion of 6 g of magnesium sulphate significantly reduced (P<0.05) the mean CRA PI from 1.42 (SD 0.67) to 0.93 (SD 0.18) and the mean CRA RI (P < 0.008) from 0.62 (SD 0.07) to 0.53 (SD 0.10). The PCA PI decreased (P= 0.01) from 0.97 SD (0.14) to 0.78 SD (0.18) and the PCA RI decreased (P= 0.02) from 0.58 SD (0.07) to 0.48 SD (0.09). Angle‐corrected flow‐velocity decreased non‐significantly after the magnesium sulphate infusion.

Conclusions
Patients with pre‐eclampsia have high CRA and PCA flow‐velocity suggestive of vasospasm. Magnesium sulphate acutely vasodilates the small arteries in the retina, increasing retinal blood flow. Changes in the blood flow in the retina may be indicative of similar changes in other end‐arterial branches of the internal carotid artery. This non‐invasive Doppler method may provide a means to monitor the effects of therapeutic interventions in patients with pre‐eclampsia.
Midpregnancy plasma zinc in normal and growth retarded fetuses—a preliminary study
Authors: NASRAT HASSAN , BLOXAM DAVID , NICOLINI UMBERTO , WILLIAMS NORMAN , TANNIRANDORN YUEN , NICOLAIDES PETER , ROEDECK CHARLES H.
Published: August 2005

Objective
To determine plasma zinc concentrations in normally and abnormally growing fetuses.

Design
Prospective observational study.

Setting
Fetal Medicine Unit, Queen Charlotte's Maternity Hospital.

Subjects
53 pregnant women attending for fetal blood sampling at between 18 and 40 weeks gestation. 27 fetuses were normal (central group), 11 fetuses were growth retarded and 15 were malformed.

Main outcome measures
Plasma zinc concentrations in maternal and fetal blood at lime of fetal blood sampling.

Results
In normally growing fetuses, between 18 and 40 weeks gestation, there was no fall in maternal plasma zinc concentration; the fetal level fell by 36%. In 10 fetuses with symmetrical growth retardation, plasma zinc concentration tended to be low, but was not significantly different from that in the normal control fetuses.

Conclusion
The results suggest that (i) placental transfer of zinc is an uphill secretory process and that it is a rate‐limiting step in the accumulation of zinc by the fetus and (ii) in fetuses with symmetrical intrauterine growth retardation, a low plasma zinc is probably a parallel phenomenon and not necessarily an aetiological factor.
Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear
Authors: BEK K. M. , LAURBERG S.
Published: August 2005

Objective
To assess the influence of various risk factors on long term anal incontinence in women with a complete obstetric tear of the anal sphincter.

Design
Postal questionnaire.

Setting
Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark.

Subjects
152 women with complete obstetric tear of the anal sphincter.

Main outcome measures
Occurrence and duration of anal incontinence in relation to any delivery.

Results
56 of 121 respondents had experienced a subsequent vaginal delivery; 23 (41%) of these had had transient anorectal incontinence directly after the complete tear and four (7%) had permanent anorectal incontinence. In the 23 women with transient anorectal incontinence directly after the complete tear, 9 (39%; 95% CI 19%‐59%) developed anorectal incontinence after the next delivery, and this was permanent in four (17–4%; 95% CI 2%–33%). In the 29 women without anorectal incontinence after complete tear, two had transient incontinence of flatus but for less than 14 days after the next delivery.

Conclusions
Transient anal incontinence after a complete tear is a predictor of anal incontinence after subsequent vaginal delivery. The major long term problem in our study of premenopausal women was incontinence of flatus. This possibility should be discussed with the women when a further pregnancy is planned.
Fetal heart rate in early pregnancy and chromosomal disorders
Authors: VAN LITH J. M. M. , VISSER G. H. A. , MANTINGH A. , BEEKHUIS J. R.
Published: August 2005

Objective
To investigate normal fetal heart rate in early pregnancy and assess the hypothesis that abnormal fetal heart rate is associated with fetal chromosomal abnormalities.

Design
Prospective descriptive cross‐sectional study.

Setting
Antenatal clinic associated to the University Clinic of Obstetrics, University Hospital Groningen, The Netherlands.

Subjects
424 pregnant women who attended for prenatal counselling.

Interventions
Measurements of fetal heart rate from 6–16 weeks gestation, cross‐sectional study.

