bluuebunny/crossref_metadata_2025 huggingface dataset:
Memory loss during pregnancy
Authors: Sharp Katharine , Brindle Peter M. , Brown Malcolm W. , Turner Gillian M.
Published: August 2005

Objective
To investigate possible impairment of memory during pregnancy.

Design
The performance of pregnant women in a variety of tests of memory was compared to that of controls.

Setting
The Bristol Maternity Hospital.

Subjects
Forty‐eight volunteer pregnant women attending for routine antenatal checks were compared to 19 nonpregnant controls.

Main outcome measures
Subjectively perceived rating of memory impairment, objective measures of recall, recognition and priming memory.

Results
Pregnant and control groups were given a series of tests of memory at the end of which they were asked to rate their own memory at present compared to some weeks ago (when they were not pregnant). Of the pregnant women 39 out of 48 (81%) rated their current memory as being impaired; only three out of 19 (16%) of the control subjects did so. Objective tests revealed that the pregnant group was significantly impaired in the recall of lists of words, particularly when learning was incidental rather than explicit. The pregnant group was also significantly impaired in two measures of priming memory. No significant deficit was found in recognition. The deficits were found for both primigravid and multigravid women, and were present in all trimesters of pregnancy.

Conclusions
The majority of women believe their memory to be impaired during pregnancy. Objectively, during pregnancy there is significant impairment of memory as tested by recall or by priming, but not by recognition. The pattern of memory loss differs from that of other amnesic conditions. Information imparted to pregnant patients may not be retained as well as might be expected.
Retrospective analysis of platelet numbers and volumes in normal pregnancy and in pre‐eclampsia
Authors: Ahmed Yusuf , van Iddekinge Basil , Paul Carolyn , Sullivan Mark H. F. , Elder Murdoch G.
Published: August 2005

Objective
To determine the distribution of platelet volumes and numbers through pregnancy, and to compare these to changes in platelet volumes and numbers in women with pre‐eclampsia.

Subjects
Four hundred twenty‐eight women with normal pregnancy from whom four or more platelet measurements were available were identified. 74 women with pre‐eclampsia (blood pressure 140/90 mmHg, at least 0.5g protein/24 h urine collection) from whom platelet measurements were available between 27 and 30 weeks of gestation were identified.

Results
Mean platelet volume and platelet number remained constant in normal pregnancies between the first trimester and the end of pregnancy. A persistent increase of 0.8 fl ( 90th centile) in mean platelet volume was found in 14 out of 15 pre‐eclamptic patients between 24 weeks and 38 weeks of gestation and in only 13 of 428 normal pregnant individuals. Platelet numbers were decreased by 50 × 109/l (i.e. to less than the 10th centile) in 12 of the 15 patients with pre‐eclampsia. 10% of the normal pregnant population showed a similar decline in platelet numbers showing that changes in platelet numbers may be a less accurate assessment of the development of pre‐eclampsia.

Conclusion
We suggest that longitudinal determination of platelet volumes may be of use in identifying those women at risk of pre‐eclampsia.
Hypnosis: practical applications and theoretical considerations in normal labour
Authors: Jenkins Mary W. , Pritchard M. H.
Published: August 2005

Objective
To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women.

Design
A semi‐prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy.

Subjects
One hundred twenty‐six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included.

Setting
Aberdare District Maternity Unit, Mid Glamorgan, Wales.

Intervention
Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy.

Outcome measures
Analgesic requirements, duration of first and second stages of labour.

Results
The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group (P<0.0001); the mean lengths of the second stage were 37 min and 50 min, respectively (P<0.001). In the parous women the corresponding values were 5.3 h and 6.2 h (P<0.01); and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P<0.001) in both hypnotised groups compared with their controls.

Conclusion
In addition to demonstrating the benefits of hynotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.
The effect on fetal arteriolar oxygen saturation resulting from giving oxygen to the mother measured by pulse oximetry
Authors: McNamara H. , Johnson N. , Lilford R.
Published: August 2005

Objective
To determine if pulse oximetry could detect any changes in fetal arteriolar oxygen saturation resulting from maternal administration of oxygen.

Design
A prospective study comparing study comparing the fetal pulse oximetry reading before and after giving 27% and 100% oxygen to the mother. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry.

Setting
Labour ward, St. James's University Hospital, Leeds University, UK.

Subjects
Twelve fetuses presenting by the vertex in normal uncomplicated labour.

Main outcome measures
The change in fetal arteriolar oxygen saturation recorded by the pulse oximeter in response to oxygen administration to the mother.

Results
Twenty‐seven percent oxygen increased the average fetal arteriolar oxygen saturation by 7.5%, the effect being reversed when the oxygen was withdrawn. One hundred percent oxygen increased fetal arteriolar oxygen saturation by 11% and when the oxygen was withdrawn oxygen saturation dropped by 10%. One hundred percent inspired maternal oxygen was more effective than 27%. The gradient of the fetal oxygen regression slope is steeper with 100% oxygen than 27% and it is steeper when oxygen is given compared to when it is withdrawn. This suggests that the fetus responds to the new placental oxygen gradient by accepting oxygen more rapidly than it gives it up. Using a quadratic regression model, it took 9 min for fetal oxygen saturation to reach its maximum value after giving the mother oxygen.

