bluuebunny/crossref_metadata_2025 huggingface dataset:
Concomitant and repeated happenings of complications of the third stage of labour
Authors: HALL MARION H. , HALLIWELL RUTH , CARR‐HILL ROY
Published: August 2005

Summary. Complications of the third stage of vaginal delivery have been studied among 36312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless. only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.
Quantitation of vaginal discharge in healthy volunteers
Authors: GODLEY M. J.
Published: August 2005

Summary. The mean quantity of vaginal discharge measured on four occasions during one menstrual cycle in 22 asymptomatic volunteers was 1.55 g/8 h although the amount varied significantly between different days of the cycle. The maximum occurred at mid‐cycle (1.96 g/8 h) and low mean values were seen on day 7 (1.38 g/8 h) and day 26 (1.37 g/8 h), contrasting with the widely held view that the discharge increases premenstrually. This cyclical variation was statistically significant (P < 0.02) in celibate women using no contraception but was less marked in sexually active women taking the combined oral contraceptive pill.
The management of cervical intraepithelial neoplasia by coagulation electrodiathermy
Authors: WOODMAN C. B. J. , JORDAN J. A. , MYLOTTE M. J. , GUSTAFESON R. , WADE‐EVANS T.
Published: August 2005

Summary. Of 140 women with cervical intraepithelial neoplasia treated with a single application of coagulation electrodiathermy, 123 (88%) remain cytologically free of disease after a median follow‐up of 3 years. The new squamocolumnar junction was colposcopically visible in 70% of the 130 patients assessed after treatment. In 15 of 17 women requiring further treatment. residual disease was suspected at the time of the first postoperative assessment. The incidence of significant morbidity following this procedure was 4%. In selected patients coagulation electrodiathermy is an effective method of treating pre‐invasive disease of the cervix.
Assessment of bleomycin, adriamycin and mitomycin‐C in the treatment of recurrent cervical cancer
Authors: MEANWELL CLIVE A. , LUESLEY DAVID M. , BLACKLEDGE GEORGE , MOULD JOHN J. , CHAN K. K. , PERREN TIMOTHY J. , LAWTON FRANK G.
Published: August 2005

Summary. Twenty women with recurrent squamous cell carcinoma of the cervix were treated with bleomycin followed by adriamycin and mitomycin‐C. Treatment was repeated every 28 days. In 18 patients who could be assessed there was one complete response and five partial responses (response rate 33%). Two partial responses were seen in 13 lesions arising from previously irradiated sites of disease (response rate 23%). Three complete responses and three partial responses were observed in 10 lesions arising from non‐previously irradiated sites of disease (response rate 60%). In all responding cases tumour regression was noted before the end of the third cycle of treatment. Toxicity was predictable and manageable. These results suggest that chemotherapy may be used as a cytoreductive procedure before radical local treatment.
Blood pressure and the menstrual cycle
Authors: GREENBERG G. , IMESON J. D. , THOMPSON S. G. , MEADE T. W.
Published: August 2005

Summary. A retrospective analysis of data from 207 non‐pregnant premenopausal women showed that the mean level of systolic blood pressure varied with the stage of the menstrual cycle, being higher on days 17–26, the part of the luteal phase during which the peak of progestogen levels develops, than during the luteal phase as a whole, and significantly higher than the mean for all other days of the cycle. The mean levels were 125.4 mmHg (SE 1.76) for days 17–26, 122.5 (SE 1.25) for days 15–28 and 120.1 (SE 1.07) for days 1–16,27 and 28. This finding supported the hypothesis that endogenous progestogen might have a hypertensive effect, as does exogenous progestogen. However, a second study designed to confirm this finding failed to do so, showing no cyclical change in the level of blood pressure. The subjects in the first study may have been subject to greater psychological stress when the measurements were made than were those in the second, a possibility supported by the large difference in pressure between the two studies. The discrepancy between the two sets of results could be explained if the effect possibly associated with progestogen levels in the retrospective study was due not to a hypertensive action per se but to a progestogen‐related increased reaction to stress.
Natural history of cervical human papillomavirus (HPV) infections based on prospective follow‐up
Authors: SYRJÄNEN K. , VÄYRYNEN M. , SAAKIKOSKI S. , MÄNYJÄRVI R. , PARKKINEN S. , HTPPELÄINEN M. , CASTREN O.
Published: August 2005

Summary. To assess the natural history of human papillomavirus (HPV) lesions in the uterine cervix, a prospective follow‐up of untreated lesions has been conducted since late 1981. The present report summarizes the data on 343 women with cervical HPV lesions currently followed‐up for a mean of 18.7 (SD 15.2) months by colposcopy and PAP smears (group R) or by additional punch biopsy (group A). Initially these tw7o groups were classified on the first PAP smears, presenting with HPV‐induced cytopathic changes, and either with (group A) or without (group B) concomitant changes suggestive of cervical intraepithelial neoplasia (CIN). The clinical course of the HPV lesions could not be predicted adequately from the findings of the first PAP smears, as evidenced by the higher progression rate (154%) in the 214 women initially classified in group B, compared with 116% in the 129 women classified in group A. Furthermore, the number progressing to careinomia in situ requiring conization was equal (seven patients) in the two groups. This necessitated a more flexible approach to follow‐up, permitting transfer of patients between groups, which resulted in a final allocation of 261 women to group A, and 82 to group B. To date, 25% of the total of 343 HPV lesions have regressed. 61% have persisted, and 14% have progressed. Of the latter, a total of 14 (4.1%) have been coned due to progression to carcinoma in situ. The rate of regression seems to be inversely related, and progression directly related. to the degree of HPV‐associated CIN. The results are discussed in the light of the well‐established natural history of classical CIN. Generally recognized as premalignant tesions. The present results, demonstrating that the natural history of cervical HPV lesions is very similar to that o f CIN, further substantiate the concept of HPV lesions as precursors of cervical cancer. With the potential to progress to carcinoma in situ when left untreated.
Risks of preterm delivery and small‐for‐gestational age infants following abortion: a population study
Authors: PTCKERING RUTH M. , FORBES JOHN F.
Published: August 2005

