bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of circulating tumour‐associated antigens in serum of women with cervical neoplasia
Authors: ADELUSI B. , NAHMIAS A. J. , IBRAHIM A. N. , AUERSPERG N.
Published: August 2005

Summary. Hyperimmune rabbit sera to partially purified human cervical cancer tissue antigen (CaCx TAA) and to human cervical cancer culture cell line antigens (C‐41I‐TAA) were used to demonstrate circulating tumour‐associated antigens (C‐TAA) in the sera of women with cervical neoplasia. Rabbit anti‐CaCx serum detected C‐TAA in 80% of the 60 sera from women with invasive cancer, cancer in situ and severe dysplasia and the rabbit anti‐C‐4II serum detected 67% of these cases. Negative reactions were obtained in over 95% of the 154 control sera with either rabbit serum. These results suggest that, in view of the difficulty of obtaining large specimens of cervical cancer tissues for the development of immunodiagostic procedures, the use of a cervical cancer cell line, such as C‐4II, appears desirable. Such cell lines would also be advantageous for studies aimed at providing further support for the association between genital herpes simplex virus infection and human cervical cancer.
Very early neonatal seizure rate: a possible epidemiological indicator of the quality of perinatal care
Authors: DENNIS JENNIFER , CHALMERS IAIN
Published: August 2005

Summary. The most frequently cited objective of perinatal care is the prevention of mortality and morbidity; but there is no general agreement about the indices which should be used to assess the extent to which this broad objective is being achieved. As mortality and morbidity observed during the perinatal period may reflect pathological processes originating earlier in pregnancy, putative indices of perinatal care should ideally be evaluated in clinical experiments comparing different modes of practice. Also, because perinatal practice can affect mortality and morbidity in a reciprocal manner, it is important to define indices of both mortality and morbidity. Morbidity indices should preferably be based on neonatal clinical signs which are both unambiguous and strongly predictive of later morbidity. We propose that the frequency of neonatal seizures beginning within 48 h of birth should be considered as an index which may meet these criteria in respect of full‐term babies.
A randomized controlled trial of non‐stress antepartum cardiotocography
Authors: FLYNN ANNA M. , KELLY JOHN , MANSFIELD HUGH , NEEDHAM PETER , O'CONOR MARIA , VIEGAS OSBORN
Published: August 2005

Summary. In a prospective randomized controlled study of non‐stress antepartum cardiotocography (CTG), involving 569 tracings in 300 patients, ‘non‐reactive’ traces showed a significant association with stillbirths and neonatal deaths, intrauterine growth retardation, admission to special care baby unit for conditions associated with intrauterine hypoxia, and low Apgar scores at 1 and 5 min. The report of the CTG was made available to the clinician in 144 patients and withheld in 156 patients. With the report available, significantly more patients were allowed to continue their antenatal care as out‐patients, and significantly more antenatal inpatients were allowed home. There were no other significant differences in management, or outcome in the two groups.
Predictive value of, and observer variability in, several ways of reporting antepartum cardiotocographs
Authors: FLYNN ANNA M. , KELLY JOHN , MATTHEWS KEITH , O'CONOR MARIA , VIEGAS OSBORN
Published: August 2005

Summary. Each of three scoring systems, and oscillatory frequency, had significantly poorer correlation with fetal outcome than reporting the cardiotocograph (CTG) as either ‘reactive’ or ‘non‐reactive’. There was no significant difference in the intra‐ and inter‐observer variability when the CTG was reported in this way.
Inhibition of the renin‐aldosterone axis and of prolactm secretion during pregnancy by l‐dopa
Authors: KAULHAUSEN H. , ÖNEY T. , LEYENDECKER G.
Published: August 2005

Summary. Recently, interactions between dopaminergic mechanisms and aldosterone secretion were described in non‐pregnant subjects. The present study examined the effect of 1000 mg of l‐dopa by mouth on plasma renin activity (PRA), and the concentrations of plasma aldosterone (PA) and prolactin (PRL) during normal pregnancy. Under basal conditions, there was a clear decrease of PRA, PA and PRL 60 min after oral intake of L‐dopa in seven subjects; a further decrease was observed during the following 45 min, resulting in a total decrease of 41 (PRA), 44 (PA) and 56 (PRL) % of the respective arithmetic mean of the basal values. However, the response of PA to isopressor angiotensin II infusions was comparable before and shortly after treatment with l‐dopa in 16 pregnant subjects. The decreased activity of the renin‐aldosterone axis after administration of l‐dopa may be attributed to an accumulation of dopamine and cate‐cholamines in the brain, resulting in a diminution of sympathetic outflow from the central nervous system. The simultaneous and comparable changes of both PRA and PA after L‐dopa treatment, as well as the reversibility of aldosterone suppression by infusion of angiotensin II, suggest that the inhibition of aldosterone secretion by L‐dopa is mediated by a decrease of renin release.
Cervical suture in Scotland: strengths and weaknesses in the use of routine clinical summaries
Authors: COLE SUSAN K.
Published: August 2005