Main outcome measures
Fetal heart rate expressed as beats/min.

Results
Karyotyping showed a normal chromosomal pattern in 414 fetuses. The median fetal heart rate increased from 138 beats/min at 6 weeks to 177 beats/min at 9 weeks, thereafter, fetal heart rate gradually decreased to 150 beats/min at 16 weeks. Karyotyping showed 10 abnormalities: five trisomies 21, three trisomies 18, and two mosaic patterns in chorionic villi. Fetal heart rate of the trisomic fetuses was distributed around the median with that of all Down's syndrome fetuses within the normal range. In one fetus with trisomy 18, the heart rate exceeded the 90th centile, in another it fell under the 10th centile. The two fetuses with a mosaic pattern in chorionic villi had heart rates outside the normal range.

Conclusion
Fetal heart rate in chromosomally abnormal fetuses in early pregnancy do not appear to be consistently different from that in normal fetuses. The use of a single measurement of fetal heart rate is not valuable for screening purposes. Chromosomal mosaicism in chorionic villi may be associated with abnormal fetal heart rate.
Folate and vitamin B12 concentrations in maternal and fetal blood, and amniotic fluid in second trimester pregnancies complicated by neural tube defects
Authors: ECONOMIDES D. L. , FERGUSON J. , MACKENZIE I. Z. , DARLEY J. , WARE I. I. , HOLMES‐SIEDLE M.
Published: August 2005

Objective
To investigate maternal and fetal folate and vitamin B12 concentrations in pregnancies affected by neural tube defects (NTD).

Design
Measurement of folate and vitamin B12 concentrations in amniotic fluid, fetal blood and maternal blood samples in midgestation.

Subjects
32 women undergoing termination of pregnancy at 14–21 weeks gestation for social reasons (n = 24) or for fetuses with neural tube defects(n = 8).

Interventions
Fetoscopy before intra‐amniotic injection of prostaglandins.

Results
In normal pregnancies there was a positive correlation between maternal and fetal serum folate, and the fetal serum and red blood cell folate concentrations were higher than the maternal. There were no differences in amniotic fluid, maternal blood or fetal blood folate concentrations between pregnancies with NTD and normal pregnancies. Although amniotic fluid vitamin B12 was lower in pregnancies with NTD, maternal serum vitamin B12 concentration was not reduced.

Conclusion
In this small group of pregnancies with NTD at mid‐gestation there is no evidence to suggest folate or vitamin B12 deficiency.
Transfer and metabolism of platelet‐activating factor by fetal membranes, amnion and chorio‐decidua
Authors: MORRIS CHRISTINE , SULLIVAN M. H. F. , ELDER M. G.
Published: August 2005

Objective
To determine the metabolism of 3H‐Platelet‐activating factor (3H‐PAF) during transfer through human fetal membranes.

Design
3H‐PAF was added to the fetal side of cultured intact fetal membranes, amnion and chorio‐decidua obtained from three pregnancies ending in elective caesarean section.

Main outcome measures
Radioactivity was measured on both sides of the tissue, and in the tissue itself. In some experiments, the metabolism of 3H‐PAF was assessed by thin‐layer chromatography.

Results
Very little 3H‐PAF crossed the intact fetal membrane (<2%) during 24 h of culture. Most of the 3H‐PAF which accumulated in the membrane was converted to a range of metabolites in the chorio‐decidua.

Conclusions
These results suggest that PAF in amniotic fluid may not reach the decidua, and therefore is unlikely to be involved in the control of prostaglandin production from this tissue.
Long term follow up of women after hysterectomy with a history of pre‐invasive cancer of the cervix
Authors: WIENER J. J. , SWEETNAM P. M. , JONES J. M.
Published: August 2005

Objective
A long term review of women after hysterectomy with a history of pre‐invasive carcinoma of the cervix.

Design
193 women had cervical intra‐epithelial neoplasia and two had adenocarcinoma in situ either at hysterectomy or at previous cone biopsy. These were followed up by annual cytology.

Setting
South Glamorgan Health Authority.

Subjects
Of 195 women who had a hysterectomy, 143 have been followed up cytologically for more than 10 years and 43 for more than 20 years: a total of 2800 women years of experience.

Main outcome measures
Timing of abnormal smears.

Results A detailed reviw of the five women with abnormal smears. The estimated percentage of women who remain negative is 98% at five years, 98.4%, at 10 years and 96.5 % at 20 years.