Conclusion
This study confirms that a pulse oximeter is able to measure an increase in fetal arteriolar oxygen saturation when oxygen is administered to the mother.
A randomised prospective study comparing the new vacuum extractor policy with forceps delivery
Authors: Johanson R. B. , Rice C. , Doyle M. , Arthur J. , Anyanwu L. , Ibrahim J. , Warwick A. , Redman C. W. E. , O'Brien P. M. S.
Published: August 2005

Objective
To compare assisted vaginal delivery by forceps with delivery by vacuum extractor, where a new vacuum extractor policy was employed which dictated the cup to be used in specific situations.

Design
Multicentre randomised controlled trial.

Setting
Four district general hospitals in the West Midlands.

Subjects
Six hundred‐seven women requiring assisted vaginal delivery, of whom 296 were allocated to vacuum extractor delivery and 311 to forceps.

Main outcome measures
Delivery success rate, maternal perineal and vaginal injuries, maternal anaesthetic requirements, neonatal scalp and facial injuries.

Results
Of the vacuum extractor group, 85% were delivered by the allocated instrument compared to 90% in the forceps group (odds ratio (OR) 0.64; 95% confidence intervals (CI) 0.4–1.04). However, more women in the vacuum extractor group were delivered vaginally (98%) than in the forceps group (96%). There were significantly fewer women with anal sphincter damage or upper vaginal extensions in the vacuum extractor group (11%vs 17%, OR 0.6; 95% CI, 0.38–0.97). There were significantly fewer women in the vacuum extractor group requiring epidural or spinal anaesthetics (25.4%vs 32.7%, OR 0.69; 95% CI 0.49–0.99) or general anaesthetics (1%vs 4%, OR 0.17; 95% CI 0.04–0.76). Although there were significantly more babies in the vacuum extractor group with cephalhaematomata (9%vs 3%, OR 3.3; 95% CI 1.4–7.4) there were fewer babies in the vacuum extractor group with other facial injuries. There were three babies in the forceps group with unexplained neonatal convulsions.

Conclusions
Assisted vaginal delivery using the new vacuum extractor policy is associated with significantly less maternal trauma than with forceps. Further studies are required to assess neonatal morbidity adequately.
Investigation of factors influencing folate status in women who have had a neural tube defect‐affected infant
Authors: Wild J. , Schorah C. J. , Sheldon T. A. , Smithells R. W.
Published: August 2005

Objective
To investigate folate intake and blood levels of vitamins in women with and without a history of neural tube defect (NTD)‐affected infant and to explore the relation between red cell and serum folate in those women.

Subjects
Twenty‐nine women with a history of NTD‐affected infant, who had taken periconceptional vitamin supplements one year or more prior to the study and twenty‐nine controls with no such history.

Main outcome measures
Dietary intake of folate was assessed by questionnaire and blood levels of folate, vitamin B12 and vitamin C were measured.

Results
Neither dietary intake of folate nor any of the blood vitamins measured were lower in the women with a history of NTD infant. The majority of women who had received periconceptional vitamin supplementation subsequently had adequate folate intakes and red blood cell folates greater than 160 ug/l. Smokers had lower plasma Vitamin C levels than nonsmokers. Multiple regression analysis suggested that the relation between red blood cell (RBC) and serum folate may differ between women with and without a history of NTD.

Conclusions
Women with a history of NTD‐affected infants may have different folate metabolism from those who have not.
Maternal nutritional status in pregnancy and blood pressure in childhood
Authors: Godfrey K. M. , Forrester T. , Barker D. J. P. , Jackson A. A. , Landman J. P. , Hall J. St. E. , Cox V. , Osmond C.
Published: August 2005

Objective
To examine the relation between indices of maternal nutrition during pregnancy, including haemoglobin concentration, skinfold thickness and body weight, and the child's blood pressure at 10 to 12 years of age.

Design
Follow up study of children whose mothers had haemoglobin estimations, weights and skinfold thicknesses recorded during pregnancy.

Setting
Kingston, Jamaica.

Subjects
Seventy‐seven children whose mothers took part in a prospective study of nutrition during pregnancy in relation to fetal growth.

Main outcome measure
Blood pressure at 10 to 12 years of age.

Results
The child's mean systolic pressure adjusted for current weight rose by 2.6 mmHg (95 % CI 0.5–4.6, P= 0.01) for each 1 g/dl fall in the mother's lowest haemoglobin during pregnancy. Mothers with a lower haemoglobin had thinner skinfold thicknesses, especially over the triceps (P= 0.005). In multiple regression analyses, taking account of the child's sex and current weight, there was a strong association between thin maternal triceps skinfold thickness at 15 weeks of gestation and raised blood pressure in the offspring. Taking account of the mother's triceps skinfold thickness abolished the relation between lower haemoglobin and raised blood pressure in the child. Lower weight gain between 15 and 35 weeks of gestation was independently associated with raised children's blood pressure. Systolic pressure rose by 10.7 mmHg (95 % CI 5.7 to 15.6, P= 0.0001) for each log mm decrease in the mother's triceps skinfold thickness, and by 0.6 mmHg (95% CI 0.1 to 1.0, P= 0.02) for each 1 kg decrease in the mother's weight gain during pregnancy.

