bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual function after childbirth: women's experiences, persistent morbidity and lack of professional recognition
Authors: Glazener Cathryn M. A.
Published: August 2005

Objective
To describe the sexual behaviour of postnatal women, including time of restarting intercourse, problems encountered, use of contraception and related use of available services.

Design
Longitudinal survey using postal questionnaires following discharge from hospital, and at eight weeks and twelve to eighteen months postnatally.

Setting
The questionnaires referred to postnatal care received in a teaching hospital and general practitioner delivery units, and in the community.

Population
Randomly selected one in five sample of women who were delivered in the Grampian Region of Scotland over a 12‐month period.

Main outcome measures
Times to restarting intercourse and contraception; problems related to intercourse and their relation to perineal pain, tiredness and method of infant feeding; and perceived need for and adequacy of help.

Results
The median times to restarting intercourse and contraception were each six weeks. Problems with intercourse were reported by 569/1075 (53%, 95% CI 50–56) of women in the first eight weeks after delivery, and by 215/435 (49%, 95% CI 45–54) in the subsequent year. Women who reported perineal pain, depression or tiredness experienced problems related to intercourse more often than those who did not. Women who breastfed their infants were significantly less interested in intercourse than those who bottlefed, irrespective of tiredness or depression, but this effect did not persist in the long term. The need for help with problems was expressed by 7% to 13% of women, but a quarter of these had not sought it.

Conclusions
Postnatal sexual problems are common. Health professionals ought to educate and prepare patients antenatally; be trained to identify problems; and be competent to deal with them openly and sympathetically.
Accuracy of oscillometric blood pressure monitoring in pregnancy and pre‐eclampsia
Authors: Gupta Manish , Shennan Andrew H. , Halligan Aidan , Taylor David J. , de Swiet Michael
Published: August 2005

Objective
To assess the accuracy of the Omron HEM 705 CP oscillometric device for the measurement of blood pressure in pregnancy and pre‐eclampsia.

Setting
Two teaching hospitals.

Participants
Eighty‐five pregnant women with a wide range of blood pressures, and 43 women with pre‐eclampsia.

Methods
Evaluation was carried out according to the British Hypertension Society protocol, incorporating criteria of the Association for the Advancement of Medical Instrumentation (AAMI).

Results
Mean differences (device minus observer) for systolic blood pressure were −0.9 mmHg (SD 10) in normal pregnancy, and −2 mmHg (SD 10) in the women with pre‐eclampsia. For diastolic blood pressure, Korotkoff phase V, the differences were −1.5 mmHg (SD 10), and −8 mmHg (SD 8) respectively; i.e. the device consistently under‐read the diastolic blood pressure in pre‐eclamptic women by a mean of 8 mmHg when compared with conventional sphygmomanometry. Korotkoff phase IV could not be accurately reproduced. According to the British Hypertension Society grading criteria, the device reached a ‘B’ grading in the 85 pregnant women. In pre‐eclampsia only a ‘C’ grade was reached for systolic blood pressure, and ‘D’ grade for diastolic blood pressure. Accuracy criteria stipulated by the AAMI were not met in any situation.

Conclusion
The Omron HEM 705 CP does not reach acceptable accuracy criteria for blood pressure measurement when compared with trained observers in women with pre‐eclampsia, as judged by the British Hypertension Society Protocol. It also failed to meet the AAMI criteria, although the methodology stipulated by the AAMI may not be applicable to a pregnancy population.
The Stockholm Birth Centre Trial: maternal and infant outcome
Authors: Waldenstrom Ulla , Nilsson Carl‐Axel , Winbladh Birger
Published: August 2005

Objective
To compare an in‐hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome.

Background
The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midwives, restricted use of medical technology, and discharge within 24 h after birth.

Methods
Of 1860 women meeting low risk medical criteria in early pregnancy and interested in birth centre care, 928 were randomly allotted birth centre care and 932 standard maternity care. Data were collected mainly from hospital records, and analysis was by intention‐to‐treat.

Results
Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical differences were observed in maternal morbidity or in perinatal mortality, neonatal morbidity, Apgar score or infant admissions to neonatal care. Perinatal mortality, defined as intrauterine death after 22 weeks of gestation and infant death within seven days of birth, occurred in eight cases (0.9%) in the birth centre group and in two cases (0.2%) in the standard care group (OR 4.04, 95% CI 0.80 to 39.17; P= 0.11). Subgroup analysis showed that a larger proportion of first‐born babies in the birth centre group (15.6%) were admitted for neonatal care than in the standard care group (9.5%) (P= 0.003), whereas the converse was the case for the newborns of multiparous women: 4.7% and 8.4%, respectively (P= 0.04). The overall rates of operative delivery (e.g. caesarean section, vacuum extraction and forceps), 11.1% in the birth centre group and 13.4% in the standard care group, did not differ statistically (P= 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group.

Conclusion
Birth centre care was associated with less medical interventions than standard care without any statistically significant differences in health outcomes. However, the excess of perinatal deaths and of morbidity in primigravidas’ infants in the birth centre group gives cause for concern and necessitates further studies.
Experience of Finnish women with Norplant insertions and removals
Authors: Ollila E. , Sihvo S. , Merilainen J. , Hcmminki E.
Published: August 2005

Objective
Norplant® and Norplant‐2® have been available for use by Finnish women since 1984 and 1986, respectively. The objective of this study was to explore Norplant users’ experiences of insertions, removals and medical treatments.

