bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study of pre‐operative procedures to assess cervical invasion by endometrial carcinoma
Authors: Toki Toshihiko , Oka Kenji , Nakayama Kuniaki , Oguchi Osamu , Fujii Shingo
Published: August 2005

Objective
To compare the accuracy of different diagnostic procedures currently used to assess cervical involvement in endometrial carcinoma.

Design
Retrospective observational study.

Setting
Department of Obstetrics and Gynecology, Shinshu University Hospital, Matsumoto, Japan.

Participants
Sixty‐four patients with endometrial carcinoma were evaluated pre‐operatively for cervical involvement by six different diagnostic procedures: cervical cytology, endocervical curettage, transvaginal ultrasonography, hysteroscopy, magnetic resonance imaging, and serum levels of CA125. The number of positive and negative diagnoses of cervical invasion by each of these procedures were correlated with the actual invasion determined by histological examination.

Results
Cervical invasion was confirmed in 12 (18.8%). Endocervical curettage showed high sensitivity (91%), the highest negative predictive value (96%), and the lowest negative likelihood ratio (0.14). Hysteroscopy showed high positive likelihood ratio (8.2) and low negative likelihood ratio (0.20). Magnetic resonance imaging showed the highest positive predictive value (75%) and the highest positive likelihood ratio (12.5). Magnetic resonance imaging was excellent for predicting stromal invasion, whereas hysteroscopy was superior for assessing mucosal involvement to magnetic resonance imaging.

Conclusion
Endocervical curettage is a good test for excluding cervical involvement by endometrial carcinoma. Hysteroscopy is a good test in making both positive and negative diagnoses for cervical involvement. Magnetic resonance imaging is an excellent test for detecting cervical involvement, especially when the stroma is invaded.
Antenatal glucocorticoid administration increases corticotrophin‐releasing hormone in maternal plasma
Authors: Korebrits C. , Yu D. H. T. , Ramirez M. M. , Marinoni E. , Bocking A. D. , Challis J. R. G.
Published: August 2005

Objective
This study was designed to determine whether maternal corticotrophin‐releasing hormone (CRH) concentrations are altered after maternal betamethasone administration for fetal lung maturity in women with threatened pretenn labour and whether these effects are dependent on gestational age.

Methods
Our study included 49 women with threatened preterm labour who received prenatal betamethasone for fetal lung maturity between 24 and 31 weeks of gestational age and 11 women who did not. Maternal blood was taken before and after glucocorticoid administration or at 24 hours after initial sampling. Plasma CRH, adrenocorticotrophin (ACTH) and cortisol concentrations were determined by radioimmunoassays. The women were stratified into 24–25 weeks, 26–27 weeks, 28–29 weeks, and 30–31 weeks completed gestation.

Results
At each gestational age, maternal cortisol concentrations decreased by approximately 85% after glucocorticoid administration. Overall mean cortisol values fell from 580.0 (SD, 351.8) to 89.7 (96.6) nmol/L (n= 40, P < 0.001). Overall mean ACTH values decreased from 9.9 (4.7) to 5.0 (3.4) pmol/L (n= 43, P < 0*001), and the approximate 50% decrease was similar at each gestational age. In marked contrast, overall mean CRH values increased from 58.0 (37.0) to 87.8 (68.6) pmol/L (n= 49, P < 0.001) after betamethasone administration. There was no change in maternal cortisol, ACTH or CRH values over 24 hours in women who did not receive betamethasone.

Conclusions
We conclude that maternal betamethasone administration increases maternal plasma CRH values between 24 and 31 completed weeks of gestation.
Disproportionate fetal growth and fingerprint patterns
Authors: Wheeler T. , Godfrey K. , Atkinson C. , Badger J. , Kay R. , Owens R. , Osmond C.
Published: August 2005

Fingerprint whorl patterns are formed during fetal life. In a group of 180 term infants, those with more fingerprint whorls tended to have a small abdominal circumference (P= 0.09) and high ratio of head to abdominal circumference (P= 0.008). These associations were independent of the relation between the whorl counts of the mothers and their infants. We also found an independent correlation between the babies’ whorl count and the combination of increasing subscapular (P= 0.03) and decreasing triceps (P= 0.02) skinfold thicknesses of the mothers. Whorl patterns are associated with adult hypertension; maternal nutritional status may influence their common origin during fetal development.
A randomised comparison of strategies for reducing infective complications of induced abortion
Authors: Penney Gillian C. , Thomson Margaret , Norman Jane , McKenzie Hamish , Vale Luke , Smith Robert , Imrie Moira
Published: August 2005

Objectives
To determine lower genital tract carriage rates of C. trachomatis, N. gonorrhoeae and bacterial vaginosis among women seeking termination of pregnancy. To compare two clinical management strategies for minimising the risks of infective morbidity after induced abortion.

Design
Prevalence of infections was assessed by screening women undergoing abortion. Clinical management strategies were compared by a randomised trial.

Setting
The gynaecology departments of four hospitals in Scotland.

Participants
1672 women undergoing induced abortion.

Interventions
Women randomised to prophylaxis received metronidazole 1 g rectally before abortion plus doxycycline 100 mg twice daily for seven days. Women randomised to screen‐and‐treat received appropriate antibiotics only if screening proved positive for one or more infection.

