bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomised controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour
Authors: Choy C.M.Y. , Lau W.C. , Tam W.H. , Yuen P.M.
Published: December 2003

Objective
To compare the efficacy and safety of intravenous oxytocin with intramuscular syntometrine in the management of the third stage of labour

Design
A prospective randomised trial

Setting
A university teaching hospital

Methods
A total of 991 women having a singleton pregnancy and vaginal delivery were randomised by a computer‐generated number to receive either 1ml syntometrine intramuscularly or 10 units of intravenous Syntocinon after delivery of the anterior shoulder of the fetus

Main outcome measures
Blood loss during delivery, rate of postpartum haemorrhage, need for repeated oxytocics, haemoglobin level before and 24 hours after delivery, duration of third stage, need for manual removal of placenta and sides effects including hypertension, nausea, vomiting, headache and chest pain

Results
The use of intravenous oxytocin was associated with a reduction in postpartum blood loss (P < 0.001) but there was no difference in the risk of postpartum haemorrhage in the need for repeated oxytocic injections and the drop in peripartum haemoglobin level between the two groups. There was also no difference in the risk of prolonged third stage, or in the need for manual removal of placenta. The use of syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% CI 1.00–5.70). Other side effects were mild in nature with no differences between the two groups

Conclusions
There are no important clinical differences in the effectiveness of intramuscular syntometrine and intravenous oxytocin for the prevention of postpartum blood loss. Intravenous oxytocin is less likely to cause hypertension
Acupuncture treatment during labour—a randomised controlled trial
Authors: Ramnerö Agneta , Hanson Ulf , Kihlgren Mona
Published: December 2003

Objective
To investigate acupuncture treatment during labour with regard to pain intensity, degree of relaxation and outcome of the delivery.

Design
Randomised controlled trial.

Setting
Delivery ward at a tertiary care centre hospital in Sweden.

Population
Ninety parturients who delivered during the period April 12, 1999 and June 4, 2000.

Methods
Forty‐six parturients were randomised to receive acupuncture treatment during labour as a compliment, or an alternative, to conventional analgesia.

Main outcome measures
Assessments of pain intensity and degree of relaxation during labour, together with evaluation of delivery outcome.

Results
Acupuncture treatment during labour significantly reduced the need of epidural analgesia (12%vs 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30 to 0.92). Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group (mean difference −0.93, 95% CI −1.66 to −0.20). No negative effects of acupuncture given during labour were found in relation to delivery outcome.

Conclusions
The results suggest that acupuncture could be a good alternative or complement to those parturients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.
Muscle strength and tibolone: a randomised, double‐blind, placebo‐controlled trial
Authors: Meeuwsen Ingrid B.A.E. , Samson Monique M. , Duursma Sijmen A. , Verhaar Harald J.J.
Published: December 2003

Objective
To investigate the effects of tibolone, a tissue‐specific compound with a mixed (estrogenic, progestogenic and androgenic) hormonal profile, on skeletal muscle strength in a group of healthy postmenopausal women

Design
Randomised, parallel group, double‐blind, placebo‐controlled, single‐centre trial conducted between August 1997 and July 1999

Participants
Eighty‐five healthy women, between one and 15 years postmenopausal, (mean [SD] age, 54.2 [4.7] years) recruited from local paper advertisements. Participants were randomly assigned to 2.5mg tibolone or to identically appearing placebo pills daily for 12 months, taken orally in the morning

Methods
Both maximal handgrip strength, representing upper body strength, and maximal quadriceps strength, representing lower body strength, were measured isometrically

Main outcome measures
Treatment effect estimates (between group differences) in handgrip strength and isometric knee extension at last visit

Results
Tibolone significantly (P= 0.04) increased handgrip strength compared with placebo (difference 0.99 kg, [95% CI 0.1–1.9]). No significant treatment effect (P= 0.61) was observed in isometric knee extension strength. Isometric strength adjusted for body mass index resulted in a trend favouring tibolone (P= 0.06). Individual trend analysis showed a significant difference in rate of change throughout the year (6.8% [95% CI 2.1–10.7]) favouring tibolone

Conclusions
Administration of tibolone increased handgrip strength in postmenopausal women compared with placebo. A trend indicating a positive effect in isometric knee extension strength adjusted for body mass index was observed. Tibolone seems to mitigate the menopause‐related decline in muscle strength
Can pre‐operative computed tomography predict resectability of ovarian carcinoma at primary laparotomy?
Authors: Byrom J. , Widjaja E. , Redman C.W.E. , Jones P.W. , Tebby S.
Published: December 2003

Objective
To assess the ability of computed tomography in predicting whether suspected ovarian cancer could be fully excised at primary laparotomy.

Design
Retrospective analysis of patient notes and pre‐operative computed tomography scans.

Setting
A UK NHS cancer centre.

Population
Seventy‐seven women who underwent laparotomy for an ovarian tumour and who had had a pre‐operative computed tomography scan.

