bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetic retinopathy in pregnancy
Authors: PRICE JOHN H. , HADDEN DAVID R. , ARCHER DESMOND B. , HARLEY J. McD. G.
Published: August 2005

Summary. The records of 23 insulin‐dependent diabetics who had serial ophthalmological examinations during pregnancy and afterwards were reviewed. Fourteen pregnancies occurred in 10 patients with no retinopathy; 30% of these patients had obstetric complications. The mean birthweight was 3.5 kg. Ophthalmological status was unchanged in this group. In eight patients with background retinopathy during 10 pregnancies the obstetric complication rate was 70% and mean birth‐weight 3.3 kg. During pregnancy there was no evidence of progression of retinopathy. One patient developed proliferative retinopathy 4 years later. Five patients had proliferative retinopathy. The mean age (32 years) and duration of diabetes at index pregnancy (18 years) was greater than for the other groups. All patients developed pre‐eclampsia and mean birthweight was 2.8 kg. Four of these patients required argon laser photocoagulation in association with pregnancy for progressive retinopathy; one died subsequently from end‐stage diabetic nephropathy; the other four have maintained their pre‐pregnancy visual acuity from 4 to 10 years.
Fetal heart rate patterns and perinatal outcome of very‐low‐birthweight infants
Authors: KARINIEMI V. , JÄRVENPÄÄ A.‐L. , TERAMO K.
Published: August 2005

Summary. The obstetric records of 125 infants weighing 500–1250 g who were born in 1978 and 1979 at the Helsinki University Central Hospital were studied retrospectively to find out any associations between fetal heart rate (FHR) patterns and perinatal outcome. FHR recordings of 79 fetuses were available for study. Normal reactive patterns were observed in nine, nonreactive in 54, decelerations in 58, silent patterns in 45 and combined distress patterns in 36 fetuses. The interval from the first pathological sign to delivery was up to 27 days. Five fetuses in the monitored group died in utero, 26 infants died neonatally and two later. The risk of neonatal death after pathological FHR patterns was lower than after an FHR pattern without abnormality. Idiopathic respiratory distress syndrome (RDS) was diagnosed in 32 infants, of whom 16 died. Forty‐seven fetuses (59%) of the monitored group were delivered abdominally and 32 vaginally. The risk of RDS was not significantly associated with FHR patterns and mode of delivery. We conclude that unlike term fetuses, low‐birthweight fetuses seem to benefit from a period of intrauterine stress reflected in abnormal FHR patterns, if caesarean section is used liberally.
Conservative management of prolonged pregnancy using fetal heart rate monitoring only: a prospective study
Authors: CARIO G. M.
Published: August 2005

Summary. Eighty patients with prolonged pregnancy were managed conservatively using outpatient non‐stress testing as the only form of fetal monitoring; there was no excess perinatal mortality or morbidity. The ‘at risk’ fetus aeared to be predominantly within the ‘postmature’ group who pass meconium. Non‐stress testing using this rigid regimen was an excellent screening test to identify the ‘at risk’ fetus and in this study had a zero false‐negative rate. Probably only one in 20 post‐term infants require induction for fetal indications.
A neurogenic element to urinary genuine stress incontinence
Authors: ANDERSON ROBERT S.
Published: August 2005

Summary. The motor unit fibre density in the external anal sphincter has been measured in 35 women with genuine stress incontinence and in 14 continent women. The mean (SD) fibre density in the normal women was 1.5 (0.15) and in the incontinent women it was 1.96 (0.34) (P<0.002). These data provide evidence of peripheral denervation of the external anal sphincter and imply synchronous denervation of the pelvic floor muscles. It is suggested that denervation is an aetiological factor in genuine stress incontinence.
Review of 59 patients with hypergonadotrophic amenorrhoea
Authors: MENON V. , EDWARDS R. LOGAN , BUTT W. R. , BLUCK MARION , LYNCH S. S.
Published: August 2005

Summary. Fifty‐nine patients presented with elevated concentrations of gonadotrophins and secondary amenorrhoea before the age of 35 years. Fifty‐three underwent laparoscopic examination and primordial follicles were observed in 16. Two others had follicles as they later became pregnant and a third showed biochemical evidence of spontaneous ovulation. There were streak ovaries in 12, two with follicles and three others with chromosomal abnormalities, two being 47XXX and one XO/XX. Two other patients had only one ovary each but no follicles. Chromosomal abnormalities were detected in two further patients one being XO/XX and the other a recombinant. Six patients became pregnant, two of them twice, resulting in four term deliveries and four spontaneous abortions. Three other patients showed biochemical evidence of ovulation; one spontaneously, one after oestrogen therapy and the third after treatment with gonadotrophin releasing hormone analogue.
An audit of abdominal hysterectomy over a decade in a district hospital
Authors: GRANT J. M. , HUSSEIN I. Y.
Published: August 2005

Summary. A retrospective survey of abdominal hysterectomy in a district hospital in two separate years (1970 and 1980) was undertaken. The mortality and short‐term physical morbidity of the operation was low. Evidence is presented of a change in attitude over the decade by gynaecologists towards abdominal hysterectomy, the trend being increasingly liberal, such that in 1980 nearly half the patients subjected to abdominal hysterectomy had no demonstrable pathology. In view of the reported adverse long‐term psychiatric and cardiovascular effects of hysterectomy, even when the ovaries are conserved, this trend must give rise to concern.
The treatment of premenstrual tension with mefenamic acid: analysis of prostaglandin concentrations
Authors: JAKUBOWICZ DIANA L. , GODARD EZAT , DEWHURST JOHN
Published: August 2005