Summary. National routinely collected hospital data for 12 months from June 1976 were used to provide information on patients with cervical suture during pregnancy. The past obstetric history and outcome of the pregnancy after suture was contrasted with the experience of all pregnant women during the same year. The nature of the data did not allow adequate examination of any change in the rate of fetal wastage, before and after suture; or in the secular change in fetal wastage in the pregnant population. After cervical suture the rates of both premature delivery and of perinatal mortality were higher than in the general pregnant population. The perinatal mortality rate in the cervical suture group showed a greater improvement after suture than was seen to occur between previous and current pregnancies in the whole population, although the excess improvement in pregnancy outcome that occurred after cervical suture could not be definitely ascribed to the suture.
Potential for cure in metastatic ovarian teratomas and dysgerminomas
Authors: NEWLANDS E. S. , BEGENT R. H. J. , RUSTIN G. J. S. , AGSHAWE K. D. B.
Published: August 2005

Summary. Between 1977 and 1981 21 patients with metastatic ovarian germ cell tumours received sequential combination chemotherapy; 18 had malignant teratomas and three dysgerminomas. Thirteen patients with malignant teratoma have had no treatment for up to 45 months (mean 27.5 months) and one patient is still having treatment. Life table estimate of survival on 1 July 1981 projects a survival of 71% in those with malignant ovarian teratomas. Four patients with malignant teratoma have died. Two of these had received extensive treatment before referral and a third achieved complete remission but relapsed and did not subsequently respond fully to further treatment. A fourth patient had an undifferentiated tumour compatible with an embryonal carcinoma which proved refractory to all treatment. The three patients with advanced dysgerminomas are all in remission and have had no treatment for 5, 14 and 33 months respectively. The majority of metastatic germ cell tumours of the ovary now appear to be curable provided that effective treatment is begun early.
Cervical intraepithelial neoplasia and ‘warty’ atypia: a study of colposcopic, histological and cytological characteristics
Authors: KIRKUP W. , EVANS A. S. , BROUGH A. K. , DAVIS J. A. , O'LOUGHLIN T. , WILKINSON G. , MONAGHAN J. M.
Published: August 2005

Summary. Colposcopic, histological and cytological characteristics of 168 consecutive patients attending a colposcopy clinic were reviewed. A group of patients demonstrated a cluster of histological features previously related to possible human papilloma virus infection of cervical epithelium, including particularly koilocytosis, double nucleation and dyskeratosis. These patients had a significantly greater occurrence of colposcopic ‘finger‐like’ lesion outline and colposcopic impression of warty change, but not of other specific colposcopic features. Over two‐thirds of patients with histological warty features did not show these colposcopic changes. Cytological changes previously related to warty lesions did not occur commonly, and appeared to underestimate the histological occurrence of such changes. Histological changes considered to represent CIN were uncommon in patients who said that they had begun sexual activity less than 10 years ago, whereas patients with warty characteristics on histology showed no such bias.
A comparison of episodic heart‐rate patterns in the fetus and newborn
Authors: VISSER G. H. A. , CARSE E. A. , GOODMAN J. D. S. , JOHNSON P.
Published: August 2005

Summary. Fourier analysis was applied to episodes of high and low heart‐rate variation in the near‐term fetus. The spectral densities of the variations in pulse intervals from 1 to 7 cycles/min, were almost identical with those found by De Haan et al. (1977) in the newborn infant during both active and quiet sleep. A computer programme, designed to separate low and high heart‐rate variation episodes in the fetus, identified seven of the eight quiet sleep episodes in four infants. None of the other neonatal behavioural states had low heart‐rate variation. It was concluded that, with other published data, there is increasing, although indirect, evidence that low heart‐rate variation episodes indicate quiet sleep in the human fetus near term.
Maternal and fetal plasma zinc concentration and fetal abnormality
Authors: H.SOLTAN M. , JENKINS D. M.
Published: August 2005

Summary.Plasma zinc concentration was significantly lower in the maternal blood of 54 women giving birth to congenitally abnormal babies either within 24 h or 24 months previously when compared with control mothers. Cord blood zinc concentrations in 20 congenitally abnormal babies were also lower than in the control babies. We conclude that low plasma zinc may be an associated factor in the aetiology of fetal abnormality.
Gall bladder volume and serum bile acids in cholestasis of pregnancy
Authors: YLöSTALO P. , KIRKINEN P. , HEIKKINEN J. , MÄENTAUSTA O. , JÄRVINEN P. A.
Published: August 2005

Summary. Gall bladder volume was measured by ultrasound in eight patients with cholestasis of pregnancy, in 21 normal pregnant women and in 14 non‐pregnant women, and at the same time serum cholic and nodeoxycholic acid levels were estimated. The gall bladder volume was 60% larger in cholestasis than that in normal pregnancy and more than two times larger in normal pregnancy than in non‐pregnant women. The serum cholic and chenodeoxycholic acid concentrations were significantly higher in cholestasis of pregnancy than those in normal pregnancy.
Multiple births in Igbo women
Authors: AZUBUIKE J. C.
Published: August 2005

Summary. In a prospective study of multiple births conducted at three hospitals, a University Teaching Hospital, an urban Maternity Hospital and a Community Hospital, in Eastern Nigeria, the average incidence was found to be 35 per 1000 births. The twinning rate was found to increase progressively with both birth rank and maternal age, with an indication that parity plays the more important role.
Determination with Hi‐Gonavis of luteinizing hormome levels in urine compared with those in plasma
Authors: VARMA T. R. , PATEL R. H. , EVERARD D.
Published: August 2005