Methods
Women who had a computed tomography scan before laparotomy for an ovarian tumour were identified. Analysis was undertaken to determine the accuracy of computed tomography in predicting malignancy, stage and residual disease. The computed tomography parameters significantly associated with residual disease were determined by a χ2 analysis. These parameters, in addition to age and CA125, were used to generate a predictive model. This model was further refined by stepwise logistic regression and a clinical scoring index was generated.

Main outcome measures
To identify those computed tomography parameters significantly associated with residual disease and to use these with CA125 and age to generate a useful clinical scoring index to predict residual disease in suspected ovarian cancer.

Results
Seventy‐seven women underwent a laparotomy for an ovarian tumour and had a pre‐operative computed tomography scan. Fifty‐one of these women had malignant disease and twenty‐five of these women had residual disease remaining. The sensitivity of computed tomography in predicting malignancy was 90% with a specificity of 85% and the overall accuracy of computed tomography for predicting stage of disease was 73% (37/51). The overall sensitivity of computed tomography in predicting residual disease was 88%, the specificity was 92% and the positive predictive value was 85%. The parameters on computed tomography that were significantly (P < 0.05) associated with residual disease were ascites, omental cake, mesenteric disease, paracolic gutter deposits, diaphragmatic deposits and pleural effusion. The predictive model generated was more accurate than computed tomography alone (sensitivity 88%, specificity 98%, positive predictive value 95%). Using stepwise logistic regression enabled the predictive model to be simplified to include mesenteric disease, omental cake, age and CA125 without any change in sensitivity or specificity and this model was used to generate a scoring index.

Conclusion
This study shows that prediction of resectability by computed tomography is excellent and is further improved by the generation of a predictive model, which can be used to generate a simple scoring index. This scoring system now needs to be tested prospectively to ensure that its performance remains as good in an independent sample population.
A double‐blind randomised controlled trial of continuous oxygen therapy for compromised fetuses
Authors: Lindow S.W. , Mantel G.D. , Anthony J. , Coetzee E.J.
Published: December 2003

Objective
To investigate the effect of chronic oxygen therapy in fetuses with absent end diastolic flow in the umbilical artery assessed by doppler analysis at 24–30 weeks of gestation.

Design
A double‐blind, randomised control trial was performed with patients blindly allocated to receive humidified oxygen or humidified air.

Setting
A tertiary referral hospital in South Africa.

Participants
Thirty‐two women who presented between 24 and 30 weeks of gestation with a confirmed finding of absent end diastolic flow in the umbilical artery.

Methods
After randomisation patients were allocated to receive a 40% mixture of humidified oxygen or humidified air from uniform coloured gas cylinders which were marked either ‘a’ or ‘b’ All women received betamethasone from 27 weeks of gestation on a weekly basis. Cardiotocographs were used from 28 weeks of gestation; after 28 weeks of gestation an amniocentesis was considered to confirm fetal maturity. Women were expected to breath the allocated gas continuously apart from meals and visits to the toilet.

Main outcome measures
Survival of the fetus was the main outcome measure with secondary outcome measures documenting improvement in the fetal condition in utero.

Results
There were 16 women randomised to receive oxygen and 16 to receive air. There were nine survivors in the oxygen group (56.3%) and six in the air group (37.5%) (relative risk 1.5, 95% confidence interval 0.7–3.2). There was a nonsignificant increase in mean birthweight in the oxygen group (858.3 grammes vs 774.4 grammes) and a nonsignificant increase in mean duration of treatment in the oxygen group (12.8 days vs 10.4 days).

Conclusion
This study did not demonstrate that chronic oxygen therapy provides any benefits to compromised fetuses between 24 and 30 weeks of gestation. Larger studies with sufficient power are necessary to assess whether oxygen therapy can reduce perinatal mortality by a clinically useful amount in this group of patients.
Knowledge, use and attitudes towards emergency contraceptive pills among swedish women presenting for induced abortion
Authors: Aneblom Gunilla , Larsson Margareta , Odlind Viveca , Tydén Tanja
Published: December 2003

Objective
To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion.

Design
Survey by self‐administered waiting room questionnaires.

Setting
Three large hospitals in the cities of Uppsala, Västerås and Örebro in Sweden.

Population
591 Swedish‐speaking women consecutively attending the clinics for an induced abortion during a four‐month period in 2000.

Results
The response rate was 88% (n= 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter.

Conclusions
Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back‐up method.
Endothelial cell expression of adhesion molecules is induced by fetal plasma from pregnancies with umbilical placental vascular disease
Authors: Wang Xin , Athayde Neil , Trudinger Brian
Published: December 2003

Objective
To test the hypothesis that local production with spill into the fetal circulation of factor(s) injurious to endothelium is responsible for the vascular pathology present when the umbilical artery Doppler study is abnormal. Expression of adhesion molecules is a feature of endothelial cell activation.

Design
Case–control study.

Setting
University teaching hospital.