Summary. We examined hospital discharge records in 1980–81 for singleton third trimester deliveries in Scotland. We compared 3000 women who had previously experienced induced termination of pregnancy, and 4000 who had experienced spontaneous abortion with primigravidae and with women in their second pregnancy, their first having resulted in a litebirth. Two aspects of low birthweight were examined: delivery before the 37th completed week of gestation, and low hirth weight for gestational age. Our comparisons were further controlled for maternal height, age, sex of infant, marital status and social class. Women with previous spontaneous abortions experienced significantly increased risk of preterm delivery but not of low birthweight for gestational age. Women with a history of induced abortion also experienced increased risk of preterm delivery, but for women aged 18–24 years, risk of low birth weight for gestational a ge was significantly reduced compared with primigravidae.
Oedema‐preventing mechanisms in subcutaneous tissue of normal pregnant women
Authors: ØIN PÄL , MALTAU JAN MARTIN , NODDELAND HAROLD , FADNES HANS OLAV
Published: August 2005

Summary. Fluid transport between the plasma and interstitial fluid compartment is governed by the Starling forces, i.e. the capillary pressure (Pc). interstitial fluid hydrostatic pressure (Pi) and colloid osmotic pressure in plasma (COPi) and interstitial fluid (COPi). The COPP, COPi and Pi were measured in 10 normal pregnant women in the first and 10 women in the third trimester of pregnancy. Interstitial fluid was collected from subcutaneous tissue by implanted wicks and Pi was measured by the‘wick‐in‐needle’technique. The COPP was reduced from 23.2 mmHg in the first trimester to 21.1 mmHg in the third trimester. Concomitantly, COPi decreased from 13.1 to 8.4 mmHg on the thorax and from 9.6 to 5.5 mmHg at the ankle. Only small changes in Pi were observed. The more marked fall in COPi than in COPP indicates that a rise in Pe, in addition to hypoproteinaemia, contributes to increased capillary fluid filtration in pregnancy. The reduction in COPi opposes the increased filtration and thereby prevents a rise in interstitial fluid volume and oedema formation. These physiological changes imply a reduced safety margin against oedema formation in late pregnancy.
Fall in the heat‐labile alkaline phosphatase isoenzyme levels during pregnancy in healthy Nigerians
Authors: OKPERE EUGENE , OKORODUDU A O. , GBTNIGIE A. O.
Published: August 2005

Summary. Estimation of heat‐labile alkaline phosphatase isoenzyme in the serum of 45 healthy non‐pregnant women and 98 women in the second and third trimesters of pregnancy revealed a statistically significant reduction of this isoenzyme during pregnancy. Variations in normal activity were also more marked in the pregnant women compared with the non‐pregnant control subjects. Now that normal serum levels of the heat‐labile alkaline phosphatase isoenzyme in pregnancy have been established it is possible to use estimations of the enzyme as part of the assessment of maternal liver function in pregnancy.
Coagulation factors and fibrinolytic proteins in menstrual fluid collected from normal and menorrhagic women
Authors: REES MARGARET C. P. , CEDERHOLM‐WILLIAMS S. A. , TURNBULL A. C.
Published: August 2005

Summary. Menstrual fluid was collected in vaginal cups inserted for 2 h during the first 2 days of menstruation and selected coagulation and fibrinolytic proteins were measured. All the samples showed a virtual absence of thrombin generating activity and exhaustion of fibrinolytic proteins. In 14 women in whom menstrual fluid was collected on both days, no significant difference in the levels of any factor was found apart from α‐2‐macroglobulin which were lower on day 1 than on day 2. Except for plasminogen and α‐2‐macroglobulin concentrations on day 1, no correlation was found between any of the factors on either day and menstrual blood loss (range 15–666 ml).
Effect of oral clonidine on human cardiovascular responsiveness: a possible explanation of the therapeutic action of the drug in menopausal flushing and migraine
Authors: GINSBURG JEAN , O'REILLY BARBARA , SWINHOE JUNE
Published: August 2005

Summary. The effect of an alpha‐adrenergic agonist, clonidine hydrochloride, on cardiovascular responses to noradrenaline, adrenaline and angiotensin was investigated in menopausal women with hot flushes. The increase in forearm blood flow induced by adrenaline, nor‐adrenaline or angiotensin was significantly less in women treated for at least 6 weeks with clonidine compared with that induced in the women by infusions given before treatment. Pulse rate during the amine infusions was significantly lower after clonidine treatment but constrictor responses in the hand were unchanged. These findings cannot be wholly explained in terms of an action of clonidine confined to adrenergic mechanisms and suggest that the drug may influence peripheral vascular responsiveness. Such an effect could explain the mechanism of the beneficial clinical action of the drug in subjects with menopausal flushing or migraine.
Lateral bead‐chain urethrocystography after successful and unsuccessful colposuspension
Authors: HERTOGS KEITH , STANTON STUART L.
Published: August 2005

