bluuebunny/crossref_metadata_2025 huggingface dataset:
A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia
Authors: Bhattacharya S. , Cameron I. M. , Parkin D. E. , Abramovich D. R. , Mollison J. , Pinion S. B. , Alexander D. A. , Grant A. , Kitchener H. C.
Published: August 2005

Objective
To compare endometrial laser ablation (ELA) with transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia.

Design
Randomised controlled trial.

Setting
Gynaecology department of a large teaching hospital.

Participants
Women with menorrhagia due to dysfunctional uterine bleeding (n= 372) were randomly allocated to ELA (n= 188) or TCRE (n= 184).

Main outcome measures
Operative complications, post‐operative recovery, relief of menstrual and other symptoms, need for further surgical treatment, satisfaction with treatment after 6 and 12 months, and differential resource use.

Results
TCRE was significantly quicker, with lower rates of fluid overload. Perioperative morbidity was low and similar hi both groups. Outcome at 12 months was also similar: 72 women (45%) had either amenorrhoea or brown discharge in the ELA group compared with 71 (49%) in the TCRE group; 79 (49%) versus 68 (46%) had lighter periods. Thirty (16%) versus36 (20%) had received further surgical treatment: 9 (5%) compared with 25 (14%) had had a hysterectomy, and 21 (11%) versus 11 (6%) had received repeat ablation. Anxiety and depression, dysmenorrhoea and pre‐menstrual symptoms were improved by both procedures and bladder symptoms were affected by neither. At 12 months 148 (90%) women in the ELA group and 140 (91%) women in the TCRE group were satisfied with their treatment. The estimated additional cost of ELA was £145 per procedure.

Conclusions
At one year there was no clear difference in clinical outcome between ELA and TCRE.

Both procedures were associated with low morbidity. ELA was the more costly procedure. Despite the need for further surgery for about one in six women, satisfaction rates were high following both ELA and TCRE.
Radiofrequency induced endometrial ablation: an update
Authors: Thijssen R. F. A.
Published: August 2005

Objective
To test the safety and efficiency of radiofrequency endometrial ablation as a nonhysteroscopic treatment of dysfunctional uterine bleeding.

Design
A multicentre trial. Setting Nineteen clinics in six countries.

Methods
From February 1990 to December 1994, 1280 women were treated with radiofrequency endometrial ablation. Inclusion criteria were: menorrhagia, age 30–55 years, a completed family, a wish to retain the uterus, no hypergonadotropic state indicating an approaching menopause, a normal sized uterus, normal cervical cytology, normal adnexa, no prolapse, no intrauterine abnormalities, and no history of a bleeding disorder. Treatment was performed according to a standard operating protocol.

Results
Either amenorrhoea or a satisfactory improvement of menstruation was obtained in 78.5% of 944 women followed for six months or more. The design of the equipment has been thoroughly revised and improved during the last four years. The complications encountered were mostly related to the handling of radiofrequency and sometimes due to failures in following the safety protocol.

Conclusions
Although the technology is complicated, the treatment is simple, fast and effective. The complications have often been unpredictable. Despite the improvements made during this period, safety must be further enhanced to develop the original concept into an established technique.
The levonorgestrel intrauterine system in the management of menorrhagia
Authors: Barrington J. W. , Bowen‐Simpkins P.
Published: August 2005

Objective
To assess the effect of a levonorgestrel releasing intrauterine system in the management of menorrhagia.

Design
A prospective study.

Setting
A district general hospital in South Wales.

Methods
Fifty women with a failed trial of medical therapy and awaiting hysterectomy or transcervical resection of the endometrium (TCRE) were treated with a levonorgestrel intrauterine system. The menstrual loss was estimated using a modified pictorial chart together with a full blood count and ferritin measurement preinsertion and at three and six to nine months postinsertion.

Results
The menstrual loss was reduced to acceptable levels in 37 women at three months and a further four by six to nine months. In all, 41 patients were taken off the waiting list for surgery, four of whom became amenorrhoeic. There was no significant change in full blood count nor ferritin measurement despite unscheduled bleeding for six to eight weeks postinsertion. Fifty‐six percent of patients noticed considerable improvement or cure of their premenstrual syndrome symptoms; 80% noted a reduction in dysmenorrhoea.

Conclusion
The levonorgestrel releasing intrauterine system is an effective nonsurgical treatment for the management of menorrhagia and dysmenorrhoea that has additional benefit as a contraceptive and in relieving premenstrual syndrome.
The effects of transdermal oestradiol and oral progestogens on haemostasis variables
Authors: Kroon U.‐B. , Tengborn L. , Rita H. , Bäckstrom A.‐C.
Published: August 2005

Objective
To evaluate the effects of 1 g (1 mg oestradiol) transdermal oestradiol gel continuously combined with 10 mg medroxyprogesterone acetate orally 12 days either monthly or every third month on haemo‐ stasis variables.

Design
An open, parallel stratified study.

Setting
Sahlgrenska University Hospital, Goteborg, Sweden

Participants
A total of 48 peri‐ and postmenopausal women less than 65 years of age participated in this study. Twenty‐seven women, who had from 2 months to 3 years since their last period were included in group I. Twenty‐one women, who were more than 3 years postmenopausal, comprised group II.

