bluuebunny/crossref_metadata_2025 huggingface dataset:
Infection with Chlamydia trachomatis and Neisseria gonorrhoeae in women with lower abdominal pain admitted to a gynaecology unit
Authors: SCOTT G. R. , THOMPSON C. , SMITH I. W. , YOUNG H.
Published: August 2005

Summary. One hundred and sixty‐five women admitted to a gynaecology unit with lower abdominal pain were screened for infection with Neisseria gonorrhoeae and Chlamydia trachomatis by members of a department of genitourinary medicine. C. trachomatis alone was detected in 21 patients. N. gonorrhoeae alone was isolated from five patients, and dual infection was present in six patients, giving a total of 32 (19%) patients in whom a sexually transmitted disease (STD) was diagnosed. The combination of an endocervical swab placed in Amies transport medium for gonococcal isolation and an endocervical slide for immunofluorescent detection of chlamydiae proved to be a simple and accurate method of screening for STD. Asaresultof contact tracing, 16 sexual partners of women in whom STD was detected were examined. Three cases of gonocoecal and ninc cases of non‐gonococcal urethritis were diagnosed. None of the sexual partners had Symptoms suggestive of genitourinary infection.
A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion
Authors: FARQUHAR C. M. , ROGERS V. , FRANKS S. , BEARD R. W. , WADSWORTH J. , PEARCE S.
Published: August 2005

The value of medroxyprogesterone acetate (MPA) and of psychotherapy in the treatment of lower abdominal pain due to pelvic congestion was assessed in a randomized controlled trial. Eighty‐four women with abnormal pelvic venography were assigned to one of four treatment groups: MPA alone, MPA plus psychotherapy, placebo alone, and placebo plus psychotherapy. Women were treated for 4 months and thereafter followed up regularly for 9 months with pain assessments, pelvic ultrasound scanning, and hormone measurements. During treatment, MPA showed a significant benefit in terms of a reduction in visual analogue scale pain score, with 73% of women reporting at least 50% improvement compared with 33% of those treated with placebo. At 9 months after the end of therapy there was no overall significant effect of MPA or psychotherapy, but there was an interaction between MPA and psychotherapy, with 71 % of the women in this group showing a ≥50% reduction in pain score. Therapy with MPA is a useful first‐line therapy for women with pain associated with demonstrable pelvic congestion.
A comparison of three methods of assessing inter‐observer variation applied to ultrasonic fetal measurement in the third trimester
Authors: SARMANDAL PURNIMA , BAILEY SUSAN M. , GRANT JOHN M.
Published: August 2005

The inter‐observer variation of fetal biparietal diameter, head circumference, abdominal circumference, and femoral length measured in the third trimester by ultrasound was studied by three different methods—coefficient of variation, correlation coefficient, and the 95% limits of agreement. The coefficients of variation were 1·6 to 3·7%, the correlation coefficients were 0·89 to 0·98 with P values of <0·001, yet the limits of agreement when applied to centile charts were found to be too wide to separate reliably small fetuses from those that were not small. We conclude that the limits of agreement is the preferred method of assessing inter‐observer variation, and we suggest that future research into growth retardation move away from ultrasonic measurements of the fetus.
The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials
Authors: GRANT ADRIAN
Published: August 2005

A systematic review of the 14 relevant controlled trials was conducted because there is no agreement about the choice of material and technique for repair of perineal trauma sustained during childbirth. Derivatives of polyglycolic acid (marketed as Dexon and Vicryl) appear to be the absorbable material of choice for both deep and skin closure. Compared with catgut their use is associated with about a 40% reduction in short‐term pain and need for analgesia. The main drawback is that some material often needs removal during the puerperium. Glycerol‐impregnated catgut is ruled out because of its link with longterm dyspareunia. Compared with the non‐absorbable materials (silk and nylon) polyglycolic acid skin sutures were associated with less shortterm perineal pain, and had no clear disadvantages. Continuous, subcuticular stitching appears preferable to interrupted, transcutaneous suturing, particularly in terms of perineal pain in the early puerperium.
Are leukotrienes involved in human uterine contractility?
Authors: BERNAL A. LÓPEZ , SOLER R. CAÑETE , TURNBULL A. C.
Published: August 2005

Summary. The effects of leukotrienes (LT) on the contractility of human and rat myometrial strips in vitro were compared with the effects of prostaglandins (PGs) and oxytocin. Preparations of human myometrial membranes were investigated for the presence and characteristics of LTC4 receptors. Neither the peptido‐leukotrienes (LTC4, LTD4, LTE4) nor LTB4 had any consistent effect, stimulatory or inhibitory, on human pregnant or non‐pregnant myometrium, at doses up to 1·25 μM; nor did they have any effect in rat non‐pregnant myometrium. As expected, PGE2, PGF2α (0·3 μM) and oxytocin (5 nM) stimulated human pregnant myometrium. PGF2α stimulated and PGE2 inhibited human non‐pregnant myometrium but oxytocin had no effect; all three compounds stimulated rat non‐pregnant myometrium. The binding of 3H‐LTC4 to human myometrium was specific (LTC4> LTD4 >>> LTE4, LTB4, PGE2, PGF2α, arachidonic acid) but of low affinity compared with the binding of 3H‐PGE2 to the same membrane preparations. These data support the view that leukotrienes have little direct influence on myometrial contractility.
Midwifery in the Netherlands. The Wormerveer study; selection, mode of delivery, perinatal mortality and infant morbidity
Authors: VAN ALTEN D. , ESKES M. , TREFFERS P. E
Published: August 2005