Conclusions
These results parallel animal experiments suggesting that impaired maternal nutrition may underlie the programming of adult hypertension during fetal life.
Endometrial sex steroid receptor expression in women with menorrhagia
Authors: Critchley Hilary O. D. , Abberton Keren M. , Taylor Nancy H. , Healy David L. , Rogers Peter A. W.
Published: August 2005

Objective
To investigate the oestrogen and progesterone receptor distribution in endometrium from reproductive age and perimenopausal women with and without menorrhagia.

Design
A comparative observational study.

Subjects
Forty‐five women with objective menorrhagia (27 categorised as reproductive age and 18 as perimenopausal) and a control group of 44 women (31 reproductive age and 13 perimenopausal) with menstrual blood loss of less than 80 ml per period.

Main outcome measures
Oestrogen receptor and progesterone receptor semi‐quantitative immunostaining scores.

Results
Comparison of control and menorrhagic endometrium in this study (whether from reproductive age or perimenopausal subjects) failed to demonstrate any major differences in either sex steroid receptor mean immunostaining score. The results demonstrated a great degree of variability in sex steroid receptor immunoreactivity between individuals. Irrespective of clinical group, significant increases in immunostaining were demonstrated in the proliferative phase of the cycle for immunoreactivity of oestrogen receptor in glands (P < 0.0005), and stromal (P= 0.002) compartments of endometrium and progesterone receptor immunoreactivity in glands (P= 0.009). Progesterone receptor immunostaining in the stromal compartments did not significantly decline (P= 0.06) in the secretory phase.

Conclusions
Endometrium from women with objective evidence of menorrhagia is indistinguishable in terms of sex steroid immunoreactivity from endometrium of women with normal monthly blood loss. This pattern of sex steroid receptor immunostaining pattern was maintained into the perimenopausal years.
Intramyometrial vasopressin as a haemostatic agent during myomectomy
Authors: Frederick J. , Fletcher H. , Simeon D. , Mullings A. , Hardie M.
Published: August 2005

Objective
To assess the efficacy of intramyometrial vasopressin for minimising bleeding and its sequelae at myomectomy.

Design
A randomised placebo controlled trial.

Setting
University Hospital of the West Indies, Kingston, Jamaica.

Subjects
Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group.

Intervention
Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline).

Main outcome measures
The efficacy of vasopressin was measured by comparing pre‐ and post‐operative haemoglobin levels and haematocrit, changes in intra‐operative pulse and blood pressure, measured blood loss, need for blood transfusion and post‐operative febrile morbidity in the treatment and control groups.

Results
The use of vasopressin resulted in median blood loss of 225 ml (range 150–400 ml) compared with 675 ml (range 500–800 ml) in the placebo group (P < 0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7g/dl vs 5.3 g/dl, P < 0.001) and haematocrit (median 5%vs 13%, P < 0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P= 0.03). There were no significant differences between the groups in intra‐operative pulse and blood pressure or post‐operative white blood cell counts or temperature.

Conclusion
The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy.
Treatment with the gonadotrophin releasing hormone‐agonist goserelin before hysterectomy for uterine fibroids
Authors: Lumsden M. A. , West C. P. , Thomas E. , Coutts J. , Hillier H. , Thomas N. , Baird D. T.
Published: August 2005

Objective
To investigate the effect of the gonadotrophin releasing hormone (GnRH)‐agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata, on the pre‐operative symptoms, difficulty of operation and operative blood loss.

Design
Randomised placebo‐controlled study.

Setting
Patients were recruited from the gynaecological outpatient departments from hospitals in Edinburgh, Glasgow and Newcastle.

Subjects
Seventy‐one premenopausal women with uterine leiomyomata who were on the waiting list for hysterectomy.

Interventions
After the presence of leiomyomata was confirmed using ultrasonography, the women were randomised to receive either the GnRH‐agonist goserelin by monthly subcutaneous injection or a sham injection for three months prior to operation. At the monthly visits, patients were asked about treatment related symptoms, fibroid related symptoms, and their bleeding patterns. Blood was taken for haematological assessment.

Main outcome measures
Haemoglobin concentrations at recruitment, at operation and post‐operatively, pre‐operative symptoms, operative difficulty and blood loss and post‐operative complications.

Results
Treatment with goserelin induced amenorrhoea in over 80% of the women, and this was associated with a significant rise in haemoglobin level. At the time of operation, fibroid related symptoms were less in the goserelin group than in the placebo group. The hysterectomy was technically easier and the median (range) operative blood loss was significantly lower in the goserelin group compared with the placebo group (187 (60–600) ml vs 308 (118–1000) ml respectively; P < 0.05, Wilcoxon signed rank test). There was no difference between the two groups in the duration of hospital stay or the frequency of post‐operative complications. The fibroids were smaller at the time of operation in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision.