Main outcome measures
Prevalences of infections; morbidity in the eight weeks following abortion as assessed by reported symptoms, general practitioner consultation and prescription rates and hospital re‐attendances; costs to the NHS of alternative managements.

Results
Prevalence rates: C. trachomatis 5.6%; N. gonorrhoeae 0.19%; bacterial vaginosis 17.5%. Overall, women allocated to receive prophylaxis had lower rates of measures of short term infective morbidity than those allocated to screen‐and‐treat. These differences only reached statistical significance for women who were reported negative on screening. The direct costs to the NHS of prophylaxis and screen‐and‐treat were calculated to be £8.17 and £18.34 per woman, respectively.

Conclusions
Prevalences of lower genital tract infections which have been implicated in increased rates of infective morbidity after abortion are similar to those reported elsewhere. Universal antibiotic prophylaxis is at least as effective as a policy of screen‐and‐treat in minimising the risk of short term infective morbidity and is far more cost efficient.
Expectant management of missed miscarriage
Authors: Jurkovic D. , Ross J. A. , Nicolaides K. H.
Published: August 2005

The option of expectant management was offered 221 women with ultrasound diagnosis of missed miscarriage. Eighty‐five women (38%) accepted; the remaining 136 women chose surgical evacuation of retained products of conception. In the expectant management group 21 women (24.7%) had a complete miscarriage, 14 (16.5%) had incomplete miscarriage necessitating surgery, and 50 (58.8%) requested surgery within 48 days from the original diagnosis. These results suggest that the success of expectant management of missed miscarriage is too low to justify its use in routine clinical practice.
Effect of dexamethasone and betamethasone on fetal heart rate variability in preterm labour: a randomised study
Authors: Senat M. V. , Minoui S. , Multon O. , Fernandez H. , Frydman R. , Ville Y.
Published: August 2005

Objective
To compare the effects of betamethasone and dexamethasone on fetal heart rate in appropriately grown fetuses.

Methods
Eighty‐two pregnant women (97 fetuses) with preterm labour were randomly allocated to receive betamethasone (n= 42) or dexamethasone (n= 40) for fetal lung maturation in a nonblinded fashion. Computerised cardiotocogram (CTG) parameters were compared before, during and after treatment.

Results
A decrease in fetal heart rate variability was found with betamethasone but no significant changes were found with dexamethasone. Fetal heart rate variability returned to pre‐treatment values within a week after cessation of treatment with betamethasone. Neonatal outcome was similar in the two groups.

Conclusions
These findings might prove useful in the management of compromised fetuses with decreased fetal heart rate variability in which the CTG should be used together with other parameters to assess fetal wellbeing during corticosteroid treatment. Dexamethasone may be preferable as the drug of choice since it was associated with significantly less alteration in fetal heart rate variability compared with betamethasone.
Delivery outcome after the use of acid‐suppressing drugs in early pregnancy with special reference to omeprazole
Authors: Källén Bengt
Published: August 2005

Objective
To study delivery outcome after maternal use of acid‐suppressing drugs during early pregnancy.

Design
Cohort study of women identified by interview in early pregnancy.

Population
Sweden women giving birth from 1995 to early 1997.

Methods
Comparison of infants exposed to acid‐suppressing drugs with all births in 1995–1996.

Main outcome measures
Presence of congenital malformations.

Results
Proton pump blockers were used by 275 women, H2 receptor antagonists by 255 women, and both categories of drugs by 20 women. No effect of the use of omeprazole or H2‐receptor antagonists on the rate of congenital malformations could be demonstrated.

Conclusions
Though a teratogenic effect of these drugs cannot be completely ruled out, the individual risk after exposures during the first trimester seems to be negligible.
Radical trachelectomy: a way to preserve fertility in the treatment of early cervical cancer
Authors: Shepherd John H. , Crawford Robin A. F. , Oram David H.
Published: August 2005

In the Centenary year of Wertheim's hysterectomy for the treatment of invasive cervical cancer, it is appropriate to look at less radical methods of managing early stage disease. Radical trachelectomy with pelvic lymphadenectomy is a conservative but locally radical procedure, preserving the corpus uteri and therefore fertility potential. The first 10 cases in a pilot study are presented. One patient has required post‐operative radiotherapy and another a completion radical hysterectomy. Three live births by caesarean section and three other pregnancies have resulted. Careful selection within strict criteria may allow this more conservative approach without compromising cure. These procedures should be carried out in referral centres with continuing follow up and review.
A randomised placebo controlled trial of oral misoprostol in the third stage of labour
Authors: Justus Hofmeyr G. , Cheryl Nikodem V. , de Jager Marinda , Gelbart Bradley R.
Published: August 2005

Objective
To compare oral misoprostol 400 μg with placebo in the routine management of the third stage of labour.

Design
A double‐blind placebo controlled trial.

Setting
The labour ward of an academic hospital in Johannesburg, South Africa with 7000 deliveries per annum.

Participants
Low‐risk women expected to deliver vaginally.

Methods
Women in labour were randomly allocated to receive either misoprosto1 400 μg orally or placebo after the birth. Conventional oxytocics were given immediately if blood loss was thought to be more than usual. Postpartum blood loss in the first hour was measured by collection in a special flat plastic bedpan. Side effects were recorded.

Main outcome measures
Measured blood loss ≥ 2 1000 ml within the first hour after birth. Use of additional oxytocics.