Design
A questionnaire was sent to women who had received Norplant® or Norplant‐2® implants one to two years earlier (n= 262) in normal clinical settings; the response rate was 79%.

Results
At insertion, problems were experienced by 9% and at least some pain by 23% of women. During the first year 20% of all users (14% of Norplant® and 33% of Norplant‐2® users) had their implants removed. Problems were experienced at removal by 33% of women and pain was experienced by 40%; nevertheless most users were satisfied with the device. Findings were similar for the two types of Norplant. Forty‐two percent of the women had received minipills containing levonorgestrel before Norplant insertions in an attempt to assess Norplant's suitability, and 8% had received drugs for adverse effects caused by Norplant.

Conclusions
Studies including perspectives of Norplant users and the whole lifespan of Norplant (including removal) should be conducted in all clinical settings where Norplant is provided.
Automated blood pressure measurement as a predictor of proteinuric pre‐eclampsia
Authors: Halligan Aidan W. F. , Shennan Andrew , Lambert Paul C. , Bell Stephen C. , Taylor David J. , de Swiet Michael
Published: August 2005

Objectives
To investigate the relation between antenatal clinic, obstetric day unit and 24‐hour ambulatory blood pressure measurements and 24‐hour proteinuria levels in hypertensive pregnancies.

Design
An observational study.

Participants
Forty‐eight women presenting with new hypertension after 20 weeks of gestation.

Results
The closest relation was found between ambulatory blood pressure measurements and 24‐hour proteinuria levels. No significant relation was found between the conventional diastolic blood pressure threshold of 90 mmHg and 24‐hour proteinuria levels.

Conclusions
Ambulatory blood pressure measurement gives better information about disease status in pre‐eclampsia as assessed by proteinuria than does conventional sphygmomanometry.
Comparison of second trimester biometry in singleton and twin pregnancies conceived with assisted reproductive techniques
Authors: Gardosi Jason , Mul Theo , Francis Andy , Hall Jenny , Fishel Simon
Published: August 2005

The objective of this study was to investigate the size of singleton vs twin pregnancies at the time of a second trimester dating scan. The analysis included 86 infants from 63 pregnancies achieved with assisted reproductive techniques, comprising 40 singletons and 46 twins. Measurements of second trimester biparietal diameter (n= 85) and femur length (n= 74) were plotted against the precisely known gestational age. A common regression line was calculated for each parameter and the residuals for singletons and twins were compared. Gestational age and weight at birth were also analysed for each group. There was no significant difference between singletons and twins in biparietal diameter or femur length in second trimester. In contrast, twins had a lower mean birthweight, gestational age at birth, and weight‐for‐gestational age centile compared with singletons. Singleton babies from these pregnancies had an average birthweight centile of 49.8% (i.e. close to the median for spontaneously conceived pregnancies in our population). We concluded that the same pregnancy dating charts can be used for singletons and twins. At corresponding gestational age, twins are smaller than singletons at birth because of slower growth in the third trimester.
Medical abortion or vacuum aspiration? Two year follow up of a patient preference trial
Authors: Howie F. L. , Henshaw R. C. , Naji S. A. , Russell I. T. , Templeton A. A.
Published: August 2005

Objective
To describe and compare health outcomes two years after medical abortion or vacuum aspiration in women recruited into a patient preference trial during 1990 to 1991.

Design
Women recruited to the original, partially randomised study were contacted for assessment using a structured interview.

Setting
Grampian region of Scotland, UK.

Participants
One hundred and forty women who had participated in a partially randomised study of first trimester abortion two years previously.

Intervention
Vacuum aspiration or medical abortion using mifepristone and gemeprost.

Main outcome measures
Long‐term general, reproductive and psychological health; acceptability of procedure; perceived value of choice of method of termination.

Results
There were no significant differences between women who had undergone medical abortion or vacuum aspiration two years previously in general, reproductive or psychological health. Almost all women placed a high value on the provision of choice of method of termination. There was a significant difference in perception of long term procedure acceptability among women who had been randomised to a method of termination.

Conclusions
Women should have the opportunity to choose the method of termination. This opportunity will result in high levels of acceptability, particularly at gestations under 50 days of amenorrhoea.
Levator ani function before and after childbirth
Authors: Peschers Ursula M. , Schaer Gabriel N. , DeLancey John O. L. , Schuessler Bernhard
Published: August 2005

Objective
To evaluate pelvic floor muscle strength before and after vaginal birth.

Design
Prospective repeated measures study.

Setting
Main district hospital.

Population
Fifty‐five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group.

Methods
Pelvic muscle strength was evaluated by palpation, perineometry and perineal ultrasound before childbirth in the 36th to 42nd week of pregnancy, three to eight days postpartum and six to ten weeks postpartum.

Main outcome measures
Pelvic floor muscle strength on palpation, intravaginal squeeze pressure and vesical neck elevation during squeeze.

Results
Pelvic floor muscle strength is significantly reduced three to eight days postpartum in women following vaginal birth but not in women after caesarean delivery. Six to ten weeks later palpation and vesical neck elevation on perineal ultrasound do not show any significant differences to antepartum values, while intravaginal pressure on perineometry remains significantly lower in primiparae, but not in multiparae.