Summary. Hi‐Gonavis, an immunological luteinizing hormone/human chorionic gonadotrophin (LH/hCG) test kit, was used to measure the periovulatory LH excretion in the urine of 25 patients over two cycles. The LH plasma level was simultaneously determined by radioimmunoassay. The lower detection limit of Hi‐Gonavis is 12.5 i.u. of LH/l of urine. Urinary LH levels of 50 i.u./l were associated with plasma levels of at least 12 i.u./l. Such values were found usually on the day before the mid‐cycle peak of LH. The pre‐ovulatory increasing plasma LH levels correlated closely with the urinary values. The urinary LH level reflects that in plasma; the Hi‐Gonavis method can be used to predict the occurrence of ovulation.
Long‐term effects of cyproterone acetate on the pituitary adrenal axis in adult women
Authors: HAGUE W. M. , MUNRO D. S. , SAWERS R. S. , DUNCAN S. L. B. , HONOUR J. W.
Published: August 2005

Summary. Function of the pituitary‐adrenal axis was assessed in 16 adult female patients who had been taking cyproterone acetate for >1 year. Some evidence of reduced basal cortisol output was seen in 25% of the patients, but plasma cortisol levels could be stimulated both by hypoglycaemia and by direct corticotrophin (ACTH) stimulation. The latter effect was confirmed by analysis of steroid excretion in urine although basal excreation rates indicated extensive adrenal suppression. These results suggest that cyproterone acetate does have some glucocorticoid activity which is able partially to suppress the pituitary—adrenal axis, but leaves it still responsive to stress.
Relation between the luteinizing hormone peak, the nadir of the basal body temperature and the cervical mucus score
Authors: TEMPLETON A. A. , PENNEY G. C. , LEES M. M.
Published: August 2005

Summary. The results of a cervical mucus scoring system and of basal body temperature (BBT) chart interpretation were compared with those of a short‐incubation radioimmunoassay for luteinizing hormone (LH) in 198 ovulatory menstrual cycles. The timing of the maximal cervical mucus score was similar to that of the LH peak in all but 7% of assessable cycles. In contrast, the timing of the nadir of the BBT differed widely from that of the LH peak in 45% of cycles with interpretable charts. These findings suggest that cervical mucus scoring might be useful for identifying the time of ovulation where LH assays are unavailable or where speed and economy are at a premium.
High oestrogen excretion in pregnancy
Authors: McFADYEN I. R. , WORTH H. G. J. , WRIGHT D. J. , NOTTA S. S.
Published: August 2005

Summary. Fifty‐one women with singleton pregnancies whose urinary oestrogen excretion was above the 95th centile of the hospital's reference range on two or more occasions were reviewed. The women did not differ from the general population in race, parity, age, height or weight gain during pregnancy, but they were slightly heavier. Fetal and placental weights were greater than the corresponding values in the general population, as were the volumes of urine containing the oestrogen, but none of these differences was sufficient to account for oestrogen excretion above the 95th centile. Eleven patients, has a glucose tolerance test, two of them had abnormal results and nine had normal results but heavy babies. Patterns of oestrogen excretion did not identify a high‐risk population but the women with consistently high excretion gave birth to eight of the nine babies that weighed 4 kg in this population. Twenty‐two of the women had 23 subsequent pregnancies in which oestrogen excretion was measured: excretion was normal in 17, low in two and above the 95th centile in four.
Serum ferritin in women of reproductive age
Authors: TAYLOR DAVID J. , MALLEN CAROL , McDOVGALL NEIL , LIND TOM
Published: August 2005

Summary. Serum ferritin, measured by radioimmunoassay, was studied in a population of 154 women of reproductive age and during a menstrual cycle in a group of 22 women. Serum ferritin concentrations ranged from 4.7 to 169 μg/1 (median 21.3 μg/1). Recent childbirth was associated with low serum ferritin values, whereas oestrogen/progestogen oral contraception and normal menstruation appeared to have little effect. In the absence of iron supplements, it appears to take up to 2 years after pregnancy before pre‐pregnancy serum ferritin values are regained.
Changes in erythrocyte volume and shape in pregnancy
Authors: BOLTON F. G. , STREET MARION J. , PACE A. J.
Published: August 2005

Summary. Erythrocyte measurements were made in groups of women in pregnancy and the early puerperium and were compared with those of non‐pregnant women. The mean cell volume rises in pregnancy and this persists in the early puerperium, although declining, while the erythrocyte becomes more spherical with a decreasing diameter and increasing thickness. The diameter and thickness changes revert to the non‐pregnant values by the early puerperium.
Cervical resistance in patients with previous spontaneous mid‐trimester abortion
Authors: ANTHONY G. S. , CALDER A. A. , MACNAUGHTON M. C.
Published: August 2005

Summary. The Cervical Resistance Index (CRI) was measured in 20 patients with a history of previous spontaneous midtrimester abortion. The mean CRI was 2.44±0.78 in patients with a history suggestive of cervical incompetence and 4.91±0.41 in 102 patients who were parous women with normal menstrual cycles. This new procedure which is used in the non‐pregnant state provides an additional method for diagnosis of cervical incompetence.
Amniotic fluid acetylcholinesterase: a retrospective and prospective study of the qualitative method
Authors: READ A. P. , FENNELE S. J. , DONNAI DIAN , HARRIS R.
Published: August 2005