Results
The groups were well matched. Measured blood loss ≥ 1000 ml occurred in 15/250 (6%) after misoprostol and 23/250 (9%) after placebo (relative risk 0.65; 95% confidence interval 0.35–1.22). The difference may have been reduced by the greater use of conventional oxytocics in the placebo group, which was statistically significant for intravenous oxytocin infusion (2.8% vs 8.4%, relative risk 0.33, 95% confidence interval 0.140.77). Shivering was more common in the misoprostol group (190/, vs 5%, relative risk 3.69; 95% confidence interval 2.05‐6.64).

Conclusions
Shivering has been shown in this study to be a specific side effect of misoprostol administered orally in the puerperium. No serious side effects were noted. Misoprostol shows promise as a method of preventing postpartum haemorrhage. Because of the potential benefits for childbearing women, particularly those in developing countries, further research to determine its effects with greater certainty should be expedited.
Does an early postnatal check‐up improve maternal health: results from a randomised trial in Australian general practice
Authors: Gunn Jane , Lumley Judith , Chondros Patty , Young Doris
Published: August 2005

Objectives
To investigate whether a visit to a general practitioner one week after discharge results in less depression, increased breastfeeding rates, improved patient wellbeing, fewer physical problems and greater satisfaction with general practice care than the traditional six week postnatal check‐up.

Design
A randomised controlled trial.

Setting
Rural and metropolitan Victoria, Australia.

Population
Women giving birth at one rural and one metropolitan hospital between February and December 1995 inclusive.

Methods
All women received a letter and appointment date to see a general practitioner for a check‐up: the intervention group for one week after hospital discharge, the control group for six weeks after birth. A mail‐out survey was conducted at three and six months after birth, including Edinburgh Postnatal Depression Scale and Short Form 36.

Results
1017/1407 (72.3%) women giving birth at participating hospitals were eligible for the trial: 683 (67.2%) gave informed consent. The average response rate to postal follow up at three and six months was 67.5%. No significant differences were found between the groups in: Edinburgh Postnatal Depression and Short Form 36 scores; number of problems; breastfeeding rates; or satisfaction with general practitioner care. Women in the intervention group were less likely to attend for their check‐up (76.4%vs 88.4%; P=0.001), more likely to discuss labour and birth at their check‐up (OR=1.77, 95% CI 1.17–2.68), less likely to have a vaginal examination (OR = 0.51; 95% CI 0.34–0.77) or pap smear (OR = 0.34; 95% CI = 0.22–0.52) at their check; more likely to report difficulties with low milk supply (OR= 1.72; 95% CI = 1.12–2.66) and adjusting to the demands of a new baby (OR= 1.76; 95% CI 1.13–2.74), more likely to talk to a general practitioner about their baby (68.2%vs 58.0%; P= 0.02) and less likely to consult a hospital doctor about their baby (7.3%vs 14.0%, P = 0.02).

Conclusions
To make clinically important improvements in maternal health more is required than early postnatal review.
Is cystic ovarian endometriosis an asymmetric disease?
Authors: Vercellini Paolo , Aimi Giorgio , De Giorgi Olga , Maddalena Silvia , Carinelli Silvestro , Crosignani Pier Giorgio
Published: August 2005

Objective
To investigate whether asymmetry exists in the left‐ and right‐handed distribution of ovarian cystic lesions in a large series of women with endometriosis.

Design
Retrospective evaluation of a case series.

Setting
Tertiary care and referral academic centre for the study and treatment of endometriosis.

Population
A total of 1054 consecutive women undergoing first‐line surgical treatment for endometriosis in an eight‐year period.

Methods
Data were collected on indication for the intervention, age at surgery, parity and disease stage as well as side and size of ovarian endometriomas.

Main outcome measure
Frequency of left‐ and right‐sided ovarian endometriomas.

Results
Histologically confirmed endometriotic ovarian cysts were present in 561 women, which were on the left side in 255 instances, on the right in 148, and bilateral in 158. In the patients with unilateral endometriomas, the observed proportion of left cysts (255/403, 63%; 95% confidence interval, 58% to 68%) was significantly different from the expected proportion of 50% (χ21, 28.41, P < 0.001). Including also the bilateral endometriotic cysts gave a total of 413/719 (57%) left‐sided and 306/719 right‐sided endometriomas. The magnitude of these proportions did not vary appreciably during the eight years considered. The difference in proportion of left‐ and right‐sided endometriotic cysts was virtually similar in subgroups of women with different indications for surgery. Cyst side was not related to age, parity or cyst diameter.

Conclusions
The finding of a lateral asymmetry in the occurrence of ovarian endometriotic cysts is compatible with the anatomical differences of the left and right hemipelvis and supports the menstrual reflux theory.
Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders
Authors: Stead Maxine L. , Crocombe William D. , Fallowfield Lesley J. , Selby Peter , Perren Timothy J. , Garry Ray , Brown Julia M.
Published: August 2005

Objective
To assess the feasibility and acceptability of including sexual activity questionnaires in gynaecological clinical trials.

Design
A longitudinal quality of life study during the Maintenance Interferon Trial and the EVALUATE Hysterectomy Trial.

Setting
Gynaecology clinics and women's homes.