Conclusions
Pelvic floor muscle strength is impaired shortly after vaginal birth, but for most women returns within two months.
Perineal examination as a predictor of underlying external anal sphincter damage
Authors: Frudinger Andrea , Bartram Clive I. , Spencer John A. D. , Kamm Michael A.
Published: August 2005

Objective
To assess the relation between perineal inspection and sphincter integrity in parous women.

Design
Prospective observational study.

Setting
District general hospital.

Population
Fifty‐seven consecutive parous women attending a gynaecology clinic for problems unrelated to the pelvic floor.

Methods
A detailed history of bowel function and mode of delivery obtained; the perineum inspected to determine the presence and position of scarring, and anal endosonography performed.

Results
In 19 women with an intact perineum on inspection, endosonography showed perineal scarring in five, with both perineal and sphincter scarring in three. Four had urge faecal incontinence. Three patients had a perineal tear only on inspection, but this group was too small for analysis and was discounted. Nine had an episiotomy scar only. Endosonography demonstrated perineal scarring in four, and combined perineal and sphincter scarring in two; one woman in this group had urge faecal incontinence. Twenty‐six women had episiotomy and perineal tears on inspection. Endosonography revealed underlying perineal scarring in five women, with combined perineal and sphincter scarring in 14; six women in this group had urge faecal incontinence and one passive incontinence for flatus. Sonographically the scarring was anterior and circumferential rather than radial, and mostly left‐sided, whereas on inspection episiotomy and perineal scarring were right sided.

Conclusions
A normal perineum on clinical examination does not exclude underlying sphincter damage. The incidence of sphincter damage increases significantly when an episiotomy scar is associated with a perineal tear.
Women's health in midlife: the influence of the menopause, social factors and health in earlier life
Authors: Kuh Diana L. , Wadsworth Michael , Hardy Rebecca
Published: August 2005

Objective
To describe the health symptoms of a large representative sample of British women at age 47 years, and to examine the influence of the menopause allowing for social factors and health in earlier adult life.

Design
A national prospective birth cohort study. Information on health problems, menstrual cycle, use of hormone replacement therapy and life stress at 47 years was collected using a postal questionnaire. Information on health, smoking behaviour and educational attainment earlier in life had been collected at previous home visits.

Setting
England, Scotland and Wales.

Population
A general population sample of 1498 women, 84% of those sent a questionnaire.

Main outcome measure
Twenty self‐reported health symptoms over the previous 12 months.

Results
Women who had experienced an early natural menopause had a strongly raised risk of vasomotor symptoms (hot flushes or night sweats), sexual difficulties (vaginal dryness or difficulties with intercourse) and trouble sleeping. However, there was little or no excess risk of other somatic or psychological symptoms. In contrast, all types of symptoms were more common among women who had had a hysterectomy or were users of hormone replacement therapy. Women with the least education, stressful lives, or a previous history of poor physical and psychological health at age 36 also reported more symptoms at 47 years compared with other women, but adjustment for these factors in a logistic regression model did not affect the relations between symptoms and current menopausal status. For vasomotor symptoms, postmenopausal women had an adjusted odds ratio of 4.7 (95% CI 2.6–8.5) and perimenopausal women had an adjusted odds ratio of 2.6 (95% CI 1.9–3.5) compared with premenopausal women. Corresponding adjusted odds ratios for sexual difficulties were 3.9 (95% CI 2.1–7.1) and 2.2 (95% CI 1.4–3.2), and for trouble sleeping were 3.4 (95% CI 1.9–6.2) and 1.5 (95% CI 1.1–2.0).

Conclusions
Specific symptoms were clearly associated with the natural menopause. More general health concerns were common among women in middle life, particularly among those with stressful lives, or those who had had a hysterectomy or started taking hormone replacement therapy before they were postmenopausal. Appropriate advice and support needs to be easily accessible.
Vaginal vault suspension for prolapse after hysterectomy using an autologous fascial sling of rectus sheath
Authors: Barrington J. W. , Calvert J. P.
Published: August 2005

Objective
To evaluate the results of a modified rectus sheath fascial sling used as a treatment for vaginal.

Design
Retrospective analysis of case records.

Setting
District General Hospital in South Wales.

Participants
Ten women who had had a hysterectomy 2 to 20 years previously (mean 8 years).

Results
All the women were cured of symptoms related to vaginal vault prolapse. There were no intra‐operative complications. No new urinary symptoms have developed. One woman developed an enterocele which was corrected by the abdominal insertion of a prolene mesh.

Conclusion
A modified rectus sheath fascial sling is a safe, simple effective abdominal operation for the surgical correction of vaginal vault prolapse after hysterectomy. vault prolapse after hysterectomy.
Significance of a diastolic notch in the uterine artery flow velocity waveform induced by uterine embolisation in the pregnant ewe
Authors: Ochi Hiroshi , Matsubara Keiichi , Kusanagi Yasuki , Taniguchi Humiaki , Ito Masaharu
Published: August 2005

Objective
To investigate the relation between placental embolisation and the diastolic notch in the uterine artery flow velocity waveform of pregnant ewes under general anaesthesia.

Methods
Seven pregnant ewes at a gestation 16 to 17 weeks were anaesthesized and micro beads of gelfoam were injected into the uterine artery; changes in the uterine circulation were assessed by Doppler velocimetry.