Summary. Between 1969 and 1983 a group of 7980 pregnant women, booked consecutively at a practice of freestanding midwives in Wormerveer, the Netherlands, was studied. They gave birth to 8055 children. Perinatal mortality in the total group was low (11–1 per 1000) compared with national figures of 14–5 per 1000 betweén 1969 and 1983. The highest mortality (51–7 per 1000) was found in the group of 1430 infants born after maternal referral during pregnancy to a specialist obstetrician. The perinatal mortality in the group selected during pregnancy as low‐risk cases was very low (2.3 per 1000). The caesarean section rate in the total group was 1.4% and 0.4% in the selected low‐risk group. Of the 5985 infants born alive under sole care of a midwife, 3.8% were admitted to hospital. Emergency admission because of birth asphyxia occurred in 0.4%. Convulsions within 48 h of birth at term occurred in seven (0.9 per 1000) in the total group and in five infants born in the selected group (0.8 per 1000). Selection of pregnant women into groups with high and with low risk is possible with the relatively modest means available to the midwife.
Cytogenetic findings in 1250 chorionic villus samples obtained in the first trimester with clinical follow‐up of the first 1000 pregnancies
Authors: LESCHOT N. J. , WOLF H. , VAN PROOIJEN‐KNEGT A. C. , VAN ASPEREN C. J. , VERJAAL M. , SCHURING‐BLOM G. H. , BOER K. , KANHAI H. H. H. , CHRISTIAENS G. C. M. L.
Published: August 2005

Summary. First‐trimester chorionic villus sampling (CVS) was performed in a series of 1250 pregnancies. The direct method of karyotyping was successful in 1205 (96.4%). Abnormal laboratory findings resulted in 60 terminations of pregnancy (4.8%). In addition, six unexpected balanced chromosome rearrangements were detected. False‐positive cytogenetic findings occurred in 2.3%, comprising 22 with mosaicism confined to the trophoblast, and a further six non‐mosaic false‐positive discrepancies were detected, four after termination of pregnancy. The outcome of the first 1000 pregnancies is known in all but one. There were no false‐negative findings. Of 947 pregnancies meant to be continued, 34 (3.6%) ended in pregnancy loss before 28 weeks gestation. However, obstetricians with an experience of over 150 procedures had a pregnancy loss of 1.3%.
Are fixed‐dose oestrogen/progestogen combinations ideal for all HRT users?
Authors: FRASER D. , WHITEHEAD M. I. , ENDACOTT J. , MORTON J. , RYDER T. A. , PRYSE‐DAVIES J.
Published: August 2005

Summary. Although progestogens protect the endometrium against excessive oestrogen‐induced stimulation, they can cause adverse symptomatic and psychological effects and may have undesirable metabolic consequences. Thus, the minimum progestogen dose which results in consistent endometrial transformation should be prescribed. To define this dose for norethisterone and dl‐norgestrel, 197 endometrial samples obtained from postmenopausal women receiving conjugated equine oestrogens (0·625 mg or 1·25 mg daily) with one of six doses of norethisterone (or the acetate), or one of three doses of dl‐norgestrel added for the first 12 days of each calendar month were examined with the light microscope; 109 samples were also assessed by transmission electron microscopy. There was an inverse relation between the percentage of samples showing proliferative features and the progestogen dose. However, proliferative endometrium was observed in 6% of samples with the highest dose of dl‐norgestrel (500 μg) and in 3% of samples with 2·5 mg norethisterone. Conversely, complete secretory transformation was observed in 25% of samples with the lowest dose of norethisterone (0·1 mg) and in 40% of samples with 75 μg dl‐norgestrel. Mild atypical hyperplasia was diagnosed in four samples. There was a wide inter‐patient variation in response and none of the nine progestogen dose regimens induced secretory change in every patient.
Comparison between mefenamic acid and danazol in the treatment of established menorrhagia
Authors: DOCKERAY C. J. , SHEPPARD B. L. , BONNAR J.
Published: August 2005

Summary. Forty women with established menorrhagia were treated with either mefenamic acid (500 mg thrice daily for 3–5 days in two cycles) or danazol (100 mg twice daily for 60 days) in an open parallel group randomized study. Mefenamic acid reduced mean menstrual blood loss from 160ml to 127ml (20%, P<0·01). Danazol reduced mean menstrual loss from 163 ml to 65 ml (60%, P<0·001). The percentage reduction in menstrual blood loss was significantly greater in the danazol group than in the mefenamic acid group, but the adverse sideeffects occurred significantly more often in the danazol group (75%) than in the mefenamic acid group (30%, P<0–005). Overall, approximately half the women in each group were prepared to continue with the treatment they received to reduce their menstrual bleeding.
Growth hormone 24‐h serum profiles during pregnancy—lack of pulsatility for the secretion of the placental variant
Authors: ERIKSSON LEIF , FRANKENNE FRANCIS , EDEN STAFFAN , HENNEN GEORGE , VON SCHOULTZ BO
Published: August 2005