Summary. After retrospective evaluation with stored samples, the qualitative acetylcholinesterase (AChE) test has been used prospectively in conjunction with χ‐fetoprotein (AFP) assay on 986 amniotic fluid specimens received in this laboratory during 1980. The main value of AChE is in classifying fluids in which the AFP level is near the threshold between normal and abnormal. Among abnormal pregnancies with raised AFP levels, neural‐tube defects can generally be distinguished from other abnormalities by careful appraisal of the AChE gel pattern, but confirmation of these other fetal abnormalities may require high resolution diagnostic ultrasonography and perhaps fetoscopy. Neural‐tube defects with false negative AFP levels can be detected by AChE, but AChE gives occasional false positives so that it cannot be relied on in isolation for the diagnosis of neural‐tube defects.
Blood viscosity and haemostatic factors in late pregnancy, pre‐eclampsia and fetal growth retardation
Authors: THORBURN J. , DRUMMOND M. M. , WHTGHAM K. A. , LOWE G. D. O. , FORBES C. D. , PRENTICE C. R. M. , WHITFIELD C. R.
Published: August 2005

Summary. Blood viscosity and several of its determinants (packed cell volume, plasma viscosity, plasma fibrinogen and erythrocyte deformability) and several haemostatic variables (platelet count, serum fibrin degradation products and plasma soluble fibrin) were measured in 106 women during normal third‐trimester pregnancy, 12 patients with moderate pre‐eclampsia, nine patients with severe pre‐eclampsia and 16 patients with confirmed fetal growth retardation. Blood viscosity was measured at high and low shear rates (94.5 and 0.94 s−1), with and without correction to a standard packed cell volume of 0.45. In normal pregnancy low‐shear blood viscosity increased significantly towards term, associated with significant increases in packed cell volume and plasma viscosity (but not fibrinogen); there was no change in high‐shear blood viscosity at native packed cell volume and a decrease in viscosity after correction for packed cell volume, associated with a significant increase in erythrocyte deformability. Significant decrease in the platelet count and significant increases in serum fibrin degradation products and plasma soluble fibrin suggested a degree of haemostatic activation in normal third‐trimester pregnancy. In moderate pre‐eclampsia blood viscosity was significantly lower at low shear rate, due to a significantly lower packed cell volume and despite a significantly elevated plasma viscosity. In severe pre‐eclampsia high‐shear blood viscosity was significantly elevated after correction for packed cell volume, associated with a significantly reduced erythrocyte deformability; plasma fibrinogen levels were reduced, but other variables were not significantly abnormal. In fetal growth retardation blood viscosity was significantly increased at both shear rates, despite a reduced packed cell volume: this was also associated with a significant reduction in erythrocyte deformability. In general there was little correlation between blood viscosity factors and haemostatic variables, but in normal‐term pregnancy soluble fibrin levels correlated with blood viscosity at both shear rates. We suggest that increased blood viscosity and decreased erythrocyte deformability may play a role in the placental insufficiency of severe pre‐eclampsia and fetal growth retardation.
Urine dopamine in normal and hypertensive pregnancies
Authors: PERKINS C. M. , HANCOCK K. W. , COPE G. F. , LEE M. R.
Published: August 2005

Summary. Dopamine output in urine was determined in two groups of women with hypertension in pregnancy. A highly significant elevation of urine dopamine was detected in those women with pre‐eclampsia compared with that in matched control subjects. In contrast, no difference in urine dopamine output was detected between a group of multigravidae with hypertension in pregnancy and matched control subjects.
Origin and levels of trypsin in amniotic fluid throughout pregnancy
Authors: POCKNEE R. C. , ABRAMOVICH D. R.
Published: August 2005

Summary. Trypsin is present in midtrimester amniotic fluid with a mean level of 350±260 ng/ml, but has virtually disappeared by term. The trypsin originates in fetal pancreas and it is suggested that its mode of entry into the gestation sac is by passage of meconium which ceases as a physiological event by 16–18 weeks. The finding could form the basis of an antenatal test for the presence of cystic fibrosis in the fetus.
Monitoring gonadotrophin therapy by real‐time ultrasonic scanning of ovarian follicles
Authors: SALLAM H. N. , MARINHO A. O. , COLLINS W. P. , RODECK C. H. , CAMPBELL S.
Published: August 2005

Summary. Real‐time ultrasound scanning of ovarian follicles was performed during 61 cycles in 22 infertile patients being treated with sequential injections of human menopausal gonadotrophin (hMG) and human chorionic gonadotrophin (hCG). Total 24‐h urinary oestrogens were estimated (and in 13 cycles plasma oestradiol) but the amount of gonadotrophin given was based mainly on the ultrasound findings. A retrospective analysis of the results showed that there was a poor statistical correlation between the diameter of the largest follicle and the total urinary oestrogens (r= 0.39) and with the level of plasma oestradiol (r= 0.56), although similar clinical information was obtained by all methods. Ovulation was induced in 58 cycles when the leading follicle had a mean diameter of 20–25 mm (mean 21.3 mm); follicular rupture was observed in 57 cycles and in these cases there was biochemical evidence of luteinization (plasma progesterone >15 nmol/1; total urinary pregnanediol >8 μmol/24h). Three patients (three cycles) were not given hCG; one developed micropolycystic ovaries and two showed evidence of hyperstimulation (one follicle >25 mm diameter, three or more follicles 20–25 mm diameter). Twelve patients became pregnant, all with single fetuses. Subsequently one aborted, one had an ectopic pregnancy, three gave birth to normal babies at term and seven pregnancies are continuing. Real‐time ultrasound scanning of ovarian follicles is a simple, practical method for monitoring follicular growth during the administration of hMG and predicting the response to hCG.
Is diagnostic curettage harmful in women with unexplained infertility?
Authors: TAYLOR PATRICK J. , GRAHAM GORDON
Published: August 2005