Results
Gelfoam embolisation reduced uterine blood flow in a dose‐dependent manner, from a mean (95% CI) of 568 mL/min (495–641) to 159 mL/min (131–187) after the injection of 30 mg of gelfoam, and increased the uterine vascular resistance from 135 mmHg mine L−1 (103–167) to 498 mmHg mino L−1 (422–574). A diastolic notch in uterine artery flow velocity waveform was observed after 20 mg to 25 mg of gelfoam in two ewes and after injection of 30 mg of gelfoam in all seven animals. Injection of 30 mg of gelfoam increased the pulsatility index to 2–4 (1.9–2.9) from 0.6 (0.5–0.7). The mean uterine vascular resistance at the time of the appearance of a diastolic notch was 414 mmHg mine L−1 (377–451).

Conclusion
These findings suggest that an elevated pulsatility index and the presence of a diastolic notch in the uterine artery flow velocity waveform are indicators of increased uterine vascular resistance and impaired uterine circulation.
A prospective study of maternal serum insulin‐like growth factor‐I in pregnancies with appropriately grown or growth restricted fetuses
Authors: Holmes R. P. , Holly J. M. P. , Soothill P. W.
Published: August 2005

Objective
To determine whether there is a relationship between maternal serum insulin‐like growth factor‐I and fetal growth, consistent with the hypothesis that insulin‐like growth factor‐I influences maternal constraint upon fetal growth by controlling placental transfer.

Design
A prospective, observational study.

Setting
Fetal medicine unit and antenatal clinic of a large teaching hospital.

Population
One hundred and forty‐one pregnant women identified as having small or normally grown fetuses.

Methods
Fetuses were scanned every two weeks with maternal venesection at each visit. Cases (birthweight < 5th centile) were assigned to two groups: fetal growth restriction due to placental dysfunction (umbilical artery Doppler, growth velocity pulsatility index > +2 SD; n= 25) and normal small‐for‐gestational‐age (normal Doppler, growth velocity and amniotic fluid; n= 27). Eighty‐nine controls had birthweights between the 5th and the 95th centiles, normal Doppler, growth velocity and amniotic fluid. Insulin‐like growth factor‐I was measured by radioimmunoassay, and its relationship to gestational age and birthweight was assessed by regression analysis. Comparisons between case groups were made by Student's t test or analysis of covariance to allow for the effect of birthweight.

Outcome measure
The last insulin‐like growth factor‐I level before delivery within the different subgroups.

Results
In controls, maternal insulin‐like growth factor‐I increased with gestational age (p= 0.40; P= 0.0001) but did not correlate with birthweight. Insulin‐like growth factor‐I was low in the mothers of growth restricted fetuses (‐1.56 SD; P= 0.0001), but not in those with small‐for‐gestational age fetuses.

Conclusions
The control and small‐for‐gestational‐age data suggest that maternal insulin‐like growth factor‐I is not associated with endocrine control of normal placental function. Low insulin‐like growth factor‐I relates to poor placental transfer, as indicated by Doppler, rather than to low birthweight. Whether this is a regulatory mechanism, a cause or a consequence of placental dysfunction needs further study.
The influence of oral contraceptives on the risk of multiple sclerosis
Authors: Thorogood Margaret , Hannaford Philip C.
Published: August 2005

Objective
To examine the risk of multiple sclerosis in users of combined oral contraceptives.

Design
Cohort study conducted between 1968 and 1996 using diagnostic data supplied by general practitioners

Setting
General practices throughout the United Kingdom.

Population
Royal College of General Practitioners' Oral Contraception Study cohort of initially 46,000 women recruited during the late 1960s.

Methods
Directly standardised incidence rates of multiple sclerosis were calculated for current, former and never‐users of oral contraceptives using first ever cases of multiple sclerosis reported by the general practitioners. The standardisation variables were age, parity, social class and smoking history. Five‐year survival rates in the different contraceptive groups were calculated using standard life table techniques.

Results
One hundred and fourteen first ever cases of multiple sclerosis had been reported by November 1996 during 564,000 woman‐years of observation. The incidence rate in both current and former users was not materially different to that in never‐users. Although based on limited evidence there was no suggestion that the five‐year survival was affected by a woman's use of combined oral contraceptives.

Conclusions
These findings do not suggest a greatly elevated risk of multiple sclerosis during, or after, use of combined oral contraceptives.
The reliability of the detection of an early diastolic notch with uterine artery Doppler velocimetry
Authors: Farrell Tom , Chien Patrick F. W. , Mires Gary J.
Published: August 2005

This study evaluates the ability of two reviewers to detect independently an early diastolic notch in 1371 uterine artery Doppler velocity waveform recordings. Agreement between the two reviewers for the detection of uterine artery notching was assessed by using the Kappa statistic. The inter‐rater reliability for the detection of unilateral notching was 0.75 (95% CI 0.70–0.80), whereas that for the presence or absence of bilateral notching was 0.66 (95% CI 0.60–0.71). The results suggest that there was good reviewer agreement for the presence or absence of a notch on uterine artery Doppler velocimetry.
The management of squamous cell vulval cancer: a population based retrospective study of 411 cases
Authors: Rhodes Catharine A. , Cummins Carole , Shafi Mahmood I.
Published: August 2005

ObjectiveTo audit the epidemiology, management and outcome of vulval cancer in the West Midlands.

DesignA retrospective population based study using information obtained from Cancer Intelligence Unit records.

SettingThe West Midlands Health Region.