Summary. Twenty‐seven patients were studied after colposuspension with lateral bead‐chain urethrocystography. Successful operation, compared with unsuccessful operation, repositioned the bladder neck significantly closer to the posterosuperior surface of the symphysis pubis, though not significantly higher. After successful colposuspension, the proximal urethra is exposed to compression against the symphysis pubis by the momentary descent of the pelvic viscera during physical effort. Failure of the colposuspension was usually due to an inadequate repositioning of the bladder neck.
Mechanism of urinary continence after colposuspension: barrier studies
Authors: HERTOGS KEITH , STANTON STUART L.
Published: August 2005

Summary. To test the postulate that colposuspension cures genuine stress incontinence by repositioning the proximal urethra against the posterosuperior surface of the symphysis pubis, 48 patients cured by colposuspension were studied to note the effects of a barrier placed in the vagina to interrupt the posterior route of force transmission. The barrier reduced peak transmission by 59% (P<0·0001). When the barrier was used to block compression by the high cystocoele, stress incontinence recurred transiently in 90% of patients. These results confirm Hilton's postulate (1981) that colposuspension constructs a novel, mechanical urinary sphincter rather than restoring normal sphincter function.
Episiotomy and third‐degree tears
Authors: BUEKENS PIERRE , LAGASSE RAPHAEäL , DRAMAIX MICHÉLE , WOLLAST ELISABETH
Published: August 2005

Summary. The relation of episiotomy to third‐degree perineal tears was investigated in 21 273 singleton deliveries. The incidence of episiotomy was 28.4% (n=6041). Third‐degree tears occurred in 14% (85) of the deliveries with episiotomy and in 0.9% (132) of the deliveries without episiotomy (P<0.01). To avoid the effect of confounding factors, we analysed a sub‐sample that included only vertex presentations with spontaneous occipitoanterior vaginal deliveries. After stratification for birthweight and parity, no relation between episiotomy and third‐degree tear was found.
Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology
Authors: SNOOKS S. J. , HENRY M. M. , SWASH M.
Published: August 2005

Summary. The commonest cause of external anal sphincter division is injury during childbirth. We have studied 20 patients with anterior external anal sphincter division using physical and electrophysiological techniques. There was evidence of pudendal nerve damage in 60% of these patients. This finding suggests that damage to the innervation of the external anal sphincter often co‐exists with direct injury to the muscle; in these patients pelvic floor surgery may be required, in addition to sphincter repair itself.
Urodynamic and clinical assessment of the Lyodura sling operation for urinary stress incontinence
Authors: ROTTENBERG RENÉ D. , WEIL A. , BRIOSCHI P. A. , BISCHOF P. , KRAUER F.
Published: August 2005

Summary. A Lyodura sling operation for urinary stress incontinence was performed on 36 patients. The success rate was 89%, when success was defined as absence of objective urine loss at coughing or straining. with full bladder in the upright position and during a Urilos test. at least 6 months after surgery. Full urodynamic assessment, including urethral rest and stress profiles, were performed before, and 6 months after, surgery. Success of the operation depended mainly on enhancement of urethral pressure transmission. Functional length of the urethra and maximal urethral pressure did not influence the success rate. The procedure is especially suitable in patients with some degree of uterine or vaginal prolapse.
Zinc deficiency is not a cause for abortion, congenital abnormality and small‐for‐gestational age infant in Chinese women
Authors: GHOSH A. , FONG L. Y. Y. , WAN C. W. , LIANG S. T. , WOO J. S. K. , WONG V.
Published: August 2005

Summary.Zinc concentration in serum and hair was measured in a cross‐sectional study of 437 Chinese women of whom 310 were normal controls studied at various stages of pregnancy and up to 12 months after delivery. The rest had spontaneous abortions, fetuses with a birthweight below the 10th centile for gestation or congenital abnormalities. Zinc concentration fell throughout normal pregnancy, the fall being greater in serum than in hair. There was no correlation between serum and hair levels. The infant birthweight had a positive correlation with serum level but a negative correlation with hair level. Abortion, low birthweight and congenital abnormality were not associated with low concentrations of zinc in plasma or hair.
Efficacy of intrauterine volume, fetal abdominal area and biparietal diameter measurements with ultrasound in screening for small‐for‐dates babies
Authors: GEIRSSON R. T. , PATEL N. B. , CHRISTIE A. D.
Published: August 2005

Summary. The efficacy of total intrauterine, intra‐amniotic and placental volume measurements with ultrasound in screening for low birthweight (10th and 3rd centile) was compared prospectively with fetal biparietal diameter and abdominal area measurements at 32 and 36 weeks gestation in an unselected population of 362 women. In all of them the gestation was dated by ultrasound in the first half of pregnancy. Reference values were from a separate normal population studied previously. Total intrauterine volume showed the highest sensitivity in predicting babies weighing 10th centile (58% at 32 weeks and 62% at 36 weeks) and those weighing 3rd centile (78% at 32 weeks and 83% at 36 weeks). A higher number of false‐positive tests resulted in a lower predictive value of a positive test (mean 34% for babies weighing 10th centile) than that found for abdominal area (mean 54%). Abdominal measurements selected a smaller‘at risk’group. Biparietal diameter, intra‐amniotic and placental volume measurements had inferior predictive capability than total intrauterine volume and abdominal area. For screening purposes abdominal area measurements are presently more suitable than intrauterine volume. The higher sensitivity of intrauterine volume, particularly in early third trimester, is an advantage that requires further investigation with reference to intrauterine growth retardation.
The assessment of persistent bradycardia in prenatal life
Authors: CRAWFORD DIANE , CHAPMAN MICHAEL , ALLAN LINDSEY
Published: August 2005