Summary. Serum profiles of growth hormone (GW) were recorded for 24 h in women at different stages of normal pregnancy. Two monoclonal antibodies directcd against different epitopes and unaffected by human placental lactogen were used in radioimmunoassays to distinguish the pituitary 22K‐GH from the placental GH variant. The ‘normal’ episodic peak activity of GH in non‐pregnant and first trimester pregnant women was dramatically changed into a continuous very stable secretion during late pregnancy. This change was first observed at 17 weeks gestation. It is concluded that during the second half of pregnancy, serum measurements of GH reflect a major contribution from a non‐cpisodically secreted placental GH variant and a concomitant suppression of pituitary GH. This specific signal, i.e. a continuous GH secretion, may be an important regulator of maternal liver metabolism during pregnancy.
Pretreatment with mifepristone (RU 486) reduces interval between prostaglandin administration and expulsion in second trimester abortion
Authors: RODGER MARY W. , BAIRD DAVID T.
Published: August 2005

Summary. The effect of pretreatment with mifepristone on prostaglandin‐induced abortion was investigated in a double‐blind randomized trial involving 100 women in the second trimester of pregnancy. The women were randomly allocated to receive either 600 mg oral mifepristone or placebo tablets 36 h before the administration of gemeprost pessaries. The median interval between administration of prostaglandin and abortion was significantly shorter in the mifepristone group (6.8 h) compared with the placebo group (15.8 h). The women pretreated with mifepristone required significantly fewer gemeprost pessaries to induce abortion and experienced significantly less pain than the women who had received placebo.
Novel screening strategies for early ovarian cancer by transabdominal ultrasonography
Authors: CAMPBELL S. , ROYSTON P. , BHAN V. , WHITEHEAD M. I. , COLLINS W. P.
Published: August 2005

Summary. Data collected during a prospective study to assess the efficacy of detecting early ovarian cancer by transabdominal ultrasonography have been used to refine and extend the screening procedure. The analysis was based on results from 5479 self‐referred asymptomatic women, who were scheduled to undergo three annual screens consisting of one or more ultrasound scans. A positive result (based mainly on the presence of abnormal morphology) was obtained at 338 screens (326 women). Five patients with primary ovarian cancer (four stage la, one stage 1b; two at screen 1, three at screen 2) were identified (prevalence 0.09%). The apparent detection rate was 100% and the false‐positive rate (FPR) was 3.5% at screen 1 and 2.3% overall. The use of abnormal morphology, or the maximum ovarian volume (MOV) >96th centile as alternative criteria for a positive screen result, together with a defined volume change at rescan (VC) would give a FPR of 3.1% at screen 1 and 2.0% overall. The use of abnormal morphology alone at scan 1 and VC at rescan would give an overall FPR of 1.6%. The odds that a positive screen result would indicate the presence of an ovarian mass, a benign tumour, any ovarian cancer or primary ovarian cancer would be about 4 to 1, 2 to 1, 1 to 26, and 1 to 50 respectively. The results provide a more rational basis for the application and development of screening procedures for early ovarian cancer in both pre and postmenopausal women.
Late symptoms after pregnancy‐related deep vein thrombosis
Authors: BERGQVIST AGNETA , BERGQVIST DAVID , LINDHAGEN ANDERS , MÄTZSCH THOMAS
Published: August 2005

Summary. Thromboembolism during pregnancy is a rare complication with a potential fatal outcome. Very little is known about long‐term effects and therefore 104 women with thrombosis during pregnancy or puerperium were identified and their subjective complaints were assessed in a questionnaire. All had their thrombosis diagnosed by objective methods and the median follow‐up time was 11 years. In spite of anticoagulant treatment only 22% were without complaints; 4% had ulceration, all occurring in the group with thrombosis during pregnancy. Significantly more women who had had their thrombosis during pregnancy used compression bandages than those who had their thrombosis during puerperium. The severity of the symptoms increased with the increasing number of thromboses. Anticoagulant therapy of the acute episode does not appear to alter the degree of long‐term handicap in the lower limbs.
Uterine artery Doppler in the investigatioin of pregnancies with raised maternal serum alphafetoprotein
Authors: ARISTIDOU APHRODITE , VAN DEN HOF MICHAEL C. , CAMPBELL STUART , NICOLAIDES KYPROS
Published: August 2005

Summary. Uterine artery flow velocity waveforms (FVW) were obtained prospectively by continuous wave Doppler at 18–22 weeks gestation from 98 women with an unexplained elevation in maternal serum alpha‐fetoprotein (MSAFP). A notch in either the left or right uterine artery FVW was present in 18 pregnancies of which seven resulted in perinatal death and six in the birth of very immature and/or severely growth retarded babies. Conversely, in 66 of 80 pregnancies the absence of a notch was associated with the livebirth of an infant beyond 32 weeks gestation, with a birthweight above the 5th centile. It is suggested that the presence of a notch in the uterine artery FVW is a good predictor of poor perinatal outcome.
Idiopathic thrombocytopenic purpura in pregnancy: A randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count
Authors: Christiaens G. C. M. L. , NIEUWENHUIS H. K. , VON DEM BORNE A. E. G. Kr. , OUWEHAND W. H. , HELMERHORST F. M. , VAN DALEN C. M. , VAN DER TWEEL I.
Published: August 2005

Objective–To determine the efficacy of antenatal low dose oral betamethasone in preventing neonatal thrombocytopenia and/or bleeding in infants of mothers with idiopathic thrombocytopenic purpura (ITP).

