bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomised comparative study in 217 women of three disposable plastic IUCD thread retrievers
Authors: BOUNDS W. , HUTT S. , KUBBA A. , COOPER K. , GUILLEBAUD J. , NEWMAN G. B.
Published: August 2005

Objective
To assess the relative efficacy of three disposable plastic instruments in the retrieval of ‘missing’ IUCD threads.

Design
A prospective randomised comparative single centre study.

Setting
Family Planning Clinic in London, UK.

Subjects
217 of 350 IUCD users referred to the research team with ‘missing’ IUCD threads entered the study.

Intervention
All women initially underwent exploration of the endocervical canal with Spencer Wells forceps. When this procedure did not retrieve the threads, the patients were entered into the study. A maximum of two randomly chosen plastic IUCD thread retrievers were then used in any one patient to explore the uterine cavity and capture the ‘missing’ threads. The order in which the two retrievers were employed was also determined at random. Four separate entries into the uterine cavity were permitted with each instrument, the endocervical canal being explored with Spencer Wells forceps after each retraction of the instrument to identify the possible descent of the threads.

Main outcome measures
Threads brought down beyond the external cervical os, or threads brought to within the endocervical canal and then grasped by Spencer Wells forceps.

Results
In approximately 40% of all patients, the threads were retrieved with Spencer Wells forceps alone and a further 40% with the disposable plastic retrievers. About 5% had no retrievable threads, and only 2.5% of the referred patients required general anaesthesia for removal of their IUCD. The analysis of the comparative trial was confined to the 197 patients with retrievable threads which could not be brought below the external os with Spencer Wells forceps. The first plastic retriever used was successful in 50% of patients. The Retrievette (59%) and the Emmett (53%) performed better than the Mi‐Mark Helix (37%) in this study. The difference was statistically significant (P=0.03) and the 95% confidence interval for the difference of the Mi‐Mark Helix from the other two retrievers was 4% to 33%. This retrieval rate for the Mi‐Mark Helix was much worse than in previously reported studies, though one doctor did have a better success rate with this retriever. The success rates, using a second plastic retriever randomly chosen from the two not used in the first attempt, were almost identical to those observed with the first retrievers: 63%, 56% and 36%. The success rate did not appear to be influenced by the length of thread, day of cycle, device type or parity. The success of the second retriever tried did not seem to be influenced by the retriever that had failed previously.

Conclusions
Based on our experience, the initial exploration of the endocervical canal with Spencer Wells forceps is invaluable. If this simple manoeuvre fails to retrieve the ‘missing’ threads, either the Retrievette or the Emmett thread retrievers are useful tools in general practice or in the family planning clinic setting.
Second trimester amniocentesis in twin pregnancies: maternal haemoglobin as a dye marker to differentiate diamniotic twins
Authors: BEEKHUIS J. R. , DE BRUIJN H. W. A. , VAN LITH J. M. M. , MANTINGH A.
Published: August 2005

Objective
To review the use of a membrane‐free haemolysate prepared from maternal blood to distinguish the amniotic sacs at amniocentesis in twin gestation.

Setting
University Hospital, Groningen.

Method
Haemoglobin solution prepared from maternal blood.

Subjects
63 twin pregnancies having amniocentesis.

Results
The fetal loss before 28 weeks was 4%. There was no perinatal mortality. Dye was detected in the second sac in 9 of 24 women tested before 1985 and none of the 39 women since, no malformations could be ascribed to the use of the haemolysate.

Conclusion
The use of the membrane‐free haemolysate is safe, but the technique will probably gradually become redundant because of improved ultrasound.
Doppler umbilical artery flow velocity waveforms in diabetic pregnancy
Authors: JOHNSTONE FRANK D. , STEEL JUDITH M. , HADDAD NABIL G. , HOSKINS PETER R. , GREER IAN A. , CHAMBERS SARAH
Published: August 2005

Objective
To assess the effect of uncomplicated diabetes on umbilical artery flow velocity waveforms (FVWs); to investigate the relation between glycaemic control and FVWs and the predictive value of umbilical artery FVWs for antenatal fetal compromise.

Design
Prospective descriptive study.

Setting
A large diabetic pregnancy clinic in a teaching hospital.

Subjects
128 pregnancies complicated by diabetes mellitus. 170 non diabetic women with no pre‐existing or pregnancy complications.

Interventions
In diabetic pregnancies, umbilical artery resistance index (RI) Doppler recordings and glycosylated haemoglobin were measured every 2 weeks from 28 weeks.

Main outcome measures
Umbilical artery RI and antenatal fetal compromise defined as a non reactive, decelerative cardiotocograph and/or a biophysical profile score persistently <6 and leading to immediate caesarean section.

Results
Uncomplicated diabetic pregnancies had FVW values similar to those in the non‐diabetic range. Glycaemic control was unrelated to umbilical artery FVW values. Abnormal umbilical artery RI was found in nine pregnancies, these were more likely to show evidence of fetal compromise and to be associated with birth weights of <50th centile. In seven pregnancies there was evidence of fetal compromise, but only three of these pregnancies had abnormal FVW values.

Conclusions
The non‐diabetic range of umbilical artery RI values is appropriate for diabetic pregnancies. Long‐term glycaemic control, within the range in this study, does not seem to affect umbilical artery RI. Abnormal umbilical artery RI is a significant predictor of fetal compromise in diabetic pregnancy, but fetal compromise can occur in association with normal RI values. Undue reliance should not be placed on normal FVW values in diabetic pregnancies.
Objective measurement of anxiety in hypertensive pregnant women managed in hospital and in the community
Authors: CARTWRIGHT W. , DALTON K. J. , SWINDELLS H. , RUSHANT S. , MOONEY P.
Published: August 2005

Objective
To determine whether pregnant hypertensives women are more anxious when monitored in hospital or at homes.