Summary. Diagnostic curettage as part of the investigation of the woman with unexplained infertility has not been considered a hazardous procedure. Two similar groups with unexplained primary infertility were examined laparoscopically: 53 patients had undergone diagnostic curettage as part of the investigation; 142 had not. None had an antecedent history suggestive of pelvic inflammatory disease. The incidence of laparoscopically detected chronic pelvic inflammatory changes in both groups was compared and was found to be 50.9 and 13.4% respectively (P<0.001). It was concluded that diagnostic curettage may be more hazardous in women with unexplained infertility than was believed previously.
Prognostic value of the postcoital test: prospective study based on time‐specific conception rates
Authors: HULL M. G. R. , SAVAGE P. E. , BROMHAM D. R.
Published: August 2005

Summary. Time‐specific conception rates were studied prospectively after a carefully validated post‐coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6–18 h after intercourse. The definition of a negative result, indicated by the absence of forward‐moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.
Activity of serum cytidine deaminase during pregnancy
Authors: JONES D. D. , BAHIJRI S. , ROBERTS E. L. , WILLIAMS G. F.
Published: August 2005

Summary. A simple and reliable method for the estimation of cytidine deaminase (cytidine aminohydrolase; EC 3.5.4.5) activity in pregnancy serum is described. This enzyme does not require magnesium for activation and is also more stable than deoxycytidylate deaminase (dCMP deaminase, dCMP aminohydrolase; EC 3.5.4.12). There was excellent correlation between the two enzymes (r= 0.92). Both enzymes showed increased activity in abnormal pregnancy. Both enzyme activities were found to be similar in 1305 maternal serum samples and therefore due to the simplicity of cytidine deaminase estimation it is recommended for the screening of large numbers of antenatal sera for abnormal pregnancies.
Double‐blind comparison of meptazinol and pethidine in labour
Authors: NICHOLAS A. D. G. , ROBSON P. J.
Published: August 2005

Summary. The analgesic efficacy and safety of intramuscular meptazinol and pethidine in the first stage of labour were compared in a randomized double‐blind trial in 358 patients. Pain relief was measured on a verbal rating scale, maternal side effects were recorded and neonatal outcome assessed in the first 24 h. Pain relief during the first hour after injection was significantly greater in the meptazinol than in the pethidine group at 45 and 60 min. Thereafter, there was no difference between the treatments, and the duration of action was approximately the same. Twenty‐eight per cent of patients experienced side effects after meptazinol compared with 35% after pethidine. The commonest were nausea and vomiting with a similar incidence in both groups. Most of the neonatal observations revealed no difference between the two drugs, but significantly more babies whose mothers had received meptazinol had an Apgar score of 8 at 1 min after birth.
An audit of caesarean section in a maternity district
Authors: ROSENBERG KATHRYN , HEPBURN MARY , McILWAINE GILLIAN
Published: August 2005

Summary. A prospective study of the clinical indications for caesarean sections performed in a large specialist maternity hospital was carried out during the first 3 months of 1981; similar information was collected retrospectively for 1976 and 1971. Demographic changes in the obstetric population were considered. The district section rate increased from 4·4–13% in the last decade. The three most important clinical indications contributing to the rise of caesarean section in primiparae were cephalo‐pelvic disproportion, slow progress and breech presentation. The rate of sections began to fall during the audit and has continued to decrease in the months since. Although it is rather early to draw conclusions, this trend may reflect the critical attention focused on section policy during the period of the study.
Premature rupture of the membranes and ascending infection
Authors: EVALDSON GEORGE R. , MALMBORG ANNA‐STINA , NORD CARL ERIK
Published: August 2005

Summary. The association of premature rupture of the membranes (PROM) and ascending infection was investigated in 15 women. Bacteriological, histological and immunofluorescence methods were used to study infection at various levels in the birth canal. In most of the women the membranes as well as the placentae showed heavy bacterial invasion. Bacterial distribution within the membranes showed a choriodecidual preponderance. Ascending infection appears to follow the choriodecidual route and may be a primary pathogenetic event in many instances of PROM. The anaerobe Bacteroides fragilis, which is very infrequently isolated in normal pregnant women, was found in five out of 15 women. Two infants had congenital pneumonia caused by group B streptococci and Haemophilus influenzae respectively. The neonatal outcome with PROM may be influenced by the efficiency of the individual defence mechanisms including the antimicrobial capacity of amniotic fluid.
Blood pressure, plasma osmolarity and oedema in pregnancy
Authors: GOOD W. , HANCOCK K. W.
Published: August 2005

Summary. Relations of mean arterial pressure to age, parity, plasma osmolarity, sodium and albumin were examined in normal non‐pregnant, normal pregnant and pre‐eclamptic Nigerian women. Mean arterial pressure showed a positive correlation with age in non‐pregnant subjects, but not in normal pregnant or pre‐eclamptic women. There was no siginficant correlation of mean arterial pressure with parity, plasma sodium or albumin in any of the three groups. A weak positive correlation was found between mean arterial pressure and plasma osmolarity in non‐pregnant women and, although this was absent in normal pregnancy, it reappeared as a significant negative correlation in pre‐eclampsia. These observations were considered, with special reference to osmotic aspects of the changes involved, and biophysical aspects of oedema are discussed. It is suggested that the osmotic properties of interstitial fluid albumin play a key role in the development of both physiological and pathological oedema in pregnancy.
Prognostic significance of raised serum α‐fetoprotein levels in twin pregnancies
Authors: GHOSH A. , WOO J. S. K. , RAWLINSON H. A. , FERGUSON‐SMITH M. A.
Published: August 2005