SampleFive hundred and six women with vulval carcinoma notified to the Cancer Intelligence Unit, during two three‐year periods: 1980–1982 and 1986–1988; 411 women had a proven histological diagnosis of squamous cell carcinoma of the vulva.

ResultsHistology was available for 4541506 women (90%); 411/454 women (91%) had squamous cell carcinoma: these formed the study population. The women were treated at 35 hospitals, 16 of which averaged one case or less per year. The median age at diagnosis was 74 years. Presentation was delayed by more than one year in 631284 women with data (22%), and 971284 cases (34%) had more than one symptom. A biopsy was taken in 268 women (65%) and surgery was the primary treatment in 344/411 cases (84%). Fifteen different operations were used. Simple vulvectomy (35%) and radical vulvectomy with bilateral inguinal lymphadenectorny (34%) were the commonest surgical procedures; 190/344 (55%) had a lymphadenectorny; of these 102 women had negative node histology and 78 women had nodal metastases, with results not recorded in 10 cases. Overall, only 46% of all women (190/411) studied had a lymphadenectomy. Recurrence was recorded in 123/411 women (30% of the total). Univariate analysis showed significantly worse five‐year survival for older age, advanced stage, incomplete excision, poor differentiation, lack of lymph node resection, positive lymph node pathology and treatment in a hospital with less than 20 cases in total. A multivariate analysis using Cox proportional hazards model identified the first five factors as independent predictors of five year survival. Omission of lymphadenectorny was independently associated with poorer survival (RR 2.17,95% CI 1.53–3.07).

ConclusionsThere is wide variation in the management of vulval cancer with inadequate usage of lymphadenectorny and many centres treating few cases. Survival analysis shows prognostic variables as expected; omission of lymphadenectomy adversely affects survival.
Transplacental early amniocentesis and pregnancy outcome
Authors: Tharmaratnam S. , Sadek S. , Steele E. K. , Harper M. A. , Nevin N. C. , Dornan J. C.
Published: August 2005

The effect on pregnancy outcome of transplacental needle insertion was studied in 401 consecutive women attending for early amniocentesis between 10 and 14 completed weeks of pregnancy. Transplacental early amniocentesis was associated with a significantly higher incidence (P < 0.001) of blood‐stained amniotic fluid taps but a lower incidence (not significant; P > 0.05) of pregnancy loss and miscarriages. Women in the nontransplacental early amniocentesis group had a significantly higher (P < 0.01) incidence of late procedure‐related antenatal complications, such as preterm rupture of membranes or preterm labour. Our study showed that transplacental early amniocentesis is a safe procedure; contrary to present recommendations, the study also showed that avoiding the placenta during early amniocentesis is an unnecessary practice.
Computerised evaluation of fetal heart rate in post‐term fetuses: long term variation
Authors: Mandruzzato Giampaolo , Meir Yoram J. , D'Ottavio Giuseppina , Conoscenti Giancarlo , Dawes Geoffrey S.
Published: August 2005

Computerised fetal heart rate records were obtained between 1987 and 1993 using the Sonicaid System 8000 for a cross‐sectional study of postdates fetal heart rate variation; 567 singleton pregnancies at 41 and 43 weeks provided 1502 records. In all cases gestational age had been verified by ultrasound examination in early pregnancy. The mean minute range of the long term pulse interval variation, which is known to be correlated with fetal oxygenation was found to decrease progressively from an average value of 48.5 ms at 41 weeks to 46.4 ms and 42.4 ms at 42 and 43 or more weeks, respectively. When conservative management of postdate pregnancies is chosen, accurate measurements are needed to follow the evolution of fetal condition. Reference values for calculated pulse interval variation at later gestational ages are now provided.
A randomised controlled trial of antibiotic prophylaxis for vesico‐vaginal fistula repair
Authors: Tomlinson A. John , Thornton James G.
Published: August 2005

Objective
To test the hypothesis that intravenous antibiotics given intra‐operatively reduce the failure rate of vesico‐vaginal fistula repair.

Design
A single blind, randomised controlled trial.

Setting
A district hospital in Benin, West Africa.

Population
Seventy‐nine women undergoing repair of an obstetric vesico‐vaginal fistula by a single surgeon at Hopital Evangelique; two women had repeat operations.

Methods
Participants in the treatment group (n = 41) received ampicillin 500 mg intra‐operatively. Controls (n = 40) received no prophylactic antibiotics.

Main outcome measures
Failure of fistula closure and objective incontinence (a positive pad test) at hospital discharge. Secondary outcomes included febrile morbidity, other antibiotic use and urinary infection.

Results
Antibiotic prophylaxis did not reduce the odds of failed repair (OR 2.1 95% CI 0.75–6.1) or of objective incontinence (OR 1.9; 95% CI 0.72–5.1). The women in the antibiotic prophylaxis group received less post‐operative antibiotics and had less urinary infections at day 10.

Conclusions
Prophylactic antibiotics should not be used in vesico‐vaginal fistulae repair in the developing world outside randomised controlled trials.
A double‐blind, placebo controlled study of postmenopausal oestrogen replacement therapy and carotid artery pulsatility index
Authors: Jackson Simon , Vyas Sanjay
Published: August 2005

Objective
To determine whether postmenopausal oestrogen replacement therapy affects carotid artery pulsatility index.

Design
A prospective double‐blind placebo controlled trial.

Setting
University associated teaching hospital.