Conclusions
This study demonstrates the benefits of goserelin in women having total abdominal hysterectomy for uterine leiomyomata.
Clustering of perinatal markers of birth asphyxia and outcome at age five years
Authors: Yudkin P. L. , Johnson A. , Clover L. M. , Murphy K. W.
Published: August 2005

Objectives
In a cohort of term infants with cerebral depression at delivery, to investigate the association of perinatal signs of birth asphyxia, particularly abnormal fetal heart rate patterns in labour, acidaemia, and serious neonatal encephalopathy, with neurodevelopmental outcome at age five years.

Design
Five year follow up study of a birth cohort.

Setting
Regional maternity hospital.

Subjects
One hundred and eighty‐four singleton infants with a 1 min Apgar score ≤ 3, born at term between January 1984 and September 1985.

Main outcome measures
Neonatal death, cerebral palsy, and scores on a battery of neurodevelopmental tests at age five.

Results
Seven infants had a cluster of perinatal signs suggestive of birth asphyxia; all included serious neonatal encephalopathy. Three of these infants died neonatally, three had spastic quadriparesis with profound developmental delay, and one was unimpaired at the age of five. Among the remaining infants, no association was found between severely abnormal fetal heart rate patterns in labour and scores on neurodevelopmental tests, or between acid–base status at delivery and test scores.

Conclusions
Birth asphyxia, identified by a cluster of abnormal perinatal signs, including serious neonatal encephalopathy, has a poor prognosis. If serious encephalopathy is not present, cerebral depression at birth preceded by abnormal fetal heart rate patterns in labour, or with acid–base derangement, is not predictive of later impairment.
Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence
Authors: Spence‐Jones Clive , Kamm Michael A. , Henry Michael M. , Hudson C. N.
Published: August 2005

Objective
To investigate the aetiological importance of bowel dysfunction in patients with uterovaginal prolapse and urinary stress incontinence.

Design
Observational study using a questionnaire about obstetric history and bowel function, and anorectal physiological studies.

Setting
Physiology unit and gynaecological outpatients departments of two teaching hospitals.

Subjects
Twenty‐three women with uterovaginal prolapse (mean age 57 years), 23 women with urinary stress incontinence (mean age 52 years) and 27 control women (mean age 52 years).

Results
There was no statistically significant difference between the three groups in their parity, age or birthweight of their children. However, straining at stool as a young adult prior to the development of urogynaecological symptoms was significantly more common in women with uterovaginal prolapse (61%vs 4%, P < 0.001) and women with urinary stress incontinence (30%vs 4%, P < 0.05), compared with controls. A bowel frequency of less than twice per week as a young adult was also more common in women with uterovaginal prolapse than in control women (48%vs 8%, P < 0.001). At the time of consultation, 95% of the women with uterovaginal prolapse were constipated, compared with only 11% of control women. Many of these women also needed to digitate to achieve rectal evacuation. Compared with controls, women with uterovaginal prolapse had a prolonged pudendal nerve terminal motor latency (1.9 ms vs 2.2 ms, respectively, P= 0.003). Women with stress incontinence of urine had a normal pudendal nerve latency (2.0 ms). Other tests of anorectal function were normal.

Conclusions
Constipation, in addition to obstetric history, appears to be an important factor in the pathogenesis of uterovaginal prolapse.
Investigation of folate intake and metabolism in women who have had two pregnancies complicated by neural tube defects
Authors: Wild Jennifer , Seller Mary J. , Schorah Christopher J. , Smithells Richard W.
Published: August 2005

Object
To investigate folate intake and blood levels of folic acid and vitamin C in women with and without a history of two NTD‐affected pregnancies and to measure the increase in serum folate following ingestion of orange juice.

Subject
Sixteen women with a history of two NTD‐affected infants and 16 controls with no such history, none of whom were either pregnant or taking vitamin supplements. The orange juice loading test was carried out on eight matched pairs.

Main outcome measures
Dietary intake of folate was assessed by questionnaire and blood levels of folate and vitamin C were measured.

Results
There was no evidence of decreased intake of folate in subjects who had had two NTD‐affected pregnancies. In controls, both serum and red cell folate showed significant correlation with dietary folate, while in subjects there was no such correlation. Subjects also had smaller increases in serum folate following an oral load than controls, although the differences were not significant.

Conclusion
Women who have had two NTD‐affected pregnancies may have defective folate metabolism. Further investigations on short term utilisation of ingested food folates in these women are required.
Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes
Authors: Budeiri D. J. , Li Wan Po A. , Dornan J. C.
Published: August 2005

Objective
To demonstrate similarities and differences between the various instruments used by clinical trialists for measurement of premenstrual syndrome to encourage development of consensus of measurement to aid future research.

Design
Computer and manual searches of all trials of drugs used for premenstrual syndrome supplemented by retrieval of all questionnaires and scales cited. Letters were sent to the main manufacturers to identify trials not in the public domain.

Main outcome measures
Number of scales in current use for classifying premenstrual syndrome; the symptoms included within them; their organisation of symptoms into clusters; the numerical values used in the scaling; the most frequently used items; and the extent of overlap in the criteria used.