Samples
Fetal plasma was collected from 27 normal pregnancies, 39 pregnancies with umbilical placental vascular disease defined by abnormal umbilical artery Doppler and 11 pregnancies with pre‐eclampsia and normal umbilical artery Doppler.

Methods
Isolated and cultured human umbilical vein endothelial cells from normal pregnancies were incubated with fetal plasma from three study groups. mRNA expression of intercellular cell adhesion molecule‐1 (ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1) and platelet‐endothelial cell adhesion molecule‐1 (PECAM‐1) were assessed by reverse transcription‐polymerase chain reaction. To confirm the occurrence of this in vivo, we measured the levels of soluble fractions of sICAM‐1, sVCAM‐1 and sPECAM‐1 in the fetal circulation in the fetal plasma used for endothelial cell incubation.

Results
The mRNA expression of ICAM‐1 [median 1.1 (interquartile range 0.5–1.9) vs 0.7 (0.3–1.2), P < 0.05] and PECAM‐1 [2.1 (1.2–3.0) vs 1.5 (0.7–2.1), P < 0.05] was significantly higher following incubation with fetal plasma from umbilical placental vascular disease compared with the normal group. There was no difference in the expression of VCAM‐1 [1.2 (0.9–1.8) vs 1.1 (0.8–1.6), ns]. The group with maternal pre‐eclampsia and normal umbilical artery Doppler did not differ from the normal group. In the umbilical placental vascular disease group, the results were similar in the presence or absence of pre‐eclampsia. For soluble fractions of the adhesion molecules released into the fetal circulation, we found the levels (ng/mL) of sICAM‐1 [median 248.5 (interquartile range 197.3–315.7) vs 174.2 (144.5–212.9), P < 0.05] and sPECAM‐1 [9.3 (6.2–11.1) vs 6.1 (5.4–7.7), P < 0.05] in fetal plasma to be significantly increased in the presence of umbilical placental vascular disease compared with the normal.

Conclusions
Vascular disease in the fetal umbilical placental circulation is associated with an elevation in mRNA expression by endothelial cells of ICAM‐1 and PECAM‐1. Our study provides evidence for endothelial cell activation and dysfunction in umbilical placental vascular disease. We speculate that the plasma factor(s) affecting the vessels of the umbilical villous tree is locally released by the trophoblast. The occurrence of the maternal syndrome of pre‐eclampsia appears to be independent of this.
The effect of body mass index on three methods of fetal weight estimation
Authors: Farrell Tom , Holmes Rob , Stone Peter
Published: December 2003

Objective
To assess agreement between three methods of estimation of fetal weight and determine the influence of maternal obesity.

Design
Prospective observational study.

Setting
A tertiary referral teaching hospital.

Population
Unselected women attending for induction of labour.

Method
Maternal, clinical and ultrasonic estimations of fetal weight were made prior to induction of labour in 96 consenting women. The estimations of fetal weight were performed independently by the three methods.

Main outcome measure
Bland and Altman plots to show limits of agreement, and intraclass correlation coefficients.

Results
Variable levels of accuracy were obtained for maternal, clinical and ultrasound estimates of fetal weight. Ultrasound estimation of fetal weight performed equally best for women of high and low body mass index (BMI). For women of low BMI, the intraclass correlation coefficient (ICC) was 0.90 (95% CI 0.83–0.94) and 0.87 (95% CI 0.77–0.93) for women with high BMI. Despite this, the limits of agreement for ultrasound were in the order of −700 to +500 g. Both maternal and clinical estimation of fetal weight under‐estimated true fetal weight in women with low BMI and over‐estimated the true fetal weight in women with high BMI. The largest observed mean difference was obtained with clinical palpation in both low and high BMI women.

Conclusion
The accuracy of ultrasound estimation of fetal weight was better than maternal and clinical estimation of fetal weight and was not influenced significantly by maternal BMI.
Factors associated with maternal mortality in rural Guinea‐Bissau. A longitudinal population‐based study
Authors: Høj L. , Da Silva D. , Hedegaard K. , Sandström A. , Aaby P.
Published: December 2003

Objective
To assess demographic and obstetric risk factors for pregnancy‐related death in a multiethnic rural population in a developing country.

Design
A prospective survey of women in the fertile age‐range.

Setting
Rural Guinea‐Bissau.

Population
More than 15,000 women living in 100 clusters were visited at six‐monthly intervals over a period of more than six years. A total of 10,931 pregnancies were registered prospectively; 85 of these pregnancies resulted in maternal or late maternal death.

Main outcome measure
Maternal mortality ratio.

Method
In the rural areas of Guinea‐Bissau, we conducted a prospective survey of women in the fertile age range. More than 15,000 women living in 100 clusters were visited at 6‐monthly intervals over a period of more than six years. An analysis of demographic, environmental and obstetric risk factors for maternal death was performed based on 10,931 prospectively registered pregnancies; 85 of these pregnancies resulted in maternal or late maternal death.