Design
Prospective randomized controlled trial.

Setting
Rosie Maternity Hospital and women's homes.

Subjects
Ninety‐nine pregnant hypertensive women: 50 had their blood pressure measured telemetrically from home, and 49 had it measured in hospital.

Main outcome measures
Number of episodes of monitoring, duration of monitoring, mean blood pressure during monitoring, gestational age at delivery, trait and state anxiety levels.

Results
There were no significant differences in anxiety levels, or in any other outcome measure, between the home and hospital groups.

Conclusion
When blood pressure is being monitored serially in pregnant hypertensive women, there is no measurable difference in their anxiety levels, whether they are in hospital or at home.
The effects of fetal exposure to danazol
Authors: BRUNSKILL PETER J.
Published: August 2005

Objective
To assess the consequences of exposure to danazol in utero. Additionally, by assessing the risk, to facilitate the counselling of pregnant women inadvertently exposed to danazol in early pregnancy.

Design
Retrospective review of reported case histories.

Subjects
129 women exposed to danazol during pregnancy were identified from individual case reports, data from the Australian Drug Reactions Advisory Committee and the United States Food and Drug Administration and from the reports of danazol exposure made directly to the manufacturers.

Main outcome measures
Teratogenic effects of fetal exposure to danazol in relation to dosage and duration of exposure.

Results
Of the 129 reported pregnancies, 12 miscarried and 23 were aborted. Of the 94 completed pregnancies, 37 resulted in the birth of normal males, 34 in non‐virilized females and 23 in virilized females. Virilization occurred in a proportion of female fetuses with a pattern of cliteromegaly, fused labia and urogenital sinus formation. Surgery to the genital tract was usually, but not always, required in childhood. The abnormality has not been reported where danazol therapy had been discontinued before the 8th week of pregnancy. Although more common in the higher dosages, virilization was reported in one case with a 200 mg daily dosage.

Conclusions
Danazol should remain contraindicated in pregnancy and clinicians should give careful contraceptive advice to patients commencing or continuing danazol therapy. Nonetheless it is possible to be cautiously optimistic about the outcome of danazol‐exposed pregnancies, particularly if treatment is discontinued before 8 completed weeks gestation.
Standards in fetal monitoring—practical requirements for uterine activity measurement and recording
Authors: Steer P. J.
Published: August 2005

External monitoring of uterine contractility in human labour can record contraction frequency accurately, but cannot determine true intra‐uterine pressure reliably. It is therefore suitable for use in spontaneous labour where there is a need for a marker of contractions to aid in continuous fetal heart rate pattern interpretation. Intra‐uterine pressure measurement can provide quantitative information more reliably over intervals of 10–60 minutes. Although active pressure values for individual contractions can vary by up to 50% when measured simultaneously by two or more intra‐uterine catheters/transducers, this variation is not systematic and cumulative measures vary by less than 5%. The measurement of baseline tone is affected by variables not related to uterine activity and should therefore be excluded when quantitative measures are made.
The effect of anxiety and depression during pregnancy on obstetric complications
Authors: Perkin M. R. , Bland J. M. , Peacock J. L. , Anderson H. R.
Published: August 2005

Objective
To investigate the effects of anxiety and depression during pregnancy on obstetric complications using the data collected from the St George's Birthweight Study.

Design
Prospective population study.

Setting
District general hospital in inner London.

Subjects
A consecutive series of 1860 white women booking for delivery were approached. Of these, 136 refused and 209 failed to complete the study for other reasons, leaving a sample of 1515.

Main outcome measure
Data were obtained by research interviewers at booking, 17, 28, and 36 weeks gestation and from the structured antenatal and obstetric record. The predictor variables were the anxiety and depression scores measured using the General Health Questionnaire. The outcome variables were five obstetric complications: preterm delivery; nonspontaneous onset of labour; major analgesia in the first and second stages of labour; and nonspontaneous vaginal deliveries. The possible confounding effects of 35 socio‐economic, psychological and personal variables were investigated using logistic regression.

Results
The factors that had the strongest relation with the outcomes were parity and maternal age. Depression during pregnancy was unrelated to the obstetric complications. Anxiety was weakly related to analgesia/anaesthesia in the second stage of labour (P= 0.04). However, anxiety accounted for only 0.1 % of the variance in use of major analgesia/anaesthesia. The most effective model, that for analgesia/anaesthesia in the first stage of labour, accounted for only 7.3% of the variance.

Conclusions
In the general population of pregnant women, anxiety and depression during pregnancy, while undesirable in themselves, are of little importance in the evolution of obstetric complications.
Prediction of fetal acidaemia in intrauterine growth retardation: comparison of quantified fetal activity with biophysical profile score
Authors: Ribbert Lucia S. M. , Nicolaides Kypros H. , Visser Gerard H. A.
Published: August 2005

Objective
To study the relation between quantified fetal movements and fetal activity assessed by the biophysical profile score and the pH in umbilical arterial blood at elective caesarean section.

Design
Fetal activity was assessed within 24 h prior to caesarean section for decelerative fetal heart rate patterns both by quantification (% of time spent moving) and by applying the biophysical profile score (BPS) criteria.

Setting
Department of Obstetrics, University Hospital.