Results
Three hundred and fifty clinical trials of 115 different drugs were identified. The most common symptoms or signs used in the scales were (frequency in square brackets) irritability [44], headache or migraine [40], depression [37], tearfulness [34], tension [31], anxiety [31], breast tenderness [31], mood swings or lability [30], back pain [30], weight gain [29], abdominal bloating [28], lack of concentration [28], food craving [28], and increased appetite [26]. Sixty‐five different questionnaires or scales were used to classify premenstrual syndrome and for assessing entry eligibility and treatment outcomes; of these 65, 47 included sufficient details for a formal analysis and 18 scales grouped the symptoms or items into clusters or subgroups.

Conclusion
There is wide diversity in the scales used for assessing entry eligibility and treatment outcomes in premenstrual syndrome. This makes comparative evaluation of possible treatments extremely complex and difficult. It is recommended that authorities and organisations involved in conducting trials of treatments for premenstrual syndrome develop a consensus statement about the best instrument to be used. Regulatory authorities could perhaps provide guidance to which scales they would accept when clinical trials of drugs for premenstrual syndrome are submitted to them for assessment. This would ensure that industry‐sponsored trials provide objective data. Consensus is required given the poor performance of most current treatments of premenstrual syndrome.
Expression of integrin adhesion molecules in endometrium and endometriosis
Authors: Bridges J. E. , Prentice A. , Roche W. , Englefield P. , Thomas E. J.
Published: August 2005

Objective
To compare the expression of cell adhesion molecules by endometrium and endometriosis.

Design
A comparative study of integrin expression, determined immunohistochemically, in eutopic and ectopic endometrium biopsied synchronously from patients with endometriosis diagnosed at laparoscopy or laparotomy.

Setting
University Departments of Obstetrics and Gynaecology, and Pathology, Southampton; Department of Obstetrics and Gynaecology, Newcastle upon Tyne.

Samples
Eighteen paired samples of endometria and endometriosis.

Results
A wide distribution of collagen‐laminin receptor proteins was demonstrated. α1 integrin expression was limited to secretory endometrium. β3 expression was only demonstrated on proliferative endometrium.

Conclusions
Expressions of the integrin proteins differed between the various elements of the endometrium. Cyclical changes in integrin expression also were demonstrated. No difference in cell adhesion molecule expression was seen when comparing endometrial and endometriosis samples.
Antenatal fetal magnetocardiography: a new method for fetal surveillance?
Authors: Quinn Andrew , Weir Andrew , Shahani Uma , Bain Rhoderick , Maas Peter , Donaldson Gordon
Published: August 2005

Objective
To establish the reliability of fetal magnetocardiography as a method of measuring the time intervals of the fetal heart during the antenatal period.

Design
A prospective study.

Setting
Wellcome Biomagnetism Unit, Southern General Hospital.

Subject
One hundred and six low risk pregnant women at 20 to 42 weeks gestation.

Main outcome
measures Success in obtaining QRS complexes, P waves and T waves. Correlation of time intervals with fetal outcome.

Results
The technique was acceptable to pregnant women. A QRS complex was successfully demonstrated in 68 (67%) of the unaveraged traces. Using off‐line averaging techniques on these 68 cases, P waves were obtained in 75% and T waves in 72%. Although good quality traces were obtained throughout the range of gestational ages, in general it was more difficult below 28 weeks. QRS duration (R2= 7%, P= 0.02) demonstrated a positive linear correlation with increasing gestation. Of the 35 (51%) cases with umbilical vein pH analysis available, only one result was less than 7.2. No significant relation was found between measurements of the fetal waveforms and the pH results.

Conclusion
The technique of fetal magnetocardiography provides a significant advance in the technological field for the demonstration of QRS complexes and the full PQRST waveforms in gestations from 20 weeks onwards. With further technical improvements the clinical impact of this technique can be assessed more fully.
Intravenous immunoglobulin in the prevention of recurrent miscarriage
Authors:   The German RSA/IVIG Group
Published: August 2005

Objective
This study was undertaken to verify a specific effect of intravenous immunoglobulin on the outcome of pregnancy in patients with a history of recurrent miscarriage as an alternative to immunotherapy with allogeneic leucocytes.

Study design
In a randomised double‐blind multicentre study 64 patients with a history of unexplained primary recurrent miscarriage were treated with intravenous immunoglobulin (verum) or 5% human albumin (placebo) infusions during their following pregnancy.

Results
Success rates for both verum and placebo, were compared excluding seven patients with explained miscarriage (20/27 (74%) versus 21/30 (70%)) and without any such exclusion (20/33 (61%) versus 21/31 (68%)). The difference between the two groups was not statistically significant.

Conclusions
A specific effect of intravenous immunoglobulin in primary recurrent miscarriage could not be demonstrated. These results imply the possibility of psychological influence, i.e. a placebo effect of intravenous immunoglobulin, on the outcome of pregnancy. Since success rates for both verum and placebo were in the same range as for treatment with allogeneic leucocytes, psychological effects might be responsible also for other kinds of immunotherapy for prevention of recurrent miscarriage. However, it cannot be excluded that success rates only reflect background values as reported for recurrent miscarriage patients without any treatment.
Continuing medical education
Authors: Purdie David W.
Published: August 2005

When you are old and grey and full of sleep And nodding by the fire, take down this book And slowly read…

W. B. Yeats
Persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy
Authors: Chen Ruey‐Jien , Huang Su‐Cheng , Chow Song‐Nan , Hsieh Chang‐Yao , Hsu Hey‐Chi
Published: August 2005

Objective
A 16 year review of persistent gestational trophoblastic tumour when the antecedent pregnancy was a partial hydatidiform mole.