Main outcome measures
The following parameters were determined: von Willebrand factor antigen, factor VII antigen, fibrinogen, antithrombin, protein C, protein S, plasminogen activator inhibitor activity, tissue plasminogen activator antigen, prothrombin fragment1+2, thrombin‐antithrombin complex and platelets.

Results
Both regimens decreased fibrinogen, factor VII antigen as well as antithrombin.

Conclusions
These changes were mainly ‘in an anti‐thrombotic direction’. The overall impression is that the transdermally administered oestrogen in combination with an oral progestogen induced favourable, although slight changes in the haemostatic system. The possible influence of these changes on the risk of cardiovascular disease remains yet to be studied.
Urinary tract injuries during obstetric intervention
Authors: Rajasekar Dhanasekaran , Hall Marion
Published: August 2005

A retrospective case record review of obstetric urinary tract injury in the Grampian region from 1976 to 1993 identified 16 cases of bladder injury (0.1 per 1000 deliveries, 1.4 per 1000 caesarean sections and four cases of ureteric injury (0.03 per 1000 deliveries, 0.27 per 1000 caesarean sections). Diagnosis of bladder injury was immediate, but of ureteric injury often delayed. Although the injury rates are lower than previously reported and previously reported risk factors not confirmed, this audit has resulted in guidelines for junior staff, compliance with which will be monitored, and every case of urinary tract injury will be reviewed.
Indicators of platelet turnover in thrombocytopenic infants
Authors: Sciscione Anthony C. , Bessos Hagop , Callan Nancy , Blakemore Karin , Kickler Thomas
Published: August 2005

Glycocalicin has been found to be a marker of increased platelet turnover, while interleukin‐6 may be increased in response to thrombocytopenia. We used these markers to study the pathophysiology of thrombocytopenia in newborn infants. Cord blood platelet counts were obtained from 499 infants. Thrombocytopenic infants (< 100,000/mm3) and a control group had ELISA assays for interleukin‐6 and glycocalicin performed. The mean levels of glycocalicin and interleukin‐6 were elevated in cord blood of thrombocytopaenic infants. Infants with intrauterine growth restriction and thrombocytopaenia had no detectable glycocalicin in their plasma, despite elevated levels of interleukin‐6. This probably reflects impaired thrombopoiesis in these infants.
Recto vaginal septum adenomyotic nodules: a series of 500 cases
Authors: Donnez Jacques , Nisolle Michelle , Gillerot Stephane , Smets Mireille , Bassil Salim , Casanas‐Roux Françoise
Published: August 2005

Objective
Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions.

Setting
An academic teaching hospital.

Participants
A series of 500 women undergoing laparoscopy for pelvic pain or infertility.

Results
Laparoscopic (n= 497) and laparotomic (n= 3) excision of endometriotic nodules resulted in considerable pain relief. Histologically the rectovaginal nodule was similar to an adenomyoma as it was a circumscribed nodular aggregate of smooth muscle and endometrial glands and stroma. The variations in oestrogen receptor and progesterone receptor content suggested a regulatory mechanism different from that of eutopic endometrium.

Conclusion
This form of disease should be considered as an entity distinct from peritoneal and ovarian endometriosis, and originating from the Miillerian rests present in the rectovaginal septum.
Conservative surgery for Stage I ovarian carcinoma in women of childbearing age
Authors: Zanetta Gerardo , Chiari Stefania , Rota Sonia , Bratina Giorgio , Maneo Andrea , Torri Valter , Mangioni Costantino
Published: August 2005

Objective
To assess the results of a policy of tailored conservative surgical management for young women with stage I ovarian carcinomas.

Design
Retrospective study.

Participants
Ninety‐nine women aged 40 years or younger who underwent either primary surgery in our department or were referred after primary surgery performed elsewhere.

Methods
Of the 99 women in our study, 56 underwent fertility‐sparing surgery and 43 more radical surgery. Minimal requirements for conservative management were adequate staging and complete information about the therapeutic options. Factors important in the choice of the treatment were, age, wish to preserve fertility, histologic type and grade, and the stage of the tumour.

Results
Conservative treatment was conducted in 84% of nulliparous and in 33% of parous women; 62% of grade 1 tumours, 48% of grade 2, and 50% of grade 3 were treated conservatively. With a median follow up of seven years, we observed five recurrences (9%) of carcinoma in women treated conservatively and five (12%) in those treated more radically. Two women (one in each treatment arm) were saved after recurrence. Two recurrences after conservative surgery involved the residual ovary (3.6%). Two women developed borderline tumour in the contralateral ovary and both were treated by surgery.

Conclusion
After adequate staging and accurate information is given to the patient, conservative treatment may be safe in some women with early ovarian cancer. The risk of recurrence in the contralateral ovary is low. Conservative surgery may be also considered in some Stage I grade 3 tumours and in some women with stage IC tumours.
Maternal serum inhibin‐A in pregnancies complicated by insulin dependent diabetes mellitus
Authors: Wallace Euan M. , Crossley Jennifer A. , Ritoe Savitri C. , Groome Nigel P. , Aitken David A.
Published: August 2005

We have examined whether insulin dependant diabetes mellitus (IDDM) affects maternal serum levels of inhibin‐A, a recently described prenatal marker of Down's syndrome, by comparing levels in 169 women with IDDM with levels in 432 nondiabetic pregnant women between 15 and 20 weeks of gestation. There was a small but significant increase in the inhibin‐A level in the diabetic women only when levels were corrected for maternal weight: median MoM 1.17 (P < 0.01 vs controls, Student's t test). The underlying mechanism for this elevation in pregnancies complicated by IDDM currently remains obscure.
A longitudinal study of maternal bloodflow in normal pregnancy and the puerperium: analysis of Doppler waveforms using Laplace transform techniques
Authors: Brackley Karen J. , Ramsay Margaret M. , Pipkin Fiona Broughton , Rubin Peter C.
Published: August 2005

Objective
To describe changes in the maternal cerebral circulation and the external iliac arteries throughout pregnancy and the puerperium using the Laplace transform analysis of Doppler waveforms.