Subjects
Nineteen growth retarded fetuses.

Main outcome measures
Fetal generalised movements (FGM%), fetal breathing movements (FBM%), total fetal activity (TFA%= FGM%+ FBM%); FGM, FBM and tone as assessed according the biophysical profile score (BPS); umbilical arterial pH.

Results
In all 11 acidaemic fetuses (pH <7.20) TFA% was below the 10th centile for normal fetuses; nine had decreased FGM% and eight decreased FBM%. Absence of FGM or tone according to the biophysical profile score was only seen in two acidaemic fetuses.

Conclusion
TFA% <11.7% was a better predictor of acidaemia at birth than either reduced FGM%, FBM%, or absence of FGM, FBM and tone as defined in the biophysical profile score. The two methods of assessing FBM were identical in predicting acidaemia, suggesting that in presence of acidaemia the decrease of FBM may be an all‐or‐none phenomenon. Furthermore, the data indicate that reduction in body movements may precede reduction in breathing movements.
Objectively measured tobacco exposure during pregnancy: neonatal effects and relation to maternal smoking
Authors: Bardy Ali H. , Seppälä Timo , Lillsunde Pirjo , Kataja J. Matti , Koskela Pentti , Pikkarainen Jarmo , Hiilesmaa Vilho K.
Published: August 2005

Objective
To measure quantitatively and objectively the maternal and fetal tobacco exposure during pregnancy and its neonatal effects.

Design
Tobacco exposure was assessed from maternal serum samples, obtained during the first half of pregnancy and from umbilical serum samples obtained at delivery, by measuring the concentration of nicotine metabolite, cotinine. Data on the respective pregnancies and neonates were collected from the Finnish Medical Birth Registry.

Setting
Finland.

Subjects
One thousand two hundred and thirty‐seven pregnancies and newborns, representing all pregnancies resulting in a liveborn infant during one week in one country.

Main outcome measures
Gestational age, birthweight and crown‐heel length of newborns.

Results
Cotinine (>6 μg/l) was detected in either maternal or umbilical serum in 300 pregnancies, and these mothers and newborns were classified as exposed. Important differences occurred between measured exposure and reported smoking behaviour. Of the exposed mothers, 38% were nonsmokers and 3.4% of the nonexposed mothers were smokers. Tobacco exposure was associated with shorter gestational age, reduced birthweight and shorter crown‐heel length of the newborns. After correction for parity, gender, and gestational age, the exposed newborns were on average 188 g (95% confidence interval (CI) 123–253 g) lighter and 10 mm (95% CI7–13 mm) shorter than the nonexposed newborns. One μg/ml of cotinine in maternal serum resulted in a mean decrease of 1.29 g (95% CI 0.55–2.02 g) in birthweight and in a mean decrease of 0.059 mm (95% CI 0.035–0.083 mm) in birth length. Maternal cotinine concentrations better explained the neonatal findings than the reported smoking habits.

Conclusions
There is a quantitative dose and effect relation between tobacco exposure and a decrease in the gestational age at birth and size of the neonate. The smoking habit reported by mothers themselves is not an accurate measure of fetal tobacco exposure.
Stereomicroscopic demonstration of chorionic villi: differentiation between miscarriage and ectopic pregnancy
Authors: Dæby Kristiansen John , Clausen Ingo , Nygaard Nielsen Majbrit , GRove Thomsen Sten
Published: August 2005

Objective
To evaluate direct peroperative stereomicroscopic examination of endometrial curettings in the differentiation between miscarriage and ectopic pregnancy.

Design
A prospective consecutive controlled study.

Setting
Odense University Hospital, Odense, Denmark.

Subjects
One hundred and fifty‐nine women with vaginal bleeding and/or abdominal pain in early pregnancy and no fetus seen on ultrasound.

Main outcome measures
The results of stereomicroscopy were compared with the histological diagnoses.

Results
There was 90% (95% CI, 84–94%) agreement between the stereomicroscopic and histological examinations. Fifteen per cent had an ectopic pregnancy. The sensitivity of stereomicroscopy as a marker of ectopic pregnancy was 92% (73–99%), the specificity 94% (88–97%). The predictive value of a positive test was 73% (54–88%) and that of a negative test 98% (94–100%).

Conclusion
Direct peroperative stereomicroscopy of endometrial curettings is a valuable diagnostic tool for immediate differentiation between miscarriage and ectopic pregnancy.
Validation of the SpaceLabs 90207 ambulatory blood pressure monitor for use in pregnancy
Authors: Shennan Andrew H. , Kissane Jenny , de Swiet Michael
Published: August 2005

Objective
To determine the accuracy of the SpaceLabs 90207 ambulatory blood pressure monitor in pregnant women.

Design
Prospective observational study.

Setting
Queen Charlotte's and Chelsea Hospital for Women.

Subjects
One hundred and twenty‐two pregnant women from the antenatal population of Queen Charlotte's Hospital.

Methods
Evaluation was carried out according to the British Hypertension Society (BHS) Protocol.

Results
The mean difference between observer and device for systolic blood pressure was 3 (SD 4) mmHg. For diastolic blood pressure the difference was 5 (SD 6) mmHg for Phase IV (muffling of Korotkoff sound), and 4 (SD 4) mmHg for Phase V (disappearance of Korotkoff sound). According to the BHS grading criteria, the device reached a B grading for systolic blood pressure. B grading was also reached for diastolic blood pressure (Phase V) but grade C for diastolic blood pressure (Phase IV). The accuracy criteria stipulated by the Association for the Advancement of Medical Instrumentation (AAMI) were also met for both systolic and diastolic blood pressure.