Design
Cases of persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy were reviewed for the period 1976 to 1992. DNA ploidy was analysed by flow cytometry.

Setting
A University Hospital which is a reference centre for gestational trophoblastic tumour.

Subjects
The case notes of 207 women with persistent gestational trophoblastic tumour were reviewed.

Main outcome measures
A rise (or failure to fall) of βhCG titre, or sign of metastasis.

Results
Six (2.9 %) women had partial hydatidiform mole as the antecedent pregnancy and all were initially judged to be low risk. However, two developed pulmonary metastasis; one woman developed persistent gestational trophoblastic tumour shortly after a hysterotomy, and none developed choriocarcinoma. The geometric mean of serum βhCG concentrations at the initiation of chemotherapy was 868mIU/ml (95% CI 114–1524). Of the six women, one achieved remission after total abdominal hysterectomy, and five after chemotherapy. The mean interval from starting treatment to remission was 68 days (95% CI 27.9–108.0). The initial PhCG titre and interval were not statistically different from those found in cases of persistent gestational trophoblastic tumour when the antecedent pregnancy was not partial hydatidiform mole. Of the six, the DNA content was triploid in three and diploid in two. One of the two diploid cases required multiple courses of chemotherapy to achieve remission.

Conclusion
Partial hydatidiform mole can have malignant sequelae and can develop very soon after treatment. Its DNA content can be either diploid or triploid, the lungs being the most common site of metastasis. After evacuation of partial hydatidiform mole, immediate chest X‐ray and regular follow up of the serum βhCG level is necessary.
The value of an absorbable adhesion barrier, Interceed®, in the prevention of adhesion reformation following microsurgical adhesiolysis
Authors: Li T. C. , Cooke I. D.
Published: August 2005

Objective
To determine whether Interceed®, an absorbable adhesion barrier, confers any additional benefit over conventional microsurgery, including the use of an adjuvant (hydrocortisone), in the prevention of adhesion reformation after pelvic microsurgery.

Design
A prospective, randomised, controlled study.

Setting
Jessop Hospital for Women, Sheffield, UK.

Subjects
Twenty‐eight women who underwent pelvic microsurgery for infertility or for chronic pelvic pain and who had bilateral pelvic adhesions and deperitonealised areas following adhesiolysis.

Interventions
Following microsurgical adhesiolysis, one side of the pelvis was randomised to have its deperitonealised areas covered with Interceed, whereas the contralateral side served as the control. A second look laparoscopy was carried out 3 to 14 weeks after microsurgery to evaluate adhesion reformation.

Main outcome measure
The amount of adhesion reformation at second look laparoscopy compared with the amount of deperitonealised area exposed following microsurgical adhesiolysis.

Results
The use of Interceed resulted in a significant reduction of adhesion reformation over and above that achieved by conventional microsurgical techniques with hydrocortisone as an adjuvant.

Conclusion
Interceed, an absorbable adhesion barrier, is of value in the prevention of adhesion reformation and may be used in conjunction with hydrocortisone instilled intraperitoneally at the conclusion of microsurgery.
A comparative study of the fetal electrocardiogram recorded by the STAN and Nottingham systems
Authors: Skillern Laurence , Cockburn Jayne , Benjamin Mark , Malcolm Pearce J. , Sahota Daljit , Reed Nick , Mohajer Mich , James David , Symonds Malcolm
Published: August 2005

Objective
To compare the T:QRS ratio recorded by the STAN and Nottingham fetal electrocardiogram (FECG) monitors.

Design
Prospective observational study.

Setting
London teaching hospital delivery suite and research unit.

Methods and subjects
The T:QRS ratios generated by the STAN and Nottingham FECG monitors were simultaneously recorded and compared using signals generated from a computer‐produced ECG signal and signals from 11 term fetuses recorded during labour.

Results
There was an acceptable level of agreement between the two systems with the computer‐generated signals, but it was not clinically acceptable with the signals from the fetuses recorded during labour. Disagreements in the T:QRS values were probably due to differences in the reference points for the measurement of the S‐T segment and T‐wave height.

Conclusion
The different points of reference for measurement of S‐T segment and T‐wave height can explain poor agreement between the two methods of FECG waveform analysis. The suggested adopted points of reference are those corresponding to adult electrocardiographic methodology.
The treatment of stage I carcinoma of the cervix in the west of Scotland 1980–1987
Authors: Bissett D. , Lamont D. W. , Nwabineli N. J. , Brodie M. M. , Symonds R. P.
Published: August 2005

Objective
To examine the results of different treatments for Stage IA and IB carcinoma of the cervix in patients treated in the West of Scotland between 1980 and 1987.

Design
A retrospective review of case records.

Setting
The Beatson Oncology Centre, Western Infirmary and Bclvidere Hospital, Glasgow, and the departments of gynaecology of hospitals in the west of Scotland.