Results
In the adjusted model maternal mortality ratio increased with increasing distance from the regional hospital (OR>25 km= 7.4 [95% CI: 1.6–132]). Multiple pregnancy was found to increase the risk of maternal death (OR = 3.4 [95% CI: 1.3–7.5]). The risk of subsequent maternal death was increased if the fetus was stillborn (OR = 5.3 [95% CI: 2.8–9.4]). Women living in the region of Gabu had higher mortality than those living in Biombo (OR = 2.5 [95% CI: 1.3–5.1]). No category of age or parity were associated with an increased risk of maternal mortality. Predictive values did not exceed 3% for any of the significant risk factors.

Conclusions
For the purpose of reducing maternal mortality, the screening approach of antenatal care is of limited value. Age and parity should not be used routinely as selection criteria for transfer of otherwise healthy pregnant women to higher‐level health institutions. Twin pregnancy seems to be the only operational risk factor identified in this study. Stillbirth is associated with an increased risk of maternal death. Regional differences must be studied further. The distance to emergency obstetric care (EOC) may determine the outcome of a complicated delivery.
Does fetal tracheal fluid flow during fetal breathing movements change before the onset of labour?
Authors: Kalache K.D. , Chaoui R. , Marks B. , Wauer R. , Bollmann Rainer
Published: December 2003

Objective
To examine changes in intra‐tracheal fluid flow parameters during fetal breathing movements throughout the second half of pregnancy in the normally developing human fetus.

Design
Prospective cross‐sectional study.

Setting
Fetal medicine unit at the Charité University Hospital in Berlin.

Methods
Assessment of tracheal fluid flow was attempted in 340 healthy fetuses (GA 20–40 weeks) in which fetal breathing movements were seen by B‐mode scan. Colour Doppler was applied to visualise the tracheal fluid flow, followed by spectral Doppler to record the velocity waveforms. The records of 53 fetuses divided into five gestational age groups (20–23, 24–27, 28–31, 32–35 and 36–40 weeks of gestation) containing 40 or more continuous breathing cycles (inspiration and expiration) were considered for analysis. Only regular breathing phases were examined and the volume obtained by integration of the tracheal fluid flow displaced during fetal breathing movements was calculated.

Results
The intra‐tracheal flow volume moved during inspiration (Vi) and expiration (Ve) increased until 36 weeks of gestation after which there was a flattening until term. This suggests either a reduction of lung liquid production or a diminished lung liquid volume. The median difference between Vi and Ve was positive in the first four age groups and negative in the last one suggesting that, in mature fetuses, the effect of fetal breathing movements no longer results in an influx.

Conclusions
Our data demonstrate a modification in fetal behaviour that manifests itself during the last four weeks before birth and has the potential to reduce lung liquid volume.
Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial
Authors: Petersen Rodney W. , Quinlivan Julie A.
Published: December 2003

Objective
To examine the effect of counselling and relaxation intervention on psychological symptoms in patients with gynaecological cancer between the post‐operative period and the six‐week review.

Design
Randomised controlled trial.

Participants
Fifty‐three patients with gynaecological cancer.

Setting
Three Australian tertiary referral hospitals.

Methods
Fifty‐three patients were randomised to control or intervention and completed the baseline Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire‐28 (GHQ‐28) questionnaires. The intervention consisted of a relaxation and counselling session performed by a senior doctor. Follow up questionnaires were completed at six weeks. Demographic and tumour data were collated independently.

Results
Complete data were available on 50 patients. There were no significant differences in demographic, social support or tumour characteristics between the two groups. Multivariate analysis determined that only the intervention and baseline score were significant predictors of outcome. The intervention was associated with a significant reduction in total HADS score (P= 0.002). The reduction was seen in both anxiety and moderate depression subscales (P= 0.001 and P= 0.02). The intervention was also associated with a significant reduction in total GHQ‐28 score and in three of the four subscale scores (somatisation, anxiety and personality development; all P < 0.02). However, no significant difference was found in the fourth subscale of major depression.

Conclusion
A relaxation and counselling intervention performed by a treating doctor reduces psychological symptoms in women with a new diagnosis of gynaecological cancer.
Can the levonorgestrel intrauterine system replace surgical treatment for the management of menorrhagia?
Authors: Nagrani Rani , Bowen‐Simpkins Peter , Barrington Julian W.
Published: December 2003

Menorrhagia is a common gynaecological condition for which medical treatment is often ineffective and a large number of women undergo major surgery. Previous short term studies have shown a significant number of women with menstrual problems may avoid surgery if a levonorgestrel intrauterine system (LNG‐IUS) is fitted but no long term studies exist to ascertain if this benefit is sustained. This four to five year long term follow up study showed 50% of women continued to use the device and 67.4% avoided surgery. The LNG‐IUS is well accepted and effective in the management of menorrhagia and has major cost implications to the National Health Service.
Relationship between total homocysteine and folate levels in pregnant women and their newborn babies according to maternal serum levels of vitamin B12
Authors: Guerra‐Shinohara Elvira M. , Paiva Adriana A. , Rondó Patrıacute;cia H.C. , Yamasaki Kátia , Terzi Carolina A. , D'Almeida Vânia
Published: December 2003

Objective
To determine total homocysteine and folate levels in pregnant women according to vitamin B12 (B12) levels, and to analyse the impact of maternal B12 levels on the nutritional status of their newborn babies.