Sample
Ninety‐six women with advanced ovarian cancer participating in the Maintenance Interferon Trial and 542 women undergoing a hysterectomy in the EVALUATE Hysterectomy Trial.

Methods
Quality of life questionnaires, including the sexual activity questionnaire, were completed by women prior to randomisation and periodically after randomisation.

Main outcome measures
Compliance rates of the sexual activity questionnaire, both overall and with respect to the level of sexual functioning and age of the women. Attitudes of the women towards completing the questionnaire, and suitability of using the sexual activity questionnaire in clinical trials.

Results
Compliance rates of over 80% were achieved in both trials, both overall and for each questionnaire completed. The age of the woman did not appear to influence the completion of the questionnaire, nor did her level of sexual functioning. Women were supportive of the research and did not find the questionnaire intrusive.

Conclusions
It is feasible to include sexual activity questionnaires in gynaecological clinical trials requiring repeated assessment of quality of life over a long period of time. The sexual activity questionnaire is an appropriate tool to carry out investigations of sexual functioning and is worth considering for use in future clinical trials.
Selective deficit of angiogenic growth factors characterises pregnancies complicated by pre‐eclampsia
Authors: Reuvekamp Alida , Velsing‐Aarts Francien V. , Poulina Indira E. J. , Capello Jaques J. , Duits Ashley J.
Published: August 2005

Objective
To compare serum levels of angiogenic growth factors vascular endothelial growth factor (VEGF), placental growth factor (PIGF) and angiogenin in pre–eclamptic women and matched controls.

Design
Retrospective analysis of −70°C stored serum of women who developed pre‐eclampsia and matched controls.

Setting
Department of Gynaecology and Obstetrics, St Elisabeth Hospital, Curaqao, Netherlands Antilles.

Sample
Thirty women with pre‐eclampsia and 30 normotensive controls matched for age and gestation.

Results
VEGF and PIGF serum levels were significantly lower in pre–eclamptic pregnancies, compared with controls (VEGF 0.31 ± 1.20 vs 18.30 ± 24.97 pg/mL, P= 0.0004; PIGF 54.19 ± 32.05 vs 497.95 ± 340.51 pg/mL, P < 0.0001). Matched couple analysis showed VEGF serum concentrations to be lower in the majority of pre–eclamptic women and PIGF concentrations to be lower in all pre–eclamptic women. Angiogenin serum levels showed no statistical significant difference between pre–eclamptic pregnancies and controls (523.68 ± 367.55 vs 670.41 ± 251.54 ng/mL, P= 0.058), with matched couple analysis showing no clear pattern.

Conclusions
Decreased serum levels of VEGF and PIGF characterise, and therefore seem to be of importance during (the development of), pre‐eclampsia. This selective deficit of angiogenic growth factors might in part explain the shallow placentation found in this pregnancy complication.
Elevated mid‐trimester maternal corticotrophin‐releasing hormone levels in pregnancies that delivered before 34 weeks
Authors: Leung T. N. , Chung T. K. H. , Madsen Gemma , McLean Mark , Chang A. M. Z. , Smith Roger
Published: August 2005

Objective
To test whether maternal corticotrophin‐releasing hormone levels are elevated in the mid–trimester for those women who subsequently had spontaneous preterm delivery and to assess the clinical utility of the measurement in the prediction of preterm delivery.

Design
A prospective observational study.

Setting
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.

Population
1047 low risk pregnant women recruited at 15–20 weeks of gestation.

Methods
Venous samples were assayed for levels of corticotrophin‐releasing hormone. The investigators responsible for the laboratory assay were blinded to the obstetric outcome.

Main outcome measures
Incidence of preterm, term and post‐term pregnancies.

Results
Those who were delivered spontaneously at a preterm gestational age (before 34 weeks) had significantly higher corticotrophin–releasing hormone levels in the mid–trimester, compared with those who were delivered at term or post–term. There was a trend towards lower corticotrophm–releasing hormone levels with more advanced gestational age at delivery. When the measurement of corticotrophin–releasing hormone was used to predict delivery before 34 weeks, the best cut off was 1.9 MoM, which produced a sensitivity of 72.7% and specificity of 78.4%. This translated to a positive predictive value of 3.6%, negative predlctive value of 99.6% and relative risk of 9.4 when the background prevalence of spontaneous preterm delivery before 34 weeks was 1.1%. The likelihood ratio was 3.4.

Conclusions
Mid‐trimester maternal corticotrophin‐releasing hormone levels are elevated in pregnancies destined to deliver preterm before 34 weeks. When used alone in a low risk population, the measurement has a low predictive power for preterm delivery. However, the likelihood ratio of 3.4 implies that in high risk populations the test may be considerably more valuable.
High resolution imaging of endometriosis and ovarian carcinoma with optical coherence tomography: feasibility for laparoscopic‐based imaging
Authors: Boppart S. A. , Goodman A. , Libus J. , Pitris C. , Jesser C. A. , Brezinski M. E. , Fujimoto J. G.
Published: August 2005

High resolution imaging of gynaecological tissue offers the potential for identifying pathological changes at early stages when interventions are more effective. Optical coherence tomography (OCT) is a high resolution high speed optical imaging technology which is analogous to ultrasound B–mode imaging except reflections of light are detected rather than sound. The OCT technology is capable of being integrated with laparoscopy for real–time subsurface imaging. In this report, the feasibility of OCT for differentiating normal and pathologic laparoscopically–accessible gynaecologic tissue is demonstrated. Differentiation is based on architectural changes of in vitro tissue morphology. OCT has the potential to improve conventional laparoscopy by enabling subsurface imaging near the level of histopathology.
Comparison of treatment outcomes of imipramine for female genuine stress incontinence
Authors: Lin Ho‐Hsiung , Sheu Bor‐Ching , Lo Mei‐Chen , Huang Su‐Cheng
Published: August 2005

Objective
To assess the efficacy of imipramine as a treatment of genuine stress incontinence and to explore the possible determining factors for treatment success and failure.