Summary. Twelve patients with persistent fetal bradycardia were referred for echocardiographic assessment; in 10 patients the fetus had complete heart block, six isolated and four with associated structural heart disease. In the remaining two patients an atrial arrhythmia was producing a fetal sinus bradycardia. Complete heart block with structural heart disease has a poor prognosis. Isolated complete heart block has a good prognosis if the pregnancy is carefully managed. A sinus bradycardia due to atrial ectopic beats is a benign arrhythmia. Echocar diographic assessment of the heart can give an accurate prognosis in fetal bradycardia and provide a basis for appropriate obstetric management.
The transfer of free fatty acids across the human placenta
Authors: HENDRICKSE W. , STAMMERS J. P. , HULL D.
Published: August 2005

Summary. Thirty‐three matched maternal venous and umbilical cord vein and artery plasma samples were obtained at elective caesarean section and the concentrations of the individual free fatty acids determined. The maternal levels were 1.009 (SEM 0.043) and the umbilical vein‐artery difference was 0–036 (SEM 0.011) mmol/l. There was a significant correlation between the mean concentration in maternal venous blood and the vein‐artery difference for myristic, palmitic stearic, linoleic and docosahexaenoic acids but not for oleic acid. When arachidonic acid concentration in the fetus was high, then the veinartery difference was negative (flow t o the placenta), when it was low, the difference was positive (flow to the fetus). Thus whilst there appears in general to be a flow of fatty acid to the fetus dependent on maternal free fatty acid concentrations, the transfer of arachidonic acid is largely determined by other factors. The reasons why oleic acid does not behave like the other fatty acids is not clear.
Gestation sac size in in‐vitro fertilization pregnancies
Authors: DE CRESPIGNY LACHLAN CH. , ROBINSON HUGH P. , MURPHY ANTHONY , McBAIN JOHN C. , GRONOW MICHAEL , BAYLY CHRISTINE M. , ANDREW SPEIRS Obstetrician & Gynecologist  , IAN W. , JOHNSTON H.
Published: August 2005

Summary. The gestation sac size in pregnancies resulting from in‐vitro fertilization (IVF) and embryo transfer have been compared with those in spontaneous pregnancies. Small‐for‐dates gestational sac sizes were found in 36% of the IVF pregnancies. This proportion held for both singleton and multiple pregnancies. With increasing gestation beyond 8 weeks the gestation sac volume increasingly approached normal. In contrast to spontaneous conceptions, IVF pregnancies had a low rate of pregnancy loss once fetal heart movements were demonstrated, when the gestation sac size was small‐for‐dates. Small sac size in an IVF pregnancy may lead to the misdiagnosis of a failed pregnancy.
The outlook for women with borderline epithelia tumours of the ovary.
Authors: TASKER M. , LANGLEY F. A.
Published: August 2005

Summary. Seventy‐two women with borderline epithelial tumours of the ovary have been followed up for between 3 and 9 years. Patients with disease confined to one or both ovaries had a good prognosis, irrespective of histological type. When extra‐ovarian spread was present at the time of diagnosis, neither the histological type nor the amount of residual tumour predicted the long‐term outcome in individual patients.
Perinatal events which precede periventricular haemorrhage and leukomalacia in the newborn
Authors: WEINDLING A. M. , WILKINSON A. R. , COOK J. , CALVERT S. A. , FOK T‐F. , ROCHEFORT M. J.
Published: August 2005

Summary. Ultrasound brain scans were obtained daily for the first 5 days after birth, on day 7 and then weekly until discharge from hospital in 86 babies during a 12‐month period. The babies weighed <1501 g or were <34 weeks gestational age. Fifty‐one (59%) had normal scans. 34 (40%) developed periventricular haemorrhage, and seven (8%) developed periventricular cysts (associated with periventricular haemorrhage in six). Factors associated with periventricular haemorrhage were perinatal hypoxia, acidosis, hypercapnia and hypoxia after birth. Babies who developed periventricular cysts (periventricular leukomalacia) were more likely to have been hypoxic at birth and in four of the seven there had been a maternal antepartum haemorrhage. The association of perinatal hypoxia with periventricular haemorrhage and leukomalacia suggests that intraparturm events may predispose to the onset of these lesions which then develop postnatally. Prevention of perinatal hypoxia may play an important role in diminishing the disability caused by these conditions.
Hormonal response to electrocautery of the ovary in patients with polycystic ovarian disease
Authors: AAKVAAG ASBJØRN , GJØNNÆSS HALVARD
Published: August 2005

Summary. Fifty‐eight women with polycystic ovarian syndrome (PCO) were treated with electrocautery of the ovarian capsule and then studied by hormone analysis for 12 months. In 72% ovulation appeared to occur within 4 weeks and in this group mean serum LH and FSH levels showed a statistically significant increase the day after electrocautery, followed by a gradual decline in LH lo a level significantly below the pretreatment value. No changes in LH and FSH were seen in those who did not ovulate. The mean levels of testosterone, androstenedione and dihydrotestosterone which were in the upper normal range or slightly above before treatment were significantly reduced after electrocautery. Serum oestradiol levels showed a significant increase after 1 week, when progesterone levels were still unchanged, suggesting that follicular development was already in progress. The mean serum level of sex hormone binding globulin was slightly below the normal range before treatment and then increased gradually. Endocrine responses to electrocautery were similar to those described previously after wedge resection. The simplicity of this treatment and the good response make it an attractive alternative for treating infertility associated with PCO.
Distribution of epithelial membrane antigen in normal and abnormal endometrial tissue
Authors: MORSE ANNE R. , CURRAN GEOFFREY J.
Published: August 2005