Design
A prospective longitudinal study.

Setting
Department of Obstetrics and Gynaecology, Nottingham University Hospital.

Sample
A cohort of 17 healthy women studied every four weeks from early pregnancy until term and up to three months postpartum. Pre‐conception data were available for 10 subjects.

Methods
Doppler signals were recorded from the internal carotid, middle cerebral and external iliac arteries. The waveforms were analysed using two different techniques: standard indices (systolic: diastolic ratio, pulsatility and resistance indices) and Laplace transform analysis, an alternative method of waveform shape analysis which may provide additional haemodynamic information.

Results
Vessel wall tone decreased at an early stage in pregnancy in the cerebral circulation and in the external iliac artery, but this rose again following delivery. The Laplace transform analysis techniques suggest dramatic eight‐fold increases in downstream resistance within the external iliac artery in the second half of pregnancy. An increase in downstream resistance to flow also occurred in the internal carotid artery whereas more stable conditions were noted in the middle cerebral artery.

Conclusions
Having a preliminary idea of the normal ranges for the Laplace transform analysis variables during pregnancy in a variety of maternal vessels, haemodynamic changes in pregnancies complicated by conditions, such as pre‐eclampsia, can now be studied.
Age and basal follicle stimulating hormone as predictors of in vitro fertilisation outcome
Authors: Sharif Khaldoun , Elgendy Manal , Lashen Hany , Afnan Masoud
Published: August 2005

Objective
To examine the relative effect of basal follicle stimulating hormone (FSH) concentration and the woman's age on predicting the ovarian response to gonadotrophin stimulation, normal fertilisation rate and pregnancy rate in in vitro fertilisation (IVF) treatment following pituitary desensitisation.

Design
Descriptive cohort study.

Participants
Three hundred and forty‐four women undergoing their first IVF cycle.

Methods
Basal (menstrual‐day 3) FSH concentration was measured and the woman's age calculated before she underwent pituitary desensitisation followed by gonadotrophin ovarian stimulation and IVF treatment.

Main outcome measures
Cancellation rate due to poor ovarian response, total dose of gonadotrophin required to achieve follicular maturity, number of oocytes collected, normal fertilisation rate and pregnancy rate were compared between banded values of the variables studied.

Results
Increasing basal FSH concentration was associated significantly with increased cancellation rate, but increasing age was not. Both increasing basal FSH and age were associated significantly with increased total gonadotrophin dose, and reduced number of oocytes collected and pregnancy rate. Analysis of variance showed that the association for basal FSH with the number of oocytes was significant, independent of, and stronger than the effects of age. Logistic regression analysis showed that age, but not basal FSH, was independently associated with pregnancy rate. Neither basal FSH, nor age had significant association with normal fertilisation rate.

Conclusion
Basal FSH concentration is a better predictor of cancellation rate and of the number of oocytes collected in IVF treatment than age, but age is a stronger predictor of pregnancy rate.
Are neonatal brain lesions due to intrauterine infection related to mode of delivery?
Authors: Baud O. , Ville Y. , Zupan V. , Boithias C. , Lacaze‐Masmonteil T. , Gabilan J.C. , Frydman R. , Dehan M.
Published: August 2005

Studies of antenatal and intrapartum factors involved in the development of cerebral palsy have identified intrauterine infection and chorioamnionitis as high risk situations for white matter damage, especially periventricular ledcomalacia. To characterise adverse or protective perinatal factors further, we undertook a multiple regression analysis of selected perinatal events in a population of 110 inborn premature neonates with documented chorioamnionitis. In the total population of 110 infants delivered at between 25 and 32 weeks, 101 (92%) survived the first week of life and two were subsequently excluded. Of the 99 remaining infants, 20 (20%) developed periventricular leukomalacia including 16 (80%) cystic lesions. Forty‐five (45%) babies were born by lower segment caesarean section, and for 37 of these, this was carried out before labour. Fetal presentation at delivery was breech in 14 (26%) of those born vaginally and 23 (52%) of those born by lower segment caesarean section (OR 3 [95% CI 1.–71). Among predetermined perinatal risk factors for periventricular leukomalacia, logistic regression analysis showed that delivery by caesarean section was associated with a dramatic decrease in the incidence of periventricular leukomalacia (OR 0.5 [95% CI 0.4–0.71). These preliminary results warrant confirmation and preferably a prospective study before considering caesarean section as a protective perinatal factor of periventricular leukomalacia.
Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial
Authors: Langer Ana , Campero Lourdes , Garcia Cecilia , Reynoso Sofia
Published: August 2005

Object
To evaluate the effects of psychosocial support during labour, delivery and the immediate postpartum period provided by a female companion (doula).

Design
The effects of the intervention were assessed by means of a randomised clinical trial. Social support by a doula was provided to women in the intervention group, while women in the control arm received routine care.

Setting
A large social security hospital in Mexico City.