Design
A prospective study.

Setting
University department of obstetrics and gynaecology.

Participants
Forty women with genuine stress incontinence were enrolled.

Methods
Each woman was treated with 25 mg imipramine three times a day for three months.

Main outcome measures
Each woman had a 20‐minute pad test and urodynamic study including uroflowmetry, both filling and voiding cystometry, and stress urethral pressure profile before and after treatment.

Results
After treatment, 35% (n= 14) were cured, 25% (n= 10) improved by 2 50% and in the remaining 40% (n= 16) treatment failed. The efficacy of successful treatment was 60% (95% CI44.8–75.2). The median age and parity, as well as menopausal status, showed no statistical differences between the two groups. The pre‐treatment data including pad weight, functional urethral length, maximal urethral pressure, bladder compliance at urgency, bladder capacity, and average and maximal flow rates showed no statistical differences between the two groups except urethral closure pressure (P= 0.001). Besides, the functional urethral length and urethral closure pressure were significantly improved in the treatment success group. After medication, the median functional urethral length was 3 cm (intraquantile range [IQR] 2.3–3) in the treatment success group vs 2.3 cm (IQR 2–3) in the treatment failure group (P= 0.028). The urethral closure pressure was 77 cmH, O (IQR 61–105) for the treatment success group vs 40 cmH, O (IQR 34–53) in the treatment failure group (P < 0.0001).

Conclusions
The efficacy of imipramine for genuine stress incontinence was 60% (95% CI 44.8–75.2). The pre‐treatment high urethral closure pressure may serve as a predictor for treatment success.
Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients
Authors: Junor E. J. , Hole D. J. , McNulty L. , Mason M. , Young J.
Published: August 2005

Objective
To determine whether specialist gynaecological surgeons improved survival in women with ovarian cancer when compared with general gynaecologists.

Design
Retrospective case note review.

Population
All women diagnosed with ovarian cancer in Scotland in 1987, 1992, 1993 and 1994.

Methods
Data on prognostic factors and surgical and post‐operative management was extracted from case notes. Surgeons were classified as specialist gynaecologists, general gynaecologists or general surgeons by an independent committee with no knowledge of an individual's outcome. Cox's proportional hazards model was used to determine the relative risk of a patient dying, if managed by specialist and general gynaecologists, after adjustment for age, histology, tumour differentiation, presence of ascites and socio‐economic status. Analysis was performed separately for each FIGO stage.

Main outcome measures
Relative hazard ratios for survival up to three years.

Results
Survival benefit for specialists varied according to the stage of the disease. The greatest benefit was observed among women with Stage III disease (44% of women presented at this stage) where there was a 25% (relative hazard ratio = 0.75, P= 0.005) reduction in the rate of dying for women operated on by specialist gynaecologists, compared with women operated on by general gynaecologists. Differential use of platinum chemotherapy did not explain this survival advantage. Specialist gynaecologists more often debulked tumour to c 2 cm than general gynaecologists in Stage III cases (36.3%vs 28.7%, P= 0.07). In women with Stage III carcinoma with > 2 cm remaining, survival was significantly improved for women treated by specialist gynaecologists (relative hazard ratio = 0.71, P= 0.007). No significant differences were observed for patients with Stages I, II and IV disease, although there were fewer deaths in women with early stage disease.

Conclusions
Specialist gynaecologists improve survival for some women with ovarian cancer.
Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database
Authors: Zondervan Kina T. , Yudkin Patricia L. , Vessey Martin P. , Dawes Martin G. , Barlow David H. , Kennedy Stephen H.
Published: August 2005

Objectives
To estimate the prevalence and incidence in primary care of chronic pelvic pain in women in the UK.

Design
Cross‐sectional analysis of MediPlus UK Primary Care Database. Setting One hundred and thirty‐six general practices in the UK.

Population
From 284,162 women aged 12–70 who were registered on the database and who had a general practice contact in 1991,24,053 chronic pelvic pain cases were identified between 1991 and 1995.

Methods
Chronic pelvic pain was defined as pelvic pain lasting for at least six months, and cases were identified on the basis of contacts with general practice. Pain due to malignancy, chronic inflammatory bowel diseases or pregnancy, or which occurred only during menstruation or sexual intercourse, was excluded.

Main outcome measures
Prevalence and incidence rates of chronic pelvic pain in primary care by age and region.

Results
Monthly prevalence and incidence rates of chronic pelvic pain were 21.5/1000 and 1.58/1000, respectively, with an annual prevalence of 38.3/1000. Monthly prevalence rates increased significantly with age (P < 0.001) from 18.2/1000 in 15–20 year olds to 27.6/1000 in women older than 60, as symptoms persisted longer in older women. Prevalence and incidence rates varied significantly between regions (P < 0.001), with the lowest monthly prevalence in Scotland (16.0/1000) and the highest in Wales (29.4/1000).