Summary. Eighty patients with premenstrual tension were treated prospectively with mefenamic acid for a mean period of 13 months. Most of them (86%) reported significant relief of premenstrual tension. Symptoms of dysfunctional menorrhagia or primary dysmenorrhoea were also alleviated. In 19 patients, the plasma concentrations of prostaglandin (PG) E2, PGF2α and 13,14‐dihydro‐15‐keto‐prostaglandin F2α (PGFM) were measured at intervals throughout three menstrual cycles. During the first cycle the patients received no treatment; in the subsequent two cycles they received either mefenamic acid or placebo in a randomized double‐blind crossover manner. Similar measurements were made in 22 matched control subjects. The plasma concentrations of PGE2, PGF2α and PGFM were significantly lower in the 19 patients in all three menstrual cycles compared with the values in the control subjects. Excess synthesis of prostaglandins of the 1 series may occur in premenstrual tension and, by precursor depletion, result in decreased synthesis of the 2‐series prostaglandins.
Smoking in pregnancy: effects on mother and fetus
Authors: KELLY J. , MATHEWS K. A. , O'CONOR M.
Published: August 2005

summary

The maternal and fetal effects of smoking tobacco or non‐tobacco cigarettes were studied in 75 pregnant patients and compared with a matched control group of 22 pregnant patients who did not smoke. The increase in maternal heart rate, maternal mean arterial pressure and fetal heart rate, and decrease in fetal heart rate ‘baseline variability’ and in fetal movements, were shown to be due primarily to the nicotine content of the cigarette.
Degradation of the coer‐releasing intrauterine contraceptive device and its significance
Authors: CHANTLER E. N. , SCOTT KRISTIN , FILHO C. ISAIA , ELSTEIN MAX , FARAGHER E. B. , LORIMER G. W. , BROUGH I.
Published: August 2005

summary

Measurements were made of the coer remaining on used Gravigard intrauterine contraceptive devices (lUCDs) that had been in utero for up to 40 months. The topography and composition of the surface deposits were analysed by scanning electron microscopy and energy‐dispersive X‐ray analysis. The rate of coer loss decreased exponentially from 0–42 μmol d−1 (26–7 μg d−1) upon insertion to 0‐056 μimol d−1 (3–6 μg d−1) after 26 months of use; between 27 and 40 months of use a linear release of 0–32 μimol d−1 (20–3 μg d−1) was observed. There was no correlation between this changing rate of coer loss and the pregnancy rate with the device in situ. The changes in the rate of coer loss were probably due to the growth of a surface corrosion product which, due to internal stresses, fractured after about 2 years and exposed fresh coer; this results in a progressive increase in breakage of the coer wire after 3 years. It is recommended that a coer IUCD of this type be replaced after 3 years.
A prospective study of primary cytomegalovirus infection during pregnancy: final report
Authors: GRIFFITHS P. D. , BABOONIAN C.
Published: August 2005

summary

In a 7‐year prospective study cytomegalovirus (CMV) was shown to infect aroximately twice as many pregnant women as did rubella virus. Fetal loss occurred in 4/26 (15%) early CMV infections which was seven‐fold higher than the rate found in controls (16/744; 2·2%). There was no evidence that fetal loss resulted from intrauterine transmission of virus. Fifty‐eight women experienced primary CMV infection and congenital infection was found in nine (20%) of the 46 infants from whom clinical samples were obtained. Transmission of virus was found in 20%, 0% and 40% in the first, second and third trimesters respectively. All babies were normal at birth but two have so far developed definite intellectual impairment attributable to cytomegalovirus infection. The mothers of both of these cases were infected after the fetus had become legally viable. We conclude that the lessons learned from studying rubella infection during pregnancy cannot be alied to cytomegalovirus; in particular, we could find no evidence that termination of pregnancy should be offered to women with early CMV infections.
Maternal diabetes and neonatal respiratory distress. I. Maturation of fetal surfactant
Authors: JAMES D. K. , CHISWICK M. L. , HARKES A. , WILLIAMS M. , TINDALL V. R.
Published: August 2005

summary

The phospholipid composition of amniotic fluid samples from 30 normal patients and 44 diabetic patients over the last 10 weeks of pregnancy was studied. Higher levels of phosphatidylcholine (PC) and phosphatidylinositol (PI) were found in diabetic pregnancies where there was excellent glucose control. These differences were statistically significant at 34–36 weeks. Phosphatidylglycerol (PG) aeared significantly earlier in the well controlled diabetic pregnancies. but even in the poorly controlled diabetics the levels of PC, PI and PG were comparable to those in normal pregnancies. There was no evidence of delayed aearance of fetal surfactant phospholipids in either the well or poorly controlled diabetic pregnancies. The absolute lecithin (PC)/sphingomyelin (SM) ratio in diabetic pregnancies was generally greater for any given gestational age than those in normal pregnancies. Whilst in most cases this was due to a higher PC concentration, in a few poorly controlled diabetics it was the result of a lower concentration of SM.
Treatment of severe pregnancy‐associated hypertension with the calcium antagonist nifedipine
Authors: WALTERS B. N. J. , REDMAN C. W. G.
Published: August 2005