Summary. The distribution of epithelial membrane antigen (EMA) on normal and abnormal endometrial tissue was studied as a method for distinguishing atypical hyperplasia from adenocarcinoma. Histological sections from 47 patients (nine adenocarcinoma, ninc atypical hyperplasia, nine cystic hyperplasia, 19 normal endomctrium and one sircoma) were studied with an immunocytochemical alkaline phosphatase technique that derrionstratcd EMA. At adilution of 1:1000 the majority of normal tissue was negative whereas all the abnormal tissue stained positively. At a slightly higher dilution all adenocarcinomas expressed thc antigen although only a few of the hyperplastic lesions (16%) stained with the antibody. The value of this approach for automated screening is discusscd.
Vasotocin analogues which competitively inhibit vasopressin stimulated uterine activity in healthy women
Authors: ÅKERLUND MATS , HAUKSSON ARNAR , LUNDIN STEFAN , MELIN PER , TROJNAR JERZY
Published: August 2005

Summary. Three analogues of posterior pituitary hormones, 1 ‐ deamino ‐ 2 ‐ D ‐ Tyr(OEt) ‐ 4 ‐ Val ‐ 8 ‐ Om ‐ vasotocin(dE ‐ VVT), l‐deamino‐2‐D‐Tyr(OEt)‐4‐Thr‐8‐Orn‐vasotocin(dE‐TVT) and 1‐deamino‐2‐D‐Tyr(OEt)‐oxytocin(dE‐OXY) were compared for their inhibitory effects on vasopressin (VP)‐induced uterine activity in healthy women. At menstruation, during recording of intrauterine pressure (18 recording sessions in 11 women), intravenous infusion of lysine vasopressin (LVP, 1 ng/min/kg/body weight) induced an increase of the uterine activity and dysmenorrhoea‐like symptoms. Intravenous injections of all analogues (10 μg/kg body weight) caused relief of symptoms and inhibition of uterine activity, dE‐TVT was the most effective and dE‐OXY was least active. With dE‐TVT almost complete inhibition of contractions was seen during the first 10 min after injection. The duration of effect was also greatest with that analogue (40–50 min). Only dE‐OXY had an agonist effect on spontaneous uterine activity. Pharmacokinetic studies of intravenous dE‐TVT (10 ng/kg body weight) showed that the plasma half‐life was approximately 16 min and the clearance 30 1/h. The bioavailability of 100 ng/kg given intra‐nasally was about 5·5%. Further studies are recommended.
Bladder drainage for caesarean section under epidural analgesia
Authors: KERR‐WILSON R. H. J. , McNALLY SINEAD
Published: August 2005

Summary. Fifty patients undergoing elective caesarean section under epidural analgesia were randomized prospectively to be catheterized with an ‘in‐out’ or an indwelling urethral catheter. Of the patients who had catheterization for the time of surgery alone 44% subsequently required recatheterization, whereas all patients with indwelling catheters voided spontaneously on their removal. The frequency of significant bacteriuria was the same in both groups.
Mid‐trimester levels of alphafetoprotein in the screening of low birthweight
Authors: CHARD T. , RICE A. , KITAU M. J. , HIRD V. , GRUDZINSKAS J. G. , NYSENBAUM A. M.
Published: August 2005

Summary. Elevated maternal levels of alphafetoprotein (AFP) in midtrimester are believed by some to be a useful screening test for premature labour, low birthweight and low birthweight for gestation. In a prospective study on 887 randomly selected pregnant women we found that although there was an association between low birthweight and elevated AFP, the test would miss five out of every six cases of low birthweight and there would be nine false‐positives for every case correctly identified. The test is not therefore sufficiently predictive of low birthweight to be of value as a screening test for this condition.
A comparison of fixed regimens for obtaining human cleaving oocytes for research purposes
Authors: MESSINIS IOANNIS E. , TEMPLETON ALLAN , ANGELL ROSLYN , AITKEN JOHN
Published: August 2005

Summary. A fixed schedule for ovarian stimulation and follicular aspiration, previously used in our department for research purposes, was modified in an attempt to increase the recovery and cleavage rates of the oocytes. Three different clomiphene regimens were used to stimulate the ovaries of normal volunteer women requesting laparoscopic sterilization (50 mg and 150 mg daily for 5 days, and 50 mg daily for 10 days). Oocytes were recovered from 83% of the aspirated follicles, i.e. 1·6 oocytes/patient: 65% of the oocytes cleaved after in‐vitro fertilization and, on average, 1·0 cleaving egg was obtained per patient. There were no differences in the recovery and cleavage rates between the three clomiphene regimens. It is concluded that a sufficient number of cleaving embryos for research purposes can be generated with the present fixed regimen, which offers little inconvenience to the volunteers as the day of egg recovery can be predicted some time in advance.
Effects of dydrogesterone on the oestrogenized postmenopausal endometrium
Authors: LANE G. , SIDDLE N. C. , RYDER T. A. , PRYSE‐DAVIEST J. , KING R. J. B. , WHITEHEAD M. I.
Published: August 2005