Setting–Hospital department of obstetrics and gynaecology, referral centre.

Patients–41 pregnancies in 38 women were randomized. The results of 13 pregnancies were considered non‐assessable. The final analysis involved 14 in the betamethasone group and 14 in the non‐treatment group. All fulfilled the criteria for ITP.

Interventions–The treated group received 1.5 mg betamethasone orally per day, from day 259 till day 273 and 1 mg from day 273 till delivery.

Main outcome measures–Effects of treatment were assessed in terms of maternal platelet counts after the first trimester and neonatal platelet counts at birth and the first week of life and neonatal bleeding episodes.

Results–There were no significant differences in neonatal platelet counts at birth. Two infants in the belamethasone group and one in the untreated group had a severe thrombocytopenia either at birth or during the first week of life (<50 × 109/1). Seven infants in the betamethasone group and six in the nontreatment group had a mild thrombocytopenia. The overall frequency of neonatal thrombocytopenia was similar: 64% in the betamethasone group and 57% in the untreated group (95% CI of the true difference: –43.5% to +29.5%). There was also no significant difference in neonatal bleeding episodes. Conclusions–Low‐dose betamethasone in pregnant women with TTP does not prevent thrombocytopenia or bleeding in their newborn infants.
Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies
Authors: TYRRELL S. N. , LILFORD R. J. , MACDONALD H. N. , NELSON E. J. , PORTER J. , GUPTA J. K.
Published: August 2005

Objective–To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy.

Design–A pragmatic randomized trial.

Setting–St James's University Hospital, Leeds.

Subjects–500 pregnant women at high risk of intrauterine growth retardation or still birth.

Interventions–Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians.

Main outcome measures–Gestational age al delivery, obstetric intervention rates and short‐term neonatal morbidity.

Results–Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end‐diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end‐diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5‐min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group.

Conclusions–The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end‐diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.
Endometrial, physical and psychological effects of postmenopausal oestrogen therapy with added dydrogesterone
Authors: SIDDLE N. C. , FRASER D. , WHITEHEAD M. I. , JESINGER D. K. , ENDACOTT J. , PRESCOTT P. , PRYSE‐DAVIES J.
Published: August 2005

Summary. Sixteen postmenopausal women receiving conjugated equine oestrogens 1.25 mg/day. continuously, were randomly allocated to add dydrogesterone 20 mg/day for 12 days each calendar month for 3 months and then 10 mg/day in an identical fashion for a further 3 months, or to receive the dydrogesterone doses in reverse sequence. The effects of the two dydrogesterone doses on endometrial histology, vaginal bleeding, and the symptomatic and psychological status were compared. Endometrial samples were obtained around day 10 of progestogen addition. Dydrogesterone, 20 mg, induced uniform, late secretory transformation in all samples; with 10 mg one sample showed mixed early and late secretory features and another demonstrated late secretory changes associated with atypical hyperplasia. Both dydrogesterone doses induced an acceptable withdrawal bleed; most bleeding episodes were ‘spotting’ or normal in amount, and heavy bleeding was reported infrequently. There was one episode of breakthrough bleeding. There were no differences in bleeding patterns between the two dose regimens. Anxiety, and the physical and psychological status were significantly improved after 3 months of therapy. Significant benefits on depression were observed less clearly. There were no differences between the two dydrogesterone doses on anxiety, depression and the physical and psychological status, and, overall, the addition of the progestogen did not antagonize oestrogen benefits.
Determinants of fetal and maternal atrial natriuretic peptide concentrations at delivery in man
Authors: VOTO LILIAN A S. , HETMANSKI DAVID J. , PIPKIN FIONA BROUGHTON
Published: August 2005

Summary. Matched maternal venous (MV), umbilical artery (UA) and umbilical vein (UV) concentrations of atrial natriuretic peptide [ANP] were measured in 36 normotensive women at term delivery (23 vaginal, 13 caesarean) and 17 non‐pregnant women in the first half of the menstrual cycle. MV [ANP] at caesarean section was similar to that in nonpregnant women, but UA and UV [ANP] were higher (P<0.01 for both). UA, but not UV, [ANP] was markedly raised after vaginal delivery. Plasma concentrations of aldosteronce[ALD] were measured in 16 of the matched sets of samples. No statistically significant association was found between [ANP] and [ALD] in either maternal or fetal samples. Neither maternal nor fetal [ANP] correlated with serum Na+ or osmolality, haematoerit, blood pressure or heart rate.
The importance of the behavioural state in biophysical assessment of the term human fetus
Authors: PILLAI MARY , JAMES DAVID
Published: August 2005

Summary. We have examined how the different behavioural states exhibited by 78 healthy fetuses at term influence the result of the nonstress test (NST) and biophysical profile score (BPS). In association with state 1F the average recording time to obtain a satisfactory NST and EPS was 27.0 and 26.3 min respectively, and 52.6% and 44.0% respectively failed to achieve a ‘normal’ result. In contrast, satisfactory results were always obtained in the two active states (2F and 4F), and the average time was 3–5 min. Mature fetuses spend on average one third of the time in state 1F, and knowledge of its characteristics is therefore important, for the interpretation of biophysical tests. Our results suggest that continuation of biophysical recording for at least 40 min is necessary before an unreactive NST or low BPS should be regarded as suspicious. We suggest that interpretation of the NST and BPS should be made in the light of knowledge of normal patterns of behavioural development rather than using an arbitrarily defined scoring system.
The efficacy and tolerance of mifepristone and prostaglandin in first trimester termination of pregnancy
Authors:   UK MULTICENTRE TRIAL
Published: August 2005

Objective— To investigate the use of oral mifepristone (RU 486) and vaginal gemeprost for the induction of legal first trimester abortion.