Summary. Maternal serum α‐fetoprotein (AFP) was measured during the second trimester in 219 twin pregnancies uncomplicated by neural‐tube defects (NTD) and in 11 twin pregnancies discordant for NTD. Serum AFP levels were recorded in multiples of the median value (MOM) calculated from normal singleton pregnancies. Of the twin pregnancies uncomplicated by NTD 49% had AFP levels <2·5 MOM, 7·8% had levels >5 MOM and 59% of these were associated with either abortion, stillbirth or fetus papyraceous. In twin pregnancies with serum AFP levels <5 MOM an unsuccessful outcome was noted in only 4% (χ2, P<0·05). There was a significant negative correlation between serum AFP levels and combined birthweights (r=0·954). All 11 pregnancies discordant for NTD had serum AFP values >5 MOM and this level appears to be a suitable cut‐off point above which there should be further diagnostic investigations and monitoring of fetal well‐being.
Hysterectomy following sterilization
Authors: TEMPLETON A. A. , COLE SUSAN
Published: August 2005

Summary. Using record linkage data derived from Scottish hospital discharge summaries, admissions to gynaecological units and hysterectomy rates have been studied following sterilization. The average annual gynaecological admission rate per 1000 women was 43·7 in the group of sterilized women and 21·5 in the control subjects. The average annual hysterectomy rate was 9·3 in the sterilized women and 2·5 in the control subjects. Although there were differences in age and pregnancy number between cases and controls, these did not account for the observed differences. This study was not able to determine whether the increase in gynaecological morbidity was due to the sterilization procedure or to the characteristics of the women sterilized.
Infants born before 29 weeks gestation: survival and morbidity at 2 years of age
Authors: KITCHEN W. H. , YU V. Y. H. , ORGILL A. A. , FORD G. , RICKARDS A. , ASTBURY J. , RYAN M. M. , RUSSO W. , LISSENDEN J. V. , BAJUK B.
Published: August 2005

Summary. In a collaborative study involving two hospitals with large maternity services, 166 liveborn infants of gestational age from 24 to 28 weeks were born in the calendar years 1977 and 1978. Of these infants, 75 (45·2%) died either in hospital or after discharge home. At the age of 2 years, 16 (9·6%) of the cohort had a major handicap [cerebral palsy, Mental Developmental Index (MDI) under 69, deafness or blindness]. An additional 20 children (12·0%) had significant developmental delay (MDI 69 to 84, −2 to −1 SD below mean) and 53 (31·9%) were considered to be free of these handicaps. Psychological assessments were not performed on two survivors (1·2%) but reliable reports indicated that they were free of major handicaps. Long‐term survival increased in a stepwise fashion from 9·1% at 24 weeks to 68·5% at 28 weeks gestation, and there was a trend for major handicap and significant developmental delay to decrease in incidence with increasing maturity. Of the 58 children who had presented by the vertex 42 (72·4%) were free of significant handicap; however, of the 31 children in whom there had been either a breech presentation or a transverse lie, only 11 (35·5%) were free of significant handicap (χ2=9·69, P<0·01). The mode of delivery (vaginal or caesarean section) did not significantly affect the handicap rate in the survivors.
Characterirtics and management of intrapartum prolonged fetal bradycardia
Authors: LANGER O. , SONNENDECKER E. W. W.
Published: August 2005

Summary. Twenty‐five patients had intrapartum prolonfed fetal bradycardia, defined as a drop of the fetal heart rate (FHR) by ≥50 beats/min maintained for ≥3 min; 10 were deliverdd by caesarean rection and 15 vaginally. The only neonatal death occurred in thd group delivered abdominally. Statistical analysis showed no difference in amplitude or duration of deceleration in the two groups but the 1 and 5 min Apgar scores were higher in the group delivered vaginallx (P<0·01), wherdas the onset of deceleration to delivery interval was shorter in the group delivered by caesarean section (P<0·005). Appropriatd management of prolonged bradycardia is outlined and the characteristics of the FHR tracings ard identified that are of prognostic value in detdrmining whether or not immediatd delivery is indicated.
Decrease of serum oestriol during intravenous hexoprenaline or salbutamol treatment
Authors: HAUKKAMAA M. , GUMMERUS M.
Published: August 2005

Summary. Patients with premature labour were treated with intravenous hexoprenaline (18 patients) or salbutamol (10 patients) infusion between 26 and 36 weeks gestation. After at least 12 h infusion, oral therapy was started. Serum total oestriol was determined by radioimmunoassay every 6 h during intravenous treatment, and then every day after stopping the infusion, for 4 days. The mean serum total oestriol concentration decreased significantly during the intravenous β‐mimetic infusion (P<0·005). One day after stopping intravenous treatment, serum oestriol returned to pretreatment levels. The results show that fetal monitoring by maternal oestriol determinations is not reliable during intravenous β‐adrenoceptor agonist therapy.
Stress hormones and placental steroids in physical exercise during pregnancy
Authors: RAURAMO I. , ANDERSSON B. , LAATIKAINEN T. , PETTERSSON J.
Published: August 2005