Design
Cross sectional observational study.

Setting
Two public hospitals in Jundiai City, São Paulo, Brazil.

Sample
Sixty‐nine pregnant women and their respective newborn babies at the time of delivery.

Methods
Maternal blood was collected up to 8 hours before delivery. Umbilical cord blood was collected after the expulsion of the placenta. Total homocysteine was measured by high perfomance liquid chromatography, folate by ion capture methodology and B12 by enzyme immunoassay.

Main outcome measures
Relationship between low maternal vitamin B12 levels and total homocysteine and folate levels in pregnant women and new born babies.

Results
There was a significant correlation between maternal and neonatal B12 levels, but not between maternal B12 and neonatal red blood cell (RBC) folate. There was a weak correlation between maternal B12 levels and neonatal serum folate. However, there were significant correlations between maternal and neonatal total homocysteine levels and between neonatal B12 and neonatal total homocysteine levels. Mean (±SD) umbilical cord blood B12, RBC folate, serum folate and total homocysteine levels were 1.7 ± 0.8, 1.8 ± 0.8, 2.2 ± 0.8 and 0.9 ± 0.3 times higher than maternal B12, RBC folate, serum folate and total homocysteine values, respectively.

Conclusions
These data suggest that pregnant women with low B12 levels are unable to provide the necessary amount of B12 to their fetuses. The clinical consequences could be the presence of neurological abnormalities as well as the lack of utilisation of homocysteine for methionine transformation.
Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches
Authors: Brodszki J. , Länne T. , Stale H. , Batra S. , Maršál K.
Published: December 2003

Objectives
To assess endothelial function and vascular mechanical properties in normotensive pregnant women with high resistance in the uteroplacental circulation.

Design
Cross‐sectional prospective study.

Setting
Doppler ultrasound laboratory at university department of obstetrics and gynaecology referral centre for high risk pregnancies.

Participants
Forty‐two caucasian normotensive pregnant women: 23 with uncomplicated pregnancies and 19 with bilateral uterine artery notches.

Methods
Flow‐mediated dilatation of the brachial artery was measured by ultrasonography at 25 gestational weeks. Concentrations of nitrite and nitrate in the plasma were established at 25 and 32 gestational weeks. The elastic properties of the common carotid artery, abdominal aorta and popliteal artery were measured with an ultrasonic echo‐tracking system.

Results
Flow‐mediated dilatation at two minutes after cuff deflation was significantly lower in the bilateral notch group compared with the control group, 8.3% and 13.7%, respectively (P= 0.0007). The ability to sustain vasodilatation was reduced in the bilateral notch group (P= 0.02). Lower values of nitrite and nitrate in the plasma were found at 32 gestational weeks in the bilateral notch group than in the control group (mean 24.76 μM/L (SD 5.6) and 30.93 μM/L (8.2), respectively; P= 0.008). Nitrite and nitrate levels tended to be lower in the bilateral notch group even at 25 gestational weeks (29.45 μM/L (8.3) and 35.73 μM/L (11.0) in the bilateral notch and control group, respectively; P= 0.09). There was no difference in aortic, carotid or popliteal elasticity between the two groups.

Conclusions
Healthy normotensive pregnant women with bilateral uterine artery notches show impaired endothelial function, but no differences in vascular mechanical properties.
Maternal smoking during pregnancy and nicotine and cotinine concentrations in maternal and neonatal hair
Authors: Jacqz‐Aigrain E. , Zhang D. , Maillard G. , Luton D. , André J. , Oury J.F.
Published: December 2003

Objective
Conflicting data have been reported in the association between maternal smoking and adverse effects during pregnancy and in neonates. Some studies, conducted on a limited number of patients have evaluated maternal consumption and fetal exposure by measuring nicotine and cotinine in the hair. Our aims were to evaluate the relationship among maternal cigarette consumption, fetal smoking exposure and outcome of pregnancy in a population of pregnant women who smoked.

Design
Mothers smoking during pregnancy were included at their first prenatal visit and followed prospectively. Maternal data (demographic variables, obstetrical history and cigarette consumption), neonatal data and birth indicators (number of weeks of gestation, type of delivery, weight) were collected. Hair samples from the mothers and the babies were collected at birth.

Setting
The present study was conducted in the Department of Obstetrics of the University Hospital Robert Debré in Paris.

Population
A total of 254 women smokers were included in the study and 182 mother/neonate pairs were analyzed after exclusion of 50 babies whose hair samples were inadequate and 22 for various other reasons.