Conclusions
Chronic pelvic pain is a common condition in the UK, with a prevalence in primary care comparable to migraine, back pain, and asthma. Its prevalence in the general population is likely to be considerably higher.
Pure stress leakage symptomatology: is it safe to discount detrusor instability?
Authors: James Mark , Jackson S. , Shepherd A. , Abrams P.
Published: August 2005

Objective
To determine whether the combination of a urological history and urinary diary, with rigorous selection criteria, can be used to define a group of women on whom urodynamic assessment is unnecessary prior to offering surgery for urinary stress incontinence.

Design
Retrospective review of the urodynamic records of women attending for assessment between January 1992 and December 1996.

Setting
Urodynamic Department, Southmead Hospital, Bristol.

Population
5193 women who attended the urodynamic clinic during the five year study period.

Methods
Self‐completion of a urinary diary in the preceding week before urodynamic assessment and a detailed urological history before undergoing cystometry by all women in the study period. Data were entered onto a computer database. Women reporting stress incontinence in the absence of bladder filling symptoms, with a normal urinary diary showing daytime frequency of seven times or less and nocturia of no more than once, had the results of their filling cystometry analysed.

Results
Of 5193 women, 555 had symptoms of pure stress incontinence and a normal urinary diary. Incontinence was confirmed objectively in 81%, with 9% having incontinence secondary to detmsor instability; 5% had detrusor instability as the sole cause of their incontinence with 4% having a mixed picture of detrusor instability incontinence and urethral sphincter weakness.

Conclusion
Genuine stress incontinence cannot be diagnosed reliably from a urological history, even when rigorous selection criteria are used in combination with a normal urinary diary. Without cystometry, incontinence secondary to detmsor instability will be missed.
Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial
Authors: Crowther Caroline A. , Kornman Louise , O'Callaghan Stephen , George Korula , Furness Margaret , Willson Kristyn
Published: August 2005

Objectives
To assess the efficacy of an ultrasound scan at the first antenatal visit.

Design
Randomised clinical trial.

Setting
Women's and Children's tertiary level hospital, Adelaide, Australia.

Population
Six hundred and forty–eight women attending for their first antenatal visit at less than 17 weeks of gestation who had no previous ultrasound scan in the pregnancy, who were expected to give birth at the hospital, and for whom there was no indication for an ultrasound at their first visit.

Methods
Eligible consenting women were enrolled by telephone randomisation into either the ultrasound at first visit group, who had an ultrasound at the time of their first antenatal visit, or the control group in whom no ultrasound assessment was done at their first antenatal visit. Both groups of women completed a questionnaire at the end of the first visit on their feelings towards the pregnancy and anxiety levels. Data were collected on details of any ultrasound assessments, including the 18 to 20 weeks morphology scan, and pregnancy outcome. All primary analyses were on an intention–to–treat basis.

Main outcome measures
The number of women who needed adjustment in dates of 10 days or more on the basis of their 18 to 20 weeks ultrasound morphology scan, who were booked for their morphology scan at sub–optimal gestations, who had a repeat of their maternal serum screening test, or who felt worried about their pregnancy at the end of the first antenatal visit.

Results
Fewer women (9%) in the ultrasound at first visit group needed adjustment of their expected date of delivery as a result of the 18 to 20 week ultrasound, compared with 18% of women in the control group (RR 0–52,95% CI 0.34–0.79; P= 0.002). The number of women who had the 18 to 20 week ultrasound assessment timed suboptimally was similar to that in the control group (16% vs 21%), as was the number of women who had a repeat blood sample taken for maternal serum screening (6 vs 6%). Fewer women in the ultrasound at first visit group reported feeling worried about their pregnancy (RR 0.80, 95% CI 0.65–0.99; P= 0.04) or not feeling relaxed about their pregnancy (RR 0.73, 95% CI 0.56–0.96; P= 0.02), compared with women in the control group.

Conclusions
A routine ultrasound assessment for dating offered to women at the first antenatal visit provides more precise estimates of gestational age and reduces the need to adjust the estimate of the date of delivery in mid–gestation. Women who had an ultrasound at the first visit reported more positive feelings about their pregnancy, compared with women in the control group at that time.
Climacteric vasomotor symptoms do not imply autonomic dysfunction
Authors: Virtanen Irina , Polo‐Kantola Päivi , Erkkola Risto , Polo Olli , Ekholm Eeva
Published: August 2005

Objective
To study whether oestrongen replacement therapy has an effect on autonomic haemodynamic control in postmenopausal women.

Design
A placebo‐controlled, prospective, randomised, double‐blind cross‐over trial.

Population
Fourteen healthy postmenopausal women who had had a hysterectomy, of whom 12 were double‐blind.

Methods
At the end of each treatment period we conducted autonomic nervous system tests: the Valsalva manoeuvre, the deep breathing test, study at rest and the active orthostatic test. Baroreflex sensitivity was evaluated non‐invasively from the Valsalva manoeuvre. Heart rate variability was assessed in time and frequency domains during supine rest and standing. Serum oestradiol was also measured and the previous two weeks' symptoms were assessed.