Participants
Twenty‐eight postmenopausal women who were more than 12 months postmenopausal and who had not taken exogenous oestrogen.

Interventions
Independent randomisation to receive oral oestradiol (2 mg daily) or placebo for 20 to 24 weeks.

Main outcome measures
Internal carotid artery Doppler pulsatility index, measured within one centimetre of the carotid bifurcation.

Results
Replicate data were available from 27 women. The mean pulsatility index decreased by ‐0.11 in 15 women receiving oestradiol, compared with a mean rise of 0.05 in the 12 women who received placebo (P = 0.006, 95% CI for treatment difference 0.06–0.31).

Conclusions
Oestrogen replacement decreases postmenopausal carotid artery pulsatility index, probably reflecting decreased peripheral vascular resistance. This is a further mechanism whereby hormone replacement therapy may impart cardiovascular protection.
The Ipswich Childbirth Study: 1. A randomised evaluation of two stage postpartum perineal repair leaving the skin unsutured
Authors: Gordon Beverley , Mackrodt Carolyn , Fern Elizabeth , Truesdale Ann , Ayers Sarah , Grant Adrian
Published: August 2005

Objective
To evaluate a policy of two stage postpartum perineal repair leaving the skin unsutured.

Design
A stratified randomised controlled trial using a 2 × 2 factorial design.

Setting
The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.

Sample
1780 women requiring surgical repair of episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery.

Methods
A policy of two‐stage perineal repair leaving skin unsutured was compared with a policy of three stage repair including skin closure with interrupted or subcuticular sutures. Both groups were assessed by a research midwife, blind to the allocation, completing questionnaires at 24 to 48 hours and 10 days postpartum, and by self‐completed questionnaires at three months after birth.

Main outcome measures
1. 24 to 48 hours postpartum: perineal pain; healing; 2. 10 days postpartum: perineal pain, healing and removal of sutures; 3. three months postpartum: perineal pain, removal of sutures, resuturing, dyspareunia, and failure to resume pain‐free intercourse.

Results
Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. No differences were detected in perineal pain at 24 to 48 hours (62%vs 64%; RR 0.96, 95% CI 0.90–1.03; 2P = 0.3) and 10 days (25%vs 28%; RR 0.90,95% CI 0.77–1.06; 2P = 0.2). Significantly fewer women allocated to two‐stage repair reported tight stitches at ten days (14%vs 18%; RR 0.77, 95% CI 0.62–0.96, 2P = 0.02); similar numbers of repairs were judged to be breaking down (five compared with seven women). At three months postpartum fewer women allocated to the two‐stage repair reported perineal pain and more had resumed pain‐free intercourse. Amongst women who had resumed intercourse there was a significant difference in dyspareunia (15%vs 19%; RR 0.80, 95% CI 0.65–0.99; 2P = 0.04). Significantly fewer women in the two‐stage repair group (7%vs12%; RR 0.61, 95% CI 0.45–0.83; 2P = < 0.01) reported removal of suture material. Four women in the two‐stage repair group had required resuturing, compared with nine allocated to the three‐stage repair.

Conclusions
Two‐stage repair of perineal trauma leaving the skin unsutured appears to reduce pain and dyspareunia three months postpartum. There are no apparent disadvantages, in particular no evidence of an increased risk of breakdown of the repair and resuturing.
The effect of physiological urine dilution on pregnancy test results in complicated early pregnancies
Authors: Ikomi Amaju , Matthews Margaret , Kuan Ah Mun , Henson Gaye
Published: August 2005

This study addresses the likelihood of false negative urine pregnancy test results, due to physiological urine dilution as described in some anecdotal reports. In this prospective study 320 pregnancy tests were performed on urine samples of varying concentrations obtained from 40 women, with suspected complications of early pregnancy, who had presented for ultrasound scans. Four different pregnancy tests were used and serum βhCG levels were measured quantitatively. Despite a mean fivefold increase in urine dilution, the pregnancy tests with low βhCG detection limits maintained maximal sensitivity. The detection of βhCG in dilute urine was adversely affected by using pregnancy tests with higher βhCG detection limits and these tests should be used with caution when assessing gynaecological emergencies.
Value of magnetic resonance imaging with an endovaginal receiver coil in the pre‐operative assessment of Stage I and IIa cervical neoplasia
Authors: DeSouza N. M. , McIndoe G. A. J. , Soutter W. P. , Krausz T. , Chui K. M. , Hughes C. , Mason W. P.
Published: August 2005

Objective
To assess the value of high resolution endovaginal magnetic resonance images (MRI) of the uterine cervix in planning management of early cervical cancer.

Design
Prospective cross‐sectional study.

Setting
Specialist gynaecological oncology unit of a postgraduate teaching hospital.

Participants
Thirty nine women aged 25–76 years old (mean 42.5 years) with invasive carcinoma Stage I or IIa of the cervix.

Methods
A ring coil was positioned endovaginally around the cervix. Imaging was performed on a 1.0 T HPQ Vista or 0.5 T Asset (Picker, Highland Heights, Ohio, USA) using T1 weighted and T2 weighted sequences in transverse and sagittal planes with thin slices (2.5 mm) and small fields of view (12 cm). Tumour volumes were measured and any extension into adjacent organs and parametrium was noted. The patients were followed up after treatment and the outcome related to the MRI findings.