Summary. Postmenopausal women receiving conjugated oestrogens 1·25 mg daily continuously were also given dydrogesterone either 5, 10 or 20 mg daily for the first 12 days of each calendar month. Endometrial tissue obtained on the sixth day of combined therapy in the third or subsequent treatment cycle was subjected to histological, ultrastructural and biochemical assessments. Dydrogesterone provoked secretory histological and ultrastructural changes within the endometrium in a dose‐dependent manner. A daily dose of 5 mg produced sub‐optimal responses but 10 and 20 mg daily produced effects similar to those observed in the secretory phase of the ovulatory cycle. Dydrogesterone 10 mg and 20 mg daily reduced epithelial DNA synthesis and nuclear oestradiol receptor levels to values within the secretory phase range. A dose‐response relation was seen in the induction of oestradiol‐17β and isocitrate dehydrogenase activities; hyperphysiological values were observed with 20 mg of dydrogesterone daily. This study has dernonstrated that dydrogesterone exerts potent anti‐oestrogenic and progestational effects on the human endometrium which are dose‐related. The 10 and 20 mg doses induced responses equal to or greater than those observed in the secretory phase of the ovulatory cycle and both dosages can be recommended for use in combination with exogenous oestrogens in postmenopausal women: and they may also have a role in the management of anovulatory dysfunctional uterine bleeding.
Developments in chemotherapy for medium‐ and high‐risk patients with gestational trophoblastic tumours (1979–1984)
Authors: NEWLANDS E. S. , BAGSHAWE K. D. , BEGENT R. H. J. , RUSTIN G. J. S. , HOLDEN L. , DENT J.
Published: August 2005

Summary. Identification of various prognostic factors at the start of chemotherapy allows patients with gestational trophoblastic tumours to be categorized into low‐, medium‐ and high‐risk groups so that they can be given the minimum treatment necessary to eliminate their disease. Most patients in the low‐risk category can be treated with minimal toxicity using a methotrexate/folinic acid regimen and these patients are not considered in this report. Before 1979 patients in the medium‐risk category were treated with a sequence of drugs which included, hydroxyurea, methotrexate, 6‐mercaptopurine, actinomycin D, vincristine and cyclophosphamide. Since 1979 etoposide has been substituted for vincristine and cyclophosphamide. The 76 patients treated between 1979 and 1983 are all alive and in remission 1·1.85. Three patients (4%) relapsed and required retreatment and all are in remission. Fifty‐six patients in the high‐risk group, most at risk of developing drug resistance, were treated with a regimen incorporating etoposide with methotrexate, actinomycin D (EMA) and vincristine and cyclophosphamide (CO). EMA and CO were given on alternate weeks, resulting in an overall survival rate of 84%. Patients who had received prior chemotherapy had a survival rate of 74% and a relapse rate of 19% compared with 93% survival and 3% relapse rate in those who had not received prior chemotherapy. Toxicity with the EMA/CO regimen was significantly less than with an earlier regimen (CHAMOCA) used in the high‐risk group.
Estimation of gestational age by last menstrual period, by ultrasound scan and by SP1 concentration: comparisons with date of delivery
Authors: AHMED A.G. , KLOPPER A.
Published: August 2005

Summary. The date of delivery in 62 normal pregnant women was predicted by last menstrual period, by ultrasound scan and by the serum concentration of Schwangerschaftsprotein 1 (SP1). It was found that SP1 concentration in the first trimester gave as reliable an indication of when labour would occur as did the last menstrual period or ultrasound scan.
Long‐term follow‐up of children prenatally exposed to ritodrine
Authors: HADDERS‐ALGRA M. , TOUWEN B. C. L. , HUISJES H. J.
Published: August 2005

Summary. In a group of 78 6‐year‐old children exposed to ritodrine treatment during pregnancy for an average of 28·2 days and in two matched control groups, no statistically significant differences could be found regarding urinalysis, body‐length, weight, head circumference, neurological findings, and general behaviour as perceived by parents and teachers. However, school performances of ritodrine‐treated children, as estimated by the teacher of the infant school, were considered to be less good. Whether this difference can be attributed to exposure to ritodrine or should rather be explained by the less favourable obstetric situation, which led to imminent preterm delivery, is an unsolved question.
Gut peptides in lactation
Authors: HOLST N. , JENSSEN T. G. , BURHOL P. G. , JORDE R. , MALTAU J. M. , HAUG E.
Published: August 2005

Summary. The circulating levels of prolactin (PRL), vasoactive intestinal polypeptide (VIP), somatostatin (SRIH), cholecystokinin (CCK), pancreatic polypeptide (PP), insulin, motilin and blood glucose were measured in nine nursing women 27–40 days after delivery to establish the possible role of some gastrointestinal regulatory peptides in human breast feeding. During the last 20 min of suckling a significant (P<0·05) increase in serum PRL was observed concomitantly with a significant decrease in plasma SRIH levels (P<0·05 at 20 min and P<0·01 at 30 min). There was a highly significant inverse correlation between mean PRL and SRIH levels during the first 30 min of breast feeding (r= ‐0·996, P<0·00l). Pancreatic polypeptide (PP) also increased significantly (P<0·01) during nursing, while there were no changes in the plasma levels of the other gastrointestinal regulatory peptides studied.
Transcapillary fluid balance in pre‐eclampsia
Authors: ØIAN PÅL , MALTAU JAN MARTIN , NODDELAND HARALD , FADNES HANS OLAV
Published: August 2005