Participants
Seven hundred and twenty‐four women with a single fetus, no previous vaginal delivery, < 6 cm of cervical dilatation, and no indications for an elective caesarean section were randomly assigned to be accompanied by a doula, or to receive routine care.

Outcome measures
Breastfeeding practices, duration of labour, medical interventions, mother's emotional conditions, and newborn's health.

Methods
Blinded interviewers obtained data from the clinical records, during encounters with women in the immediate postpartum period, and at their homes 40 days after birth. Relative risks and confidence intervals were estimated for all relevant outcomes.

Results
The frequency of exclusive breastfeeding one month after birth was significantly higher in the intervention group (RR 1.64; I‐C: 1.01–2.64), as were the behaviours that promote breastfeeding. However, the programme did not achieve a significant effect on full breastfeeding. More women in the intervention group perceived a high degree of control over the delivery experience, and the duration of labour was shorter than in the control group (4.56 hours vs 5.58 hours; RR 1.07 CI (95%) =−1.52 to −0.51). There were no effects either on medical interventions, mothers' anxiety, self‐esteem, perception of pain and satisfaction, or in newborns' conditions.

Conclusions
Psychosocial support by doulas had a positive effect on breastfeeding and duration of labour. It had a more limited impact on medical interventions, perhaps because of the strict routine in hospital procedures, the cultural background of the women, the short duration of the intervention, and the profile of the doulas. It is important to include psychosocial support as a component of breastfeeding promotion strategies.
Association of circulating endothelin and noradrenaline with increased calcium‐channel binding sites in the placental bed in pre‐eclampsia
Authors: Ferreira‐de‐Almeida José A. , Amenta Francesco , Cardoso Filomena , Polónia Jorge J.
Published: August 2005

Objective
To evaluate factors contributing to both placental hypoperfusion and maternal vasoconstriction in pre‐eclampsia.

Design
Single centre, comparative study of calcium‐channel density and affinity in the placental bed of pregnant women with normotension and pre‐eclampsia.

Setting
Teaching hospital.

Participants
Twenty‐two primigravidae in the third trimester of pregnancy: 10 with pre‐eclampsia and 12 normotensive.

Methods Plasma levels of endothelin‐1 (by RIA) and noradrenaline (by HPLC‐ED) were measured. Both pharmacological characterisation and anatomical localisation of dihydropyridine‐sensitive binding sites (using radioligand‐binding studies and autorradiographic techniques) were determined with 3H‐isradipine in placental bed tissues to determine both the density (Bmax) and the affinity (Kd) of receptor sites.

Results
Higher plasma levels of endothelin‐1 and noradrenalin were found in women with pre‐eclampsia compared with normotensive women. Placental bed tissues bound 3H‐isradipine in a saturable, reversible time and temperature‐dependent manner with very low Kd values. Study of the 3H‐isradipine specificity binding included the use of several dihydropyridine displacers. In the group with pre‐eclampsia the Scatchard analysis of the results showed a significant increase (P < 0.001) both in the affinity [Kd = 0.23 nmol (0.04) vs 0.45 nmol (0.03), pre‐eclampsia vs norrnotensive] and in the density of calcium‐channel binding sites [Brnax = 77.70 frnol/rng (1.30) vs 64.30 fmourng (1.80) tissue, pre‐eclampsia vs normotensive]. Autoradiography confirmed that in the placental bed tissue of those with pre‐eclampsia there was a much higher silver grain density in the arteries walls, compared with norrnotensive women.

Conclusions
In pre‐eclampsia there is an increase in the maternal circulation of two strong vasoconstrictor factors (endothelin‐1 and noradrenalin) and a sharp increase both in the density and the affinity of calcium‐channel binding sites in placental bed central area. The latter may strongly contribute to the perpetuation of the uteroplacental hypoperfusion either by itself or by amplifying the local actions of circulating factors, such as endothelin‐1 and noradrenalin.
Does gestational hypertension become pre‐eclampsia?
Authors: Saudan Patrick , Brown Mark A. , Buddle Megan L. , Jones Michael
Published: August 2005

Objective
To determine the likelihood of progression from gestational hypertension (GH) to pre‐eclampsia (PE) in hypertensive pregnant women and whether this change can be identified in advance by available clinical and laboratory measures.

Design
A retrospective analysis and a prospective study.

Setting
St George Hospital, Sydney, a teaching hospital of the University of New South Wales delivering 2500 women per year.

Population
Eight hundred and forty‐five women with new hypertension in the second half of pregnancy, managed by a uniform protocol (661 in the retrospective analysis, 184 in the prospective study).

Methods
Clinical and laboratory data at initial presentation were compared among women with GH who developed PE and those who remained with a diagnosis of GH until delivery. Data predictive for progression from GH to PE were analysed by logistic regression analysis.

Main Outcome Measured
Progression from GH to PE.

Results
In the retrospective analysis, 416 women initially presented as having GH and 62 (15%) progressed to PE. In the prospective study, 112 women initially presented with GH and 29 (26%) progressed to PE, giving an overall progression of 17%. In both studies, women who developed PE from GH presented earlier than those who remained with GH until delivery. In multiple logistic regression analyses prior miscarriage and early gestation at presentation were associated with increased likelihood of progressing from GH to PE.