summary

The calcium antagonist, nifedipine, was given orally to 21 women with acute episodes of severe hypertension during pregnancy or in the puerperium. A rapid and significant fall in blood pressure by an average of 26/20 mmHg was seen at 20 min after administration. The hypotensive effect was not significantly enhanced in those women already taking medication to lower the blood pressure. The principal side effects were headache and cutaneous flushing. No adverse fetal effects were detected. This is the first study of the use of this drug to control hypertension in pregnancy. The aarent efficacy of nifedipine justifies its further investigation in controlled trials.
Lupus anticoagulant in pregnancy
Authors: LUBBE W. F. , BUTLER W. S. , PALMER S. J. , LIGGINS G. C.
Published: August 2005

summary

In a group of 10 women with circulating lupus anticoagulant 25 intrauterine deaths were previously documented in the nine multigravidae. The presence of lupus anticoagulant activity was confirmed by showing prolongation of the activated partial thromboplastin time and kaolin clotting time with failure of correction of the prolongation on incubation with normal plasma. A clinical diagnosis of systemic lupus erythematosus (SLE) was made in four women. Three had deep vein thrombosis in pregnancy, one chorea gravidarum while two had only recurrent fetal losses. All the women had positive antinuclear antibody tests and blood platelet counts <175 × 109/1. Anti‐smooth muscle antibody and VDRL tests were each positive in half the patients; anti‐DNA antibody was present in two patients with clinically active SLE. In six pregnancies correction of the activated partial thromboplastin and kaolin clotting time was attempted using prednisone (40–60 mg/day); aspirin, 75 mg/day, was added. Five live infants were obtained, four by spontaneous delivery, when the restoration of the clotting abnormalities to normal was achieved. In one woman presenting with extensive deep vein thrombosis a live infant was delivered following therapeutic doses of heparin and low dose aspirin. Maternal lupus anticoagulant activity has major implications for pregnancy and should be excluded in women with a clinical suspicion of SLE, a positive antinuclear antibody test, thrombotic episodes, biologically false‐positive VDRL and unexplained late or repetitive early fetal losses.
Amoebic liver abscess in pregnancy. Case reports
Authors: MITCHELL R. W. , TEARE A. J.
Published: August 2005

summary

Amoebic liver abscess is a rare complication of pregnancy. Two patients are described, one of whom was diagnosed at laparotomy at 28 weeks gestation, after which the pregnancy progressed normally to term. Diagnostic features and the importance of early treatment with metronidazole and aspiration or laparotomy are discussed.
Observations on the source of pregnancy‐associated plasma protein A (PAPP‐A)
Authors: BERSINGER NIKLAUS A. , KLOPPER ARNOLD
Published: August 2005

Summary. Pregnancy‐associated plasma protein A (PAPP‐A) was measured in 26 women before and after hysterectomy. The PAPP‐A concentration declined significantly in 24 of them. It is concluded that the uterus is a source of the protein.
Human placental lactogen in pre‐eclampsia
Authors: OBIEKWE B. C. , STURDEE D. , COCKRILL B. L. , CHARD T.
Published: August 2005

Summary. Serum placental lactogen (hPL) was measured in serial blood samples obtained from 663 pregnant women at weekly intervals from 36 to 40 weeks. The group included 231 women with pre‐eclampsia. Levels of hPL were significantly elevated in primigravidae with this condition but not in multigravidae. In all groups hPL levels were significantly reduced in association with growth retardation, but the clinical value of this observation appeared to be greater in multigravidae than in primigravidae. It is suggested that in primigravidae with pre‐eclampsia maternal hPL levels reflect both the pathology of the disease as well as the condition of the fetus.
xMerits of an individualized approach to fetal movement counting compared with fixed‐time and fixed‐number methods
Authors: GRANT ADRIAN , HEPBURN MARY
Published: August 2005

Summary. The most commonly employed methods for maternal counting of fetal movements take no account of variation in the level of activity between fetuses. This may result in false alarms or prolonged counting in pregnancies in which perceived movements are infrequent. A new counting method is described in which an individualized hourly rate of perceived movements is first calculated for each patient; then, the time taken to feel this number is recorded each day for the remainder of the pregnancy. The new system is associated with a substantially lower false alarm rate than a system of counting for an hour and continuing for a second hour if the level is low. In comparison with the Cardiff ‘count‐to‐10’ method, the amount of time spent counting each day was more uniform and was halved overall. Although this system is more complicated to initiate these clear advantages suggest that it should be subjected to large‐scale feasibility trials.
Fetal transcutaneous carbon dioxide tension during the second stage of labour
Authors: THOMSEN STEN G. , WEBER TOM
Published: August 2005

Summary. Fifteen women were studied during the second stage of labour by measuring simultaneously fetal transcutaneous carbon dioxide tension (Tc Pco2 and maternal end‐expiratory Pco2. A linear increase of Tc Pco2 with time was observed, predominantly because of changing maternal respiration patterns. The degree of maternal hyperventilation had no adverse effect on the status of the newborn infant.
The short luteal phase and infertility
Authors: SMITH STEPHEN K. , LENTON ELIZABETH A. , LANDGREN BRITT‐MARIE , COOKE IAN D.
Published: August 2005