Conclusion
The SpaceLabs 90207, when compared with trained observers, is accurate in determining both systolic and diastolic blood pressure for clinical purposes, as judged by the BHS Protocol in pregnancy.
Anti‐D concentrations in fetal and maternal serum and amniotic fluid in rhesus allo‐immunised pregnancies
Authors: Economides Demetrios L. , Bowell Peter J. , Selinger Mark , Pratt Geoffrey A. , Ferguson Jane , Mackenzie I. Z.
Published: August 2005

Objective
To investigate the relation between anti‐D concentrations in maternal serum, fetal serum and amniotic fluid, and the development of fetal anaemia.

Design
Observational cross sectional and longitudinal study.

Setting
Regional referral centre.

Subjects
Sixty‐one women undergoing fetal blood sampling at 19 to 36 weeks' gestation for fetal blood and haematocrit estimation for the management of Rh (D) allo‐immunisation. Thirty‐eight pregnancies (7 with an Rh (D) negative fetus) were tested only once but the rest had two to five fetal blood samplings.

Interventions
Ultrasound guided fetal blood sampling and amniocentesis, and automated analysis of anti‐D antibody quantitation.

Results
There were strong correlations between maternal serum, fetal serum and amniotic fluid anti‐D concentrations. Analyses of both longitudinal and cross sectional data demonstrated a decrease of the maternal/fetal serum anti‐D ratio with gestation. In pregnancies with Rh (D) negative fetuses the maternal/fetal anti‐D ratio was significantly lower (P<0.0001) than in those with Rh (D) positive fetuses. The degree of fetal anaemia (delta haematocrit) was correlated with maternal serum and amniotic fluid anti‐D concentrations (r=−0.55, n= 54, P<0.0001; r=−0.57, n= 44, P<0.0001, respectively) but there was a weaker correlation with fetal serum anti‐D (r= 0.37, n= 54, P<0.01).

Conclusion
Anti‐D concentrations in maternal serum, fetal serum and amniotic fluid are correlated with fetal anaemia. The decrease in maternal/fetal anti‐D ratio with gestation suggests an increase in placental permeability for anti‐D with advancing pregnancy.
The effect of placental syncytiotrophoblast microvillous membranes from normal and pre‐eclamptic women on the growth of endothelial cells in vitro
Authors: Smárason Alexander K. , Sargent Ian L. , Starkey Phyllis M. , Redman Christopher W. G.
Published: August 2005

Objectives
To determine if placental syncytiotrophoblast microvillous (STBM) membranes contain factors which could cause the maternal endothelial cell disturbance thought to be central to the pathophysiology of the maternal syndrome of pre‐eclampsia.

Design
STMB membranes isolated from pre‐eclamptic or normal placentae were added to cultures of endothelial cells and their effect on the proliferation (measured by 3H‐thymidine incorporation), viability (measured by 51Cr release) and growth as a monolayer of these cells was determined. Membranes prepared from red blood cells, and nonendothelial adherent and nonadherent cell lines were used as specificity controls.

Subjects
STBM membranes were isolated from the placentae of primigravid women, 10 having caesarean sections for breech presentations and 10 for pre‐eclampsia.

Results
STBM membranes from the placentae of normal and pre‐eclamptic women suppressed endothelial cell proliferation to a similar extent and disrupted the cell monolayer to form a honeycomb‐like pattern. This change in morphology was seen before significant endothelial cell death occurred. Red blood cell membranes had no effect on either endothelial cell proliferation, viability or monolayer integrity. Endothelial cells from human umbilical arteries and bovine adrenal capillaries were similarly suppressed, but comparable concentrations of STBM membranes had no effect on nonendothelial cell lines.

Conclusions
Syncytiotrophoblast microvillous membranes specifically interfered with endothelial cell growth in vitro. Our results demonstrate that there are trophoblast products which could cause the maternal syndrome of pre‐eclampsia through endothelial cell damage.
Plasma oestrogens in postmenopausal women with endometrial cancer
Authors: Nyholm Henrik C. J. , Nielsen Anette L. , Lyndrup Jens , Dreisler Anne , Hagen Claus , Haug Egil
Published: August 2005

Objective
To study plasma levels of oestrogens and androgens, sex hormone‐binding globulin (SHBG) and follicle stimulating hormone (FSH) in postmenopausal patients with endometrial cancer.

Design
Patients and controls were matched for age, body mass index, parity and years since menopause.

Setting
Department of Obstetrics and Gynaecology, Hvidovre Hospital, Denmark.

Subjects
Fifty postmenopausal patients with endometrial cancer and 54 matching controls.

Measurements
Plasma levels of SHBG, FSH, oestrone, oestradiol, oestrone‐sulphate, dehydro‐epiandrosterone sulphate, testosterone, and androstenedione were measured by radio‐immunoassays. Free fractions of oestradiol and testosterone were calculated according to levels of SHBG and albumin.

Results
The levels of oestradiol, free oestradiol, and oestrone were elevated (P<0.001) in patients compared with controls (oestradiol: 51 (45–59) vs 37 (34–41) pmol/1; free oestradiol: 0.69 (0.59–0.80) vs 0.48 (0.42–0.54) pmol/1; oestrone: 180 (159–204) vs 119 (107–133) pmol/1 (mean values (95% CI) in patients vs controls)). Furthermore, an increased oestrone:androstenedione ratio (0.095 vs 0.072, P<0.01) was found in patients. SHBG correlated negatively (P<0.001) with body mass, while the free fractions of oestradiol and testosterone correlated positively (P<0.01) with body mass, in both patients and controls. Multiple regression analysis showed that the differences in oestrogen levels between the two groups persisted when controlling for the effect of body mass, age, years since menopause, parity, and levels of SHBG and FSH.