Conclusion
Approximately 15–25% of women initially diagnosed with GH will develop PE and this is more likely with earlier presentation or if the woman has had a prior miscarriage. Women with gestational hypertension diagnosed after 36 weeks of gestation have only about 10% risk of developing PE. These data should help stratify the risks of mildly hypertensive pregnant women being managed as outpatients in their third trimester.
Prevalence of faecal incontinence among women with urinary incontinence
Authors: Khullar Vik , Damiano Rocco , Toozs‐Hobson Phil , Cardozo Linda
Published: August 2005

Four hundred and sixty‐five women attending a urodynamic clinic were interviewed, and completed a detailed bowel questionnaire, about their urinary and bowel symptoms. All the women underwent video‐cystourethrography with pressure and flow studies. The reported incidence of faecal incontinence was 15.3% (n= 71) on direct questioning and 26% 0(n = 121) on the postal questionnaire. Faecal incontinence was more common in women with a urodynamic diagnosis of detrusor instability (30′%1 (n= 26)) than among women diagnosed as having genuine stress incontinence (21% (n= 38)). Denervation and myogenic injuries sustained during childbirth have been suggested as a common cause for genuine stress and faecal incontinence, but there may be an alternative mechanism to explain why women with detrusor instability suffer from faecal incontinence.
An immunohistochemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina
Authors: Hodgins Malcolm B. , Spike Rosemary C. , Mackie Rona M. , MacLean Allan B.
Published: August 2005

Objective
Tomap potential sites of sex steroid action in the human vulva.

Methods
Monoclonal antibodies to androgen, oestrogen and progesterone receptors were used to stainfrozen sections of vulval skin, vagina and suprapubic skin. A scoring system was devised to comparereceptor distribution in the epidermis and dermis of skin with vaginal epithelium and stroma.

Results
Androgen receptors were seen in epidermal keratinocytes, sebaceous glands, sweat glands, hairfollicles and dermal fibroblasts of skin, and epithelial cells and stromal fibroblasts of the vagina. Androgen receptor scores were significantly higher in the epidermis of labia majora and minora thanin vaginal epithelium. Oestrogen receptors were seen in basal and suprabasal cells of vaginalepithelium and epidermis of labia minora but were restricted to basal keratinocytes in true skin.They were seen in stromal fibroblasts and vaginal smooth muscle, and dermal fibroblasts of theskin. Oestrogen receptors were highest in vaginal epithelium and stroma, and lowest insuprapubic skin. Progesterone receptors were seen in vaginal epithelium, fibroblasts and smoothmuscle but not in the vulva. There was no evidence of significant differences in androgen oroestrogen receptor staining in the vulva of pre‐ or postmenopausal women.

Conclusion
The transition from vagina to vulva is marked by an increase in androgen and a decrease inoestrogen and progesterone receptors. This distribution of receptors would indicate a limited role foroestrogen creams on the vulva.
The effects of ovarian hormone deficiency on wound contraction in a rat model
Authors: Calvin M. , Dyson M. , Rymer J. , Young S.R.
Published: August 2005

Objective
to demonstrate the effect of a deficiency of ovarian hormones on the process of wound contraction, using the oophorectomised rat model of the human menopause.

Design
A randomised controlled trial.

Population Ninety‐six adult Wistar rats were randomly allocated into either an oophorectomised groupor a sham‐oophorectomised control group.

Methods Having confirmed a significant reduction in plasma oestradiol levels in the oophorectomisedrats, full‐thickness excised lesions were made in the flank skin of the adult rats at either two weeks orfour months after oophorectomy, so that the effects of two different durations of hormone deficiencycould be assessed and compared with the sham‐oophorectomised controls. Following wounding, therats were left for 3, 5, 10 or 22 days; wound contraction was assessed from photographs of thewounds taken at these intervals after injury.

Results
In the rats wounded four months after oophorectomy there was a slower rate of woundcontraction, resulting in larger wounds at days 3, 5, 10 and 22, compared with control rats. No significant difference was observed in rats wounded two weeks after oophorectomy, indicating that the effects of ovarian hormone deficiency on this process are delayed.

Conclusion
Due to the pivotal role of wound contraction in the process of wound healing these findingsmay be of clinical relevance and could have an important impact on the administration of hormonereplacement therapy.
A randomised trial of low dose aspirin for primiparae in pregnancy
Authors: Golding J. ,   on behalf of The Jamaica Low Dose Aspirin Study Group
Published: August 2005

Objective
To investigate whether low dose aspirin medication given to primiparous women provides benefit in preventing pre‐eclampsia or intrauterine growth retardation.

Design
Randomised double‐blind controlled trial of low dose aspirin and placebo in pregnancy.

Population Residents of the parishes of Kingston and St Andrew, Jamaica; 6275 primiparae enrolled between 12 and 32 weeks of gestation.

Main outcome measures
Hypertensive disorders of pregnancy (including pre‐eclampsia and eclampsia), preterm delivery, and low birthweight. In addition, to assess whether enrolment early, rather than late had more beneficial effect. Possible adverse effects on the woman and her infant were monitored.