Summary. The distribution of the length of the luteal phase was investigated in 187 women with regular, apparently ovulatory menstrual cycles of whom 95 had unexplained infertility and the other 92 comprised a group of healthy volunteer subjects. If the short luteal phase is associated with infertility it might be expected t o occur more frequently in women with unexplained infertility. A short luteal phase (defined as a luteal phase lasting ≤ 11 days) was found in 9% of the infertile group and in 8% of the normal group showing that these cycles do not occur more frequently in women with infertility.
The use of 16,16‐dimethyl‐transδ2 prostaglandin E1 methyl ester (gemeprost) vaginal pessaries for the termination of pregnancy in the early second trimester. A comparison with extra‐amniotic prostaglandin E2
Authors: CAMERON I. T. , BAIRD D. T.
Published: August 2005

Summary. The use of gemeprost pessaries has been compared in an open randomized trial with the extra‐amniotic infusion of prostaglandin E2 (PGE2) for the termination of pregnancy between 12 and 16 weeks gestation. The success rates were 77% and 79% for the pessary and infusion group respectively, and these rates were unaffected by parity. There was no significant difference in the cumulative abortion rate between the two groups, nor were there differences in the induction‐abortion interval, nor in the time taken to the onset of pain or bleeding. However, women in the pessary group required significantly less analgesia than those in the infusion group. Side‐effects, experienced both during treatment and during the 6 weeks after abortion, were similar in both groups. Gemeprost vaginal pessaries are an effective alternative to the extra‐amniotic infusion of PGE, for the termination of pregnancy in the early second trimester.
Cervical healing and Langerhans' cells
Authors: MACLEAN ALLAN B.
Published: August 2005

Summary. A study of cervical epithelium healing after laser treatment found the early presence of Langerhans' cells. These cells were demonstrated using a histochemical technique for adenosine tri‐phosphatase. The significance of Langerhans' cells in healing epithelium and their probable immunological role is discussed.
Premalignant lesions and microinvasive carcinoma of the cervix in Jewish women: an epidemiological study
Authors: BARAM A. , GALON A. , SCHACHTER A.
Published: August 2005

Summary. During the years 1979–1982 cervical smears were taken from 3974 women at the cervical pathology unit at the Serlin Maternity Hospital, Tel Aviv Medical Center, Tel Aviv. There were 69 patients with positive cytology who had colposcopic directed biopsies which revealed cervical intraepithelial neoplasia (CIN) or a microinvasive lesion: a prevalence rate of 17 per 1000. Epidemiological characteristics of the 69 patients with CIN and microinvasion revealed that these women were younger than those with negative cytology, had more sexual partners and pregnancies, started their sexual activities earlier, and only half of them were married. In the whole series 57% of the women were of Ashkenazi origin and 43% were of Eastern and Sephardic origin, whereas in the group with positive cytology the proportion of women of Eastern and Sephardic origin was twice that of Ashkenazi origin, 64 and 36% respectively. Only 4·5% of women in the CIN group declared themselves as religiously observant compared with 9·8% in the control group.
A routine system for monitoring perinatal deaths in Scotland
Authors: MCILWAINE GILLIAN M. , DUNN FRANCES H. , HOWAT ROBERT C. , SMALLS MARY , WYLLIE MARGARET M. , MACNAUGHTON MALCOLM C.
Published: August 2005

Summary. Since 1983 the monitoring of perinatal deaths in Scotland has been incorporated into the established data collection system which monitors maternal and child health in Scotland. This paper describes the transition from a research project to the routine system and the extension of the data collection to include paediatric and pathological findings. This information is provided by local co‐ordinators in active clinical practice. Baseline data are obtained from the routine maternity discharge document (SMR 2). A summary of the findings for the first 4 years of the study, 1977, 1979, 1980 and 1981 is presented, including information about birthweight and gestation‐specific perinatal mortality rates; perinatal mortality rates by time of death in relation to labour and singleton and multiple perinatal mortality rates by the obstetric complication preceding the death.
Spontaneous cephalic version of breech presentation in the last trimester
Authors: WESTGREN M. , EDVALL H. , NORDSTRöM L. , SVALENIUS E. , RANSTAM J.
Published: August 2005

Summary. A prospective longitudinal investigation of spontaneous cephalic version from breech presentation in the last trimester is reported. All pregnancies were assessed with ultrasound in the 32nd week of gestation, and were thereafter checked weekly. Of the 310 singleton breech presentations identified at 32 weeks, spontaneous cephalic version occurred in 177 (57%) while breech presentation persisted in 133 patients (43%). Of 140 patients with a breech presentation at delivery 95% were already presenting by the breech in the 32nd week. Spontaneous cephalic version was less likely in pregnancies with extended fetal legs, low birth‐weight, short umbilical cord and primiparity.
Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation
Authors: GILES WARWICK B. , TRUDINGER BRIAN J. , BAIRD PHILLIP J.
Published: August 2005