Conclusion
Patients with endometrial cancer exhibit increased plasma levels of oestradiol and oestrone. Speculatively, these oestrogens may result from an increased oestrone conversion from androstenedione, an increased ovarian and adrenal secretion of androstenedione, or alternative oestrogen production routes. The present findings support the hypothetical role for oestrogens in the aetiology of endometrial cancer.
Flow cytometric studies of ploidy and proliferative indices in the Yorkshire trial of adjuvant progestogen treatment of endometrial cancer
Authors: Thornton J. G. , Ali S. , O'Donovan P. , Griffin N. , Wells M. , Macdonald R. R.
Published: August 2005

Objective
To estimate whether flow cytometric indices provide independent measures of prognosis or predict response to prophylactic progestogens in endometrial cancer.

Design
Endometrial tumour specimens were retrieved and analysed by flow cytometry from 257 women who had been randomly allocated in a previous trial to receive prophylactic progestogen in addition to conventional therapy for endometrial carcinoma.

Setting
Fourteen district and two teaching hospitals in West Yorkshire.

Subjects
Women developing primary endometrial cancer between 1975 and 1983.

Main outcome measures
Tumour ploidy status and proliferative indices and the relation of these to tumour stage and grade, to prognosis and to response to progestogens.

Results
Ploidy status and proliferative indices were related to tumour stage, grade and patient survival but were not independent predictors of survival. They did not predict patients who would respond to progestogens although there was a nonsignificant trend towards patients with diploid tumours surviving longer after progestogen treatment.

Conclusions
Flow cytometry adds little to established prognostic indicators for endometrial cancer.
Does elective cryopreservation of all embryos from women at risk of ovarian hyperstimulation syndrome reduce the incidence of the condition?
Authors: Wada I. , Matson P. L. , Troup S. A. , Morroll D. R. , Hunt L. , Lieberman B. A.
Published: August 2005

Objectives
To analyse the incidence and factors associated with the ovarian hyper‐stimulation syndrome (OHS) in our IVF/GIFT programme before and after the introduction of a strategy to cryopreserve all embryos from women judged to be at risk.

Design
Two hundred forty‐one consecutive IVF/GIFT cycles from January to December 1989.

Setting
Specialist fertility unit, Manchester, UK.

Interventions
Pituitary suppression was effected by a daily subcutaneous injection of buserelin (500 μg) beginning 7 days before the expected menses. The ovarian stimulation was with variable amounts of human menopausal gonadotrophin. Ovulation was induced with 10 000 i.u. human chorionic gonadotrophin (hCG). From January to May (period A), gametes/embryos were replaced and 2000 i.u. hCG given, irrespective of the serum oestradiol (E2) concentration. From June to December (period B), all the embryos from women with an E2>3500 pg/ml on the day of ovulatory trigger were electively cryopreserved.

Main outcome measures
Serum E2, features of moderate or severe OHS, clinical pregnancies.

Results
The OHS occurred in 10/105 (9.5%) and 12/136 (8.8%) cycles in periods A and B, respectively. Fewer women (6% versus 60%, P<0.05) who had their embryos cryopreserved developed severe OHS compared with women with an E2 >3500 pg/ml who became pregnant after gamete/embryo transfer in period A. The main factors associated with the development of OHS were serum E2 concentrations >3500 pg/ml, whether gamete/embryos were replaced and the additional hCG given, the occurrence of a pregnancy and the presence of polycystic ovary disease.

Conclusion
The elective cryopreservation of all embryos from women with high E2 levels reduced the severity, but not the incidence of symptomatic OHS.
Vaginal delivery after previous caesarean section: is X‐ray pelvimetry necessary?
Authors: Thubisi M. , Ebrahim A. , Moodley J. , Shweni P. M.
Published: August 2005

Objective
To determine whether antepartum X‐ray pelvimetry (XRP) reliably identified women suitable for a trial labour or repeat elective caesarean section after one previous section.

Design
A prospective controlled trial in which women were randomly allocated to either an antepartum XRP group who had XRP at 36 weeks gestation to determine mode of delivery, or a control group who had a trial labour without antepartum XRP. Following delivery, all controls had postpartum XRP.

Setting
Department of Obstetrics and Gynaecology, King Edward VIII Hospital, Durban, South Africa.

Subjects
Three hundred‐six women with a history of one previous caesarean section.

Main outcome measures
Mode of delivery, birthweight and maternal and perinatal mortality and morbidity in the two groups.

Results
In the antepartum XRP group, 23 of 144 (16%) of women delivered vaginally compared with 60 of 144 (42%) controls (P<0.0001). Of the 84 women with adequate antepartum XRP only 23 (27.7%) delivered vaginally. In the control group, 33 of 60 (55%) women who had vaginal deliveries had inadequate postpartum XRP and would have had a caesarean section if this information was known in the antepartum period; 62 of 84 (74%) caesarean sections in the control group had adequate postpartum XRP. Birthweight of the infants was similar in the two groups. There were no maternal or perinatal deaths. Maternal morbidity was similar in the two groups. Neonatal morbidity was minimal.