Results
Of enrolled primiparae, 97% were followed throughout pregnancy. There were no differences between those on aspirin and those on placebo in the development of hypertensive disorders (e.g. for a rise in diastolic pressure of 25 mmHg the odds ratio [OR] was 1.02 [95% CI 0.86–1.211; for proteinuric pre‐eclampsia OR 1.15 [95% CI 0.92–1.44]; eclampsia OR 0.82 [95% CI 0.44–1.531); except for oedema which was significantly less prevalent in those on aspirin (OR 0.85 [95% CI 0.75–0.961). Women on aspirin were not significantly less likely to deliver preterm (OR 0.93 [95% CI 0–79‐1.091) or have a larger fetus (mean birthweight difference 18 g [95% CI ‐9 to 451). They were, however, significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum; for postpartum haemorrhage OR 1.40 (95% CI 1.13–1‐73).

Conclusions This trial shows that low dose aspirin has no consistent beneficial effect in primiparae.
The Collaborative Randomised Amnioinfusion for Meconium project (CRAMP): 2. Zimbabwe
Authors: Mahomed K. , Mulambo T. , Woelk G. , Hofmeyr G. J. , Gülmezoǧlu A. M.
Published: August 2005

Objective
To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.

Design
Multicentre randomised controlled trial.

Setting
A large urban academic hospital. Electronic fetal heart rate monitoring was not used.

Participants
Women in labour at term with moderate or thick meconium staining of the amniotic fluid.

Interventions
Transcervical amnioinfusion of 500 mL saline over 30 minutes, then 500 mL at 30 drops per minute. The control group received routine care. Blinding of the intervention was not possible.

Main outcome measures
Caesarean section, meconium aspiration syndrome and perinatal mortality.

Results
There was no difference in risk for caesarean section in the two groups (amnioinfusion 9.5%vs control 12.3%; RR 0.84, 95% CI 0.53–1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1%vs 12.8%; RR 0.24, 95% CI 0.12–0.48), and there was a trend towards fewer perinatal deaths (1.2%vs 3.6%; RR 0.34, 95% CI 0.11–1.06).

Conclusions
Amnioinfusion is technically feasible in a developing country situation with limited intrapartum facilities. In this study amnioinfusion for meconium stained amniotic fluid was associated with striking improvements in perinatal outcome.
Pregnancy after heart or heart‐lung transplantation: a series of 10 pregnancies
Authors: Troché V. , Ville Y. , Fernandez H.
Published: August 2005

Objective
To evaluate pregnancy after heart or heart‐lung transplantation in France.

Design
A questionnaire survey of all French centres performing heart and heart‐lung transplants provided an exhaustive registry on pregnancy after transplantation.

Methods
A questionnaire was sent to 36 centres. Anonymous reports on transplantation and subsequent pregnancies between 1984 and 1996 were analysed.

Results
Of 1290 heart and 120 heart‐lung transplantation performed during the study period, 10 pregnancies (seven after heart transplantation and three after heart‐lung transplantation) were reported in nine women who were delivered of 11 infants. High blood pressure complicated nine pregnancies and severe pre‐eclampsia occurred in two. One woman developed Kaposi sarcoma of the cervix. Delivery at 35 weeks gestation (27–39) was by caesarean section in 50% cases. Mean birthweight was 1990 g (700–2880g) and 50% of the infants had a birthweight < tenth centile. One infant developed cardiomyopathy as a condition inherited from her mother, and congenital hepatitis B was diagnosed in another.

Conclusions
Pregnancy after heart and heart‐lung transplantation is feasible and can be successful, but this should be planned when cardiac and respiratory functions are stable. Adequate obstetrical and genetic counselling should be provided.
Fetal growth velocity in the prediction of intrauterine growth retardation in a low risk population
Authors: Owen Philip , Khan Khalid S.
Published: August 2005

Objective
To determine whether fetal growth velocity derived from two antenatal ultrasound measurements in the third trimester, 28 days apart, can identify infants born with anthropometric features of intrauterine growth retardation.

Design
Prospective observational study.

Setting
Department of obstetric ultrasound, Ninewells Hospital, Dundee.

Subjects
Two hundred and seventy four low risk women participating in a longitudinal study of serial fortnightly ultrasound in pregnancy.

Methods
Growth velocities of the fetal abdominal area and bi‐parietal diameter were calculated from the third from last and last measurements prior to delivery. Receiver Operator Characteristics curves were employed to determine an optimal cutoff point for velocity to predict intrauterine malnourishment.

Main outcome measures
Likelihood ratios for fetal abdominal area and bi‐parietal diameter growth velocity in the prediction of growth retarded infants with skinfold thickness < 10th centile; ponderal index < 25th centile, or mid‐arm circumference to occipito‐frontal circumference ratio (MAC:OFC ratio) of less than ‐1 SD. A likelihood ratio of > 10 generates significant changes in the pre‐test probability of growth retardation, whereas a likelihood ratio of 5 to 10 generates only moderate changes.

Results
Fetal abdominal area velocity predicted growth retardation with likelihood ratio 10.4 (95% CI 3.9 to 26) for skinfold thickness; likelihood ratio 9.5 (95% CI 4.6 to 19) for ponderal index; a likelihood ratio 4.7 (2.3 to 8.4) for MAC:OFC. Bi‐parietal diameter velocity predicted growth retardation with likelihood ratio 6.5 (95% CI 1.9 to 20) for skinfold thickness but did not predict low ponderal index or MAC:OFC ratio.