Conclusion
Cytological screening ofall women who had a hysterectomy with a history of CIN is indicated for the first two years after hysterectomy. Thereafter the estimated incidence of 0.7 per 1000 women years is higher than the general population but it is not a sufficient reason to screen more frequently. We recommend screening for the carcinoma of the vagina to be every three years which is the same screening frequency as for cervical carcinoma in the general population.
the treatment of intrahepatic cholestasis of pregnancy by dexamethasone
Authors: HIRVIOJA MARJA‐LIISA , TUIMALA RISTO , VUORI JUHANI
Published: August 2005

Objective
To investigate whether dexamethasone supression of fetoplacental oestrogen production can reduce obstetric cholestasis.

Design
Observational study.

Setting
Department of Obstetrics and Gynaecology, University of Tampere, Finland.

Subjects
10 women, at between 28 and 37 weeks gestation, with intrahepatic cholestasis of pregnancy.

Interventions
Treatment with 12 mg oral dexamethasone daily for 7 days, after which the therapy was gradually discontinued over 3 days.

Main outcome measures
Serum oestriol, oestradiol, total bile acids and ALAT were measured before and during therapy and on days 4 and 7 and ALAT also on day 12. Differences were tested by paired t test.

Results
Itching disappeared or was relieved in all patients. Serum oestriol level fell significantly by day 1 of treatment, serum oestradiol and total bile acid levels by day 4 and ALAT by day 12 from the beginning of the therapy.

Conclusion
Dexamethasone is a drug of choice in the treatment of intrahepatic colestasis of pregnancy.
The accuracy of catheter‐tip pressure transducers for the measurement of intrauterine pressure in labour
Authors: CHUA S. , ARULKUMARAN S. , YANG M. , RATNAM S. S. , STEER P. J.
Published: August 2005

Objective
To assess the reliability of intrauterine pressure measurements in labour with transducer tipped catheters.

Design
Prospective clinical study.

Setting
Delivery ward, National University Hospital, Singapore.

Subjects
20 women admitted in early labour were randomly allocated to two groups.

Interventions
Women in the first group had two catheters that had been tied together introduced transcervically into the same amniotic fluid pocket. The second group had two catheters introduced in different directions so that each catheter tip was in a different pocket of amniotic fluid.

Main outcome measure
The contraction to contraction pressure difference recorded by the two catheters in the same uterus. In addition, the cumulative uterine active pressure generated by one catheter was compared with that of the other.

Results
There were differences in peak pressure of up to 4–5.3 kPa (30–40 mmHg) during some contractions. The difference in pressure recordings between the two catheters could not be explained by effects of loculation of amniotic fluid. However, the pressures recorded were not systematically higher in one catheter than in the other. Cumulative uterine activity was very similar when assessed by each catheter in the same uterus.

Conclusion
Intrauterine pressure measurements using transducer tipped catheters provide reliable information on the cumulative pressure wherever the catheter tip was sited in the uterus, but there are variations in pressures recorded during individual contractions.
Noninvasive assessment of the maternal cerebral circulation by transcranial Doppler ultrasound during angiotensin II infusion
Authors: Kyle Phillipa M. , Swiet Michael de , Buckley Davina , Serra Vicente Serra , Redman Christopher W. G.
Published: August 2005

Objective
To examine the relationship between experimentally induced increments in blood pressure and maternal middle cerebral artery flow velocity patterns measured by transcranial Doppler ultrasound (TCD).

Design
Prospective experimental study.

Setting
John Radcliffe Maternity Hospital, Oxford.

Intervention
Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the temporal cranial approach at 28 weeks gestation before, during and 10 min following an angiotensin II infusion.

Subjects
101 normotensive primiparous women at 28 weeks gestation.

Results
A significant rise in blood pressure and fall in heart rate were demonstrated between pre‐infusion and maximum angiotensin II infusion (maximum blood pressure) recordings. Simultaneous changes were observed in all flow velocity indices, shown as a decrease in systolic velocity and pulsatility index, and an increase in diastolic and mean velocity (P<0.0001). These values all returned to baseline levels 10 min post infusion (P<0.0001). Statistical analysis suggested that the change in flow velocity is related to the rise in blood pressure rather than the direct effect of angiotensin II on the cerebral circulation.