Methods
Nicotine and cotinine concentrations in the maternal and neonatal hair were measured at birth by radio‐immunoassay.

Main outcome measures
Cigarette consumption was based on self reporting and quantified each trimester. It was expressed more precisely during the third trimester by the mean number per cigarette per day. Nicotine and cotinine concentrations in the maternal and neonatal hair at birth were also analysed.

Results
Nicotine and cotinine concentrations in maternal hair were associated with cigarette consumption during the third trimester of pregnancy (P < 0.003 and P < 0.01, respectively). In neonates, only cotinine concentrations were associated to maternal cigarette consumption (P < 0.0001). This association remained significant in a multivariate analysis, which included maternal cotinine hair concentrations and the ethnic group.

Conclusions
Our results have shown a strong relationship between maternal cigarette consumption and fetal exposure to smoking measured by cotinine concentrations in neonatal hair. Further studies are required to look for associations between fetal exposure and adverse pregnancy outcome.
Absence of enhanced systemic inflammatory response at 18 weeks of gestation in women with subsequent pre‐eclampsia
Authors: Djurovic Srdjan , Clausen Torun , Wergeland Ragnhild , Brosstad Frank , Berg Kåre , Henriksen Tore
Published: December 2003

Objective
To compare indicators of systemic inflammatory response in the second trimester in women who developed pre‐eclampsia with normal pregnancies.

Design
Prospective nested case control study derived from a cohort of 2190 pregnant women. Blood samples were obtained at 18 weeks of gestation. The following inflammatory parameters were measured: tumour necrosis factor‐α (TNF‐α), plasminogen activator inhibitor‐1 (PAI‐1), interleukin‐1β (IL‐1β), IL‐6, IL‐10, microCRP and tissue factor (TF).

Setting
Institute of Medical Genetics, University of Oslo, and Department of Medical Genetics, Ullevål University Hospital and Departments of Obstetrics and Gynecology, Aker University Hospital, Oslo, Norway.

Sample
The cases were 71 women who subsequently developed pre‐eclampsia. The controls were 71 healthy, pregnant women matched for age, parity and first trimester body mass index (BMI).

Methods
Venous blood was drawn from fasting subjects into 5 mL test tubes containing EDTA. Samples were analysed for inflammatory parameters : IL‐1‐β, IL‐6, IL‐10, TNF‐α, PAI‐1, TF (ELISA‐technique) and CRP (latex‐enhanced immunonephelometric assay), strictly according to the manufacturer's recommendation.

Main outcome measures
The matched case and control subjects were compared by the paired two‐tailed Wilcoxon signed rank test. All P values were two‐tailed and P < 0.05 was deemed statistically significant.

Results
We found no differences in plasma concentrations of PAI‐1, IL‐1β, IL‐6, IL‐10, microCRP, TNF‐α or TF at 18 weeks of gestation between women who subsequently developed pre‐eclampsia and matched control women.

Conclusion
In contrast to findings from women with overt pre‐eclampsia, the present study indicates that there are no indications of intensified systemic inflammatory response at 18 weeks of gestation in women who later develop pre‐eclampsia.
The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms
Authors: Van, der Vaart C.H. , Van, der Bom J.G. , de Leeuw J.R.J. , Roovers J.P.W.R. , Heintz A.P.M.
Published: December 2003

Objective
To study the contribution of hysterectomy to the occurrence of urge‐or stress urinary incontinence symptoms

Design
A population‐based, cross‐sectional cohort study conducted in 1999

Setting
A university medical centre in The Netherlands

Population
Random sample of 2322 women, between 35 and 70 years of age, from a suburban area in the central part of The Netherlands

Methods
Self‐report questionnaire with questions from the Urogenital Distress Inventory, sociodemographic variables and data on obstetric and gynaecological history

Main outcome measures
Multivariate logistic regression analysis was used to obtain odds ratios with 95% confidence interval of the type and bothersomeness of urinary incontinence for hysterectomy

Results
One thousand, six hundred and twenty‐six women (70%) responded. The adjusted odds of urge (1.9, 1.4;2.6) and bothersome urge (2.6, 1.4;4.4) urinary incontinence were increased for women who had a hysterectomy. This association was not limited to the elderly but also occurred in women under 60 years of age. No increased odds of stress or bothersome stress incontinence were found

Conclusions
Meta‐analysis has shown that hysterectomy increases the odds of urinary incontinence by 30%. However, a distinction between the different types of urinary incontinence symptoms has not been made. Such a distinction is of importance since urge incontinence gives a significantly greater reduction in health‐related quality of life as compared with stress incontinence. Therefore, our finding that women scheduled for hysterectomy have an increased risk of developing urge incontinence symptoms indicates that these women should be counselled about this particular consequence
Effects of tibolone and continuous combined hormone replacement therapy on bleeding rates, quality of life and tolerability in postmenopausal women
Authors: Huber J. , Palacios S. , Berglund L. , Hänggi W. , Sathanandan S.M. , Christau S. , Helmond F.
Published: December 2003

Objective
To compare the effects of tibolone and conjugated equine oestrogens continuously combined with medroxyprogesterone acetate on bleeding rates, quality of life (QoL) and tolerability.