Results
There was one false positive and one false negative result among five Stage Ia patients being assessed for residual disease after cone biopsy or LLETZ. The MRI assessment of the size and distribution of the tumour was confirmed histologically in all 31 patients with Stage Ib or IIa disease who were treated surgically. One of these patients in whom no endocervical tumour was visible on MRI underwent radical trachelectomy. Three patients had radiotherapy as primary treatment. Patients with Stage Ib or IIa disease who had tumour volumes > 10 cm3 with early parametrial extension on MRI had a substantially worse prognosis at 24 months (disease‐free survival 58.3% vs 95.5%, P= 0.003).

Conclusion
High resolution MRI with an endovaginal coil allows precise measurement of tumour volume and identifies patients with small volume disease who might be considered for more conservative therapy. This technique also reveals early parametrial invasion that cannot be identified reliably by any other method. Early parametrial invasion in women with large tumours appears to have a very much worse prognosis.
Pre‐operative serum level of tumour‐associated trypsin inhibitor and residual turnour size as prognostic indicators in Stage III epithelial ovarian cancer
Authors: Venesmaa Pekka , Stenman Ulf‐Håkan , Forss Matti , Leminen Arto , Lehtovirta Pentti , Vartiainen Juhani , Paavonen Jorma
Published: August 2005

Objective
To evaluate the use of the pre‐operative tumour‐associated trypsin inhibitor (TATI) level and residual tumour size at primary surgery as a prognostic indicators for patients with Stage III epithelial ovarian cancer.

Design
Retrospective cohort study.

Setting
Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland.

Participants
Ninety‐eight women with Stage III ovarian cancer.

Methods
TATI was measured by radioimmunoassay from serum samples obtained within one week before surgery. A cutoff value of 22 μg/L was used. Multivariate analysis included pre‐operative TATI level, age, histologic grade and histologic type. Mantel‐Cox test was used for calculating statistical significance of differences in survival between groups.

Main outcome measures
Cumulative five‐year survival, pre‐operative serum TATI level and residual tumour size.

Results
Surgery was optimal (residual tumour size ≤ 2 cm) in 55 patients and suboptimal (residual tumour size > 2 cm) in 43. Pre‐operative TATI level ≤ 22 μg/L predicted better prognosis both in patients with optimal and suboptimal surgery compared with patients with pre‐operative TATI level > 22 μ/L. Patients with optimal surgery and a pre‐operative TATI > 22 μg/L had a twofold relative risk of death compared with those with a pre‐operative TATI ≤ 22 μg/L. The cumulative survival was less than three years for patients with suboptimal surgery and pre‐operative TATI > 22 μg/L.

Conclusions
Pre‐operative serum TATI in combination with residual tumour size may be useful in stratifying patients with Stage III ovarian cancer into different categories in randomised treatment trials.
Optimising maternal‐fetal outcomes in preterm labour: a decision analysis
Authors: Macones George A. , Bader Thomas J. , Asch David A.
Published: August 2005

Objective
To compare, using decision analytic techniques, maternal and fetal risk and benefits of three strategies for the management of preterm labour after 32 weeks. These strategies are empiric tocolysis, no tocolysis, or amniocentesis for fetal maturity testing.

Data Sources
Published medical literature provided the probabilities, including those for tocolysis efficacy, maternal and neonatal outcomes, and steroid efficacy.

Data Synthesis
Separate decision trees were created for hypothetical cohorts of patients presenting with preterm labour at 32,34, and 36 weeks of gestation to compare strategies. The primary outcome was the total number of expected adverse maternal and neonatal events for each strategy at each gestational age.

Results
At 32 weeks tocolysis yielded the lowest total number of adverse maternal and neonatal events. At 34 weeks, both tocolysis and no tocolysis yielded similar overall outcomes. At 36 weeks most clinical outcomes were good regardless of strategy.

Conclusions
This analysis supports the empiric use of tocolytics at 32 weeks. At 34 weeks, either tocolysis or no tocolysis appear to be reasonable alternatives. At 36 weeks no tocolysis is probably preferred. This analysis also suggests that amniocentesis should not be employed in the management of preterm labour at these gestational ages.
A role for noradrenaline in pre‐eclampsia: towards a unifying hypothesis for the pathophysiology
Authors: Manyonda Isaac T. , Slater Donna M. , Fenske Christine , Hole David , Choy Mei Y. , Wilson Catherine
Published: August 2005

Objective
To compare plasma catecholamine (noradrenaline and adrenaline) levels in pre‐eclamptic to normotensive pregnancy, and to study the activity of synthetic enzymes for catecholamines in placental and trophoblastic cell cultures. We postulated that catecholamines might be an important signal secreted by the fetoplacental unit in pre‐eclampsia.

Methods
We recruited 12 women with pre‐eclampsia and 12 pregnant women with nonproteinuric hypertension undergoing delivery by caesarean section, 23 normotensive women undergoing elective caesarean section at term, and 26 normotensive primigravid women with ongoing pregnancies at gestations equivalent to those women with pre‐eclampsia. We measured venous blood concentrations of catecholamines. Following delivery, we studied tyrosine hydroxylase (the rate limiting enzyme for catecholamine synthesis) activity in placental tissue of these women as well as from four eclamptic women not in the observer study. We used Northern blot analysis to quantify mRNA for tyrosine hydroxylase and dopamine‐β‐hydroxylase (D‐P‐H, a non‐rate‐limiting synthetic enzyme for catecholamine) in placental tissue, as well as in trophoblast cells in primary culture and trophoblast cell lines.