Conclusion
Transcranial Doppler can detect changes in the cerebral circulation associated with alterations in blood pressure during pregnancy. The technique needs to be evaluated further in hypertensive disease.
Asymptomatic women at high risk of vertical HIV‐1 transmission to their fetuses
Authors: Tibaldi Cecilia , Tovo Pier A. , Ziarati Nahid , Palomba Elvia , Salassa Bernardino , Sciandra Mauro , D'Ambrosio Rosa , Ponti Antonio , Sinicco Alessandro
Published: August 2005

Objective
To identify how reliably CD4+ (helper) lymphocyte count and p24 antigenaemia can predict mother‐to‐infant transmission of human immunodeficiency virus type 1 (HIV‐1).

Design
Prospective study.

Setting
University of Turin Center for Intravenous Drug Users (IVDU) and/or HIV‐1 seropositive pregnant women.

Subjects
Twenty‐nine infants born to asymptomatic seropositive women from November 1985 to June 1991.

Results
Seven children (24%) developed symptomatic infection, while 22 healthy seronegative children at the age of 18 months were considered uninfected. A CD4+ lymphocyte count persistently <500/mm3 during pregnancy was associated significantly with the child's infection status with a relative risk (RR) of 11.4. (CI 1.58–82.05). A marked association (RR 13.6) (CI 1.93–95.72) was similarly detected between maternal antigenaemia and the risk of the child being infected. In a multivariate logistic analysis, crude and adjusted odds ratios (OR) of transmission were 27.0 (95% CI 2.5–291.2) and 35.6 (1.1–1159) for low CD4+ counts; 64 (3.2–1261) and 51.6 (2.5–1058) for p24 antigenaemia.

Conclusions
Asymptomatic HIV positive women with a CD4+ count below 500/mm3 or p24 antigenaemia are about ten times as likely to transmit the virus to their children. CD4+ lymphocytes decrease during pregnancy and a low CD4+ cell count early in pregnancy remains low up to delivery. Therefore knowledge that they have a low CD4+ lymphocyte count early in pregnancy may help women to decide whether or not to continue their pregnancy.
Assisted conception using buserelin and human menopausal gonadotrophins in women with polycystic ovary syndrome
Authors: Wada I. , Matson P. L. , Troup S. A. , Lieberman B. A.
Published: August 2005

Objective
To compare the outcome of in vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) cycles in women with or without ultrasound features of polycystic ovary syndrome (PCOS).

Design
A consecutive series from January to December 1989.

Subjects
Twenty‐five women with PCOS scheduled for assisted conception. The controls were 139 women with normal ovaries.

Setting
A single centre specialist fertility unit, Manchester, UK.

Interventions
Pituitary desensitisation was with buserelin. In the PCOS group ovarian stimulation was with 1 ampoule (75 iu FSH) of hMG/day in 12 women (Group I) and two ampoules/day in 13 (Group II). The controls (Group III) were given two ampoules of hMG daily. Human chorionic gonadotrophin (hCG; 10 000 iu) was given when three follicles measured 20 mm diameter.

Main outcome measures
Serum oestradiol (E2) concentrations, number of follicles, clinical pregnancies, features of the ovarian hyperstimulation syndrome (OHS).

Results
Women with PCOS (Groups I or II) had more follicles 14 mm diameter on the day of the hCG injection (P<0.005), higher serum E2 concentrations on the day after the hCG (P<0.05) and more oocytes retrieved (P<0.05) than the controls. The OHS was more prevalent in those with PCOS (32% versus 6.5%; P<0.05). The clinical pregnancy rate per embryo transfer (27% versus 22%) or gamete transfer (25% versus 39%) and the rate of spontaneous miscarriage (33% versus 12%) were not statistically different.

Conclusions
The pregnancy rate and outcome of pregnancy following IVF or GIFT in women with or without PCOS are similar. Women with PCOS are at a higher risk of developing OHS.
A paramedic based emergency domiciliary obstetric service: the South Glamorgan experience
Authors: Hibbard Bryan M. , Dawson Andrew , Boyce Janet , Oliver Mary , Goodall Keith , Organ Philip , Rookes Neville
Published: August 2005

Objective
To assess the potential benefits of using extended trained ambulance personnel (paramedics) as primary responders for domiciliary obstetric and gynaecological emergencies.

Design
An observational study of performance and analysis of operational data in a newly established service.

Setting
A mixed urban and rural population served by South Glamorgan Health Authority.