Summary. The fluid transport between the plasma and interstitial fluid compartment is governed by the Starling forces, i.e. the capillary pressure (Pc), interstitial fluid hydrostatic pressure (Pi) and colloid osmotic pressure in plasma (COPp) and interstitial fluid (COPi). Interstitial fluid was collected from subcutaneous tissue on the thorax and ankle by implanted wicks and Pi was measured using the ‘wick‐in‐needle’ technique. In pre‐eclampsia, COPp, is reduced due to hypoproteinaemia and this predisposes towards loss of fluid from the vascular compartment. An important oedema‐preventing mechanism is reduction of COPi, which serves as a homeostatic buffer against increased capillary filtra‐tion. This mechanism works in moderate, but not in severe preeclampsia. A higher COPi was found both at the thorax (8·3 vs 7·0 mmHg) and ankle (5·9 vs 3·9 mmHg) in the group with severe pre‐eclampsia compared with the group moderate pre‐eclampsia, in spite of a significant reduction in COPp (15·5 vs 19·9 mmHg). These findings suggest that an increased microvascular permeability of plasma proteins to subcutaneous tissue contributes to COPp reduction in severe pre‐eclampsia.
Dietary factors in the aetiology and treatment of constipation during pregnancy
Authors: ANDERSON ANNIE S.
Published: August 2005

Summary. Using a 7‐day weighed‐intake method, dietary factors implicated in the aetiology of constipation were examined by comparison between the nutrient intakes of nine women with constipation in the third trimester of pregnancy who had not altered their diets, and a matched group of nine women who had not suffered constipation at any time during pregnancy. No significant differences were found for intakes of major nutrients, including dietary fibre, between the constipated and non‐constipated groups, indicating that inappropriate diets do not appear to be the primary cause of constipation during pregnancy. The nutrient intakes of 40 women with constipation in the third trimester of pregnancy were examined to assess dietary changes made in attempts to treat constipation. No difference in intakes of dietary fibre were found between those who claimed to have increase their intakes, and those who had not altered their diets. Both were well below the level of dietary fibre intake known to be successful in treating Constipation
Distribution of prostaglandin endoperoxide synthase and prostacyclin synthase in the late pregnant uterus
Authors: MOONEN P. , KLOK G. , KEIRSE M. J. N. C.
Published: August 2005

Summary. Prostacyclin (PGI2) synthase and prostaglandin endoperoxide synthase (cyclo‐oxygenase; PGH synthase) were measured with specific immunoradiometric assays in myometrial microsomes from different areas of a primigravid uterus at 34 weeks gestation. PGH synthase concentrations increased significantly from fundus toward lower segment (P <0·005), but that trend did not apply to PGI2 synthase concentrations, which were significantly higher on the placental than on the non‐placental side of the uterus (P <0·005). PGI2 synthase concentrations showed no further increase with increasing proximity to the placental bed. In myometrium underneath the placental bed there was an inverse relation between the PGH and PGI2 synthase concentrations (r=0·86; P <0·0l) which did not apply to other regions of the uterus. The data suggest that local rather than general mechanisms control uterine PGH and PGI2 synthase concentrations, and that uterine prostaglandin and PGI2 production strongly depend on anatomical relations that have been neglected in previous studies on uterine prostaglandin biosynthesis.
Effect of epidural analgesia on maximum and minimum blood pressures during the first stage of labour in primigravidae with mild/moderate gestational hypertension
Authors: GREENWOOD PETER A. , LILFORD RICHARD J.
Published: August 2005

Summary. One of the arguments used in favour of epidural analgesia for hypertensive patients in labour is its effect on mean arterial blood pressure, although the fetal and maternal risk from hypertension is more closely linked to maximum recorded levels. We have therefore assessed the effect of epidural analgesia on maximum blood pressure. There was no change in the maximum systolic or diastolic blood pressure after epidural analgesia when compared to baseline values or levels in untreated hypertensive controls. We conclude that this form of analgesia should be offered to hypertensive patients purely for its analgesic effect and not as a method for blood pressure control.
Comparative study of meptazinol and pethidine for the relief of pain in labour
Authors: SHEIKH A. , TUNSTALL M. E.
Published: August 2005

Summary. A double‐blind comparison of pethidine and meptazinol in the relief of pain during labour was undertaken in 205 healthy women. The protocol allowed 100 mg of the test drug to be repeated at intervals of 2 h to a maximum of three doses. It was noteworthy that only 29 mothers were given a second dose of narcotic. Every woman receiving one injection of meptazinol complained of moderate to severe pain after 2 h; 97% of those receiving one injection of pethidine were complaining of moderate to severe pain after 2 h. There was no difference between the two drugs with regard to pain relief or in side‐effects both in mother and baby.
Caesarean and post‐partum hysterectomy 1968–1983
Authors: STURDEE D. W. , RUSHTON D. I.
Published: August 2005

Summary. There have been 47 caesarean or post‐partum hysterectomies over a period of 15 years at Birmingham Maternity Hospital, a frequency of 7 per 10 000 deliveries. In 12 patients the procedure was performed electively for a gynaecological or haematological disorder. In the remainder, emergency hysterectomy was necessary as a life saving measure, in most instances to overcome uncontrollable haemorrhage. The commonest cause of uncontrollable bleeding was a morbidly adherent placenta which occurred in 1 per 4348 pregnancies, and was associated with previous uterine surgery particularly if combined with placenta praevia. Such patients require the presence of an experienced obstetrician to make an early decision to operate and perform a technically demanding operation.
Ovulatory disorders and inflammatory adnexal damage: a neglected cause of the failure of fertility microsurgery
Authors: HAMILTON C. J. C. M. , EVERS J. L. H. , HOOGLAND H. J.
Published: August 2005