Design— An uncontrolled multicentre observational study.

Setting— 13 Hospital gynaecological units in Scotland and England.

Subjects— 588 Pregnant women with up to nine weeks amenorrhoea having legal abortions.

Interventions— Oral mifepristone 600 mg followed 48 h later by vaginal gemeprost 1 mg. Women stayed in the hospital for a minimum of 4 h on each occasion.

Main outcome measures— Frequency of complete abortion and the need for subsequent surgical evacuation, analgcsia and blood transfusion.

Results— There was complete abortion in 94% (95% C192–96%). None of the 46 women at <43 days gestation needed surgical evacuation. This was performed in 6.5% of the remainder but among these the rate did not increase with gestation. Five women (four from one centre) required both curettagc and blood transfusion. A fall in haemoglobin concentration of 2–4 g/dl occurred in only 1%. Narcotic analgesia was required after gemeprost by 37% of nullipara and 13% of multipara. Overall 26% had vomiting and 13% diarrhoea.

Conclusion— The sequential use of oral mifepristone and vaginal gemeprost is effective in inducing abortion up to the 63rd day of pregnancy. Efficient management of pain and bleeding is easier if women are in a hospital for some hours after the gemeprost.
A quantitative study of endometrial development in the luteal phase: comparison between women with unexplained infertility and normal fertility
Authors: LI T. C. , DOCKERY P. , ROGERS A. W. , COOKE I. D.
Published: August 2005

Summary. This study compared endometrial development in the luteal phase of women with unexplained infertility (n= 30) with that in women with normal fertility (n= 70) by the use of quantitative histological techniques (morphometric analysis) on endometrial specimens which were precisely timed from the luteinizing hormone surge. When overall endometrial development (histological dating) was considered, the proportion of women with unexplained infertility who had retarded endometrial development (20%) was found to be significantly higher than for women with normal fertility (3%) (P<0·01). When individual histological features were considered, women with unexplained infertility were found to have significant deviation from the normal range established from fertile women in only five of the 14 histological features measured. All of these five features related to the glandular but not to the stromal component of the endometrium; four of these five features are related to glandular secretory activity.
Pelvic floor damage and childbirth: a neurophysiological study
Authors: ALLEN R.E. , HOSKER G. L. , SMITH A. R. B. , WARRELL D. W.
Published: August 2005

Summary. Ninety six nulliparous women were investigated to establish whether childbirth causes damage to the striated muscles and nerve supply of the pelvic floor. The techniques used were concentric needle electromyography (EMG), pudendal nerve conduction tests and assessment of pelvic floor contraction using a perineometer. There was EMG evidence of re‐innervation in the pelvic floor muscles after vaginal delivery in 80% of those studied. Women who had a long active second stage of labour and heavier babies showed the most EMG evidence of nerve damage. Forceps delivery and perineal tears did not affect the degree of nerve damage seen. We conclude that vaginal delivery causes partial denervation of the pelvic floor (with consequent re‐innervation) in most women having their first baby. In a few this is severe and is associated with urinary and faecal incontinence. For some it is likely to be the first step along a path leading to prolapse and/or stress incontinence.
The use of obstetric analgesia in Sweden 1983–1986
Authors: GERDIN EVA , CNATTINGIUS SVEN
Published: August 2005

Summary. The use of obstetric analgesia was investigated in a Swedish population‐based prospective study of 335 207 births, which represents almost all women who had vaginal deliveries in Sweden between 1983 and 1986. Lumbar epidural analgesia (EDA) was used in 16%, paracervical block (PCB) in 12%, pethidinc or morphine in 49% and pudendal block in 62%. All four types of analgesia were much more commonly used by nulliparae than multiparae. Variables such as maternal age, smoking, nationality, relationship with the infant's father and gestational age had only moderate influence on the rates of different types of analgesia. EDA and PCB were more frequently used in larger than in smaller hospitals and in the daytime than at night. No such differences were found for pethidine or morphine, or pudendal block, which were administered routinely by midwives.
Middle cerebral artery flow velocity waveforms in fetal hypoxaemia
Authors: VYAS S. , NICOLAIDES K. H. , BOWER S. , CAMPBELL S.
Published: August 2005

Summary. In 81 small‐for‐gestational age fetuses (SGA) colour flow imaging was used to identify the fetal middle cerebral artery for subsequent pulsed Doppler studies. Impedence to flow (pulsatility index; PI) was significantly lower, and mean blood velocity was significantly higher, than the respective reference ranges with gestation. Fetal blood sampling by cordocentesis was performed in all SGA fetuses and a significant quadratic relation was found between fetal hypoxaemia and the degree of reduction in the PI of FVWs from the fetal middle cerebral artery. Thus, maximum reduction in PI is reached when the fetal PO2 is 2‐4 SD below the normal mean for gestation. When the oxygen deficit is greater there is a tendency for the PI to rise, and this presumably reflects the development of brain oedema.
The management of primary fallopian tube carcinoma
Authors: GURNEY HOWARD , MURPHY DAMIAN , CROWTHER DEREK
Published: August 2005