Results
Autonomic nervous function was mostly normal for age and unchanged by oestrogen. Vasomotor symptoms were not associated with autonomic dysfunction. Baroreflex sensitivity was 13.3 ms/mmHg (SD 7.4 ms/mmHg) with placebo and 10.5 ms/mmHg (SD 5.4 ms/mmHg) with oestrogen (P= 0.052). This was mostly due to a fall in three of the highest indices. In the orthostatic test the 30 s blood pressure overshoot in two women exceeded the normal 90% confidence interval upper limit, making the mean response strong, especially in the symptomatic group (n= 7). Oestrogen attenuated this overshoot.

Conclusions
Oestrogen did not have a consistent effect on the autonomic nervous system. Oestrogen attenuated a highly sensitive baroreflex and a strong 30 s blood pressure rise in the orthostatic test. This minor effect of oestrogen could be due to the fact that, in general, women with menopausal symptoms do not have impaired autonomic haemodynamic control. The effect of oestrogen in women with autonomic nervous system dysfunction remains to be studied.
Screening for coeliac disease in women with a history of recurrent miscarriage or infertility
Authors: Kolho K.‐L. , Tiitinen A. , Tulppala M. , Unkila‐Kallio L. , Savilahti E.
Published: August 2005

Because subclinical coeliac disease may decrease fertility or complicate pregnancy, we screened women with recurrent miscarriage of unknown aetiology (n= 63), unexplained infertility (n= 47) and infertility with a known cause (n= 82), for anti‐endomysium antibodies in serum to find undiagnosed coeliac disease. One woman (1.6%) with recurrent miscarriage, another woman (2.1%) with unexplained infertility and one woman (2.0%) in the control group (n= 51), were considered to have coeliac disease. We could not demonstrate a higher frequency of coeliac disease in women with infertility or recurrent miscarriage, but suggest that undiagnosed coeliac disease is common in women.
The placenta in maternal hyperhomocysteinaemia
Authors: Khong T. Y. , Hague W. M.
Published: August 2005

It is becoming increasingly apparent that mild or moderate hyperhomocysteinaemia may be associated with adverse perinatal complications and outcomes. The placental pathology in 14 pregnancies from 11 women diagnosed retrospectively to have hyperhomocysteinaemia, following a recent history of intrauterine fetal growth restriction, abruption or of thromboembolic disease, were reviewed. Most of the placental findings indicated abnormal placentation but these were not specific to maternal hyperhomocysteinaemia nor found in every placenta. Features observed included absence of trophoblast‐induced physiological vascular changes, acute atherosis, intraluminal endovascular trophoblast in the third trimester, infarction, retroplacental haematoma formation and accelerated villous maturity. Uteroplacental vascular thrombosis was also seen. Three of the women had a subsequent pregnancy where they were treated empirically with folic acid, and these resulted in improved perinatal outcomes. The finding of placental pathology warrants investigation of the woman for hyper‐ homocysteinaemia. Further randomised controlled trials of folic acid supplementation in preventing pregnancy complications associated with hyperhomocysteinaemia should be conducted.
Primary repair of obstetric anal sphincter rupture using the overlap technique
Authors: Sultan Abdul H. , Monga Ash K. , Kumar Devinder , Stanton Stuart L.
Published: August 2005

Objective
To evaluate the feasibility of a new technique of primary overlap anal sphincter repair instead Setting A teaching hospital and a district general hospital.

Methods
Between June 1995 and November 1996, two obstetricians repaired 32 anal sphincters ruptured during vaginal delivery. A ruptured internal sphincter was repaired separately and the torn ends of the external sphincter were overlapped and sutured with 310 polydioxanone sulphate sutures (Ethicon, Edinburgh, UK).

Main outcome measures
Bowel function, clinical assessment, anal endosonography and manometry performed at a mean of 140 days after delivery.

Results
Eight percent of the women experienced incontinence of flatus. Fifteen percent had persistent sonographic external sphincter defects, and 44% had internal sphincter defects. The maximum mean resting pressure was 58 mmHg (range 37–135) and the mean maximum incremental squeeze pressure 54 mmHg (range 8–104). None had defaecatory difficulty and no complications were encountered with the new technique of repair.

Conclusions
Reservations regarding the feasibility of the overlap technique of primary repair are unfounded, as both subjective and objective outcomes are favourable compared with other studies using end‐to‐end approximation. A multicentre randomised study of the overlap vs end‐to‐end repair technique is now planned. of end‐to‐end repair.
Temporal changes in fetal cardiovascular, behavioural, metabolic and endocrine responses to maternally administered dexamethasone in the late gestation fetal sheep
Authors: Bennet L. , Kozuma S. , McGarrigle H. H. G. , Hanson M. A.
Published: August 2005

Objective
To determine the primary (0–12 h) and secondary (12–24 h) effects of dexamethasone on fetal heart rate, short term heart rate variation, blood pressure, breathing movements and electrocortical activity, blood gas exchange, metabolism and adrenocortical function in the late gestation sheep fetus.

Design
Comparison of the effects of a single maternally administered intramuscular injection of dexamethasone (12 mg) with those of saline vehicle from 1 h before injection to 24 h post‐injection. Fetal cardiovascular and behavioural parameters were recorded continuously. Fetal and maternal blood samples were taken at regular intervals for blood gas, glucose and lactate, cortisol and adrenocorticotrophin measurements.