Subjects
One hundred and five patients with Stage IA and 420 patients with Stage IB carcinoma of the cervix.

Results
A variety of treatments were used for women with Stage IA disease, with an overall actuarial five year survival of 100%. The overall actuarial five year survival for women with Stage IB disease was 79.5%. Patients with Stage IB disease treated by radical hysterectomy (n= 123) or radical radiotherapy (n= 229) had similar five year survival rates (86.3% and 79.5%, respectively), whereas patients treated initially by nonradical surgery (n= 68) had a significantly worse five year survival (68.1%; P= 0.008).

Conclusions
These results emphasise the need for adequate and appropriate surgery and the centralisation of treatment for early cervical cancer.
The effect of maternal posture on fetal cerebral oxygenation during labour
Authors: Aldrich C. J. , D'Antona D. , Spencer J. A. D. , Wyatt J. S. , Peebles D. M. , Delpy D. T. , Reynolds E. O. R.
Published: August 2005

Objective To measure the effect of changes in maternal posture on fetal cerebral oxygenation during normal labour.

Design A prospective study comparing changes in the fetal cerebral concentrations of oxy‐haemoglobin, deoxyhaemoglobin and cerebral blood volume, measured by near infrared spectroscopy, in women with effective epidural analgesia when moved from the left lateral to the supine position during labour.

Setting A London teaching hospital obstetric unit.

Subjects Fourteen women during uncomplicated labour at term.

Results When compared with the left lateral position, the supine position was associated with a significant decrease in the mean concentration of fetal cerebral oxyhaemoglobin of 1.12 (SD 1.0, 95% CI 0.49 to 1.75) μmol. 100 g−1(P < 0.01) without any significant change in the mean concentration of deoxyhaemoglobin and cerebral blood volume. These changes were associated with a significant decrease in the mean cerebral oxygen saturation of 8.3 (SD 8.8, 95% CI 1.5 to 15.1)% (P < 0.05, n= 9).

Conclusion Changes in maternal posture during labour, in women with effective epidural analgesia, are associated with a significant decrease in fetal cerebral oxygenation.
Measurement of fetal liver, brain and placental volumes with echo–planar magnetic resonance imaging
Authors: Baker Philip N. , Johnson Ian R. , Gowland Penny A. , Hykin Jonathan , Adams Valerie , Mansfield Peter , Worthington B. S.
Published: August 2005

Objective To quantify accurately in utero fetal liver, brain and placental volumes using echo planar imaging, and to assess whether the technique has the potential to enhance intrauterine fetal assessment.

Design Thirty‐two singleton, complicated pregnancies were scanned using echo planar imaging, a form of magnetic resonance imaging. Pregnancies were subdivided on the basis of whether the fetus was found subsequently to have an individualised birthweight ratio above (n= 21) or below (n= 11) the 10th centile. Comparisons of the organ volumes of these two groups were made.

Results The first quantitative in utero measurement of fetal liver volume showed a linear relation between liver volume and gestational age in fetuses where the individualised birthweight ratio was above the 10th centile (the normal growth group). Ten of the 11 liver volume measurements of fetuses subsequently found to have an individualised birthweight ratio below the 10th centile fell on or outside the 95% confidence limits established for the normal growth group. In contrast, no such differences were demonstrated when the brain and placental volumes were considered, with 10 of the 11 brain measurements and all of the 11 placental measurements falling within the 95% confidence limits of the normal growth group.

Conclusions A single measurement of fetal liver volume using echo planar imaging enabled accurate identification of fetuses subsequently found to have individualised birthweight ratios below the 10th centile. If these findings are repeated in larger, more representative studies, this suggests that the technique has the potential to contribute to intrauterine fetal assessment.
Standing at work and preterm delivery
Authors: Henriksen Tine Brink , Hedegaard Morten , Secher Niels Jørgen , Wilcox Allen J.
Published: August 2005

Objective Guidelines in some European countries and the United States suggest that pregnant women should avoid prolonged standing and heavy lifting in the workplace during the second and third trimester of pregnancy. However, results from epidemiological studies on this topic are ambiguous. The aim of this study was to evaluate the influence of standing and walking at work in the second trimester on preterm delivery in a population with a low frequency of other workplace hazards.

Subjects and design A prospective cohort of 8711 women with singleton pregnancies was established during 1989 through 1991. Information was collected during the 16th week of pregnancy about medical and obstetrical history, general lifestyle factors and exposures at work. The analyses were restricted to 4259 respondents who worked at the 16th week. Potential confounders and effect modifiers were evaluated by stratification and multivariate analyses.

Results After adjustment for confounders, women standing more than five hours per work day had an odds ratio (OR) for preterm delivery of 1.2 (95% CI 0.6 to 2.4) compared with women standing two hours or less. For walking, the OR was 1.4 (95% CI 0.7 to 2.5). Many women were unable to separate periods of standing from periods of walking; a combined measure of these two exposures was created to reflect exposure intensity. Women who reported more than five hours of both standing and walking had an adjusted OR of 3.3 (95% CI 1.4 to 8.0) compared with women who reported two hours or less on either of the exposures. No adverse effects were seen for lifting or other types of physical exertion.