Main outcome measures
Work load, response times, management and transfer of patients, efficiency of communications and appropriateness of training.

Results
There was an initial increase in requests above that when a hospital‐based service operated. Targets for response times were met. The mean response time for providing appropriate skilled help was halved compared with the previous arrangements and a safe and efficient service was provided. Prompt transport and advance notice and preparation for reception in the delivery unit contributed to optimal management. Medical staff depletion in the delivery unit was minimised.

Conclusion
An Emergency Domiciliary Obstetric Service based on primary response by specially trained ambulance service paramedics can beneficially replace traditional hospital‐based Obstetric Flying Squads.
Invasive carcinoma of the cervix following local destructive treatment for cervical intraepithelial neoplasia
Authors: Anderson M. C.
Published: August 2005

Objective
To investigate the occurrence of invasive carcinomas following local destructive treatment for cervical intraepithelial neoplasia (CIN) and to evaluate the factors responsible.

Design
A multicentre retrospective study.

Subjects
Forty‐nine women registered with the British Society for Colposcopy and Cervical Pathology from 24 centres throughout Great Britain between 1985 and 1992, who had been treated by local destructive methods for CIN and who subsequently developed invasive carcinoma of the cervix.

Results
Of the 49 women whose details were submitted, 42 had squamous cell carcinoma, six adenosquamous carcinoma and one adenocarcinoma. Eight had microinvasive carcinomas (Stage Ia) at the time of diagnosis, 24 had Stage Ib tumours and eight Stages II to IV. Thirteen women have died. Thirty‐five women had been treated by laser vapourisation, ten by cold coagulator, two by diathermy and two by cryosurgery. In 19 women (39%) the diagnosis of invasive carcinoma was made on the first follow up visit or within one year of treatment. Five patients did not present with invasive disease until more than five years after treatment.

Conclusions
The data presented suggest that many, but not all, of the invasive carcinomas presenting after local destructive treatment for CIN resulted from failure to recognise early invasive disease at the time of the initial assessment. The importance of thorough evaluation before undertaking these forms of treatment is emphasised. The use of excisional procedures should further reduce the small risk of invasive carcinoma developing after treatment for CIN.
Erythrocyte sodium lithium countertransport in normal and hypertensive pregnancy: relation to haemodynamic changes
Authors: Macphail Sheila , Thomas Trevor H. , Wilkinson Robert , Davison John M. , Dunlop William
Published: August 2005

Objective
To establish the changes in erythrocyte sodium lithium countertransport (SLC) with advancing normal pregnancy and to determine if these changes were different in pregnancy induced hypertension (PIH). The changes in both groups were assessed in relation to haemodynamic changes.

Design
SLC, mean arterial pressure (MAP), cardiac output (CO) and total peripheral vascular resistance (TPVR) were determined serially during normal pregnancy and cross‐sectionally in PIH. Women were studied again 20 weeks after delivery where possible.

Setting
Routine antenatal clinic and antenatal ward of a regional reference centre.

Subjects
Fifty‐one normal primigravid women were studied serially and 41 primigravid women with PIH were studied at time of diagnosis.

Results
During normal pregnancy SLC (mmol Li/h/l cells) increased from a nonpregnant value of 0.24 ± 0.02 (mean ± SEM) to 0.32 ± 0.02 at 14 weeks, and 0.37 ± 0.02 at 20 weeks gestation. This was maintained until 38 weeks (0.40 ± 0.02). The increase until 20 weeks occurred at the time of greatest change in CO (5.10 ± 0.18 to 6.79 ± 0.20 l/min) and TPVR (1327 ± 58 to 969 ± 33 dyn/s/cm−5). The decrease in TPVR with a rise in SLC is opposite to the relation reported in essential hypertension so that a functional relation is unlikely. However, the changes within pregnancy were positively correlated (r = 0.43, P<0.01). In hypertensive pregnancies TPVR was elevated compared with normotensive pregnancies (1543 ± 100 vs 1090 ± 37) but the SLC was not different from that found in normotensive pregnancies (0.43 ± 0.02 vs 0.40 ± 0.02).

Conclusions
The changes in SLC activity suggest dynamic effects on erythrocyte membrane function during pregnancy. However, no differences could be found between normal and hypertensive pregnancy and SLC is unlikely to be of value as a marker of hypertensive risk during pregnancy.