Conclusions
Fetal abdominal area velocity is useful in identifying infants with reduced skinfold thickness or low ponderal index. Prospective evaluation of serial ultrasound and velocity calculation in a selected population at increased risk of growth failure and a clearer understanding of the relative significance of the different neonatal anthropometric measures of impaired growth achievement is necessary before the estimation of growth velocity can be recommended in clinical practice.
A multicentre study comparing cervicography and cytology in the detection of cervical intraepithelial neoplasia
Authors: De Sutter Ph. , Coibion M. , Vosse M. , Hertens D. , Huet F. , Wesling F. , Wayembergh M. , Bowlon C. , Autier Ph.
Published: August 2005

Objective
To evaluate in a multicentre setting the performance of cervicography compared with

Design
Prospective comparative multicentre study.

Setting
Three hospitals with outpatient gynaecology clinics and three cancer screening clinics.

Participants and methods
Cervical cytology and cervicography were performed on 5724 women. If one or both tests showed an abnormality suggestive of at least a low grade squamous intraepithelial lesion, a colposcopy with directed biopsy was carried out. Cervicograms were evaluated by four experienced ‘senior’ assessors and by ten new ‘junior’ assessors.

Results
Results were fully analysed for 5192 women (9l%). A cervical biopsy was carried out on 228 women and this confirmed a true positive lesion in 116 cases (incidence rate: 2.2%). Of these, 72 cases (62.1%) were detected by cervicography and 64 (55.2%) by cytology. This difference was not statistically significant (McNemar: P= 0.475). Only 20 cases of CIN (17%) were concordantly detected by both tests. Senior assessors performed significantly better with a detection capacity of 80.6% compared to a detection capacity of 56.6% for the junior assessors (χ2 test: P= 0.034).

Conclusions
Cervicography must be considered as a complementary test to cytology. Overall detection of CIN is improved, but this is mainly due to the detection of more low grade lesions. The lower sensitivity and specificity in high grade lesions compared with cervical cytology is the main limitation of cervicography in screening for CIN. An important finding was that the performance of cervicography was highly dependent on the assessors’ experience.
Double‐blind, placebo‐controlled study of magnesium hydroxide for treatment of sensory urgency and detrusor inst ability: preliminary results
Authors: Gordon David , Groutz Asnat , Ascher‐Landsberg Jessica , Lessing Joseph B. , David Menachem P , Razz Olga
Published: August 2005

In a prospective, randomised, double‐blind, placebo‐controlled study 40 women with sensory urgency or detrusor instability randomly received either magnesium hydroxide (group A) or placebo (group B). Pre‐ and post‐treatment symptoms, frequency‐volume charts and cystometry results were compared. Eleven of 20 patients receiving magnesium (55%) reported a subjective improvement of their urinary symptoms, compared with five patients taking placebo (20%) In both study groups there was no statistically significant difference in pre‐ and posttreatment urodynamic parameters in those reporting symptomatic improvement. Magnesium was well tolerated by patients in group A, and no side effects were reported. These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women.
Bone density in long term users of depot medroxyprogesterone acetate
Authors: Gbolade Babatunde , Ellis Sylvia , Murby Brian , Randall Sarah , Kirkman Rosemary
Published: August 2005

Objective
To identify any adverse effect on bone density in long term users of depot medroxyprogesterone acetate (DMPA) for contraception.

Design
Cross‐sectional measurement of bone density in users with amenorrhoea of more than one year or any woman using DMPA for more than five years.

Setting
Community Family Planning Clinics in Portsmouth and Manchester.

Population
One hundred and eighty‐five women aged 17–52 years (mean 33.3 years) who had used DMPA for between 1 and 16 years and were attending the clinics for further injections, between August 1994 and August 1996.

Methods
Dual energy X‐ray measurement of bone density of femoral neck and lumbar spine, and venous blood sample taken just prior to the next injection of DMPA.

Main outcome measures
Bone density of femoral neck and lumbar spine and serum oestradiol in relationship to years of DMPA use and duration of amenorrhoea.

Results
Most women (n= 153) had serum oestradiol levels < 150 pmol/l. Despite this, the mean bone density of the lumbar spine compared with the population mean for women aged 20–59 years gave a Z score (95% CI) of ‐0.332 (‐0.510 to ‐0.154). There was no significant difference in the mean density of the femoral neck from the normal population mean.

Conclusion
Despite amenorrhoea and low serum oestradiol, this sample of long term DMPA users had bone density only minimally below the normal population mean. We therefore found no clinically important adverse effect on bone density and therefore no reason to recommend bone conserving measures, such as add‐back oestrogen.
The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta‐analysis
Authors: Brocklehurst Peter , French Rebecca
Published: August 2005

Objective
To investigate the association between maternal HIV infection and perinatal outcome by a systematic review of the literature and meta‐analysis.

Methods
Appropriate publications were identified using electronic and hand searching of relevant journals from 1983 to 1996. Studies were included in the review if they were prospective cohorts with pregnant women identified as being HIV‐infected with a control group of pregnant women who were not infected with HIV. Methodological quality was assessed for each study. Data were extracted for pre‐determined outcome measures. Sensitivity analyses were performed to explore the association between HIV infection and an adverse perinatal outcome for the following study characteristics: clinical setting (developed or developing countries), methodological quality (high or poor) and whether studies controlled for potential confounding.