Results
Venous blood concentrations of noradrenaline were significantly higher in pre‐eclamptic women compared with normotensive women. Tyrosine hydroxylase activity was greater in placental tissue from pre‐eclamptic and eclamptic compared with normotensive pregnancies, as were mRNA levels for this enzyme. The mRNA levels for the non‐rate‐limiting D‐β‐H in women with pre‐eclampsia were similar to those in normotensive pregnancies. First trimester trophoblast cells in primary culture and trophoblast cell lines transcript mRNA for tyrosine hydroxylase and D‐β‐H.

Conclusions
Trophoblasts have the capacity to secrete catecholamines, and we found increased activity of the rate‐limiting synthetic enzyme in placental tissue from pre‐eclamptic pregnancies. We postulate that the higher levels of catecholamines we found in the plasma of women with pre‐eclampsia might be of placental origin. We hypothesise that in pre‐eclampsia ischaemic trophoblast tissue secretes catecholamines as a physiological signal to increase maternal blood flow to the fetoplacental unit, which itself is spared the vasoconstrictor effects of catecholamines (placental vessels are known to be unresponsive to catecholamines). However, since the basic pathology—defective trophoblast invasion—is not corrected, the increased blood flow fails to resolve the ischaemia, and the secretion of catecholamines is therefore sustained or even enhanced. Noradrenaline is known to cause lipolysis. This results in breakdown of triglycerides to free fatty acids, which are oxidized to lipid peroxides. The latter are cytotoxic and cause widespread endothelial cell damage and dysfunction, culminating in the clinical syndrome of pre‐eclampsia.
The effect of fetal neck position on nuchal translucency measurement
Authors: Whitlow B. J. , Chatzipapas I. K. , Economides D. L.
Published: August 2005

Objective
To determine the influence of the position of the fetal neck on nuchal translucency measurement.

Design
A prospective cross‐sectional study.

Population
One hundred and ninety‐six.

Methods
Nuchal translucency was measured in the mid‐sagittal plane, with the fetal neck in the flexed, neutral and extended positions. Measurements were made to the nearest 0.1 mm. Statistical analysis used the paired t‐test for differences between the extended and neutral positions, [A extended nuchal translucency] and the flexed and neutral positions [A flexed nuchal translucency].

Results
The mean extended nuchal translucency was 0.62 mm greater than the mean neutral nuchal translucency value [95% confidence interval 0.53 to 0.70, T= 14.33, P 0.000011. The mean flexed nuchal translucency was 0.40 mm less than the mean neutral nuchal translucency value [95% CI 0.34 to 0.47, T = 11.99; P= < 0.000011. The repeatability coefficient was lower in the case of neutral nuchal translucency measurements [0.48] and was higher in the other groups [extended = 1.04, flexed = 0.701.

Conclusion
Fetal neck position can make a significant difference to nuchal translucency measurements. Repeatability of measurements are more accurate with the fetal neck in the neutral position. These findings have important implications for clinicians using nuchal translucency to screen the general obstetric population.
Maternal intensive care and near‐miss mortality in obstetrics
Authors: Baskett T. F. , Sternadel J.
Published: August 2005

Objective
To determine the level of near‐miss maternal mortality and morbidity due to severe obstetrical complications or maternal disease in a tertiary maternity hospital.

Design
Retrospective review.

Setting
A free‐standing maternity hospital delivering 5500 infants per year.

Methods
The information coded in the perinatal database concerning women who had required transfer for critical care to a general hospital was reviewed for the 14 year period 1980 to 1993. The complications necessitating transfer and the specialised consultants and services required were noted.

Results
Over 14 years there were 76,119 women delivered with two maternal deaths (2.6/100,000). Fifty‐five women required transfer for critical care (0.7/1000). The main reasons for transfer were hypertensive disease (25%), haemorrhage (22%) and sepsis (15%). Transfer to an intensive care unit was required by 80%, and the remainder were transferred to specialised medical or surgical units. Twenty different specialist groups were consulted. The 55 patients spent 280 days in critical care and 464 days hospital after‐care (mean 13 days, range 3–92).

Conclusion
A review of near‐miss maternal mortality helps delineate the continuing threats to maternal health and the type of support services most commonly required.
In vivo assessment of failed trophoblastic invasion of the spiral arteries in pre‐eclampsia
Authors: Matijevic Ratko , Johnston Tracey
Published: August 2005

Objective
To assess the ability of colour/pulsed Doppler ultrasound to detect failed physiologic change of the spiral arteries in pregnancies complicated by pre‐eclampsia.

Design
Prospective matched‐pairs caw controlled study.

Setting
Tertiary referral teaching hospital.

Sample
Sixteen women with severe pre‐eclampsia and 16 normotensive controls.

Methods
Colour/pulsed Doppler assessment of blood flow in the uterine arteries and spiral arteries in central and peripheral parts of the placental bed.

Main outcome measures
Impedance to blood flow in the spiral arteries in pre‐eclamptic group compared with normotensive controls.

Results
In women with pre‐eclampsia there is significantly higher impedance to blood flow in spiral arteries compared with normotensive women.

Conclusions
Ultrasound colour/pulsed Doppler based investigation of blood flow in the spiral arteries in ongoing pregnancy can detect failed physiological change of these vessels in pre‐eclampsia. This is in concordance with histologic data.