Summary. Placental microvascular anatomy was correlated with antenatal assessment of the umbilical circulation in 106 patients to further validate the measurement of the A/B ratio (the ratio of peak systolic to least diastolic flow velocity) of the umbilical artery flow velocity time wave‐forms as an index of blood flow resistance. Three groups of patients were studied: a normal group of 38 uncomplicated pregnancies, a control group of 33 potentially ‘at risk’ pregnancies with a normal A/B ratio matched by risk factors and gestation with the third group of 35 pregnancies with a high A/B ratio. Placental arterial resistance was quantitated by counting the number of small muscular arteries (<90 μm diameter) in the tertiary stem villi in a standard microscopic field (mean 18·5 fields/placenta). The modal small arterial vessel count was shown to be significantly less in the group with a high fetal risk and a high A/B ratio (1–2 arteries/field) than in both the normal and control groups (7–8 arteries/field). The tertiary villus count did not vary between groups. Antenatal studies of umbilical artery flow velocity waveforms with Doppler ultrasound identify a specific microvascular lesion in the placenta characterized by obliteration of small muscular arteries in the tertiary stem villi.
Growth of total intrauterine, intra‐amniotic and placental volume in normal singleton pregnancy measured by ultrasound
Authors: GEIRSSON R. T. , OGSTON S. A. , PATEL N. B. , CHRISTIE A. D.
Published: August 2005

Summary. The growth of total intrauterine, intra‐amniotic and placental volume during the latter half of pregnancy was studied longitudinally with ultrasound in 115 healthy women with normal singleton pregnancies. A parallel planimetric area method was used. The range and distribution of normal values between 20 and 40 weeks was determined for a main study group of 103 primiparous women with which values from 12 parous women were compared. Total intrauterine volume increased from a median of 1006 ml to 4420 ml, intra‐amniotic volume from 716 ml to 3406 ml and placental volume, calculated as the difference between total intrauterine and intra‐amniotic volume, increased from 259 ml to 801 ml. Variation between individuals was wide at all stages of pregnancy. No significant difference was found between primiparous and parous women. Between successive 5‐week periods from 20 to 40 weeks there was evidence that women tended to maintain their initial volume ranking. During the 30–35 week period, rate of growth of total intrauterine and intra‐amniotic volume was somewhat faster than the near constant mean rate at other times, while the rate of growth of placental volume decreased after 30 weeks towards term.
Gastroschisis and exomphalos: precise diagnosis by midpregnancy ultrasound
Authors: REDFORD DAVID H. A. , McNAY MARGARET B. , WHITTLE MARTIN J.
Published: August 2005

Summary. As part of a regional screening programme for neural‐tube defects the cause of the raised α‐fetoprotein levels was correctly identified in 13 pregnancies with a fetal abdominal wall defect by the 22nd week. Careful ultrasound study identified gastroschisis in seven fetuses and exomphalos in six: the presence or absence of a sac, the course of the umbilical vessels and the abdominal organs involved were the most important diagnostic criteria. Pregnancy continued into the third trimester in five cases complicated solely by gastroschisis and two babies have survived the neonatal period following surgical correction. It is suggested that precise identification by ultrasound of the type and severity of abdominal wall defect and also of the presence or absence of associated anomalies will enable the selection of some babies with gastroschisis or isolated exomphalos which have a good prognosis for survival without handicap.
Baseline fetal heart rates from 15 to 38 weeks gestation in normotensive and hypertensive pregnancies
Authors: DAWSON A. J. , DALTON K. J. , NEWCOMBE R. G.
Published: August 2005

Summary. To determine whether the fetal heart behaves differently in normotensive and hypertensive pregnancies, the changes in baseline fetal heart rate were investigated prospectively from 15 to 38 weeks gestation in 16 women who were normotensive at the time of booking in the antenatal clinic. Fetal heart rate recordings were made ultrasonically, and were computer‐processed by the programs TELEPLOT and BASELINE. Those women who remained normotensive exhibited a decrease of fetal heart rate with advancing gestational age, but this did not occur in the six women who eventually developed hypertension.
Progesterone, cortisol and oestradiol‐17β in the initiation of human parturition: partitioning between free and bound hormone in plasma
Authors: WILLCOX DAVID L. , YOVICH JOHN L. , McCOLM SUSAN C. , PHILLIPS JOHN M.
Published: August 2005

Summary. The concentrations of total and free progesterone, oestradiol‐17β, and cortisol were measured in the plasma of 24 pregnant women from 10–17 days prepartum, during labour. and for 2–3 days postpartum. All the women were delivered vaginally, and their hormonal profiles were similar, whether they initiated labour spontaneously (n=11) or were induced by rupture of the fetal membranes (n=13). Before labour, the plasma concentrations of total radioimmunoassayable progesterone, oestradiol‐17β and cortisol were 557 3 (SEM 70.3) nmol/l and 590 0 (SEM 76.7) nmol/l, 94 3 (SEM 18.7) nmol/l and 111 6 (SEM 19.8) nmol/l, and 1087.2 (SEM 103.7) nmol/l and 1020 7 (SEM 100.7) nmol/l, for the spontaneous and induced groups, respectively. During labour progesterone and oestradiol‐17β declined in maternal plasma to around 130 nmol/l and 30 nmol/l in both groups by the end of the third stage. The free fractions of progesterone and oestradiol‐ 17β remained constant throughout labour and over the entire study period at 2–3% and 1–2%, respectively. Total plasma cortisol rose to 1243.7 (SEM 83.3) nmol/l (P<0.02, spontaneous group) and 1247.5 (SEM 97.4) nmol/l (P<0 001, induced group) by the end of the first stage of labour. Concomitantly, free cortisol increased from 4.5–5.5% to 7.2–8 2% over this period so that its concentration increased by approximately 2 5‐fold in both groups of women during labour. We conclude that the total and physiologically‐active free concentrations of progesterone and oestradiol‐17β in maternal plasma do not change immediately before the onset of labour. That is, the onset of human parturition does not involve ‘progesterone withdrawal’ or ‘oestrogen augmentation’ in peripheral plasma. Total and free concentrations of cortisol are elevated in maternal plasma during labour possibly due to maternal stress.
Placental protein and hormone measurements in twin pregnancy
Authors: WESTERGAARD J. G. , TEISNER B. , HAU J. , GRUDZINSKAS J. G.
Published: August 2005