Summary. Failure of reconstructive tubal surgery is usually attributed to pre‐existing endosalpingeal damage, recurrent adhesion formation or progressive inflammatory disease. We studied ovarian follicle development and ovulation by ultrasound in 25 infertile patients with laparoscopically proven sequelae of pelvic inflammatory disease. Failure of the follicle to rupture was seen in 13, although luteinization occurred. The mean mid‐luteal progesterone concentration in cycles with an unruptured follicle was significantly lower than the concentrations both in ovulatory cycles in the same patients and in a comparison group of 45 normally ovulating women (P <0·01). Microsurgical adhesiolysis did not seem to influence the occurrence of the ovulation disorder.
Doppler ultrasound assessment of cerebral blood flow in the human fetus
Authors: WLADIMIROFF J. W. , TONGE H. M. , STEWART P. A.
Published: August 2005

Summary. A mechanical sector and linear array real‐time scanner combined with a pulsed Doppler system was used for recording the flow velocity waveform in the internal carotid artery, the lower thoracic part of the descending aorta and umbilical artery in the human fetus. A total of 42 fetuses in normal pregnancy and nine growth‐retarded fetuses between 26 and 41 weeks gestation was studied. In normal pregnancy the mean pulsatility index (PI) in the internal carotid artery varied between 1·5 and 1·6, in the descending aorta between 1·7 and 1·8 and in the umbilical artery between 0·7 and 1·3. In the growth‐retarded fetuses the PI was reduced in the internal carotid artery and raised in the descending aorta and umbilical artery, suggesting an increased peripheral vascular resistance in the fetal body and placenta and a compensatory reduction in peripheral vascular resistance in the fetal cerebrum, i.e. a brain‐sparing effect in the presence of fetal hypoxia.
The effect of maternal labetalol on the newborn infant
Authors: MACPHERSON M. , PIPKIN F. BROUGHTON , RUTTER N.
Published: August 2005

Summary. The possibility that placentally‐transferred labetalol might cause sympathetic blockade in the newborn infant was examined by measuring systolic blood pressure, heart and respiratory rates, palmar sweating, blood glucose and the metabolic and vasomotor responses to cold stress. Measurements were made serially over the first 72 h of life in 22 term infants, 11 born to mothers treated with labetalol and 11 carefully matched controls. Infants of mothers treated with labetalol showed a mild transient hypotension which had disappeared within 24 h [mean systolic blood pressure at 2 h, 58·8 (SEM 2·4) mmHg compared with 63‐3 (SEM 3·0) mmHg for controls, P<0·05]. There were no other significant differences between the two groups. It is concluded that labetalol does not cause clinically important sympathetic blockade in the mature newborn infant.
Labetalol does not alter the placental and fetal blood flow or maternal prostanoids in pre‐eclampsia
Authors: JOUPPILA PENTTl , KIRKINEN PERTTI , KOIVULA ANTERO , YLIKORKALA OLAVI
Published: August 2005

Summary. The effect of intravenously administered labetalol (1 mg/kg) on placental and fetal blood flow was studied in 13 pre‐eclamptic women. Although the maternal blood pressure decreased, no changes occurred in the blood flows in the intervillous space, the umbilical vein or the fetal descending aorta, nor did the indices of peripheral vascular resistance in the fetal aorta change, but the placental vascular resistance did decrease. Labetalol had no effect on prostacyclin or thromboxane A2 as measured by urinary 6‐keto‐prostaglandin F1α and serum thromboxane B2 respectively. These findings are clinically relevant since they suggest that labetalol reduces maternal blood pressure without interfering with the placental or fetal blood flow.
Enhanced platelet release reaction related to arterial plasma adrenaline and blood pressure in pre‐eclampsia
Authors: ØIAN PÅL , LANDE KNUT , KJELDSEN SVERRE ERIK , GJESDAL KNUT , AAKESSON INGVAR , EIDE IVAR , MALTAU JAN MARTIN
Published: August 2005

Summary. The platelet release product β‐thromboglobulin (BTG) in venous plasma, and arterial and venous catecholamines were measured in 13 severe pre‐eclamptic and 13 normotensive pregnant women. In the pre‐eclamptic group, BTG was significantly higher and the platelet count significantly lower than in the normotensive pregnant group. In the pre‐eclamptic group, arterial concentrations were significantly higher for adrenaline, noradrenaline and dopamine, whereas in venous plasma only adrenaline and dopamine were higher. Significant positive correlations appeared in the pre‐eclamptic patients between venous BTG and arterial adrenaline (r= 0·82), arterial noradrenaline (r= 0·76) and venous adrenaline (r= 0·55). In the pre‐eclamptic group, BTG also highly correlated with systolic (r= 0·84) and diastolic blood pressure (r= 0·77) and heart rate (r= 0·67). These findings indicate that sympathetic nervous tone, as measured by arterial and venous plasma catecholamines, is a good predictor of in‐vivo blood platelet activation. In pre‐eclampsia, increased sympathetic tone may play a key role in platelet activation and consumption and thus in the activation of the coagulation system.