Results
Thirty‐one studies were eligible to be included in the review. The summary odds ratio of the risk of pre‐defined adverse perinatal outcomes related to maternal HIV infection were as follows: spontaneous abortion 4.05 (95% CI 2.75–5.96); stillbirth 3.91 (95% CI 2.65.5–5.77); fetal abnormality 1.08 (95% CI 0.7–1.66); perinatal mortality 1.79 (95% CI 1.14–24.31); neonatal mortality 1.10 (95% CI 0.63–1.93); infant mortality 3.69 (95% CI 3.03–4.49); intrauterine growth retardation 1.7 (95% CI 1.43–2.02); low birthweight 2.09 (95% CI 1.86–2.35) and pre‐term delivery 1.83 (95% CI 1.63–2.06). Sensitivity analyses showed that the association between infant mortality and maternal HIV infection was stronger in studies conducted in developing countries when compared with developed countries [odds ratios (OR) 3.72 (95% CI 3.05–4.54) and 8.6 (95% CI 0.53–141.05), respectively]; studies of higher methodological quality compared with those of poorer quality [odds ratios 14.57 (95% CI 6.93–30.65) and 3.37 (95% CI 2.74.14), respectively] and studies which had used restriction or matching to control for potential confounding factors compared with those that had not [OR 11.60 (95% CI 5.71–23.58) and 3.35 (95% CI 2.73–4.12), respectively].

Conclusions
The findings of this review have implications for women infected with HIV who are planning a pregnancy or who find themselves pregnant. There appears to be an association, although not strong, between maternal HIV infection and an adverse perinatal outcome. This relationship may be due to bias including uncontrolled or residual confounding. There does, however, appear to be a real and large increase in the risk of infant death in developing countries associated with maternal HIV infection, especially so when there has been an attempt to control for confounding.
Eisenmenger's syndrome in pregnancy: maternal and fetal mortality in the 1990s
Authors: Yentis S. M. , Steer P. J. , Plaat F.
Published: August 2005

To determine maternal and fetal mortality associated with Eisenmenger's syndrome in the UK, a postal questionnaire was sent to 225 NHS obstetric units with neonatal intensive care units, requesting information about maternal and fetal outcome in cases of Eisenmenger's Syndrome between 1991 and 1995. Fifteen cases were identified. The maternal mortality was 40% and fetal loss 8%. Only 15% of infants were born at term. Maternal mortality associated with Eisenmenger's syndrome remains as high as it has been for the past 50 years. Pooling of national data on rare medical conditions in pregnancy is required to aid management of individual cases.
Folates in the periconceptional period: are women getting enough?
Authors: Mathews Fiona , Yudkin Patricia , Neil Andrew
Published: August 2005

Objective
To examine the prevalence of folic acid supplementation prior to conception and in the first trimester of pregnancy, and to identify sociodemographic variables associated with the use of supplements.

Design
Observational study.

Setting
District general hospital in the south in England.

Population
Nine hundred and sixty‐three randomly selected pregnant nulliparous Caucasian women recruited from May 1994 to February 1996 inclusive.

Methods
Questionnaire administered at approximately 16 weeks gestation.

Main outcome measures
Intakes of supplemental folic acid before conception and during pregnancy.

Results
31.5% (303/963) (95% CI 28.5–34.4) of pregnant women reported using supplements containing folic acid prior to conception. The proportion using pre‐conceptional folic acid increased by approximately 1% per month during the 22 months of the study. 38.1% (367/962) (35.1 to 41.2) of women began taking folic acid only after the confirmation of pregnancy, and this proportion appeared constant over time. Young age, smoking and low educational attainment were statistically significant predictors of failure to use folic acid both before and during pregnancy.

Conclusions
Use of folic acid before conception in nulliparous women is much higher than the 2% to 3% reported in earlier studies of all pregnant women, and appears to be increasing. However, many women still only begin taking folic acid after conception, despite current health education strategies. New approaches, focusing on women who are currently least likely to take folic acid ‐ those who are young, are of low educational backgrounds, and are smokers ‐ may now be required. Given the inevitably of unplanned pregnancies, efforts must also be made to increase the currently static uptake of folic acid immediately after the confirmation of pregnancy.
Pregnancy and homozygous beta thalassaemia major
Authors: Daskalakis George J. , Papageorgiou Ioannis S. , Antsaklis Aristides J. , Michalas Stylianos K.
Published: August 2005

Nine pregnant women with homozygous β‐thalassaemia major followed a strict transfusion regimen to maintain their haemoglobin level > 10g/dl. One pregnancy was terminated because of concern about desferrioxamine teratogenicity and another ended in miscarriage at 11 weeks. All other women were delivered by elective caesarean section between 37 and 38 weeks. There were no obstetric complications or perinatal deaths.
Nationwide maternal mortality in Surinam
Authors: Mungra A. , van Kanten R. W. , Kanhai H.H.H. , van Roosmalen J.
Published: August 2005

Objective
To assess the magnitude, causes and associated factors of maternal mortality in Surinam.

Methods
Nationwide confidential enquiry. Maternal deaths were identified using various methods and sources for the period 1991–1993. All cases were examined by a maternal mortality expert committee for substandard care analysis.

Results
The national maternal mortality ratio was 226 per 100,000 live births, which is six times higher than the official maternal mortality ratio of 38 for the preceding three year period. The main causes of death were haemorrhage (30%) and pre‐eclampsia (20%). In 95% of analysed cases, substandard care factors which had contributed to the deaths were present at one or more levels of maternity care.

Conclusions
Maternal mortality was found to be several times higher than had been officially reported for Surinam during the previous three decades. Improvement of maternity care services in Surinam is needed, and has to be addressed at all levels, from the community, health centre and hospital to the Conclusions highest level of organisation.