Summary. The hormonal responses to exercise during later pregnancy were studied in relation to an exercise test in ten healthy women. At the end of the 10‐min exercise, maternal heart rate had risen from 93±3·2 (mean±SEM) to 157±6·3 beats/min, and systolic blood pressure from 120±3·4 to 148±5·4 mmHg, but diastolic blood pressure was unchanged. Plasma concentrations of noradrenaline and adrenaline rose rapidly during the exercise, from 2·9±0·3 to 6·9±l.2 nmol/1 and from 0·31±0·04 to 0·47±0·08 nmol/1 respectively. The serum concentration of prolactin did not change during the test, but 30 min after the exercise the value had risen from 146±17 to 212±22 mg/ml, thereafter slowly declining. The serum concentration of cortisol remained unchanged. The mean concentration of oestriol rose from 31·5±2·6 to 33·9±3·0 nmol/1 at 5 min after the exercise, thereafter declining to 29±2·6 nmol/1. After the test, levels of progesterone and oestradiol also fell slightly. Mild irregular uterine activity was found in four subjects. Cardiotocography revealed a transient fetal tachycardia in two subjects.
Vitamin A concentration in amniotic fluid and maternal serum related to neural‐tube defects
Authors: PARKINSON CHRISTINE E. , TAN JENNY C. Y. , GAL ISABEL
Published: August 2005

Summary. The vitamin A concentration of amniotic fluid and maternal serum was measured during the second trimester of pregnancy in 106 women, 12 of whom had a baby with a neural‐tube defect. In these 12 pregnancies the amniotic fluid vitamin A concentration was significantly higher than in 94 normal pregnancies. There was a highly significant correlation between amniotic fluid vitamin A and both zinc and α‐fetoprotein (AFP) levels. The maternal serum vitamin A levels were also significantly related to serum zinc levels. Women with a raised serum AFP level, but a normal baby, had significantly higher amniotic fluid vitamin A levels and significantly lower serum vitamin A levels compared with those in women with normal serum AFP levels.
Influence of laparoscopic follicular aspiration under general anaesthesia on corpus luteum progesterone secretion in normal and clomiphene‐stimulated cycles
Authors: KEMETER P. , FEICHTINGER W. , NEUMARK J. , SZALAY S. , BIEGLMAYER Ch. , JANISCH H.
Published: August 2005

Summary. In 32 patients with unstimulated normal cycles and 24 with cycles stimulated with clomiphene and human chorionic gonadotrophin (hCG) all visible follicles were punctured laparoscopically under general anaesthesia for the purpose of in vitro fertilization. In unstimulated cycles the time of surgery was between 24 and 32 h after the first luteinizing hormone (LH) increase in the urine; in the cycles stimulated with hCG (5000 i.u.) laparoscopy was between 35 and 37 h after injection. Blood samples for progesterone determination were taken about 7 days later. Progesterone levels were compared with those in a control group not subjected to surgery, in which the progesterone levels were determined 7 days after the LH increase. There was no statistically significant difference in the progesterone levels in the unstimulated subjects after laparoscopy compared with those in the control subjects but progesterone levels in the stimulated subjects were significantly higher (P<0·01). Durations of the luteal phases showed no significant differences thus laparoscopy under general anaesthesia does not impair luteal function.
Amniotic fluid and plasma concentrations of pregnancy‐associated plasma protein‐A (PAPP‐A) throughout pregnancy: comparison with other fetoplacental products
Authors: BISCHOF P. , DUBERG S. , HERRMANN W. , SIZONENKO P. C.
Published: August 2005

Summary. The development of a sensitive radioimmunoassay has enabled measurements of pregnancy‐associated plasma protein‐A (PAPP‐A) to be performed from early pregnancy. The present paper compares the plasma concentrations of PAPP‐A with the levels of two trophoblastic proteins, human placental lactogen (hPL) and the β‐subunit of human chorionic gonadotrophin (β‐hCG), with a steroid of fetoplacental origin, total oestriol (total E3), and with a fetal protein, α‐fetoprotein (AFP). PAPP‐A was also measured in amniotic fluid and in maternal urine. In contrast with the secretion of the other substances studied, which either reach a plateau or even decrease during the last 4 weeks of pregnancy, PAPP‐A steadily increased in the maternal circulation from 7 to 40 weeks gestation. It is proposed that PAPP‐A production is either not related to placental mass or that PAPP‐A is not of trophoblastic origin. The increase of PAPP‐A in amniotic fluids parallels the increase in maternal blood; virtually no PAPP‐A is excreted in urine.
Intrauterine‐pressure studies in African nulliparae: normal labour progress
Authors: COWAN D. B. , VAN MIDDELKOOP A. , PHILPOTT R. H.
Published: August 2005

Summary. Uterine activity was measured in 29 nulliparous African women, who were in the active phase of spontaneous labour, and who were delivered vaginally without supplementary oxytocin. A fluid‐filled intrauterine catheter, an external strain gauge and a pressure‐curve integrator were used to quantitate uterine activity. The rate of dilatation of the cervix from entry to the study to full dilatation of the cervix was >1 cm/h; this constituted normal labour progress. In nulliparous African women the minimum level of uterine activity likely to be associated with a cervical dilatation rate of 1 cm/h was 1200 kPas/15 min and the median uterine activity level in the active phase of normal labour was 1824 kPas/15 min.
Lack of effect of circulating prostacyclin on contractility of the non‐pregnant human uterus
Authors: MÄKÄRÄINEN L. , YLIKORKALA O.
Published: August 2005