Conclusion
Antepartum XRP is not necessary prior to a trial labour in women with one previous caesarean section. It increases the caesarean section rate and is a poor predictor of the outcome of labour.
Discordant birthweight and late fetal death in like‐sexed and unlike‐sexed twin pairs: a population‐based study
Authors: Rydhström Håkan
Published: August 2005

Objective
To study the relation between pregnancy loss (one or two fetal deaths in a pair) in twin pregnancy and gender (like‐sexed and unlike‐sexed pairs), discordant birthweight, and placentation.

Design
The type of placentation for gestations with pregnancy loss was studied, based on material retrieved from the original medical records, for a defined region comprising 20.0% of the total twin population.

Subjects and setting
Four thousand one hundred and ninety‐one unlike‐sexed and 10875 like‐sexed twin pairs born in Sweden between 1973 and 1989, in most cases with a gestational duration 28 or more completed weeks.

Results
The relative risk (RR) for pregnancy loss in like‐sexed pairs, compared with unlike‐sexed ones, was 2.3 and the 95% confidence limits (CL) 1.7–3.1. Not until discordance exceeded 999 g did the pregnancy loss rate for unlike‐sexed pairs increase significantly, compared with the (first) stratum with discordance less than 250 g (RR = 6.3; CL 3.5–11.3). For like‐sexed twin pairs a higher pregnancy loss rate, compared with the first stratum, was seen already in the stratum with discordance 250–499 g (RR = 1.3; CL 1.0–1.8); a significant increase in pregnancy loss rate was found in all the three strata 500–749 g (RR = 2.1; CL 1.5–3.0), 750–999 g (RR = 3.5; CL 2.3–3.0), and 1000 g or more (RR=10.9; CL 8.4–14.2), respectively. When calculating the discordance as a percentage of the weight of the larger twin, unlike‐sexed pairs experienced a significant increase in pregnancy loss when discordance exceeded 40 to 50%. For like‐sexed ones, the corresponding figures were 20 to 30%. In the 47 unlike‐sexed pregnancies complicated by pregnancy loss, both twins died in two pregnancies (4.3%), whereas for like‐sexed pairs the corresponding figures were 65/279 (23.3%). Of 47 gestations with pregnancy loss in a defined region, 32 were monochorionic (monozygous), nine were like‐sexed dichorionic (monozygous or dizygous), and six were unlike‐sexed (dizygous).

Conclusions
Pregnancy loss was twice as high in like‐sexed compared with unlike‐sexed pairs, and only in like‐sexed pairs was pregnancy loss strongly correlated to birthweight discordance. In twin pregnancies with one fetal death the risk for the surviving twin to succumb is five to six times higher in like‐sexed compared with unlike‐sexed pairs and is most probably related to monochorionicity.
Charts of fetal size: 2. Head measurements*
Authors: Chitty Lyn S. , Altman Douglas G. , Henderson Annabel , Campbell Stuart
Published: August 2005

Objective
To construct new size charts for fetal head circumference, biparietal diameter and other head dimensions.

Design
A prospective, cross sectional study.

Setting
The routine ultrasound department of a London teaching hospital.

Subjects
The fetuses of 663 women seen in the routine antenatal booking clinic whose ultrasound and menstrual dates agreed within 10 days.

Methods
Fetuses were scanned once only for the purpose of the study at gestations between 12 and 42 weeks, when up to 20 dimensions were measured. For each measurement separate regression models were fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived by combining these two regression models, assuming that the measurements have a normal distribution at each gestational age.

Results
A total of 594 fetuses had their biparietal diameter measured and their head circumference measured directly. Both head diameters were recorded for 587 fetuses and the circumference was also derived from these, as was the cephalic area. New charts are presented for biparietal diameter (both outer–outer and outer–inner), head circumference (directly measured and derived from diameters). The directly measured head circumferences were consistently (by about 1%) greater than those derived from measurement of the head diameters. The new charts are compared with previously published charts that are in wide use. Charts for occipitofrontal diameter, cephalic index and cephalic area are also presented.

Conclusions
We have constructed new size charts for the fetal biparietal diameter and for head circumference, both measured directly and derived from head diameters. We have demonstrated the difference between the size charts constructed from these two sets of values and hence the importance of using the appropriately derived chart when assessing the head circumference. The differences between the new charts for biparietal diameter and head circumference and previous ones may be largely due to methodological differences.
First trimester maternal serum pregnancy‐associated plasma protein A and pregnancy‐specific βl‐glycoprotein in fetal trisomies
Authors: Bhrsinger N. A. , Brizot M. L. , Johnson A. , Snijders R. J. M. , Abbott J. , Schneider H. , Nicolaides K. H.
Published: August 2005

Objective
To examine the potential value of maternal serum levels of pregnancy‐associated plasma protein A (PAPP‐A) and pregnancy‐specific βl‐glycoprotein (SP1) in the detection of fetal trisomy.

Design
Cross‐sectional study.

Setting
The Harris Birthright Research Centre For Fetal Medicine, King's College Hospital Medical School, London, UK and Division of Maternal‐Fetal Medicine, Jefferson Medical College, Philadelphia, USA.

Subjects and methods Maternal serum PAPP‐A and SP1 concentrations were measured at 10 to 13 weeks gestation in samples from 42 pregnancies with fetal trisomy (trisomy 21, n= 29; trisomy 18, n= 9; trisomy 13, n= 4) and in samples from 210 matched controls.