Design
A double‐blind, randomised comparative trial.

Setting
Thirty‐seven centres in six European countries.

Population
Five hundred and one postmenopausal women, under 65 years of age with an intact uterus.

Interventions
For 12 months, women received daily treatment with tibolone 2.5 mg (n= 250), or conjugated equine oestrogens 0.625 mg continuously combined with medroxyprogesterone acetate 5 mg (CEE–MPA, n= 251).

Main outcome measures
The primary outcome was vaginal bleeding rate during cycles 4–6. The secondary outcomes were vaginal bleeding rate during cycles 1–3, 7–9 and 10–13, cumulative bleeding rate, QoL, wellbeing, climacteric symptoms, urogenital complaints and tolerability.

Results
Treatment with tibolone led to a significantly lower bleeding rate during cycles 4–6 compared with CEE–MPA (15.0%vs 26.9%; P= 0.004); there was a similar difference during cycles 1–3. Both treatments improved QoL, wellbeing, climacteric symptoms and urogenital complaints. By intent‐to‐treat analysis, tibolone significantly improved sexual drive, interest and/or performance, compared with CEE–MPA at 12 months (P= 0.017). Although both treatments were well tolerated, there was a significantly lower incidence of breast tenderness with tibolone than CEE–MPA (2.4%vs 17.1%; P < 0.001).

Conclusion
The vaginal bleeding rate during cycles 4–6 was significantly lower in women using tibolone. Both treatments improved QoL, wellbeing, climacteric symptoms and urogenital symptoms. Breast tenderness was significantly less frequent with tibolone.
The creation of twin centile curves for size
Authors: Ong Stephen , Lim Meh‐Noi , Fitzmaurice Ann , Campbell Doris , Smith Anne P. , Smith Norman
Published: December 2003

Objective
To create twin centile charts for size.

Design
Retrospective study.

Setting
Aberdeen Maternity Hospital.

Methods
Ultrasound measurements of abdominal circumference (AC), biparietal diameter (BPD) and femur length (FL) for 1011 twin pregnancies were extracted from a databank. The methodology is based on that described by Altman and Chitty [Br. J. Obstet. Gynaecol. 101 (1994) 29.]; only one measurement from each twin was used, polynomial regression models were fitted separately to the mean and standard deviation (SD) of the ultrasound parameter as functions of gestational age. The centiles were obtained assuming that at each gestation, the measurements had a normal distribution.

Results
The growth pattern of AC for twins appear to follow closely that of singletons until 32 weeks. Thereafter, there is a gradual but definite fall off in growth away from singleton standards. The pattern of growth of FL is largely similar to that of singletons. From mid to early third trimester, the BPD of twin babies was larger than that of singletons.
What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation?
Authors: Coughlan Carol , Kearney Rohna , Turner Michael J.
Published: December 2003

Objective
To determine the mode of the next delivery for primigravid women who have an elective caesarean section for breech presentation.

Design
Retrospective cohort study.

Setting
University teaching hospital.

Population
All primigravid women who had an elective caesarean section for a singleton pregnancy in the years 1992 to 1997 and who delivered their next baby in the hospital before 1999.

Methods
Review of hospital computerised records.

Main outcome measures
Mode of delivery and fetal presentation at next delivery.

Results
Of 194 women who had an elective caesarean section with a breech presentation as a primigravida, 19 (9.8%) had a breech presentation at the time of elective caesarean section for their next baby compared with only two (1.7%) in the 121 women who had an elective caesarean section with a cephalic presentation as a primigravida (RR 5.9 [95% CI 1.4–25.0]). Despite the increased likelihood of another breech presentation, the overall repeat section rate was 43.8% (n= 85) in women with a previous breech presentation (n= 194), compared with 61.2% (n= 74) in women with a previous cephalic presentation (n= 121) (RR 0.72 [95% CI 0.58–0.89]). Of those women allowed to labour after elective caesarean section as a primigravid, the vaginal birth rate was 109/130 (84%) if the presentation previously was breech compared with 47/69 (68%) if the presentation previously was cephalic (RR 1.2 [95% CI 1.03–1.50]).

Conclusions
Women who have an elective caesarean section for a breech presentation in their first pregnancy have about a 1 in 10 chance of having an elective caesarean section for a breech presentation in their second pregnancy. Overall, the incidence of repeat caesarean section for their second baby was 43.8%, and of those allowed to labour, 84% achieved a vaginal delivery. These results compared favourably with women who had an elective caesarean section with a cephalic presentation in their first pregnancy. This information is important in advising primigravid women with a breech presentation about longer term implications of elective caesarean section. It also allows healthcare managers to anticipate the resource implications of any changes in clinical practice for women with a breech presentation in their first pregnancy.
Relationship between customised birthweight centiles and neonatal anthropometric features of growth restriction
Authors: Owen Philip , Farrell Tom , Hardwick J. Christopher R. , Khan Khalid S.
Published: December 2003

Objective
To determine the relationship between customised birthweight centiles (adjusted for maternal and fetal physiological variables) and neonatal anthropometric features of intrauterine growth restriction (IUGR).