Summary. Maternal serum levels of human placental lactogen (hPL), schwangerschaftsprotein 1 (SP1), pregnancy‐associated plasma protein A (PAPP‐A), placental protein 5 (PP5) and total oestriol (E3) were measured serially in 35 twin pregnancies during the third trimester. Eighteen pregnancies had major complications including dysmaturity of one or both fetuses in nine, premature labour in six, and placental abruption in three. Serum levels of all five variables were higher than in singletons, this distinction being greatest for hPL and lowest for SP1 and E3. The levels of hPL, PP5 and E3 just before delivery were significantly correlated with the total birthweight, a correlation with placental weight being evident only for hPL and PP5. A significant correlation between the five biochemical variables at 33–34 weeks was only seen between hPL and PAPP‐A. Protein and hormone levels in. the abnormal twin pregnancies were not apparently different from those in the normal twin pregnancies. These data suggest that only hPL levels biochemically reflect this extreme of fetal and placental growth, but that neither the levels of hPL nor any of the other biochemical indices examined are altered in abnormalities in twin pregnancy
Does ultrasound examination render biochemical tests obsolete in the prediction of early pregnancy failure?
Authors: WESTERGAARD J. G. , TEISNER B. , SINOSICH M. J. , MADSEN L. T. , GRUDZINSKAS J. G.
Published: August 2005

Summary. Serum levels of fetal, placental and maternal hormones and proteins [β‐fetoprotein (AFP), human chorionic gonadotrophin, human placental lactogen. schwangerschaftsprotein 1, pregnancy associated plasma protein‐A (PAPP‐A), oestradiol‐17β, progesterone, pregnancy zone protein] were measured in 108 women with bleeding during the first half of pregnancy. Ultrasound examination at the time of each blood sampling revealed a fetal heart action on at least one occasion in 77 women. Spontaneous abortion occurred in 42 pregnancies, 31 of these showed no ultrasound sign of fetal life, whilst the fetal heart action was observed repeatedly until abortion in the remaining 11 women. Abnormally low levels of PAPP‐A were most likely to indicate pregnancy failure, in particular if the fetal heart action was seen at the time of blood sampling. The predictive value, sensitivity and relative risk of a single depressed PAPP‐A level were respectively 49, 89 and 41%, the predictive value of a normal result being 99%. With the exception of AFP, all other biochemical indices examined were consistently in the normal range in this group of women. If ultrasound findings were not considered, the biochemical indices were of comparable value in the prediction of spontaneous abortion. PAPP‐A levels were uniformly depressed in all patients who spontaneously aborted, frequently weeks before this event, in the presence of a live fetus.
The ‘birth plan’ experience
Authors: EKEOCHA C. E. O. , JACKSON P.
Published: August 2005

Summary. All antenatal patients booked for hospital confinement in Huddersfield have been offered a ‘birth plan’ on which to indicate their wishes regarding labour ward procedures. The first 100 plans have been analysed and the information supplemented by a questionnaire answered by the women in the puerperium.
Changing problems and priorities in obstetrics
Authors: BAIRD DUGALD
Published: August 2005

Summary. National perinatal mortality data suggest that the root causes of many deaths may lie in the environmental circumstances in which the mother grew up. Aberdeen primigravidae under the age of 20 years who gave birth to a baby with a birthweight of <2500 g between 1968 and 1972 were divided into those where there was an associated obstetric complication and those where the cause of the low birthweight infant was ‘unexplained'. The ‘unexplained’ group were more often smaller, underweight, cigarette smokers, and from relatively large families in the lower socioeconomic classes. Investigations of case records and by interview revealed that the mothers of these primigravidae were similarly disadvantaged and it is argued that further improvement in perinatal health and mortality will depend on the elimination of this continuity of social disadvantage.
A paediatrician asks—why is it called birth injury?
Authors: ILLINGWORTH RONALD S.
Published: August 2005

Summary. It is irrational to ascribe a child's so called ‘brain damage’ to labour or delivery without considering other factors. ‘Brain damage’ occurs without difficult labour or perinatal hypoxia and caesarean section is no guarantee against it. Severe difficulties in delivery and severe hypoxia at birth are in the great majority not followed by evidence of ‘brain damage’. In the maternal history there is a significantly greater incidence of relative infertility, and of pregnancies associated with low birthweight or intrauterine growth retardation, postmaturity, antepartum haemorrhage, pre‐eclampsia or infections. There are often genetic factors, more congenital anomalies and pathological evidence of underlying abnormality. There is an interaction of numerous factors, prenatal, perinatal and postnatal and it is simplistic to ascribe ‘brain damage’ to single factors, such as breech delivery or hypoxia at birth, without considering the antecedent causes of those factors.
Obstetric aspects of Gaucher disease
Authors: GOLDBLATT J. , BEIGHTON P.
Published: August 2005