Summary. The outcome of 30 patients with primary fallopian tube carcinoma is described. Treatment varied over the 22 year period of accrual and included combinations of surgery, radiotherapy and chemotherapy. There was an apparent increase in stage at treatment with time which was probably related to more precise staging at laparotomy and the greater use of computerized tomography. The median survival for all patients was 28 months and the 5‐year survival was 18%. Ten patients received postoperative chemotherapy for residual disease with an overall response rate of 80% and median progression‐free and overall survival times of 14 and 21 months respectively. The pattern of relapse was similar to that seen in ovarian carcinoma, with all but one patient having the pelvis or abdomen as the main site of recurrence. Primary fallopian tube carcinoma has a response to treatment and a tumour biology similar to that of ovarian carcinoma. It is recommended that the management of this uncommon malignancy should continue to be along the lines of ovarian carcinoma, with initial treatment by cytoreductive surgery followed by chemotherapy or radiotherapy for residual disease.
Vitamin B6 in the treatment of the premenstrual syndrome–a review
Authors: KLEIJNEN JOS , TER RIET GERBEN , KNIPSCHILD PAUL
Published: August 2005

Summary. A search of the literature yielded 12 controlled trials on vitamin B6 in the treatment of the premenstrual syndrome. These are discussed with emphasis on methodological aspects. A major drawback of the trials is the limited number of patients included. The existing evidence of positive effects of vitamin B6 is weak, and some well‐designed trials with positive results would be needed to change this view.
Fetal monitoring with pulse oximetry
Authors: JOHNSON NICHOLAS , JOHNSON VALERIE A. , FISHER JOHN , JOBBINGS BRIAN , BANNISTER JEFFREY , LILFORD RICHARD J.
Published: August 2005

Summary. Continuous fetal monitoring was achieved with a fetal scalp pulse oximetry sensor in 86 labours. The average recorded fetal oxygen saturation in early labour (cervical dilatation < 5 cm) was 68% (SD 13%). At the end of labour (cervical dilatation ≥ 9 cm) the recorded mean oxygen saturation was 58% (SD 17%). The largest range of readings during a single labour was 81%‐11% but this drop was associated with cord compression. The average SD during 1 h of normal labour was 10%. A second group of 40 fetuses was monitored during induction of labour before and after elective amniotomy. Oxygen saturation did not appear to change after amniotomy (mean change −0.4%, SD 1.2%) and there was no difference between mean antenatal or early intrapartum readings. We excluded the amniochorionic membranes as a possible source of data corruption by measuring their in vitro absorption spectra and confirming that they do not preferentially absorb light of either 660 or 940 nm wavelength. Non‐invasive pulse oximetry can be used to monitor the fetus before and during labour.
Placental abruption. A case‐control investigation
Authors: ERIKSEN GUNNAR , WOHLERT MOGENS , ERSBAK VIBEKE , HVIDMAN LONE , HEDEGAARD MORTEN , SKAJAA KRISTJAR
Published: August 2005

Summary. The course of pregnancy and labour, neonatal outcome and social circumstances, were compared between 87 women with placental abruption and a control group of 5697 women. First and second trimester haemorrhage, amniocentesis, congenital malformations, maternal smoking and a job involving much standing or walking were associated with placental abruption.
The role of vaginal scan in measurement of endometrial thickness in postmenopausal women
Authors: NASRI M. N. , SHEPHERD J. H. , SETCHELL M. E. , LOWE D. G. , CHARD T.
Published: August 2005

Summary. Transvaginal ultrasound scanning was performed on 111 postmenopausal women. Of these women, 103 had postmenopausal bleeding, and eight were undergoing hysterectomy. Of the 103 women with bleeding, 93 had dilatation and curettage (D&C) and 10 patients were treated conservatively with a repeat scan in six months. A correlation of ultrasound findings and endometrial histopathology was possible in 94 patients. In 59 of these (63%) the endometrium was atrophic and the ultrasound endometrial thickness was 5 mm or less. In 29 (31%) patients the endometrial histology was abnormal and ultrasound endometrial thickness was greater than 5 mm. In six patients the endometrium was atrophic, but the ultrasonic endometrial thickness was apparently greater than 5 mm due to intracavity fluid. We suggest that an endometrial thickness of 5 mm is an appropriate cut‐off level for conservative management of patients with postmenopausal bleeding, or in screening for endometrial carcinoma.
How does the mode of delivery affect the cost of maternity care?
Authors: CLARK LIANE , MUGFORD MIRANDA , PATERSON CATHERINE
Published: August 2005

Summary. In this paper we present estimates of the difference in the cost of hospital care for women having different modes of singleton delivery. The estimates are based on observation of resources used in different procedures, and on data from the North West Thames Region Maternity Information System. For vaginal delivery the average cost is £363, but could fall between £189 and £773, and for caesarean section the average cost is £1123, with a likely range from £837 to £1560. The wide ranges in the costs of the two modes of delivery reflect variation in the length of stay and in the intensity of care required. The average cost for intrapartum care and postnatal stay is estimated to be £451 for all singleton births. Variation in operative delivery rates between hospitals implies differences in the overall cost of care at different maternity units. This partly reflects differences in the needs of the population served by the units, but also differences in clinical practice. It is important for decision makers to consider the balance between the costs and outcomes of different policies of care.
A randomized comparison of oxytocin, sulprostone and placebo in the management of the third stage of labour
Authors: POESCHMANN R. P. , DOESBURG W. H. , ESKES T. K. A. B.
Published: August 2005

Objective— To compare the effect on post partum bloodloss of the postpartum prophylactic administration of oxytocin or sulprostone in low risk women having an expectant management of the third stage.