Design
Observational study.

Population
Two‐hundred and seventy women with low risk pregnancies participating in a cohort study of serial ultrasound biometry.

Methods
Customised birthweight centiles were calculated following adjustment for maternal weight, height and ethnic origin, gestational age at delivery, birth order, and sex of the infant. Three separate neonatal anthropometric measures were used to define IUGR: subscapular or triceps skinfold thickness <10th centile; ponderal index <25th centile; and mid‐arm circumference to occipito‐frontal circumference ratio (MAC/OFC) <−1 standard deviation (SD). Relationship of the centiles to these outcomes was evaluated using likelihood ratios (LR) and kappa statistic. These approaches allowed us to examine the strength of the association: an LR of 5–10 would be expected to generate moderate changes in the pre‐test probability of IUGR, whereas a kappa value of 0.2–0.4 would reflect fair agreement between customised birthweight centiles and neonatal anthropometric measures.

Results
Customised birthweight centile of 10 or less had the following LR values for the various anthropometric criteria for IUGR: 5.1 (95% CI 3–8.5) for low skinfold thickness; 4.3 (95% CI 2.5–7.1) for low ponderal index; and 3.9 (95% CI 2–6.6) for low MAC/OFC ratio. The kappa values were: 0.4 (95% CI 0.26–0.51) for low skinfold thickness; 0.33 (95% CI 0.21–0.46) for low ponderal index; and 0.13 (95% CI 0–0.26) for low MAC/OFC ratio.

Conclusion
In a low risk population, customised birthweight centiles can only be moderately useful in the identification of neonates with low skinfold thickness and low ponderal index.
A randomised study comparing a low dose of mifepristone and the Yuzpe regimen for emergency contraception
Authors: Ashok Premila W. , Stalder Catriona , Wagaarachchi Prabhath T. , Flett Gillian M. , Melvin Louise , Templeton Allan
Published: December 2003

Objective
To compare 100 mg mifepristone with the standard Yuzpe regimen for emergency contraception.

Design
Randomised controlled trial.

Setting
Family Planning Clinic, Aberdeen.

Sample
One thousand women seeking emergency contraception within 72 hours after an episode of unprotected sexual intercourse.

Methods
Women were randomised to receive either 100 mg (half tablet) of mifepristone as a single dose or the Yuzpe regimen (two tablets each with 50 μg ethinyloestradiol and 0.25 mg levonorgestrel, to be repeated 12 hours later).

Outcome measures
Crude pregnancy rates, proportion of pregnancies prevented, side effects and patient acceptability.

Results
The crude pregnancy rates (95% CI) for the Yuzpe regimen and mifepristone were 3.6% (2.3–5.7) and 0.6% (0.2–1.8), respectively, with a significant difference between the two groups (RR 6.04; 95% CI 1.75–20.75). Mifepristone prevented 92% of pregnancies and the Yuzpe regimen preventing 56%. An increasing coitus to treatment interval was associated with contraceptive failure in the Yuzpe group (P= 0.03) with no association seen with mifepristone. Following administration of mifepristone 24.5% and 13.1% given the Yuzpe regimen had a delayed period (RR 2.14; 95% CI 1.46–3.15). Overall, mifepristone was better tolerated than the Yuzpe regimen with significantly fewer side effects. More women were satisfied (P < 0.0001) with mifepristone as an emergency contraceptive and would recommend it to a friend (P= 0.02).

Conclusion
Mifepristone administered in a 100 mg dose is a highly effective post‐coital contraceptive with high patient acceptability and fewer side effects compared with the standard Yuzpe regimen. Delay in the onset of menstruation did not decrease patient acceptability.
Few women wish to be delivered by caesarean section
Authors: Hildingsson Ingegerd , Rådestad Ingela , Rubertsson Christine , Waldenström Ulla
Published: December 2003

Objective
To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.

Design
National survey.

Setting
Swedish antenatal clinics.

Population
3283 Swedish‐speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999–2000).

Methods
A questionnaire was mailed shortly after the first antenatal visit.

Main outcome measures
Women's preferences for mode of delivery.

Results
3061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one‐year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience.

Conclusions
Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.
The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour
Authors: Buhimschi Catalin S. , Buhimschi Irina A. , Malinow Andrew M. , Kopelman Jerome N. , Weiner Carl P.
Published: December 2003

Objective
To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship.

Design
Prospective measurement of intrauterine pressure during the second stage of labour.

Setting
North American university hospital.

Population
Forty full‐term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia.

Methods
A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor–tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions.

Results
Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction‐enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness.

Conclusion
Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a ‘controlled environment’ for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.