Summary. The medical aspects of 21 pregnancies in 11 women with type I, non‐neuronopathic Gaucher disease have been reviewed. One pregnancy ended in a spontaneous abortion at 12 weeks and two pregnancies in one patient resulted in two children with the Hurler syndrome which is unrelated to Gaucher disease. The other 18 pregnancies resulted in the birth of normal infants at full‐term, four by caesarean section and the remainder by normal vaginal delivery. Only one patient experienced a significant exacerbation of her Gaucher disease during pregnancy. Fifteen of the pregnancies were associated with mild haematological complications but active intervention was necessary in only two instances. It can be concluded that there are few contraindications to pregnancy in women with Gaucher disease.
Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy
Authors: MASSON G. M. , ANTHONY F. , CHAU E.
Published: August 2005

Summary. Serum concentrations of human chorioni gonadotrophin (hCG). schwangerschaftsprotein l(SPl), progesterone and oestradiol were measured in 116 pregnant women experiencing varying degrees of nausea and vomiting or no nausea at all at between 9 and 16 weeks gestation. The patients were categorized into four groups, namely asymptomatic, nausea alone, nausea and vomiting and hyperemesis gravidarum. The distribution of levels for each group were examined in relation to the calculated normal ranges. Statistically higher hCG levels were found in out‐patients with nausea alone or nausea and vomiting than in the asymptomatic women. No significant differences were found between the groups for any of the other measured variables, including the progesterone/oestradiol concentration ratio.
Maternal azathioprine therapy and depressed haemopoiesis in the babies of renal allograft patients
Authors: DAVISON J. M. , DELLAGRAMMATIKAS H. , PARKIN J. M.
Published: August 2005

Summary. Maternal immunosuppression with azathioprine during pregnancy can depress fetal haemopoiesis resulting in neonatal throm‐bocytopenia and leucopenia with the potential for serious sequelae. The effect on the infant of adjusting azathioprine dosage on the basis of maternal total leucocyte count has been studied in 10 pregnancies in eight renal allograft recipients. Throughout the first six pregnancies azathioprine dosage was unchanged and although the characteristic pregnancy leucocytosis was evident it was not maintained in four patients whose leucocyte counts by 32 weeks gestation were significantly less than our norm [10·3 (SD 1·7) ×109/1] and who subsequently had babies with cord leucocyte counts 8·0×109/l, again significantly less than our norm [13·7 (SD 3·9) ×109/1]. A significant correlation existed between maternal leucocyte counts at 32 weeks gestation and at delivery and cord leucocyte count (r=0·847; P<0·01 and r=0·915; P<0·01 respectively). Three of these infants had platelet counts 100×109/1 but there was no correlation between maternal platelet counts at 32 weeks gestation or at delivery and cord platelet count. For the next four pregnancies policy changed: at 32 weeks gestation azathioprine dosage was halved if maternal leucocyte count was at or below the ISD band (8·6×109/1) for normal pregnancy. All of the infants were haemotologically normal and two patients whose first babies had leucopenia and thrombocytopenia had second babies without problems. Analysis of data from all 10 pregnancies still demonstrated a significant correlation between cord leucocyte count and maternal leucocyte count at delivery but no longer at 32 weeks gestation. It is concluded that in pregnant renal allograft recipients adjustment of azathioprine dosage so as to maintain maternal total leucocyte count within normal physiological limits for pregnancy avoids neonatal leucopenia and thrombocytopcnia.
The effects of age and body composition on circulating serum oestrogens and androstenedione after the menopause
Authors: JENSEN JYTTE , RIITS BENTE JUEL , HUMMER LOTTE , CHRISTIANSEN CLAUS
Published: August 2005

Summary. Circulating levels of oestrone, oestradiol and androstenedione were measured in two large groups of postmenopausal women, in one group the women were between 46 and 56 years of age and in the second, older group they were 70 years of age. In addition the fat mass was calculated from the height, weight and age of the women. Serum concentrations of both oestrogens did not change with age, whereas the serum androstenedione concentration decreased significantly. A change in body composition included decreased height and increased fat mass in the older group. Serum concentrations of both oestrogens correlated significantly with the fat mass and serum androstenedione as well as with each other. From the correlation analysis it may be concluded that the conversion rate of androstenedione to oestrone, and of oestrone to oestradiol, increases with age, which presumably explains the unchanged concentrations of the circulating oestrogens in relation to postmenopausal age, although the precursor decreases during the same period.
Clinical implications for immunoscintigraphy in patients with ovarian malignancy: a preliminary study using monoclonal antibody 791T/36
Authors: SYMONDS E. M. , PERKINS A. C. , PIMM M. V. , BALDWIN R. W. , HARDY J. G. , WILLIAMS D. A.
Published: August 2005

Summary. Twelve patients with suspected primary and recurrent carcinoma of the ovary have undergone immunoscintigraphy with an anti‐tumour monoclonal antibody in order to assess the impact of the technique on patient management. Consistent tumour uptake of radiolabelled antibody was visualized in malignant tumours after subtraction of the blood background activity. Eight patients were imaged before surgery and in all of these the sites of uptake visualized on the images agreed with the surgical findings. In one patient with recurrent disease the imaging information was used as an aid for establishing the extent of external beam radiotherapy. A repeat study in this patient 6 months later revealed a reduction in the size of the tumour, which still concentrated labelled antibody and confirmed the viability of repeat investigations. Immunoscintigraphy was capable of providing diagnostic information which may offer an alternative to second‐look surgery in these patients.
Radionuclide imaging of ovarian tumours with 123I‐labelled monoclonal antibody (NDOG2) directed against placental alkaline phosphatase
Authors: DAVIES J. O. , DAVIES E. R. , HOWE K. , JACKSON P. C. , PITCHER E. M. , SADOWSKI C. S. , STIRRAT G. M. , SUNDERLAND C. A.
Published: August 2005