Results
In controls, both maternal serum PAPP‐A and SP1 increased significantly with gestation and in trisomic fetuses levels of both hormones were reduced. However, discriminant analysis demonstrated that SP1 did not contribute significantly in the distinction between trisomic and control pregnancies. Although levels of PAPP‐A were reduced throughout the gestational range examined (10 to 13 weeks), especially in cases with fetal trisomy 21, the deviation was more pronounced at 10 to 11 weeks than at 12 to 13 weeks gestation. In 45% of pregnancies with fetal trisomy 21 and 70% of pregnancies with trisomies 18 or 13 maternal serum PAPP‐A levels at 10 to 11 weeks gestation were below the 5th centile of the normal range.

Conclusion
Maternal serum PAPP‐A concentration in the first trimester of pregnancy may prove to be useful in the prediction of risk for fetal trisomies.
Risk of preterm delivery in pregnant women with group B streptococcal urinary infections or urinary antibodies to group B streptococcal and E. coli antigens
Authors: McKenzie H. , Donnet M. Louise , Howie P. W. , Patel N. B. , Benvie Dawn T.
Published: August 2005

Objective
To establish whether there is an association between preterm delivery and either group B streptococcal urinary infection or the presence of urinary antibodies to group B streptococcal or E. coli antigens.

Design
A prospective study with urine culture and antibody measurement performed at the first antenatal visit and at 28 weeks gestation.

Setting
Ninewells Hospital, Dundee.

Subject
Two thousand and forty‐three women registering consecutively at an antenatal clinic.

Main outcome measure
Delivery at less than 37 weeks gestation.

Results
No increase in preterm delivery was observed in women with positive urine cultures for group B streptococci either at booking or at 28 weeks, even when confirmed by positive repeat cultures. Preterm delivery was more common in women with elevated urinary antibodies to E. coli antigens at booking (relative risk 1.81, 95% CI 1.22–2.68, P= 0.005) and at 28 weeks (relative risk 2.36, 95% CI 1.60–3.48, P < 0.0001) and to group B streptococcal antigens at 28 weeks (relative risk 2.24, 95% CI 1.46–3.43, P= 0.0003).

Conclusions
These data do not support previous reports that positive urine cultures for group B streptococci are associated with an increased risk of preterm delivery. Our report of an association between elevated levels of urinary antibodies and preterm delivery is a new finding consistent with the possibility that a local inflammatory response to uro‐genital infection may be important in stimulating the onset of preterm labour. The results suggest that screening for urinary antibodies at 28 weeks gestation might help to identify a group of women at increased risk of prematurity.
Retraction: Low dose aspirin in women with raised maternal serum alpha‐fetoprotein and abnormal Doppler waveform patterns from the uteroplacental circulation
Authors: Hamid R. , Robson M. , Pearce J. M.
Published: August 2005

Objective
To investigate the use of low dose aspirin in the reduction of perinatal morbidity and mortality in women with unexplained raised maternal serum alpha‐fetoprotein and abnormal uteroplacental Doppler waveform patterns.

Design
Prospective randomised controlled trial.

Setting
A tertiary referral obstetric service.

Subjects
One hundred and sixty‐four women referred to our unit with raised maternal serum alpha‐fetoprotein and a structurally normal fetus had abnormal uteroplacental Doppler waveform patterns at 24 weeks of gestation.

Intervention
Women were randomly allocated to two groups, receiving either low dose aspirin 75 mg (n= 76) or placebo (n= 88) daily until delivery.

Main outcome measures
Preterm labour, low birthweight, the occurrence of placental abruptions and perinatal mortality.

Results
The frequency of severely small for gestational age infants (birthweight < 5th centile) was reduced in the aspirin treated group to 16% compared with 25% in the placebo group (95% CI –21% to 13%). The frequency of delivery before 34 weeks of gestation was 26% in the aspirin group and 42% in the placebo group (95% CI–30% to 1%). The perinatal mortality was 240/1000 in the aspirin group and 320/1000 in the placebo group (95% CI–22% to 6%). None of these reductions was statistically significant. Although the frequency of placental abruptions was similar in the two groups, significantly more babies died from abruption in the aspirin treated group (91%versus 30%, 95% CI 28% to 94%). Low dose aspirin did cause a significant reduction (P= 0.008) in deaths from causes other than placental abruption.

Conclusion
This trial revealed a benefit of low dose aspirin therapy in women with raised maternal serum alpha‐fetoprotein and abnormal uteroplacental Doppler waveform patterns, but the effect was smaller than expected. Although a reduction in deaths from small preterm babies was observed, there was an increase in the number of deaths following placental abruption without a significant increase in the number of abruptions. We recommend that this should be considered before giving aspirin to these high risk women and that other investigators should specifically look for this effect.
Serum CA 125 levels and sonography in the pre‐operative assessment of myometrial invasion of endometrial cancer
Authors: Lehtovirta Pentti , Cacciatore Bruno , Ylostalo Pekka
Published: August 2005

Objective
To assess the value of elevated serum CA 125 levels and ultrasonography in predicting deep myometrial invasion of endometrial cancer.

Design
We assessed pre‐operatively serum CA 125 levels and myometrial invasion by ultrasonography in women undergoing laparotomy because of endometrial cancer. The results were compared with histological determination of myometrial invasion of endometrial cancer. Invasion was classified as superficial (less than one‐half of myometrium involved) or deep (more than one‐half of myometrium involved).

Setting
University hospital.

Subjects
Seventy‐eight women with a histologically proved endometrial carcinoma confined to the uterus: nine had Stage IA disease, 45 Stage IB, five Stage 1C, one Stage IIA, four Stage IIB and 14 Stage IIIA. The myometrial invasion was found to be superficial in 57 (73%) patients and deep (more than half) in 21 (27%), respectively.