Sample
Sixteen chronically instrumented singleton fetal sheep at 127–133 days of gestation (term is about 147 days).

Results
During the primary phase short term heart rate variation fell (P < 0.001), and this was associated with a transient fall in the incidence of fetal breathing movements, a fall in fetal heart rate and a rise in fetal blood pressure. By 12 h there was a significant increase in short term heart rate variation (P < 0.001) and a rise in fetal heart rate, but blood pressure and fetal breathing movements had returned to normal. Dexamethasone significantly reduced fetal PaO2 throughout most of the experimental period, particularly 1 h post‐injection (P < 0.005). Fetal and maternal plasma cortisol and adrenocorticotrophin concentrations fell significantly from 1 h post‐injection.

Conclusions
The effects of dexamethasone on fetal heart rate variation are more complex than previously described with both a fall and an increase observed depending on the t h e at which heart rate variation was measured after injection. Dexamethasone also caused a significant fall in fetal PaO2, and although this was not to hypoxic levels in normoxic fetuses it does raise questions about the potential impact of dexamethasone on chronically hypoxic fetuses.
Undiagnosed breech revisited
Authors: Leung Wing Cheong , Pun Ting Chung , Wong Wai Ming
Published: August 2005

Objectives
To study the incidence of undiagnosed breech and to compare the obstetric outcome with those diagnosed before the onset of labour in a local teaching hospital where external cephalic version at term is routinely offered.

Design
A retrospective casenote analysis.

Setting
Tsan Yuk Hospital, a teaching hospital in Hong Kong.

Participants
One hundred and thirty‐one women with a singleton breech presentation at term, delivered in a local teaching hospital from 1 January 1997 to 31 December 1997. The group of 22 women who had successful external cephalic version performed was included.

Results
Breech presentation was diagnosed at the antenatal clinic in 103 women (79%). In the remaining 28 women (21%), breech presentation was diagnosed for the first time after the onset of labour. Undiagnosed breech presentations were more likely to deliver vaginally (42%) than those diagnosed at the antenatal clinic (1 1 %)(P < 0.001). Vaginal delivery was still more common in the undiagnosed group (46%) than the diagnosed group (26%), even when the group with successful external cephalic version was included (P < 0.05), although the difference became less obvious. The demographic characteristics, birthweight, type of breech and short term neonatal outcomes were comparable between the two groups.

Conclusion
It is important to include women who had successful external cephalic version when comparing the obstetric outcome of undiagnosed and diagnosed breeches. Careful assessment for vaginal delivery is still very useful even when breech presentations are first diagnosed after the onset of labour because the infants are even more likely to deliver vaginally with no great excess of neonatal morbidity.
Randomised trial comparing expectant with medical management for first trimester miscarriages
Authors: Nielsen Sven , Hahlin Mats , Platz‐Christensen Jens
Published: August 2005

Objective
To compare the efficacy of antiprogesterone (mifepristone) in combination with a synthetic prostaglandin E, analogue (misoprostol) for outpatient treatment of miscarriages.

Participants
One hundred and twenty‐two women with first trimester miscarriages.

Methods
The women were randomised to treatment with mifepristone 400 mg orally followed by a single oral dose of 400 μg misoprosto 148 hours later (n= 60) or expectant management (n= 62). Women were re‐evaluated five days later. If retained intrauterine products of conception were found with an antero‐posterior diameter above 15 mm on transvaginal ultrasound, surgical evacuation was performed.

Results
Eighty‐two percent of the women randomised to pharmacological treatment and 76% of those randomised to expectant management had an empty uterine cavity after five days. Convalescence time was 1.8 days longer for women randomised to pharmacological treatment. Pain, bleeding, complications, and satisfaction with the treatment did not differ between the groups.

Conclusions
Most cases of spontaneous incomplete miscarriage will become a complete miscarriage without intervention. This study shows that outpatient treatment with a combination of antiprogesterone and a prostaglandin El analogue did not increase the rate of complete miscarriage, compared with expectancy alone, by a clinical important degree.
Early diagnosis of major cardiac defects in chromosomally normal fetuses with increased nuchal translucency
Authors: Zosmer N. , Souter V. L. , Chan C. S. Y. , Huggon I. C. , Nicolaides K. H.
Published: August 2005

Objective
To determine the value of early ultrasound examination for prenatal diagnosis of cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation.

Design
Prospective audit. Setting Fetal Medicine Centre.

Methods
Specialist fetal echocardiography was carried out in 398 chromosomally normal fetuses with a nuchal translucency measurement above the 99th centile (2 3.5 mm). In the first 75 pregnancies the cardiac scan was carried out at 17–22 weeks and the next 323 cases had one scan at 13–17 weeks and another at 20–22 weeks. Pregnancy outcome was obtained in all of the cases.

Results
Major cardiac defects were present in 29 (7.3% of 398) cases and in 28 of these the diagnosis was made by antenatal echocardiography. In 27 of the 29 fetuses with major cardiac defects echocardiography was carried out at 13–17 weeks and an abnormality was suspected in 24 of the cases (88%).

Conclusions
Increased nuchal translucency in chromosomally normal fetuses is associated with an increased prevalence of major cardiac defects and, as such, is an indication for specialist fetal echocardiography. Most of the cardiac abnormalities are detectable on antenatal fetal echocardiography and many can be excluded by early scanning.