Summary. A radiolabelled monoclonal antibody (NDOG,) directed against placental alkaline phosphatase (PLAP) was used in the radio‐immunodetection of ovarian carcinoma. Tumour deposits were successfully visualized in 11 of 15 patients and the abnormalities demonstrated were classified as focal or diffuse. Of the 11 patients, eight showed focal abnormalities alone and three had a diffuse abnormality, of which two also showed a focal abnormality. False‐positive results may occur not only due to uptake of 123I by gut mucosa and an inadequately blocked thyroid gland but also from activity in an incompletely emptied bladder. A false‐negative result occurred due to high background activity in the liver masking a known, discrete tumour deposit.
Outcome of pregnancy following induced abortion Report from the joint study of the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists
Authors: FRANK P. I. , KAY C. R. , LEWIS T. L. T. , PARISH S.
Published: August 2005

Summary. A total of 1590 general practitioners and 795 gynaecologists in England. Scotland and Wales are participating in a long‐term, prospective study concerning the sequelae of induced abortion. In the present report a comparison is made between the outcome of the first post‐index pregnancy in 745 women whose index pregnancy ended in an induced abortion (cases) and that in 1339 women who had an unplanned index pregnancy but were not referred f o r induced abortion (controls). There were no statistically significant differences between cases and controls. The increased relative risk which was found amongst the induced abortion group of non‐viable outcome, low birthweight and shortened gestation, could have arisen by chance. Further analysis of a larger number of pregnancies is required to permit confident interpretation of these observations. The present data provide no reason for alterations in the current management of induced abortion, or the subsequent pregnancy.
Improvements in the registration and analysis of fetal heart rate records at the bedside
Authors: DAWES G. S. , REDMAN C. W. G. , SMITH J. H.
Published: August 2005

Summary. A microprocessor system is described for on‐line analysis of the fetal heart rate detected by conventional Doppler systems. A brief account is given of the instrumentation and program structure. The system has been tested by analysing normal and abnormal antenatal fetal heart rate records. Pulse Doppler with autocorrelation measurement of the fetal pulse interval reduced the signal loss in clinical practice by a factor of 10, to an average of 2.1% in 629 records from uncomplicated pregnancies. Yet it is still necessary to identify signal loss, because it occasionally rises t o unacceptable levels in association with fetal movements or hiccups. Medium‐term measures of fetal heart rate variation (within 16–0.1 cycles/min) varied with gestational age, but were a better index of fetal well‐being than longer‐term measures. The application of the system t o fetal monitoring is illustrated.
Computerized histories facilitate patient care in a termination of pregnancy clinic: the use of a small computer to obtain and reproduce patient information
Authors: LILFORD R. J. , BINGHAM P. , BOURNE G. L. , CHARD T.
Published: August 2005

Summary. An inexpensive microcomputer has been programmed to obtain histories from patients attending a pregnancy termination clinic. The system is nurse‐interactive; yes/no and multiple‐choice questions are answered on the visual display unit by a light pen. Proper nouns and discursive text are typed at the computer keyboard. A neatly formatted summary of the history is then provided by an interfaced printer. The history follows a branching pattern; of the 370 questions included in the program, only 68 are answered in the course of an average history. The program contains numerous error traps and the user may request explanations of questions which are not immediately understood. The system was designed to ensure that no factors of anaesthetic or medical importance would be overlooked in the busy out‐patient clinic. The computer provides a much more complete history with an average of 42 more items of information than the pre‐existing manual system. This system is demanding of nursing time and possible conversion to a patient‐interactive system is discussed. A confidential questionnaire revealed a high degree of consumer acceptance.
Effectiveness of vaginal administration of progesterone
Authors: GLAZENER CATHRYN M. A. , BAILEY IAN , HULL MICHAEL G. R.
Published: August 2005

Summary. Vaginal administration of 200 or 400 mg of progesterone in a wax suppository every 12 h in normal women was effective in rapidly achieving and maintaining serum progesterone concentrations at physiological levels appropriate to the midluteal phase of the ovarian cycle and early pregnancy. Given in the follicular phase for 5 days in five subjects at each of two doses, progesterone reached concentrations in serum after 4 and 12 h o f 21–105 nmol/l (mean 46·4 nmol/l SD 17·2, n= 50) with 200 mg dosage and 21–101 nmol/l (mean 53·8 nmol/l SD 16·6, n= 49) with 400 mg dosage. There was no significant reduction in levels between 4 and 12 h after administration, in contrast to previously reported findings, suggesting that the wax base led to slow release of the hormone. The uptake of progesterone in the midluteal phase was assessed in 10 subjects by comparing successive cycles treated with progesterone or placebo in a randomized double‐blind manner. Using only the 400 mg dosage, the mean serum progesterone level was raised by 69%: the untreated level being normal (38·17 SD 10·01 compared with 64·49 SD 23·22 nmol/l, n= 10). This was despite an assumed concomitant fall in endogenous hormone production as suggested by a 28% reduction in oestradiol‐17β levels. Thus vaginal administration of progesterone in wax appears to be effective and convenient, and preferable to the use of other progestogens in various circumstances in which a fetus may be exposed to the drug.