Results
CA 125 levels were above 35 iu/1 in 17 (21.8 %) of 78 patients: nine (42.8 %) of 21 with deep myometrial invasion and eight (14%) of 57 with superficial invasion (P < 0.01). The positive predictive value of an elevated CA 125 level for deep myometrial invasion was 52.9% and the negative predictive value 80.3 %. Sonography correctly estimated invasion in 69 cases (88.5%). Deep invasion was assessed by ultrasound with a significantly (P < 0.01) higher sensitivity than CA 125 (95.2% vs. 42.8). Positive and negative predictive values for deep myometrial invasion of sonography were 71.4% and 98%, respectively.

Conclusion
Ultrasonography was more accurate than serum CA 125 levels in predicting myometrial invasion of endometrial carcinoma.
Variation in obstetric care within and between hospital levels in Finland
Authors: Hemminki Elina , Gissler Mika
Published: August 2005

Objective
In obstetrics, both area and hospital variation has previously been documented for operative procedures, but not for other treatments or diagnostic procedures. This study investigated the extent of variation in care during pregnancy, at birth and after birth.

Design and methods
The variation was studied by hospitals (n= 52) by hospital level. To account for differences in women's background characteristics, logistic regression analyses were done. The data came from the 1991 Finnish Birth Register which records data on all births (n= 64 171).

Results
All interventions and care practices studied varied notably from one hospital to another, with the variation usually being greater within hospitals of the same level than between hospitals of different levels. Each of the seven non‐operative interventions showed a larger variation than did each of the four operative interventions. Standardisation for mothers’ background characteristics did not eliminate this variation. Some interventions, but not all, were clustered in the same hospitals.

Conclusions
Such large variation indicates a need for further studies on the benefits of obstetric interventions and of care practices, and on better application of research results to obstetric care.
A survey of views on hormone replacement therapy
Authors: Norman S. G. , Studd J. W. W.
Published: August 2005

Objective
To investigate the attitude of consultant gynaecologists and general practitioners to various aspects of hormone replacement therapy and to compare the findings in these two groups.

Design
Anonymous postal survey of 589 general practitioners and 998 consultant gynaecologists; 373 (63%) and 655 (66%) valid replies, respectively, were received.

Main outcome measures
Views on universal treatment of eligible women, indications for hormone replacement therapy, prescribing practice, pretreatment investigation, monitoring, and contraindications to treatment.

Results
More consultants (64%) than general practitioners (56%) thought hormone replacement therapy should be offered to all eligible women, with a significant trend against treatment amongst more senior consultants. Most practitioners were prepared to offer treatment before the cessation of menstruation, but only 27% of consultants and 11% of general practitioners recommended indefinite treatment. Most limited treatment to less than 10 years. Menopausal symptoms, premature natural and surgical menopause, and a family history of osteoporosis were regarded as indications for treatment, but less than half felt established osteoporosis an indication. Hormone replacement therapy was judged to reduce the risk of ischaemic heart disease and osteoporosis by both groups but there was less consensus on the prevention of cerebrovascular accident. In general, consultants had more faith in hormone replacement therapy as prophylaxis. One‐quarter of consultants said that hormone replacement therapy should be initiated by consultants. Only 4% of general practitioners shared this view. About 30% of both groups required mammography, but less than 10% required sophisticated tests. A range of common cardiovascular conditions were regarded as contraindications, although general practitioners were more likely to regard thrombosis and cerebrovascular accident as contraindications. Breast cancer and a family history of breast cancer were regarded with suspicion by both groups.

Conclusions
Practitioners were positively inclined to hormone replacement therapy, but many were unconvinced of its chronic use and use in those with cardiovascular conditions. There were differences in views as to who should initiate therapy.
Endometrial resection follow up: late onset of pain and the effect of depot medroxyprogesterone acetate
Authors: Jacobs Susan A. , Blumenthal Norman J.
Published: August 2005

Objective
To observe longer term (9 to 18 months) follow up of women after a transcervical resection of the endometrium (TCRE) and the effect of post‐operative medroxyprogesterone acetate on the results.

Design
An observational study.

Setting
A district public hospital and a nearby private hospital in Sydney, Australia.

Subjects
Sixty‐one women who underwent TCRE from January to December 1991 were contacted 9 to 18 months after the procedure. They were questioned about symptoms and levels of satisfaction at six months, 12 months and at the time of interview, 9–18 months after the procedure. The 27 women treated from 1 January to 31 August 1991 were given medroxyprogesterone acetate 150mg at the time of surgery. From 1 September to 31 December 1991 no medroxyprogesterone acetate was given (32 women). Two women underwent immediate hysterectomy, and are included as unsuccessful TCREs but are excluded from description of effects of medroxyprogesterone acetate on the results of TCRE.

Results
Late onset, defined as after 12 months, of pain with or without bleeding occurred in 7 out of 52 women (13.5%). Overall, 49 out of 61 women (80.3%) were satisfied with the operation at the time of interview, 9 to 18 months post‐operatively. Success rates, measured by satisfaction, were 89% (24/27) in the medroxyprogesterone acetate group and 75% (24/32) in the no medroxyprogesterone acetate group.

Conclusion
Follow up after endometrial resection revealed that a definite subgroup of women develop late onset of pain with or without bleeding. Results at four to six months do not necessarily correlate with longer term outcomes. This needs to be investigated with larger, long term follow up studies, as does the apparently beneficial effects of medroxyprogesterone acetate on the long term results of TCRE.