Design— Randomized, placebo controlled, double‐blind trial.

Setting— Radboud University Hospital, Nijmegen (67 women) and Lievensberg Hospital, Bergen op Zoom (10 women).

Participants— 77 women entered the trial (three were excluded).

Interventions— The intramuscular injection, immediately after the birth of the baby, of either oxytocin 5 IU, sulprostone 500 ng or 0.9% saline.

Main outcome measures— Quantitative postpartum blood loss and length of third stage.

Results— Postpartum blood loss was reduced almost equally, by about 35%, by oxytocin (P = 0.02), or sulprostone (P = 0.05). The mean length of the third stage was shorter in both groups receiving the active treatment, this effect was significant in the sulprostone group (P = 0.01).

Conclusion— Prophylactic administration of oxytocin or sulprostone directly after delivery followed by expectant management of the third stage reduces post partum blood loss and shortens the third stage.
Experience with tissue expansion vaginoplasty
Authors: JOHNSON NICHOLAS , BATCHELOR ANDREW , LILFORD RICHARD JAMES
Published: August 2005

Summary. In vaginal agenesis, a vagina can be treated by tissue expansion vaginoplasty. We have performed 17 such procedures. One procedure was abandoned because of infection of the temporary implant. In four women the first stage had to be repeated: in one the implant was placed too superficially, in another it did not provide adequate expansion, in a further instance the implant became infected and the fourth woman received a surgical wound to her labia. The second stage was successful in all 16 women who now have a vagina lined with viable epithelium. The vaginal length was satisfactory in all but one. Two women complained of a vaginal discharge due to hair at the vaginal vault, two women developed postoperative haematomas and one experienced introital stenosis. The disadvantage of the procedure is that it requires two operative stages and involves a prolonged hospital stay but it is not technically complex and results in a full length vagina that does not require dilatation.
Crouching over the toilet seat: prevalence among British gynaecological outpatients and its effect upon micturition
Authors: MOORE K. H. , RICHMOND D. H. , SUTHERST J. R. , IMRIE A. H. , HUTTON J. L.
Published: August 2005

Summary. This study investigated whether British women prefer to crouch over public toilet seats, and measured the effect of such a voiding position on urine flow rate and residual urine volume. Of 528 consecutive women who attended a general gynaecological clinic and completed an anonymous questionnaire, 85% usually crouched over the toilet when using a public convenience, 12% applied paper to the seat and 2% sat directly on public toilet seats. When using a friend's bathroom 38% of the women voided by crouching. Results were similar for 155 patients attending a urodynamic clinic, 80 of whom were studied while voiding in both positions. There was a 21% reduction in average urine flow rate and a 149% increase in residual urine volume in the crouching position. Women undergoing urodynamic tests should be asked which voiding position they used before abnormal results are interpreted. Patients with a reduced functional bladder capacity may benefit from being encouraged to sit comfortably on the toilet whenever possible.
Life events and low birthweight—analysis by infants preterm and small for gestational age
Authors: MUTALE THEO , CREED FRANCIS , MARESH MICHAEL , HUNT LINDA
Published: August 2005

Summary. Social stress was assessed in 92 women with low‐birthweight babies and 92 controls using the detailed LEDS measure of life events and severe chronic difficulties. The low‐birthweight group was divided into preterm delivery (n = 40), small for gestational age (SGA) (n = 40) and mixed groups. Multivariate analysis was performed using a bino‐mial‐logit model to examine whether social factors were independently and significantly associated with low birthweight once the effect of demographic factors, obstetric factors and smoking/drinking were taken into account. Comparison of preterm births with controls indicated that three factors were significantly associated: a previous low‐birthweight baby, severe life event/difficulty and bleeding during pregnancy. For SGA babies the factors were: previous low‐birthweight baby, low social support and smoking. By using a reliable measure of life events and adequate numbers of low‐birthweight babies, this study overcame the potential inaccuracies of previous studies and indicates a more specific relation between social stress and low birthweight.
Stopping smoking in pregnancy: effect of a self‐help manual in controlled trial
Authors: HJALMARSON A. I. M. , HAHN L. , SVANBERG B.
Published: August 2005

Summary. For medical reasons, encouraging women to stop smoking during pregnancy and post partum has high priority. Many smokers want to stop smoking but decline clinical treatment when it is offered. The aim of this study was to find a method which was accepted by a large number of smokers, had a high success rate and, at the same time, required little involvement from personnel. For one year, all pregnant smokers attending 13 of the 14 public health maternity clinics in Gothenburg for their first appointment were invited to participate in this study. Inclusion criteria were daily smoking, a gestational age of less than 12 weeks and ability to understand Swedish. A total of 745 women was registered, but 22 of them stopped smoking before the treatment. The remaining women were randomized to a treatment group (n = 492) and a control group (n = 231). Of the 492 women in the treatment group 417 (85%) accepted the idea of using the self‐help manual written especially for pregnant women and given to each woman in the treatment group by the obstetrician. Overall 10.4% of the treatment group stopped smoking up to 8 weeks after delivery compared with 5.2% of the control group (odds ratio 0.5, 95% CI 0.2–0.9). The ex‐smoking status was verified by measurement of thiocyanate in blood. The self‐help manual had a high acceptance rate and a success rate that was double the rate in the control group.
Fetal umbilical artery velocity waveforms and subsequent neonatal outcome
Authors: TRUDINGER B. J. , COOK C. M. , GILES W. B. , NG S. , FONG E. , CONNELLY A. , WILCOX W.
Published: August 2005