Conclusions Our findings suggest that standing and walking at work during the second trimester may present a particular risk for preterm delivery, and workplace guidelines are justified. Further research is needed to address the specific mechanisms by which physical exertion, including standing and walking, might cause preterm delivery.
A Scottish audit of hysteroscopic surgery for menorrhagia: complications and follow up
Authors:   Scottish Hysteroscopy Audit Group
Published: August 2005

Objective To evaluate the efficacy and safety of hysteroscopic surgery undertaken by a cross section of gynaecologists.

Design A prospective registration of cases of hysteroscopic surgery by gynaecologists. Patient satisfaction was assessed at six and twelve months post‐operatively by postal questionnaire.

Setting Thirteen hospitals in seven Scottish Health Boards. Secretariat in Aberdeen Royal Infirmary.

Subjects Women having hysteroscopic surgery for menstrual problems.

Interventions A few questions were added to the proforma during the audit.

Results Between December 1991 and December 1993, 978 cases were registered. Consultants performed the majority of procedures. Complications occurred in 12% of cases and included one death from toxic shock syndrome. Uterine perforation and significant fluid overload occurred in 1 % of cases. To date, 732 women have been followed up at six months, 554 at twelve months and 80 at 24 months. Eighty‐four percent of those returning their questionnaires were satisfied or very satisfied at twelve months. By twelve months, repeat procedures had been performed in 13% and hysterectomy in 11%. Sixty‐six percent of women with a paid job had returned to work within two weeks and 88% within four weeks.

Conclusions Overall, hysteroscopic surgery had a low rate of morbidity and satisfactory efficacy with rapid post‐operative recovery. Gynaecologists who have shown caution with the advent of this surgery can now be encouraged to take up endometrial ablation for dysfunctional uterine bleeding. Clinical guidelines are currently being prepared.
Scalp blood lactate: a new test strip method for monitoring fetal wellbeing in labour
Authors: Nordström Lennart , Ingemarsson Ingemar , Kublickas Marius , Persson Bengt , Shimojo Nobuo , Westgren Magnus
Published: August 2005

Objective
To determine fetal scalp blood lactate with a new test strip method in parturients with normal and abnormal cardiotocograms during labour and to describe the relation to maternal lactate, fetal scalp blood pH, cord artery lactate and acid‐base balance.

Setting
Labour wards at the University Hospitals of Huddinge and Lund and at the County Hospital of Östersund, Sweden.

Materials and method
Fetal scalp blood was sampled for lactate (n= 269) and pH (n= 285) determination in 177 parturients with abnormal intrapartum CTG. Lactate and pH were also analysed in a group of 64 women with normal pregnancies and with a reactive fetal heart rate tracing prior to sampling of fetal scalp blood. At fetal blood sampling lactate was also determined in maternal capillary blood, while at birth lactate and acid‐base balance in cord artery blood was performed in almost all cases.

Main outcome measurements
Medians and percentiles (lactate and acid‐base balance). Correlation between fetal scalp blood lactate (dependent) and scalp blood pH, cord artery blood lactate and acid‐base parameters and labour time prior to fetal blood sampling.

Results
In the group with abnormal cardiotocograms, fetal scalp and umbilical artery blood lactate and acid‐base parameters differed significantly from the same parameters in the normal group. The fetal‐maternal lactate gradient changed from negative in the normal group to positive in the fetal distress group. Multiple regression analysis, with scalp lactate as the dependent parameter, revealed a significant correlation with fetal scalp blood pH (P < 0.001) and umbilical artery lactate (P < 0.01).

Conclusions
Intrapartum scalp blood lactate was significantly correlated with pH and cord artery lactate. The results indicate that increased lactate levels in fetal blood sampling describes fetal lactacidosis. The new disposable test strip requiring only 5 μl of blood for lactate determination may be better than traditional methods for monitoring fetal wellbeing in labour.
A randomised double blind comparison of Syntometrine® and Syntocinon® in the management of the third stage of labour
Authors: Yuen Pong Mo , Chan Norman S. T. , Yim So Fan , Chang Allan M. Z.
Published: August 2005

Objective
To compare the effect of intramuscular Syntometrine and Syntocinon in the management of the third stage of labour.

Design
A randomised double blind prospective study.

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

Subjects
One thousand consecutive patients with singleton pregnancy and vaginal delivery in February and March 1993.

Results
The use of Syntometrine in the management of the third stage not only reduced the blood loss after delivery but was associated with a 40% reduction in the risk of postpartum haemorrhage (odds ratio 0.60; 95% CI 0.21–0.88), and the need for repeat oxytocic injections (odds ratio of 0.63; 95% CI 0.44–089). The two drugs did not differ in their effect on the duration of the third stage. However, the incidence of manual removal of the placenta was higher when Syntometrine was used (odds ratio 3.7; 95% CI 1.03–123), although the overall incidence remained low. Side effects from both drugs, such as nausea, vomiting, headache and hypertension, were uncommon.

Conclusion
Intramuscular Syntometrine is a better choice than Syntocinon in the management of the third stage of labour.