Summary. To study the effect of prostacyclin (PGI2) on the contractility of the non‐pregnant human uterus, the intrauterine pressures in the isthmus and fundus of the uterus were recorded before, during and after intravenous PGI2 at different phases of two consecutive menstrual cycles in eight women. Infusions of 1–8 ng of PGI2 mur−1 kg−1 for 20 min caused no changes in intrauterine pressure either during menstruation or any other phase of the cycle when compared with the contractility patterns in the same woman during the control infusion. Thus these data suggest that circulating PGI2 is not involved in regulating the contractility of the non‐pregnant human myometrium.
Premature ovulation after ovarian ultrasonography
Authors: TESTART J. , THEBAULT A. , SOUDERES E. , FRYDMAN R.
Published: August 2005

Summary. Whereas follicle rupture never occurred before the 37th hour after an ovulatory stimulus (either the onset of the LH surge or hCG administration) in control patients, ovulation was observed at 26 to 36 h in women submitted to ultrasonography during the late follicular phase. Premature ovulation was observed in 5 out of 23 and 8 out of 19 cycles when ultrasonography occurred during the 3 days preceding or in the 36 h following ovulatory stimulus. This as yet unexplained observation leads us to reconsider the advisability of ovarian scan during the late follicular phase of the menstrual cycle.
Induction of labour: a comparison of a single prostaglandin E2 vaginal tablet with amniotomy and intravenous oxytocin
Authors: KENNEDY J. H. , STEWART P. , BARLOW D. H. , HILLAN E. , CALDER A. A.
Published: August 2005

Summary. In a randomized controlled study of 100 women of low parity and favourable induction features, induction of labour by means of a single vaginal tablet containing 3 mg of prostaglandin E2 (PGE2) was compared with the conventional method of amniotomy and intravenous oxytocin. Four of the patients (8%) who received the prostaglandin tablet required additional intravenous oxytocin to achieve delivery. The prostaglandin group had a longer mean overall induction‐delivery interval but a shorter amniotomy‐delivery interval than the oxytocin group. One patient in the PGE2 group and two in the oxytocin group required caesarean section. The PGE2 treated patients expressed a higher level of satisfaction with their method of induction, they required less analgesia, had less blood loss at delivery and their babies had a lower incidence of neonatal jaundice.
The rationale of primitive delivery positions
Authors: RUSSELL J. G. B.
Published: August 2005

Summary. Women throughout the ages preferred to be delivered with their trunks vertical and most delivery positions illustrated in historical texts indicate that an upright posture with abducted thighs has been the rule. There is evidence that such a position considerably increases the outlet measurement of the pelvis. Primitive delivery positions often accentuate the mechanical forces usually acting on the pelvis.
Amniotic fluid phosphatidylglycerol and the lecithin/sphingomyelin ratio in the assessment of fetal lung maturity
Authors: WHITTLE M. J. , WILSON A. I. , WHITFIELD C. R. , PATON R. D. , LOGAN R. W.
Published: August 2005

Summary. Based on the analysis of 561 amniotic fluid samples obtained within 72 h of delivery, including 288 samples collected from the vagina, the detection of phosphatidylglycerol (PG) in the fluid together with the determination of the lecithin/sphingomyelin (L/S) ratio gave an accurate prediction of the risk of the newborn infant developing respiratory distress syndrome (RDS). In the presence of PG, regardless of the L/S ratio, only 0·6% of the babies developed RDS, while absent PG was associated with an 82·8% incidence of RDS. The predictive ability was improved by knowing the L/S ratio since in the presence of both PG and a mature L/S ratio (≥2·0), no baby developed RDS whereas 3·4% of them did when the ratio was immature despite the presence of PG. The test appears to be a useful determinant of the risk of RDS in babies born to diabetic mothers and it seems particularly effective in assessing amniotic fluid collected vaginally. It is recommended that laboratories dealing with amniotic fluid from high‐risk pregnancies should detect PG as well as measuring the L/S ratio.
Effects of clomiphene treatment on infertile women with normal menstrual rhythm
Authors: FLEMING R. , COUTTS J. R. T.
Published: August 2005

Summary. Fourteen infertile women with normal menstrual rhythm were investigated; each provided daily blood samples throughout two menstrual cycles: one control cycle and another on therapy with clomiphene (50 mg/day) given either from days 1 to 5 (n=7; group I) or from days 5 to 9 (n=7; group II) of the cycle. The effects of this empirical clomiphene therapy on the menstrual cycles were assessed by reference to the delay from termination of clomiphene therapy to ovulation (day after the LH peak) and by comparing pre‐ovulatory oestradiol levels and luteal phase progesterone indices (total progesterone levels from days 4 to 8 post LH peak) in patients' control and treated cycles. No differences were observed in the effects of the treatment on the two groups of women except that the clomiphene to ovulation delay was greater in those treated earlier in the cycle (group I). Clomiphene caused increased follicular development as indicated by elevated pre‐ovulatory oestradiol levels but this was not followed by improved progesterone indices. Ovarian ultrasonography indicated that the increased follicular development was in terms of numbers of follicles and not in maturity or oestrogen biosynthetic capacity of individual follicles. The lack of increased luteal progesterone levels thereafter indicated that mean luteal progesterone production per luteinized follicle was reduced. Clomiphene therapy as given in this study was therefore not successful in stimulating increased follicular/luteal hormone production from the dominant follicle/corpus luteum in such patients.