Summary. Flow velocity waveforms (FVWs) from the fetal umbilical artery were recorded from 2178 pregnant women over a 6‐year period. All of them had an obstetric factor indicating increased risk of fetal compromise. A total of 6749 studies was recorded. The systolic diastolic (AB) ratio was measured and classified as normal (<95th centile), elevated (95–99th centile), high (>99th centile) or extreme (absent diastolic flow). The results of these studies have been related to subsequent fetal and neonatal outcome. An abnormal umbilical artery FVW was associated with shorter gestation and infants with lower birthweight, shorter length and lower ponderal index. There was a highly significant association between an abnormal FVW and the birth of an infant small for gestational age. The significance of the association increased with the increased abnormality of the umbilical artery FVW and this was independent of gestational age. Preterm infants associated with high or extreme AB ratios spent twice as long in the neonatal nursery than those with normal AB ratios. Analysis of 794 pregnancies studies serially indicated that an abnormal FVW in which the AB ratio was increasing, in contrast to a decreasing AB ratio, predicted a poor outcome for both size at birth and duration of neonatal intensive care. We conclude that in high risk pregnancy Doppler umbilical artery FVW studies predict the most compromised fetuses in terms of growth retardation and requirements for neonatal intensive care.
The variation of endometrial response to a standard hormone replacement therapy in women with premature ovarian failure. An ultrasonographic and histological study
Authors: LI T. C. , DOCKERY P. , RAMSEWAK S. S. , KLENTZERIS L. , LENTON E. A. , COOKE I. D.
Published: August 2005

Summary. The endometrial response to a standard hormone replacement therapy in 18 women with premature ovarian failure was examined by serial ultrasonographic measurement of endometrial thickness and histological study of endometrial biopsy taken on day 19 of the cycle. Women with idiopathic ovarian failure (n = 10) had significantly better response than women with Turner's syndrome (n = 4), whereas women with premature ovarian failure associated with previous chemotherapy (n = 4) had an intermediate response. These observations suggest that the endometria of women with Turner's syndrome responded suboptimally to steroid hormones. However, all endometrial biopsies studied revealed secretory changes. Overall, the results of histological dating of endometrial biopsy were found to be positively correlated with endometrial thickness on day 19 of the cycle (r = 0.72, P < 0.01). The plasma concentration of oestradiol on days 15, 19 and 29 of the artificial cycle were found to be significantly higher than those on the corresponding days of the natural cycle.
A comparative study of ethamsylate and mefenamic acid in dysfunctional uterine bleeding
Authors: CHAMBERLAIN G. , FREEMAN R. , PRICE F. , KENNEDY A. , GREEN D. , EVE L.
Published: August 2005

Summary. The effects of ethamsylate and mefenamic acid on menstrual blood loss were compared in a double‐blind trial in 34 women with men‐orrhagia. Both drugs produced statistically significant reductions in blood loss during the 3 months of treatment; the overall reduction was 20% in the ethamsylate group and 24% in the mefenamic acid group. Compared with pretreatment values, blood loss was significantly less in each of the 3 treatment months in the mefenamic acid group, but only in the second and third months of treatment in the ethamsylate group. However, more women had a clinically useful reduction in blood loss (>40%) in the ethamsylate group. The onset of effect of mefenamic acid was rapid but ethamsylate showed a comparatively greater effect as the trial progressed. Cessation of treatment was followed by an increase in blood loss, more pronounced in mefenamic acid group who reverted to pre‐treatment levels. A greater number of side‐effects were reported with mefenamic acid.
The obstetric and neonatal outcome of pregnancy in women with a previous history of infertility: a prospective study
Authors: LI T. C. , MACLEOD I. , SINGHAL V. , DUNCAND S. L. B.
Published: August 2005

Objective— To compare the frequency of common antenatal problems, the amount of antenatal surveillance and the obstetric and neonatal outcome in women with and without a history of infertility.

Design— A prospective cohort study with age and parity matched controls.

Setting— A single consultant unit at the Jessop Hospital for Women, Sheffield, over a 22‐month period.

Subjects— 114 women with a history of infertility who reached 16 weeks gestation with a singleton live fetus and 114 control women matched for age and parity.

Main outcome measures— Frequency of antepartum, complications, amount of antepartum surveillance, obstetric and neonatal outcome.

Results— Common antenatal complications were not increased. In the infertility compared with the control group, the relative risk of requiring an emergency caesarean section was 2.43 (95% CI 1.05–5.63). There was no difference in birthweight.

Conclusion— Many of the previously observed differences in outcome of pregnancy in women after infertility compared with those without are associated with age and parity but these characteristics do not explain the increased frequency of emergency caesarean section.